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Diseases/ Digestion
diseases of digestion veterinary medicine
| Question | Answer |
|---|---|
| What is lymphatic plasmacytic stomatitis? | atypical immune response of unknown etiology |
| What are lymphatic plasmacytic stomatitis signs? | inflamed gums, often with minor calculus |
| What contributes to lymphatic plasmacytic stomatitis? | many cats have underlying disease that interferes with local immunity in gingava; cats should be screened for disease |
| Who is predisposed to lymphatic plasmacytic stomatitis? | siamese, himalayans, abyssinians |
| What is the treatment of lymphatic plasmacytic stomatitis? | clean teeth, antibiotics, oral antiseptics, daily brushing w/ antibacterial solutions, hard diet, rechecks |
| What to do if lymphatic plasmacytic stomatitis recurs? | extract all premolars, molars, and retained roots; if still recurs remove remaining teeth; give steroids |
| What is oral neoplasia? | common neoplasia, melanomas and squamous cell carcinomas most common, also fibrosarcomas |
| Who gets oral neoplasia? | older animals |
| Who is at risk for oral neoplasi? | males have increased risk for melonoma and fibrosarcoma |
| Who is at greater risk for melonoma? | dogs with pimented oral mucosa |
| What is common with oral neoplasia? | benign neoplasms (papilomas, epulides) |
| What are oral neoplasia melanomas? | rapidly growing tumors charcterized by early bone involvement; may metastatize to lungs |
| What is oral neoplasia squamous cell carcinoma? | ulcerative, erosive neoplasms *invade bone and metastisize to regional lymph nodes |
| What is treatment for oral neoplasia? | surgical removal, chemo, radiation *poor prognosis* |
| Diseases of Stomach: What is gastritis? | common cause of vomiting in dogs |
| What are causes of acute gastritis? | *gastric indiscretion(garbage),spoiled food, change in diet, food allergy; infection (bacterial, viral, parasitic); toxins; foreign object ingestion |
| What is physiologic cause of gatritis? | mucosa is damaged, inflammation occurs, signs develop |
| What are signs of gastritis? | anorexia, acute vomiting, +/- dehydration, +/- painful abdomen |
| How do you diagnose gastritis? | based on HX and PE; cbc/chem (cbc may indicate stress leukogram and dehydration) |
| What is treatment for gastritis? | *NPO 24-36 hrs, fluid therapy, feed low fat diet, ie, hills i/d, cottage cheese, chicken/rice; *antiemetics(chlorpromazine, metoclopramide, cerinia) |
| Who is prone to Gastric Dilation/Volvulus (GDV)? | disease of dogs 2-10, large and giant breed, deep chested |
| What is the cause of Gastric Dilation/Volvulus? | unclear mechanism: diet and exercise; delayed gastric emptying, pyloric obstruction, aerophagia, and engorgement possible gastric dysrhthmias; *filling w/ air causes dilation (bloat) *air filled stomach twisting on it axis causes volvulus |
| What is physiology of Gastric Dilation/Volvulus? | enlarged stomach pushes against diaphragm, breathing difficult,blocks venous return thru hepatic portal vein & caudal vena cava; increased pressure on gastric wall causes ischemia/necrosis; Spleen may be involved; hypovolemic, edotoxic shock may result |
| What are signs of Gastric Dilation/Volvulus? signs | weakness, collapse, depression, nausea, non-productive retching, hypersalivation, abdominal pain and distension, increased hr and resp |
| How to diagnose Gastric Dilation/Volvulus: | HX and PE demonstrates weak,shocky animal (long crt, abnormal mm);xray;ecg may show vent.arrhthmia/sinus tach; cbc/chem for correction of electrolye and pH imbalances,& fluid therapy |
| How do you treat Gastric Dilation/Volvulus? | *emergency!* decompress stomach(18 g needle), stabilize patient, prep for surgery *stomach tube* treat shock (fluids) *bicarbonate (if total carbon dioxide <12 mEq) *IV antibiotics targeted against gram-/anaerobes; cefoxtin, ampicillin |
