Lit GIT, Hepatobiliary, Pancreatic

Question 1

(2 papers)
How useful was video capsule endoscopy (VES) in identifying GI bleeding (GIB) in dogs with microcytosis as compared to traditional endoscopy?

What were the complications & associated risk factors with use of VES to diagnose GIB in dogs?

Answer 1

Mabry JVIM 2019
Capsules were able to identify gastric mucosal lesions in 15/16 & SI lesions in 12/14 dogs, who had biochemical evidence of GI bleeding. However, most would have been identified by traditional endoscopy. Authors suggest use for cases post-negative endoscopy & inconclusive abdo imaging.

Stiller JVIM 2021
Most common complication - incomplete study.
Risk factors - PO admin (vs endoscopically admin capsules) - poor visualisation in stomach & colon, good in SI; simethicone or opioids, chronic enteropathy, capsule gastric transit time >6 hrs.
Overall VCE may be useful to ID bleeding GIT lesions in dogs with questionable GIB.

Question 2

What was the utility of BUN/creatinine ratio (UCR) in differentiating GI bleeding (occult vs overt) from healthy dogs?

Answer 2

Stiller JVIM 2021
UCR overall not clinically useful marker of occult GIB - sig higher in overt GIB, but no sig diff between occult GIB & healthy dogs. Also no sig diff between upper vs lower GIB.
If normal [Hb] and Hct, much higher chance of being healthy vs occult GIB.
If encounter increased UCR in a dog w/o overt GIB, esp if Hct within middle-upper RI, GI protectants not indicated.

Question 3

1. What do the scoring systems MCAI and CAPCSI represent when used to assess hospitalised dogs with acute pancreatitis (AP)? What variables do these systems assess?
2. Were these 2 scoring systems useful in differentiating survivors from non-survivors to discharge?
3. Which 2 serum parameters were assessed as potential biomarkers for clinical progression in hosp dogs with AP, and were there any correlations identified with either of the above scoring systems?

Answer 3

Keany JVIM 2021

1. MCAI = modified canine activity index (MCAI). Based on CIBDAI. Assesses 7 variables – activity, appetite, cranial abdo pain, V+, faecal consistency, dehydration, blood in faeces.
   CAPCSI = canine acute pancreatitis clinical severity index. Assesses 4 variables: cardiac – any abnormal rate or rhythm), respiratory (presence of ARDs or pneumonia, dyspnea/tachypnea), intestinal integrity (GI signs, appetite, intestinal sounds on auscultation), vascular forces (SBP, alb < or >18g/dL).
2. MCAI - yes, CAPCSI - no (no sig diff)
3. CRP & cPLI. Both were positively correlated with MCAI.

Question 4

In cats that underwent choledochal stenting for the treatment of extrahepatic biliary obstruction (EHBO), EHBO recurrence was …. And occurred in …… cats, with …..being a major risk factor for recurrence. ……% cats survived to discharge, with …..positively associated with survival to discharge. Overall median survival time was…..days.

Answer 4

Griffin JVIM 2021
Common, 38.9% (40%), cholelithiasis, 78.3%, absence of peritoneal effusion, 931 days.

Question 5

What is a normal CD: CBD ratio for cats? (CD = cystic duct)

What was the utility of measuring pancreatic enzyme activity in bile, in differentiating cats with normal vs abnormal (increased) CD/CBD ratios?

Answer 5

Fujimoto JVIM 2021
3.4

Cats with CD/CBD ratio >3.4 had significantly higher amylase activity in the bile vs cats with ratio <3.4.
*NB study population enrolled healthy cats, not sure if data applies to cats with cholangitis.

Question 6

What does the G value represent on TEG?

What proportion of dogs with chronic enteropathy were hypercoagulable as measured by TEG?

G value of CE dogs negatively correlated with ……. (list 3 variables), and positively correlated with …. (list 1 variable).

G values were not significantly different between normo- & hypoalbuminemic dogs. (T/F)

Answer 6

Dixon JVIM 2021
G value = global measure of clot strength. Increased when hypercoagulable.

44.7%
Hct, serum albumin concentration & duration of CSx
Age

True

Question 7

In dogs treated with meloxicam 0.2mg/kg PO SID x15d, what were the changes in hematologic, gastroscopic analysis results & serum gastrin concentrations at 3 timepoints (T5, T10, T15)?

How did gastroscopy and serum gastrin correlate with gastric ulceration (GU)?

Answer 7

Elfadadny JVIM 2021
- Decreased Hb, RBCC, PCV at T10 & T15.
- Increased serum gastrin, image analysis results (integrated density/ID, ulcer index/UI) over time
- Sig decrease in PI (pixel intensity) over time.

Gastroscopy = gold standard for early descriptive diagnosis of GU.

Serum gastrin = a good predictor of gastroscopic score of ulcers, increased concentration = good indicator for presence of GU.

Question 8

What are the most common sonographic findings in cats with EPI? (List 4)

Answer 8

• Most common = minimal-no sonographic pancreatic changes (39% cats).
• Thin pancreatic parenchyma (27%)
• Pancreatic duct dilatation >2.5mm and/or tortuosity (27%)
• Diffuse SI dilatation with echogenic contents (36%)

Question 9

Measurement of plasma lidocaine/ monoethylglycylxylidide concentration in dogs with liver shunts to assess shunt closure
a) Differences in [ ] between dogs with complete vs partial shunt closure
b) Sensitivity & specificity?

Answer 9

Devriendt JVIM 2021

a) Median [MEGX] was higher in dogs with closed EHPSS cf diagnosis, but not different in dogs with persistent shunting.

96.2% sens & 82.8% specificity.

Question 10

1) Apart from ammonia, what other substances may contribute to the development of hepatic encephalopathy?

2) Changes in BCAA-to-AAA ratio in PSS dogs receiving medical tx, and correlation with neurological function?

Answer 10

Devriendt JVIM 2021
1) Increased [ ] of glutamine, glutamate, manganese; systemic inflammation. Decreased r branched-chain amino acids (BCAA): aromatic
amino acids (AAA) ratio can induce derangements in central NTR function –> trigger HE.

2) BCAA-to-AAA ratio remained low after starting medical tx, despite concurrent marked improvement in neuro score.
Ratio increased 3months post-sx, still indicates moderate-severe hepatic dysfunction.

Question 11

What is the optimal cut-off CCECAI score for predicting diet responsiveness in PLE dogs?

Answer 11

Nagata JVIM 2020
CCECAI score sig lower in FR-PLE dogs.
Cut-off CCECAI of 8 had 88.9% Sp & 82.6% Sn.
Also longer survival, better prognosis in FR-PLE dogs.

Question 12

Plasma renin activity (PRA) was significantly higher in ….. dogs, but was not significantly different in dogs with …… compared to congenital EHPSS & healthy dogs.
PAC was significantly ….. in the above 2 groups of dogs compared to cEHPSS & healthy dogs.
Study findings suggest that ……plays a role in the pathophysiology of portal hypertension in dogs.

Answer 12

Sakamoto JVIM 2020
Chronic hepatitis (CH)
Primary hypoplasia of the portal vein [PHPV]
Higher
RAAS activation

Question 13

Describe:
1) Mechanisms by which Cu & Pb cause hepatic injury
2) Mechanisms for hepatic Cu accumulation (List 3)

Answer 13

Gori JVIM 2021
1)
- Defective hepatic metabolism
- Oxidative stress to hepatocytes (esp Pb)
- High intracellular Cu: oxidative damage –> hepatocellular necrosis & inflammation

2)
- Primary metabolic defects in hepatic Cu metabolism
- Cholestasis causing impaired biliary excretion of Cu
- Excess daily Cu intake

Question 14

What were the correlations between a) hepatic [Cu] and hepatic [Pb], and b) hepatic [Cu] and/or [Pb] and bloodwork parameters in dogs with chronic hepatitis?

Answer 14

Gori JVIM 2021
Dogs with abnormal hepatic [Cu] may also have higher hepatic [Pb].
In dogs with high hepatic [Pb], microcytosis may be present.

Question 15

What is the current recommended antibiotic class to treat dogs with E coli-associated GC?
What was the incidence of resistance to this antibiotic in GC dogs in a 2020 study? Which 3 regions of E coli was resistance mainly associated with?
What was the long-term outcome following treatment of GC dogs with MDR E coli isolates? Which alternative antibiotics were used in these cases?

Answer 15

Manchester JVIM 2020
Fluoroquinolones
62.5% (15/24 dogs) – common!
GyrA and parC mutations; plasmid-mediated resistance (less common)
Good long-term outcome (sustained complete clinical response for median of 59 months) in FQ-resistant dogs when treated with abx guided by susceptibility testing (carbapenems – meropenem or doxycycline).

Question 16

When using spec FPL to diagnose pancreatitis in sick cats, the false positive rate was ……% as compared to a false negative rate of ……%.

(T/F) Selected biochemistry tests (ALT, ALKP, ALB, tCa, TBIL) were useful as adjunctive results to corroborate a diagnosis of pancreatitis.

Answer 16

Lee JVIM 2020

10%, 24%

False

Question 17

What was the mortality rate in dogs with naturally occurring acute pancreatitis (AP)?

Select 2 parameters below which were associated with non-surviving dogs with AP, and if these were increased/decreased.
- Serum [α2AP]
- Serum [α1PI]
- Anti-thrombin activity
- Canine acute pancreatitis severity (CAPS) score
- Inflammatory cytokine [ ] (IL-6, TNF-a)

Answer 17

Kuzi JVIM 2020

19% mortality rate.

CAPS score - higher scores.
Anti-thrombin activity - decreased.

(Serum [α2AP] & [α1PI] not useful)
(IL-6 & TNF-a positively correlated with cPLI & CRP)

Question 18

(3 papers)
a) What are the 4 different forms of B12?
b) What were the effects of IM hydroxocobalamin (OH-B12) administration in cats with B12 deficiency & GI disease? List 3.
c) What was the protocol used?

d) In comparison, what was the effect of 6 weeks of IM cobalamin supplementation in cats with GI disease?

e) What about efficacy of PO cyanocobalamin in cats with CE?

Answer 18

Kook JVIM 2020
a) Naturally occurring forms - methyl-Cbl, adenosyl-Cbl, hydroxo-Cbl (OH-Cbl). Synthetic form - cyano-Cbl (CN-Cbl)
b)
- Decreased clinical disease activity score (appetite, V+, D+, BW, activity)
- Increased serum [B12]
- Decreased & eventually normalised MMA [ ] in 95% cats –> normalised cellular B12 deficiency
c) 300ug IM q2wks, B12 measured at wk 8 (before 4th injection) & wk 12 (1 month after 4th injection).

Kempf JVIM 2017
d) Overall, SQ protocol did not correct cellular B12 deficiency in this study.
- Normalised B12 levels & biochemical parameters transiently, but by 10 weeks post supp B12 had reduced again.
- Clinical disease activity score improved during treatment but increased after stopping.
- Serum/urine MMA concentrations did not normalise in 6-12/20 (30-60%) cats at week 6.

Toresson JFMS 2016
250mcg cyanocobalamin PO SID. 100% cats had supranormal B12 at 3-13wks.

Question 19

Ki-67 is a marker of ……., while CD3 is a marker of …… activity. Dogs with chronic inflammatory enteropathies had ……. Ki-67/CD3 ratio in the ……region of intestinal biopsies, and this correlated with ……….as an indicator of clinical severity.

Answer 19

Karlovits JVIM 2020
Cellular proliferation
T-cell
Upregulated
Lamina propria crypt
CCECAI scores

Question 20

T foetus causes chronic ……(small/large/mixed) intestinal diarrhoea.

Which of 2 faecal collection methods used to diagnose T foetus infection via PCR had a higher detection rate?

What is the recommended treatment for T foetus infection in cats? What were the 2 limitations to using this drug (wrt success rate)?

Answer 20

Hedgespeth JVIM 2020
Large intestinal D+

Loop technique had higher probability (OR 2.04) of positive T foetus PCR results vs colonic flush technique.

Ronidazole
Lack of association with PCR results
21% all-cause tx failure rate

Question 21

Which serological markers & autoantibodies are potentially useful biomarkers to discriminate between dogs with IBD & acute GI disease/normal dogs?

Answer 21

Estruch JVIM 2020
IgA seropositivity against E. coli OmpC (outer membrane porin C)
- Spec 93-99%, sens 76-97%
Canine autoantibodies against polymorphonuclear leukocytes (APMNA)
- Spec 78-98%, sens 66-86%

Question 22

How did IHC & clonality testing affect final diagnosis & clinical implications for cats with IBD vs LSA?

Biopsy samples from which GIT regions were the most useful? Upper SI, lower SI, upper + lower SI

Answer 22

Chow JVIM 2020
Integrating IHC and clonality testing with histo significantly increased no. of cases diagnosed with LSA (45.8% of defIBD cases & 100% of possLSA cases reclassified as LSA).
But clinical implications/consequence for patient outcome is unclear.

Upper SI. LSI samples rarely changed the diagnosis (only 2.3% LSA cases diagnosed based on LSI bx alone).

