Gastroenterology (1-13) Flashcards
(288 cards)
1
Q
name the term
difficulty eating/swallowing
A
dysphagia
2
Q
name 3 general causes of dysphagia
A
- physical/morphological causes in oral cavity
- physical/morphological causes in pharyngeal area
- functional (neuromuscular) causes
3
Q
name 4 physical/morphological causes of dysphagia in the oral cavity
A
- gingivitis
- cleft palate
- symphysiolysis (jaw dislocation)
- growths (benign/malignant)
4
Q
name 5 physical/morphological causes of dysphagia in the pharyngeal area
A
- feline stomatitis
- laryngeal neoplasia
- enlarged tonsils
- foreign body
- retropharyngeal abscess
5
Q
name 4 functional (neuromuscular) causes of dysphagia
A
- masticatory myositis
- cricopharyngeal achalasia
- rabies, tetanus, botulism
- CNS disease (trigeminus neuritis, facial paralysis, laryngeal paralysis)
6
Q
what 2 things must you differentiate dysphagia from
A
- vomiting
- regurgitation
7
Q
name the term
the action of bringing swallowed food up again to the mouth;
passive process (no heaving/abdominal muscle contraction);
no prodromal signs (nausea, hypersalivation, pacing)
A
regurgitation
8
Q
name 3 luminal causes of regurgitation
A
- foreign body
- neoplasia
- granuloma
9
Q
name 6 intramural causes of regurgitation
A
- megaoesophagus
- oesophagitis
- stricture
- granuloma
- oesophageal diverticulum
- dysmotility (brachycephalics)
10
Q
name 3 extramural causes of regurgitation
A
- vascular ring anomaly (PRAA)
- mediastinal mass
- hiatal hernia
11
Q
A
12
Q
name 4 clinical signs of an oesophageal foreign body
A
- regurgitation
- anorexia
- drooling
- pain when swallowing
13
Q
name 2 treatment options for an oesophageal foreign body
A
- endoscopic removal of object asap (ideal)
- if digestible, push into stomach
14
Q
name 4 frequent causes of mediastinal masses
A
- lymphomas
- thymomas
- mesotheliomas
- carcinomas (thyroid, lung)
15
Q
name 5 local diseases (oesophagus only) that are differentials for generalized megaoesophagus
A
- focal myasthenia gravis
- idiopathic
- congenital
- oesophagitis (reflux)
- hiatal hernia/gastro-oesophageal intussusception/dysmotility (brachycephalics)
16
Q
name 5 systemic diseases that are differentials for generalised megaoesophagus
A
- myasthenia gravis
- paraneoplastic (mediastinal mass)
- lead intoxication?
- assoc. w/ endocrine disease? (hypothyroidism, hypoadrenocorticism)
- dysautonomia (rare)
17
Q
how to diagnostically differentiate myasthenia gravis from generalized megaoesophagus
A
AchR-antibodies
18
Q
how to diagnostically differentiate paraneoplastic from generalized megaoesophagus
A
radiographs
(mediastinal mass)
19
Q
how to diagnostically differentiate hypothyroidism from generalized megaoesophagus
A
serum T4/TSH
20
Q
how to diagnostically differentiate hypoadrenocorticism from generalized megaoesophagus
A
basal cortisol or ACTH stimulation test
21
Q
how to diagnostically differentiate lead intoxication from generalized megaoesophagus
A
blood lead levels
22
Q
how to diagnostically differentiate dysmotility/sliding hernias from generalized megaoesophagus
A
fluoroscopy (referral)
23
Q
how to diagnostically differentiate oesophagitis from generalized megaoesophagus
A
treatment trial / endoscopy
24
Q
how to diagnostically differentiate idiopathic/congenital from generalized megaoesophagus
A
diagnosis of exclusion
25
this is an acquired disease of the neuromuscular junction;
(auto-)immune disorder;
antibodies against nicotinic AChR on the postsynaptic muscle terminal
Myasthenia gravis
26
what is the treatment for Myasthenia gravis
Acetylcholine esterase blockers
27
name 3 clinical signs of generalised myasthenia gravis
1. exercise intolerance, weakness
2. "bunny hopping" gait
3. +/- regurgitation
28
what is the management for idiopathic/congenital megaoesophagus (3)
1. gastroprotectants/antacids
2. feeding management
3. Bailey's chair
29
name 4 gastro-intestinal signs
1. vomiting
2. diarrhea
3. abdominal pain
4. weight loss
30
name 4 signs of abdominal pain
1. bruxism (teeth grinding)
2. inappetence
3. lethargy
4. aggression
31
name 4 causes of acute vomiting that all respond well to "supportive" treatment
1. acute gastritis
2. garbagitis
3. food intolerance
4. food hypersensitivity
| conundrum!
32
name 7 common GI diseases
1. inflammation, infection
2. outflow obstruction
3. foreign body
4. GDV
5. Dysmotility
6. bilious vomiting
7. neoplasia
33
name 4 places haematemesis may originate from
1. stomach
2. lungs
3. naso-oral cavity
4. oesophagus
34
name 4 GI causes for haematemesis
1. Drugs (NSAID, pred), caustic agent
2. gastric neoplasia
3. foreign body
4. chronic enteropathy
35
name 4 extra-GI causes of haematemesis
1. liver, kidney, pancreas, hypoadrenocorticism...
