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GIT Flashcards

1
Q

before supplementary nutrition…

A

correct electrolyte and acid-base imbalances
stabilise
shock - reduced GIT perfusion
consider periods of at home anorexia

compromised patients - may have insulin resistance, reduced absorptive and digestive enzyme production

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2
Q

reasons patients may refuse to eat in hospital

A

stress
pain
absence of preferred food
nausea
physical incapacity

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3
Q

supplementary feeding - fat

A

calorically dense
indicated if critically ill - difficult to get nutritional volume in
contraindicated in pancreatitis

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4
Q

supplementary feeding - high protein

A

contraindicated in hepatic and renal disease and pancreatitis

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5
Q

energy requirements

A

RER = 70 x (bodyweight)^0.75

or (in animals 3-25kg)

RER = (30 x BW) + 70

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6
Q

resting energy requirements (RER)

A

calories needed for normal function in fasted patient under thermo-neutral conditions

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7
Q

calculating energy requirements

A

weigh
calculate RER
divide RER by diet content (kcal) to give daily amount
divide by total number of feeds
do not exceed 5-10ml/kg when introducing food

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8
Q

enteral feeding

A

to GIT

use gut if works

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9
Q

parenteral feeding

A

nutrients via IV

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10
Q

tube types

A

naso-oesophageal/nasogastric
oesophagostomy
gastrostomy (PEG)
enterostomy or jejunostomy

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11
Q

factors in choosing tube type

A

patient condition
injury/illness
food needed
availability of resources (including staff)
financial factors
duration of feeding required

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12
Q

naso-oesophageal/nasogastric

A

most common
through nostril
distal tract must be functional
conscious placement
3-5 days (up to 10) - short term
easy to place
no GA needed
can be used immediately and removed easily
patient can eat and drink around tube
patient may pull out
around head - bite risk
can only put liquid down - not crushed oral medication

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13
Q

Oesophagostomy

A

surgical placement into oesophagus
distal GIT must be functional
contraindicated if secondary oesophageal disorder
wider than NG so can prepare own diet
weeks/months
easy placement and any time removal
can give crushed medications
GA needed
biting risk
wound management needed for risk of infection
risk of stricture formation

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14
Q

Gastrostomy

A

into stomach through body wall
bypasses oral cavity and oesophagus
contraindicated if primary gastric disease
has to stay in for 10-14 days to allow seal to form between stomach and abdominal wall prevent leaks into abdominal cavity –> pancreatitis
can be left in for months-years
further from head so less biting
variety of diets
can give crushed medications
can’t use for 24 hours after placement
needs GA
risk of local infection
risk of pancreatitis/peritonitis

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15
Q

Jejunostomy (j-tube)

A

invasive and challenging to place
mid-long term support
bypasses upper GIT
patient can still eat by oral route if needed
jejunum has no storage capacity - trickle feeding instead of bolus
usually only referral cases

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16
Q

total parenteral nutrition (TPN)

A

IV
short term - 3-5 days
only if unable to feed enterally, increased aspiration risk or if other methods have failed
aim to meet all protein and energy needs
Partial parenteral nutrition - combined with other methods
intensive nursing needed

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17
Q

postural feeding

A

megaoesophagus
intake split into 3-4 small meals
soft wet food rolled in small balls and fed from height
sitting position

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18
Q

enamel

A

outermost layer
97% calcium and phosphorus
no circulatory system - can’t be replaced

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19
Q

dentin

A

majority of tooth
made by odontoblasts
laid down through life
nerve supply - responds to stress

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20
Q

pulp

A

living tissue
nerves, blood and connective tissue
where odontoblasts live
provides nutrition, protection and sensation - pain if damaged

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21
Q

gingiva

A

gums
both attached and free sections

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22
Q

cementum

A

anchors tooth

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23
Q

alveolar bone

A

portion of the jaw the teeth sit in
covered in periosteum

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24
Q

periodontal ligament

A

in periodontal space between tooth and alveolar bone
shock absorber
holds tooth in place

