Exam 3

Question 1

Regurgitation

Answer 1

Reflux of undigested food from mouth or esophagus before it has reached the stomach

Question 2

Congenital megaesophagus (chronic regurgitation in immature animal) - what causes it?

Answer 2

Great Danes, Irish Setters, German Shepherds, etc. – due to impaired motor neuron function

Question 3

Cricopharyngeal achalasia (chronic regurgitation in immature animal) - What causes it?

Answer 3

muscle doesn’t relax – prevents food from entering esophagus

Question 4

Chronic regurgitation in adult animals (list of conditions)

Answer 4

megaesophagus
Neurologic diseases
Chaga’s disease

Question 5

Megaesophagus

Answer 5

In a dog with megaesophagus, the esophagus muscles do not force food into the stomach. When gravity alone does not allow the food to enter the stomach, the food will simple regurgitate, or fall back out of the mouth

Question 6

Management of Achalasia (A rare disorder making it difficult for food and liquid to pass into the stomach.), other Anomalies

Answer 6

Usually surgical correction, or
Bougienage (. A bougie is a thin cylinder of rubber, plastic, metal or another material that a physician inserts into or though a body passageway, such as the esophagus, to widen the passageway, guide another instrument into a passageway, or dislodge an object.) and treatment of esophagitis
Remove foreign bodies, and treat for esophagitis

Question 7

Management of Megaesophagus

Answer 7

Feed the animal on stairs or from an elevated platform
Gravity helps move ingesta to stomach
Feed different forms of food/different feeding regimens to find what is best tolerated
Observe closely for aspiration pneumonia

Question 8

Management of Reflux Esophagitis

Answer 8

Medical therapy for esophagitis
Withhold food for 3-4 days; then offer small amounts of a food slurry 3-6 times daily for several days. If this is well tolerated, feed a canned food for several more days; thereafter, gradually return to a normal diet.

Question 9

Vomiting

Answer 9

Forceful ejection of the contents of the stomach and sometimes proximal small intestine – some delay after eating;
partially digested;
pH may be <4

Question 10

common causes of vomiting`

Answer 10

obstruction of the bowels or stenosis. Various GI diseases.

Question 11

Results of vomiting on the body

Answer 11

Electrolyte and acid-base imbalances

Dehydration

Question 12

Management of Vomiting

Answer 12

Fluid therapy if dehydration present
Withhold all food 12-48 hours; withhold water 12-24 hours
Specific therapy for cause, if it can be identified
After vomiting has stopped, gradually return patient to full feed and water over a 3-5 day period
Highly digestible food is recommended

Question 13

Gastric Dilatation with Volvulus (GDV) (Bloat)

Answer 13

Laxity of the gastrohepatic ligament
Gastric dilatation with gas
Obstruction to eructation and passage of gas from the stomach

Question 14

Possible Causes of bloat Bloat

Answer 14

Consumption of large amounts of food in one feeding
Physical activity shortly after eating a large meal
Excessive dietary calcium
Rapid food consumption
Giant and large breeds of dogs predisposed

Question 15

Clinical signs of Bloat

Answer 15

Sudden abdominal bloating
Retching with inability to vomit
Moaning in pain
Dyspnea
Collapse
Death may occur within a few hours
Due to absorption of endotoxins, acidosis, tissue hypoxia, spleen strangulation, shock

Question 16

Management of Bloat (after it has occurred)

Answer 16

A true emergency
Decompress stomach
Treat for shock
Administer oxygen
If volvulus has occurred, correct surgically and perform gastropexy; feeding tube may be inserted at time of surgery
Withhold food and water 24 hours post-op. Start back on small amounts water and highly digestible food; gradually increase to normal requirement over several days

Question 17

Prevention of Bloat

Answer 17

Feed smaller meals more often
Use mechanisms which prevent gulping food (and air)
No strenuous exercise for 2 hours after feeding
No excess calcium in diet
Some recommend elective gastropexy

Question 18

Diarrhea

Answer 18

Passage of loose or liquid stools at increased frequency

Question 19

clinical signs of small bowel diarrhea

Answer 19

Less frequent
Large volumes
If hemorrhagic, blood is dark red to black,tarry (melena)

Question 20

clinical signs of small bowel diarrhea

Answer 20

Frequent
Small amounts
Often contains mucus and/or fresh blood

Question 21

Effects of diarrhea

Answer 21

Fluid/electrolyte losses

Dehydration

Question 22

Management of diarrhea

Answer 22

Fluid therapy if dehydrated
Withhold food, but not water for 1-4 days for more severe cases
Treat initiating cause if can be identified
Return slowly to food with highly digestible diet normal diet over several days

Question 23

Colitis Causes

Answer 23

Parasitic
Bacterial
Stress
Neoplasia
Etc.