| How to treat Gastric Dilation/Volvulus: (cont) | *potassium supplement if < 3 mEq; monitor ECG; treat v-tach w/ lidocaine or procanimade;surgery follow-up care |
| How to prevent Gastric Dilation/Volvulus: | avoid feeding one lg meal; limit exercise after eating; feed high quality, protein, low fat diet; avoid easily fermentable food; DZ has 15-18% mortality rate; *gastropexy no guarantee against future episodes* |
| Diseases of Small Intestine: What is acute diarrhea? What causes it? What are the signs? | most common diarrhea; change in diet, drug therapy, stressful situations causes disruption of normal bacterial flora *signs* abrupt onset diarrhea, +/-vomiting |
| How to diagnose acute diarrhe: | rule out other causes (MDB); fecal sample- direct and float; HCT to monitor hydration |
| How do you treat acute diarrhea? | supportive and symptomatic:fluid and electrolyte therapy, NPO 24-48 hrs, water if no vomiting, pepto bismol or loperamide, antibiotics, bland low-fat diet for 3-5 days |
| Causes of Parasitic Diarrhea: | Toxocara canis, Toxascaris leonina , and Toxocara cati (roundworms), Trichuris vulpis,(whipworms) Ancylostoma caninum, Isopora spp (coccidia), Capillaria aerophila, Giardia spp, Tritrichomonas foetus |
| Causes of Viral Diarrhea: | parvovirus, distemper, coroavirus, feline panleukopenia |
| What are Chronic Enteropathies? | *chronic small intestinal inflammatory bowel disease (IBD);dogs/cats *chronic antigenic stimulation of the intestinal lumen (many causes) infiltration of lamina propria w/ lymphocytes and plasma cells (damage to mucosa and abnormal intestinal absorption) |
| What are Chronic Enteropathies signs? | often non specific; chronic intermittent vomit/,+/- diarrhea, listlessness, weight loss, older animals, Borborygmus (gas sounds in intestine), halitosis, flatulence, signs progressive over time |
| How to diagnose Chronic Enteropathies: | PE often normal, edema or ascities if protein losing enteropathy, MDB, fecal, x-ray, endoscopy/biopsy (looking for lymphotic-plasmacytic infiltrates) |
| How do you treat Chronic Enteropathies? | prednisone, azathioprine, metronidazole, intestinal protectants (sucralfate, H2 blockers), vitamin therapy to replace fat-soluable vitamins, dietary modifications, limit carb, avoid lactose, low-fat diets, good quality protein diet, hypoallergenic diet |
| Chronic Enteropathies TX (cont) | treatment can be long and expensive, often not cured, monitor dogs and cats on long term anti-inflammatory therapy |
| Diseases of Large Intestine--What is large inflammatory bowel disease? | very similar to small intestine diseases, excessive number of inflammatory cells in mucosa, unknown etiology, likely multi factorial, colonic inflammation disrupts mucosal integrity and results in decreased absorption of water and electrolytes |
| What are the signs of large inflammatory bowel disease? | diarrhea w/o weight loss, increased frequency of defecation w/ decreased fecal volume, tenesmus, hematochezia (frank blood), increased mucus, +/- dyschezia; +/- mild fever |
| How do you diagnose large inflammatory bowel disease? | MDB, fecal, x-ray, colonoscopy with biopsy; histo will show lymphocytes and plasma cells in large intestinal lamina propria |
| How do you treat large inflammatory bowel disease? | sulfasalizine (caution with cats);Keratoconjunctivitis-KCS *(may cause dry eye in dog with long term use) , prednisone, metronidazole, azathioprine, tylosin, mesalamine(sim to sulfasalazine , anti inflammatory drug w/free radicals) |
| What is diet recommendation for large intestinal inflammatory bowel disease? | hypoallergenic diets; low fat diets with high fiber; goal is to control signs; may have frequent defecation chronically |
| What is the cause of Intussusception? | unknown, but can result from parasites, foreign bodies, infections, neoplasia |
