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Doctor of Veterinary Medicine (Work in progress) > Veterinary Medicine - Gastrointestinal Diseases > Flashcards

Veterinary Medicine - Gastrointestinal Diseases Flashcards

1
Q

Clinical signs esophageal diseases? Also - name the clinical signs expected if complications occur (2 specific complications of esophageal diseases)

A

Regurgitations

Hypersalivation

Sialoadenosis

Gagging

Aspiration pneumonia: Fever, Lethargy, Anorexia, Tachypnea, Dyspnea, Cough

Nasopharyngitis +/- Nasopharyngeal stenosis: Reverse sneezing, Sneezing, Stridor, Stertor.

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2
Q

Oro-pharyngeal Vs. esophageal disease - Name one hallmark clinical sign for each

A

Oro-pharynx - Dysphagia

Esophagus - Regurgitations

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3
Q

What in the neurological exam can give a hint to Myasthenia Gravis?

A

Progressively weakening palpebral reflex

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4
Q

Regurgitations Vs. Vomiting: Pharynx/Esophagus/Stomach - Pain on swallowing

A

Possible

Frequent

No

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5
Q

Regurgitations Vs. Vomiting: Pharynx/Esophagus/Stomach - Ejection period after meal

A

Immediate

Immediate / Delayed

Delayed

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6
Q

Regurgitations Vs. Vomiting: Pharynx/Esophagus/Stomach - Qualities of ejected food (Digested / Undigested, Color)

A

Undigested, Colorless

Mostly undigested. Can be partially digested. Mostly colorless, Yellowish-greenish color also possible (more commonly associated with gastric content but not limited to)

Digested. Yellowish-greenish color (Bile)

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7
Q

Regurgitations Vs. Vomiting: Pharynx/Esophagus/Stomach - Ability to drink (Poor / Normal)

A

Poor

Normal

Normal

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8
Q

Regurgitations Vs. Vomiting Pharynx/Esophagus/Stomach - Swallowing attempts (Single/Multiple)

A

Multiple

Single

Single

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9
Q

Regurgitations Vs. Vomiting: Pharynx/Esophagus/Stomach - Commonly associated with secondarily causing dyspnea and coughing due to Aspiration Pneumonia

A

Yes

Yes

No

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10
Q

Reflux of food content from the stomach to the esophagus is always abnormal (True/False)

A

False

Normal healthy dogs can regurgitate from time to time as seen in fluoroscopic studies of the lower esophageal sphincter

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11
Q

Assessment & Diagnosis of Dysphagia - Physical examination / additional diagnostics

A

Full PE (emphasis on Initial oro-pharyngeal exam, sialoadenosis, masses, chest auscultation for signs of aspiration pneumonia)

Neurological assessment (with emphasis on cranial nerves, muscle symmetry, palpebral, swallow reflex, tongue motility)

Eating/drinking test (If not scheduled for anesthesia)

Full biochem panel (with emphasis on clues for endocrinopathies/CK levels/additionally - Cholinesterase levels, AB titers for MG)

Full oro-pharyngeal examination under sedation

Imaging: X-Ray / Fluoroscopy (Swallow study) / Endoscopy.

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12
Q

Pharyngeal dysphagia - Mechanical problems (DDs)

A

Pharyngitis: Viral (e.g. Calicivirus, Herpes), Bacterial, due to reflux

Corrosive agents

Masses (e.g. Granuloma, Abscess,
Neoplasia, Polyp, Cyst)

Sialoadenosis

Anatomical defects: Hypoplasia/Hyperplasia of soft palate

Misc. Stricture, Foreign body, Trauma

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13
Q

Pharyngeal dysphagia - Functional Problems (DDs)

A

Neurological (CNS/PNS diseases)

Junctionopathies (e.g. Myasthenia Gravis, Organic Phosphate (Chronic), Botulism)

Muscles: Myositis (Immune, Infectious, Pre-neoplastic), Muscle dystrophy, Storage diseases, Hypothyroidism

Cricopharyngeal Achalasia

Cricopharyngeal Asynchrony

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14
Q

Cricopharyngeal Achalasia - Treatment (2 options)

A

Botox injection (Short term)

Myotomy of Cricopharyngeal m.

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15
Q

Cricopharyngeal Asynchrony - Treatment

A

Conservative treatment:
-Find the food with the best texture for this specific dog
-High frequency + small quantities of food each time
-Bailey’s Chair

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16
Q

Esophagitis - DDs

A

Pill esophagitis (e.g. Doxycycline)

Reflux esophagitis (e.g. Anesthesia, 2nd to BAOS, Certain drugs)

Ingestion of caustic material

Foreign Body

Chronic Vomiting

Granuloma/Neoplasia/Inflammation involving the LES.

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17
Q

Reflux esophagitis (DDs)

A

Drugs (e.g. Anesthesia, Atropine, Anti-histamines)

Hiatal hernia

Due to upper respiratory disease (BAOS, Nasopharyngeal disease)

Coughing

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18
Q

Sialoadenosis - A Clinical sign / PE finding that is usually suggestive of pathology in what organ?

A

Esophagitis

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19
Q

Esophagitis - Clinical signs. Also, try to think of complications and their respective clinical signs

A

Mild cases - only regurgitations

Severe inflammation: Anorexia, Fever, Regurgitations, Pain on swallowing, Weight loss, Hypersalivation, Sialoadenosis

Signs of aspiration pneumonia: Fever, Cough, Dyspnea

Signs of anemia: Melena, pale mucus membranes, weakness

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20
Q

What is a common intra-mural sequela of esophagitis?

A

Stricture

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21
Q

Esophagitis - Treatment

A

Treat underlying issue

Switch to small portions + High frequency feedings

Low fat diet

Feed from above with neck extended (can use Baileys chair)

GI Protectants (Sucralfate, PPI), Pro-Motile (Metoclopramide)

Analgesia

*Gastric tube in severe cases

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22
Q

Sucralfate - Important thing to remember if additional drugs are also meant to be administered with it

A

Sucralfate can interfere with the absorption of other drugs. When giving sucralfate - separate from food and other drugs 2 hours before and after administration.

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23
Q

H2 Receptor blockers - Most relevant drug of the family? How long does it remain effective?

A

Famotidine

24-48 Hours

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24
Q

Proton pump inhibitors (PPI’s) - Relevant drugs, what are 2 Important points to remember with long term usage?

