Smallies 1 Flashcards
Define Tenesmus
Continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness
Define Haematochezia
Passage of fresh blood through the anus, usually in or with stools
Define Dyschezia
A functional condition characterised by at least 10 minutes of straining and crying before successful or unsuccessful passage of soft stools
Define Diarrhoea
An increase in faecal volume, water content and frequency of defaecation
Explain how the LI can compensate for the failure of the SI
The LI can reabsorb water but will not be able to compensate for nutrient absorption or digestion
What is the difference in water content in formed and unformed stool?
Formed: 60-80% water
Unformed: 70-90% water
List stool characteristics and general signs in SI disease
Large volume, watery, melaena, weight loss
List stool characterisitics and general signs in LI disease
Urgency, tenesmus, haematochezia, small volume, increased frequency, presence or mucus/fresh blood
Define Dysphagia
Difficulty swallowing
List clinical signs of dysphagia
Gagging, dropping food, retching, exaggerated swallowing effort, ptyalism, fear of eating combined with a ravenous appetite
Define ptyalism
Excessive salivation
List the 5 classifications of dysphagia and explain each where the abnormality is seen
Oral - prehending and transporting bolus to base of tongue
Pharyngeal - transporting bolus from oropharynx
Cricopharyngel - transporting bolus through upper oesphageal sphincter
Oesophageal - transporting bolus through oesophagus
Gastro-oesophageal - transporting bolus across the lower oesophageal sphincter
What are the 3 phases of vomiting
Prodromal, retching, expulsion
Explain the 3 phase of vomiting (prodromal, retching and expulsion)
Prodromal - see signs of nausea (e.g. ptyalism, appetite loss, lip licking) and excessive swallowing
Retching - get retrograde duodenal contractions with rhythmic inspiratory movements against a closed glottis and dilation of the cardia/lower oesophgeal sphincter
Expulsion - reduced oesophgeal and pharyngeal tone and active expulsion of gastric/duodenal contents by contraction of abdominal muscles
What are the possible causes of vomiting? (list categories, not specifcs)
Diet, stomach conditions, intestinal problems, abdominal, metabolic/endocrine, bacterial, viral, parasites, infections, toxins, iatrogenic, central/CNS
What are dietary causes of vomiting?
Change of diet (planned or unplanned)
Spoiled food
Food intolerance - non immune mediated
Food allergy - immune mediated
What are stomach condition causes of vomiting?
Inflammatory - gastritis (acute or chronic) or ulceration (less common but can be chronic)
Physical - FB, outflow obstruction, hiatal hernia
Functional - motility disorder
Neoplastic - adenocarcinoma, lymphoma, leiomyoma
What are intestinal condition causes of vomiting?
Inflammatory - IBD (common), infectious enteritis/colitis, SIBO/ARD
Physical - FB, intusussception, volvulus
Functional - ileus, constipation
Neoplastic - carcinoma, lymphoma, leiomyoma, MCT
What are abdominal causes of vomiting? (list by organ)
Pancreas - acute or chronic pancreatitis, pancreatic tumour, EPI with SIBO
Peritonitis - septic
Liver disease - cholangiohepatitis, chronic hepatis, cholecystitis, biliary obstruction
Renal - CKD, AKI, pyelonephritis, urinary tract obstruction
Uterine - pyometra, pregnancy
Prostatic disease - prostatisi, paraprostatic cyst, prostatic tumour, benign hypoplasia
What are metabolic/endocrine causes of vomiting?
Hyperthyroidism Azotaemia Hypoadrenocorticism Diatbetic ketoacidosis Hypercalcaemia Hepatic encephalopathy - congenital PSS
What are bacterial causes of vomiting
Salmonella Clostridium perfringens E.coli Campylobacter jejuni Yersinia
What are viral causes of vomiting?
Parvovirus/feline panleucopenia Coronavirus (FIP) FeLV FIV Distemper Canine Adenovirus Rotavirus
List parasitic causes of vomiting?
Worms - toxocara, taenia, uncinaria, trichuris
Protozoa - isospora, cryptosporidium, giardia, tritrichmonas
List toxin causes of vomiting?
Ethylene glycol, raisins, theobromine, lead, lilies, ivy, conkers, adder bites
List drug (iatrogenic) causes of vomiting?
Antibiotics, NSAIDs, cyclosporine, digoxin
List central/CNS causes of vomiting?
Motion sickness Idiopathic vestibular disease Encephalitis Limbic epilepsy Tumours
What are the indications to induce emesis?
Gastric decontamination after toxin ingestion
Foreign body ingestion
What are the contraindications of inducing emesis?