Question 23

How did the spec CPL assay compare to 2 in-house assays (VetScan cPL, Vcheck cPL) in terms of:
- Result repeatability
- Pancreatic lipase concentration measurements?

Answer 23

Cridge JVIM 2020
- Spec cPL has the highest repeatability, while Vcheck cPL & VetScan cPL has significantly lower repeatability - both in-house assays may provide discrepant categorical results (“pancreatitis” vs “equivocal” vs “not pancreatitis”) for the same sample.
- Lower PLI concentrations on in-house cf spec CPL assay.

Question 24

How did AUS correlate with spec CPL & clinical diagnosis in the diagnosis of pancreatitis in dogs?

What 3 AUS parameters were assessed?
Sensitivity & specificity of these parameters (in isolation & combination) to diagnose pancreatitis?

Answer 24

Cridge JVIM 2020
AUS weakly correlated with spec CPL, moderately correlated with clinical diagnosis. AUS changes did not correlate with spec CPL or CDx changes.

Pancreatic enlargement, pancreatic echogenicity, altered mesenteric echogenicity.

In isolation: 89% sensitivity & 43% specificity
Combo of 3 critieria: 43% sensitivity & 92% specificity

Question 25

1. What diagnostic test should be considered when surgically correcting peritoneopericardial and/or congenital central diaphragmatic hernias in dogs & cats? 2. Reason for above test? (hint: association with type of organ disease) 3. What 2 immunohistochemical stains are useful for diagnosis of the disease mentioned in 2?

Answer 25

Seibert JAVMA 2021 1. Liver biopsies of non-herniated liver tissues for histo 2. Ductal plate malformations (DPMs) are strongly associated with PPDH & CCDH in dogs & cats. (Types: congenital hepatic fibrosis, renal DPM). 3. Cytokeratin-19 (to stain ductal elements & illustrate malformative bile duct profile) & Ki-67 (assessment of cell proliferation). Allows differentiation from injuries provoking ductular reactions (e.g. traumatically herniated, torsed, or ischemic liver lobes).

Question 26

1. What was the survival & recurrence rate for cats with idiopathic megacolon that underwent subtotal colectomy? 2. What factors were negatively correlated with survival? 3. What additional procedure during surgery was associated with a less favourable outcome in these cats, and what are the reasons?

Answer 26

Grossman JAVMA 2021 1. 86% survival (14% died as a direct result of tx or complications of megacolon). 32% recurrent constipation (median 344d) - not associated with ICJ removal/retention. 2. Factors - BCS <4/9, pre-existing cardiac disease, major peri-op complications, long-term post-op liquid faeces. 3. Removal of the ICJ (associated with long-term liquid faeces & poorer owner-perceived outcome)

Question 27

What surgical technique may be useful to reduce regurgitation in brachycephalic dogs poorly responsive to medical management?

Answer 27

Hosgood JAVMA 2021 Circumferential hiatal rim reconstruction combined with oesophagopexy. *Reconstruction of the diaphragmatic crural musculature around the oesophagus keeps the muscle contracted around the oesophagus to support GE tone during GES relaxation, thus preventing reflux. Oesophagopexy keeps the LES near the crural musculature sling.*

Question 28

What clinical and histologic findings were observed in dogs with ketoconazole-induced liver injury? Long term prognosis for these dogs?

Answer 28

Macho JAVMA 2020 CSx - lethargy, anorexia, V+ Elevated serum liver enzymes. Histo - variable lobular injury, mixed inflammatory infiltrates, conspicuous aggregates of ceroid-lipofuscin–engorged macrophages (Kupffer cells) that marked regions of parenchymal damage. Long term px - 35% (5/14) developed chronic hepatitis (3 with pyogranulomatous inflammation). Survival after illness variable (3.5d to 41mths). 50% died due to liver-related causes. *Sequential bloodwork for LE monitoring advised pre & during tx.*

Question 29

1. Which 3 methods are available for hepatic copper quantification in liver biopsies of dogs & cats? 2. What was the level of agreement between quantitative results obtained by these methods?

Answer 29

Miller JAVMA 2021 1. Atomic absorption spectroscopy (AAS), inductively coupled plasma mass spectrometry (ICP-MS), digital image analysis of rhodanine-stained sections. 2. AAS & ICP-MS analysis **often underestimated** hepatic Cu concentrations vs digital image analysis. Coefficient of variation significantly increased for dogs with higher hepatic [Cu].

Question 30

Dogs with gastrooesophageal intussusception (GEI): 1. Signalment 2. Survival rates (short & long term) 3. MST 4. Major post-operative (sx/endoscopic) complication & associated risk factors

Answer 30

Grimes JAVMA 2020 1. Young dogs (median 13mths), males (72%), GSD (33%) 2. 88% survived to discharge 3. MST 995d 4. Persistent regurgitation. Risk factors - dogs with acute (

Question 31

What clinical manifestations can be seen with protoporphyric hepatopathy in dogs? Disease pathogenesis? Treatment?

Answer 31

Kunz JAVMA 2020 Bloodwork findings consistent with liver dysfunction (microcytosis +/- anemia, hypochol, hyperBIL) Poor growth, skin lesions (protoporphyric photosensitivity), pigmentary hepatopathy (dark brown-black liver). Pathogenesis - porphyria syndromes reflect disrupted heme synthesis. Occurs due to defects in cytosolic and mitochondrial enzymes (predominantly in the BM & liver) responsible for heme synthesis. CSx associated with the accumulation of intermediates of the heme synthetic pathway: porphyrins (heme, protoporphyrin, and oxidative products of porphyrinogens) and porphyrin precursors. Tx - avoiding conditions known to induce heme synthesis and catabolism, UDCA, SAME & vit E, avoiding sunlight exposure.

Question 32

What patient, clinical, endoscopic & histologic features were observed in dogs with histologic diagnosis of chronic gastritis with lymphofollicular hyperplasia?

Answer 32

Faucher JAVMA 2020 Patient - younger, brachycephalics CSx - less commonly reduced BCS or D+, more commonly inspiratory dyspnea & exercise intolerance *(may occur as a consequence of increased negative intrathoracic pressure)* Endoscopic - gastric mucosal hyperaemia & discolouration Histo - more severe gastritis

Question 33

What novel interventional technique was used in a dog with EHBDO secondary to pancreatitis refractory to medical management? Other potential indications for procedure?

Answer 33

Chmelovski JAVMA 2020 US & fluoroscopic-guided placement of percutaneous transhepatic cholecystostomy drainage (PCD) catheter - to facilitate continual biliary drainage. Bile recycled by adminstering bile back to patient via NG tube - clinical improvement within 24hrs. Removed after 5 weeks when repeat cholangiography confirmed BD patency. Other indications - transient causes of EHBO, patients too unstable to undergo more invasive biliary diversion techniques, biliary diseases that can be medically managed otherwise.

Question 34

What was the risk of dehiscence & non-survival to discharge in cats undergoing large intestinal full thickness incisional biopsies? List the risk factors associated with: - Wound dehiscence only - Non-survival to discharge only - Both of the above

Answer 34

Lux JAVMA 2021 Dehiscence rate ~8%, non-survival 6% Risk factors: - Non-survival to discharge: low serum glob, repair of colonic trauma or dehiscence, post-op colonic dehiscence. - Dehiscence: hypoalbuminemia, renal dysfunction, blood product admin, admin of >2 abx classes, intra-abdominal faecal contamination. - Both: band Np, partial colectomy with colonic R&A, blood product admin, post-op CPA, incisional inflammation/ infection, blood product administration.

Question 35

Dogs undergoing intestinal R&A had ....(higher/lower) dehiscence rates of ......% compared to .....% in dogs undergoing enterotomy. What 2 other factors were associated with increased risk of intestinal dehiscence for either surgical procedures?

Answer 35

Lopez JAVMA 2021 Higher (~6x), 18%, 3.8% ASA class >3, older age

Question 36

What was the main neurological sign observed in dogs undergoing PSS attenuation that developed PANS? What % of these dogs developed additional neuro signs? What was the progression & recurrence rate of PANS both short & long term?

Answer 36

Escribano Carrera JAVMA 2021 Seizures. 40% additional neuro signs. 48% neuro signs resolved by discharge. Most neuro signs (apart from seizures) resolved within 1 month post-op. Recurrent seizures in 50% dogs. If survive at least 30 days, likely to survive >6mths & can live a good QOL.

Question 37

Most common aetiology for sialoceles in dogs? What medication may be a viable treatment option for dogs with sialoceles?

Answer 37

Ortillés JAVMA 2020 Idiopathic (88%) -* ddx sialadenitis, siadenolithiasis, FB, trauma, neoplasia, HWD, post-op complication, congenita maxillary malformation* N-acetylcysteine 10% as an intracanalicular injection - mucolytic effects (also anti-inflammatory & anti-oxidant). Can be given at time of diagnostic imaging.

Question 38

1. Which 3 methods are available for hepatic copper quantification in liver biopsies of dogs & cats? 2. What was the level of agreement between quantitative results obtained by these methods?

Answer 38

Miller JAVMA 2021 1. Atomic absorption spectroscopy (AAS), inductively coupled plasma mass spectrometry (ICP-MS), digital image analysis of rhodanine-stained sections. 2. AAS & ICP-MS analysis **often underestimated** hepatic Cu concentrations vs digital image analysis. Coefficient of variation significantly increased for dogs with higher hepatic [Cu].

Question 39

What clinical and histologic findings were observed in dogs with ketoconazole-induced liver injury? Long term prognosis for these dogs?

Answer 39

Macho JAVMA 2020 CSx - lethargy, anorexia, V+ Elevated serum liver enzymes. Histo - variable lobular injury, mixed inflammatory infiltrates, conspicuous aggregates of ceroid-lipofuscin–engorged macrophages (Kupffer cells) that marked regions of parenchymal damage. Long term px - 35% (5/14) developed chronic hepatitis (3 with pyogranulomatous inflammation). Survival after illness variable (3.5d to 41mths). 50% died due to liver-related causes. *Sequential bloodwork for LE monitoring advised pre & during tx.*

Question 40

What clinical and histologic findings were observed in dogs with ketoconazole-induced liver injury? Long term prognosis for these dogs?

Answer 40

Macho JAVMA 2020 CSx - lethargy, anorexia, V+ Elevated serum liver enzymes. Histo - variable lobular injury, mixed inflammatory infiltrates, conspicuous aggregates of ceroid-lipofuscin–engorged macrophages (Kupffer cells) that marked regions of parenchymal damage. Long term px - 35% (5/14) developed chronic hepatitis (3 with pyogranulomatous inflammation). Survival after illness variable (3.5d to 41mths). 50% died due to liver-related causes. *Sequential bloodwork for LE monitoring advised pre & during tx.*

Question 41

How many cases can you reuse endoscopic cup biopsy forceps for while maintaining procurement of good quality biopsies?

Answer 41

Cartwright JVIM 2016 10-15 cases

Question 42

What is the preferred biopsy forcep size in cats to yield diagnostic quality endoscopic biopsies?

Answer 42

Bottero JVIM 2019 Large (2.4mm) forceps rather than small (1.8mm)

Question 43

What modalities exist to measure gastric emptying in cats? How reliable are these tests?

Answer 43

Husnik JVIM 2017 - Radionuclide scintigraphy (99mTC) gold standard. - AUS - in this study showed good correlation with scintigraphy; considered a suitable alternative. - Liquid barium sulfate gastrogram - unreliable (insensitive). - Breath testing with 13C isotope-labelled sodium acetate - fair correlation with scintigraphy.

Question 44

Which 2 drugs have a prokinetic effect on the stomach of healthy cats as assessed sonographically? In contrast, which drug can cause delayed gastric emptying in these cats? Include the MOA of these drugs in your answer.

Answer 44

Husnik JVIM 2017 Metoclopramide & erythromycin - shorten GE times & increase the motility index of antral contractions. - Erythromycin: motilin agonist, initiates interdigestive type III migrating motor complexes (MMCs) Exenatide causes an initial delay in GE. - MOA: glucagon-like peptide-1 (GLP-1) analogue. GLP-1 (incretins) are normally secreted by GIT in response to food intake, promote satiety, effect GE to reduce post-prandial glycemic excursions.

Question 45

What was the incidence of GI bleeding (subclinical vs clinical) in dogs receiving chronic NSAID therapy? Did this vary across use of different NSAIDs?

Answer 45

Mabry JVIM 2021 Subclinical GI erosions common in NSAID-treated dogs (83%) cf control dogs (with chronic enteropathy). Erosions seen with all 3 NSAID types (carprofen > meloxicam > firocoxib).

Question 46

(2 papers) What is the utility of abdominal CT for identifying mechanical GI obstructions in dogs? What about the utility of laparoscopy vs ex lap?

Answer 46

Winter JAVMA 2017 Complete agreement with exlap (both partial & complete obstruction). Feasible, rapid & accurate modality, faster than US. Obstructed dogs had significantly larger intestinal diameter ratios. Barry JAVMA 2017 Laparoscopy was feasible & clinically applicable in select cases of dogs with suspected GI obstruction. Smaller incision length (25% that of ex lap), duration 36min (vs 12min for ex lap). Still recommend keeping liberal criteria to convert to an open sx approach to address other identified lesions.