A

Omeprazole/Omepradex/Pantoprazole

1) After 4 weeks - Taper off slowly to avoid massive resurgence of acid production

2) Can cause dysbiosis

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25
Q

Pro-motile drugs - Names, Effects and which is considered a more effective pro motile drug?

A

Metoclopramide (Pramin) - Constricts LES, Promotes stomach contractility, Anti-Emetic

Cisapride (Preplusid) - Constricts LES, Promotes contractility along the entire GI tract (except for the esophageal striated muscle)

Cisapride > Metoclopramide

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26
Q

Mechanical causes for regurgitations (Esophagus) - The 3 main categories are:

A

Intra-luminal

Intra-mural

Peri-esophageal (Extra-esophageal)

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27
Q

Mechanical causes for regurgitations (Esophagus) - Intraluminal - DDs

A

Foreign body

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28
Q

Esophageal foreign body - Diagnosis & Treatment

A

History and clinical signs

Chest X-rays

Endoscopy (Gold standard)

Removal via endoscopy is best. If not possible - pushing the foreign body to the stomach and removal via surgery is also a possibility

+/- Treatment for esophagitis

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29
Q

Esophageal stricture - Causes

A

Caustic agents

Esophagitis

Surgery

Foreign Body

Luminal or Peri-Esophageal masses

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30
Q

Esophageal Stricture - Diagnosis

A

Endoscopy

Swallow study via Fluoroscopy

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31
Q

Esophageal stricture - Treatment

A

Bougienage (Balloon dilatation) + Short course of GC (to prevent inflammation and recurrence)

Stent (in the event of recurrence)

Surgery

+ Gastric tube and treatment for esophagitis

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32
Q

Mechanical causes for regurgitations (Esophagus) - Intramural - DDs

A

Esophagitis

Stricture

S.Lupi (In relevant countries)

Neoplasia

Diverticulum

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33
Q

S.Lupi (Esophageal) - Diagnosis

A

History (Mainly lack of preventative treatment) and clinical signs

Chest X-rays:
-Soft tissue opacity in the caudal mediastinum (caudal third of esophagus)
-Aortic mineralization and aneurism
-Spondylitis (T6-T12)

Fecal analysis

Endoscopy (Gold standard) - Typical appearance of S.Lupi granuloma - Smooth bulge continuous with the esophageal wall

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34
Q

S.Lupi (Esophageal) - Atypical presentations

A

Migration through the CNS (causing paresis/plegia)

Migration through Mesenteric arteries - Ischemia to GI and necrosis. Can cause either septic peritonitis or Hemoabdomen

Cutaneous fistula

Aortic rupture - Acute collapse & hemothorax (Acute death).

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35
Q

Esophageal neoplasia - Common types and locations (intra-mural / Peri-esophageal masses that can lead to regurgitations)

A

Intra-mural: Carcinomas (Cats), Sarcomas (S.Lupi), Leiomyoma

Peri-Esophageal: Thymoma, Chemodectoma

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36
Q

Esophageal neoplasia - Treatment & Prognosis

A

Surgery / Laser

Excellent if on a thin stock

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37
Q

Esophageal Diverticula - Diagnosis

A

Contrast study

Endoscopy

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38
Q

Mechanical causes for regurgitations (Esophagus) - Peri-esophageal - DDs

A

Vascular ring anomalies (e.g. PRAA)

GI accidents (e.g. Sliding hiatal hernia, Gastro-esophageal intussusception)

Mediastinitis

Intra-thoracic neoplasia (e.g. Pulmonary neoplasm, Heart-base tumor)

Severe lymphadenopathy

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39
Q

Persistent right aortic arch (PRAA) - Diagnosis

A

Classic history - regurgitations begin upon weaning and switching to solid foods (puppyhood)

Chest X-rays +/- Contrast study

CT

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40
Q

Persistent right aortic arch (PRAA) - Common complications (2)

A

Growth retardation (with good appetite)

Aspiration pneumonia (Cough, Fever, Dyspnea)

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41
Q

Hiatal hernia - Signalment

A

Congenital - Brachycephalic breeds over-represented

Acquired: 2nd to upper respiratory tract diseases (Nasopharynx in particular), Trauma with damage to the diaphragm

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42
Q

Hiatal Hernia - Clinical signs

A

Esophagitis - Regurgitations, Melena, Hypersalivation, Sialoadenosis

Fever and anemia in severe cases

Aspiration pneumonia (Fever, Dyspnea, Cough).

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43
Q

Hiatal Hernia - Diagnosis

A

Chest X-rays: Soft tissue opacity in the caudal mediastinum (caudal third of esophagus)

False negative rates high with sliding hiatal hernia and do not rule out the disease

Endoscopy (J-Maneuver)

Fluoroscopy

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44
Q

Hiatal Hernia - Treatment

A

Treat Reflux Esophagitis (PPI, Protectants, Pro-Motiles)

Treat Respiratory Disease (Surgery for Brachycephalic)

Last Resort - Gastropexy

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45
Q

Megaesophagus - Most Common: Congenital/ Acquired

A

Acquired

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46
Q

Megaesophagus - 2 Most common causes for acquired megaesophagus?

A

1) Idiopathic

2) Myasthenia Gravis

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47
Q

Megaesophagus - Congenital - Most commonly affected breed

A

German Shepard

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48
Q

Megaesophagus - Congenital - Classic presentation /Clinical signs. Also, What is another major DD?

A

Regurgitations from weaning

Aspiration pneumonia

Growth retardation

Vascular ring anomalies (e.g. PRAA)

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49
Q

Megaesophagus - Acquired - DDs

A

Idiopathic

Neuropathies: (e.g. Inflammation, vascular, Neoplasia) mainly involving the Vagus nerve CN9 (CNS/PNS)

Junctionopathies: Organic phosphates (Chronic), Myasthenia Gravis, Botulism, Tetanus

Muscles: Myositis, Dermatomyositis, Muscle Dystrophy, Storage Diseases

Led Poisoning

Endocrinopathies: Addison’s disease, Hypothyroidism

Chronic distal impaction: Foreign body, LES achalasia

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50
Q

Megaesophagus - Diagnosis

A

Full history & PE

Full neurological exam (with emphasis on medullary CNs)

Chest X-rays (Diagnosis of megaesophagus is usually achieved via X-rays)

CBC, Panel, UA (Aspiration Pneumonia, CK, Clues for Endocrinopathies, Basal cortisol, T4)

Fluoroscopy + Swallow study (When not obvious on X-rays)

ACh Anti-body titer / Tensilon test (If other clinical signs of Myasthenia Gravis are present

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51
Q

Megaesophagus - Treatment & Prognosis

A

-Treat underlying cause if possible (And then full remission is also possible)

-High frequency/Small quantities feedings

  • food with appropriate texture for the dog (based on trial & error)

-Feed from above so neck is extended upward. Can use a Baileys Chair

-Gastric tube (last resort)

-Treat episodes of aspiration pneumonia

Prognosis: Mostly poor in the long run but depends on the primary cause.

