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ECVIM Certifier > GI > Flashcards

GI Flashcards

1
Q

Infectious disease associations with feline caudal stomatitis?

A

FeLV, FIV, calici, herpes, Pasteurella.

Not bartonella

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2
Q

What subset of cats responds poorly to full mouth extraction for stomatitis?

A

Calicivirus/prev medical management

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3
Q

Alternative management for caudal stomatitis?

A

Feline interferon gamma - can use if refractory after. full mouth extraction

Also ciclosporin; > 300 trough

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4
Q

What nerves are required for swallowing?

A

Vagal, facial, glossopharyngeal, trigeminal, hypoglossal

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5
Q

Cricopharyngeal dyssynchrony versus achalasia?

A

First functional - pharyngeal muscles too weak to propel bolus, second structural - bar

DON’T do surgery in former

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6
Q

How do you experimentally reproduce cricopharyngeal achalasia?

A

Vagal nerve pharyngeal branch transsection

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7
Q

Effect of oesophagitis on LES?

A

Eosphageal hypo motility/LES weakness, impair cholinergic pathways

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8
Q

What is Barret’s oesosphagus?

A

Replacement of normal squamous epithelium of distal oesophagus with metaplastic columnar epithelium

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9
Q

What contrast agent should be used if oesophageal perforation is suspected?

A

Iodinated - not barium

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10
Q

Most sensitive way to diagnose oesophagitis?

A

Scope - erythema, increased vascularity, oedema, mucosal striations with submucosal vascularity distal third
Increased granularity
Severe - exudative pseudomembrane and ulcer

NB squamocolumnar junction normal

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11
Q

What drugs prevent GERD during GA?

A

Nothing consistently

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12
Q

Sucralfate use in oesophagitis?

A

Physical barrier, promote ulcer healing.

Stim PGE2 and epidermal growth factor.
Negative ions bind positive disrupted tissue.

BUT only adheres in acid environment and oesophagus is mostly alkaline?

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13
Q

Outcome balloon versus bougienage oesophageal stricture?

A

No diff. Bougienage more force can be applied.

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14
Q

Factors causing gastric ulcer?

A

Acid, bile, decreased mucosal perfusion, decreased bicarbonate in protective mucous layer

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15
Q

Parietal cell acid secretion?

A

H+ K+ ATPase pump - not all active at the same time

Stim gastrin, acetylcholine, histamine (endocrine, neurocrine, paracrine)

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16
Q

Why is ranitidine pro kinetic?

A

Inhibits acetylcholinesterase activity

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17
Q

Renal failure and H2 blockers?

A

Renal excreted, drop dose or frequency

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18
Q

Why is omeprazole coated?

A

Unstable in acid environment of stomach

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19
Q

When should omeprazole be administered?

A

One hour before a meal to ensure onset coincides with max proton pump activity - only binds to active pumps

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20
Q

What pH to achieve haemostasis in GI bleeding?

A

Greater than 6 - omeprazole CRI

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21
Q

Omeprazole metabolism?

A

Cp450

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22
Q

Misoprostal mechanism of action?

A

PGE1, cytoprotective, increased bicarb/mucous secretion, increase turnover and blood supply of gastric mucosal cells.

Inhibits parietal cell proton pump activity.

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23
Q

Benefit of misoprostal?

A

Only prevention of NSAID ulceration

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24
Q

Sucralfate and renal failure?

A

Aluminium tox - impaired excretion.

Sucrose sulfate and aluminium salt.

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25
Q

Aluminium antacid?

A

Neutral salt formation, neutralise H+ to water, decrease pepsin activity, bind bile acids, stim PGE2

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26
Q

Neoplasia and Helicobacter?

A

Lymphoma and heilmannii in cats

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27
Q

Why are Tritrichomonas susceptible to 5-nitroimidazoles?

A

Use anaerobic metabolic pathways, reduce the drugs to cytotoxic nitro anions which disrupt protozoal DNA.

Ronidazole - only needs once daily dosing. NB ronidazole resistance

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28
Q

SE of ronidazole?

A

Dose and duration dependent neurotoxicity - NB narrow safety margin,

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29
Q

Most sensitive dx. for T. foetus?

A

Colon saline flush PCR, more sens if has diarrhoea

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30
Q

Asymptomatic T. foetus - yes or no?

A

Yes. Also 88 % spontaneous resolution of signs but not infection within 2y

Signs can also relapse

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31
Q

Which Giardia species and assemblage affects humans, dogs and cats?

A

Duodenalis.

A - from humans dogs and cats
B - most common humans, also dog
C and D - most dogs (species specific)
F - cat

A and B occ infect dogs and cats, unknown whether common transmission occurs

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32
Q

Drugs to treat Giardia?

