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522 (dog & cat class) > GI med 1 > Flashcards

GI med 1 Flashcards

1
Q

what are the general steps to obtaining a diagnosis/treatment plan for a GI issue? ie the steps for a GI workup

A
  1. get a good hx (incl diet hx)
  2. what is the primary complaint?
  3. acute vs chronic?
  4. PE
  5. differential list
  6. consider therapeutic trial vs diagnostic tests
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2
Q

what is the most important part of the GI workup?

A

good history!

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3
Q

dietary indiscretion is usually ____ and dietary intolerance is usually ___.

A

acute, chronic

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4
Q

what are some causes of dietary indiscretion?

A
  • recent and sudden diet change
  • feeding of table scraps
  • free roaming behaviour
  • excessive ingestion of hair
  • feeing a low-quality poorly digestible diet

usually acute!

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5
Q

what are some causes of dietary intolerance?

A
  • “allergy”
  • inability to digest
  • difficult digestion

usually chronic, usually no urgency markers

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6
Q

if the patient’s main complaint is dysphagia, then what is most likely the inciting cause?

A

oral cavity/laryngeal/upper esophageal disease

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7
Q

what is vomiting indicative of?

A

primary or secondary GI disease

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8
Q

what is regurgitation indicative of?

A

swallowing of esophageal problems

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9
Q

tell me the difference between SI and LI bowel diarrhea
1. stools
2. mucus
3. blood
4. fat
5. vomiting
6. gas
7. weight loss

A

SI / LI

  1. large, no tenesmus, 2-3x/day / small, tenesmus, >3x/day
  2. no / yes
  3. melena / fresh
  4. sometimes / no
  5. sometimes / not usual
  6. sometimes / not usual
  7. often / not usual
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10
Q

true or false: acute signs are sometimes self-limiting

A

true

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11
Q

true or false: dysphagia and regurgitation disorders are usually separate from other GI disorders and are also more urgent

A

true

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12
Q

what is the difference b/t primary and secondary GI disease?

A

primary: causes within the GI system
secondary: causes outside GI diseases affecting GI

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13
Q

what are some ddx for regurgitation?

A
  • esophagitis
  • hiatal hernia
  • ring anomalies
  • neoplasia
  • FBs
  • megaesophagus
  • GERD
  • MG
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14
Q

true or false: dental disease is an important cause of GI disease

A

false!!! it is NOT

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15
Q

true or false: GI ulcers are not common in cats and dogs unless predisposing factor

A

true

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16
Q

when should you consider a therapeutic trial?

A

for vomiting, diarrhea, ± anorexia if no GI urgency markers

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17
Q

what are the GI urgency markers? what do they mean?

A

means you need to do diagnostics!

  • unstable pt
  • marked or rapid weight loss
  • concerning PE findings: ex painful abdomen
  • hypoproteinemia
  • abdominal effusion
  • hypovolemia, hypotension, hypoperfusion
  • anorexia if prolonged (>1-2d)
  • intractable vomiting
  • older age
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18
Q

you have GI symptoms with no GI urgency markers and decide to do a therapeutic trial. your patient has acute vomiting. what are your next steps?

A
  • NPO trial
  • GI diet
  • ± probiotics
  • ± anti-emetic
  • ± deworm (fenbendazole, for young animals)
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19
Q

you have GI symptoms with no GI urgency markers and decide to do a therapeutic trial. your patient has acute diarrhea. what are your next steps?

A
  • probiotics
  • GI diet
  • ± deworm (fenbendazole, for young animals)
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20
Q

you have GI symptoms with no GI urgency markers and decide to do a therapeutic trial. your patient has chronic vomiting. what are your next steps?

A
  • elimination diet
  • ± deworm (fenbendazole, for young animals)
  • ± probiotics
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21
Q

you have GI symptoms with no GI urgency markers and decide to do a therapeutic trial. your patient has chronic diarrhea. what are your next steps?

A
  • elimination diet
  • probiotics
  • ± deworm (fenbendazole, for young animals)
  • fibre if large bowel
  • ± Abx (tylosin)
22
Q

a GI diet is usually used for ____ conditions, and an elimination diet is usually used for ____ conditions.

A

acute, chronic

23
Q

what is a GI diet? how long should you “prescribe” a GI diet in an acutely GI patient?

A

highly digestible or low fat diets, ~100% digestion and absorption in proximal GI

1 week, then transition to regular diet slowly

24
Q

what is an elimination diet? how do you “prescribe” this diet to a chronic GI patient?

A

diet that aims to eliminate offending dietary component (diet change to more simple ingredients and no treats, or novel protein diet/hydrolyzed protein diet)

make sure pet only eats prescribed diet, min 6-8 weeks

25
Q

should we be using Abx for acute diarrhea?

A

no not really… there’s no evidence that it works.

GI diet + probiotics work!

26
Q

how do you do an NPO trial for an acutely vomiting patient with no GI urgency markers?

