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V+/D+ Flashcards

1
Q

What are the 6 perfusion parameters?

A
  1. Mentation
  2. Oral mm colour
  3. CRT
  4. HR
  5. Pulse quality
  6. Extremity temperature
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2
Q

What are the perfusion parameters of severe shock?

A
  1. Stuporous
  2. White-grey mm
  3. > 3sec CRT
  4. Tachy/bradycardia
  5. Non-palpable pulses
  6. Cold extremities
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3
Q

What are the perfusion parameters of mild shock?

A
  1. Obtunded
  2. Pink-pale mm
  3. CRT 2 sec
  4. HR: Tachy
  5. Good-fair pulse quality
  6. Normal extremity temp
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4
Q

What are the perfusion parameters of moderate shock?

A
  1. Obtunded
  2. Ppink mm
  3. 2-3sec CRT
  4. HR: inc or cats can dec.
  5. Poor pulse quality
  6. Cooler extremity temp
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5
Q

What are your 5 hydration parameters?

A
  1. Skin tent
  2. Mm
  3. Tear film
  4. Sunken eyes
  5. Signs of hypovolaemic shock
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6
Q

What are the expected hydration parameters of 5% dehydrations?

A
  1. Skin tent <1sec
  2. MM tacky
  3. Normal-dec. tear film
  4. Eyes not sunken
  5. No shock
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7
Q

What are the expected hydration parameters of 10% dehydrations?

A
  1. Skin tent >2sec
  2. MM dry
  3. Tear film Dry
  4. Sunken eyes
  5. Probably hypovol. shock
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8
Q

What are the expected hydration parameters of 8% dehydration?

A
  1. Delayed skin tent
  2. Tacky mm
  3. Decreased tear film
  4. Eyes not sunken
  5. Possible hypovol. shock
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9
Q

What 6 characteristics are used to differentiate small and large bowel diarrhoea?

A
  1. Frequency
  2. Volume
  3. Consistency
  4. Mucus
  5. Blood
  6. Tenesmus
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10
Q

What are the features of large bowel diarrhoea?

A
  1. Frequency: increased
  2. Volume: decreased
  3. Consistency: mucoid
  4. Mucus: present
  5. Blood: undigested
  6. Tenesmus: yes
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11
Q

What are the features of small bowel D+?

A
  1. Frequency: normal
  2. Volume: increased
  3. Consistency: watery
  4. Mucus: uncommon
  5. Blood: digested
  6. Tenesmus: no
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12
Q

List 10 DDX for primary GIT cause of acute gastroenteritis?

A

D:
A: idiopathic
M:
N: neoplasia (carcinoma, lymphoma), dietary indiscretion/intolerance
I: inflammatory bowel, GIT parasites, protozoa (giardia), bacterial (Salmonella, Clostridium), viral (parvo, corona), fungal, HE
T: obstruction (FB/intussusception), toxins, gastroduodenal ulceration (NSAIDs, mastocytosis),
V

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13
Q

List 7 DDx for secondary acute gastroenteritis?

A

D: renal disease (uraemia), hepatobiliary disease
A
M: Addison’s, DKA
N
I: Pyometra, prostatitis, peritonitis, pancreatitis
T
V

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14
Q

What is your main DDx of interest when performing a POC abdominal US: aFast?

A

to rule out peritonitis (free abdominal fluid)

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15
Q

Why would a serum bile acids or ammonia be performed?

A

if PSS was suspected

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16
Q

What change in WBC would you see in a puppy with parvo or sepsis?

A

decreased - as overwhelmed

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17
Q

Indications for faecal PCR

A
  1. Diarrhoea >3 d w/out ID cause

2. Concern for false neg. POC parvo test

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18
Q

List 4 bacterial causes of acute gastroenteritis

A

Clostridia spp, Salmonella spp, E.coli, Campylobacter spp.

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19
Q

What worm and protozoal causes could you rule out through faecal diagnostics?

A
  1. Worms: round, hook, whip, tape

2. Protozoa: giardia, coccidia

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20
Q

6 Indications for hospitalisation

A
  1. In shock/collapsed
  2. Protracted vom/diarrhoea (>12h)
  3. Severe or Haemorrhagic V/D
  4. Severe abdo pain
  5. Concern for surgical problem (FB)
  6. Evidence of systemic illness (fever)
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21
Q

When is a feeding tube indicated?