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52
Q

Stomach - What are the 4 main defense mechanisms against acidity

A

Tight epithelium

Mucosal barrier with HCO3-

Vast blood supply to the mucosa

PGE2 (Promotes the former three)

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53
Q

Stomach - Helicobacter can be part of the normal flora in cats and dogs (T/F)

A

True

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54
Q

Stomach - 2 Causes for stomach-originating dysbiosis

A

Atrophy of the stomach glands due to chronic disease

Prolonged use of anti-acids (e.g. PPIs)

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55
Q

Gastric disease - Clinical signs

A

Vomiting

Retching

Hematemesis

Melena, Burping

Nausea, Hypersalivation

Tympany

Abdominal pain

Weight loss (Chronic)

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56
Q

Vomiting - What questions are important to ask the owners?

A

First! Differentiate between vomiting and regurgitations! Different set of DDs:
-Content digested/undigested
-How long does it occur in relation to meal time
-Color/colorless
-Abdominal contraction y/n (the biggest differentiating sign)
-Blood?
-Volume?
-Frequency?
-When did it start?
-Vaccinated?
-What does he eat?
-Has access to the outside?
-Other clinical signs?

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57
Q

Vomiting - Intra-GI - DDs

A

Food: Garbage intoxication, dietary indiscretion, Intolerance

Inflammation: Infectious (e.g. Parvovirus, Distemper, Giardiasis)/Non-Infectious (e.g. Chronic inflammatory enteropathies)

Gastric ulcers

GI Accidents (e.g. Foreign body, Intussusception)

Neoplasia

Bilious vomiting

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58
Q

Vomiting - Extra-GI - DDs

A

-Hepatopathies

-Nephropathies (e.g. AKI, CKD)

-Pancreatitis

-Biliary tract disease

-Endocrinopathies (Addison’s disease, DKA, Hyperthyroidism)

-Abdominal disease (e.g. Peritonitis)

-Vestibular Disease

-Drugs\Toxins (e.g. Organic phosphates, Apomorphine)

-Shock, Sepsis, SIRS, Endotoxemia

-Electrolytes/Acid-Base Disorders

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59
Q

Vomiting - Treatment

A

Treat underlying cause

Correction of fluids, electrolytes

Anti-Emetics (e.g. Maropitant, Ondansetron, Metoclopromide)

GI-Protectants in case of ulcers (e.g. PPI)

Analgesia (if indicated)

Change of diet (e.g. low fat, tuna, rice, hypoallergenic). Can either be for a few days or for an extended period of time depending on the etiology

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60
Q

Anti-emetics - Name the main drugs (3)

A

Metoclopramide

Maropitant

Ondansetron

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61
Q

Metoclopramide - 2 Contraindications

A

GI accidents (e.g. Foreign body, Intussusception)

GI Bleeding (Can interfere with clot formation

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62
Q

Cerenia - In addition to being an effective anti-emetic, what is the drugs added effect and through what mechanism?

A

Analgesia (Substance P blocker through NK-1 Receptor)

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63
Q

GI Protectants - Name the main drugs

A

Anti-acids: H2 Blockers (e.g. Famotidine)

PPI (e.g. Omepradex)

Adsorbents: Sucralfate

PGE2: Misoprostol (Cytotec)

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64
Q

Describe the diet aspect in treating a simple acute case of gastritis and vomiting (Types of food and general composition)

A

Switch to easily digestable diet for 5-7 days - High in carbs, moderate protein, low fat & low fibers. Can switch to commercial diet or home made (e.g. rice, chicken, tuna). Switch back to previous food gradually over the course of 3-4 days

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65
Q

Usually acute gastritis is diagnosed tentatively from history and clinical signs. What would make you want to go further with additional diagnostics?

A

Hematemesis

Systemic clinical signs

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66
Q

Which specific glucocorticoid is most notorious for causing gastric ulcers

A

Dexamethasone

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67
Q

Gastric ulcers - General categories of causes (4)

A

Acid over-production

Decreased perfusion

Direct damage to the mucosa

Decreased prostaglandin production

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68
Q

Gastric ulcers - causes

A

Acid over-production: Kidney failure (Gastrin, uremia), Liver failure (Gastrin), Neoplasia such as MCT (Histamine), Gastrinoma

Damage to the mucosa: Foreign body, Gastritis, Pancreatitis, neoplasia (e.g. Leiomyoma)

Decreased perfusion: Addison’s disease Sepsis, SIRS, DIC, Shock

Decreased PGE production: NSAIDs > Steroids

Misc. Stress-related mucosal disease, Ulcers of working dogs.

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69
Q

Gastric ulcers - Clinical signs

A

Vomiting

Hematemesis, Melena

Abdominal pain

Pale mucus membranes (severe cases)

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70
Q

Gastric ulcers - NSAIDs - Typical anatomical location of gastric ulcers

A

Antrum

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71
Q

Gastric Ulcers - Treatment

A

Treat underlying cause

Fluids, Electrolytes, Colloids (in cases of severe hypoproteinemia)

GI-Protectants (e.g. PPIs, Famotidine, Sucralfate, Misoprostol in case of NSAIDs-derived ulcers)

Anti-emetics (e.g. Maropitant, Ondansetron, Metoclopramide)

Analgesia (e.g. Buprenorphine, Butorphanol, Tramadol)

Antibiotics (If indicated)

*Surgery in specific cases (Neoplasia, Perforation)

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72
Q

Chronic gastritis - DDs

A

Chronic inflammatory enteropathies

Chronic foreign body (Rare but possible)

Hypertrophic gastritis

Atrophic gastritis

Helicobacter (Controversial)

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73
Q

Helicobacter - Considered always a cause of disease (T/F)

