Smallies 4 Flashcards
What can biochemistry and urinalysis show in a case of LI disease?
Often unhelpful
May identify concurrent disease or show significant consequences of the LI problem e.g. luid/electrolyte imbalance or azotaemia
If you only have high urea on biochemistry for LI disease what is this indicative of?
GI bleed
What might you see on haematology when investigating LI disease?
Signs of inflammation or parasitism
Anaemia of chronic disease or due to blood loss
Discuss the use of imaging in the investigation of LI disease?
Often unhelpful
Radiography
- consider for abdominal pain
Get thoracic view if suspecting neoplasia (met check)
Ultrasonography
- can look for other abdomen pathology
Loss for mass lesions or evidence of wall thickening/loss of layers
What bowel preparation should be done before endoscopy of the large bowel?
Starve for significant period of time
Oral laxatives
Enema the day before
Enema once anaesthetised
What is the rationale for high fibre diets in colonic disease?
Colonocytes use VFAs (butyrate and proprionate) for energy metabolism
VFAs are derived from fibre fermentation
What is the dietary management of acute colitis?
Highly digestible, low fat diet
High in fibre
What is the most common cause of chronic LI diarrhoea?
Chronic colitis
What are the types of IBD?
Lymphocytic-plasmacytic
Eosinophilic
Histiocytic/granulomatous
What is the commonest type of chronic colitis in the dog?
Lymphocytic-plasmacytic
What age and breed of dog is most likely to get lyphocytic-plasmacytic chronic colitis?
Any age but especially 6mths-4yrs
Any breed but especially GSDs, rough collies, labs
What are characteristics of intestinal diets?
Highly digestible Low fat Low residue --> reduced faecal bulk High fibre Single source of protein
What drugs can be used in the management of acute colitis?
Corticosteroids (preds) - 1st line treatment
Other immunosuppressive drugs e.g. ciclosporine, azathioprine, chlorambucil
Metronidazole
Sulphasalazeines
Antibiotics
What is granulomatous colitis and which dogs does it tend to affect?
Aparticularly aggressive form of ulcerative colitis
Boxers and French Bulldogs due to genetic predisposition
How is granulomatous colitis diagnosed?
Biopsy
- granulomatous inflammation
Fluorescence in situ hybridisation (FISH) technique identifies colonic mucosal invasion by E.coli
How is granulomatous colitis treated?
8 weeks of enrofloxacin - be sure of diagnosis, need to be able to justify long term use of enrofloxacin
Poor response may mean resistance
What is the most common type of LI neoplasia?
Benign adenomatous polyps
Where are LI neoplasias normally seen
Proximal colon
How are LI neoplasia diagnosed?
History (flattened stool, surface blood, straining?)
Rectal exam
Radiography (distortion of colon path, trapping of gas)
Ultrasonography
Endoscopy+/- biopsy
What are degenerative causes of constipation?
Dysautonomia
Perineal hernia
What are anomalous causes of constipation?
Extra-colonic compressoin e.g. prostatic disease Stricture Inactivity Behaviour Obesity
What are metabolic causes of constipation?
Megacolon secondary to hypercalcaemia or hypokaemia
What are neoplastic causes of constipation?
Adenoma/adenocarcinoma
Leiomyoma/Leiomyosarcoma
Lymphoma
What are nutritional causes of constipation?
Food - bones, hair, high fibre, chicken carcases etc
FB
Dehydration
What are inflammatory causes of constipation
Stricture
Anal sacculitis
Anal furunculosis
What are idiopathica causes of constipation?
Idiopathic megacolon
Dysautonomia
What is the diagnostic plan for constipation?
History Physical exam Radiography Ultraouns Bloods (for underlying disease) Protoscopy
What are the two types of feline megacolon?
Primary/dilated
Secondary/hypertrophic
What is the managementof constipation?