| What is Intussusception? | occurs when smaller, proximal segment of intestine at ileocolic junction invaginates into larger, more distal segment of large intestine, telescoping effect causes partial to complete blockage and compromises blood supply, causing necrosis |
| What are signs of Intussusception? | vomiting , anorexia, depression, diarrhea (often bloody) |
| How to diagnose Intussusception: | palpation of sausage-like mass in cranial abdomen; ultrasound shows multi-layered concentric rings representing large intestinal wall layers |
| How do you treat Intussusception? | surgical reduction or resection of necrotic bowel, fluids and electrolytes; broad spectrum antobiotics, post surgery; no solid food for 24 hrs, then bland diet for 10-24 days to allow healing intestinal walls |
| What is the prognosis for Intussusception? | recurrence infrequent, prognosis depends on extent of damage, common in puppies with heavy parasitic infestation |
| What is Megacolon? Who is prone? | fairly common in cats(middle-age to older cats); can occur from hypokalema, hypothyroidism, pelvic deformities; 62% of cases are idiopathic; believed to involve a defect in neurostimulation for colon evacuation |
| What are signs of megacolon? | straining to defecate, vomiting, weakness, dehydration, anorexia, small hard feces +/- blood, mucus |
| How to diagnose megacolon? | PE, distended colon is filled with firm, packed feces,x-ray show colon width greater than length of lumbar vertebra, MDB;(possible dehydration, increased HCT) |
| What is treatment for megacolon? | stool softeners, Ducolax, docusate, lactulose, enemas, Cisapride, correct dehydration and electrolyte imbalances, to protect against sepsis thru damaged colonic wall, treat any underlying disease; antibiotics to prevent sepsis |
| How to give enemas for megacolon or constipation? | lubricated red rubber feeding tube inserted and enema solution injected; pre-fabricated pet enemas include warm, soapy water (avoid docusate(emollient); mineral oil(lubricant) hexachlorophene); |
| WHAT NOT TO DO re: enemas for megacolon or constipation: | *DO NOT USE PHOSPHATE ENEMAS IN CATS OR SMALL DOGS *DO NOT MIX DOCUSATE AND MINERAL OIL |
| Explain docusate enema for megacolon or constipation. | docusate possesses wetting and emulsifying properties, salts reduce surface tension & allow water and fat to penetrate ingesta and formed feces; may have an effect on cells of colonic mucosa allowing the cells to more easily secrete water into lumen |
| Explain use of mineral oil in enema for mega colon or constipation. | lubricates feces and reduces water reabsorption out of the lumen |
| Why is using mineral oil and docusate together in enema for megacolon or constipation contraindicated? | contraindicated because docusate will act as a surfacant on the mineral oil, allowing it to be absorbed by the colonic mucosa, and the mineral oil will prevent water from getting to feces |
| What diet is indicated for megacolon? | increase fiber, soft canned food, salt food to increase water intake |
| Explain surgery for megacolon? | subtotal colectomy if refractory to medical and dietary management; rehydrate and correct electrolyte imbalances before anesthsia |
| Cautions during surgery for megacolon. | use caution when removing feces from colon manually; use well lubricated gloved finger, x-ray after to ensure empty colon; use soothing cream post-evacuation, make sure patient is kept clean and dry |
| Diseases of Rectum/Anus What is perineal hernia? Who does it affect? | common in intact older male dogs >8; atrophy of levator ani muscle causes herniation of rectum and pelvic organs into ischiorectal fossa |
| What are the signs of perineal hernias? | perineal swelling, tenesmus, dyschezia, constipation, possible urethral obstruction if bladder involved |
| What is treatment of perineal hernias? | with stool softeners and enemas palliatively until surgical correction via herniorraphy |