A

False

Found in 40-100% of both clinical and non clinical dogs and cats

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74
Q

Helicobacter - Same Isolates as Humans (T/F)

A

False

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75
Q

Helicobacter - Treatment (+ Duration of treatment)

A

2 Weeks: Amoxicillin, Metronidazole, Omeprazole

76
Q

Gastric block/Delay in emptying - Mechanical DDs

A

GI Accidents (e.g. Foreign body, GD, GDV, Intussusception)

Pyloric Stenosis - Congenital (Brachycephalic) / Acquired (Hypertrophic Gastritis)

Neoplasia, Abscess, Granuloma, Polyp

Extra-gastric block (e.g. Organomegaly, Bad past gastropexy)

77
Q

Gastric block/Delay in emptying - Ileus - DDs

A

Inflammation: Gastritis, Ulcers Pancreatitis, Peritonitis

Electrolyte imbalance: Hypokalemia, Hypercalcemia

Increased sympathetic innervation (e.g. Pain, Stress, Trauma, Shock)

Dysautonomia

Drugs (e.g. Opiates, Anti-cholinergic)

78
Q

Gastric Ileus - Treatment

A

Treat underlying cause

Correct Fluids, Electrolyte

Treat Inflammation, Ulcers

Pro-motiles (e.g. Metoclopramide, Cisapride)

Anti-Emetics

GI-Protectants (in case of ulcers)

Analgesia (If indicated)

79
Q

Weight lose with normal /increased appetite - DDs

A

Malabsorption/Maldigestion

Intestinal Parasites

Hyperthyroidism

Diabetes Mellitus

80
Q

Melena - DDs

A

Coagulopathies: Thrombocytopenia, Thrombocytopathy, Decrease in clotting factors (in rare cases)

Swallowed blood:
1) Upper GI bleeding (e.g. Mouth, Esophagus)
2) Lower respiratory tract

Gastric & small intestinal ulcer (e.g. GI inflammation/Infection, Neoplasia, GI accidents, Addison’s disease, Pancreatitis, Liver failure, Portal hypertension, Severe uremia, NSAIDs)

81
Q

Melena - Main CBC & Panel findings

A

CBC:
Anemia (Microcytic-hypochromic. mostly regenerative)
Thrombocytosis (Iron deficiency)

Panel:
Hypoproteinemia
Hypocholesterolemia
Increased urea (due to digestion of plasma proteins)

82
Q

PLE - Clinical signs / Common PE findings / Associated pathology

A

Lethargy

Anorexia / Normal / Increased appetite

Weight loss

Vomiting, Diarrhea

Melena, Hematemesis

Ascites/Peripheral edema/Pleural effusion (Tachypnea, Dyspnea), Pericardial effusion

Thrombus formation (Loss of anti-coagulation factors)

83
Q

Dysbiosis - Causes

A

Achlorhydria (e.g. Atrophic gastritis, Chronic use of PPIs

Mucosal disease (e.g. Chronic inflammatory enteropathies, Neoplasia, Infectious diseases of the GI)

Accumulation of ingest (e.g. Ileus, Chronic impaction, EPI)

84
Q

Chief complaint of diarrhea - Questions to ask the owners

A

-Since when? (Acute/Chronic)
-Differentiate between small and big intestine diarrhea (Volume, Frequency, Consistency, Tenesmus, Urgency, Melena/Hematochezia, Mucus)
-Vaccination status?
-Deworming?
-What does he eat?
-Additional clinical signs?
-Access to the outside?
-Eats outside?
-Came in contact with a sick animal?
-Underwent surgery?
-On medications?
-Appetite?
-Weight loss?

85
Q

Acute diarrhea - Intra-GI - DDs

A

Dietary indiscretion, Garbage intoxication

Infectious:
-Worms (e.g. Ascarids, Strongyloides)
-Viruses (e.g. Parvovirus, Distemper, Rota, Panleukopenia, FIV, FeLV, FECV)
-Protozoa (Coccidiosis, Giardiasis, Cryptosporidium, Trichomonas)
-Bacterial (e.g. E.coli, Campylobacter, Sallmonelosis)

GI Accidents (e.g. Foreign body, Intussusception, Volvulus) - Unless complete impaction - usually doesn’t present with diarrhea then.

86
Q

Acute diarrhea - Extra-GI - DDs

A

Pancreas: Pancreatitis

Hepatopathies (e.g. Liver failure Biliary tract diseases (e.g. Cholangitis)

AKI (With severe uremia)

Endocrinopathies: DKA

Abdominal: Peritonitis, Prostatitis. Sepsis, SIRS, Endotoxemia

Drugs

Toxins (Organic Phosphates)

Vascular: R-CHF, Portal Hypertension

Ileus - Hypokalemia, Hypercalcemia.

87
Q

Diarrhea - 3 Clinical findings that indicate further diagnostics

A

1) Melena / Hematochezia

2) Systemic clinical signs

3) Chronic diarrhea (>3 Weeks)

88
Q

Acute diarrhea +/- vomiting (With or without blood) & Polycythemia - 2 Main differentials (One is a general differential and one is a specific pathology of the GI)

A

1) Dehydration

2) Acute hemorrhagic diarrhea syndrome (AHDS. Formerly known as HGE)

89
Q

Dehydration vs. AHDS - What is a classic lab parameter that can help differentiate between the two?

A

Total solids (TS)

Dehydration - high (proportional to increase in HCT)

AHDS - Low

90
Q

Intestinal diseases & Eosinophilia - DDs

A

GI parasites

Neoplasia / Para neoplastic

Addison’s disease

Eosinophilic IBD

Food responsive diarrhea

91
Q

Intestinal Diseases & Thrombocytosis - DDs

A

Iron deficiency

Inflammation

92
Q

Intestinal Diseases & Lymphocytopenia - DDs

A

Stress-leukogram

Lymphangiectasis

93
Q

Intestinal diseases - Classic panel findings

A

Hypoproteinemia (PLE, GI bleeding)

Hypocholesterolemia (PLE, GI bleeding)

High urea (GI bleeding)

Hypokalemia / Hyponatremia / Hypochloridemia (Vomiting, Diarrhea)

Hyperkalemia (Addison’s disease)

Elevated liver enzymes (e.g. Reactive hepatopathy)

Amylase (Enteritis)