Question 47

(2 papers) What are unique but normal findings of the caecum identifiable on US & endoscopy in asymptomatic cats? Is loss of caecal wall layering on US predictive of malignancy in cats?

Answer 47

Hahn JFMS 2016 AUS - lymphoid follicles in caecal mucosa & submucosa (forms a follicular layer). Endoscopy - dimpled appearance of caecal mucosa. Hahn JFMS 2017 No. Loss of caecal wall layering on US identified in 7/18 (39%) cats; did not appear as a reliable predictor of the severity of histologic inflammation or malignancy. Neither did local steatitis or LN size.

Question 48

What is the PPV for ultrasound to predict mucosal SI disease in cats (based on History) vs submucosal/muscularis lesions?

Answer 48

Guttin JVIM 2019 In a population with a high prevalence of GI disease, the PPV for ultrasound predicting mucosal disease on histology was HIGH (72-100%) but LOW for submucosal/muscularis lesions (18-57%). *Meaning SI submucosal & muscularis disease may still be apparent despite lack of US lesions, suggesting full-thickness biopsy may not be essential in these cats.*

Question 49

What is a neutrophil-based biomarker for chronic enteropathy in dogs? What assays can be used to measure this & what is the Sn/Sp of this biomarker? What 2 other antibodies may biomarker-positive dogs test positive to that were assessed in this study?

Answer 49

Florey JVIM 2017 **Perinuclear antineutrophil cytoplasmic antibodies (pANCAs).** Serum marker for dogs with food responsive enteropathy - higher seropositivity vs SRE. **Indirect immunofluorescence (IIF) **- timing consuming & low inter-observer agreement. This study - used a **human granulocyte IF assay.** Assessed for pANCAs & cytoplasmic ANCAs (cANCAs). Quick & easy to perform; good agreement with previous assays. Seropositivity (cANCA+ or pANCA+) **Sn 61%, Sp 100% to predict FRE.** **Myeloperoxidase (MPO), proteinase-3 (PR-3)** protein antibodies - enzymes that may be involved in neutrophil degranulation and generation of ROS etc.

Question 50

What differences in peripheral blood lymphocyte (PBL) subtypes were noted between dogs with IBD vs healthy controls, as assessed using flow cytometry? Did this change after treatment & achievement of clinical remission in IBD dogs?

Answer 50

Galler JVIM 2017 IBD dogs had significantly decreased **CD21+ B cells & TCR-gamma-delta+ T lymphocytes** No changes pre & post-treatment/clinical remission.

Question 51

(3 papers) What transporter mediates intestinal absorption of bile acids, and which regions of the GIT is this expressed? What changes in bile acid metabolism are expected in dogs with chronic enteropathy? What are the effects of a 7-day course of tylosin on faecal bile acids & microbiota in healthy dogs? What are the effects of corticosteroid treatment on faecal bile acids & microbiota in dogs with SRE?

Answer 51

Giaretta JVIM 2018 * Apical sodium-dependent bile acid transporter (ASBT). Expressed in ileum (highest), caecum & colon. * CE dogs had increased % of primary bile acids (reduced hydroxylation to secondary BAs by depletion of C. hiranonis). * Also downregulated ABST expression, which negatively correlated with histopathologic score. Manchester JVIM 2018 * At D7 of tylosin - decreased faecal microbiota diversity (decreased anaerobes Fusobacteriaceae & Veillonellaceae) * At D21 & D63 - increased primary unconjugated BAs. Changes in bacteria taxa did not uniformly resolve weeks after tylosin discontinuation. Guard JVIM 2019 * Steroid tx did not change dysbiosis index, but significantly increased % of secondary faecal unconjugated BA at 2-3mths (28% to 94%) - suggesting steroids have regulatory effect on faecal BAs.

Question 52

What RBC abnormalities are more common in dogs with GI lymphoma vs chronic enteropathy?

Answer 52

Parachini-Winter JAVMA 2019 Anaemia 3+ RBC anomalies, (Sn 71%, Sp 70%) Particularly presence of eccentrocytes (29% LSA vs 4% CIE) *Eccentrocytes reflect oxidative injury.*

Question 53

What is calprotectin? What can it potentially differentiate in dogs?

Answer 53

Heilmann JVIM 2018 Calprotectin (CAL) = DAMP, a product of macrophages and neutrophils, ligand is TLR4. * In this study, faecal CAL was able to differentiate IRE/SRE dogs from FRE & ARE dogs using a cut-off of 15.2+ug/g with Sn 80% & Sp 75%. * Higher FCAL in dogs with no/partial response vs complete response. * Also correlated with CCECAI score, faecal S100A12 but not CRP --> may be useful marker of disease severity (need larger studies). Heilmann JVIM 2018 (review)? Calprotectin was associated with CIBDAI score & significantly decreased after treatment.

Question 54

Are faecal calprotectin & IgA useful for puppies in diagnosis of enteropathogens?

Answer 54

Grellet JVIM 2016 No. Faecal CAL was influenced by age though (higher concentrations in younger pups). Faecal IgA concentration was LOWER in pups shedding 1+ enteropathogen vs none, but not influenced by age.

Question 55

What bacterial groups are assessed in the Dysbiosis index? What is its diagnostic performance?

Answer 55

Heilmann JVIM 2018 (Biomarker review) Total 7 groups. Blautia, Clostridium hiranonis, E. coli, Faecalibacterium, Fusobacterium, Streptococcus & Turicibacter. Sn 74%, Sp 95% | Mnemonic: Best Friends Take Care (of you) & Solve Everything Forever

Question 56

What tests may screen soft coated wheaten terriers for PLE prior to clinical signs?

Answer 56

Heilmann JVIM 2018 (biomarker review) Faecal alpha protease inhibitor (FPAI) & perinuclear anti-neutrophilic cytoplasmic antibodies (pANCAs) (latter also used to detect dogs with FRE)

Question 57

What biomarker may be able to predict requirement for immunosuppressive treatment in CE dogs?

Answer 57

Heilmann JVIM 2018 (biomarker review) CRP 9.1+; Sn 72%, Sp 100%

Question 58

(3 papers) In dogs with CIE: What is a marker of eosinophil activation/degranulation? Is it useful to differentiate amongst CE dogs? Did this marker correlate with peripheral eosinophilia or clinical severity scores? What immunohistochemical stain can be used to highlight degranulated/activated Eos on GI biopsies? What is the limitation of routine H&E in identifying these Eos? What is a marker of mast cell activation?

Answer 58

Heilmann JVIM 2018 (biomarker review) * **Serum 3-Bromotyrosine (3-BrY) for Eos** Sattasathuchana JVIM 2017 * Serum 3-BrY higher in SRE > FRE > Healthy dogs * Serum 3-BrY not associated with peripheral Eos counts or CCECAI. Bastan JVIM 2018 * Routine H&E can detect intact but not degranulated/activated Eos. * Immunolabelling with monoclonal antibodies against **eosinophil granule protein eosinophil peroxidase (Epx).** * Sig higher intact & degranulated Eos in duodenal LP of dogs with eosinophilic enteritis (EE) & mixed enteritis vs controls. Heilmann JVIM 2018 (biomarker review) * **N-methylhistamine for mast cells**

Question 59

What factors in canine CIE are associated with lower Vitamin D?

Answer 59

Wennogle JVIM 2019 * Higher CCECAI scores, lower Vitamin E (alpha tocopherol), lower cholesterol & lower albumin, higher histopathologic scores (duodenum + ileum). * Serum Vit D binding protein (VDBP) concentrations were not different. * Hypothesis: fat malabsorption contributes

Question 60

What cytokines are underexpressed in duodenal biopsies of GSDs with CE? What immunologic phenotype may this be associated with?

Answer 60

Kathrani JVIM 2019 Lower IL-13 & IL-33 mRNA expression in GSDs (vs non-GSDs with CE & healthy Beagles). Th2 cytokines.

Question 61

(2 papers) Which plasma amino acid has been associated with a higher CCECAI score in dogs? Which plasma amino acid is lower in dogs with PLE? Which biochemical parameter did this correlate with?

Answer 61

Yu JVIM 2019 Serine (Methionine & tryptophan [ ]s also lower in IBD dogs vs controls) Kathrani JVIM 2018 Tryptophan (unknown if role in pathogenesis or consequence of PLE). Correlated with serum albumin.

Question 62

What organism is neutrophilic enteritis in cats associated with?

Answer 62

Maunder JVIM 2016 Campylobacter coli

Question 63

Are serum & saliva assays to detect allergen-specific globulins useful for identifying adverse food reactions in dogs? What is the gold standard diagnostic test?

Answer 63

Lam JAVMA 2019 No, high level of positive results in healthy dogs. Elimination diet trials = gold standard.

Question 64

What is the difference in GI biopsy samples between CE dogs with normal vs low albumin?

Answer 64

Jablonski Wennogle JVIM 2017 More likely to have villous stunting, crypt distension, lacteal dilation, intraepithelial lymphocytes & LP neutrophils. Also had higher histo scores for these parameters.

Question 65

(2 papers) What parameters do contrast enhanced ultrasonography assess and what can it potentially detect? Did these parameters differ between CIE, lymphoma and healthy dogs; and following treatment in affected dogs?

Answer 65

Nisa JVIM 2019 * Duodenal inflammation (CEUS assessed intestinal perfusion parameters. Time intensity curves used to assess peak intensity (PI)). * PI & AUC were higher in symptomatic CE dogs & correlated with clinical score - potentially useful parameters to exclude CIE. But perfusion parameters for lymphoma dogs did not differ cf CIE or healthy dogs. Linta JVIM 2021 * Similarly found higher PI & AUC in duodenum of CIE vs healthy dogs. But parameters did not change with treatment.

Question 66

What was the effect of feeding an animal protein-free diet for 60 days on the microbiome in dogs with FRE?

Answer 66

Bresciani JVIM 2018 Increased microbiota richness in FRE dogs (closer to healthy microbiota), no changes in healthy dogs.

Question 67

What was the effect of feeding an animal protein-free diet for 60 days on the microbiome in dogs with FRE?

Answer 67

Bresciani JVIM 2018 Increased microbiota richness in FRE dogs (closer to healthy microbiota), no changes in healthy dogs.

Question 68

What are short chain fatty acids & their roles? What changes to SCFAs have been seen in dogs with CE?

Answer 68

Minamoto JVIM 2019 Major end products of bacterial carbohydrate fermentation in the intestinal tract. Reduced total concentrations of SCFA, including acetate & propionate. Accompanied by higher dysbiosis index & reduced microbial diversity. Barko JVIM 2018 Review - Essential energy source for colonocytes - Signaling molecules > act thru' receptors (GPR41) in enteroendocrine cells to decrease gut transit time, increase SCFA recovery & promote adiposity. - Maintain intestinal epithelial barrier - strengthen tight junctions, regulate intestinal motility, stimulate pdtn of anti-inflammatory compounds. - Bind to G-protein receptor on neutrophils to decrease migration > downregulate inflammation.

Question 69

(2 papers) What is the diagnostic utility of the ePARR protocol in differentiating lymphoma from other cases in dogs? Did this differ with sample type (FFPE vs fresh frozen tissue vs FNA)? Is clonality on PARR always associated with neoplasia?

Answer 69

Ehrhart JVIM 2018 For discrimination of LSA, ePARR had: * 92% Sn & 92% Sp, 92% accuracy for FFPE tissues * 85% Sn & 85% accuracy for flow cytometry * 100% Sn & 100% Sp & 100% accuracyfor FNA ePARR performed poorer for immunophenotyping (B vs T cell) rather than differentiating between LSA vs non-LSA> Marsilio JVIM 2019 No. Clonality (consistent with SCL or emerging) was detected in healthy cats that did not develop GI signs on long term FU. Possible reasons include benign clonality (can occur from antigenic stimulation), pseudoclonality due to insufficient target DNA, or primer binding issues.

Question 70

What scintigraphy could be useful to diagnose PLE in dogs?

Answer 70

Engelmann JVIM 2017 99mTc labelled human serum albumin (HSA) given IV. Abdo imaging obtained at 10, 60, 120, 240min post injection. Positive result for PLE = exudation of 99mTc into the intestinal tract.

Question 71

Does gastrooesophageal and/or laryngopharyngeal reflux occur in healthy dogs as detected by nuclear scintigraphy? What about aspiration?

Answer 71

Grobman JVIM 2020 Reflux but not aspiration is common in healthy dogs (100% of dogs in this study). Frequency ~2 events/5mins, duration ~6sec.

Question 72

By how much does a 1 point increase in CCECAI increase the hazard of death in PLE dogs?

Answer 72

Kathrani JVIM 2019 22.9%. Dogs with CCECAI score 8 and/or urea >7mmol/L.

Question 73

Are there any diagnostic features which can predict clinical response or outcome in dogs with PLE? What survival differences are there between PLE dogs receving steroid monotherapy vs steroid+2nd line immunosuppressant?

Answer 73

Salavati Schmit JVIM 2019 No diagnostic feature was predictive of clinical response or outcome. Median time until serum albumin reached >20 g/L = 13 days. MST 85d for steroid only dogs (13-463d), 166d for pred+2nd IS dogs (8-390d). Looking at range of MST, steroid tx alone can be appropriate for dogs with PLE.