| What are perianal fistulas (anal fistula)? | single or multiple ulcerated sinuses that involve perianal tissue often large breed dogs |
| What are the signs of perianal fistulas? | causes pain, bleeding, self mutilation, dyschezia, anal stenosis, tenesmus, incontinence, licking perianal area, foul odor to anal area |
| What is treatment of perianal fistula? | cyclosporin +/- ketoconazole, tacrolimus 0.1% topical, prednisone, azathioprine stool softeners(lactolose) antimicrobials (adjunct for seconary dermatitus) |
| What type of surgery for perianal fistula? | debride ulcers and diseased tissue, possibly cryosurgery; may use medical tx first to decrease the size of the fistulas then surgery |
| Diseases of the Liver What is cholangiohepatitis? | common hepatobiliary disorder of cats, less in dogs; complex of disorders that involve cholangitis, cholangiohepatitis, and biliary cirrhosis: bile duct inflammation leads to hepatocyte involvement, progresses to cirrhosis |
| What is cholangiohepatitis (cont) and who it affects. | cause unknown; ascending biliary infections from GI tract and immune-mediated causes have been suggested; Persian cats predisposed; sometimes occurs in conjuction with pancreatitis and IBD in cats (Triaditis) |
| What are the signs of cholangiohepatitis? | anorexia, depression, weight loss, vomiting, dehydration, fever, jaundice, ascites, hepatomegaly |
| How to diagnose cholangiohepatitis. | cbc--neutraophilia w/ left shift; mild, regenerative anemia |
| What does chemistry testing for cholangiohepatitis reveal? | mild to moderate increase in ALT, normal to increased ALP, mild to moderate increase in GGT, normal to increased fasting serum bile acids, hypoalbuminemia,(later stages), decreased BUN(later stages) |
| What other diagnostic tests do you do for cholangiohepatitis? | Xrays: hepatomegaly or choleliths may be observed |
| What might a liver biopsy of cholangiohepatitis show? | cellular infiltrates in or near bile ducts; +/- portal triad fibrosis (definative diagnosis) |
| What is treatment for cholangiohepatitis? | antibiotics, ursodeoxycolic acid, prednisone, fluid and electrolyte corrections, vitamin and nutritional support, S-adenosylmethioonie |
| What is prognosis for cholangiohepatitis? | prognosis uncertain and variable tx may be prolonged and expensive permanent damage to liver my occur |
| What is Feline Hepatic Lipidosis? | idiopathic, most common hepatopathy in cats adult, obese cats any age , sex, breed |
| What are Feline Hepatic Lipidosis triggers? | stress, diet changes, boarding, illness, enviro. change resulting in anorexia if anorexia >2 weeks; imbalance occurs between breakdown of peripheral lipids and lipid decreased BUN(later stages) |
| What are the signs of Feline Hepatic Lipidosis? | anorexia, depression, weight loss, spoadic vomiting, hepatomegaly, possible bleeding tendencies (petechiae, bleeding from gums) |
| How to diagnose Feline Hepatic Lipidosis: | CBC -nonregenerative anemia; stress neutrophilia, lymphopenia |
| What would chem tests of Feline Hepatic Lipidosis show? | greatly increased ALP, increased ALT, AST, hyperbilirubinemia, hypoalbuminemia, increased serum bile acids |
| What would other diagnostic tests of Feline Hepatic Lipidosis show? | x-rays--mild hepatomegaly; ultrasound--hyperechoic liver; histopathology--severly vacuolized hepatocytes |
| How to treat Feline Hepatic Lipidosis: | high protein, high calorie diet, feeding tube, (for up to 2 mos), IV fluids-potassium supplementation, metaclopramide sq 15 min before feeding if vomiting occurs, wean cat off feeding tube |
| How to prevent Feline Hepatic Lipidosis: | avoid stress in obese cats, early intervention essential, a cat that usually eats well and just stops is at risk, prevent obesity; treatment may be long and $$; cure rate 60-65%, |
| What are Portosystemic shunts? | ductus venosus remains patent (open) after birth, and the blood from abdominal viscera will continue to bypass liver, and liver is unable to filter deleterious and toxic substances |
