Gastroenterology Flashcards by Andrea Savarese

Caused by inflammatory bowel disease restiricted to this area, Heliobacter, Physaloptera (more in dogs), Ollulanus (more in cats). Signs include chronic vomiting (daily) and anorexia

Chronic gastritis

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How to diagnose intestinal lymphangiesctasia

Clinical pathology: Hypoalbuminemia, Hypocholesterolemia

Snowballs that leak chyle following biopsy when endoscope used. Full thickness biopsy may be helpful

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Ascending infection from the intestinal tract up the biliary tree and sometimes invading the hepatic parynchyma

Suppurative cholangitis/ cholangiohepatitis

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Normal frequency with normal to increased volume and possible melena

Small bowel diarrhea

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Drugs used to prolong transit time. Used as symptomatic treatment of diarrhea

Loperamide and Diphenoxylate

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First diagnostic approach to esophageal disease. If no foregin object or perforation use barium contrast

Plain cervical and thoracic radiographs

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Treatment of antibiotic responsive enteropathy

Tetracycline, tylosin, or amoxicillin usually 2-4 weeks

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Wearing of the teeth. If gradual reparative dentin is laid down to prevent pulp exposure.

Attrition

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How to differentiate lymphosarcoma from IBD in histopath

Immunohistochemical stains show monoclonal population or there are findings in other organs. Paneoplastic hypercalcemia may be seen

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Caused by gastroesophageal reflux, persistent vomiting, foreign bodies. Also common with doxycycline administration and recent anesthesia

Esophagitis

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Idiopathic condition with loss of autonomic nerve function so see loss of both sympathetic and parasympathetic tone. Usually see megaesophagus with concurrent dysuria, dilated pupils, constipation. Effects any non conscious action of the ANS. Occurs more commonly in the central midwest US dogs.

Dysautonomia (Key Gaskell)

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Treatment for acute gastritis

Supportive care of parenteral fluids. Withholding food for 12-24 hours. Refeed small amounts initially and water with a bland diet.

If doesnt response to conservative therapy diagnosis probably not correct.

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Treatment for intestinal lymphangiectasia

Treat underlying cause.

If idiopathic: ultra-low fat diet, prednisone to decrease inflammation from granulomas.

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Diagnosis of periodontal disease

Based on oral exam, both initial and under general anesthesia with probe and dental radiographs

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Canine Dental Formula

2 (I 3/3 C 1/1 P 4/4 M 2/3) = 42

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How to diagnose antibiotic responsive enteropathy

Response to therapy. Can be supported by low cobalamin and high folate in serum.

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Developmental abnormalities of Westies, Scotties, and Cairn terriers. Can exhibit swelling of mandible and TMJ. Resolves at maturity.

Craniomandibular osteopathy

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Four mechanisms of hepatic lipadosis

Increases lipid mobilization from peripheral fat (Insulin deficiency or anorexia)
Decreased oxidation of liver lipids
Reduction of lipid removal from the liver (fasting)
Excessive lipid synthesis in the liver (Not part of clinical hepatic lipadosis)

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Has greatest diagnostic value in the dog and cats for pancreatitis

Pancreatic lipase immunoreactivity (PLI)

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Could be due to gastroduodenal reflux induced vomiting which occurs when stomach has been empty for long period of time like overnight. Treat by feeding extra meal later at night

Bilious vomiting syndrome

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Used in diarrhea to absorb toxins. Makes stool seem more firm and the salicylate may have anti-prostaglandin activity so it is bad for cats

Bismuth subsalicylate

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Treatment for hiatal hernia

If symptomatic: surgery using gastropexy and reconstruction of the esophageal hiatus. Supportive care for reflux used.

If no surgery just use supportive care. Prognosis good after surgery and with aggressive medical management.

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Mandibular branch of trigeminal affected. Need supportive care for 1-9 weeks of recovery

Idiopathic Trigeminal Neuritis

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Fluid choice as maintenance after animals with loss from vomiting and anorexia is corrected.

Half strength saline with 5% dextrose or oral fluids. Helps prevent hypernatremia.

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Chronic inflammatory disease. Suspected immunodeficiency in GSD. Characterized by fistulous tracts that form from the deeper structures to the skin around the anus and sometimes inside the rectum. Colitis may be present along with smell and pain. Diagnosis from exam

Perianal fistula

Acute care for megacolon

De-ostipation with fluids, enemas, PEG solutions. Do not use phosphate enemas or detergent.