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25
closed mouth exam
lips oral mucosa occulsion
26
open mouth exam
gingiva cheek mucosa palate tongue floor of mouth discharge foreign bodies masses swelling inflammation fractures ulcers NB: not whole tooth is visible - could be root pathology
27
GA dental exam
intubation lateral recumbency pharyngeal pack chlorhexadine prep mouth gag - only large dogs, not for long radiographs to see hidden pathology
28
occlusion
upper incisors should overlap lower lower canines should fit into upper diastema upper and lower premolars should interdigitate
29
number of teeth
missing or supernumery retained deciduous teeth overcrowding - common in brachycephalics
30
appearance of teeth
defects shape discolouration fractures
31
oral soft tissue exam
discolouration inflammation oedema
32
Periodontal disease
common any disease affecting soft tissue or tissues holding teeth in place may need radiographs to see full extent signs - gingivitis, plaque build up (can mineralise to calculus), gingival recession, bone loss, mobile teeth, tooth loss
33
plaque
made by bacteria --> gingivitis as immune response --> tissue destruction --> plaque mineralises to calculus and prevents healing --> attachment loss --> tooth becomes mobile and falls out
34
mouth directions
mesial - towards midline distal - away from midline buccal - towards buccal mucosa lingual - towards tongue labial - towards lips palatal - towards palate interproximal - between teeth coronal - towards tip of crown of tooth apical - towards root of tooth
35
periodontal probe
blunt ended measures attachment loss assess gingival inflammation test tooth mobility
36
dental explorer
sharp ended detect softened enamel explore defects - fracture sites and tooth resorption check for pulp exposure don't put in gingival sulcus
37
gingivitis index
0 - none 1 - mild - slight change in colour, no bleeding 2 - moderate - redness, oedema, bleeding 3 - severe - ulceration, prone to spontaneous bleeding
38
periodontal grading index
score for individual teeth attachment loss estimated with probe and confirmed with x-ray - probe tends to overestimate depth 0 - healthy - pink, firmly attahced 1 - gingivitis due to calculus deposition, reversible by brushing, no attachment loss 2 - up to 25% detachment, deepened sulcus 3 - 25-50% attachment loss 4 - over 50% attachment loss, may see horizontal bone loss, severe inflammation
39
furcation index
furcation = area where roots divide on multi rooted tooth - measure of amount of bone loss 0 - no bone loss 1 - less than 1/3 bone loss 2 - more than 1/3 lost but not all 3 - open furcation
40
mobility index
measure of loss of normal support around tooth - periodontal ligament and bony support 0 - no mobility (<0.2mm) 1 - <1mm horizontal movement 2 - >1mm horizontal movement 3 - any vertical movement
41
dental radiography techniques
parallel - plate parallel to target with beam aimed straight at it - caudal mandibular teeth only bisecting angle - creating shadow of teeth and capturing it - used when can't get in parallel extra oral - plate not inside mouth - cats and small mouths, skyline view of maxillary arcade
42
common dental pathology - small animal
vertical bone loss - radiograph, creates pocket horizontal bone loss - can get probe under tooth type 1 resorption - common in cats, remove full tooth type 2 resorption - cats - tooth blends with jaw at root, remove top (not root so can't remove whole thing) trauma - chewing something hard uncomplicated crown fracture - dentin exposed but not pulp complicated crown fracture - pulp exposure - painful
43
open vs closed extraction
open - multirooted teeth, elevation of mucoperiosteal flap and bone removal (surgical extraction) closed - usually single root teeth, incision into gingival attachment and breakdown of periodontal ligament
44
Colic - definition
abdominal pain - predominately GIT associated but can involve a number of systems
45
colic causes
smooth muscle spasm inflammation - colitis/ulceration distension - impaction/gas accumulation obstruction - impaction tension on mesentery - displacement tissue congestion/infarction/necrosis - torsion/volvulus, strangulation --> endotoxemia combination of above
46
colic - endotoxemia
