GI-lecture 1 Flashcards
(41 cards)
What are the main goals of GI medicine?
Determine if primary GI or secondary GI
Determine if severe or if treat’em street’em is good enough
Establish an etiological diagnosis
Why is history important with GI disease?
- signalment
- signs
- duration
- severity
e. g. what did it look like to begin with–small bowel diarrhea –maldigestion, malabsorption–>large bowel diarrhea–>urgency, defecation in the house–>owner notices
How do you differentiate vomiting and regurgitation?
vomit
1. actively vomiting
2. bile
3 acidic (may have bicarb from intestine, may not be acidic)
4. digested food (depends length of time since feeding)
5. prodromal
regurgitation
- passive act
- no bile
- non-acidc
- undigested food
- no progromal signs
What features do you use to differentiate small vs large bowel diarrhea?
- frequency (high with large bowel)
- urge (large bowel)
- volume (large bowel–each bowel movement smaller, small bowel each bowel movement larger)
- mucous (large bowel)
- frank blood (large bowel)
- melena (upper GI)
- weight loss (usually small bowel–maldigestion, malabsorption. can occur with large bowel if so severe animal is not eating)
What are the features of a good physical exam?
- thorough! Includes rectal!!
- nose to tail
- looking not only for information on primary GI problems but also to ensure no other concurrent illnesses
What are general things you look at with a good physical exam?
- mentation
- TPR–e.g. aspiration complications
- mucus membranes (color, CRT)
- hydration–animal vomiting and diarrhea-dehydration
- general nutrition (weight)–chronic weight loss?
What are the things you look at with an oropharyngeal exam?
- teeth
- mucous membranes
- tongue–look under tongue! linear foreign body may be under base of tongue
- palate
- gag reflex
- sedation (tonsils, pharynx, larynx, epiglottis)
What are the things you want to focus on in the head and neck?
- salivary glands
- lymph nodes
- muscles of mastication
- esophagus
- thyroid gland
What are the things you want to focus on in abdominal palpation?
- liver (can elevate front of animal)
- pancreatic region (most dogs w/ pancreatitis painful, cats rarely 10%)
- stomach (and spleen)–GDV etc
- intestines (pain, thickness, consistency, positioning, mobility)
- colon, rectum–in cats constipation associated with vomiting, mucus pasing
- anal region (anal sac dz, perianal fistulas)
What are the things you want to focus on in rectal examination?
- fecal sample
- feel mucosa
- sublumbar lymph nodes
- anal glands
- urethra
- PROSTATE (if present)
What can be done with fecal exams?
- float (zinc sulfate etc)
- direct smear (clostridial spores, giardia)
- fecal fat, fecal occult blood
- giardia elisa
- parvovirus elisa (false positive, false negatives)
- electron microscopy
- culture (campy, salmonella, e. coli with typing)
What should you do on standard lab evaluation? why?
- CBC: anemia, esoinophilia, stress leukgram, NRBC, basophilic stippling
- SERUM CHEMISTRIES: electrolytes, protein losing dz, secondary causes
- URINALYISIS: protein loss, urobilinogen?
in more chronically, severely sick animals
What are ancillary lab tests?
- amylase, lipase–not specific
- TLI (trypsin, trypsinogen)-dogs EPI, cats: EPI and pancreatitis?
- PLI more specific test, though still false positivies–not that good, doesn’t change what would do in cat
- cobalamine (decreased in SIBO, may be needed t tx of some GI dz)
- folate (incresed in SIBO)
Why do you measure cobalamine?
small intestine bacterial overgrowth it is decreased. May need to give cobalamine in dog with GI dz in tx?
Why is fPLI in cats not useful?
there is a wide variation in sick and nonsick animals. very hard to interpret. Does not tell you animal is sick because the pancreas is sick. Could have elevated PLI due to foreign body. Could make you miss other diagnoses.
What are two types of radiography that can be done?
- plain radiographs
2. contrast studies
What are types of contrast studies?
- barium swallow–worry about with surgery–foreign body, holds bacteria, difficult to get all out-sticks to stuff
- positive contrast gastrogram
- double contrast gastrogram
- barium series
- BIPS
- barium enema
Why may dogs have a lot of air in stomach with esophageal issues?
breathe faster, swallow a lot of air, get a lot of air in esophagus, stomach
What can you use ultrasonography for?
- visualize extraintestinal organs
- assess mural thickness
- assess lymph nodes size
- find fluid, foreign bodies–if fluid in abdomen, likely surgical, can also tap
Why is it good to U/S bowel loops?
see if focal or generalized disease, see what layers affected e.g. a thickened muscularis may be infiltrative dz or inflammation
What are the pros and cons of exploratory surgery?
pros
- entire GI tract accessible
- better biopsies
- can do other biopsies concurrently
cons
- more invasive
- more difficult to evaluate lumen????
What should you do with exploratory surgey if everything is normal?
Take BIOPSIES!
- liver and bile culture
- stomach and intestine (duodenum, jejenum, ileum) NOT COLON
- pancreas? spleen?
- lymph node biopsy
Why is it important to biopsy multiple regions of GIT?
because there are diseases that are only in one region and not another. DON’T just biopsy the apparently dz location
Why don’t you biopsy colon?
the complication rate is much higher with biopsy of colon (even normal colon). Go rectally instead