Caustic substance ingestion Lethargy/debilitation Dyspnoea Neurological signs Abdominal surgery Spinal injury
Names drugs used to induce vomiting
Apomorphine - dopamine agonist
A2A - medetomidine or xylazine
Hydromorphone + midazolam
List reasons for ptyalism that is unrelated to nausea
Oropharyngeal disease
PSS
Salivary gland disease e.g. siadenitis
What points from a history should make you worry about a vomiting case?
Several days duration Rapid deterioration Persistent vomiting and/or inappetence Haematemesis Profuse SI diarrhoea Weight loss
What physical examination findings should make you worry about a vomiting case?
Weak, collapsed, MM: dry/tacky, pale or congested Tachycardia, bradycardia, arrhythmias Weak and thready pulses Hypothermia or pyrexia Abdominal pain or distention Melaena or haemorrhagic diarrhoea
What screening tests can you do for a vomiting case?
Blood tests - haematology/CBC, biochemistry, electrolytes
Urinalysis - dipstick, USG, sediment exam +/- culture
What diagnostic imaging can you do for a vomiting case?
Radiograph - abdominal +/- thorax (mets, aspiration)
Ultrasound - abdomen +/- guided biopsy
When is endoscopy indicated and contraindicated in a vomiting case?
Indications - chronic disease
Contraindications - acute disease (unless confirming presence of an ulcer or FB)
What patient preparation is required for endoscopy?
Starve the patient - not performed ‘on the day’
Ideally after radiographic study
What specific disease tests can be used for a vomiting case?
TT4 Pancreastic lipase immunoreactivity ACTH stim FeLV/FIV Serum cobalamin Serum folate Pre and post prandial bile acid
/what supportive care and stabilisation can be done for a vomiting case?
Fluid therapy +/- electrolyte replacement
Anti-emetics (if no obstruction or history of toxin ingestion)
Gastroprotectants
Prokinetics
Nutrition
Nursing care
Describe the ideal anti-emetic drug
Broad spectrum activity - peripheral and central
Minimal CVS side effects - these patients may be dehydrated or haemodynamically unstable
Wide therapeutic index - clearance mechanisms may be compromised (e.g. renal/hepatic)
Minimal CNS side effects (sedation) - reduces risk of aspiration
Minimal negative effects on GI motility - reduces risk of ileus
What is Maropitant and discuss pros and cons of its use
Selective NK1 receptor antagonist
Effective against peropharal and central pathways
Advantages:
- Has analgesic properties so useful for painful conditions e.g. pancreatitis
- Suitable for cats and dogs
- Comes in oral and injectable forms
Disadvantages:
- Pain at injection site
- Can only use for 5 days (injection) or 14 days (oral)
What is Metoclopramide and discuss pros and cons of its use
Dopamine, 5-HT3 and H1 receptor antagonist
More central than peripheral effects
Variable prokinetic effects
Advantages:
- Suitable for cats and dogs
- Comes in oral and injectable forms
Disadvantages:
- Short acting (CRI may be best?)
- Rarely causes extrapyramidal side effects (agitation, ataxia, aggression)
Now replaced by Maropitant unless using aCRI
Explain how dogs and cats are normally resistant to bacterial gastritis
Very acidic environment
Monogastric stomach is a barrier to infection and prevents colonisation of the SI
Very few things can survive past the stomach
Sterile environment
Give reasons for disruption to the gastric barrier to bacterial gastritis
Neonates - barrier functions not yet well developed
Abnormal gastric environment - food related or antacids (iatrogenic)
How is the stomach protected from gastric ulceration from stomach acid?
the gastric mucosal barrier has tight intercellular junctions, a bicarbonate-rich mucous layer and local prostaglandins controliing mucosal blood flow, bicarb production and mucus.
It is also dynamic tissue so can have rapid epithelial turn over
What are causes of gastric ulceration associated with failure of the mucosal barrier?
acid hypersecretion
direct physical injury e.g. FB
reduction of prostaglandins e.g. COX inhibitors (NSAIDs)
What are benign causes of gastric ulceration?
Iatrogenic e.g. NSAIDs Metabolic/endocrine e.g. Addisions, azotaemia, Complication of IBD SHock and sepsis Stress
What are malignant causes of gastric ulceration?
Primary gastric neoplasia e.g. adenocarcinoma, lymphoma
Gastrinoma
MCT
Ulcerative intestinal tumours
What are physical causes of gastric disease?
FB - can cause gastritis, ulceration, obstruction, performation
Obstructive mass lesions e.g. neoplastic, inflammatory, granuloma, polyp
Gastric dilation +/- volvulus
What are function causes of gastric disease?