A

Place a feeding tube for enteral nutrition if extended period of anorexia (generally >3d): feed despite ongoing vom, regurgitation

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22
Q

Indications to use anti-emetics

A
  1. Existing aspiration pneumonia/risk: mentally depressed/exhausted, impaired gag reflex, dyspnoeic for
  2. Protracted nausea (ptyalism, lip licking)
  3. Not self-limiting vom
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23
Q

List 3 antiemetics

A

Maropitant
Ondansetron
Metoclopramide

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24
Q

Indications for antacids

A
  1. Reduce gastric acidity

2. Useful if existing gastric ulceration/erosion (haematemesis, endoscopy)

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25
Q

What are two risks of antacids admin?

A
  1. Dysbiosis

2. Increase risk of aspiration pneumonia

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26
Q

2 examples of Gastric protectants

A

sucralfate

barium

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27
Q

4 indications for surgery

A
  1. Suspect intestinal obstruction
  2. Particular rad abnormalities(Gas distended intestinal loops, stacked loops consistent w/ mechanical ileus, Pneumoperitoneum, Pyometra)
  3. Particular abdominocentesis abnormalities (Septic, suppurative abdominal fluid (intracellular bacteria))
  4. When all else fails
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28
Q

What are two ‘imitators’ of GIT pain?

A
  1. Spinal disease w/ pain (IVDD)

2. Lead poisoning

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29
Q

List the possible body systems to investigate in an acute abdomen case.

A
  1. GIT
  2. Uro-genital
  3. Spleen
  4. Hepatobiliary
  5. Pancreas
  6. Peritoneum
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30
Q

List 4 DDx for pancreas origin pain

A
  1. Acute pancreatitis
  2. Pancreatic abscess
  3. Pancreatic infarction
  4. Neoplasia
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31
Q

List 5 DDx for peritoneum origin pain

A

D
A
M
N: neoplasia (carcinomatosis)
I: Peritonitis (Septic, Sterile, Sclerosing encapsulating)
T: Herniation esp. secondary strangulation: perineal (spontaneous), inguinal, abdominal wall (w/ trauma), evisceration, penetrating wounds
V

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32
Q

List 5 DDx for splenic pain origin

A 
D:
A:
M
N: neoplasia (HAS, others) *haemoabdomen
I: splenitis, splenic abscess
T: splenic torsion
V: splenic vein thrombosis
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33
Q

List DDx for hepatobiliary pain

A

D:
A
M
N: hepatobiliary neoplasia
I: acute hepatitis/cholangiohepatitis, Necrotizing cholecystitis, bile peritonitis, hepatic abscess
T: Biliary mucocoele, Gall stones (cholecystoliths) +/- obstuction
V: liver lobe torsion

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34
Q

List 3 radiographic indications for surgery

A
  1. GDV
  2. GIT obstruction
  3. Septic peritonitis
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35
Q

2 changes to abdominal fluid biochemistry with septic peritonitis

A
  1. Low Glucose: BG to fluid glucose different >20mg/dL (glucose will be consumed by bacteria thus will be lower than in blood).
  2. High Lactate: fluid lactate >2.5mmol/L
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36
Q

What opioids are recommended for acute abdo?

A
  1. Fentanyl CRI 2-5ug/kg/hr IV: ideal dt short duration of action, thus easy to titrate
  2. Methadone 0.1-0.4mg/kg IV (or IM, SC) q4-6hrs
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37
Q

DDx for primary GI disease

A

D
A: pyloric hypertrophy
M
N: neoplasia - small intestinal lymphoma, adenocarcinoma, MCT
N: nutrition - food responsive enteropathy
I: infections -parasites - toxocara canis/cati, infection w/ helicobacter pylori
I: inflammatory - IBD, lymphocytic plasmacytic gastritis
T: jejunal FB, trichobezoar
V

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38
Q

How does pancreatitis presentation differ between cats and dogs?

A

In dogs looks a lot like primary GI disease and in cats looks more secondary GI

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39
Q

Cats w/ hyperthyroidism can look..

A

like they have primary GI disease; intermittent V+ over long periods and otherwise well

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40
Q

EPI can look like

A

primary GI disease

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41
Q

7 signs to pursue diagnostics

A
  1. V+ severe and persistent (>2wks)
  2. No or incomplete response to symptomatic therapy
  3. Animal regurgitating
  4. Can palpate GI abnormality
  5. Other systemic signs are present eg. PU/PD, icterus
  6. Animal appears systemically unwell
  7. Systemic signs clearly preceded the V+
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42
Q

tests for pancreatitis

A

pancreatic lipase immunoreactivity (cPLI, fPLI)
CBC
Abdo US

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43
Q

tests for liver disease

A

ALT, ALP, GGT, bilirubin, bile acids

Abdo US

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44
Q

Azotaemia parameters

A

BUN, creatinine, phosphate, USG

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45
Q

investigating DKA

A

blood and urine glucose + ketones

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46
Q

investigating hypercalcaemia

A

serum calcium - total and ionised

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47
Q

investigation hypoA

A

Na+, K+, baseline cortisol, ACTH stim. test

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48
Q

investigating hyperthyroidism in cats

A

total T4

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49
Q

clear bile suggestive of?