Question 74

What cells predominate in the LN paracortex vs germinal centre? Where does lymph enter the LN?

Answer 74

Craven JVIM 2019 (PLE review) Paracortex: T cell Germinal centre: B cell Lymph enters subcapsular sinus & cortex

Question 75

What IHC markers can be used to differentiate lymphatics from capillary endothelium?

Answer 75

Craven JVIM 2019 (PLE review) Prox-1 & CD31

Question 76

What bacteria/toxin is associated with AHDS in dogs?

Answer 76

Sindern JVIM 2018 Clostridium perfringens which encodes pore-forming toxin genes *NetE & NetF.* Prevalent in 48% AHDS dogs (0% CPV dogs & 12% healthy dogs).

Question 77

What is intestinal leiomyositis? Describe associated imaging findings. What is an important consideration when obtaining intestinal biopsies for diagnosis? Treatment options & prognosis?

Answer 77

Zacuto JVIM 2016 Suspect autoimmune condition affecting intestinal s.m. Causes dysmotility and pseudoobstruction. Marked gastric distention & dilated SI. **Requires full thickness GI biopsies for diagnosis (disease in muscularis propria layer)** Histology - mononuclear inflammation, myofiber degeneration & fibrosis. Various treatments trialled without significant clinical improvement. Prognosis guarded; MST 19d.

Question 78

What % of dogs with acute haemorrhagic D+ subsequently develop chronic GI signs?

Answer 78

Skotnitzki JVIM 2021 28% of AHDS dogs, median 4 years for development of chronic GI signs. Possible that AHDS induced severe intestinal mucosal damage & associated barrier dysfunction may trigge chronic GI disease later in life.

Question 79

What % of dogs attending dog parks in N California had enteropathogens detected? The presence of which pathogen affected faecal consistency in these dogs, and what diagnostic tests for reliable for its detection?

Answer 79

Hascall JVIM 2016 38% dogs (of which 46% had D+). Presence of Giardia associated with D+ (9% dogs infected) **Giardia PCR not useful; **negative in 41% dogs that were faecal float positive or direct fluorescent antibody test. Identification of Giardia cysts also variably reliable depending on lab.

Question 80

Which 2 enzymes is cobalamin a cofactor for? What does an increase in methylmalonic acid (MMA) lead to? What are methods of identifying cobalamin deficiency apart from a serum cobalamin level?

Answer 80

Kather JVIM 2019 (Cobalamin review) Methionine & Methylmalonyl CoA. MMA increases if MMCoA not active. MMA inhibits carbamoyl phosphate synthetase (which converts ammonia to carbamoyl phosphate) --> hyperNH3 results Increased serum homocysteine & MMA concentrations.

Question 81

What is Imerslund-Gräsbeck syndrome? What breeds does it affect? What treatment options exist?

Answer 81

Kook JVIM 2018 Congenital cobalamin malabsorption. Beagles. Also Aus Shepherds, Beagles, Border Collies, Giant Schnauzers. Maintenance dose of monthly or bimonthly 1mg SQ HYDROXOcobalamin (OH-Cl) was effective in this paper - both resulted in similar urinary MMA concentrations. Kook JVIM 2019 1mg PO SID was also effective to maintain urinary [MMA] WRI.

Question 83

What type of anemia can be observed in a hypocobalaminemic state? Was this observed in a population of anemic dogs?

Answer 83

Stanley JVIM 2019 Megaloblastic (macrocytic), non-regenerative. Anemic dogs had high prevalence of vitamin B deficiencies (NR: 64% hypoB12, 18% hypofolatemic) but no association of low B12 with megaloblastic anemia.

Question 84

What hematologic parameters are altered in pregnant bitches? Which stage of pregnancy were these observed (early or late)? Did changes influence neonatal survival?

Answer 84

Nivy JVIM 2019 Anemia common in LATE pregnancy. Also associated with increased serum iron & transferrin saturation (opposite of women), decreased serum B12 (severity increased with larger litter size & parity no.). No association with neonatal survival.

Question 85

Was PO cobalamin supplementation effective for treatment of hypocobalaminemic dogs with chronic enteropathies?

Answer 85

Toresson JVIM 2016 Yes, 100% dogs (51/51) became normocobalaminemic. Serum B12 rechecked at 20-200days. Used CYANOcobalamin of various brands. (NB: Protexin cobalazorb = cyanocobalamin)

Question 86

(2 papers) What are the effects of metronidazole on: - Dogs with acute diarrhoea - Faecal microbiome & metabolome of healthy dogs?

Answer 86

Langlois JVIM 2020 (acute D+ dogs) Metro reduced time to resolution of D+ (2.1 vs 3.6 days) and reduced % of dogs with C perfringens carriage post treatment (23% vcs 78%). Long term effects and overall utility not studied. Pilla JVIM 2020 Metro x14d in combo with hydrolyzed protein diet vs metro only vs healthy dogs. Metro significantly decreased microbiome richness (impt bacteria e.g. Fusobacteria) that did not fully resolve 4 weeks after stopping drug. Increased dysbiosis index, faecal total lactate; decreased 2' bile acids (deoxycholic acid & lithocholic acid).

Question 87

What is the effect of hospitalisation on gastric emptying time in dogs?

Answer 87

Warrit JAVMA 2017 Assessed using wireless motility capsule. Hosp prolongs gastric emptying time. Median 71hrs vs 17hrs @ home.

Question 88

Based on a systemic review, is probiotic administration effective in preventing or treating acute vs chronic GI disease in dogs?

Answer 88

Jensen JVIM 2019 Limited-negligible effect for prevention or treatment of acute GI disease. For chronic GI disease, dietary intervention remains most impt. Probiotics didn't seem to significantly improve clinical signs. But overall noted that studies were often underpowered.

Question 89

What was the effect of Synbiotic administration on diarrhoea in kennelled dogs?

Answer 89

Rose JVIM 2017 Pre-probiotic mixture. Decreased incidence (18.8% vs 27.2%), no. of days (2 vs 3.2), & occurrence of 2+ days of D+ (4.6% vs 8%).

Question 90

(2 papers) What are the effects of synbiotic administration on: 1. Healthy cats receiving clindamycin? 2. Healthy dogs receiving enrofloxacin & metronidazole?

Answer 90

1. Stokes JVIM 2017 (cats) Reduced V+ & improved appetite - clinical benefits may persist for 6 weeks after drug discontinuation. Did not reduce D+. 2. Whittemore JVIM 2019 (dogs) Decreases food intake derangements. Resulted in milder GI signs after several weeks of treatment --> suggesting that clinical effects of synbiotics persist >9 weeks after drug discontinuation.

Question 91

What bacterial strain does Prokolin Advanced contain? What was the effect of Prokolin Advanced on acute D+ in dogs?

Answer 91

Nixon JVIM 2019 Enterococcus faecium 4b1707. Placebo-controlled trial. Reduced duration of D+ (32hrs vs 47hrs). Rate of resolution was 1.6x faster in probiotic treated dogs.

Question 92

What were the effects of administering a probiotic containing Enterococcus faecium SF68 on biochemical variables in dogs?

Answer 92

Lucena JVIM 2019 No changes in liver enzymes (ALT, ALKP). Decreased chol by D28, progressive increase in TG (1/36 dogs became hyperTG). Changes were not clinically relevant in this study, but longer trial needed to assess this.

Question 93

(2 papers) What % of patients experience complications from O tube placement, and was this different between dogs & cats? What % of patients with complications required surgical intervention or were euthanised due to tube-related complications? Separate study: what are the two primary complications with O tube placement in cats?

Answer 93

Nathanson JVIM 2019 44% complication rate, similar amongst dogs vs cats (43 vs 45%). 22% cats & 35% dogs required sx debridement. 3% patients euthanised. Breheny JVIM 2019 Overall 35% complication rate. Tube dislodgement 15%, infections 12%. Increased risk of infection with steroids, oncolytic agents or discharge at stoma site.

Question 94

Does prophylactic administration of maropitant & metoclopramide reduce the incidence of post-op GI reflux in dogs?

Answer 94

Jones JAVMA 2019 No.

Question 95

What were the effects of prophylactic maropitant administration in cats receiving dexmedetomidine & morphine?

Answer 95

Martin-Flores JAVMA 2016 Maropitant given 20hrs prior. Significantly decreased incidence of emesis but did not decrease incidence of signs of nausea.

Question 96

What is prevalence of GE reflux during anaesthesia for cats? Did pre-GA omeprazole administration affect serum gastrin concentration & gastric pH in these cats?

Answer 96

Garcia JVIM 2017 Omeprazole x2 doses given 18-24hrs & 4hrs before GA. 33% (similar to dogs). Omeprazole did not sig increase serum gastrin concentration, but significantly increased gastric pH (7 vs 2.8 for controls).

Question 97

Do swallow study findings change with age in dogs?

Answer 97

Harris JVIM 2017 No differences in swallow metrics across age groups. Study noted GE reflux occurs in healthy dogs (concordant with Grobman JVIM paper).

Question 98

What oesophageal dysmotility disorders have been observed in brachycephalic dogs on VFSS assessment?

Answer 98

Eivers JVIM 2019 Prolonged oesophageal transit time, decreased propagation of secondary peristaltic waves, GERD, hiatal hernia.

Question 99

What type of hiatal hernia is most common in cats? Congenital or acquired? What % had comorbidities? Were there survival differences in cats treated medically vs surgically?

Answer 99

Phillips JVIM 2019 Type 1 HH (85%). Acquired likely more common (68% cats 3yo+). 77% had comorbidities (commonly respiratory - URT obstruction). Medically managed cats survived longer (MST 2559d vs 771d for sx). | Recap: hiatal hernia types - Type 1 (sliding) - Type 2 (paraesophageal)

Question 100

What comorbidity is commonly seen with chronic feline gingivostomatitis?

Answer 100

Kouki JVIM 2017 Oesophagitis +/- columnar metaplasia. Lack of GI signs. Salivary & oesophageal pH same as controls.

Question 101

(2 papers) What VFSS findings are observed in dogs with LES achalasia-like syndrome? What oesophageal disorder can be associated with LES achalasia-like syndrome in dogs? And what %? What treatments are available & what is the clinical response?

Answer 101

Grobman JVIM 2019 **Megaoesophagus (73.7%).** Baseline oesophageal fluid-line (68.4%) “Bird beak” (63.2%) - *dilated distal oesophagus terminating in an elongated taper (“bird beak”) through the LES during active pharyngeal swallowing* Oesophagus ranged from acontractile, hypo to hypermotile. Grobman JVIM 2019 **Mechanical dilation (balloon or bougienage), botulism toxin A injections, or LES myotomy & fundoplication **(creating a sphincter around the LES using the gastric fundus to prevent reflux). This study tried balloon dilation + BTA injections 1st - 100% dogs had significant CSx improvement (80% reduction in regurg, increased BW) by 21d & lasted for 40d. 6 dogs had persistent megaO & abnormal O motility --> later had myotomy & fundoplication with sustained improvement though megaO persisted.

Question 102

(3 papers) How may famotidine be given to improve its efficacy? What occurs with chronic use (14+ days) of oral administration? How can this effect be attenuated?

Answer 102

Tolbert JVIM 2019 (dogs) Famotidine CRI suppresses acid production in people, as opposed to IV bolus therapy. Chronic use diminishes efficacy of oral famotidine (increased mean % time of intragastric pH <3 or 4). Hedges JVIM 2019 (dogs) Famotidine 8mg/kg/d CRI after 1mg/kg IV loading dose (but not standard doses) achieved clinical goals as in people (MPT ingastric pH 3+). Alternative to IV PPI in dogs. Golly JVIM 2019 (cats) Famotidine PO BID administration diminished efficacy on intragastric pH in healthy cats. This was avoided by twice daily EOD dosing.

Question 103

(2 papers) What is the difference between omeprazole and esomeprazole? What is the efficacy of esomeprazole in dogs with different routes of administration? Is drug efficacy dose-dependent? What dose is indicated?

Answer 103

Hwang JVIM 2017 Omeprazole = racemic mixture of R and S enantiomers (converted to active form in acidic compartment of gastric parietal cells). **Esomeprazole is the S enantiomer. ** In this study was effective given PO, IV and SQ to healthy Beagles. Bioavailability: SC (106%) > PO enteric-coated granules (71%). ** BUT highest efficacy for PO** (based on mean % time gastric pH 3+ or 4+) 0.5-1mg/kg IV BID (similar to other study) Seo JVIM 2019 No difference in PK parameters & acid suppressant effect for 0.5 & 1 mg/kg esomeprazole IV BID. MPT for intragastric pH 3+ or 4+ = 81-90% collectively - effective to increase intragastric pH in healthy Beagles.

Question 104

What is the effect of sucralfate on gastric mucosal permeability in dogs exposed to acid injury (using an ex-vivo stomach model)?

Answer 104

Hill JVIM 2018 Sucralfate application at time of/after injury significantly reduced the time to recovery of barrier function. Potential utility to treat/prevent stress-related mucosal disease.

Question 105

Does sucralfate administration affect bioavailability of fluoroquinolones? Did effects differ between FQs?

