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Flashcards in GI Deck (97):
1

What is the cut off for feline small intestinal size radiographically?

No more than twice the high of the central portion of L4, or 12 mm.

2

What are the most common causes of hemoabdomen in a cat

Non neoplastic- 54%. Neoplastic- 46%

3

Define pure transudate

< 2.5 g/dL TP
<500 cells/ul

4

Define modified transudate

2.5-5 g/dL TP
300-5500 cells/ul

5

Define an exudate

TP >3 g/dL
Cell count > 5000-7000cells/ul

6

Describe ratio approach to small intestinal diameter measurement in cats

Ratio of maximal small intestinal diameter to the height of the cranial endplate of L2 should not be > 2

7

Describe ratio approach to small intestinal diameter measurement in dogs

Ratio of maximal small intestinal diameter to the narrowest width of L5 on a lateral radiograph should not be >1.6

8

According to silverstein, what is the sense/spec of the SNAP cpLI

Sensitivity 92-94%. Specificity 71-78%

9

According to silverstein, what is the sens/spec of the cPLI

82% sent with severe panc, 63.6% with less severe panc.
96.8% specificity

10

According to silverstein, what is the sens/spec of the SNAP fPLI

Sens 79%, Spec 80%

11

According to silverstein, what is the sens/spec of the fPLI

Sensitivity 67% in all cats with panc and 100% in cats with moderate to severe panc

Specificity 100%.

12

Risk factors for development of AP in dogs

Middle aged-older
Overweight
Hx of prior or recurrent GI signs
Concurrent endocrinopathies (DM, hypoT, HAC)
Yorkies, min schn, terriers may be at risk.

13

What electrolyte abnormality is prognostic in cats with AP?

hypocalcemia- associated with poorer outcome

14

T/F PLI is affected by renal disease and steroid administration

false

15

Evidence for early nutrition in AP in people

Fewer complications including fewer infections, decreased risk of MODS, decreased mortality rates, less expense, and shorter duration of hospitalization when compared to parenteral nutrition.

16

what are the functions of each of these cells in the stomach:
Parietal cells
Chief cells
Mucus- producing cells

Parietal cells- secrete hydrochloric acid
Chief cells- secrete pepsinogen
Mucus-producing cells- secrete bicarb

17

Life span of enterocytes at villus

2-5 days

18

What is the organism is implicated in histocytic ulcerative colitis of Boxer dogs? How diagnosed and treated?

E. coli.
Identify organisms with fluorescent in situ hybridization (FISH).
Treat with FQ.

19

Treatment for campylobacter

Erythromycin, enrofloxacin, cefoxitin.

20

Breeds with congenital megaesophagus

Wire-haired fox terriers
Min SChn
GSD
Great danes
irish setters
labs
newfies
shar peis

Siamese cats

21

Causes of acquired Megaesophagus

**MG
Addisons
Lead and thallium poisoning
Lupus
Esophageal neoplasia
Severe esophagitis
Inflammatory myopathies
Peripheral neuropathies

22

What type of food should be fed to animals with delayed gastric emptying

Frequent small meals that are low in fat and protein and high in carbs (cottage cheese, rice, pasta)

23

What cells store serotonin in the GI tract

enterochromaffin cells - secrete serotonin (5-HT) into lamina propria with overflow into portal circulation and intestinal lumen

24

What is the function of the 5-HT-1p receptors in the GIT

Initiates peristaltic and secretory reflexes
No drugs target this

25

What is the function of the 5-HT3 receptors in the GI tract. What drugs work here?

Activates extrinsic sensory nerves and is responsible for sensation of nausea and induction of vomiting from visceral hypersensitivity.

Ondansetron and granisetron are 5-HT3 receptor inhibitors.

26

What is the function of the 5-HT4 receptors in the GIT?

Increase pre-synaptic release of ACH and calcitonin gene-related peptide, thereby enhancing neurotransmission. This promotes propulsive peristaltic and secretory reflexes..

CIsapride is a 5-HT4 receptor agonist

27

What drugs are known to inhibit the metabolism of cisapride

Clarithromycin
Erythromycin
FLuconazole
Itraconazole

(metabolized by the liver by cytochrome p450)

28

MOA of reglan

Central dopaminergic antagonist and peripheral 5-HT3 receptor antagonist and 5-HT4 agonist.