94
Q

Causes for decrease in B12

A

EPI

Dysbiosis

Ilial diseases

Short bowel syndrome

Congenital B12 receptor deficiency

Nutritional deficiency

95
Q

Name 3 ancillary blood parameters that can help assess digestion & absorption

A

TLI

B9 (Folate)

B12 (Cobalamin)

96
Q

Folate (B9) - Name one cause for increased levels and one cause decreased levels

A

Decreased: Proximal small intestinal disease

Increased: Dysbiosis

97
Q

Acute Diarrhea - Treatment

A

Short course dietary change

Supportive treatment if necessary:
-Fluids, Electrolytes, Glucose
-Appetite stimulant
-Anti-emetics
-GI-Protectants (If GI ulceration is suspected)
-Pre & Probiotics

98
Q

Acute hemorrhagic diarrhea syndrome - AHDS (Formerly known as HGE) - Signalment

A

Young to middle aged (median age - 5 years old) small breed dogs (But can be in any breed and age)

99
Q

Acute hemorrhagic diarrhea syndrome - AHDS (Formerly known as HGE) - Main clinical signs

A

Acute Hematemesis & Hematochezia / Melena

100
Q

Acute hemorrhagic diarrhea syndrome - AHDS (Formerly known as HGE) - Classic lab finding

A

Hemoconcentration (Classically HCT > 58%) with normal to low TS

101
Q

Acute hemorrhagic diarrhea syndrome - AHDS (Formerly known as HGE) - Proposed etiologies

A

Clostridium perfringens endotoxins

Food allergy

Dysbiosis

102
Q

Acute hemorrhagic diarrhea syndrome - AHDS (Formerly known as HGE) - Main DDs (Name 4)

A

Addison’s disease

Pancreatitis

Parvovirus

Coagulopathies

103
Q

Acute hemorrhagic diarrhea syndrome - AHDS (Formerly known as HGE) - Treatment & Monitoring & Prognosis

A

Fluids, Correct electrolytes, glucose (If indicated), Colloids (in severe hypoproteinemia)

Enteral feeding

GI support (Anti-emetics, GI protectants, Appetite stimulant)

Analgesia

*Antibiotics (Ampicillin/Metronidazole) - (controversial and not indicated in all cases)

PCV/TS Every 6-24h

Good-excellent if treated in time. Big improvement expected in 24h and full recovery within a few days

104
Q

Viral enteritis - Causative agents (dogs and cats)

A

Dogs - Parvovirus, Distemper, Rota, Noro, Corona

Cats - FeLV, FIV, FECV, Panleukopenia

105
Q

Viral enteritis - Signalment

A

Young animals

Unvaccinated

Immunosuppressed

Kennels/Crowded-housing

106
Q

Viral enteritis - Parvovirus in dogs - Typical bloodwork findings

A

CBC:
-Inappropriately low neutrophils (Within normal range) / Neutropenia
-Mild anemia

Panel:
-Hypoproteinemia
-Hypoglycemia
-Hyponatremia
-Hypokalemia
-Hypochloridemia
-Azotemia

107
Q

Parvovirus - Treatment & Monitoring (Bloodwork)

A

-Intensive fluid therapy (Preferably through a central catheter)
-Correct electrolytes (Mainly potassium), Hypoglycemia
-Colloids if severely hypoproteinemic
-GI support: Anti-emetics (Multiple if necessary), Pro-motiles, GI protectants. -Apatite stimulant (Only after vomiting and severe nausea has subsided
-Analgesia
-Antibiotics for 2nd infections (Combination of Beta-lactam + Aminoglycoside considered treatment of choice)
-De-worming
-Keep warm & clean

PCV/TS, Creatinine, Glucose, Albumin, Electrolytes

*Once in 3-4 days - rechecking CBC for rebound neutrophilia is recommended (Associated with the recovery stage of the disease)

108
Q

Parvovirus - Diagnosis

A

Mainly based on Sig., History and clinical signs

Biggest clue is from the CBC - Inappropriately low neutrophils / Neutropenia (not specific)

Definitive diagnosis - Serology from fecal sample / PCR from blood samples

109
Q

Bacterial enteritis - Signalment (4 Main Ones)

A

Young animals

Immunosuppressed / Congenital immunodeficiency

Kennel/Low hygiene crowded living conditions

Secondary to other GI diseases (e.g. Chronic inflammatory enteropathies, Viral infections)

110
Q

Bacterial Enteritis - Main pathogens (4)

A

Campylobacter

E.Coli

Salmonella

Clostridium

111
Q

Bacterial enteritis - Diagnosis

A

Mainly signalment and history

Fecal smear: Large homogenous (or disproportional) population of a single type of bacteria (Suggestive of dysbiosis) along with Large amount of neutrophils

112
Q

Bacterial enteritis - General treatment + Specific antibiotic treatment for specific bacteria

A

Supportive Tx:
-Fluid, Electrolytes
-Short course of dietary change - Easily digestible (Commercial or home made)

Anti-emetics

GI protectants

Appetite stimulant

Analgesia

Antibiotics: Salmonella - Fluoroquinolones. E.Coli - Aminoglycosides, TMS, Fluoroquinolones. Clostridium - Penicillin, Metronidazole. Campylobacter - Macrolides

113
Q

Fungal enteritis - What is the most common type of pathogen? Usually secondary to…? (2)

A

Yeast

Immunosuppression, GI inflammation

114
Q

Parasitic enteritis/colitis - Main pathogen

A

Worms:
-Round worms (e.g. Ascarids such as Toxocara and toxocaris, Strongyloides)
-Cestodes (e.g. Dyplidium Caninum)
-Hookworms (e.g. Ancylostoma)
-Whipworms (e.g. Trichuris (Colon))

Protozoa:
-Giardia
-Cryptosporidium
-Coccidiosis (Colon)
-Trichomonas (Colon).

115
Q

Parasitic enteritis/colitis - Protozoa - name the main diagnostic methods for each of the following: Coccidia, Giardia, Cryptosporidium

A

Coccidia - Direct fecal smear, Fecal flotation

Giardia - Direct fecal smear, Antigen-specific kit (Feces)

Cryptosporidium - Antigen-specific kit (Feces)

116
Q

Parasitic enteritis/colitis - Protozoa - When looking on fecal smears - what parasite can be easily mistaken for Giardia?