Answer 105

KuKanich JVIM 2016 Concurrent sucralfate administratino reduced mean bioavailability for ciproflox (48% relative to ciproflox alone), which improved to 87% when delayed by 2hrs. But no sig diff in bioavailability for concurrent sucralfate + enroflox (104% bioavailability).

Question 106

(3 papers) What factors were associated with oesophageal perforation from FB? What was the survival rate to discharge for these dogs, and was surgical intervention always necessary? What were the risk factors for requiring sx in dogs with oesophageal FB obstruction? What was a major post-procedural complication & how common was it? What was the most common location for O FB?

Answer 106

Sterman JAVMA 2018 Risk factors - fishhooks, delay between ingestion & evaluation. 12% perforation (or suspected). 87% (13/15) survival to discharge. No, 8/13 surviving dogs did not require sx intervention. Brisson JAVMA 2018 Terrier breeds (30.5%), duration of FB entrapment, BW, anorexia, lethargy, rectal temp, O perforation. 94.6% survival to discharge, 88% with excellent long term outcome. Complication - O stricture (11.2%). Burton JVIM 2017 Distal O = most common location (50%). Sx required in 6% dogs. Similar survival rate as above studies (95%). Risk factors for death - increased # of post-procedural complications including O haemorrhage, O perforation, if endoscopy post-sx was recommended but declined. Length of CSx was NOT. O stricture rate 2.1% (lower than Brisson paper but not all dogs had FU).

Question 107

What is the recommended treatment for sialocoele in dogs & what is the rate of recurrence? What is an alternative therapy?

Answer 107

Poirer JVIM 2018 Surgery, recurrence 5-14%. Radiation therapy (salivary gland is highly sensitive to RT). 54% CR & 45% PR. Min total 16 or 20Gy in 4Gy fractions appeared effective for refractory sialoceles (remission >2yrs).

Question 108

xxx What are some differences clinically and biochemically between dogs with chronic gastritis and gastric carcinoma?

Answer 108

JVIM 2019 Dogs with carcinoma were older, had lower BCS, lower folate and higher CRP (25+)

Question 109

What is a potential sequelae to abrupt withdrawal of chronic PPI administration in cats? Did this result in derangements in electrolytes (Ca, Mg) or cobalamin?

Answer 109

Gould JVIM 2016 (60d omeprazole course in this study, healthy cats). Rebound acid hypersecretion. NO changes in Ca, Mg or B12, but caused hypergastrinemia.

Question 110

(2 papers) What is the increased odds of GI mucosal lesions (specifically lesion scores 4+ = >25 hemorrhages or punctate erosions, ≥1 invasive erosion, and/or ≥1 ulcer) associated with: a) prednisolone b) clopidogrel c) prednisolone/clopidogrel combination d) prednisolone/aspirin combinationd

Answer 110

Whittemore JVIM 2019 - Aspirin - odds not mentioned but higher lesion scores noted on D14 - Pred 11x higher odds - Pred/aspirin combo 31.5x higher odds Whittemore JVIM 2019 - Clopidogrel/prednisolone: 7x higher odds - Pred: 7x higher odds. In both studies, lesions were severe in many cases, and worse on D14 cf D28, but dogs were not clinical.

Question 111

What is the effect of liver disease on mirtazapine pharmacokinetics in cats? Does this affect dosing considerations?

Answer 111

Fitzpatrick JVIM 2018 Delayed time to maximal concentration (4hrs vs 1hr), prolonged half life (14hrs vs 7hrs). T1/2 correlated with ALT & TBIL. Cats with LD might require less frequent administration of mirtazapine (study didn't suggest how often)

Question 112

What are some differences clinically and biochemically between dogs with chronic gastritis and gastric carcinoma?

Answer 112

Seim-Wiske JAVMA 2019 Dogs with carcinoma were older (>8yo), had lower BCS, lower folate & higher CRP (25+mg/L)

Question 113

xxx paper? What was the reported concordance between SNAP FPL and spec FPL?

Answer 113

JVIM 2019 97% agreement when SNAP was low, 90% agreement when SNAP was high.

Question 114

Name 4 risk factors for death in acute pancreatitis in dogs. What scoring system were these 4 factors incorporated into to allow early & accurate prediction of short-term death in dogs with AP?

Answer 114

Fabrès JVIM 2019 SIRS, coagulation disorders, increased creatinine, ionized hypocalcemia. Canine Acute Pancreatitis Severity (CAPS) score. (simplied sCAPS = used RR instead of SIRS)

Question 115

What is the Sn/Sp of FUJI DRI chem lipase for the diagnosis of acute pancreatitis in dogs?

Answer 115

Yuki JVIM 2016 Sn 100%, Sp 89.5%, AUC 98% Study also suggested CRP may be useful biomarker for recovery (sig diff at 5d post-tx cf baseline); and high ALT associated with extended hospitalisation.

Question 116

Is Beta-HB increased in dogs with acute pancreatitis without DM?

Answer 116

Hurrell JVIM 2016 Yes, median 0.3mmol/L (range 0-2.9). BHB was higher in AP w/o DM > sick dogs w/o AP > healthy fasted dogs.

Question 117

What CT changes may be seen in dogs with acute pancreatitis, and how did this compare to ultrasound?

Answer 117

French JVIM 2019 CT better to identify portal v. thrombosis cf US. Overall CT better identified dogs with more severe disease (heterogenous contrast enhancement) - as this was associated with longer hospitalisation, more relapses & more likely to have portal vein thrombosis. | See Cridge JVIM 2020 paper on US

Question 118

In a non-blinded JSAP study, what was the effect of prednisolone in the initial treatment of dogs with acute pancreatitis?

Answer 118

Okanishi JSAP 2019 Study used prednisolone 1mg/kg PO SID. Faster improvement in CRP, clinical score & reduced mortality at 1 month (11.3% vs 46.1%).

Question 119

In a JSAP study, what was the cut-off DGGR lipase activity (in U/L) with the highest Sn/Sp for the diagnosis of acute pancreatitis in dogs?

Answer 119

Hope JSAP 2021 DGGR >42.15 U/L - Sn 81%, Sp 92% (NB: lower cut-offs cf previous papers of >80 or >130 - these had good Sp >90% but poor Sn ~40%)

Question 120

xx paper? How well does pancreatic ultrasound correlate with Spec cPL for the diagnosis of pancreatitis?

Answer 120

JVIM 2019 Weakly. this study used a clinical assessment as the gold standard for diagnosis of pancreatitis and found that the degree of ultrasound changes affected the Sn/Sp of ultrasound, with enlargement, pancreatic and mesenteric changes all being present, Sn 43 and Sp 92

Question 121

What sonographic changes of the stomach may be encountered in dogs with acute pancreatitis?

Answer 121

Murakami JVIM 2019 Increas gastric wall thickness (oedema) with thickened hyperechoic submucosa in most (12/14) +/- muscularis. Focal thickening (adjacent to pancreatitis) predominantly. Complete loss of wall layering in 2/14 dogs. US changes resolved with treatment in 3/14 dogs that had FU.

Question 122

What is asymmetric dimethylarginine (ADMA)? What is its utility as a marker in canine acute pancreatitis?

Answer 122

Gori JVIM 2020 ADMA = potent endogenous inhibitor of NO synthesis, increased [ ] indiates NOS imbalance, encountered in SIRS, sepsis, CVS disease (people). Serum ADMA was higher in AP dogs vs controls, positively correlated with CAPS (clinical score). Also may be prognostic - associated with mortality. Survivors had sig decrease in ADMA at revisit cf admission.

Question 123

What was the survival rate of dogs with PABDO (pancreatitis-associated bile duct obstruction), and how long did biochemical parameters take to improve? Did the severity of bile duct dilation influence outcome?

Answer 123

Wilkinson JVIM 2020 79% survival, of which 94% had medical management alone. Serum TBIL elevation peaked at 8d (though CSx improved by then). TBIL decline starts ~15d. Severity of BD dilation (6-7mm) & peak TBIL (180-200mmol/L) did not differ between survivors & non-survivors.

Question 124

How did 4 assays (SNAP cPL, Spec cPL, VetScan cPL Rapid Test, Precision PSL) compare in the diagnosis of pancreatitis in dogs? Specifically what were the Sn/Sp for VetScan cPL Rapid Test & the Precision PSL assays?

Answer 124

Cridge JVIM 2018 Good to excellent level of agreement amongst 4 assays. But author emphasizes that still need to correlate with clinical findings to confirm diagnosis. Sn across 4 assays = 74-100%. VetScan 74-83%. Sp: VetScan cPL Rapid Test (77–83%) > Spec cPL (74-81%) > SNAP cPL (71-77%) > Precision PSL (64–74%).

Question 125

What was the survival rate documented in a large retrospective feline pancreatitis study? What % of cats had EHBDO identified on US? And a positive prognostic indicator?

Answer 125

Nivy JVIM 2018 77.7% survival to discharge. Causes - 86.6% idiopathic (ddx GA< trauma, OP toxicosis, hemodynamic compromise). 24% EHBDO. Positive px indicator - antibiotic treatment.

Question 126

How did spec FPL compare to DGGR lipase assay for the diagnosis of pancreatitis in cats? And did these tests correlate with pancreatic histopathology?

Answer 126

Oppliger JVIM 2016 Similar performance for both assays. Both had poor Sn (spec FPL 42%, DGGR 36%) but excellent Sp (100% both). Both had limited agreement with pancreatic histo (sig decrease in Sn/Sp when lymphocytic inflammation up to 10% in a section was considered normal).

Question 127

What serum vitamin levels have been shown to be lower in dogs with EPI? Did these improve with treatment?

Answer 127

Barko JVIM 2018 Retinol & alpha-tocopherol. 25OHD significant lower in EPI dogs with weight loss. Altered homeostasis of lipid-soluble vitaminds did not change with enzyme replacement therapy.

Question 128

What similarities & differences in clinical presentation & treatment can be seen in cats vs dogs with EPI? What % of cats have hypocobalaminemia & folate derangements?

Answer 128

Xenoulis JVIM 2016 77% low B12. 47% increased folate, 5% decreased folate. CSx - Similar: weight loss (91%), poor hair coat (50%) - Diff: appetite variable - anorexia (45%) vs increased appetite (42%), lethargy (40%). Unformed faeces (62%), watery D+ (28%) - much more common in dogs. - V+ (19%) - Wide age range (can be

Question 129

What 2 drugs were identified as potential treatments for hepatic lipidosis (HL) in cats based on an organoid study?

Answer 129

Haaker JVIM 2019 **T863** * DGAT1 inhibitor (primary enzyme responsible for triacylglycerol (TAG) synthesis from external FFAs) **AICAR ** * Decreases PLIN2 (perilipin 2) mRNA (protein which stabilises lipid droplets) Overall both drugs decreased TAG accumulation by 46% & 55% respectively.

Question 130

(3 papers) What parasitic agent(s) have been associated with pancreatic disease in cats? What sample type has a higher egg count yield to identify the parasite listed above?

Answer 130

Xenoulis JVIM 2016 Trematode (flukes) - Eurytrema procyonis (Raccoon pancreatic fluke) - associated with EPI & pancreatitis. Köster JFMS 2016 Platynosomum spp. - cat specific, live in hepatic ducts & GB. Tropical & subtropical regions. Rare but can cause eosinophilic pancreatitis. Köster JVIM 2016 Bile better than faeces for Platynosomum spp. (1450 eggs/mL vs 46 eggs/mL). Consider cholecystocentesis for bile analysis for cats with chronic cholangitis/cholecystitis & negative FEC for Platynosomum.

Question 131

What other congenital disease is gallbladder agenesis associated with in dogs? What imaging findings are seen with GB agenesis? What breed was overrepresented in this study?

Answer 131

Sato JVIM 2018 Ductal plate malformation (16/17 dogs), acquired PSS (5/17) CBD dilation w/o BD obstruction. Chihuahuas (10/17; 59%)

Question 132

What % of bile cultures were positive in dogs vs cats in a 2016 study? What were the most common isolates? Was presence of infection always associated with cytological inflammation? What biochemical marker is associated with a positive bile culture in cats & dogs? What had higher yield for microorganisms, cytology or culture? In a separate study, did biliary ultrasound findings correlate with positive bile cultures in dogs vs cats?

Answer 132

Peters JVIM 2016 - Dogs 30% positive (only 5% had inflammation), cats 22% positive (19% had inflammation). Cats more likely to have inflammatory + infectious bile, whereas bactilia more commonly occurs in dogs w/o associated inflammation. - Cytology (24%) vs culture (21%). - E coli (15%), Enterococcus (6.7%) - CPLI - associated with presence of microbes and/or inflammatory cells. Pashmakova JAVMA 2017 Cats & dogs 33% had bactibilia on cytology, but only 21% had positive bile C&S. *(Did not differentiate by spp. & not all had both aerobic/ anaerobic cultures)* Tamborini JVIM 2016 Dogs. Isolates - E coli, Enterococcus, Clostridium. Policelli Smith JVIM 2017 - Cats: abnormal GB US has high Sn 96% but poor Sp 49% for positive vs negative bile C&S results respectively. **So US has high NPV 96%** (normal US > positive C&S highly unlikely). - Dogs: GB US has lower Sn 81%, poor Sp 31%, **NPV 88%** to predict bile infection (meaning even with abnormal GB, positive bile C&S unlikely).