A

Fenbendazole, pyrantel/praziquantel, metronidazole

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33
Q

What to use if Giardia + spore forming rod?

A

Metronidazole as has activity cf C perfringens

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34
Q

Albendazole problem?

A

Bone marrow suppression

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35
Q

Febantel and pyrantel for Giardia?

A

Synergistic

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36
Q

Probiotics help with giardia?

A

Not in dogs

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37
Q

Hygiene?

A

Bath dog on last day of treatment

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38
Q

Problem with Giardia antigen?

A

Don’t know how long it persists.

2-5% false positive

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39
Q

Most sensitive faecal float Giardia?

A

Centrifugal floatation, three in 5 days

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40
Q

Parvo environmental resistance?

A

Resistant because non-enveloped

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41
Q

What parvovirus causes disease in cats?

A

CPV 2b

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42
Q

When does parvovirus infect rapidly dividing cells?

A

5 - 7 d

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43
Q

WBC picture in Parvo?

A

Neutro-lymphopenia but can get lymphocytosis even when neutrophil count still decreased.

Viral stim lymph and neuts consumed in intestine

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44
Q

What does Parvo ELISA detect?

A

Viral antigen.

False neg - decreased shedding in later stage or dilution (CPV2c?)

False pos - vaccine up to 5d later

PCR diff from vax - quant, higher virus load?

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45
Q

Antiemetic in parvo?

A

Maropitant more weight gain cf ondansetron

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46
Q

Feline interferon in parvo?

A

Decreased mortality and clin signs in dogs

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47
Q

Toll like receptors in IBD?

A

TLR 4 and 5 polymorphisms in GSD

TLR 5 other breeds

mRNA - upreg TLR 2, 4, 9 - TLR 2 corr with dz severity

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48
Q

Mucosal immune cell changes IBD?

A

Increased Th1 cytokines in cats IBD

Dogs - CD11c pos dendritic cells DECREASED (?exaggerrated inflamm?)

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49
Q

pANCA?

A

Perinuclear antineutrophilic cytoplasmic antibodies

Poor sens good spec dog IBD

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50
Q

How many dogs relapse after diet trial?

A

8 % - so few actually food intolerant

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51
Q

How many CE dogs failed food and AB respond to steroid?

A

30 %

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52
Q

Ileum bx?

A

Often required to find feline lymphoma or lymphangiectasia

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53
Q

Types of hiatal hernia?

A

I - sliding, oesophagus and stomach
II - paraoesophagheal, stomach alone
III - widened hiatus, oesophagus cardia and fundus
IV - liver stomach SI

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54
Q

Causes of hiatal hernia?

A

Congenital in brachys esp Frenchie

Acquired any increase abdo pressure or negative thoracic pressure

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55
Q

How to dx hiatal hernia on oesophagoscopy?

A

J manoeuvre - separation between diaphragmatic impression and squamocolumnar junction <2cm

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56
Q

What breed gets gastrooesophageal intussusception?

A

GSD

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57
Q

Bacterial content of GI tract?

A

Increases from distal SI - 60 % faecal mass = bacteria

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58
Q

What is a microbiome?

A

Collective genome of GI microbes

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59
Q

What is the function of the gut bacteria?

A

Metabolism - ferment non-digestible material eg produce SCFAs for colonocyte energy. SCFAs antiinflamm (induce Treg)
Vitamin synthesis (A K B12 biotin folate)
Deconjugate bile acids (primary to secondary)

Epithelial protection - compete with pathogens and excrete antimicrobial substances, increase barrier integrity

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60
Q

Deconjugated bile acids in the GI tract?

A

Decrease inflammation, inhibit C difficile spore germination, increase GLP 1

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61
Q

What happens in dysbiosis?

A

Decreased diversity, less bacteroides, more clostridia

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62
Q

What happens to the microbiome in chronic enteropathy?

A

Lowest diversity, change doesn’t improve with therapy, more proteobacteria inc e coli, less bacteroides/fusobacteria, if transfer microbiome to healthy animal increase IBD susc

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63
Q

Association of dysbiosis and clinical signs in GI dz?

A

No, but does corr with histopath severity

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64
Q

Effects of prebiotic?

A

Nondigestible CHO eg fructooligosaccharide - produce SCFA to increase Treg and decrease colonic pH

Some evidence that improves dysbiosis/faecal score in dogs and cats

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65
Q

Probiotic IBD?

A

VSL 3 increase Foxp3 in IBD dog mucosa

Others imp dysbiosis, faecal scores, D+ incidence , clin signs FRE

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66
Q

What is a synbiotic?

A

Combo of pre and probiotic

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67
Q

Faecal microbiota transplant?