2. neoplasia (mast cell, gastrinoma)
3. sepsis/shock
4. heat stroke
36
name the 3 main causes of haematemesis/melena in CATS
1. GIT tumors
2. ulcerations
3. coagulopathies
37
name the 6 main causes of haematemesis in DOGS
1. hookworm
2. ulceration
3. neoplastic
4. ingested blood
5. hypoadrenocorticism
6. coagulopathies
38
name 4 treatment options for a vomiting dog with no haematemesis and clinically well
1. Nutrition (bland v. elimination diet)
2. anti-emetic (maropitant, ondansentron)
3. probiotic
4. gastro-protectant (Sucralfate)
39
what treatment should be given to a vomiting dog with haematemesis and clinically well
antacid
(omeprazole, famotidine/Ranitidine, barium)
40
name 6 treatment options for a vomiting dog that is clinically unwell
1. intravenous fluids
2. blood transfusions
3. surgey (ulcers)
4. endoscopy (foreign body)
5. feeding tube
6. parenteral feeding
41
name the 4 types of diarrhea
1. osmotic
2. incr. motility
3. secretory
4. incr. permeability
42
name the 4 main causes of diarrhea
1. infectious agent
2. parasitic
3. diet
4. additive (e.g. chemicals)
43
# small or large intestine problem?
diarrhea with:
decreased appetite,
abdominal discomfort,
chronic weight loss
and vomiting
small intestine
44
# small or large intestine problem?
diarrhea with:
no change in appetite,
abdominal discomfort,
no/small amount of weight loss,
and some vomiting
large
45
# small or large intestine problem?
diarrhea with:
no/limited incr in volume per defacation,
no mucus,
no/small incr. in frequency,
no tenesmus,
no dyschezia,
and presence of melena (digested blood)
small intestine
46
# small or large intestine problem?
diarrhea with:
incr. volume per defecation,
mucus,
incr. frequency,
tenesmus,
dyschezia,
and haematochezia (fresh blood)
large intestine
47
# name the term
present, painful desire to evacuate the bowel despite an empty colon
tenesmus
48
# name the term
difficulty pooping
(disordered defecation)
dyschezia
49
name 6 signalments which may indicate that the diarrhea is infectious
1. young animal
2. unvaccinated
3. ill thrift
4. recently boarded at a kennel
5. poor husbandry
6. haematochezia or pyrexia
50
name 3 nematodes that may cause acute diarrhea in the dog
1. roundworms
2. hookworms
3. whipworms
51
name 2 nematodes that may cause acute diarrhea in a cat
1. roundworms
2. hookworms
52
name 3 protozoa that may cause acute diarrhea in a dog or cat
1. Isospora
2. Cryptosporidium
3. Giardia
53
name the 3 most common causes of acute diarrhea if the dog/cat is clinically well
1. dietary
2. nematodes
3. protozoa
54
what specific clinical sign may be seen with an animal affected by hookworms causing acute diarrhea
anemia
55
what specific clinical sign may be seen with an animal affected by roundworms causing acute diarrhea
pulmonary signs
56
name 5 treatments for a clinically well dog/cat with acute diarrhea
1. fluid (PO, SQ, IV)
2. (acid-base)
3. electrolytes
4. anti-emetic (2-3d)
5. (anti-diarrhea)
57
name 10 clinical signs that make an acute diarrhea case more worrying/more complicated
1. significant weight loss
2. fever
3. abdominal pain/effusion
4. organomegaly, abdominal mass
5. moderate to severe dehydration
6. severe lethargy
7. melena or haematochezia
8. pallor, jaundice, congestion
9. frequent vomiting
10. PU/PD
58
name 3 clinical signs with acute diarrhea that indicate prescribing antibiotics
1. fever and neutropenia
2. asp. pneumonia
3. suspected sepsis
59
what should you prescribe if an animal is vomiting blood or has melena in stool?
anti-acids
(omeprazole)
60
what are the clinical signs for Canine Parvovirus-2 (CPV-2)
anorexia and vomiting (first 12-48h)
then diarrhea/haematochezia
61
name 4 main differentials for Canine Parvovirus-2 (CPV-2)
1. foreign body
2. intestinal intussusception
3. garbage disease
4. severe infestation
62
when will a dog start shedding canine parvovirus-2 (CPV-2) antigens
10-12 days post-infection
63
name 2 reasons for a false-negative Parvoviral antigen test (snap test)?