Question 133

(2 papers) What is a significant concern based on bile culture results influencing treatment decisions in dogs with cholangitis/ cholecystitis? What improved prognosis in dogs with cholangitis/ cholangiohepatitis in a retrospective study? What was one negative prognostic indicator? What was the most common histologic findings? What % of dogs had positive liver and/or bile cultures?

Answer 133

Tamborini JVIM 2016 - Antimicrobial resistance was an important feature of aerobic isolates (10/16 E. coli isolates were resistant to 3+ abx classes). Harrison JVIM 2018 - Cholecystectomy reduced risk of death. MST 671d. - Age (>13yo) had 5x greater hazard of death. Neutrophilic inflammation (>> lymphocytic) 47% bile, 44% liver Parkanzky JVIM 2019 Evaluated long term survival of GBM dogs that underwent cholecystectomy. If survive 14d post-op, MST 1802d (sx), 1340d (med). But **MST much shorter (203d) if initial medical management but then required sx. ** Decreased survival associated with higher GBM type, ALKP increase. --> Overall med management is still reasonable alternative if cannot pursue sx (as long as emergent sx is not indicated down the road).

Question 134

(3 papers) What is the Sn/Sp for AUS to detect ruptured GB mucoceles in dogs? Does rupture have prognostic significance?

Answer 134

Jaffey JVIM 2018 High Sp 91% but poor Sn 56%. PPV 6.74, GB rupture + bile peritonitis associated with 2.7x increased likelihood of death. Tamborini JVIM 2016 Biliary tract rupture (33% cases) significantly increased mortality (50%). Youn JAVMA 2018 Significantly increased mortality in non-elective (20%) vs elective cholecystectomies (2%). Higher TBIL & ALT, lower alb associated with non-survival.

Question 135

What is leptin? What alterations in leptin expression were observed in dogs with GBM?

Answer 135

Lee JVIM 2017 Leptin = hormone derived from mature adipose tissue. Role in energy metabolism (central level). Primarily functions as a fasting hormone through regulating food intake & energy consumption. Also physiological modulator in several diseases (e.g. pancreatitis, endocrinopathy, neoplasia). GBM dogs have increased serum leptin; increased GB tissue leptin mRNA & leptin receptor expression. No diff in serum leptin amongst GBM dogs with/without endocrinopathies. GBM dogs undergoing sx had higher serum leptin vs those that did not.

Question 136

Why is urine analysis important in dogs with GBM? How does the clinical finding impact prognosis in these dogs?

Answer 136

Lindaberry JVIM 2021 Proteinuria is significantly associated with GBM formation in dogs; also increased magnitude with disease severity. Diagnosis & treatment of proteinuria in GBM dogs might minimize long term morbidity from renal disease.

Question 137

What coagulation derangements occur in dogs with GBM?

Answer 137

Pavlick JVIM 2021 Hypercoagulable state in 83% GBM dogs based on whole blood kaolin-activated TEG. Plasma-based coagulation testing - increased total protein C activity, fibrinogen, platelet counts & D-dimers; prolonged APTT, low vWF activity. Suggest more complex state of hemostasis.

Question 138

What dog breed in the UK is predisposed to developing GBMs? Were there any other breed-specific clinical factors influencing treatment or prognosis?

Answer 138

Allerton JVIM 2018 Border Terriers (85x odds). None identified in this study (similar clin path changes, no endocrinopathies associated).

Question 139

Were dogs with cholelithiasis more likely symptomatic or subclinical? Were there differences in outcome between medically vs surgically vs combo treated dogs?

Answer 139

Allan JVIM 2021 Symptomatic more likely (44%). No. Cholelith resolution observed in 50% med, 71% sx, 50% no tx (note small #s). Medical tx can be effective depending on clinical presentation & cholelith location (also #?). **(All dogs with choledocholithiasis were symptomatic/painful - sx indicated). ** MST 457d (no diff between incidental vs symptomatic dogs.

Question 140

What endocrinopathy is associated with cholestatic disease with/without GBM in dogs? What differences in drug requirements were observed between GBM+PDH dogs vs cholestasis+PDH & PDH only dogs? What is a proposed reason (wrt drug PK) for this difference?

Answer 140

Kim JVIM 2017 PDH. GBM+PDH dogs had more severe CSx & sig diff serum cholesterol & post-ACTH stim cortisol at diagnosis. GBM+PDH dogs required higher optimal trilostane dosages (2.5x) cf cholestasis+PDH group (1.5x) & PDH only group. Cholestatic disease may decreased ability of bile secretion (trilostane is hydrophobic - metabolised in liver & requires bile for excretion)

Question 141

What coagulopathy is associated with high disease severity in dogs with chronic hepatitis? What TEG finding is a negative prognostic indicator in these dogs?

Answer 141

Fry JVIM 2017 Hyperfibrinolysis (higher ALT) Hypocoagulable state (dogs with portal hypertension)

Question 142

What was the Sn/Sp of the following markers for acute vs chronic hepatitis (respectively) in Labradors: - ALT - ALKP - Serum BA

Answer 142

Dirksen JVIM 2017 In general all 3 markers have poor Sn for acute, & highly variable Sn for chronic. All had excellent Sp for acute, chronic & reactive hepatitis (>90%). 1. ALT - Sn 45% for acute, 71% for chronic. 2. ALKP - Sn 15% for acute, 35% for chronic. 3. SBA - Sn 15% for acute, 13% for chronic. In dogs with increased LE, ALT was sig higher in primary (312) vs reactive hepatitis (91), but ALKP were not sig different.

Question 143

(3 papers) What microRNA panels may be useful biomarkers to diagnose hepatobiliary diseases? What about the utility of miRNAs in monitoring therapeutic response & disease progression as evaluated in a study of Labradors with chronic hepatitits?

Answer 143

Dirksen JVIM 2016 miRNA panel can differentiate between various liver diseases: - **miR-126 **- chronic hepatitis - **miR-200c **- HC carcinoma - **miR-21 & 222 **- GBM - **miR-122** highest in GBM group - No difference in miRNA [ ] in congenital PSS or adenoma groups Oosthuyzen JVIM 2018 **miR-122 **can be used to diagnose liver disease in dogs. Upper RI (3312 copies/uL) had Sn 77% & high Sp 97%. Sakai JVIM 2019 **Serum miR-122 & miR-29a ** positively correlated with grade of CH & stage of fibrosis in Labs. May be useful to monitor response to tx & disease progression.

Question 144

Were the following serum biomarkers (IL-6, CCL2, CRP) useful in identifying dogs with hepatic fibrosis or necroinflammatory disease?

Answer 144

Raghu JVIM 2018 Overall single measurements have limited utility. IL-6 was ~2x increased in dogs with high fibrosis scores (but marginal stat sig). CCL2 significantly higher in dogs with necroinflammatory dz, but had considerable overlap with dogs w/o. CRP & AST:ALT ratios correlated poorly fibrosis & necro-inflammatory scores.

Question 145

Were the following serum biomarkers (IL-6, CCL2, CRP) useful in identifying dogs with hepatic fibrosis or necroinflammatory disease?

Answer 145

Raghu JVIM 2018 Overall single measurements have limited utility. IL-6 was ~2x increased in dogs with high fibrosis scores (but marginal stat sig). CCL2 significantly higher in dogs with necroinflammatory dz, but had considerable overlap with dogs w/o. CRP & AST:ALT ratios correlated poorly fibrosis & necro-inflammatory scores.

Question 146

What is the interobserver agreement like for liver histology?

Answer 146

Lidbury JVIM 2017 Fair for fibrosis but poor for necroinflammatory. Authors recommended 1+ pathologist to evaluate each section.

Question 147

How common is concurrent pancreatic injury evident in dogs with DKA? Did this influence disease progression & outcome?

Answer 147

Bolton JVIM 2016 73% in this study (based on increased cPLI). No. Similar periods of hospitalisation & short-term outcome (survival to discharge).

Question 148

Can RBC and/or plasma glutathione (GSH) concentrations predict liver GSH levels in dogs?

Answer 148

Barry-Heffernan JVIM 2019 No. But dogs undergoing liver bx had evidence of increased systemic oxidative stress vs healthy controls.

Question 149

What was the diagnostic agreement of laparoscopic punch, cup & needle biopsies compared to wedge for the liver?

Answer 149

Kimbrell JVIM 2018 Compared 3mm to 5mm cup forceps. 3mm lap cup biopsy forceps had smaller tissue yield (less portal triads), but maintained a similar level of histologic diagnostic accuracy to 5mm cup. 67-69% agreement.

Question 150

What is perflubutane? What could it be used to differentiate in dogs with liver disease?

Answer 150

Morishita JVIM 2017 A second generation ultrasound contrast agent. Phagocytosed by Kupffer cells. Washout ratio of this agent in the hepatic vein was able to predict hepatitis from other non-inflammatory disorders (congenital PSS, PHPV), with **Sn 100% & Sp 85% using a cut-off of

Question 151

What is the impact of obesity on the liver biochemically and on ultrasound?

Answer 151

Belotta JVIM 2018 Associated with higher ALP & GGT. Also changes in portal vein indices (e.g. portal blood flow volume) & abnormal HV spectral wave.

Question 152

1. What histologic finding seen with chronic hepatitis in dogs has significant prognostic indications? 2. What do hepatic stellate cells mainly store? 3. What is a key event in the development of hepatic fibrosis? 4. What 2 substances are the primary mediator & accelerator of HF respectively? 5. List other key players in the pathogenesis of HF. Name 1 cell type involved in HSC apoptosis.

Answer 152

Eulenberg JVIM 2018 (Hepatic fibrosis review) 1. Hepatic fibrosis. Contributes to development of portal hypertension & acquired PSS. 2. Vitamin A. 3. **Activation of hepatic stellate cells (Ito cells)** = key step in the development of hepatic fibrosis. Stellate cells undergo phenotypic changes which promote myofibroblastic phenotype >> ultimately ECM deposition. 4. Most potent mediator of HSC proliferation = **platelet derived growth factor (PDGF)**. Also a chemoattractant & guide HSCs to site of injury. PDGF is release by platelets, sinusoidal endothelial cells, liver resident Mp, myofibroblasts. - Transforming growth factor beta-1 (TGFB-1) = major accelerator of HF. Portal fibroblasts, connective tissue growth factor (CTGF), endothelin-1, Local RAS, ROS, hepatocytes, cholangiocytes, sinusoidal endothelial cells. NK cells (HSC apoptosis).

Question 153

What are the distinct clinical features of lobular dissecting hepatitis? Prognosis?

Answer 153

Eulenberg JVIM 2018 (Hepatic fibrosis review) - Typically (not always) affects young dogs (~2yo) - Breeds: Standard Poodle, Rottweiler, GSD, GR, American Cocker Spaniel. - Disease progerssion is rapid. Poor px with short survival. - Histo: diffuse inflammatory cell infiltrate & dissection of the lobular parenchyma with reticulin fibers (type III collagen) surrounding single or small groups of hepatocytes.

Question 154

Name 2 mechanisms contributing to ascites with chronic hepatitis in dogs. A minimum of how many portal triads is recommended for pathologist interpretation? Name 3 special stains that allow for more accurate histologic assessment of HF.

Answer 154

Eulenberg JVIM 2018 (Hepatic fibrosis review) - Combo of splanchnic arterial vasodilation, decreased cardiac output & RAS activation > Na & H2O retention. - High sinusoidal pressure drives fluid into the interstitial space Ascites = negative px indicator in CH dogs. 11 portal triads. Masson’s trichrome stain - stains type I collagen fibers Picrosirius red - stains type I & III collagen fibers Reticulin - stains reticulin fibers (type III collagen)

Question 155

What is the effect of endothelin-1? What may it be increased with?

Answer 155

Sakamoto JVIM 2017 Vasoactive peptide; released from sinusoidal endothelial cells and induces vascular smooth muscle & stellate cell contraction. In this study, hepatic ET-1 mRNA levels & plasma ET-1 protein levels were increased in CH dogs (3.7x controls). Weak but significant positive correlation between plasma ET-1 & splenic pulp pressures (as indicator of portal hypertension).

Question 156

What was the impact of cyclosporine treatment on dogs with presumed CH?

Answer 156

Ullal JVIM 2019 78% dogs achieved biochemical remission (defined as ALT <1.1x URI of ALT) with CsA + hepatoprotectant combo. Time to remission 2.5mths, median CsA dose 7.9mg/kg/d. 38% GI signs, 25% gingival hyperplasia. No clinicopathological factors evaluated including hepatoprotectant use were sig associated with likelihood of remission.

Question 157

What is the evidence for autoimmune hepatitis in Dobermans?

Answer 157

Dyggve JVIM 2017 Increased levels of anti-histone autoantibodies detected in 92% subclinical & 84% clinical Dobermans. Suggestive of autoimmune disease & potential screening test. *(AHA = subset of anti-nuclear antibody family; target histone protein subunits or histone complexes)*

Question 158

What is p21 & what is its potential prognostic impact in dogs with chronic hepatitis?

