Flashcards in SA GI (MR) Deck (200):
Electrolyte and acid/base balance
Where does water absorption in the gut happen?
What does LI do?
Form up feces Remove the rest of the water
TQ!!! Where is watery dxa from?
What occurs in the GI?
Mechanical and Chemical Digestion Digestion& absorption – (•Carbs •Protein •Lipids •Vitamins) Fluid Balance Motility
Fluid Balance in GI: In healthy intestine how much of presented fluid does Jejumun absorb? Ileum? Colon?
• J-absorbs 50% • I- absorbs 75% of remaining half • C-absorbs 90% of remaining after ileum
Motility is what type of motion?
•Slow wave motion
TQ!!! What is the motion of the GI Controlled by? •Controlled by ANS + ENS, hormones
•Controlled by ANS + ENS, hormones
What are Segmental contractions?
Mixing not moving along
IF you give a promotility agent will you get dxa or constipation?
With Reduced activity regarding Segmental contractions what will you see cx?
What do Parastaltic contrations do?
With Reduced activity regarding Segmental contractions what will you see cx?
Fasted state is usually in what phase?
What is Minor contractile activity? What phase?
•MMC migrating motor complexes – housekeeping Fasted
Abnormal Swallowing Halitosis Ptyalism Gagging and multiple swallowing attempts Abnormal prehension Weight loss Painful mouth Coughing – aspirating Hematemesis - vomit blood
What parts does it take to swallow?
Mouth tongue pharynx larynx UES Esophagus
Dysphagia Rule Outs?
Foreign bodies Ulceration Inflammation/Infection Uremia Feline Stomatits Glossitis Calicivirus, etc. Dental disease Fractures Sialoadenitis - inflamed salivary glands (Spiro Circa Lupi) Neuromuscular Dz Masses
Additional Dysphagia Ruleouts for Cat?
Eosinophilic granuloma Lymphocyitc/Plasmacytic gingivitis/pharyngitis
If you have a cat with oral ulcers, nasal, and ocular discharge is it most likely herpes or calici?
Calici like the mouth too
IF you have a cat with nasal and ocular discharge is is most likely herpes or calici?
Eye & nose = Herpes
What neuromuscular dzs can cause dysphagia?
Masticatory muscle myositis (MMM) Oropharyngeal dysphagia Cricopharyngeal achalasia and asynchrony Tetanus/Botulistm/Rabies - neuromuscular transmission Neurological dysfunction
What are the phases of Oropharyngeal dysphagia?
Oral phase Pharyngeal phase Cricopharyngeal phase
Paresis or paralysis of which Nerves can cause dysphagia? -
5 7 9 10 12
What types of Masses cause dysphagia?
What types of Neoplastic masses cause dysphagia?
Squamos Cell Carcinoma - Bad (Cats mostly) Malignant Melanoma – Bad FSA OSA Epulis (AA) Acanthomatous Amaloblastoma Plasmacytomas - usually benign
How should an animal be examined with mouth pain?
Complete PE - Pyrexia (can be systemic) Complete oral exam - specially teeth, under the tongue Palpate face and neck - Masses, FB, pain, SC emphysema Complete neurological exam Auscultation Thoracic Neck Observe animal eating if necessary
Do Blood work if? (2)
PE and CS indicate systemic involvement anesthesia is needed
Specific testing on cats?
FeLV/FIV MMM - 2M antibody titer
What is MMM?
Autoimmune disease against the masticatory muscles in cats.
Thorax Soft tissue neck - only need 1 view bc of spine +/- dental - close lil ones +/- skull - not the same of dental, may not be close enough
What is more appropriate for skull?
Which is better for Bone, CT or MRI
Which is better for Soft Tissue CT or MRI?
Which exams might you have to Sedate a cat for?
Oral Pharyngeal Laryngeal
Contrast (Barium Swallow) studies you can perform to evaluate the oral cavity?
What is fluoroscopy?
A 3D real-time radiograph (like a movie)
Parts of Esophagus?
Upper Esophageal Sphincter Esophagus Lower esophageal sphincter
What type of muscle is Lower Esophageal Sphincter?
Striation of Dog Esophagus? Cat?
Dog = All striated Cat = Distal portion striated
Innervation to Espphagus?
Vagus Somatic & Autonomic
What type of peristalsis occurs in espphagus?
1º and 2º (left over) peristalsis
What is 1º peristalsis stimulated by?
TQ!!! The MOST COMMON clinical manifestation of ESOPHAGEAL disease is?
REGURGITATION!!! Hx with Regurgitation? Chronicity Recent anesthesia - #1 Reason for regurg Foreign body ingestion/removal Dysphagia Halitosis Hypersalivation Weight loss - Can be severe +/- coughing & dyspnea +/-depression & anorexia
Why does anesthesia commonly cause regurgitation?
Lower sphincter is relaxed, acid can splash up into esophagus causing esophagitis (destroys mucosal surface)
What does esophagus do when it's pissed?
How can you cause a cat esophagitis in a cat thru pilling?
Doxycycline very caustic
Is Regurgitation passive or active? Vomitting?