Gastric motility disorders
Stasis - often associated with chronic gastritis/IBD, ulceration, infiltrating neoplasia or pancreatitis
Metabolic causes of stasis e.g. hypokalamia, hyper/hypocalcaemia
What are neoplastic causes of gastric disease?
Carcinoma Lymphoma Leiomyoma Meiomyosarcoma Fibrosarcoma
What is bilious vomiting syndrome (+ signalment and common presentation)
Common in dogs
Chronic intermittent bilious vomit
Typically early morning on an empty stomach
List clinical signs associated with gastric disease in dogs and cats
Vomiting, salivation, burping, retching, reflux, poor appetite, melaena, weight loss, halitosis, abdominal pain (lethargy, depression, praying position), bloating
What are the clinical signs for chronic gastritis?
chronic intermittent vomiting - food or bile
loss of appetite
diarrhoea
Clinical signs wax and wane, may gte occasional flare ups
What are the clinical signs for GDV?
acute onset in dogs
unproductive retching
distended and painful abdomen
if prolonged will get circulatory problems leading to a crisis
What are the clinical signs for gastric ulceration?
Seen in dogs more than cats Poor appetite Salivation Abdominal pain Haematemesis Melaena Weight loss Anaemia
Outline the investigations for gastric disease
Signalment, full clinical history, thorough physical examination then screening tests e.g. blood, urine and imaging
What are the clinical signs and diagnostic test findings of pyloric outflow obstruction?
Vomiting 6-8 hours after food
Hypocaloraemia, hypokalaemia, metabolic alkalosis
Distended food filled stomach on radiograph
Briefly desribe the key points of a diet trial
Must try for at least 6 weeks
Use a single source of protein and single source of CHO
Use novel or hydrolysed protien
Name examples of gastroprotectants
Polyaluminium sucrose sulphate
Bismuth subsalicylate
Kaolin products
When are antacids used and list examples
USed for gastric ulceration, chronic gastritis and reflux oesophagitis
Proton pump inhibitors - omeprazole
H2 blocker - ranitidine
Aluminium hydroxide
When are corticosteroids considered for therapy for gastric disease?
For chorinc gastritis or IBDwhen there has been no response to diet and gastroprotectants
What is feline triaditis?
Multiorgan inflammatory disease affecting the liver, pancreas and small intestine
When is surgical intervention indicated for gastric disease?
Pyloric outflow obstruction
FB (if can’t be removed endoscopically)
Perforated ulcers
Tumour resection e.g. leiomyoma
What are the advantages of radiography for the GIT?
Gives global overview Can assess adjacent thorax and skeleton Good for detecting gas or mineralisation Useful for acute conditions Cheap and widely available
What are teh disadvantages of radiography for the GIT?
Superimposition of structures Lack of inherent radiographic contrast (cr thorax) Soft tissue and fluid appear the same Magnification Less useful for chronic conditions
List challenges of radiography and how to avoid them
Low inherent constrast (soft tissue/fluid/fat) –> low kV
Minimising scatter –> low Kv, collimation, use of grid
Movement blur –> chemical and physical restraint
PAtient prep –> fasted for 24 hrs, empty bladder
What are the uses of contrast studies in the GIT?
Document function by taking sequential still images or using real time readiography (fluoroscopy)
List examples of contrast studies for the GIT and liver
GIT: barium swallow (fluroscopy), gastrography (air, barium or double contrast), barium series, barium enema, pneumocolon
Liver: mesenteric portovenography (water soluble iodine)
What structures can you see on radiography?
Liver, stomach, spleen, kidneys, small intestine, caecum, colon, urinary bladder, prostate gland, diaghragm, body wall, sublumar musculature, thoracolumabar/lumbar vertebrae, caudal ribs, part of bony pelvis
What can you not see on radiography (normally)?
Adrenal glands, gall bladder, ovaries, uterus, mesentary, meseteric LN, omentum, pancreas, abdominal aorta, abdominal vena cava
What are teh advantages of GIT ultrasonography?
Assess internal architecture and vasculature Real time assessment Good soft tissue definition Accurate measurement FNA/biopsy guidance
What are the disadvantages of GIT ultrasonography?
Limited field fo view
Difficult if large amounts of gast present
Very equipment and operator dependent
What is the order of radiopacites (from most lucent structures to most opaque)?