Treat underlying cause Rehydration Enemas water +/- soap +/- lactulose Dietary fibre LAxatives Prokinetics Surgical colectomy
What laxatives can be used in the management of constipation?
Dietary fibre supplementation - bulk producing agents e.g. poorly digestable polysaccharides or sterculia granules
Stool softeners e.g. anionic detergents
Lubricants e.g. paraffin
Hydrating agents e.g. lactulose
What are fluid maintenance requirements for a 18kg dog?
2 x 18 = 36ml/hr = 864 ml/day`
What is the fluid deficit for an 18kg dog that is 10% dehydrated?
0.1 x 18 = 1.8L
What is an isotonic crystalloid fluid?
A fluid that is a balanced electrolyte solution equivalent to the osmolarity of the patient’s RBCs and plasma
Give an example of a balanced isotonic crystalloid fluid?
Lactated Ringers Solution (Hartmanns)
Calculate drops per minute for a patient needing a total of 3,414mls over 24 hours using a drip factor of 20 drops/ml
3414 x 20 = 68280 drops in 24 hrs
= 2845 drops/hr
= 47 drops/min
What will you see on biochemistry and urinalysis with pre-renal azotaemia?
High urea
High creatinine
Concentrated USG
What will you see on biochemistry and urinalysis with renal azotaemia?
High urea
High creatinine
Low USG
What is cachexia associated with?
Chronic disease e.g.
- congestive heart failure
- chronic kidney disease
- neoplastic disease
- chronic inflammatory/infectious dz
What are the characteristics of cachexia?
Poor calorie intake
Inflammation –> circulating cytokines –> detrimental effect on metabolism
Define sarcopenia
Loss of lean body mass that occurs with ageing but no significant cliical disease
How can inadequate diet be a cause for weight loss?
Poor quality
Change in type/formulation
Starvation
What are causes of weight loss when there is an adequate diet?
Competition for food
Oral disease
Increased metabolic rate e.g. hyperthyroidism
Increased calorie requirement e.g. pregnancy
Impaired use or loss of nutrients e.g. PLN/PLE
Chronic inflammatory disease
Neoplastic disease
Pathologic weight loss e.g. inflammatory myositis
What are infectious causes of weight loss?
Chronic infections e.g. granulomatous disease such as mycobacteria
FeLV/FIV
FIP
How can pyrexia leaad to weight loss?
Pyrexia increases basal metabolic rate
What endocrinopathies can cause weight loss with an increased appetite?
DM
Hyperadrenocorticism - get a loss of muscle mass with fat redistribution
Hyperthyroidism
What GI diseases can cause weight loss with increased appetite?
EPI
Intestinal malabsorptive disease e.g. IBD, lymphangiectasia, PLE
Describe the process of investigating weight loss
Obtain thorough history Complete physical exam Generate problem list Define primary and secondary problems Undertake diagnostic tests
What is ascites?
An abnormal collection of protein containing fluid in the abdomen
How can collapse be related ascites?
Haemoabdomen due to splenic bleed
How can diarrheoa be related to ascites?
Ascites could be due to hypoalbuminaemia from GI loss e.g. PLE
How can PUPD be linked to ascites
PLN progressing to CKD
How could jaundice be related to jaundice?
Leak in biliary system
How could exercise intolerance be associated with ascites?
Cardiac or pericardia disease
How could anuria be linked to ascites?
Urethra or bladder rupture
What physical exam findings might indicate pleural effusion?
Dull chest sounds
Why is abdominal ultrasound useful when investigating ascites?
Confirm presence of fluid
Look for underlying cause
Ultrasound guided sampling if needed
Why is abdominal radiography useful when investigating ascites?
Contrast radiographs can help identify a leak in the urinary system
What tube would you use when collecting fluid for protein and biochemical analysis?
Plain tube
What tube would you use for collecting fluid for cell couts and why?
EDTA
Preserves cell morphology
Compare blood and fluid glucose levels with a peritonitis case?