A

stomach issue

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50
Q

yellow/green bile suggestive of?

A

duodenum

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51
Q

brown, fetid, large volume vomit suggests?

A

intestinal obstruction

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52
Q

‘coffee grounds’/haematemesis suggests

A

ulceration/neoplasia

53
Q

vom of a meal >12hrs after ingestion suggests

A

delayed gastric emptying

54
Q

Primary small intestinal GIT dz DDx

A

D
A: antimicrobial responsive enteropathy, food responsive enteropathy
M:
N: neoplasia
I: inflam/infiltrative, parasites (ancylostoma caninum, toxocara canis/cati), giardiasis, salmonella
T: obstruction
V:

55
Q

Primary large intestinal GIT dz DDx

A 
D
A: 
M
N: neoplasia, diet related
I: inflam/infiltrative lymphocytic plasmacytic colitis, parasites trichuris vulpis (whip), tritrichomonas (cats), clostridia, campylobacter
T: obstruction (bone fragments)
V:
56
Q

Tests for secondary GI causes of diarrhoea (primarily small bowel)

A
  1. Trypsin-like immunoreactivity (TLI) to rule out EPI
  2. Liver disease - ALT, ALP, GGT, Bilirubin, Bile acids, Abdo US
  3. HypoA - Na+, K+, baseline cortisol, ACTH stim
  4. HyperT (cats) - total T4
  5. Toxaemia - CBC
57
Q

3 GI helminths

A

toxocara, ancylostoma, trichuris

58
Q

1 cat and 1 dog GI enteric protozoa

A

dog - giardia

cat - tritrichomonas

59
Q

there is a faecal snap test for which enteric protozoa?

A

giardia (Idexx)

60
Q

tx for giardia

A

fenbendazole, drontal plus for 3d

61
Q

what info do you gain by investigation folate and cobalamin serum levels?

A
  • decreased cobalamin –> EPI, bacterial dysbiosis, ileal dz, + common in cats w/ IBD
  • decreased folate –> prox. SI dz
  • inc. folate –> bacterial dysbiosis w/ EPI
62
Q

empirical anti-parasitic treatment

A
  1. pyrantel or equivalent plus praziquantel OR

2. fenbendazole trial

63
Q

duration of dietary trial for possible food response enteropathy?

A

2-4weeks

64
Q

empirical tx of SI D+ (for antibiotic responsive enteropathy)

A
  1. Tylosin 20mg/kg q12h PO 4-8wks

2. Metronidazole 10-15mg/kg PO BID

65
Q

3 indications that you should biopsy the GIT

A
  1. Severely affected w/ systemic manifestations (anorexia)
  2. Presence of hypoalbuminaemia, hypoglobulinaemia suggests a PLE
  3. Abnormalities on abdo US - changes to GI wall layers
66
Q

Gastric/intestinal biopsies are necessary to provide a dx for which (5) dz?

A
  1. gastritis (diff. types)
  2. IBD (colitis - endoscopy)
  3. Infiltrative dz; neoplasia, fungal (histoplasmosis)
  4. lymphagiectasia in SI
  5. Breed-assoc. enteropathies
67
Q

benefits of endoscopic biopsies

A
  • minimally invasive

- direct visualisation of oesophagus, stomach, prox duodenum, colon + ileum

68
Q

what can you not reach via endoscope?

A

jejunum

69
Q

3 indications for lap. surgical biopsy

A
  1. endoscopic biopsy not avail
  2. focal dz in mid-intestine suspected
  3. if more widespread intra-abdo disease (cats!!)
70
Q

what is the complication rate of lap. sx biopsies?

A

20% - wound breakdown, septic peritonitis

71
Q

advantages of surgical biopsy

A
  • Evaluate entire abdo
  • can target areas that look abnormal
  • can sample all SI
  • full thickness biopsies
72
Q

Disadvantages of surgical biopsies

A
  • morbidity of ex lap
  • concern in hypoalbuminaemic dogs
  • higher risk of dehiscence thatn w/ endoscopy
73
Q

tritrichomonas causes?

A

chronic large bowel D+ in cats

74
Q

Trichuris can mimic..