Unknown syndrome with poor gastric emptying with a lack of anatomic obstruction or inflammatory lesions. In dogs. Causes vomiting several hours after eating

Idiopathic gastric hypomotility

How to diagnose acute gastritis

Exclusion based on history and PE. Radiographs and blood work should be included

Treatment for perianal fistulas

Cyclosporine and Tacrolimus for 16 weeks or until 2 weeks past resolution. Antibiotics and hypoallergenic diet, Neuter

Requires opening (relaxation) of the lower esophageal sphincter when the food bolus arrives

Gastroesophageal phase of swallowing

How disease of the GIT causes vomiting

Through noiceptors and stretch receptors sending efferent information via vagus to the emesis center

Six sided soft steel bur on an air driven high speed hand piece scaler. Vibrates calculus off. Has potential to cause enamel injury or injury to the pulp.

Rotary Scaler

Syndrome that can accompany many GIT diseases. Intestines are "Leaky" through inflammation, infiltration, and congestion or bleeding leading to low protein states. Pan-hypoproteinemia expected. Cats are not usually effected

Protein losing enteropathy

Alveolar bone fuses to cementum of tooth in absence of periodontal ligament

Anklyosis

Can be seen in cytology and gastric washings

Ollulanus

Treatment for chronic active hepatitis

Prednisone, Ursodiol, and S-AMe

Painful condition in cats, idiopathic but could be related to excessive host response to oral flora or calci virus. Complaint includes halitosis, dysphagia, and ptylism

Lymphocytic plasmacytic stomatitis

Trauma leads to bleeding of pulp and blood travels up dentin tubules to give tooth a pink tone. May resolve but is considered irreversible damage when tooth is purple or gray.

Pulpitis

Drugs used to shorten transit time. Used as Prokinetics

Metoclopromide, Cisapride, Erythromycin, Ranitidine

Involves primary peristalsis which is triggered by swallowing and secondary peristalsis which is triggered by stretch of the esophagus to move the food to the lower esophageal sphincter.

Esophageal phase of swallowing

Fluid replacement for supportive care in severe pancreatitis cases

IV crystalloid fluid therapy (Lactated ringers) -Colloids used if hypoproteinemia or shock due to antithrombotic effects

Dopamine receptor blockade used to prevent vomiting

Metoclopromide

A diaphragmatic abnormality that allows part of the stomach to prolapse into the thoracic cavity. Shar pei dogs are predisposed. Regurgitation is most common sign.

Hiatal hernia

Clinical pathology changes with hepatic lipadosis

Increased bilirubin, Increased ALP, Increased GGT maybe. | Increased PT/PTT and ACT because of Vit K deficiency.

Inflammation of the lips, could be immune mediated

Chelitis

How to diagnose exocrine pancreatic insufficiency

Measure trypsin-like immunoreactivity (its low in effected dogs)

Caused by ingestion of bad food, FB, toxins, and drugs. More common in dogs than cats. Signs include vomiting, and anorexia but often no clinical signs

Acute gastritis

Used where there is back diffusion of HCl acid across the mucus gel barrier causing ulceration to the gastric, esophageal or duodenal mucosa.

Antacids. Maalox, Sulcralfate, Famotadine (H2 antagonist), PPIs, Prostoglandin E (Misoprostol)

Combination used to treat heliobacter

Metronidazole, Omeprazole, and Amoxicillin

How to diagnose IBD

Elimination of known causes of small bowel diarrhea with intestinal biopsy. Full thinkness biopsies are gold standard. What is seen on endoscopy might not match histopathology.

Treatment for IBD

Before Biopsy: if not hypoproteinemic- dewormer, elimination diet (often home cooked 2-4 weeks), and antibiotic trial. After Biopsy: Strict hypoallergenic diet combines with immunosuppressive therapy and possible antibiotic therapy.

Diagnosis of FORLs in cats by

Take radiograph of third left and right mandibular premolars, if affected cats whole mouth should be evaluated

How to diagnose esophageal cicatrix

Contrast esophagram or esophagoscopy

Substance P inhibitor used to prevent vomiting

Cerenia

Scaler that uses an air compressor with a high speed hand piece to generate a lower frequency vibration to produce minimal heat. Water used as an irrigant. Expensive and need good compressor for power.