29

What drug can be used to restore dopamine to ACH balance if adverse effects noted from raglan?

Diphenhydramine

30

Oral absorption of cisapride INCREASES/DECREASES with food.

INCREASES. Give 15 minutes before feeding.

31

What is MOA of erythromycin and clarithromycin's effect in the GIT

Motilin receptor agonists. Stimulate migrating motility complies and integrate peristalsis in the GIT.

Also stimulate cholinergic and noncholinergic neuronal pathways that increase motility.

Increases gastroesophageal sphincter pressure, increases gastric emptying, accelerates colonic transit, stimulates canine but not feline colonic smooth muscle in vitro.

32

MOA of ranitidine/ nizatidine

Histamine H2 receptor antagonists.
Prokinetic activity due to acetylcholinesterase inhibition

Greatest activity in the proximal GIT.

33

What BUN/creatinine ratio is suggestive of GI Hemorrhage

>20:1

34

What can cause a false positive result on the occult fecal blood test? What does this test measure?

Test detects peroxidase activity.
Diets containing red meat or with high peroxidase activity (fish, fruits, vegetables).
Peroxidase-producing bacteria in GI tract can also cause false positive result.

35

What % of feline esophagus is smooth muscle

Caudal 1/3.
In dogs, esophagus is entirely striated muscle

36

Where is the CRTZ and what is unique about it vs. the rest of the brain

Floor of the fourth ventricle- lacks intact blood-brain barrier.

37

What receptors are located in the emetic center? Where is the emetic center?

Medulla oblongata of the brain stem

Serotonergic (5HT1) and adrenergic (alpha2) receptors.

38

What receptors are located in the CRTZ

Dopaminergic (D2)
Histaminergic (H1)
Andrenergeic (alpha2)
Serotonergic (5HT3)
Cholinergic (M1)
Neurokinergic (NK1)
Enkephalinergic (ENK u, d)

39

What receptor does apomorphine stimulate to induce vomiting?

Dopaminergic receptors in CRTZ

40

Differences in vestibular stimulation of vomiting in dog vs. cat?

In the dog, vestibular stimulation feeds directly into CRTZ before activating the emetic center, vs. the vestibular system acts directly on the emetic center in the cat.

41

What receptors are located in the vestibular system to induce vomiting?

Histaminergic (H1)
Cholinergic (M1)
NMDA

42

what receptors are located in the cerebral cortex to induce vomiting and what stimulates them?

Anxiety/anticipation stimulates
Benzodiazepine receptor
Enkephalinergic opioid receptor

43

List at least 12 medications commonly assoc with diarrhea

H2 blocker
Misoprostol
PPI
Oral antacids
Quinidine, procainamide, digoxin
ACEI
B-blockers
Azathioprine
Cyclophosphamide
Cyclosporine
Mitotane
Trilostane
Methimazole
acarbose
Amitriptyline
Parasiticides
Bethanechol
Clomipramine
Cochicine
Acetazolamide
NSAIDS

44

T/F:
Diarrhea is most common from increased peristalsis rather than decreased segmental contractions

FALSE.
Diarrhea typically from decreased segmental contractions

45

T/F:
Anticholinergics decrease propulsive peristalsis and segmental contractions

TRUE.
Predispose to ileus.

46

MOA of opioid-containing antidiarrheals
Decrease/Increase propulsive contractions
Decrease/increase segmental contractions

Decrease propulsive contractions and increase segmental contractions.

47

Risk factors for leakage following intestinal anastomosis

pre-op peritonitis
intestinal FB
serum albumin <2.5
intraoperative hypotension

48

Where do the histamine blockers specifically work in the GIT?

H2RAs block histamine receptor on gastric parietal cell- competitively inhibiting gastric acid secretion.

49

Which of the following histamine receptor blockers have delayed absorption by food

Famotidine
Ranitidine
Cimetidine

Cimetidine
not ranitidine or famotidine.

50

which H2RA are metabolized by liver and which excreted in urine?

Famotidine- excreted unchanged in urine
Ranitidine and cimetidine- metabolized by liver.

51

What is cimetidine's effect on hepatic blood flow?