A

One case report eosinophilic IBD, 8 dogs with refractory C perfringens

Large study of parvo puppies - - faster resolution

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68
Q

Antibiotics and microbiome?

A

Tylosin decreases diversity and increases primary bile acids

Metro decreases diversity and decreases secondary bile acids

Probiotics can ameliorate GI signs from AB admin

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69
Q

GI defence mechanisms?

A

Gastric acid denatures protein, enzymes and bacteria cause proteolysis, AB peptides (defensins), peristalsis

Microvillus membrane, tight junctions, unstirred water layer

Immune system - gut associated lymphoid tissue

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70
Q

Where are microfold cells found and what do they do?

A

Peyer’s patch, present luminal antigen to DCs and macros

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71
Q

What MHC interacts with which T cell?

A

I - CD8

II - CD4

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72
Q

How do APCs stim CD4 lymphocytes?

A

IL1 - they stim CD8 cytotoxic with IL2

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73
Q

Why is IgA not broken down in GI tract?

A

Secretory IgA - gets secretory component from pIgR on enterocyte as passes through

NB dimeric with joining J chain

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74
Q

What lymphocytes live in the upper villus lamina propria in dogs and cats?

A

Dog - alpha beta TCR CD4

Cat - CD8 > CD4

Mostly v differentiated due to antigenic stim

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75
Q

What other inflammatory cells normally live in LP?

A

Eosinophil (esp crypts) and small number neutrophils, mast cells

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76
Q

What are the inductor and effector tissues of the GI tract?

A

Inductor - peyers patch

Effector - lamina propria

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77
Q

Where do dendritic cells live in GI?

A

PP and LP, follicular ones store antigen for B cell stim

Live below enterocyte layer in villus lamina propria, sample luminal antigen - generate immune response or tolerance

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78
Q

Primary product of plasma cells in GIT?

A

IgA, mostly pericryptal LP

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79
Q

What cells express TLRs GIT?

A

Macros/APCs/enterocytes

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80
Q

When do enterocytes use MHCII?

A

Dogs - antigen presentation in healthy

Cats - only in inflammation

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81
Q

Innate lymphoid cells?

A

1 - NK - IFNgamma
2 - IL 5/13
3 - IL17/22

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82
Q

Intraepithelial lymphocytes?

A

Evolutionarily older gamma delta chain TCR

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83
Q

T helper cell cytokines?

A

Th1 - IL2 IFNgamma - intracellular pathogens/neoplasia. cellular immunity. activate CD8 and macro

Th2 - IL 4 - 6, 13 - Ig class switching and B cell differentiation to plasma cells

Th17 - IL 17, inflammatory

Th3 - TGFbeta - oral tolerance effectors

Treg - IL10, oral tolerance - NB CD 25 CD 4+ Foxp3+

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84
Q

How does lymphoid homing work in GALT?

A

Alpha 4/beta 7 on lymphocyte and mucosal addressin cell adhesion molecule 1 (MAdCAM1) on endothelial cell, chemokine/receptors

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85
Q

Lipopolysaccharide recognised by?

A

TLR 4 and NOD2

Nucleotide binding oligomerisation domain

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86
Q

Flagellin recognised by?

A

TLR 5

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87
Q

Lipopeptides recognised by?

A

TLR 2

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88
Q

Where do TLR and NOD live?

A

TLR membrane, NOD intracellular

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89
Q

Parasite/virus/bacteria/commensal TLR response pathway?

A

Parasite - IL4, STAT 6, Th2, eosinophil basophil mast cell

Virus - IFN, STAT 4, Th1, IFNgamma, macrophage

Pathogen bacteria - NFKB - ubiquitation - IL1beta, IL6, IL8, Th17 - expansion - IL17

Commensal - no ubiquitation, IL12/27, Treg and Th3 - IL10 and TGF beta

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90
Q

TLR dog IBD?

A

2 4 9

5 GSD

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91
Q

Inhibitor of gastric acid secretion?

A

D cells - somatostatin - stim by low pH and vagus

Somatostatin inh histamine from ECL cell

PGE2 also inh acid

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92
Q

Where do proton pumps live?

A

In the cytoplasm when not activated

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93
Q

Transporters on parietal cells?

A

H+K+ATPase, Cl bicarb, Cl-K+

NET: H+ and Cl- to lumen, bicarb and Na to blood basolateral

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94
Q

What effect does COX1 inh have on GI mucosa?

A

Decreased PGE2 - decreased bicarb mucous vascular activity, increased neutrophil activation and free radical production

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95
Q

What topical effects do NSAIDs have on GIT?

A

Mitochondrial injury of mucosa

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96
Q

Corticosteroid effects on GIT?

A

Decreased mucosal cell growth, decreased mucus, decreased prostaglandin, increased acidity

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97
Q

Features of NSAID induced ulcer?