A

hypoA - causes large bowel D+

75
Q

Ancylostoma causes…

A

anaemia, small bowel D+ in dogs

76
Q

Toxocara canis/cati causes…

A

ill-thrift, pot belly, V+, small bowel D+

77
Q

melena is a sign of…

A

high GI bleeding (gastric/duodenal ulceration/neoplasia)

78
Q

causes of local ulcerative GI dx and haematemesis

A 
D: IBD - lymphocytic plasmacytic infiltrate
A: NSAIDs, corticosteroids
M
N: neoplasia - gastric carcinoma
I: Helicobacter infection, gastritis
T: gastric FB
V
79
Q

systemic causes of haematemesis

A
  • renal failure (uraemia)
  • pancreatitis
  • hypoA
  • liver failure (rare)
  • hyperacidity - gastrinoma, MCT
  • haemostatic disorder
80
Q

5 parts of haematemesis tx

A
  1. Hospitalisation + investigation
  2. ID and Tx primary cause
  3. IVFT
  4. PPIs - pantoprazole IV, omeprazole PO
  5. Gastric protectants - sucralfate 1g/dose q12h PO
81
Q

DDX for gastric dysmotility and delayed emptying

A
  • gastric +/- pyloric hypertrophy –> pyloric stenosis
  • gastric neoplasia
  • FB in stomach (or lodged in pylorus)
  • compression of the pylorus by external masses (eg. liver, neoplasia)
  • can see w/ chronic gastritis/ IBD
82
Q

3 histological classifications of IBD

A
  • lymphocytic-plasmacytic enteritis (LPE)
  • eosinophilic enterocolitis
  • granulomatous enterocolitis
83
Q

CS of IBD

A
  • rel to anatomical location; vom (cats), anorexia, weight loss, chronic/small bowel d+ (dogs)
  • abdo pain, intestinal bleeding, borborygmus
    +/- oedema/effusions
84
Q

what are oedema and effusions associated with IBD?

A

protein loss - secondary lymphangiectasia

85
Q

what is often assoc. w/ IBD in cats?

A

often assoc. w/ other lymphocytic-plasmacytic inflammation
ie. cholangiohepatitis + pancreatitis

Triaditis

86
Q

what may IBD in cats progress to?

A

may co-exist or progress to intestinal small cell lymphoma

87
Q

how do dog and cat presentations of IBD differ?

A

cats vom and dogs shit

88
Q

what is your first step in tx IBD in dogs?

A

Dietary trial ‘hypoallergenic’

- should see response in 2wks

89
Q

what tx do you trial after diet in canine IBD?

A

antimicrobials –> tylosin, metronidazole

90
Q

You have trialed a hypoallergenic diet and tylosin in a dog with IBD with no response – what are you next plans of action?

A
  1. Immunosuppressives: prednisolone 1-2mg/kg q12h PO x14d tapering over time.
    +/- azathioprine, cyclosporine (if poor response or BIG doggo to reduce pred dose)
91
Q

how does your treatment of feline and canine IBD differ?

A
  1. Both have the dietary trial first but cats don’t trial antimicrobials –> straight to immunosuppressives.
  2. Cats also NEVER add azathioprine, use chlorambucil instead.
  3. Also add cobalamin (Vit.B12) in cats
92
Q

What grading is used with GIT lymphoma?

A
  1. Low grade = small cell
  2. Medium -grade = lymphoblastic
  3. high-grade = B-cell > T-cell
93
Q

how can you differentiate low-grade alimentary lymphoma in cats from IBD?

A

req. combo of morphological and immuno-phenotyping techniques +/- PCR

94
Q

Tx of low grade alimentary lymphoma (LGAL) in cats

A
  • pred + chlorambucil
95
Q

what are boxers predisposed to re. large bowel diarrhoea

A

histiocytic colitis

96
Q

What are your 3 empirical therapies for dogs w/ large bowel diarrhoea + tenesmus?

A
  1. Fenbendazole 50mg/kg q24h 3-5d
  2. Feed: novel protein for 4-6wks
  3. Add soluble fibre - metamucil 1tsp/5kg/meal
97
Q

CS of histiocytic ulcerative colitis in boxers

A
  • severe large bowel signs: profound weight loss and severe haematochezia
98
Q

tx. of granulomatous histiocytic ulcerative colitis

A

enrofloxacin 10mg/kg q24h PO 8-12wks

99
Q

mild constipation tx

A
  1. microlax enema
  2. warm water/saline enema w/ lubricant
    * always follow up and ensure that defaecation occurs
100
Q

Describe process of deobstipation

A

manual removal of faeces w/ the animal under GA often necessary after rehydration. All obstipated animals, broad spec antimicrobials for possible bacteraemia, initial enema (water lubricant) to begin faecal softening. GA w/ ETT (huge risk of aspiration), warm saline enema w/ lubricant jelly via soft feeding tube/10 French urinary catheter into the colon. Mannual breakdown of faeces by transbadominal massage/instruments. Remove fragments via anus. Rads to document success.