Decreases by 20%

52

MOA of PPIs

irreversibly inhibit hydrogen-potassium adenosine triphosphatase on the luminal side of the parietal cell, thus stopping secretion of hydrogen ions into the gastric lumen.

53

Absorption of omeprazole is increased/decreased by food

Decreased

54

MOA of sucralfate

Binds to epithelial cells especially at erosions and ulcers, remaining there for 6 hours. Serves as physical barrier protecting ulcer from pepsin and bile acids.
Stimulates local production of prostaglandins and binding to epidermal growth factor, which favors mucosal repair

55

Adverse effects of sucralfate

Constipation
Adsorption of other drugs (enrofloxacin)

56

MOA of misoprostol

Prostaglandin E1 analog
Antacid and mucosal protective properties:
Stimulates secretion of mucus and bicarbonate and increases gastric mucosal blood flow

Antisecretory effect on gastric acid, acting directly on parietal cells.

57

Adverse effects of misoprostol

Uterine contractions, diarrhea

58

SE of maropitant in young dogs and what age?

Bone marrow hypoplasia when given to puppies younger than 11 weeks.

59

What affect do NK1 antagonists have on anesthetic drugs?

Reduce the MAC of sevoflurane.

60

Route of elimination of raglan

kidneys

61

What is the MOA of promazine derivative antiemetics

Antidopaminergic and antihistaminergic effects that block CRTZ and at higher doses the MVC.
Also have anticholinergic, antispasmodic and alpha blocking effects

62

MOA and contraindications of aminopentamide

anticholinergic used as antiemetic.
Used with caution in patients with glaucoma, cardiomyopathy, tachyarrythmias, hypertension, MG and gastroesophageal reflux.

63

Examples and MOA of cholinomimetic drugs as pro kinetic agents

Ranitidine and nizatidine- inhibit acetylcholinesterase.
Bethanecol - true cholinomimetic drug, binding muscarinic receptors.
Bethanecol works throughout GIT but ranitidine and nizatidine seem most effective for promoting gastric emptying

64

Define intra abdominal hypertension

Sustained or repeated pathologic elevation of IAP more than 12 mm Hg

65

Define abdominal compartment syndrome

Sustained increase in IAP of more than 20 mmHg that is associated with new organ dysfunction or failure

66

Four risk factors for ACS

1- diminished abd wall compliance
2- increased intraluminal content
3- increased abdominal content
4- capillary leak syndrome

67

Describe 4 grades of IAH and recommendations for treatment

1- IAP 12-15 mmHg - maintain normovolemia, look for underlying disease
2- IAP 16-20 mmHg- Volume resuscitation, consider decompression
3- IAP 21-25 mmHg- volume resuscitation, decompression
4- IAP >25 mmhg - decompression required

68

How much fluid should be used to fill the bladder for IAP monitoring?

0.5-1 mL/kg, maximum of 25 mL per patient of sterile 0.9% NaCl

69

How is IAP monitoring done

Insert urinary catheter, connect to 3 way stop-cock with syringe of saline and manometer. Fill bladder with 0.5-1 mL/kg saline. System is zeroed to the patient's midline at symphysis pubis with the patient in lateral recumbency and the manometer filled with saline. Stopcock closed to fluid source so that meniscus in the manometer can drop and equilibrate with pressure in urinary bladder. Difference between the reading at the meniscus and the zero point is the IAP

70

What is the normal IAP

0-5 cm H2O - dogs. 4-8 cmH2O cats

71

What factors influence the IAP reading

body position
body condition
pregnancy
increased abdominal wall tone- pain, anxiety
eternal pressure- belly bandages
volume of infusate

72

What is abdominal perfusion pressure

MAP- IAP

73

What are the sites for TFAST exam

- bilateral chest tube site (ribs 7-9)
- bilateral pericardial chest site - 5-6 ICS over heart
- sub-xyphoid view

74

What are A-lines

horizontal lines of decreasing echogenicity in far field of image, similar and equidistant from pleural line.
These are result of reverberation artifact.
May be seen in patients with and without pneumothorax

75

What are B-lines

A type of comet tail artifact.
These are reverberation artifacts originating from visceral pleura.
Hyperechoic vertical lines extending from pleural line to far edge of image, passing through A lines without fading.
Occasional B-line is normal but excessive B-lines or close together are indicative of interstitial-alveolar lung abnormality

76

What is the lung point

When moving the probe from a dorsal to ventral direction in a patient with pneumothorax, the point where the glide side returns = lung point.