A

No marked mucosal thickening/irregular edges (cf tumour) - find in antrum/near duodenal papilla

98
Q

Antiulcer goal?

A

pH > 3 > 75 % of the time

99
Q

What happens when you give H2 blocker and omeprazole concurrently?

A

Decrease omeprazole action (pumps not activated)

100
Q

Should PPIs be used in IMT?

A

No evidence for effect on survival

101
Q

How might omeprazole and clopidogrel interact?

A

In theory decrease metabolism to active clopidogrel metabolite, but in vitro no evidence the anti-platelet effect is impacted

102
Q

How might omeprazole and mycophenolate interact?

A

If increase pH, no change to mycophenolic acid which is absorbed - could decrease efficacy?

Also may impact azole and iron absorption

103
Q

Why are H2 blockers ineffective?

A

Tachyphylaxis - ECL cells start making more histamine

104
Q

Absorption of what medications are impacted by sucralfate?

A

Ciprofloxacin, theophylline, doxycycline, digoxin

NOT enroflox

105
Q

Where does the gas come from in GDV?

A

Aerophagia or carbon dioxide and H2 from bacterial fermentation

106
Q

Risk factors for GDV?

A

Great Dane, once daily feeding, fast eating, relative with GDV, older

107
Q

What would you see on a GDV X-ray?

A

Pylorus moves dorsal and left, right lat rad popeye

108
Q

Prognostic indicators for GDV?

A

Lactate > 6-9, no decrease in lactate, increase delta lactate

109
Q

How often would you encounter histopathological gastritis in healthy and symptomatic dogs?

A

Around the same, 1/3rd

110
Q

Pathophys of gastritis?

A

Decreased anti inflamm TGFbeta IL10

Increased inflamm IL 8 AND IL1beta

Altered barrier function

111
Q

Cytokine correlation with lymphoplasmacytic gastritis in dogs?

A

Corr IL10 w/ IFNalpha/IL1beta/IL8

112
Q

Breed assoc gastritis?

A

Basenji - hypertrophy fundic mucosa
Drentse Patrijshond - fundic mucosal hypertrophy, stomatitis, icterus, haemolysis, anaemia and polyneuropathy
Brachy - pyloric mucosal hypertrophy

113
Q

Gastric lymphofollicular hyperplasia?

A

Young/brachycephalic

114
Q

Features of Helicobacter?

A

Gram neg, microaeerophilic, motile, spiral, flagellated

Produce urease

115
Q

Helicobacter species in animals?

A

Large unlike small pylori in humans.

Heilmannii, felis, bizzozeronii, salomonosis

Dogs type 2 & 4 heilmannii (humans 1) but dog ownership is assoc with helicobacter…

116
Q

Prevalence of Helicobacter?

A

Approaching 100 % in some dogs and cats whether vomiting or not

117
Q

Effect of Helicobacter infection?

A

Might be commensal, with loss tolerance.

Higher gastritis scores in helicobacter dogs in some studies.

Severe polymorphonuclear/mononuclear inflammation seen in humans not seen in dogs

118
Q

Helicobacter diagnosis?

A

Brush cytology most sensitive

Can get false pos with urease test (other bacteria) or false neg if patchy or pH altering drugs

Histopath - mod Steiner’s silver stain

119
Q

Histopath changes with Helicobacter?

A

In mucous, might be intracellular, mild/mod mononuclear inflamm, lymphoid hyperplasia.

Gastric gland and parietal cell degeneration/necrosis

Pylori most severe

120
Q

Evidence to treat Helicobacter?

A

Various protocols (ABs/bismuth/omeprazole) improve frequency of vomiting, and many cases neg with histopath improvement.

BUT infection recurs with no recurrence of the clinical signs, many dogs need other therapies.

Clarithromycin does intracellular.

121
Q

Risk factor for Helicobacter recurrence?

A

Housing with other animals

122
Q

What parasites do you find in the stomach mostly?

A

Ollulanus tricuspid (cat) - very small, nodular gastritis, cause lymphocytic inflamm and lymph follicular hyperplasia - respond fenbendazole

Physaloptera (dog and cat) - large, eggs transparent - give pyrantel (2 doses cat) - insect intermediate/hedgehog paratenic

123
Q

What cytokines correlate with gastric atrophy?

A

IL 10 and IL1beta

124
Q

What is mason’s trichrome for?

A

Fibrosis histopath

125
Q

What dogs get atrophic gastritis?

A

Lundehunds - poss predisposed to gastric carcinoma

Lack of parietal cells, neuroendocrine cell hyperplasia

126
Q

What does hospitalisation do to gastric emptying time?

A

Increases it

127
Q

Most accurate way to assess gastric emptying?