Sonic Scaler

May be indicative of abnormal bacterial population in the small intestine

Decreased cobalamin but increases folate

Congenital causes of esophageal weakness

Idiopathic megaesophagus and myasthenia gravis

Severe portal fibrosis, nodular hyperplasia and bile duct hyperplasia probably end stage of the previous inflammatory processes if the cat survives

Biliary cirrhosis

Etiology unknown but Clostridial enterotoxin suspected. Usually small breed dogs. Signs include perfuse hematemesis and hematochezia with systemic signs.

Hemorrhagic Gastroenteritis (HGE)

Lymphocytes and plasma cells are the major inflammatory cell consituent. Hyperplasia of the biliary ductules and fibroplasia of the periductal tissues is a prominent feature.

Chronic nonsuppurative cholangitis or lymphocytic cholangitis

Treatment of esophageal cicatrix

Balloon dilation or bougienage followed by intralesional/systemic corticosteroids. Usually referral. Use same therapies for esophagitis.

How to diagnose esophagitis

Esophagoscopy with or without biopsy are needed.

Minimum data base for ill vomiting animals without obvious cause

CBC, Chemistry, and Urinaylasis

Antihelmetics used empirically in acute or chronic diarrhea

Fenbendazole or Drontal Plus both for 21 days

A stricture that may result from esophageal mucosal injury. Clinical signs are regurgitation.

Esophageal cicatrix

Feline Dental Formula

2 (I 3/3 C 1/1 P 3/2 M1/1) = 30

Drug that helps liquefy bile

Ursodeoxycholic acid

Treatment for HGE

Aggressive fluid therapy and parenteral antibiotics (ampicillin)

Can be detected by placing biopsy in medium that detects urease production

Heliobacter

When doing this do not use >3000rpm, and spend more than 15 sec on each tooth. Removes microscopic etches in the enamel.

Polishing

In dogs permanent canines are in

16-24 weeks

Treatment for copper storage disease

Chelate (d-penicillamine) and decrease further copper uptake from GI tract by giving zinc

When do you use local antimicrobials such as Doxirobe or Clindoral

If areas of periodontal attachment loss after cleaning the region.

Malabsorptive disease in the intestines. Idiopathic in cause. Can effect any area of GIT. Usually a response to bcterial or dietery antigens. Abnormal inflammatory cell infiltrate found on histopath usually predominated by cell type like lymphoplasmacytic or eosinophilic. Some breeds have own version of disease. Signs depend on area of GIT effected.

Inflammatory bowel disease

Treatment for EPI

Pancreatic enzyme supplementation with a low fat diet (<15%) forever. Response should be within 1 week but if not consider antibiotic responsive diarrhea or us H2 blocker

Pathogenesis of periodontal disease

Combination of oral flora and host defenses and periodontal ligament loss. Microorganisms mix with salivary proteins and extracellular polysaccharides to form soft plaque which adheres to dental surfaces and mineralized.

Maldigestive disease in the intestines. Caused by pancreatic acinar atrophy. Common in German Shepherds 1-5 years old. Signs include weight loss and good appetite with chronic small bowel disease

Exocrine pancreatic insufficiency

Autoimmune to 2M myofibrils found in masticatory muscles leads to pain, swelling, and atrophy.

Masticatory myositis

Used for patients with severe periodontal disease. Often started prior to cleaning and extended after for 7- 10 days

Systemic antimicrobials

Normal bite is

Upper incisors rostral to lower incisors, lower canine between upper canine and 3rd incisor

Pitting and discoloration of enamel in young dogs and is indicitive of systemic fever or inflammation prior to eruption

Enamel hypocalcification and hypoplasia

Physiology of enzymes from pancreas

Enzymes are secreted in inactive state and activated in the lumen of SI by action of the brush border enzyme enterokinase which converts trypsinogen to trypsin. Trypsin initiates separation of the other proteolytic enzymes from their inactive precursors.

Ineffectual straining to urinate or defecate and dyschezia or painful bowel movements. Indicative of issue in distal colon and lower urinary tract

Tenesmus

Increased frequency, decreased volume and often hematochezia, mucus, and tenesmus

Large Bowel Diarrhea

Feline Odontoclastic Resorptive Lesions

Progressive disorder in cats, begins with enamel resorption that extends to dentin eventually reaching the pulp cavity. Crown my easily fracture off leaving roots that are cause of ongoing inflammation. With type two lesions crown amputation preferred

How to diagnose HGE

Hemoconcentration (PCV >55%) and normal total protein combined with clinical signs.