Gas - most lucent (black) Fat Soft tissue/fluid Bone/mineral Metal (most opaque)
Describe the radiographic appearance of the liver
Roughly triangular with smooth distinct margins
Soft tissue opacity
Demarcated by the diaphragm cranially and stomach caudally
Ventral lobe has a fairly shape angle and is contained in the costal arch
How does hepatomegaly appear radiographically?
projection of caudoventral margin well beyond costal arch
rounding of caudoventral angle
caudal displacement of stomach axis
How does a small liver appear radiographically?
Cranial displacement of the stomach
Absence of caudoventral angle
Describe ultrasonography of the liver (technique and what you see)
Majority of the liver is examined from the ventral abdomen immediately caudal to the xiphisternum
Fan the probe from left to right and cranial and caudal
Reference point is the diaphragm (hyperechoic line)
Portal veins are ventral to hepatic veins and have hyperechoic walls (hepatic veins don’t have hyperechoic walls)
Cannot normally see hepatic arteries or bile ducts
Will see gall bladder - hypoechoic
Describe ultrasonography of the spleen (technique and what you see)
Splenic head lies on the left and is triangular - fairly fixed
Tail is more mobile - often on the left in cats but may extend to the right in dogs
More densely textured that the liver (more echogenic)
Well defined capsule with a smooth outline
Anechoic vessels can be seen entering hilus
How does the stomach appear radiographically?
Variable size and shape due to variable amounts of gast/fluid/ingesta
Rugal folds often seen as parallel lines
Gastric axis should be parallel to the ribs and perpendicular to the spine
Where goes gas and fluid sit in the stomach in RLR, LLR, VD and VD views?
RLR: fluid in pylorus
LLR: gas in pylorus
DV: gas in fundus
VD: fluid in fundus
How does the small intestine appear radiographically?
Duodenum identifiable by location - fixed
Cats tend to have less intestinal gas than dogs
Roughly even diameter throughout - no more than 1.6x height of L5 in dogs
How does the colon and rectum appear radiographically?
Often easy to identify because they are filled with faeces
What are the 5 layers seen in the GIT wall with an ultrasound?
Lumen Mucosa Submucosa Muscularis Serosa
What are two reasons of abnormal stomach wall thickening with ultrasound?
Neoplasia - loss of layering and decreased echogenicity
Severe gastritis - obsuring layers, typically hyperechoic mucosa
What are reasons for small intestinal wall thicking seen on ultrasound?
IBD - wall layers maintained
Can be normal
What are the 4 views with an AFAST scan?
Diaphragmatico-hepatic
Spleno-renal
Cysto-colic
Hepato-renal
What does AFAST stand for?
Abdominal Focused Assessment with Sonography for Trauma
What are clinical signs of dysautonomia?
Dry mouth and nose Constipation and urine retention Regurgitation Dilated pupil Bradycardia
List clinical signs of oesophageal disease
Anorexia Dysphagia Salivation (ptyalism) Aspiration pneumonia Weight loss
Compare regurgitation and vomiting
Regurgitation - variable time after eating, passive process (no abdominal retching), froth/saliva, may just look like food compressed into tubular shapes
Vomiting - nausea, active process (abdominal retching), bilious fluid (yellow)
Why should you take both lateral view when radiographing to check for aspiration pneumonia?
It has lobar distribution so may not show up on one view. You may not be able to see anything if the aspiration is within the recumbent lung
What is the test of choice for Myasthenia Gravis?
Acetyl choline receptor antibody
Where is a common site for foreign bodies to lodge in the oesophagus?
Thoracic inlet
Why is fluoroscopy useful for investigating oesophageal disease?
Excellent technique for assessing swallowing and oesophageal motility disorders. It is a way to see real time motility of the oesophagus
Oesophageal strictures are associated with…
reflux during anaesthesia and/or major surgery
severe persistent vomiting
What is an iatrogenic cause of oesophageal stricture in cats?
Doxycycline
What is the ‘normal’ clinical history for rabies?
Bite wound in the preceeding 3 weeks to 6 months
What are early clinical signs of rabies?
Anorexia, depression, mild ataxia
What clinical signs do you see as rabies progesses?
Hyperesthesia, hypermetria, regional pruritus, recumbency, coma, death
What are the 3 forms of rabies?
Furious, dumb, paralytic
What species if furious rabies common in and list clinical signs
Most common form in dogs Signs: - recumbency - biting and aggression - convulsions - exaggerated response to tactile stimuli - vocalisation
What species if dumb rabies common in and list clinical signs
Most common form in horses Signs: - depression, febrile - ataxia, drooped head - profuse salivation, yawning, tongue falccidity
What species if paralytic rabies common in and list clinical signs
most common form in cattle
Signs:
- lameness, paraparesis, recumbency, salivation