A

Radioscintigraphy

AUS valid alternative in cats

128
Q

Ondansetron mechanism of action?

A

5HT3 antagonists central and peripheral

129
Q

Metoclopramide mechanism of action?

A

Dopamine antagonist (only relevant dog as cats no dopamine on CRTZ which is why apomorphine doesn’t work). 5HT3 antagonist.

Also cholinergic (increase myenteric plexus acetylcholine) and 5HT4 agonist

130
Q

Cisapride mechanism of action?

A

Cholinergic 5HT4

131
Q

Erythromycin mechanism?

A

Motilin agonist MMC III (large)

132
Q

Maropitant?

A

NK1 antagonist central and peripheral

133
Q

Phenothiazine mechanism?

A

Alpha 2 antagonist - central

134
Q

Intestinal pseudoinstruction?

A

Leiomyositis

135
Q

Opioid GI effects?

A

Increase antral contractions/intestinal tone but decrease propulsion. increase anal sphincter and ileocecal junction tone.

136
Q

Mechanisms of diarrhoea?

A 
Luminal disturbance
Brush border membrane disease
Microvillar membrane damage
Enterocyte dysfunction
Epithelial barrier dysfunction
Disordered motility
Mucosal inflammation
Hypersensitivity
Nutrient delivery failure
Congenital abnormalities
137
Q

Where are bile salts absorbed?

A

Ileum

138
Q

What does Ecadherin do?

A

Maintains tight junctions between enterocytes

IBD decreases Ecadherin and alpha catenin

139
Q

What is the difference between vincristine and parvo crypt lesions?

A

Arrest/destruction, respectively

140
Q

What causes intestinal hyper motility?

A

SI ischaemia, enterotooxigenic bacteria, osmotic fluid retention

Decreased - undigested food in SI decreases gastric emptying

141
Q

What causes secretory diarrhoea?

A

Bacterial toxins, bacterial fermentation products, Giardia, laxatives, inflammation

142
Q

What might cause malabsorption?

A

Luminal factors - increased motility, defective substrate hydrolysis
Transport eg lymphatic problem or vascular compromise
Mucosal dysfunction

143
Q

How should you measure alpha1protease inhibitor and what does it mean?

A

Three fresh faecal samples, no rectal collection. Sensitive for PLE. Not degraded in intestine.

144
Q

D xylose test?

A

Marker of substrate absorption, insensitive in dog and indiscriminately in cats

145
Q

Unconjugated bile acids?

A

Increased if bacterial activity increases - can’t differentiate from normal postprandial increase in BAs

146
Q

What factors do pathologists assess on GI bx?

A

Villus stunting, epithelial injury, crypt distension, lacteal dilation, mucosal fibrosis, cellularity. Grade mild mod severe

147
Q

What bacteria has been associated with acute haemorrhage diarrhoea syndrome?

A

C perfringens (with enterotoxin)

148
Q

Predisposed breed for AHDS?

A

Mini schnauz

149
Q

ABs in AHDS?

A

Amoxiclav didn’t improve outcome but caused amox resistant E coli

Metro decreased time to resolution and decreased C perfringens persistence

No effect of adding metro two amox

150
Q

Probiotic in AHDS?

A

E faecium shorten duration with less requirement for AB rescue

151
Q

Why might food hypersensitivity occur?

A

Barrier function altered, unusual antigen presentation, loss of tolerance, upreg immune, microbiome abnormal

152
Q

Most common antigens for food hypersensitivity?

A

Dog - beef dairy chicken wheat

Cat - beef chicken fish

153
Q

Pathophys food hypersensitivity?

A

Either type I with IgE or delayed (dendritic cell Th1 response) - IV

154
Q

What type of GI inflammation might be more likely to be food responsive?

A

Eosinophilic

155
Q

Size of antigens?

A

7 - 10 kD too small for IgE cross linking, < 1. ultra hydrolysed too small for presentation

Hydrolysed better than novel protein

156
Q

Pseudo allergic food response?

A

Histamine from mast cells - strawberry/shellfish, mackerel has histamine

157
Q

Pathophys gluten sensitive enteropathy?

A

Irish setter, may become asymptomatic.

Autosomal recessive.

Direct intestinal mucosal tox, no T cell/Ig response, but might be immune med (increase CD4/decrease CD8)

158
Q

Secretory IgA deficiency?

A

Might be assoc GSD ARD (serum IgA irrelevant).

Decreased intestinal IgA despite increased mucosal IgA plasma cells.

Problem - when mutations in heavy chain found was all GSD not just ARD

159
Q

Immune dysfunction in ARD?

A

Increased LP CD4 cells and cytokines
Decreased TLR5 in GSD, TLR 2 and NOD2 others

ABs decrease cytokines not bacterial numbers

160
Q

Brush border enzymes ARD?