Before biopsy of intestines is performed these therapies are tried

Hypoallergenic or high fiber diet, Antibiotic trial and Response to broad spectrum deworming

How to diagnose hiatal hernia

Plain films or esophagram or films taken with pressure on the abdomen (paddle) or fluoroscopy or occasional endoscopic visualization.

Which antibiotic would you use for suppurative cholangiohepatitis

Clavamox

Common electrolyte issue with vomiting or anorexic patients.

Hypokalemia. K+ supplements often needed. Use oral supplements if able to as they are most effective.

Can occur due to hyperparathyroidism (primary or renal failure) or from nutritional causes. Treat by taping muzzle for 3 weeks.

Rubber jaw

Treatment for esophagitis

Decrease gastric acidity (omeprazole) and reducing reflux (cisapride) and protecting esophagus (sucralfate). May need gastrotomy tube to bypass esophagus so it can heal.

How to diagnose Idiopathic gastric hypomotility

Exclusion of other lesions and fluoroscopic studies showing decreased motility.

Often idiopathic. May be abnormal colonic neurotransmitters. Principally in cats. Signs include anorexia, vomiting and dehydration, with history of inappropriate defecation. Fecal mass usually palpable and massively dilated colon.

Megacolon

Immunosuppressive therapy for IBD includes

Prenisone (do not taper until clinical remission) Azathioprine (in large breeds in beginning) In cats: Prednisolone, methylprendnisolone or budesonide with Chlorambucil if need more than steroids (Cannot use Azathioprine in cats)

Contagious papilloma virus induced warts resolve spontaneously in 6-12 weeks usually by might need treatment.

Oral Papillomatosis

How to feed nasoesophageal diet for hepatic lipadosis

Use clinicare at 1/3- 1/2 the resting energy requirements once emesis under control.

Serotonin receptor antagonist used to prevent vomiting

Ondanestron

How to diagnose chronic gastritis

Gastric biopsy

Most common type of scaler. Uses linear pattern. Water used as a coolant. Minimize time on each tooth to less than 15 sec to prevent heat damage.

Ultrasonic scaler

Liver condition associated with significant ptylism

Hepatic encephalopathy

Intestinal lymphatic obstruction leading to dilation, rupture of lacteals, and loss of protein, lymphocytes, and chylomicrons at the same time granulomas occur. Usually idiopathic but can be congenital or acquired from malformation or disease. Occurs in dogs (Wheatons, Yorkies). Can have diarrhea but usually present for ascities

Intestinal lymphangiectasia

How to monitor for refeeding syndrome when treating hepatic lipadosis

Measure PCV q12h and phosphorus. (Drop in phosphorus and hemolytic crisis are signs)

Supportive care for mildly affected cases of pancreatitis

Keep NPO for at least 12 hours and begin oral alimentation SC fluids until vomiting ceases for 12 hours Re-asses frequently for more aggressive care Analgesia

Chronic care for megacolon

Altered fibre of low or high, stool softeners, cisapride, and possibly a subtotal colectomy as last resort

Frank blood in the feces. If on the surface its from distal colon, if mixed its higher up

Hematochezia

Benign overgrowth, leads to psuedopocket formation where periodontal disease can proliferate. Risk factors are boxers ad cyclosporine therapy.

Gingival Hyperplasia

Syndrome where duodenum/jejunum have higher than normal bacterial count and host has abnormal response to the bacteria. Causes impaired motility, mucosal disease, and impaired host defense. Bacteria thought to injure mucosa through deconjugation of bile acids, fatty acid hydroxylation, and generation of alcohols.

Antibiotic responsive enteropathy

Drug used to prevent bacterial translocation

Ampicillin IV

Involves forming a food bolus at the base of the tongue with subsequent opening of the upper esophageal sphincter and pharyngeal peristalsis to move the food into the esophagus.

Oropharyngeal phase of swallowing

Only way to accurately diagnose pancreatitis in the cat

Pancreatic biopsy

In cats permanent canines are in

16-20 weeks

Gastroenterology Flashcards

(112 cards)