| What are the signs of Portosystemic shunts? | anorexia, depression, lethargy, weakness, ataxia, head-pressing, circling, pacing, blindness, seizures, coma, hypersalivation 9cats) and bizarre, aggressive behavior in cats |
| Portosystemic shunts more signs: | vomiting, diarrhea, stunted growth, PU/PD/ urate urolithiasis, hematuria, ammonium biurate crystals in sediment, dilute urine |
| Diagnostics for Portosystemic shunts: | cbc: microcytosis, target cells, poikilocytosis, mild regenerative anemia xray microhepatia |
| More diagnostics for potosystemic shunts: | chem: hypoproteinemia, hypoalbuminemia, decreased BUN, mildly increased ALT< ALP, increased serum bile acids, hyperammonemia x-ray: microhepatia |
| How to treat Portosystemic shunts: | medical management seldom successful, low protein diet, lactilose, metronidazole, fluids, surgical ligation of shunt is preferred *beware of hypertension* 2nd surgery possible |
| What is prognosis for Portosystemic shunt? | excellent after surgical ligation surgery yields best results if dog is less than one year; relapses may occur (more common in cats) animals with partial ligations of shunt may require low protein diet to avoid clinical signs of hepatic encephalopathy |
| How crazy Dr C is to think we can learn ALL | CERTIFIABLE OMG!! |
| Diseases of Pancreas What is pancreatitis? | infl. of pancreas acute/chronic; digestive enzymes are activated within the gland, causes autodigestion, gland becomes inflammed,=tissue damage, high fat diets predispose, assoc w/ hepatic lipdosis, drugs , parasites, tumors, trauma may cause pancreatitis |
| What are the signs of Pancreatitis? | older, obese dog/cat w/ hx of recent fatty meal; anorexia, vomiting, depression,+/-diarrhea, dehydration fever +/-painful abdomen,shock and collapse may develop |
| How to diagnose pancreatitis? | increased serum trypsinogen-like immunoreactivity, (pancrease specific test) serum canine pancreatic lipase immunoreactivity (cPLI), and feline (fPLI) |
| What dianostics test for pancreatitis show: | cbc: leukocytosis, increased PCV; chem: azotemia, increased ALT, mild hypocalcemia, hyperlipemia, normal to increased amylase and lipase |
| What is treatment of pancreatitis? | (supportive care is mainstay)fluids and electrolyte balance; potassium; NPO 3-4 days if vomiting; antiemetics if vomiting; analgesia: Buprenorphine in cats butorphanol in dogs; +/- antibiotics enroflaxin, trimethaprim-sulfa gluccocorticoids |
| What is Exocrine Pancreatic Insuffciency (EPI) ? | pancreas loses acinar cells followed by inadequate production of digestive enzymes; usually asymptomatic until 85-90% of secretory ability has been lost;lack of normal pancreatic secretions affect mucosal lining of small intestine and decrease absorption |
| totally useless facts about pancreas | young german shepherds have genetic predisposition to pancreatic acinar atrophy; in cats EPI often caused by chronic pancreatitis |
| What are signs of exocrine pancreatic insufficiency? | mild to marked weight loss, polyphagia, coprophagia, pica, diarrhea, fatty stool, foul smelling poop, flatulence |
| How to diagnose exocrine pancreatic insufficiency? | cbc normal; increased ALT; decreased total lipid; serum trypsin-like immunoreactivity levels are decreased (fTLI and cTLI) |
| How to treat exocrine pancreatic insufficiency: | supplement pancreatic enzymes, give pancrezyme or Viokase-V; chopped raw ox or pig pancreas; low fiber diet with high digestibility; med chain triglyceride oil; vitamins; antibiotic therapy; +/- prednisone |
| What is the prognosis for exocrine pancreatic insufficiency? | EPI irreversible, requires life long treatment; expensive (pancreatic enzyme replacements) give with every meal; most animals will regain wt. and diarrhea will resolve |
Created by:
kfoster43
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