1. shedding can wax and wane
2. too early in clinical course (not started shedding yet)
64
what may cause a false positive on a Parvoviral antigen test (snap test)
recent vaccination with modified-live vaccine (5-15 days post)
65
name 4 pathogenic bacteria that have an incr. risk of causing bacterial enteritis with raw meat diets
1. Campylobacter
2. Clostridium perfringens
3. Salmonella
4. Escherichia coli
66
name 5 differential diagnoses for bacterial enteritis
1. parvovirus
2. parasite infestation
3. dietary indescretion
4. acute haemorrhagic diarrhea syndrome
5. Titrichomonas (cats)
67
# name the fecal score
very hard and dry;
requires much effort to expel from body;
no residue left on ground when picked up;
ofte nexpelled as individual pellets
score 1
68
# name the fecal score
firm, but not hard;
should be pliable;
segmented appearance;
little or no residue left on ground when picked up
score 2
69
# name the fecal score
log-like;
little or no segmentation visible;
moist surface;
leaves residue, but hold form when picked up
score 3
70
# name the fecal score
very moist (soggy);
distinct log shape visible;
leaves residue and loses form when picked up
score 4
71
# name the fecal score
very moist but has distinct shape;
present in piles rather than as distinct logs;
leaves residue and loses form when picked up
score 5
72
# name the fecal score
has texture, but no defined shape;
occurs as piles or as spots;
leaves residue when picked up
score 6
73
# name the fecal score
watery, no texture, flat;
occurs as puddles
score 7
74
name the 4 types of enteropathy
1. food-responsive enteropathy (FRE)
2. antibiotic-responsive enteropathy (ARE) bad idea - replaced w/
2. Microbiota-modifying enteropathy (MRE)
3. Immuno-modulator enteropathy (IRE)
4. non-responsive enteropathy (NRE)
75
name 3 types of diets that can be used to treat enteropathy
| (food-responsive enteropathy (FRE))
1. limited ingredient novel protein diets
2. hydrolyzed diet
3. commercial therapeutic GI diets
76
how quickly should you expect an improvement in food-responsive enteropathy (FRE) with a diet trial
2 weeks
77
what is the benefit of home-cooked vs. commercial diet?
no preservatives
(cross-contamination less likely)
78
name 4 reasons to measure vitamin B12 in a dog with chronic diarrhea/enteropathy
1. screening tool
2. prognostic factor (neg. in CE + EPI)
3. should be supplemented
4. monitoring purposes
79
name 3 additional considerations in cats with chronic diarrhea
1. more infectious causes than dogs
2. parasites more common than dogs (esp. if hunters)
3. Titrichomonas foetus: unique to cats
80
name the 3 main types of protein losing enteropathy in dogs/cats
1. primary lymphangiectasia
2. secondary lymphangiectasia due to inflammation
3. secondary lymphangiectasia due to neoplasia
81
name 7 clinical signs associated with "caudal" intestinal disease
1. faecal incontinence
2. dyschezia
3. haematochezia
4. constipation/obstipation
5. tenesmus
6. systemic signs
7. licking/itching/scooting
82
what 6 structures should you feel when performing a rectal exam on a dog
1. rectum
2. descending colon
3. urethra
4. prostate gland
5. pelvic symphysis
6. sublumbar lymph nodes
83
name 3 local/external diseases of the "caudal" intestinal tract
1. anal gland/sack disease
2. anal furunculosis/perianal fistulas
3. perineal hernia
84
# name the local/external disease of the caudal intestinal tract
tunnel-like formations in the skin and deeper tissues, usually starts as small oozing holes
perianal fistulas/anal furunculosis
| (GSDs)
85
how to treat perianal fistulas/anal furunculosis
cyclosporin,
topical tacrolimus
86
name 3 examples of abnormal content causing large intestinal or recto-anal disease
1. constipation/obstipation
2. "bone" material
3. foreign material
87
name 4 examples of rectal/colonic mucosal disease causing signs of large intestinal or recto-anal disease
1. rough/inflamed
2. strictures
3. masses/polyps
4. haematochezia/mucus
88
name 2 examples of surrounding bony structures causing signs of large intestinal or recto-anal disease
1. pelvic fractures/asymmetry/narrow pelvic canal
2. lumbar vertebrae
89
name 3 types of structures possible in the large intestine
1. inflammatory
2. traumatic
3. neoplastic
90
what is the treatment for large intestinal strictures
balloon dilation if benign;
chemo/RT if malignant
91
name 3 types of rectal masses possible in the lg intestine
1. inflammatory polyps
2. carcinoma in situ
3. other neoplasms
92
how to treat rectal masses in the lg intestine
minimal invasive removal (electric snare) or surgical pull
93
how to diagnose stricutres/rectal masses in the large intestine
endoscopy and biopsies
94
name 5 infectious causes of colitis
1. bacteria (Clostridia)
2. Parasites
3. Algae
4. Amoeba
5. Fungi
95
name 3 main parasites that cause colitis in dog/cat
1. Trichuris vulpis
2. Giardia
3. Tritrichomonas foetus (cat)
96
name 5 inflammatory causes of colitis
1. chronic enteropathy/IBD
2. Fibre-responsive
3. "idiopathic" colitis
4. irrital bowel syndrome (IBS)
5. Granulomatous colitis
97
what 2 dog breeds most commonly get granulomatous colitis
1. young boxers
2. french bulldogs
98
what bacteria causes granulomatous colitis
E. coli
99
what antibiotic should be used to treat granulomatous colitis
Fluoroquinolone
(careful of resistance!)