77

What is Meissner's plexus

Inner plexus lying in submucosa of GIT.

78

What is the stimulus for secretion, site of secretion and action of secretin

stimuli: acid, fat
site: S cells of duodenum, jejunum, and ileum
Action: stimulates pepsin secretion, pancreatic bicarbonate secretion, biliary bicarbonate secretion, growth of exocrine pancreas

Inhibits gastric acid secretion

79

What is the stimulus for secretion, site of secretion and action of gastrin

Stimuli: protein, distension, nervous control
Site: G-cells of antrum, duodenum, and jejunum
Actions- stimulates gastric acid secretion, mucosal growth

80

What is the stimulus for secretion, site of secretion and action of cholecystokinin

Stimulus: protein, fat, acid
Site: I cells of duodenum, jejunum, ileum
Action: stimulates pancreatic enzyme secretion, pancreatic bicarb secretion, gall bladder contraction, growth of exocrine pancreas
Inhibits gastric emptying

81

What is the stimulus for secretion, site of secretion and action of glucose-dependent insulinotropic peptide

Stimuli: protein, fat, carb
Site of secretion: K cells of duodenum and jejunum
Action: stimulates insulin release
Inhibits gastric acid secretion

82

What is the stimulus for secretion, site of secretion and action of motilin

stimuli: fat, acid, nervous system
Site: M cells of duodenum and jejunum
Action: stimulates gastric motility, intestinal motility

83

What hormonal signals are released after a meal to increase intestinal motility

gastrin, cholecystokinin, and insulin

84

Which two hormones inhibit intestinal motility

secretin and glucagon

85

What are the main electrolytes in saliva

high K and bicarb
low sodium and chloride

86

What is released by pyloric glands in antrum of stomach

Mainly mucus but also some pepsinogen and hormone gastrin

87

What do parietal cells secrete

hydrochloric acid as well as intrinsic factor, which is essential for absorption of vitamin B12 in the ileum.

88

What does acetylcholine stimulate, compare to gastrin and histamine

secretion of pepsinogen by peptic (i.e., Chief) cells, hydrochloric acid by parietal cells and mucus by mucous cells

Gastrin and histamine strongly stimulate secretion of acid by parietal cells but have little effect on other cells

89

At what gastric pH is gastrin secretion inhibited

less than 3
This is bc high acidity stimulates release of somatostatin from delta cells, which in turn suppresses gastrin secretion by G cells
AND the acid causes inhibitory nervous reflex that inhibits gastric secretion

90

What three hormones stimulate pancreatic secretion

acetylcholine, cholecystokinin, secretin

91

What are the crypts of lieberkuhn and what do they secrete

Lie between intestinal villi, have goblet cells, which secrete mucus and enterocytes secrete large quantities of water and electrolytes.

92

What are the following disaccharides broken into?
lactose
sucrose
maltose

Lactose- galactose + glucose
Sucrose - fructose + glucose
Maltose- glucose

93

Which glucose transporter is in the gut and causes transport of sodium with glucose into intestinal cells

GLUT1

94

Which neuroendocrine peptides inhibit vagal and spinal afferent neurons to result in delayed gastric emptying?

CCK
5HT- via 5-HT3 receptors

95

Which of these increase and which decrease GI motility:
Ach
GABA
Substance P/Neurokinin A
NO
Serotonin
VIP
Somatostatin

Ach - increase
GABA - decrease
Substance P/Neurokinin A - increase
NO - decrease
Serotonin -increase
VIP -decrease
Somatostatin- decrease

96

what electrolyte abnormalities have been shown to slow intestinal motility?

hypokalemia
hypermagnesemia
hyper- and hypo-calcemia

97

Haworth JVECC 2014: Diagnostic accuracy of the SNAP and Spec cpl tests for pancreatitis in dogs presenting with c/s of acute abdominal disease.

Findings?

SNAP and spec cpl may provide false positive diagnosis for pancreatitis in up to 40% of dogs presenting for acute abdominal disease. Good overall agreement between tests but 4/38 dogs with positive SNAP and normal Spec.