A

Reversible changes found - damage due to luminal bacteria?

161
Q

Histopath in ARD?

A

No change/mild changes

162
Q

Evidence for antibiotic trials?

A

Decrease D+ with tylosin, relapse when stop, rescue with tylosin

163
Q

What kind of antibiotic is tylosin?

A

Bacteriostatic macrolide, works on G pos and neg cocci

E coli and Salmonella resistant

164
Q

Oxytet in ARD?

A

Rapid development plasmid mediated resistance but still works

No change bacterial number - select for less harmful?

165
Q

Causes of secondary SIBO?

A

Anatomic, achlorhydria, EPI, motility, mucosal disease, obstruction

Excess lumen substrate, decreased bacterial clearance, morphologic or functional mucosal derangement

166
Q

IBD genetic/immune system changes?

A

GSD - polymorphism TLR 4,5 and NOD 2
Other dogs - polymorphism TLR 5 and also decreased
Boxers with granulomatous colitis - NCF2
Cats - increased MHC II and Th1 cytokines
Dog - decreased CD11c pos dendritic cells, increase TLR 2/4/9. Decreased Treg
Dog - circulating TCR gamma delta increase, CD21+ increase

167
Q

Amino acid changes IBD?

A

Dog - decreased methionine, proline, tryptophan

Serine neg corr with clin dz index

168
Q

Features of lymphocytic plasmacytic enteritis?

A

Increased CD4+ cells in lamina propria, increased IgG pos plasma cells, matrix metalloproteinase expression changes

169
Q

Bile acid changes IBD?

A

Faecal primary increase, secondary decrease, improve with tx

Sodium dependent bile transporter also decreased in CE and negatively correlated with histopath

170
Q

Bactericidal permeability increasing protein expression?

A

Differentiates IBD from lymphoma (BPI increase IBD vs lymphoma)

171
Q

What happens to taurine in cats with IBD?

A

Decreases but remains in RI

172
Q

Vitamin D and IBD?

A

Decreases as clin score increases. No binding protein difference.

Also assoc vitE/chol/alb/CRP/histopath

173
Q

Age and type of inflammation in IBD?

A

Eosinophilic younger, LPC older (NB siamese)

FSEF - ragdoll

GSD overrep all

174
Q

Frequency of hypocobalaminaemia/decreased folate?

A

50 % 14 % respectively.

175
Q

How often do you find intralesional bacteria in FSEF?

A

50 %

176
Q

Ideal IBD diet?

A

Gluten free, highly digestible hydrolysed protein, increased omega 3, low fat, mixed fibre

177
Q

What might predict cyclosporin/steroid resistance?

A

P-glycoprotein efflux pump activity in lymphocytes

178
Q

Evidence for dietary tx in CE?

A

Dogs - hydrolysed/novel protein no diff, hydrolysed/easily digestible no diff but prolonged response with hydrolysed

Cats - hydrolysed better than intestinal diet, no diff with fat content

179
Q

Evidence AB tx in CE?

A

Rifamixin and metronidazole decrease CRP imp clin signs

Tylosin responsive D+

HUC dogs enro

No diff add metro to pred

Tylosin > oxytet

180
Q

Immunosupp and CE?

A

Pred remission 60 - 100 % cats and dogs

Cyclosporin improve many steroid refractory dogs in one study (not another). Response short lived.

Pred/budesonide equal effect

181
Q

Probiotic and CE?

A

VSL3. increase tight junction - same outcome pred/metro when combined with elimination in one study

Other studies no difference

182
Q

Difference between CIBDAI and CCECAI? FCEAI?

A

CCECAI has alb, ascites and pruritiis

FCEAI has liver enzymes, proteins, phosphate and endoscopy

183
Q

IBD px?

A

FRE younger with more large bowel signs, lower CCECAI scores and normal albumin - better outcome

Negative outcomes - severe disease, decreased cobalamin (regardless of supplementation), pancreatic dz and hypoalbuminaemia

Cat respond better overall

Eosinophilic guarded px?

IGF1 decreases with successful tx

184
Q

What impact does cobalamin have on mucosa?

A

Decrease corr with mucosal inflamm, villous atrophy, intra-ep lymphocytes in the ileum and albumin

185
Q

Use of alpha1proteinase inhibitor in GI diagnostics?

A

Decrease in serum or increase in faeces with protein loss.

Cautious interp <1 or steroids.

More specific than sensitive, but more sensitive than decreased albumin

Increased more if crypt abscesses/lacteal dilation

186
Q

Use of faecal dysbiosis index in GI diagnostics?

A

Very specific for IRE dogs vs healthy

Bacterial diversity worse in CE, FRE too - maybe improve after tx but not normal

187
Q

CRP in GI diagnostics?