Question 24

Clinical signs of colitis

Answer 24

Large bowel diarrhea

Question 25

Constipation or Tenesmus causes

Answer 25

``` Obstructive neoplasms Megacolon Pelvic abnormalities Fungal Dietary – eating bones Etc. ```

Question 26

management of constipation

Answer 26

Enemas, manual evacuation of stool, surgery as appropriate High fiber diets generally best for recurrent problems Exercise frequently, manage medically as warranted

Question 27

sources of intestinal gas

Answer 27

Swallowed air Gas diffusion from blood to gut lumen Acid-base neutralization reaction produces CO2 Bacterial fermentation of nutrients – methane, CO2, etc.

Question 28

Management of flatulence

Answer 28

Feed free choice or several times daily in quiet location alone; adding water to food may help Feed highly digestible, low fiber, moderately low protein, soy free, wheat free diet Do not feed any vegetables, milk, table scraps, or vitamin mineral supplements

Question 29

Coprophagy

Answer 29

Eating feces, not generally harmful, boredom or habit

Question 30

Coprophagy management

Answer 30

Difficult to eradicate behavior For-Bid® - food additive if eating own feces Treat feces with hot pepper sauce, etc. to cause animal to have unpleasant experience If dog is eating cat feces, barring access to litter boxes prevents Habit usually returns

Question 31

clinical signs of hepatic disease

Answer 31

Lethargy, anorexia, depression, weight loss, vomiting, diarrhea, ascites, icterus, CNS signs, bleeding tendencies

Question 32

Management of hepatic disease

Answer 32

Symptomatic therapy for clinical signs Feed highly digestible diet moderately restricted in salt, fat, and high-quality protein, high in B vitamins For encephalopathy where clinical signs not relieved by above diet, use more protein restrictive diet, as for renal disease

Question 33

Anorexia

Answer 33

Loss of appetite before caloric needs have been met`

Question 34

Drive to eat is controlled by

Answer 34

Hunger – physiologic state resulting from lack of food Appetite – desire for food Satiety – lack of desire to eat because caloric needs have been satisfied

Question 35

Adverse effects of inadequate food

Answer 35

``` Impaired immunity Decreased resistance to infection, shock Slower recovery from surgery, cytotoxic drugs Decreased wound strength Muscular weakness Organ failure Death Severity of signs increases over time ```

Question 36

Nutrient Precedence and Needs

Answer 36

Water – highest priority Energy – 2nd priority Protein Vitamins/Minerals

Question 37

Causes for nutritional support based on history

Answer 37

Recent loss of >10% BW/below optimal BW (BCS 1 or 2) Restricted food intake/infusion of simple IV fluids for > few days Increased losses NVD or malabsorption from any cause Surgical absence of portion of GI tract Draining abscesses/wounds/burns

Question 38

Causes for increased need of nutritional support

Answer 38

Extensive burns, infection, trauma, or recent surgery Fever Chronic disease or organ dysfunction

Question 39

How to identify anorexia from physical examination

Answer 39

General Appearance Cachexia, edema Skin Thin, dry, scaly, easily pluckable hair, decubital ulcer, non-healing wounds Musculoskeletal Muscle weakness/atrophy, growth retardation, bone or joint pain, epiphyseal swelling Organ Systems Hepatomegaly, splenomegaly, ascites, small bowel distention, tumors, pregnancy

Question 40

Fluid/Electrolyte Therapy

Answer 40

``` Proper fluid balance has primary importance Goals Rehydration or treatment of shock Electrolyte replacement Normalization of acid-base balance ```

Question 41

Routes Preferred for fluid therapy

Answer 41

Oral preferred - “If the gut works, use it!", If not oral, SQ/IV/intraosseous/intraperitoneal If dehydrated >6%, best to give at least ½ IV

Question 42

Contraindications to oral fluid tx:

Answer 42

Vomiting >8% dehydration (mesenteric blood flow inadequate for fluid absorption) Pre-anesthesia

Question 43

Subcutaneous fluid therapy

Answer 43

Warmed to body temperature fluids Never > 2.5% dextrose/glucose Give <20-30 mL/kg BW at one time in several sites Absorbed over 6-8 hours

Question 44

intravenous fluid therapy if:

Answer 44

Dehydration > 8% Fluid losses faster than GI or SQ absorption Shock or electrolyte imbalances present GI tract can’t be used

Question 45

Intraosseus fluid therapy

Answer 45

Primarily in the neonate, when vein inaccessible

Question 46

Intraperitoneal Fluid therapy

Answer 46

Rarely used Dialysis Used in Pig, when veins not easily accessible

Question 47

Fluid types

Answer 47

``` Lactated Ringer’s Solution (LRS) Normal saline (0.9%) Isotonic Dextrose (5% or 2.5% Dextrose in water (D5W; D2.5W)) ```

Question 48

Feeding

Answer 48

Should begin AFTER fluid volume, electrolyte, and acid-base abnormalities have been corrected Use GI tract when possible Growth foods best unless contraindicated by uremia, etc.