100
# name the term
intractable constipation caused by prolonged retention of hard, dry feces; defecation is impossible
obstipation
101
name 3 treatment options for severe constipation
1. rehydrate before suppositories, enemas, or oral laxatives
2. attempt oral administration of larger volumes of laxatives
3. manual extraction/large volume enemas (GA)
102
name 2 important cares that must be taken to give an enema to a cat
1. ALWAYS under GA and protect airways by intubation
2. NEVER use phosphate containing products (lethal hyperphosphataemia, hypocalcaemia)
103
what should be used for large-volume laxatives in cats
polyethylene glycol (PEG)
(with NO flavoring)
104
how to administer large-volume laxatives in cats
nasogastric tube
105
what 2 things should a complete physical exam for large intestinal disease include?
rectal and neuro exam
106
what 2 ways can emetics cause vomiting by?
1. gastric irritation
2. stimulation of CNS chemoreceptor trigger zone
3. both
107
when is an emetic most effective?
1-2h after ingestion
108
what is the risk of giving emetics to a subdued animal
(reduced gag reflex/cannot swallow)
aspirate pneumonia risk
109
name 2 emetic drugs for dogs
1. hydrogen peroxide
2. apomorphine
110
name 1 emetic drug for cats
1. Xylazine
111
name the mechanism for hydrogen peroxide as an emetic
irritates oropharynx and gastric mucosa
| (oral)
112
name the mechanism for apomorphine as an emetic
CRTZ stimulation
| (injection or subconjunctival)
113
what is the mechanism for Xylazine as an emetic
centrally acting;
alpha-2-adrenergic agonist
| (injection)
114
name 4 options for toxin binders/decontamination of GIT
1. activated charcoal
2. cathartics
3. gastric lavage
4. whole bowel irrigation
115
name 2 most commonly used antiemetics
1. Maropitant
2. Metoclopramide
116
what 5 things should be considered when prescribing medications for a pet
1. Route
2. Potency
3. Frequency
4. Adverse effect
5. Cost
117
what is the SQ dosage for maropitant
1 mg/kg SQ q24h
118
what is the oral doseage for maropitant for a dog?
2 mg/kg PO q24h
119
what is the oral doseage for maropitant for a cat?
1 mg/kg PO q24h
120
what is the IV doseage for ondansetron?
| (antiemetic)
0.1-0.2 mg/kg IV q8-24h
121
what is the oral doseage for ondansetron?
| (antiemetic)
0.5-1 mg/kg PO q8-12h
122
what is the constant rate infusion doseage for metoclopramide
1-2 mg/kg/day
123
what is the PO/IV/SQ doseage for metoclopramide
0.2-0.5 mg/kg q6-8h
124
what is the mechanism of action for Maropitant?
| (antiemetic)
neurokinin-1 receptor antagonist
125
what is the mechanism of action for Ondansetron?
| (antiemetic)
Serotonin type 3 receptor antagonist
126
what is the mechanism of action for Metoclopramide?
| (antiemetic)
Dopamine antagonist
127
what drug can be used for mucosal protection in the stomach and oesophagus?
works best in an "acid" environment;
on an empty stomach, 1h before other Tx
Sucralfate
| (SUChrose ALuminum sulFATE)
128
name 4 types of prokinetics
1. Cisapride
2. Metoclopramide
3. Prucalopride
4. Domperidon
129
# name the anti-diarrhoeal
this is an opioid-derivative that blocks μ-receptors of smooth muscles (less peristalsis) AND δ-receptors of epithelium (less secretions)
| (rarely indicated, care in collies!)
Loperamide
130
these are carbohydrate polymers: >10 monomeric units;
naturally occurring in food as consumed;
raw materials which have a benefit to health;
synthetic carbohydrte polymers which have been shown to have a physiological benefit;
can be prebiotics = encourage "friendly" gut bacteria
dietary fibre
131
name 6 uses of dietary fibre
1. "bulking up" agents/laxatives
2. prokinetics for the colon (megacolon)
3. "feeding" colonic enterocytes
4. fibre-responsive colitis
5. chronic enteropathy
6. anal gland impaction
132
this is the most frequently used dietary fibre;
improves GI motility, well-fermented, moderate amount of gas and SCFA production
Psyllium
133
this is a synthetic disaccharide that cannot be metabolized by eneterocytes, so it causes osmotic diarrhea;
it is fermented by bacteria into SCFA causing increased peristalsis
Lactulose
134
this is an amphipathic polymer;
it is soluble in water and minimally absorbed in GIT;
it forms hydrogen bonds with water molecules → prevent reabsorption of water → water retention → stool softener
Polyethylene glycol (PEG)
135
# name the anti-inflammatory used for GI disease
not for acute signs;
typically used late in the work up (except for PLE!);
stop if vomiting, diarrhea, or GI bleeding
Glucocorticoids
136
# name the anti-inflammatory used for GI disease
calcineurin inhibitor;
specific T cell inhibition;
V/D most frequent adverse effects
cyclosporine
137
# name the anti-inflammatory used for GI disease
for "uncomplicated" cases of 'colitis';
can be a treatment trial if local disease is ruled out;
immunosuppressive, antibacterial and anti-inflammatory actions
Sulfasalazine
138
this is a microorganism which when consumed in adequate amounts confers a health benefit to the host
probiotic
139
this is a substance that ncourages the growth and metabolism of probiotics
prebiotic
140
this is a combination of pre- and probiotics
synbiotic
141
name 3 commonly used probiotics
1. Vivomixx (Europe)
2. Visbiome (USA, Canada)
3. Sivomaxx
142
the aim of this is to transplant healthy microbiota to dogs and cats with acute or chronic enteropathy
faecal microbiota transplant
143
what doseage of prednisolone should be given for chronic enteropathy?