A

Trichomonas

117
Q

Parasitic enteritis / colitis - Name the drug of choice for each of the following: Worms, Giardia, Cryptosporidium, Coccidia, Trichomonas

A

-Good empiric treatment for worms - Fenbendazole

-Tape/Round worms: Drontal

-Round worms: Ivermectin

-Giardia: Fenbendazole/Metronidazole (or a combination of the two)

-Coccidia: Toltrazuril, Ponazuril, Sulfadimethoxine

-Cryptosporidium: Macrolides

-Trichomonas: Ronidazole

118
Q

Chronic inflammatory enteropathies - Food-responsive enteropathy - Signalment & possible clinical signs

A

Young (but can be at any age)

Weight loss

Hyporexia / Normal / Increased appetite

Chronic diarrhea, Chronic vomiting

Borborygmus

Pruritus

In severe cases: Complications of hypoalbuminemia due to PLE (Peripheral edema, Ascites, Tachypnea/dyspnea due to pleural effusion)

119
Q

Chronic inflammatory enteropathies - Food-responsive enteropathy - Diagnosis

A

History and clinical signs

*Empirical deworming

Food trial - Change to a diet composed of a novel protein/hydrolyzed protein for 3-4 weeks (Preferably also low fat but not obligatory)

If cessation of clinical signs is achieved (usually within 2 weeks) - after a month switch back gradually to the previous diet

If clinical signs return - diagnosis is achieved

*Recommended diagnostics if possible/Indicated clinically: CBC, Panel, UA, Abdominal US, Fecal tests. Additional tests: Basal cortisol, TLI, B12 & Folate, Coagulation panel.

120
Q

Gluten-sensitivity - Poster breed

A

Irish setter

121
Q

Chronic inflammatory enteropathies - Antibiotic-responsive diarrhea - Signalment & Clinical signs (and important history clue)

A

Young German shepherds and its mixes.
Large breeds.

Chronic diarrhea

Weight loss with decreased / normal / increased appetite

Retarded growth

+/- Borborygmi

Flatulance

+/-Vomiting

Previous antibiotic treatment worked for a short while and then clinical signs returned

122
Q

Chronic inflammatory enteropathies - Antibiotic-responsive diarrhea - Diagnosis and important testing

A

Signalment, history and clinical signs

*Empirical deworming

1) Rule out food responsive diarrhea. If cessation of clinical signs is not achieved (usually within 2 weeks)

2) Response to antibiotic treatment: Tylosin / Metronidazole / Oxytetracycline for 4-6 weeks and taper-off slowly

If clinical signs return - Tentative diagnosis is achieved

*Recommended diagnostics if possible/Indicated clinically: CBC, Panel, UA, Abdominal US, Fecal tests. Additional tests: Basal cortisol, TLI, B12 & Folate, Coagulation panel.

123
Q

Chronic inflammatory enteropathies - Antibiotic-responsive diarrhea - Treatment

A

Tylosin (/Metronidazole/Oxytetracycline) - 4-6 Weeks and slowly taper off

If clinical signs return during/after tapering off - return to previous dosage and try tapering off again / permanent treatment

Food - Highly digestible, low fat +/- hypoallergenic (might also be a component of FRE)

Pro/Prebiotics

B12 Supplements

124
Q

Chronic inflammatory enteropathies - True IBD - Signalment

A

German Shepard, Basenji, Shar-Pei

Can be any breed and any age

125
Q

Chronic inflammatory enteropathies - True IBD - Diagnosis

A

Signalment, history and clinical signs

*Empirical deworming

1) Rule out food responsive diarrhea. If cessation of clinical signs is not achieved (usually within 2 weeks):

2) Response to antibiotic treatment: Tylosin / Metronidazole / Oxytetracycline for 4-6 weeks and taper-off slowly

If no cessation of clinical signs is achieved (usually within 5-7 days):

3) Endoscopy - No remarkable findings

Histology - Necessary to demonstrate inflammation - Lympho-plasmocytic / Eosinophilic infiltrates (can be inconclusive)

**Main method of diagnosis - Response to GC and slowly taper off

*Recommended diagnostics if possible/Indicated clinically: CBC, Panel, UA, Abdominal US, Fecal tests. Additional tests: Basal cortisol, TLI, B12 & Folate, Coagulation panel

126
Q

Chronic inflammatory enteropathies - True IBD - Proposed pathology (3 Main elements)

A

1) Genetic predisposition

2) Breaking of tolerance against antigens (Inflammation, Stress, dietary change)

3) Infective agent/dysbiosis

127
Q

Chronic inflammatory enteropathies - True IBD - Treatment

A

GC - Prednisone/Prednisolone/Budesonide

*2nd Immunosuppression if steroids insufficient (e.g. Cyclosporine, Chlorambucil, Cellcept, Azathioprine)

Anti-coagulants (e.g. Clopidorgrel, Low dose aspirin)

Dietary change (Hypoallergenic/Low fat) - might help

B12 Supplementation

Pro/prebiotics

In cases of severe PLE - Colloids

*Can also try fecal transplantation

128
Q

Chronic inflammatory enteropathies - True IBD - Monitoring & Negative prognostic indicators

A

Monitoring is clinically-based, according to the Canine Chronic Enteropathy Activity Index (CCEAI):
-Behavior & activity
-Vomiting, Diarrhea
-Apatite
-Weight loss/gain
(Each is scored from 0-3 from normal to worse)

Additional CCEAI monitoring:
-Pruritus
-Albumin
-Ascites
-ALP, ALT
-Total Protein

Negative prognostic indicators:
-Dogs worse than cats
-Hypoalbuminemia
-Hypercoagulability
-Concurrent Pancreatitis
-Clinically/Endoscopically/Histologically worse disease

Euthanasia - 10-20%

129
Q

Chronic inflammatory enteropathies - True IBD - Clinical improvement is associated with histological improvement (T/F)

130
Q

Lymphocytic-plasmocytic IBD Vs. Small cell-lymphoma (SCL) - Signalment, How to differentiate, Treatment

A

SCL - Older dogs and cats

IBD - Generally young-adult animals

Immunohistochemistry:
Monoclonal (SCL)
Polyclonal (IBD)

Treatment: Cornerstone is the same - Prednisone/Prednisolone + Chlorambucil.