Question 49

Coaxing to eat

Answer 49

``` Hand feed Warm food to enhance aroma Have owner visit and feed, or take home for a few hours to feed Use highly palatable foods Try different foods Drug tx – Diazepam in cats and puppies ```

Question 50

Force Feeding

Answer 50

Place food in pharyngeal area Use syringe or “meatballs” Hills’ A/D, etc. or human baby food meats Can add high calorie supplement such as Nutrical™ If feeding > few days, tube feeding better

Question 51

orogastric of nasogastric tube feeding

Answer 51

``` Least invasive Orogastric – replaced for each feeding Nasogastric – may be left in place Liquids only Can swallow with tube in place ```

Question 52

Pharyngostomy or esophagostomy

Answer 52

Requires general anesthesia for placement Esophagostomy tube generally preferred today Tube bandaged in place; may leave in for weeks; swallow with tube in place

Question 53

Gastrostomy tube feeding

Answer 53

Used less often; Post-operative in GDV cases

Question 54

Diets for tube feeding

Answer 54

Commercial foods blended with water | Liquid diet, such as CliniCare™

Question 55

Rate and volume for tube feeding

Answer 55

Normal dogs can tolerate about 90 mL/kg BW at one time without regurgitation Adult cats 45mL/kg; kittens 100 mL/kg If have been anorectic > 2 days, have decreased stomach capacity Start with half amount and gradually increase volume over several feedings Minimum three feedings/day

Question 56

Problems/complications of tube feeding

Answer 56

Mechanical Placement of tube – check prior to each feeding May get regurgitation/aspiration from improper placement or administering excessive quantities Tube may become occluded if coarse food materials used or not flushed properly Tightly cap tube when not in use GI problems Too rapid administration Administration of poorly absorbed solutes Metabolic problems Hyperglycemia if give too much glucose

Question 57

Obesity

Answer 57

> 10-15% over optimal weight

Question 58

Incidence of obesity in pets increases with:

Answer 58

``` Age, gender (female), breed Neutering (2X higher) Overweight owners, feeding habits Middle-aged to older owners Reduced physical activity ```

Question 59

Effects of obesity

Answer 59

``` Shortens life span Joint and locomotion problems Respiratory, cardiovascular difficulties Liver disease Skin disease Digestive problems, i.e. constipation Increased risk of diabetes Increased anesthetic and surgical risks ```

Question 60

Diagnosis of obesity

Answer 60

``` Complete physical examination Rule out medical causes (5%): Cushing’s disease Hypothyroidism Congestive heart failure Diabetes mellitus Etc. ```

Question 61

Assessment of Degree of obesity

Answer 61

Compare present weight to non-obese weight from medical history Assess based on amount of fat over ribs, ventral abdomen, over tailhead, over hips, etc. – give body condition score Evaluate for waddling, sluggishness, poor mobility, lack of grooming in the cat due to inflexibility

Question 62

Management of obesity

Answer 62

Psychological Encouragement Convince ALL persons associated with pet of the necessity for wt. loss Detrimental effects of obesity Benefits of weight reduction/maintenance

Question 63

Exercise for Weight Reduction

Answer 63

Loss of 1 pound requires energy deficit of about 3,500 kcal

Question 64

Benefits of exercise for weight reduction

Answer 64

``` Exercise increases energy expenditure Prevents decrease in RMR that would occur normally when caloric intake decreases Prevents losses of lean body mass Improves cardiovascular function Helps maintain weight loss ```

Question 65

Dietary Management – Weight Loss

Answer 65

Obtain complete client cooperation Evaluate patient thoroughly Weigh animal – set goal Estimate time to reach goal Decrease caloric intake to 60-70% of that required for maintaining optimum body weight Feed 3-4 X daily, or as often as practical – increases energy lost as heat Instruct owner to keep animal out of room when food being prepared or eaten Change to a weight reduction diet food Client must follow instructions, and feed only the specific amount of food prescribed Recommend beginning exercise program gradually Examine/weigh animal every 1-2 weeks

Question 66

Starvation for Weight Reduction

Answer 66

Weight loss of adipose tissue is only 3-5% greater after 7 weeks of fasting than it is when a low calorie reducing diet is fed Many consider inhumane Recurrence of obesity more likely Starvation of obese cats may result in severe hepatic lipidosis and death—always gradually reduce energy intake

Question 67

Drug Use for Weight Reduction

Answer 67

Slentrol™ introduced by Pfizer in January 2007 – FDA approved for dogs Decreases appetite Decreases fat absorption Vomiting, diarrhea, lethargy may be side effects

Question 68

Surgery for Weight Reduction

Answer 68

Seldom done in veterinary medicine

Question 69

Bougienage

Answer 69

A bougie is a thin cylinder of rubber, plastic, metal or another material that a physician inserts into or though a body passageway, such as the esophagus, to widen the passageway, guide another instrument into a passageway, or dislodge an object.

Question 70

Causes of Diarrhea

Answer 70

Results from any intestinal malfunction

Question 71

Types of Diarrhea

Answer 71

Motility Active secretory Passive secretory or osmotic Malabsorption/maldigestion