Answer 158

Kortum JVIM 2018 p21 = cell-cycle inhibitor; marker of cell senescence. Increased p21 expression in hepatocytes on histo of CH dogs (>70% in 88% cases) vs controls (most 91.8% associated with reduced survival; likely indicative of widespread hepatocellular senescence. Possible use of p21 as prognostic indicator.

Question 159

What is p21 & what is its potential prognostic impact in dogs with chronic hepatitis?

Answer 159

Kortum JVIM 2018 p21 = cell-cycle inhibitor; marker of cell senescence. Increased p21 expression in hepatocytes on histo of CH dogs (>70% in 88% cases) vs controls (most 91.8% associated with reduced survival; likely indicative of widespread hepatocellular senescence. Possible use of p21 as prognostic indicator.

Question 160

(2 papers) What are the names of the 2 copper transporters and where do they reside? Mutations in genes encoding for these transporters have been identified in which breeds?

Answer 160

Wu JVIM 2019 ATP7A (enterocyte; facilitates Cu transport into portal circulation) ATP7B (hepatocytes; Cu excretion into bile ducts). Mutation in the ATP7B is associated with copper overload. Labradors: identified to have both gene mutations. Dobermans: variant identified in the ATP7B transporter. Asada JVIM 2019 (case report, cat) SNV in AGP7B gene mutation identified in a cat = littermate --> hepatic Cu accumulation on bx. Increased blood & urine [Cu]. Responded well to penicillamine tx.

Question 161

Based on a retrospective study, what histologic findings support concerns for increased frequency of copper associated hepatopathy in dogs in recent years? Were these breed-specific?

Answer 161

Strickland JVIM 2018 Increased median [Cu] in liver tissue in CAH dogs, and increase total proportion of dogs with high hepatic [Cu] No, changes observed in both predisposed & non-predisposed breeds.

Question 162

What novel treatment was evaluated to treat copper-associated hepatopathy in dogs? MOA? Clinical response?

Answer 162

Langlois JVIM 2019 Ammonium tetrathiomolybdate (TTM). Copper chelator (used in people, sheep, rodents). Molybdenum salt forms a tight tripartite complex with Cu & albumin, which then undergoes hepatobiliary excretion. Mobilizes tissue Cu > increases serum Cu. Additive effects in intestines, plasma & liver. Dose protocol: initial PO x6 weeks, post-tx liver bx, if Cu levels improved, + 6 weeks tx. 80% (8/10) dogs had decreases in hepatic [Cu]. Variable changes in histo score, bloodwork results (not sig diff from baseline). SE: IM anemia & thrombocytopenia in 1 dog (unsure if related to TTM).

Question 163

What changes in hepatic trace mineral concentrations are observed in dogs with hepatocellular carcinoma?

Answer 163

Harro JVIM 2019 Hepatic Cu accumulation in NON-neoplastic tissue. All trace mineral concentrations were decreased in the HCC tissue cf non-neoplastic hepatic tissue. Possibly involved in pathogenesis of HCC.

Question 164

What changes in hepatic trace mineral concentrations are observed in dogs with hepatocellular carcinoma?

Answer 164

Harro JVIM 2019 Hepatic Cu accumulation in NON-neoplastic tissue. All trace mineral concentrations were decreased in the HCC tissue cf non-neoplastic hepatic tissue. Possibly involved in pathogenesis of HCC.

Question 165

What clin path parameters are prognostic markers in dogs with chronic diarrhoea?

Answer 165

Volkmann JVIM 2017 Anemia (Hct <40%), severe hypoalb (<2.0 g/dL), severe hypocobalaminemia (B12 <200 pg/mL).

Question 166

What patient age & clinical signs were common with CIV infection? What was the mortality rate for dogs with H3N2 viral infection? How long should dogs with H3N2 be isolated for?

Answer 166

Newbury JAVMA 2016 CIV positive dogs were more likely to be adult (1yo+) & inappetant. 3% mortality rate. Dunn JAVMA 2018 Dogs should be isolated for >21 days. As shedding was documented up to 20d after the 1st positive PCR and onset of clinical signs, and may persist after clinical resolution.

Question 167

What additional procedure at time of G tube placement and at-home procedure may be beneficial to prevent recurrent aspiration in dogs with megaoesophagus?

Answer 167

Manning JVIM 2016 Concurrent O tube + G tube placement. Intermittent esophageal suctioning (either via O tube or PO) if persistent regurgitation despite strict G-tube feeding. May reduce or abolish clinical episodes of aspiration pneumonia based on case series of 4 dogs. Complications - O tube site infection, clogging, oesophagitis.

Question 168

What markers were used for lymphatic endothelial cell immunolabelling on endoscopic GI biopsies in dogs, and what parameters does it measure? What was the utility of this, and in which GIT segment was its impact most significant?

Answer 168

Wennogle JVIM 2019 Prox-1, LYVE-1. Measures VLW (villus lacteal width) & MLW (mucosal lacteal width). LEC immunolabelling identified presumptive proprial mucosal lymphangiectasia in CIE dogs, esp in the ileum of hypoalbuminemic dogs. VLW correlated with lacteal dilation scores. More sensitive than routine H&E evaluation of villous lacteals to identify lymphangiectasia.

Question 169

What is the MOA for sodium benzoate (SB) & sodium phenylbutyrate (SPB) in the treatment of hyperammonemia in people? Was this effective in dogs with PSS?

Answer 169

van Straten JVIM 2019 Used in the acute and long-term treatment of people with hyperammonemia 2' to urea cycle enzyme deficiencies. Drugs provide alternative pathways for nitrogen excretion, so prevent NH3 buildup. (Benzoate and phenylacetate conjugates with glycine to form hippuric acid (HA) & phenylacetylglycine (PAG) respectively > renal excretion) Not useful, no changes in blood NH3 pre & post tx, also no clinical improvement. SE - anorexia, V+, lethargy.

Question 170

Which 2 parameters were included in a prediction model constructed to predict recovery from PSS shunting post-operatively in dogs? Were there significant factors identified?

Answer 170

Van den Bossche JVIM 2018 Plasma albumin, mRNA expression levels of hepatic gene products. - Pre-op plasma albumin concentration (higher in recovered vs nonrecovered) - Intra-op DHDH, ERLEC1 & LYSMD2 gene expression levels.

Question 171

What other ddx apart from pancreatitis should be considered with a high cPLI?

Answer 171

Aupperle-Lellbach JVIM 2019 Pancreatic neoplasia (10/12 dogs in this study had elevated spec CPL) Sp 92%, Sn 90% (for moderate/severe panc) in this paper.

Question 172

How effective was the use of an indwelling balloon dilatation O tube (B-Tube) to manage benign O structures in dogs & cats? What are the advantages of this method?

Answer 172

Tan JVIM 2018 Well-tolerated & effective. Needed 2 GAs (1st to place B tube, 2nd to repeat scope before B tube removal). Owners inflated ballon at home BID for 6 wks in this study. Effective (improved dysphagia score), more economical & decreased GA time cf repeated balloon dilatation procedures.

Question 173

Is IL-1beta pro or anti-inflammatory? What difference in IL-1b to IL-1 receptor antagonist ratio were observed in the colonic mucosa of IBD vs healthy dogs, and what is the significance?

Answer 173

Ogawa JVIM 2018 Pro-inflammatory. Higher ratio in IBD dogs. Associated with LOWER *ocln* (occludin) mRNA expression in IBD dogs. Indicates relative increases in IL-1b may attenuate ocln expression, leading to intestinal barrier dysfunction and promotion of colonic inflammation (but not in the duodenal mucosa). Occludin maintains intestinal tight junction permeability by regulating macromolecule flux across the intestinal epithelial barrier.

Question 174

Based on a systemic review, were there differences in short vs long term outcome between feeding an intestinal diet (with proteins from various sources) vs hydrolyzed soy protein diet in dogs with SI D+? What about in cats?

Answer 174

Makielski JVIM 2019 Dogs - both diets had similar short term (3mths) clinical response of 88%, but sig higher clinical remission rates in dogs fed hydrolyzed diets (13/14 vs 1/6 with intestinal). **Strong evidence** Cats - no sig diff noted, but studies may have been underpowered Overall review recommended feeding elimination diet to maintain clinical remission in dogs & cats, but not known if novel intact vs hydrolyzed protein diets are more effective.

Question 175

What is the MOA of rifaximin & its indication? How does it compare with similar drugs used for the indication listed above?

Answer 175

Makielski JVIM 2019 Poorly absorbed bactericidal rifamycin derivative, which inhibits bacterial protein synthesis by irreversibly binding to RpoB, the beta-subunit of the bacterial DNA-dependent RNA polymerase Indication- abx responsive D+ (dogs). When compared with metronidazole, both tx decreased clinical disease severity & serum CRP similarly.

Question 176

What is the utility of serum calprotectin in dogs with IBD? What impact does glucocorticoid treatment have on this biomarker in dogs with IBD? Were there differences in clincal remission rates between beudsonide vs prednisone treatment in IBD dogs?

Answer 176

Makielski JVIM 2019 Protein complex that is expressed and released into the extracellular space by activated macrophages & neutrophils at sites of inflammation. Increased levels in CIE dogs. Serum calprotectin levels remained increased despite clinical remission with tx. No diff, also similar frequency & severity of AE.

Question 177

What is a benefit of multi-strain probiotic supplementation not observed with other drugs in dogs with IBD?

Answer 177

Makielski JVIM 2019 Probiotic upregulates the expression of tight junction proteins in the intestines of IBD dogs --> enhanced epithelial barrier integrity to decreased intestinal inflammation.

Question 178

Which 2 substances (1 vitamin, 1 AA) are commonly deficient in PLE dogs? What is the clinical & therapeutic significance?

Answer 178

Allenspach VCNA 2021 PLE review **Vitamin D3.** Supplementation with vitamin D2 or D3 may improve survival. **Serum tryptophan concentration.** AA supplementation may be indicated in select cases; critical to counteract intestinal inflammation.

Question 179

What hemostatic disorder is common in PLE dogs, and what % of dogs are affected? Name 4 other important systemic complications which can occur in PLE dogs?

Answer 179

Allenspach VCNA 2021 PLE review - Hypercoagulability, 10% cases. - HypoCa (10% cases) + hypoMg. 2' hyperPTH. See twitching. - Tryptophan deficiency (absorbed in SI) - B12 deficiency

Question 180

Which breeds are predisposed to PLE? In which breed may dietary intervention alone have a favourable response? Which breed may have a unique pathogenesis causing IL & PLE and what is it?

Answer 180

Allenspach VCNA 2021 PLE review Breeds: Basenji, Lundehund, Rottweiler, Soft-coated Wheaten Terrier, Yorkshire Terrier & Chinese Shar-Pei, Border Collies, GSDs. Yorkies. Yorkies. Crypt disease identified in 90-100% dogs. Suspect IL in this breed might be 2' to crypt pathology/inflammation. Unknown aetiology (FISH did not identify bacterial DNA).

Question 181

Which 2 biomarkers may have utility for diagnosis of PLE in dogs?

Answer 181

Allenspach VCNA 2021 PLE review 1. **a1-proteinase inhibitor **- increased in serum, decreased in faeces. more sensitive ct albumin as resistant to proteolytic degradation in intestinal lumen. Need 3 faecal samples (day-day variation). *NB: assay is for adult dogs >1yo. Incr levels in puppies.* 2.** Perinuclear Antineutrophilic Cytoplasmic Antibodies (pANCAs) ** - Value as early marker for familial PLEs in SCWTs. Predict PLE and/or PLN with Sn 95% & Sp 80%. 1st abnormal test 1-2yrs before onst of hypoalb.

Question 182

What additional technique may be considered on intestinal biopsies to improve detection of intestinal lymphangiectasia? For which intestinal segment did this technique make the biggest difference?

Answer 182

Allenspach VCNA 2021 PLE review Immunolabelling for lymphatic endothelial cells (using Ab against lymphatic vascular endothelial hyaluronic acid (LYVE-1) receptor) - identified IL in almost all cases where routine histo missed lesions, so more sensitive method. Especially for ileal biopsies.

Question 183

Dietary management for PLE associated with IL: - What % on ME basis is appropriate for fat restriction in these dogs? - Are medium chain triglycerides recomended?

Answer 183

Allenspach VCNA 2021 review - Low fat (<20% ME). But some dogs need more severe restrition (ultra low fat = 3.1% ME) - homecooked diet. - No, potential for D+ & unpleasant taste. Also recent evidence that MCTs are not transported entirely via the portal circulation to the liver & can exacerbate IL.

Question 184

Allenspach VCNA 2021 PLE review What is the overall prognosis of PLE dogs? Negative prognostic factors?

Answer 184

Allenspach VCNA 2021 review Poor, only 50% survive >4mths. - **Hypoalb, serum vit D, serum tryptophan** - CCECAI >5 at 1mth post-diagnosis (includes serum alb) - Increased BUN at diagnosis, intestinal villi blunting on histo, requiring immunosuppressant tx

Question 185

What is faecal calprotectin used as a marker for in dogs?