A

> 9.1 dist FRE and ARD from IRE - very specific fairly sens. 100 % PPV to dist from NRE.

Decreases with treatment

188
Q

perinuclear Anti Neutrophilic Cytoplasmic ABs in GI diagnostics?

A

ABs against neutrophil granule components.

Predict PLE/PLN in SCWT > 2 y before albumin decreases

Increased in FRE versus NRE/IRE

Not sens but specific

189
Q

3-bromotyrosine in GI diagnostics?

A

Eosinophil peroxidase metabolite, measure in serum

Increased in IRE > FRE and in FRE > healthy

Not associated with eosinophilia or CIBDAI

190
Q

N-methylhistamine in GI diagnostics?

A

Marker mast cell activation. Serum and faeces.

Faecal increased in Norwegian lundehund and SCWT with CE.
Urine increased other dogs with CE,

Corr with histopath but not mast cell numbers.

191
Q

Calprotectin in GI diagnostics?

A

S100A8/A9. Neutrophil elastase. Faeces.

Is a TLR 4 ligand, released as DAMP. Affected by steroids and serum is non specific.

Decreased in serum and increased in faeces of CE. Can differentiate responders from partial/non-responders. Increased in SRE versus ARD/FRE.

Corr with calgranulin, CIBDAI and clinical disease. NO! CORR CRP.

Decreases with tx. Faecal best.

192
Q

Calgranulin C in GI diagnostics?

A

S100A12. Pattern recognition receptor RAGE (receptor advanced glycation end products) = target.

NOT affected by steroids.

Corr with clinical and histopath, increased in IRE/NRE versus FRE/ARDand NRE from partial/full. Measure in faeces. Increases.

193
Q

SRAGE in GI diagnostics?

A

Abrogates RAGE signalling.

Decreased in CE, no corr with anything but weakly with duodenal lesions but does increase with remission.

194
Q

Basenji enteropathy?

A

Increased globulin decreased albumin lymphoplasmacytic gastroenteritis mucosal hyperplasia increased CD 4 and 8 lymphs increased gastrin.

Hereditary. Px poor but remission reported.

195
Q

Familial PLE/PLN SCWT?

A

NPH51/KIRREL2 gene mutation, common male ancestor.

PLE before PLN.

pANCA post.

Villus blunting inflamm ep erosions might be food hypersensitivity.

Poor. px cf IBD.

196
Q

Lundehund PLE?

A

Lymphangitis. chronic gastritis gastric carcinoma. Atrophic gastritis.

severe lymphatic vessel changed lymphogranulomas around lymphatic vessels.

197
Q

Breeds predisposed to PLE?

A

SCWT rottie Yorkie maltese lundehund sharpei

198
Q

Prevalence of hypocobalaminaemia in PLE?

A

Up to 75 %, assoc with alpha 1 proteinase inhibitor in serum in yorkies

199
Q

Histopath differences PLE versus CE?

A

Villous stunting, crypt distension, lacteal distension, intraepithelial lymphocytes, LP neuts

See crypt abscesses more.

Low albumin correlated with increased villous/proprial mucosal lacteal width in the ileum.

Lymphatic endothelial cell IHC might help to identify proprial mucosal lymphangiectasia.

200
Q

What vitamin deficiencies might you encounter in PLE?

A

Fat soluble - A D E K

NB Mg Ca

201
Q

How often would endoscopic bx identify lymphangiectasia?

A

Transmucosal in 3/4 so around this much - better sens if bx ileum.

Colloid will decrease oedema and increase the biopsy size.

202
Q

Prediction of therapy response in PLE?

A

Many respond to low fat diet. Lower CCECAI versus those that needed steroids or didn’t respond. Better survival if FRE.

Negative px - CCEAI, decreased urea, decreased vitD, hypocobal, inc CRP, calprotectin and calgranulin, clonality,

203
Q

Secondary immunosuppressive drugs in PLE?

A

Chlorambucil superior to azathioprine.

70 % response cyclosporin in one study.

204
Q

Intestinal pseudoobstruction in cats?

A

Lymphoma/smooth muscle alpha actin deficiency

205
Q

Risk factors for intussusception?

A

Ileocolic most common.

Congenital hT4, parvo, AKI, lepto, neoplasia, intestinal motility increase

206
Q

How much SI removal is tolerated?

A

85 % - after this get short bowel syndrome.

Adaptive hyperplasia might compensate.

If take IC valve get SIBO

207
Q

Altered cytokines in colitis?

A

Mostly Th1, IFN gamma, IL2, IL12, TNF alpha

Increased CD3 pos T lymphs, IgA, IgG plasma cells

208
Q

Mechanism of sulfasalazine?