if gut wall is compromised toxins will start to absorb toxins into blood stream --> death high HR poor pulse quality slow jugular refill dark dry mucous membranes slow capillary refill time
47
colic - signs
inappetence reduced fecal output vocalisation agitation pawing lip curling flank watching lying down repeatedly stretching to urinate rolling/trashing sweating excessively straining
48
signs of pain - colic
mild - restelessness, pawing, flank watching - gas build up, inflammation, smooth muscle spasms moderate - lying flat, groaning - impaction or simple obstruction severe - very fractious, violenet rolling - acute colic, severe strangulation end stage - dull, unresponsive - eg. endotoxemia
49
colic - treatment priorities
analgesia and triage assess severity construct treatment plan
50
colic differentials
false colic - non-GI source - liver disease, urinary disease, peritonitis, intra-abdominal abscess, intra-abdominal neoplasia, reproductive disorders non abdominal - oesophageal obstruction, rhabomyalysis, laminitis, pleuropneumonia
51
colic - risk factors
recent changes - feeding, management, stabling, exercise dental history parasites viruses
52
colic - CV assessment
increased HR - more driven by CV status than pain pulse quality jugular refill mucous membranes - tacky then 5% dehydrated, dry and red then need fluid therapy (horses are big so takes lots of fluid to rehydrate) capillary refill time
53
boborygmi
sound of fluid and gas in intestines
54
motility - colic
hyper motility - increased smooth muscle activity - spasm colic local hypomotility - localised stasis of GIT general absence of sound - GIT ileus - common in most colics
55
analgesia - colic
xylazine (alpha-2) - first choice - short acting. But has CV effects so take into account NSAIDs - don't use right away, GI effects opioid - butorphanol (torbugesic)
56
further diagnostics - colic
nasogastric intubation - fluid/ingesta from stomach - >2l is abnormal - relfux usually needs referral trans-rectal exam - impaction, distension, displacement, masses - risk of rectal tears abdominocentesis - asses changes in peritoneal fluid - serosanguinous colour or increased protein (leakage of blood components), increased lactate (anaerobic tissue metabolism), ingesta (GIT rupture), high WBC (peritonitis) abdominal ultrasound - kidneys, small intestines, spleen, intestinal wall thickness, distension of small intestine, peritoneal fluid (structures not palpable by trans-rectal palpation)
57
colic - treatment
NSAIDs Alpha-2s Opioids Spasmolytics (anticholinergics) - buscopan - rapid onset smooth muscle relaxant fluid therapy - stomach tube - contraindicated if NG reflux or if suspected small intestinal lesion purgatives - liquid paraffin coats impaction, epsom salts breaks impaction down
58
causes of weight loss
reduced intake - not wanting to eat, not being able to, not being allowed, not being fed enough poor absorption - inadequate presentation of food, GI disease, neoplasia, parasites decreased utilisation - disorder of nutrient metabolism (liver), cushings (not really weight loss, just look ropey) excessive loss - protein losing enteropathy increased requirement - exercise, bacterial infection, chronic viral infection, neoplasia
59
Hypoalbuminemia
low albumin - protein lowing enteropathy or nephropathy reduced production - liver disease (Severe), malnutrition chronic inflammation - negative acute phase proteins
60
Anemia
common finding in weight loss decreased RBC production and lifespan
61
abdominocentesis
assess changes in peritoneal fluid low sensitivity good specificity for inflammation/bacteria, and neoplasia peritoneal inflammation/bacteria - increased protein and lactate and serosanguinous colour change neoplasia - tumours mat exfoliate cells, low grade peritoneal inflammation
62
gastroscopy
assess gastric ulceration - associated with weight loss through desire to eat rather than absorption
63
oral glucose absorption test (OGAT)
assesses absorptive capacity of small intestine 12 hour fast, baseline oxalate-fluoride give glucose take bloods every hour for 5-6 hours normal - double after 2 hours then absorbed by end partial malabsorption - 15-65% increase at 2 hours, slower to peak total malabsorption - serum glucose not above 15% of baseline
64
fecal blood test
frank blood in feces - bleeding in rectum/colon
65
biopsies