Answer 185

Otoni JVIM 2018 Tx = IS therapy +/- abx. Marker of intestinal neutrophilic inflammation. Baseline (pre-tx): increased serum CRP, fecal cCP, CIBDAI in IBD dogs vs healthy controls Sig association between cCP & CIBDAI scores in IBD dogs >> faecal cCP decreased post-tx at 21d. (study also measured pACNA but no sig decrease noted)

Question 186

Does lap-assisted prophylactic gastropexy affect GI transit time in dogs?

Answer 186

Balsa JVIM 2017 Not in this study. Can safely administer wireless motility capsule in these dogs post-sx.

Question 187

What % of symptomatic/asymptomatic cats had histological evidence of IBD, cholangitis and/or pancreatitis? What disease combination may distinguish symptomatic from asymptomatic cats?

Answer 187

Fragkou JVIM 2016 27% IBD, 12% cholangitis, 2% pancreatitis alone. 57% >1 organ. Triaditis only identified in symptomatic cats (~30%).

Question 188

What mucosal bacterial alterations were noted in cats with GS LSA compared to IBD? What immunological changes did these alterations correlate with?

Answer 188

Garraway JVIM 2018 Higher no. of Fusobacterium spp. (ileal & colonic), and Bacteroides (ileal). Fusobacterium spp. significantly correlated with CD11b+ cell & NF-κB expression. CD11b+ = myeloid cell derivce macrophages

Question 189

Where is citrulline produced and what does serum citrulline concentration indicate in people? Did it have diagnostic or prognostic utility in dogs with CE?

Answer 189

Gerou-Ferriani JVIM 2018 Produced almost exclusively by the enterocytes of the small intestinal mucosa, not found in food (except watermelons) Indicates globally reduced enterocyte mass & absorptive function (in people). No diff between CE dogs & controls, also no diff between FRE vs ARE. No correlation with efficacy of treatment or outcome in CE dogs (based on CIBDAI, serum alb).

Question 190

What differences in serum metabolome were identified amongst dogs with congenital PSS, chronic hepatitis & healthy dogs?

Answer 190

Lawrence JVIM 2019 Increased aromatic AA (tyrosine & phenylalanine) & xylitol in cPSS dogs. 50 metabolites significantly different amongst groups in total.

Question 191

What plasma free AA concentration was different in dogs with hepatocellular neoplasia? Did this allow differentiation between malignant vs benign tumors, or changed following treatment?

Answer 191

Leela-Arporn JVIM 2019 Increased glutamic acid in dogs with liver tumor vs healthy dogs, but not sig diff between benign vs malignant HCC. Also no changes in [ ] after sx resection. Overall not useful biomarker.

Question 193

What novel adjunct treatment may be beneficial for dogs with hepatocutaneous syndrome? How does this work?

Answer 193

Nam JVIM 2017 Allogenic adipose tissue-derived mesenchymal stem cells. In this case report was infused 46x over 30mths; 8 times directly into the liver parenchyma via US-guidance, remaining times into peripheral veins. Survival 32mths. Mesenchymal stem cells (MSCs) can differentiate into various cell types > may be able to promote dermal fibroblast proliferation and angiogenesis & stimulate hepatocyte regeneration.

Question 194

What is the collective term for dogs with hepatocutaneous syndrome with/without superficial necrolytic dermatitis? What 2 hematological changes were associated with skin lesions at diagnosis? What % of dogs eventually develop SND lesions? Which 2 plasma & 2 urine parameters (and respective cut-offs) were robust biomarkers of this syndrome?

Answer 194

Loftus JVIM 2021 Aminoaciduric canine hypoaminoacidemic hepatopathy syndrome (ACHES) 73% Decreased PCV, decreased MCV. Biomarkers - plasma 1-methylhistidine (<7 nmol/mL) & cystathionine (<7.5 nmol/mL). Urine lysine (>344nmol/mg crea) & methionine (>68 nmol/mg crea).

Question 195

What is considered as optimal treatment for dogs with aminoaciduric canine hypoaminoacidemic hepatopathy syndrome (ACHES)? What % of dogs achieve remission, and what was the overall survival? DId optimal treatment prolong survival?

Answer 195

Loftus JVIM 2021 Optimal tx = receiving ≥2 IV-AA infusions, ≥3 nutritional supplements (SAMe, arginine with ornithine, glutathione, lysine, proline, O3FA or zinc) & home-cooked diet. 9% (4 dogs) achieved remission. Overall MST 359d, disease-specific MST 557d. Yes, MST >1783d with optimal tx (vs 214d with variable tx)

Question 196

What is a purported advantage of enteric coated pancreatic enzyme supplementation in dogs with EPI? Was it more efficactious based on a randomized placebo controlled study?

Answer 196

Parambeth JVIM 2018 Enteric coating reduces inactivation in the stomach by gastric acid & proteases. No sig diff between formulations (based on % acid hydrolysis faecal fat), but study was underpowered.

Question 197

How did 3 techniques of obtaining upper GI biopsies (mounted on a cucumber slice, mounted on a moisturized synthetic foam sponge vs floating free in formalin) compare in terms of biopsy quality & pathologist interpretation?

Answer 197

Ruiz JVIM 2016 Mounted better than free floating, improved quality & path interpretation (more confident diagnosis). Fewer artifacts on mounted (foam sponge) cf cucumber/free floating.

Question 198

What are 2 potential serological biomarkers of gluten sensitivity in dogs? Did levels differ in Border terriers with/without GB mucoceles? What other hormone concentration was altered in BTs with GBMs?

Answer 198

Barker JSAP 2020 Anti-gliadin IgG, anti-canine transglutaminase- 2-IgA autoantibodies, increased in BTs with paroxysmal gluten sensitive dyskinesia, decreased with gluten free diet. Increased transglutaminase-2-IgA autoantibodies & decreased cholecystokinin in BTs with GBMs (may impair GB motility).

Question 199

Are single or multiple rectal masses more common in dogs? What were the most common histologic diagnoses?

Answer 199

Adamovich-Rippe JAVMA 2017 Single (93%) Epithelial neoplasia (90%), of which 71% benign adenoma/polyp, 29% adenocarcinoma.

Question 200

What is the survival rate for dogs/cats undergoing oesophageal surgery, and factors associated with non-survival? What are the most common immediate post-op vs delayed complications?

Answer 200

Sutton JAVMA 2016 90% survival to discharge. Pneumomediastinum & leukopenia, Complications - 54% dogs, 33% cats. Immediate - respiratory, delayed - persistent regurgitation & O stricture formation.

Question 201

In dogs & cats undergoing liver lobectomy, what % required blood transfusion(s) peri-operatively & what were the associated risk factors? What was the mortality rate?

Answer 201

Hanson JAVMA 2017 17% dogs, 50% cats required transfusion. Mortality rate 8% dogs, 22% cats. Risk factors - peri-op anemia (dogs), post-op anemia (cats).

Question 202

What complication may occur when administering blood products to an anemic patient with HE?

Answer 202

Thawley VCNA 2017 review Worsening of HE. As [NH3] of stored blood increases over time in pRBCs.

Question 203

What conditions (including acid-base/electrolyte derangements) may precipitate HE?

Answer 203

Gow VCNA HE review - HypoK - increases renal proximal tubule ammoniagenesis - HypoNa - incr risk of cerebral oedema via reduced extracellular osmolarity - Metabolic alkalosis - promotes NH3 diffusion into CNS. - Hypoglycemia - GI hemorrhage - **Systemic inflammation or infection (pro-inflammatory cytokines)** - **Manganese** | Bolded have strong evidence

Question 204

What % of cats with inflammatory hepatobiliary disease have bacteria cultured? What are the 5 most common isolates?

Answer 204

VCNA 2020 triaditis review 80% (single isolate) E coli, Enterococcus, Bacteroides, Clostridium, Streps

Question 205

What non-bacterial infectious agents may be associated with pancreatits in cats?

Answer 205

VCNA 2020 review Liver/pancreatic flukes (Platynosonum fastosum, Eurytrema procyonis) Toxo FHV, FIP, virulent FCV

Question 206

Based on FISH & PCR, what is the most likely route of bacterial colonisation of the liver in cats with inflammatory hepatobiliary dz?

Answer 206

- Enteric translocation (possible altered intestinal barrier) - Hematogenous spread via portal circulation (bacteria found in portal vessels, venous sinusoids & liver parenchyma) - Rather than predominantly duodenal reflux into pancreatobiliary duct > ascending infection (e.g. during V+)

Question 207

What is the role/mechanism of Manganese in HE? Does blood [Mn] in dogs with liver dz/CPSS differ from healthy dogs?

Answer 207

Gow VCNA 2017 review - Mn is potentially neurotoxic. - Astrocytes have a high-affinity Mn transport mechanism; [Mn] can be 50x higher than surrounding cells >> oxidative damage & mitochondrial dysfunction. In people causes Alzheimer type II astrocytosis (similar changes to NH3) - Mn also stimulates microglia to release inflammatory cytokines & ROS - CPSS & chronic liver dz dogs have higher blood [Mn]; latter correlates to HE severity (in people)

Question 208

What is focal lipogranulomatous lymphangitis? Where are the predilection sites in dogs?

Answer 208

Lecoindre JSAP 2016 Severe form of IBD. Ileum & ICJ. Granulomatous inflammation involving the muscularis and serosa. No infectious aetiology identified.

Question 209

For how many days should B12 measurements be refrigerated serum samples suitable for B12 measurements? Does sample storage in light and room temperature affect measurements?

Answer 209

Kempf JAVMA 2018 5 days when kept at 6degC. Yes, decreased but only slightly (-0.14%)

Question 210

What factors increase success of IV apomorphine administration in removal gastric foreign material in dogs?

Answer 210

Kirchofer JAVMA 2019 Young dogs, dogs ingesting fabric, leather or bathroom waste. SHorter duration between FB ingestion & induction of emesis, NOT giving opioids/sedative/anti-emetics prior.

Question 211

Which of the following are the 2 predominant bacterial phyla in the intestinal tract of cats? - Firmicutes - Clostridium - Proteobacteria - Fusobacteria - Actinobacteria - Bacteroides

Answer 211

Barko JVIM 2018 Clostridium (36-92%) >>> Proteobacteria (8-14%)

Question 212

Which bacteria spp are predominant in the duodenum/jejunum vs ileum & colon?

Answer 212

Barko JVIM 2018 D & J: Clostridium (dogs), Firmicutes & Bacteroides (cats) I & C: Fusobacteria & Bacteroides (dogs). Cats - proteobacteria & actinobacteria (ileum); Firmicutes, Proteobaceria, Fusobacteria (colon). Lactobacillus present along entire GIT.

Question 213

What factors are associated with increased risk of intestinal dehiscence & death in dogs after full thickness LI incisional surgery?

Answer 213

Latimer JAVMA 2019 Death - dogs with pre-op anorexia, hypoglycemia, Np with toxic changes, pre-op abx tx. Dehiscence - pre-existing colon trauma or dehiscence, pre-existing peritonitis, blood product admin, admin of >2 abx classes, positive microbial culture results (sx samples), open abdo management of peritonitis post-op.

Question 214

What is the functional success rate of surgical repair of congenital palatal defects in dogs? What was the main complication, what % of dogs were affected and what were risk factors for its development?

Answer 214

Peralta JAVMA 2018 85% success. Oronasal fistula (ONF). 50% dogs, hard palate most common location. Risk factors for ONF - dogs >8mo, ONF at junction between soft & hard palates, dogs with hx of failed repair. Risk factor for unsuccessful functional outcome - dogs <1kg.

Question 215

What disease may temporomandibular myxomatous neoplasia be misdiagnosed as, and what considerations when obtaining biopsies may help avoid misdiagnosis?

Answer 215

Parslow JAVMA 2016 Zygomatic siaocele (similar CSx, but characteristic MRI features). Obtain bx close to TMJ joint for representative specimens.

Question 216

What was the survival rate of dogs undergoing laparaoscopic liver biopsy using 5-mm cup forceps?

Answer 216

McDevitt JAVMA 2016 95% survival to discharge. Overall low complication rate despite 27% dogs being coagulopathic, though some received FFP transfusions pre-op.

Question 217

What is a novel treatment option for colonic vascular ectasia (angiodysplasia) in dogs (and people)? What is the main procedural complication?

Answer 217

Harris JAVMA 2016 Endoscopic-assisted argon plasma coagulation treatment (multiple tx required). Colonic perforation.

Question 218

What factors were associated with intestinal dehiscence and/or mortality post GI sx in dogs?

Answer 218

Gill JAVMA 2019 ASA status ≥3 - both High [lactate] - mortality

ACVIM Literature (2016-2021) (15 decks)

• Lit Urinary
• Lit Oncology
• Lit Endocrine
• Lit Cardiovascular
• Lit Infectious
• Lit Hemolymphatic
• Lit Pharmacology, Toxicology
• Lit GIT, Hepatobiliary, Pancreatic
• Lit Metabolic, Nutrition
• Lit Neuromuscular, MSK
• Lit Respiratory
• Lit Fluids, Electrolytes, Acid-Base
• Lit Immunology
• Lit Clin Path
• Lit Misc (Ophtho, Derm, Repro etc)