A

PG synthetase inhibitor. Decreases prostacyclin /leukotriene.

Can’t use in cats, deficient glucuronyl transferase

209
Q

How many colitis cats respond to pred?

A

80 %

210
Q

What age of dogs are more likely to respond to an elimination diet for colitis?

A

Young

211
Q

T/F: colitis as a separate entity without other GI disease is common

A

False - SI usually affected too

212
Q

Suppurative inflammation in feline GI bx?

A

Campylobacter

213
Q

Dietary management for colitis?

A

Best response hydrolysed, also adding psyllium to digestible diet

Usually respond in 2w

Benefits of fermentable fibre - holds water, SCFA for colonocytes

214
Q

What organism is associated with histocytic ulcerative colitis?

A

E coli, attaching invading, in macrophages. PAS pos.

E coli replicates in phagolysosome.

Can affect ileum

215
Q

Breeds HUC?

A

Boxer frenchie some others

Usually young

216
Q

Histopath HUC?

A

CD3 pos, IgG PCs, increased MHC II

Lymphoplas, ulcerated, loss of goblet cells, loss of surface epithelium, mixed infiltrate in LP and submucosa as progresses.

May have histiocytes in LNs.

217
Q

Management of HUC?

A

Up to 100 % respond with just enro, often 2w, sustained in most. Sometimes need long term enro (low number). E coli resistance assoc with clin relapse.

Alternative to enro - chloramphenicol/TMPS (intracell)

218
Q

Percentage of enro resistant e coli HUC?

A

about 1/3, with resistance to other macro penetrating drugs too. Only sens amikacin.

Inc prevalence treated with enro, assoc with resistance and poor outcome.

219
Q

Mechanism of action of lactulose?

A

Metabolised to lactic acid which is osmotic

220
Q

What drugs could you use as colonic pro kinetics?

A

Cisapride, tegaserod (5HT4)

221
Q

Pathophys of feline idiopathic megacolon?

A

Functional smooth muscle disturbance - decreased acetylcholine/substance P and CCK response

222
Q

What cytokine changes are described in perianal fistula?

A

Increased Th1 cytokines - IL 1 beta, IL 6, TNFalpha,

Macrophage derived metalloproteinase enzymes s

223
Q

Genetic changes in GSD with perianal fistula?

A

IgA def, MHCII, NOD 2 SNP, ADAMT (inverse with matrix metalloproteinase), CTNND2

224
Q

Perianal fistula histopath?

A

Plasma cells and perivascular lymphoid nodules.

225
Q

Best drug for perianal fistula?

A

Ciclosporin or tacrolimus, 90 % partial for both. May not get complete remission.

Recurrence 30 - 50 %.

Only consider surg if no response over 6w.

226
Q

Sensitivity of cytology for septic abdo?

A

57 - 100 % depending on site of collection and prev AB

Cell count > 13000 perfect sens/spec dogs, less sens cats

227
Q

What amino acid is decreased in PLE?

A

Tryptophan

228
Q

Where does lipogranulomatous lymphangitis have a predilection for?

A

Ileum/ileocolic junction

229
Q

Assoc of albumin/serum alpha 1 proteinase inhibitor with histopath?

A

Lower in those with crypt abscess/lacteal dilation - moderate sens/spec

230
Q

T/F: citrulline is higher in CE?

A

False, no difference and not corr with anything else

231
Q

What might IL1 beta do to intestinal barrier function?

A

Decrease - only demonstrated in colon with occludin

232
Q

Does 250ug per week for 6w normalise cobalamin in all GI dz cats?

A

Cobalamin but not markers of cell def - approx half still increased serum MMA

233
Q

What animals would have increased netE and netF?

A

In faeces of AHDS, C perfringens pore forming toxins

234
Q

Colorectal polyp metalloproteinase?

A

MMP 2 and 9 increased miniature dachs eps in inflamed tissue samples

Gelatinase and serine protease

235
Q

Mechanism of action of opiate antitussives?

A

Kappa or mu receptor agonism - can be antagonised with naloxone

236
Q

Codeine features?

A

1/10 analgesia cf morphine but equal antitussive effect

237
Q

Difference between hydrocodone and codeine?

A

Hydrochodone more potent.

sedation becomes limiting factor for dosing.

238
Q

Why is the oral dose of butorphanol higher than IV?

A

High first pass metabolism

239
Q

What impact might bronchodilators have on vasculature?

A

Interfere with ventilation perfusion matching

240
Q

Mechanism of action of bronchodilators?

A

Beta 2 agonist - increase adenylate cyclase and therefore cAMP activity, relax bronchial smooth muscle.

Mast cells - stabilising effect

Increase mucociliary clearance?

Albuterol (salbutamol)/terbutaline

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