anti-inflammatory dose
144
name the 2 most common diseases of the exocrine pancreas in dogs
1. Exocrine pancreatic insufficiency (EPI)
2. acute (necrotising) Pancreatitis
145
name the most common disease of the exocrine pancreas in cats
chronic pancreatitis
146
this is inflammation of the pancreas due to autodigestion/premature activation and release of pancreatic enzymes (mostly idiopathic)
acute pancreatitis
147
this is inflammation of the pancreas due to progressive fibroinflammatory disease (lymphoplasmacytic);
can lead to EPI (exocrine failure) and/or Diabetes mellitus (endocrine failure)
chronic pancreatitis
148
pacreatitis is usually (acute or chronic?) in dogs
acute
149
pacreatitis is usually (acute or chronic?) in cats
chronic
150
name 8 risk factors for acute pancreatitis
1. adipositas
2. familiar (min. Schnauzer)
3. hypertriglyceridaemia (min. Schnauzer)
4. dietary (fatty meal?)
5. endocrine (Diabetes mellitus, hypothyroidism)
6. prev. GI or liver disease
7. drugs (Azathiprin, L-Asparaginase, etc)
8. trauma or ischaemia
151
name 3 clinical signs of acute/chronic pancreatitis
1. vomiting
2. diarrhea
3. abdominal pain, inappetence
152
name 4 biochemistry abnormalities possible seen with acute or "flaring" pancreatitis
1. elevated liver enzymes
2. elevated bilirubin and bile acids
3. hypocalcaemia (saponification)
4. azotaemia (pre-renal or renal)
153
name the 2 most commonly used specific lab tests for pancreatitis
1. abdominal ultrasound
2. quantitative canine/feline pancreatic specific lipase (SNAP test)
154
what is the treatment for acute pancreatitis
supportive!
(antiemetics, gastroprotectants, IVFT, pain management)
155
what is the main cause of EPI (exocrine pancreatic insufficiency) in dogs
pancreatic acinar atrophy
156
what is the main cause of EPI (exocrine pancreatic insufficiency) in cats
chronic pancreatitis
157
name the typical "triad" of clinical signs of EPI (exocrine pancreatic insufficiency)
1. weight loss
2. polyphagia (excessive eating)
3. chronic diarrhea (steatorrhea)
158
name the diagnostic tool of choice for EPI (exocrine pancreatic insufficiency)
Trypsin-like immunoreactivity (TLI)
159
what is the treatment for EPI (exocrine pancreatic insufficiency)
1. substitute pancreatic enzymes
2. supplement cobalamin if low (esp. cats)
160
what is the median survival time for dogs/cats with EPI (exocrine pancreatic insufficiency)
5 years
161
what is the main prognostic factor for EPI (exocrine pancreatic insufficiency)
low cobalamin
162
what dog breed is EPI (exocrine pancreatic insufficiency) especially prevalent in
German Shepherd
163
what is the most common clinical sign of liver disease
vomiting
164
what are the 4 most common clinical signs of liver disease
1. vomiting
2. diarrhea
3. weight loss
4. anorexia
165
name 3 causes of pale mucus membranes/bleedings with liver disease
1. reduced production of clotting factors
2. reduced production of vit K (to activate clotting factors)
3. blood loss anaemia
166
name 7 hepatic encephalopathy/CNS signs
1. obtundation
2. head pressing
3. focal or generalized seizures
4. fly catching
5. blindness
6. aggression
7. circling
167
what is the measurable 'toxin' causing Hepatic Encephalopathy (HE)?
ammonia
168
name 4 liver enzymes that are parameters of hepatocellular damage
1. ALT (cytoplasm)
2. AST (cytoplasm & mitochondria)
3. AP (biliary epithelium)
4. GGT (biliary epithelium)
169
what is the most specific liver enzyme (for indicating cell damage) in dogs and cats?