trans-endoscopic duodenal biopsy - pinch biopsy - mucosal tissue rectal biopsy - mucosa and submucosa surgical - full thickness can show inflammation can be definitive for intestinal lymphoma or infiltrative intestinal disease
66
upper GI conditions - cattle
mouth, teeth, throat choke - eg. feeding potatoes - can lead to free gas bloat - pass stomach tube down and see if it hits anything frothy gas bloat - gas trapped in pockets in rumen - eg. eating clover bloat from vagal nerve pressure - eg. hardware disease, lymph node enlargement, pneumonia, tumour - leads to free gas bloat, can release in some bits because no obstruction but can't do it actively
67
hardware disease - cattle
metal wedged in reticulum - varying penetration into pericardium collect with a magnet
68
acidosis - cattle
subclinical - pH < 5.5 acute clinical - pH < 5 - very sick subacute ruminal acidosis (SARA) - effect on production but not enough that you'd notice except from over time - usually nutritional issues assess - ruminocentesis - rumen pH and microbial activity
69
ketosis - cattle
post partum energy deficit fatty liver - cows have poor hepatic function for mobilising body fat pear drop small indistinct signs - production down, bit depressed diagnosis - elevated ketones in milk, urine or blood
70
cattle energy requirements
assumed 700kg - dry - - maintenance - 80MJ - pregnancy - 20MJ - milk production - 0MJ peak lactation - - maintenance - 80MJ - pregnancy - 0 MJ - milk production - 300MJ maintenance = 10% bodyweight + 10
71
GIT displacements/torsion - cattle
left displaced abomasum - ketosis (loss of GI tone --> enlarged abomasum filled with gas --> slides under rumen) - usually after calving, ping on left side of abdomen right displaced abomasum +/- volvulus - right sided ping abomasal ulceration - black feces, can rupture and kill by peritonitis caecal dilation - palpate per rectum caecal torsion - can release toxins when untwisted small intestinal torsion
72
viral causes GI disease - ruminants
rotavirus - young, 2-12 weeks- peracute diarrhoea, high mortality coronavirus - young, 1-3 weeks - shedding up to 2 weeks BVD - 6 months - 2 years - diarrhoea not main sign
73
bacterial causes GI disease - ruminants
e. coli - neonates - environmental bacteria salmonella - calves and older - acute mucoid watery diarrhoea, spread in feces clostridia - different strains, closridium perfringens johnes - mycobacterium paratuberculosis - slow burn, notifiable
74
parasitic causes of GI disease - ruminants
protozoa - cryptosporidium parvum - young - oocysts in feces, hygiene important - coccidiosis - eimeria - older calves (around weaning), persists in environment - rectal prolapse worms - strongyles - usually when turned out at pasture - liver fluke - older animals grazed in wet areas, autumn winter time
75
nutritional causes of GI disease - ruminants
milk scours peri-weaning scours SARA grain overload dietary changes - up to 6 weeks to stabilise to new diet gorging wrong mix of milk powder feeding of whole milk usually young animals
76
environmental and husbandry causes of GI disease - ruminants
failure of passive transfer poor equipment hygiene poor housing hygiene mixing of age groups - leaves younger more vulnerable stress
77
healthy calf parameters
temp - 38-38.9 rr - 15-30bpm CRT - <2 secs mm - pink and moist quick standing for feeding semi firm feces ear and head position upright no cough
78
diagnosis - GI disease in calves
scour check kit - rotavirus, coronavirus, crypto, e. coli fecal worm egg counts fecal culture - salmonella, johnes, clostridial toxin, rotavirus, coronavirus serology - johnes, BVD bulk milk surveillance - fluke, BVD, IBR, johnes, salmonella postmortem/abattoir feedback - fluke, other parasites, gross anatomy changes
79
incisor examination - horse
overbite underbite slant/smile mouth cribbing calculus mobility diastema look for draining tracts
80
canine and wolf teeth examination - horse
calculus fractured canines displaced wolf teeth blind wold teeth - unerupted mandibular wolf teeth
81
cheek teeth examination - horse
interdental spaces buccal mucosa dental overgrowth dental fractures displaced teeth supernumerary teeth diastema
82
dental exam sedation - horse
alpha-2 agonist - romifidine, xylazine or detomidine opiate - butorphanol or morphine

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