131
Q

Eosinophilic IBD - Signalment, name a clinical sign often associated with Eosinophilic IBD

A

Young adult dogs

Boxer, Doberman, German shepherd over-represented

Bleeding due to ulcers/erosions

132
Q

Eosinophilic IBD - Main DDs (4)

A

Addison’s disease

Parasites

Paraneoplastic syndrome

Food allergy

133
Q

Eosinophilic IBD - Name the unique variant in middle aged cats, Location, Classic appearance and treatment

A

Feline sclerosing eosinophilic Fibroplasia

Stomach
Small Duodenum

Granuloma-like/Mass - Can cause impaction/perforation

Antibiotics + GC

134
Q

Lymphangiectasis - Predisposed breeds

A

Yorkshire terrier, Maltese, Rottweiler

135
Q

Lymphangiectasis - Causes

A

Congenital

Secondary:
-Inflammatory diseases of the small intestine (e.g. IBD), Fibrosis, Neoplasia.
-Blockage of thoracic duct.
-R-CHF

136
Q

Lymphangiectasis - Classic bloodwork findings

A

CBC:
Lymphopenia

Panel:
Hypocholesterolemia
Hypoproteinemia
Hypocalcemia
Hypomagnesemia

137
Q

Lymphangiectasis - DDs for hypocholesterolemia

A

Addison’s disease

Liver failure

Lymphangiectasis

EPI

PLE

Hyperthyroidism

Multiple myeloma

Snake envenomation

138
Q

Lymphangiectasis - 3 main differentials which also present with hypoalbuminemia and hypocholesterolemia? In standard blood tests (CBC/Panel) - what helps differentiate between them?

A

Atypical Addison’s disease: Lymphocytosis

Lymphangiectasis: Lymphocytopenia

Liver failure: Hypocholesterolemia, Hypoalbuminemia

PLE and Lymphangiectasis: Hypocholesterolemia and Hypoproteinemia (Loss of both albumin and globulins)

139
Q

Lymphangiectasis - Diagnosis

A

Signalment, History and Clinical signs

CBC (Lymphocytopenia) & Panel findings (Hypocholesterolemia, Hypoproteinemia, Hypocalcemia, Hypophosphatemia)

On rare occasions - prolonged clotting times

Abdominal US - Hyperechoic mucosal striations (dilated intestinal lacteals)

Endoscopy - dilated lacteals can be seen microscopically as white plaques scattered across the intestinal mucosa

Histology

140
Q

Lymphangiectasis - How can you help your US findings be more prominent and conclusive?

A

Give high fat meal a few hours before the US - makes the lacteals more prominent

141
Q

Lymphangiectasis - Treatment

A

Treat underlying cause if exists

Dietary change (most important element of treatment): Extremely low-fat diet

Vitamin D supplement

Anti-coagulants (If indicated).

142
Q

Short Bowel Syndrome - How much of the small intestine can you remove?

143
Q

Short Bowel Syndrome - Treatment

A

Initially - Parenteral feeding and then start with an easy to digest food

Fat-soluble - vitamin supplementation

In case of Ileum/Ileo-cecal valve removal: B12 Supplementation, Antibiotics for secondary dysbiosis, Ursodiol, Bile acid absorbents

144
Q

Pre-Colonoscopy Enema - Preparation

A

36 Hour fast

24 Hours before procedure - Polyethylene glycol

Right before - Wash colon with hot water

145
Q

Phosphate Enema - Recommended in Animals? Why?

A

No

Can cause hyperphosphatemia

146
Q

Colitis - What is important feeding considerations? (2 elements)

A

High digestibility

Digestible fiber

147
Q

Chronic Colitis - Immunomodulatory drugs

A

Metronidazole (/Tylosin)

Sulfasalazine

Immunosuppressive drugs

148
Q

Histiocytic ulcerative colitis (HUC) - Signalment & Clinical signs & lab findings

A

Young boxers (0.6-4 Years)

Signs of colitis (chronic):
-Runny diarrhea
-Small quantity
-high frequency
-Urgency
-Mucus secretions
-Tenesmus
-Hematochezia

-Hypoproteinemia, Anemia

149
Q

Histiocytic ulcerative colitis (HUC) - Histological findings

A

Macrophages which stain positive in PAS

Lymphocytic-plasmocytic & Eosinophilic Infiltrates

Ulcers

150
Q

Histiocytic ulcerative colitis (HUC) - Diagnosis

A

Signalment (Young Boxers)

History - Signs of chronic colitis

Biopsy and histology - PAS-positive granulomatous infiltrates

151
Q

Histiocytic ulcerative colitis (HUC) - Causative Agent

A

Adhesive-invasive E.Coli

152
Q

Histiocytic ulcerative colitis (HUC) - Treatment and Prognosis

A

Fluoroquinolones for a prolonged period (9 weeks)

Good if treatment is effective - can see improvement in a week

Poor if E.Coli is resistant to Fluoroquinolones

153
Q

Chronic Colitis - Prototheca - Signalment & Clinical Signs

A

Young dogs

Signs of colitis (chronic):
-Runny diarrhea
-Small quantity
-high frequency
-Urgency
-Mucus secretions
-Tenesmus
-Hematochezia

CNS Signs

Uveitis

Skin nodules (Cutaneous form)

154
Q

Chronic Colitis - Prototheca - Diagnosis (4 methods)

A

Rectal Scrape

Biopsy

Fecal PCR

CSF PCR

155
Q

Chronic Colitis - Prototheca - Treatment & Prognosis

A

In cases of GI disease only: Itraconazole + Nystatin

In cases of disseminated disease: Itraconazole + Amphotericin B

Poor

156
Q

Chronic Colitis - Tritrichomonas Foetus - Signalment

A

Young cats

Multi-cat household/Kennels.

157
Q

Chronic Colitis - Tritrichomonas Foetus - Name the parasite that is morphologically very similar to Trichomonas Foetus

158
Q

Chronic Colitis - Trichomonas Foetus - Diagnosis (2 main methods)

A

Fecal Smear

Fecal PCR

159
Q

Chronic Colitis - Tritrichomonas Foetus - Treatment & Prognosis

A

Ronidazole for 2 weeks

Spontaneous remission can be seen 9 months after diarrhea began

Relapses also possible

Good

160
Q

Chronic Colitis - Tritrichomonas Foetus - Ronidazole side effects

161
Q

Irritable Bowel Syndrome - Signalment & Clinical signs

A

Working dogs and hyperactive breeds

Abdominal pain

Diarrhea and/or Constipation

162
Q

Irritable Bowel Syndrome - Treatment

A

Increased activity

Highly digestible food, low in fiber

163
Q

Irritable Bowel Syndrome - Name of the disease in dogs

A

Chronic idiopathic large bowel diarrhea

164
Q

Constipation/Obstipation - Mechanical obstruction - DDs

A

Intraluminal: Dry solid feces (2nd to dehydration, Lack of activity, Stress, Bones in feces, Orthopedic/Neurological problems), Foreign body (Rare).