ALT
170
name 7 things that can be measured for assessment of liver function
1. glucose
2. cholesterol
3. urea
4. albumin
5. ammonia
6. bilirubin
7. bile acids
171
describe the bile acids stimulation test (BAST)
1. fasting sample
2. feed small meal
3. 1-2h postprandial sample
if repeatedly normal = liver dysfunction ruled out
172
what is ammonia converted to in the liver
urea
173
name 2 conditions that cause increased ammonia levels
1. portosystemic shunts
2. severe liver dysfunction
174
name a cause of pre-hepatic jaundice
haemolysis
175
name 3 causes of post-hepatic jaundice
1. EHBDO (extra hepatic bile duct obstruction)
2. gall bladder
3. pancreatitis
176
name the 3 techniques for biopsies of the liver
1. surgical "wedge" biopsy
2. tru-cut
3. laparoscopic (cup or snare )
177
name 3 things biopsies of the liver should be submitted for
1. histopathology
2. quantitative copper determination
3. culture & sensitivity
178
name 4 environmental liver toxins
1. aflatoxins
2. blue-green algae
3. sagopalm
4. amanita mushroom
179
name 1 food liver toxin
xylitol
| (chewing gum)
180
what dog breed most commonly has the congenital/gene defect causing copper associated hepatitis
Bedlington Terrier
181
which type of hepatitis is purulent/neutrophilic
acute
182
which type of hepatitis is lymphoplasmacytic
chronic
183
which type of hepatitis is a mixed inflammatory picture of purulent/neutrophilic & lymphoplasmacytic
chronic-active
184
name 3 systemic infections that involve the liver and may cause hepatitis
1. Leptospirosis
2. Toxoplasmosis
3. FIP (cats)
185
how to diagnose infectious/neutrophilic cholangiohepatitis and cholecystitis
1. abdominal ultrasound
2. bile cytology and culture
3. hepatic biopsy and culture
186
what two conditions must be ruled out via abdominal ultrasound in order to diagnose infectious/neutrophilic cholangiohepatitis and cholecystitis
1. mucocele (dog)
2. EHBDO (cat>>dog)
187
name 3 viral causes of infectious hepatitis in dogs & cats (rare in UK)
1. CAV-1(HCC)
2. Feline Coronavirus (FIP)
3. Calicivirus (cat)
188
name 3 bacterial causes of infectious hepatitis in dogs & cats (rare in UK)
1. Leptospirosis
2. Mycobacterium
3. Clostridium piliforme
189
name 3 parasitic causes of infectious hepatitis in dogs & cats (rare in UK)
1. Protozoal (toxoplasma)
2. Rickettsia
3. Nematodes
190
name 3 common clinical signs of Leptospirosis
1. jaundice/hepatocellular damage
2. cholestasis
3. acute kidney injury (azotaemia, PUPD, oliguria)
191
name 2 tests used to diagnose Leptospirosis
1. PCR for Leptospira in urine
2. Microagglutination test (MAT) for specific serovars
192
what is the treatment for Leptospirosis
1. amoxicillin to stop shedding (w/in 24h) - first line
2. Doxycycline as definitive Tx (once stable)
193
how to diagnose non-infectious chronic hepatitis in dogs?
Biopsy
(for definitive diagnosis)
194
what is the treatment for non-infectious chronic hepatitis
1. supportive liver management
2. glucocorticoids
3. immunosuppressants (R/O infection!)
195
describe the aetiology of vacuolar hepatopathy
(dogs > cats)
glycogen accumulation in hepatocytes → cell swelling and cholestasis
196
what breed of dogs have the primary form of vacuolar hepatopathy
Scottish terriers
197
what species is hepatic lipidosis more common in?
(cats or dgs?)
cats
198
how will a liver with hepatic lipidosis appear on abdominal U/S
bright and enlarged
199
how to treat hepatic lipidosis?
1. nutritional support! (tube if necessary)
2. IVFT
3. vit K if coagulopathic
200
name the two types of cholangitis common in cats
Lymphocytic & Neutrophilic
201
which type of cholangitis is cats is usually unspecified, mild, jaundice
lymphocytic cholangitis
202
which type of cholangitis in cats usually meakes them severely ill
neutrophilic cholangitis
203
what are the 2 most common causes of Extrahepatic bile duct obstruction (EHBO)
1. triaditis
2. biliary neoplasia
204
name 6 causes of post-hepatic jaundice
1. cholangitis
2. cholecystitis (bacterial)
3. mucocele
4. pancreatitis
5. neoplasm
6. mechanical obstruction
205
this is concretions in the gallbladder that result in biliary obstruction;
mostly idiopathic but can be secondary to Diabetes mellitus, hyperadrenocorticism, hypothyroidism, pancreatitis
gallbladder mucocele
206
what is the treatment for gallbladder mucocele
surgical removal
207
name 3 possible congenital liver diseases in the dog
1. portosystemic shunt
2. portal vein hypoplasia
3. non-cirrhotic portal hypertension
208
name 3 clinical signs common to cats with congenital portosystemic shunts
1. hyperthermia
2. poor growth
3. copper coloured irises
209
name a sign of portosystemic shunt on baseline bloodwork
Microcytic hypochromic (anaemia) =
decr. MCV
210
which antiemetic would you prefer to use for an animal with impaired liver function?