101
Q

long-term medical management recurrent constipation

A
  1. Removal or inciting causes (drugs, bones, concurrent disease)
  2. Dietary manipulation, laxatives and prokinetics (lactulose syrup, polyethylene glycol and cisapride (compounded) most common drugs for megacolon)
102
Q

indications for subtotal colectomy

A

w/ recurring obstipation that responds poorly to exhaustive medical therapy.

103
Q

highest incidence of acute pancreatitis occurs in…

A

middle-aged, obese, sedentary female dogs

104
Q

US findings of acute pancreatitis

A

pancreatic enlargement, changes in echodensity, hyperechoic abdominal fat

105
Q

treatment of acute pancreatitis (dogs)

A
  1. feed as soon as V+ subsides - tubes/freq.small meals of high-CHO restricted fat
  2. Parenteral fluids
  3. anti-emetics + prokinetics
  4. pain relief
  5. antimicrobials in severe cases (septic/abscess) - enrofloxacin, amoxiclav

**long term restricted fat diet

106
Q

possible sequelae to acute pancreatitis

A
  • chronic recurrent pancreatitis
  • EPI
  • DM
107
Q

CS w/ pancreatitis in cats

A

usually non-specific: anorexia, lethargy +/- fever/hypothermia, weight loss, vom, abdo pan often absent, may deteriorate  signs of shock w/ acute form.

108
Q

treatment of acute pancreatitis in cats

A
  1. IVFT + lytes
  2. Feeding: tube + antiemetics
  3. Broad-ABs if indicates
  4. Dx/tx concurrent disease ie. triaditis
109
Q

what is EPI?

A

failure of pancreatic acini to produce enzymes and bicarbonate

110
Q

Pancreatic acinar atrophy is classically seen in what dog breed?

A

german shepherd

111
Q

CS of EPI

A

i. Voluminous SI diarrhoea: but can be just increased faecal bulk
ii. Weight loss, poor hair coat
iii. Ravenous appetite

112
Q

DX of EPI

A

serum TLI (fasted!)

113
Q

4 arms of management of EPI

A
  1. Pancreatic enzyme supplement
  2. Restricted fat diet, feed smaller meals 2-3x daily
  3. Cobalamin supp
  4. Control bacterial dysbiosis which can complicate EPI
114
Q

what is the most common cause of maldigestion?

A

EPI

But can also see w/ loss or impaired bile salt activity dt ileal/liver disease

115
Q

how does maldigestion affect appetite?

A

normal to greatly increased

116
Q

give an example of disruption to luminal absorption…

A

dysmotility in hyperthyroidism resulting in malabsorption

117
Q

give an example of disruption to mucosal absorption…

A

deficiency of brush border or enterocyte defects secondary to IBD

118
Q

give an example of disruption to transport absorption…

A

lymphatic obstruction – primary lymphangiectasia or lymphagiectasia secondary to IBD or neoplasia

119
Q

how can right sided congestive heart failure cause malabsorption?

A

portal hypertension

120
Q

what are the major secondary causes of malabsorption?

A
  1. hyperT

2. liver disease (can cause maldigestion dt lack of bile salts and malabsorption dt portal hypertension)

121
Q

is diarrhoea usually a feature of malutilisation?

A

no

122
Q

what are some possible causative conditions of malutilisation?

A
  • diabetes mellitus
  • congestive heart failure
  • hyperT
  • neoplasia (cachectin…)
123
Q

give an congenital cause of PLE

A

congenital lymphangiectasia

124
Q

give 2 acquired causes of PLE

A

severe IBD, intestinal neoplasia (lymphoma)

125
Q

4 ddx for hypoalbuminaemia

A
  • reduced production: chronic liver disease, malassimilation

- increased loss; haemorrhage, PLE, severe exudative skin disease

126
Q

which protein in lost via glomerular disease?

A

albumin only

127
Q

4 ddx for hypoglobulinaemia

A
  • failure of colostral transfer (foals)
  • immunodeficiencies dz (rare)
  • globulins lost w/ albumin (haemorrhage, PLEs, severe exudative skin dz)
128
Q

list 3 important diagnostics to rule out extra GIT causes of hypoalbuminaemia

A
  1. check urine for protein loss (urine protein:creatinine >2)
  2. check liver function - bile acids stim. test
  3. check PCV to look for evidence of haemorrhage

pc vet (16 decks)

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