Intramural: Neoplasia, Polyps, Granuloma, Perineal hernia, Perianal fistula, Perianal sacs enlargement, Stricture

Extra-Intestinal: Abdominal mass, Pelvic Fractures, Prostatic enlargement, Enlargement of abdominal lymph nodes (e.g. sub-lumbar)

165
Q

Constipation/Obstipation - Functional problems (Ileus) - DDs

A

Idiopathic megacolon (Cats).

Metabolic: Hypokalemia, Hypercalcemia, Hypothyroidism

Drugs: Opiates. Sympathetic stimulation (e.g. Pain, Stress)

Dehydration

Dysautonomia

Peritonitis

PNS Injury (Sacral Region)

UMN injury (e.g. Degenerative myelopathy, Lumbosacral stenosis, Trauma).

166
Q

Constipation/Obstipation - Diagnosis

A

Physical exam (Rectal exam as well)

Neurological Exam

CBC, Panel

T4+TSH

X-rays

Colonoscopy

167
Q

Constipation/Obstipation - Treatment

A

Treat underlying issue if possible

Correct hydration and electrolytes (Fluid therapy assists in liquifying the feces - very important)

Enema

Laxatives (e.g. Lactulose, Polyethylene Glycol)

Lubricant (e.g. Vaseline)

food with soluble fibers (can also add Psyllium)

Pro-motiles (only after removal of obstruction!)

168
Q

Constipation/Obstipation - What are the pro-motiles that are available to us. What is the “last resort” one and why?

A

Cisapride
Erythromycin
Remeron (Also Apatite Increase)
Ranitidine (H2 Blocker but also weak pro motile)

Bethanecol - Powerful Parasympathomimetic. Can cause Organic-phosphate-like Intoxication signs

169
Q

Constipation/Obstipation - Idiopathic Megacolon - Signalment, Treatment

A

Middle aged cats (Males&raquo_space; 70%)

Colectomy

170
Q

Septic peritonitis + Eosinophils on cytology of abdominal fluid. Suggestive of?

171
Q

PLE - Common pathology in both cats and dogs (T/F)

A

False

Rare in cats

172
Q

Fungal enteritis - Usually a marker of what pathology

173
Q

Fungal enteritis - Diagnosis and when to treat?

A

Rectal smear

When a large homogenous population is seen

174
Q

3 Major DDs for chronic diarrhea in German shepherds

A

EPI

ARD

True IBD

175
Q

Protein-losing enteropathy - Name the 3 major DDs

A

Chronic inflammatory enteropathies

Lymphangiectasis

GI Neoplasia

176
Q

Chronic diarrhea - Intra-GI - DDs

A

Chronic inflammatory enteropathies (Food-responsive diarrhea, Antibiotic responsive diarrhea, True inflammatory bowel disease (True IBD))

GI Worms,

Lymphangiectasis

Giardiasis

Neoplasia

GI accidents (Rarely chronic but possible)

177
Q

Chronic diarrhea - Extra-GI - DDs

A

Pancreas: Chronic pancreatitis, EPI. Biliary tract disease (e.g. Lymphoplasmacytic cholangiohepatitis, Mucocele). Hepatopathies (e.g. chronic hepatitis). Nephropathies (e.g. CKD). Endocrinopathies (e.g. Hyperthyroidism, Addison’s disease)

178
Q

Parvovirus - Common complications

A

Sepsis

Peripheral edema (Hypoalbuminemia)

Intussusception

Phlebitis (Prolonged hospitalization, Contamination)

179
Q

Hairballs - 2 Major categories of causes

A

Excessive grooming

Decreased/Abnormal GI motility

180
Q

Hairballs - Causes (Divided to 2 Categories and Detailed)

A

Excessive Grooming: Stress | Abdominal Pain | Musculoskeletal Pain | Neuropathies | Claw Pain | Skin Parasites and Allergies | Dry Skin | Dermatophytes

Decreased/Abnormal GI Motility: Esophagitis | Stricture| FB | Neoplasia | Megaesophagus | Mediastinal Diseases | Hernia | Gastric Ulcers | Gastritis | Enteritis (Infectious and Non Infectious | Ileus | Parasites | Intussusception | Abdominal Disease | Pancreatitis |Allergies | Cholangiohepatitis | Cholecystitis

181
Q

What can give you a clue to the presence (or past presence) of a sublingual foreign body in cats

A

Sublingual granuloma

182
Q

Hairballs - Treatment

A

Treat underlying cause

Hydration

Petrolatum / Hairball remedies

Remove excess hair (Comb / Roller)

183
Q

Protein-losing enteropathy (PLE) - 3 Common causes in puppies / Young dogs

A

Parvovirus

Chronic Intussusception

Worm Infestation

184
Q

Protein-losing enteropathy (PLE) - Treatment

A

Treat any Extra-GI underlying cause (e.g. Addison’s disease, Cardiac disease, Liver disease, Intussusception, Parvovirus)

Change diet (Novel/Hydrolyzed protein. Low fat preferred)

Antibiotic treatment (Tylosin/Metronidazole generally preferred)

Glucocorticoid treatment (Prednisone/Budesonide)

Additional immunosuppressive treatment if no response

Anti-thrombotics (e.g. Clopidogrel / Low-dose aspirin)

Probiotics

Cobalamin Supplement

185
Q

Constipation / Obstipation / Megacolon - Treatment

A

Treat underlying cause if possible

IV fluids

Enema if indicated

  • Warm Water

+/- Mineral Oil

Can also trickle PEG with NG tube

Diet - Psyllium, High fiber diet

Laxatives: Lactulose / Polyethylene Glycol (PEG)

Pro-motiles (e.g. Cisapride)

186
Q

When an animal has low-normal cobalamin levels - What test should you perform to determine if the animal could benefit from cobalamin supplements?

A

Methylmalonic Acid levels

Doctor of Veterinary Medicine (Work in progress) (17 decks)

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