metoclopramide
(eliminated in kidneys)
| (over maropitant which is eliminated in liver)
211
name 5 treatment options for chronic management of hepatic encephalopathy
1. fix underlying problem (PSS)
2. hepatic diet
3. lactulose
4. antibiotics to reduce ammonia-producing bacteria
5. anti-epileptic if indicated
211
these can be supplemented to increase caloric/protein intake in growing animals on a hepatic diet
dairy products (cottage cheese) & oils
212
name 3 features of a hepatic/liver diet
1. moderate protein content easy to digest
2. increased zinc
3. reduced copper
213
name 3 functions of Lactulose in liver treatment
1. reduces ammonia-producing bacteria (prebiotic)
2. incr. faecal pH (less avail. H+ to form ammonium ions)
3. Laxative (shorter GI transit time = less ammonia production)
214
name the most commonly used Choloretic
Ursodeoxycholic acid (UDCA)
215
which bile acids are more hydrophobic?
aggressive, cause oxidative damage to tissues they come in contact with
| (primary or secondary?)
secondary bile acids
(Lithocholic & deoxycholic acids)
216
which bile acids are more hydrophilic?
easier to excrete, preferred
| (primary or secondary?)
primary bile acids
(cholic acid)
217
what drug is most widely used in cholestatic hepatopathies?
stabilises plasma membranes, reduces biliary epithelium apoptosis, & changes bile metabolising enzymes to more hydrophilic bile acids
Ursodeoxycholic acid (UDCA)
218
name 2 antifibrotics that can be used for Tx of chronic liver disease
| (if evidence of fibrosis or no other options!)
1. Colchicine
2. Spironolactone
219
# name the antifibrotic
binds to tubulin during mtosis;
inhibits microtubule polymerisation;
mitotic spindle cannot form
Colchicine
220
# name the antioxidant
most poerful antioxidant;
dependent on cysteine in the body;
supplementation can be problematic and controversial
Glutathion (GSH)
221
# name the antioxidant
generated from ATP and methionine;
methyl donor for synthesis of important proteins;
involved in inactivation and detoxification;
can be metabolised to cysteine to make GSH
S-Adenosyl methionine (SAMe)
222
# name the antioxidant
"radical scavenger"
membrane stabilising;
immuno-modulatory;
antidote to amanita mshroom intoxication
Milk Thistle
(Silybum marianum)
223
# name the vitamin
co-factor for many enzymes;
water-soluble antioxidant;
low redox-potential
vitamin C
(ascorbic acid)
224
# name the vitamin
fat-soluble antioxidant;
prevents lipid peroxidation of cell membranes, lipoproteins, fat cells;
low redox-potential
vitamin E
(alpha-tocopherol)
225
name 3 clinical features associated with GI malignancies in the oral cavity
1. ptyalism
2. dysphagia
3. halitosis
226
name 3 clinical features associated with GI malignancies in the oesophagus
1. regurgitation
2. dullness
3. anorexia
227
name 3 clinical features associated with gastric malignancies
1. dullness
2. vomiting
3. weight loss
228
name 3 clinical features associated with GI malignancies in the small intestine
1. melena
2. diarrhea
3. weight loss
229
name 4 clinical features associated with GI malignancies in the colon
1. diarrhea
2. weight loss
3. temesmus
4. haematochaezia
230
name 2 clinical features associated with perianal malignancies
1. mass lesion
2. tenesmus
231
what are the 4 main oral tumor types in dogs
1. malignant melanoma
2. SCC
3. fibrosarcoma
4. epulid
232
what are the 2 most common oral tumour types in cats
1. SCC
2. fibrosarcoma
233
what percent of oral tumours in cats are malignant
90%
234
how to diagnose an oral tumour?
1. clinical signs
2. biopsy
3. radiography/CT
4. LN aspirate/biopsy
235
what type of biopsy should be performed for an oral tumor to avoid seeding in skin & incr. surgical margins
intraoral biopsy
(large, incisional)
236
name 3 treatment options for an oral tumour
1. radical surgery
2. surgical debulking
3. radiotherapy
237
this is the most common canine oral tumour;
locally invasive and highly metastatic
malignant melanoma
238
name 2 common sites of metastasis for an oral malignant melanoma
1. regional lymph nodes
2. lungs
239
this is the second most common canine oral tumour;
locally invasive;
variable metastatic rate depending on location
squamous cell carcinoma (SCC)
240
which SCC location has a much higher metastatic rate?
Rostral or Tonsillar?
Tonsillar SCC
241
this canine oral tumour is histologically low grade but behaves aggressively;
local invasion, slow to metastasize;
surgery cure is difficult;
response to radiation is fair to poor
fibrosarcoma
242
this canine oral tumour arises from the periodontal ligament;
tends to be slow growing and firm;
may appear similar to gingival hyperplasia;
locally aggressive, never metastasize
epulid
243
name the 3 types of epulids
1. fibromatous
2. ossifying
3. giant cell
244
this i the most common oral tumour in a cat;
infrequently metastasizes to ipsilateral regional LNs;
most common site is sublingual region
SCC
245
name 3 risk factors for oral SCC in cats
1. passive smoking
2. flea collars
3. diet
246
what is the supportive care for a cat with oral SCC
1. pain control
2. nutrition
247
what infestation has been linked to oesophageal sarcoma development?