A
  1. NPO for 12 hours (if v+, consider diagnostics)
  2. small amounts of water every 2hr for 6hr (if v+, consider diagnostics)
  3. small amounts (meatballs, teaspoons) of GI diet in 4-6 meals/day for 2-3 days (if v+, consider diagnostics)
  4. if desired, reintroduce old diet slowly
27
Q

what anti-emetic is great for acute vomiting?

A

maropitant

28
Q

for failed therapeutic trials, what should you do?

A

acute:
- rads, US
- cbc/chem/UA
- GI panel, endocrine testing

chronic:
- full lab work, GI panel, endocrine testing, GI biopsies, rads/US
- referral

29
Q

describe briefly the normal swallowing stages

A
  1. oral stage: food in mouth, goes to oropharynx
  2. pharyngeal stage: tongue pushes bolus to caudal pharynx, pharyngeal constriction of bolus to upper esophageal sphincter (UES)
  3. cricopharyngeal stage: relaxation of cricopharngeal muscles, bolus goes into esophagus
30
Q

what are the C/S of dysphagia?

A
  • exaggerated head movement
  • exaggerated prehension
  • dropping food
  • coughing, aspy pneu pneu
  • gagging, retching
  • drooling
  • regurgitation
31
Q

what are the ddx for dysphagia?

A
  • severe periodontal dz
  • oral/pharyngeal masses
  • congenital (cricopharyngeal dysphagia)
  • neuro disease
32
Q

the lower esophageal sphincter (LES) at the level of the diaphragm is made of ____ muscle in dogs and ___ in cats.

A

dogs: longitudinal striated
cats: smooth

33
Q

gastroesophageal reflux can lead to ____.

A

esophagitis

34
Q

what causes gastroesophageal reflux?

A

secondary to transient or permanent changes in barrier between esophagus and stomach (LES incompetence, hiatal hernia, motility disorders, FBs, vomiting, GERD, tetracycline + clindamycin in cats)

35
Q

what are the contributing factors to gastroesophageal reflux?

A
  • anesthetic agents
  • prolonged fasting (>24h)
  • intra-abdominal sx procedures, abd pain, GDV, gastric dilation
36
Q

what are the C/S of esophagitis?

A
  • humans = heartburn
  • anorexia
  • ptyalism
  • regurgitation
  • retching, gagging
  • coughing
  • aspy pneu pneu
  • repeated swallowing motions
  • discomfort
  • lethargy
  • weight loss
  • cats: vocalize loudly after eating

many animals are subclinical!!!

37
Q

how do you dx esophagitis?

A

hx, C/S, thoracic rads
± endoscopy, contrast radiograph (Barium)

38
Q

how do you treat esophagitis?

A

omeprazole!!!

proton pump inhibitors (PPI)

39
Q

how do you diagnose esophageal FBs?

A

hx, rads, endoscopy

40
Q

how do you tx esophageal FBs?

A

removal by endoscopy, pushing it into the stomach for acid to break down

41
Q

what is a common sequela of esophagitis

A

esophageal strictures

42
Q

how do you treat esophageal strictures?

A

balloon dilation

43
Q

what is a hiatal hernia?

A

repeated protrusion of abdominal contents through the esophageal hiatus of the diaphragm into the thorax

mostly congenital

44
Q

hiatal hernias cause ____ LES tone, leading to ____, ______, and ______.

A

reduced
regurg, esophagitis, aspiration

45
Q

how do you treat hiatal hernias?

A

medically:
- acid suppression (PPI = omeprazole)
- diet (low fat)
- pro kinetics
- LES tone mod (cisapride)

surgically:
- reduction (hiatal plication)

46
Q

what is a persistent right aortic arch?

A

embryonic right aortic arch (rather than left 4th aortic arch) becomes functional adult aorta

causes circular entrapment of esophagus by aorta on right, ligamentum arteriosum on the left

47
Q

what are the typical C/S of PRAA?

A

regurg when fed solid food, malnourished, underdeveloped, aspy pnue pneu

young animals (dogs)

48
Q

how do you diagnose PRAA

A

rads
- tracheal deviation to L in V/D, notch in ventral or dorsal border of esophagus in lateral, proximal megaesophagus

contrast radiography (barium), fluoroscopy

49
Q

how do you treat PRAA?

A

surgery

50
Q

what is the most common cause of regurgitation in dogs?

A

megaesophagus

51
Q

what are some causes of secondary megaesophagus?

A

PRAA, chronic esophagitis, myasthenia gravis, Addison’s, hypothyroidism

52
Q

how do you treat megaesohpagus?

A

acute: broad spectrum Abx (aspy pneu pneu), raised feedings, nutritiona support

chronic: feeding in elevated position, prevent weight loss, timing of feeding, encourage esophageal emptying (maintain elevation for a while after eating), promotability drugs (unproven), treat primary condition

522 (dog & cat class) (31 decks)

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