If blood glucose is 1.1mmols/l higher than effusion suggests septic peritonitis
Compare fluid lactate and bood lactate with a peritonitis case?
If fluid lactate is >2.5mmol/l and higher than blood lactate it suggests septic peritonitis
Compare creatinine and potassium fluid and blood levels with a peritonitis case?
If effusion:serum creatinine ratio >2:1 then it indicates uroabdomen in 85% dogs
If effusion:serum potassium ratio 1.4:1 then it indicates uroabdomen in 100% dogs
What are the crucial tests for fluid analysis?
Gross appearance of fluid Total protein count Total nucleated cell count cell type/s and morphology (sediment smear) Bacterial cultrue
List potential fluid types than can be sampled from the abdomen?
Transdate
Modified transudate
Exudate
Other e.g. neoplastic, blood, urine, bile, chyle/pseudochyle, eosinophilic
What is the normal physiology of abdominal fluid?
Fluid forms in small amount for lubrication and diffusion or substances e.g. electrolytes
Rate of formation depends on balance between plasma colloid oncontic pressure and hydrostatic forces
Any excess fluid in the abdominal cavity will usually be absorbed by the lymphatics
How does ascites develop?
Starlings forces are out of balance Increased filtration pressure Decreased abdorption pressure Leaky vessels Hypoalbuminaemia
What are causes of increased filtration (outward) pressure?
Increased arterial pressure
Increased venous pressure
Obstruction of local blood vessels
What are causes of decreased absorptive (inward) pressure?
Decreased plasma COP due to protein loss (particularly albumin –> hypoalbuminaemia) or decreased protein synthesis (particularly albumin)
What are causes of leaky vessels that can lead to ascites?
Local inflammation
Vasculitis
Congenital abnormalities
Lymphangitis
How can hypoalbuminaemia lead to ascites?
Hypoalbuminaemia leads to loss of endothelial integrity and further worsens fluid movement as it increases the impact of hydrostatic pressure gradient
What is the appearance, specific gravity, cell type and level of protein and nucleated cells of pure transudate?
Appearance: clear, colourless Protein: <20 g/l Nucleated cells: <1.5x10/l Specific gravity: <1.017 Cell types: few RBCs with a small mised nucleated cell population (neutrophils up to 60%, plus lymphocytes, monocytes, macrophages and mesothelial cells)
What is the appearance, specific gravity, cell type and level of protein and nucleated cells of modified transudate?
Appearance: variable Protein: 20-50 g/l Nucleated cells: <5 x10/l Specific gravity: 1.017-1.025 Cell types: moderate mixed nucleated cell poopulation (mostly neutrophils and macrophages, mesothelial cells often seen, occasional lymphocytes and monocytes)
What is the appearance, specific gravity, cell type and level of protein and nucleated cells of exudate?
Appearance: turbid/purulent Protein: >30 g/l Nucleated cells: >5x10/l Specific gravity: >1/025 Cell types: many RBCs, nucleated cells (mostly degenerative neutrophils), bacteria may be present
What are potential causes of pure transudate?
Hypoalbuminaemia PLE PLN Liver failure/disease Hypoadrenocorticism
What are causes of modified transudate?
Portal hypertension due to chronic liver disease, right-sided heart failure
Pancreatitis
Splenic/intestinal torsion
Ruptured diaphragm with entrapment of organs
What are causes of exudate?
Primary peritonitis is rate
Secondary peritonitis is important
- septic peritonitis
- non-septic peritonitis
List causes of septic peritonitis
Rupture of the GIT due to perforated ulcer or FB Penetrating abdominal wound Ruptured pyometra Tracking FB Iatrogenic
List causes of non-septic peritonitis
Pancreatitis Bile leakage Ruptured urinary tract Assocaited with haemoabdomen Neoplastic peritonitis Iatrogenic Chyloabdomen (rare)
Give an example fo how bile peritonitis can become septic?
ruptured gall bladder associated with ascending infection and cholangitis
Give an example of how uroabdomen can become septic
Ruptured bladder assocaited with infected struvite calculi
What is the appearance, specific gravity, cell type and level of protein and nucleated cells of neoplastic effusion?