Spirocerca lupi
(nematode)
248
what is the most common gastric tumour in dogs?
adenocarcinoma
249
name the 4 common types of gastric tumours
1. adenocarcinoma
2. leiomyoma/leiomyosarcoma
3. GI stromal tumour (GIST)
4. lymphoma
250
name 4 clinical signs of a gastric carcinoma
1. weight loss, anorexia
2. PUPD
3. chronic vomiting
4. anaemia
251
what is the treatment of choice for gastric cancer
surgical excision
(but very challenging, so often palliative)
252
name 3 palliative therapies for animals with gastric carcinomas
1. nutritional support
2. pain control
3. anti-nausea medication
253
what is the most common location for an adenocarcinoma in the small intestine in the dog
jejunum
254
what is the most common site of metastasis for an adenocarcinoma in the small intestine of a dog
regional lymph nodes
255
what are the most common intestinal locations for leiomyoma/leiomyosarcoma in a dog
jejunum and cecum
256
what is the most common location for a Gastrointestinal Stromal Tumour (GIST) in a dog
large intestine
257
what is the most common intestinal tumour in a cat
Lymphoma
258
name 3 clinical signs of feline GI Lymphoma
1. vomiting
2. SEVERE weight loss
3. varying degrees of anorexia
259
name 4 possible physical findings for feline GI lymphoma
1. thickened intestinal loops
2. possible abdominal mass
3. poss. hepatomegaly
4. poss. splenomegaly
260
name 3 instances where surgery is indicated for treatment of feline GI lymphoma
1. solitary lesions
2. if obstruction
3. if necessary for definitive diagnosis
261
which form of feline GI lymphoma has a better prognosis:
Lymphoblastic lymphoma OR Small Cell Lympoma?
Small Cell Lymphoma
(fair to good)
262
what is the chemotherapy protocol for lymphoblastic feline GI lymphoma
multi-drug chemotherapy protocol
(doxorubicin, L-Asparginase, prednison, cyclophosphamide, vincristine)
263
what is the prognosis for intestinal MCT of cats
grave
(unless early solitary lesion - rare)
264
name 3 common tumours of the colon/rectum
1. benign polyps and leiomyomas
2. adenocarcinoma
3. lymphoma
265
how to treat lymphocytic lymphoma
prednisone & chlorambucil
266
what is the treatment choice for polyps in the colon/rectum
surgical resection (full thickness)
267
name 2 common perianal tumours
1. sebaceous (hepatoid) adenomas and adenocarcinomas
2. apocrine gland (anal sac) carcinoma
268
what hormone are perianal sebaceous adenomas depedent on
testosterone-dependent
269
what is the treatment for sebaceous adenomas in male dogs?
surgery and castration
270
what is the treatment for an apocrine gland carcinoma?
surgery + RT + chemotherapy
271
what is the treatment for a perianal sebaceous adenocarcinoma?
surgery +/- resection of SL LN
272
name the 4 possible primary malignant hepatobiliary tumours
1. hepatocellular carcinoma
2. biliary carcinoma
3. neuroendocrine tumour
4. sarcoma
273
what is the most common primary hepatobiliary tumour in dogs
hepatocellular carcinoma
274
what is the most common primary hepatobiliary tumour in cats
biliary cystadenoma
275
# name the hepatobiliary tumour classification
large, solitary masses in a single lobe
massive tumours
276
# name the hepatobiliary tumour classification
multifocal and found in several lobes
nodular tumours
277
# name the hepatobiliary tumour classification
typically involve all lobes and may result in complete effacement of the hepatic parenchyma
diffuse tumours
278
this is the most common primary hepatobiliary tumour in dogs and 2nd most common in cats;
paraneoplastic hypoglycaemia;
may be massive, diffuse or nodular;
metastatic rate low for massive but high for nodular and diffuse
hepatocellular carcinoma (HCC)
279
this is the most common primary hepatobiliary tumour in cats and the 2nd most common in dogs;
intrahepatic more common in dogs, extrahepatic more common in cats;
very aggressive biologic behaviour with high metastatic rate
biliary carcinoma
280
what is the most common histologic type of pacreatic tumour
adenocarcinoma
281
what is the metastatic rate of pancreatic adenocarcinomas?
high
282
what is the clinical sign for islet β-cell tumours of the pancreas?
hypoglycaemia
283
name 8 differential diagnoses for hypoglycaemia
1. neonatal
2. toy breed
3. type 2 glycogen storage disease
4. hunting dog
5. sepsis
6. drugs
7. extrapancreatic malignancy
8. insulinoma
284
this drug inhibits insulin secretion and has been used to control clinical signs of an insulinoma;
but is difficult to obtain and expensive
diazoxide
285
what treatment for insulinoma generally has a better outcome
surgical excision
286
what percent of cardiac output does the liver recieve
25% cardiac output
287
what 5 questions should you ask yourself before selecting an anaesthetic drug
1. where is it metabolized?
2. what is the duration?
3. are they highly protein bound?
4. can you antagonize/reverse?
5. can you use local anaesthetic?