Appearance: may be bloody and/or turbid Protein: often >35 g/l Nucleated cells: often 5-25 x109/l Specific gravity often: >1.025 Cell type/s: o RBCs, mixed nucleated cell population o Neoplastic cells may be seen, particularly with exfoliative disease such as lymphoma
What is the appearance, specific gravity, PCV, cell type and level of protein and nucleated cells of haemorrhagic effusion?
Appearance: bloody (but does not clot unless fresh )
PCV variable: >0.10 l/l (can cf blood)
Protein: variable, often >30 g/l
Nucleated cells: variable (similar to blood >5-15x109/l)
Specific gravity: >1.025
Cell type/s:
o RBCs, no platelets, mixed nucleated and mesothelial cells
o +/- haemosiderophages depending on chronicity. Always prepare smears prior to transit as this can be an in vitro artefact
What is the appearance, specific gravity, cell type, biochem and level of protein and nucleated cells of uroabdomen?
Appearance: serosanguinous
Protein: 10-30 g/l
Nucleated cells: 5-15 x109/l
Specific gravity often: >1.025
Biochemistry: creatinine and potassium > than on blood values
Cell type/s:
o Many RBCs; mixed nucleated cells (macrophages, neutrophils, mesothelial cells)
What is the appearance, specific gravity, cell type and level of protein and nucleated cells of chylous effusion?
Appearance: milky, white or pink
Protein: 10-30 g/l
Nucleated cells: 5-20 x109/l
Cell type/s:
o Cells vary with chronicity
o Mostly mature lymphocytes early in the disease process
o Mixed with chronicity, macrophages contain Sudan staining inclusions
What are possible causes of a haemorrhagic effusion?
ruptured spleen, traumatic organ damage, coagulopathy
What are possible causes of uroabdomen?
traumatic rupture of urinary tract (RTA), rupture associated with urolithiasis or neoplastic disease, iatrogenic associated with catheterisation
How common is a chylous effusion?
Very rare
What are possible causes of chylous effusion?
lymphatic leakage or rupture. Chylothorax more common than chyloabdomen
Define peritonitis
Inflammation of the peritoneum (i.e. serous membrane lining the peritoneal cavity)
What type of fluid do you get with peritonitis?
Exudate
What is primary peritonitis?
There is no underlying abdominal pathology and it usually occurs due to haematogenous spread
What is secondary peritonitis?
Occurs secondary to abdominal pathology
Which is more common - primary or secondary peritonitis?
Primary is rare in animals and secondary is more common
Will a perforated gastsric ulcer lead to septic or non-septic gastric peritonitis?
It depends whether there is any bacteria in the stomach that might leak into the peritoneal cavity
Even if it isn’t septic the treatment is still aggressive as this is an emergency presentation
When might signalment and history be useful in a peritonitis case?
FE bitch recently in season -> pyometra
Old dog on NSAIDs for aarthritis
Old ME dog with preputial discharge -> prostatic disease
What could you find on a physical exam of a dog with peritonitis?
Abdominal pain Distended abdomen +/- fluid thrill Collapse Pyrexic/hypothermia Evidence of primary disease e.g. jaundice, anaemia
What may be seen on biochemistry with a peritonitis case?
High urea and creatinine (+/- potassium)
High bilirubin and liver enzymes
May get hypoglycaemia or hypoproteinaemia
Why might you get neutropenia with a peritonitis case?
The WBCs may have all gone to the abdomen where they can be the most helpful, so the patient appears to have neutropenia
Why should you take a blood smear to back up haematology results with a peritonitis case?
White cell counts may be normal but individual cells might look very toxic
If performing a blind abdominocentesis where should you avoid?
Avoid left cranial quadrant due to location of the spleen