Regurg = passive Vom - Active
Is there Abdominal component/retching, bile, or Nausea with regurg? Vom?
R = NO V = Yes
Will food be digested with regurg? Vom?
R = May appear to be V = Maybe
What is Appetite like for regurg? Vom?
R = Usually ++ Vom = +/-
Which are you more likely to aspirate with, Regurg or Vom?
Rule Outs for Regurgitation?
Megaesophagus/Esophageal weakness *Vascular Ring anomaly Esophageal Foreign Body Stricture, diverticula, fistulas - Pissed it off! Esophagitis Masses Hiatal Hernia GE Intussusception Lead Poisoning Canine Distemper
What is the vascular ring anomaly most often seen with regurgitation? Who gets it mostly? Where is it?
Persistent right aortic arch—most common GSD Cranial to heart
What are common causes of Esophagitis?
Post anesthesia GERD - Gastro Esophageal Reflux Dz Excessive acidity Lower Esophageal Sphincter Achalasia
Who gets Congenital Megaesophagus/Esophageal Weakness?
Any breed Danes Irish Setters Newfies ***GSD*** Shar Pei Labradors Dachshunds - can resolve at 6 months Rare in cats
Congenital Megaesophagus conditions?
***Vascular Ring Anomaly
Secondary acquired Megaesophagus/Esophageal Weakness causes?
***Myasthenia Gravis—systemic or focal esophageal Vascular Ring Anomaly Dysautonomia - RARE - ANS don't work right Polymyopathy/myositis Polyneuropathy/neuritis SLE - Systemic Lupus Erythematosus Addison's Toxic - Lead, OP, thallium Botulism Polyradiculoneuritis/Coonhound Familial canine dermatomyositis Familial reflex myoclonus Glycogen storage disease CNS disease Infection, neoplasia Hypothyroidism
What tumor like to occur in conjunction with Myasthenia Gravis and Megaesophagus?
Most common Esophageal masses?
Neoplasia - Esophageal or Extraesophageal Granulomas - Spirocerca lupi
What is Hiatal Hernia?
Stomach herniates thru diaphragm puts pressure on esophagus
What is Gastro-Esophageal intussusception?
stomach intussuscepts into esophagus
Diagnostic tests with Regurg?
Survey radiography Thoracic & Cervical Contrast radiography Fluoroscopy Endoscopy CBC/Chem?UA Fecal Neuromuscular Eval Brain CT/MRI CSF Analysis
Important to Evaluate Radiographs for?
Esophageal Dilation Air Displacement Foreign bodies Masses Pneumomediastinum Metastatic disease Aspiration pneumonia
Where on radiograph should you look for aspiration pneumonia?
Right Mainstem Broncus to RT middle lung lobe. Likely place for aspirated food to go
What two things like to happen together? Besties if you will?
Aspiration Pneumonia & Megaesophagus!
What will you likely see with Metastatic Dz?
Aspiration Pneumonia She said DING DING DING after this.
What is Pneumomediastinum a sign for? Where might it occur?
Fistulas Hole Between trachea and esophagus Hole Between Esophagus and mediasteinum
What should you be aware of with megaesophagus and Contrast radiography?
Aspiration always a risk
Why is barium + food better than just barium?
Esophagus works on Bolus
Fluoroscopy is a way to analyze what?
Endoscopy is good because it allows? What therapeutic interventions can you perform with Endoscopy?
Direct visualization Assessment of severity of disease FB removal Balloon dilation
Why should you run CBC/CHEM/UA?
Allow for systemic evaluation
Fecal evaluation is checking for?
What Titers are you testing for to dx Myasthenia Gravis?
Acetylcoline antibody titers - Gold Standard
What test is for MMM?
2 n Ab Titer
What would Creatinine Kinase tell you in regards to regurgitation?
General Myositis or Myopathy
How would you Rule out Addisons?
ACTH stimulation test
Neoplasia Strictures Diverticula
Parts of stomach?
Cardia Fundus Body Antrum
Nervous control of Stomach? Specifically?
Autonomic - Vagus and Ciliac plexus Enteric - Myenteric and submucosal plexus
How does stuff get moved along in stomach?
Peristalsis and MMC
What do Parietal cells do?
HCl - neuroendocrine stimulation of Gastrin Ach Histamine
Chief cells release?
Mucous cells release?
Phases of secretion?
What controls the Cephalic phase of secretion?
PNS - ACh
What controls the Gastric Phase of secretion
When you vomit what are you vomiting?
all the way down to SI HCl & HCO3- (more bicarb in SA)
What acid/base balance do find in your normal small animal vomiter? Why?
Metabolic Acidosis - You start vomiting from your SI Lots of bicarb in intestines More bicarb than acid leaves
What acid/base situation would a High GI Blockage create?
Hypochloremic Metabolic Alkalosis
Why is there a lot more chance of aspiration with aspiration than vomiting?
In vomiting epiglottis is coordinated to protect trachea
What is in control of Tightly coordinated reflex action of vomiting?
Vomiting center DA, histamine, Ach Chemoreceptor trigger zone (CRTZ) - Responds to toxins/drugs Limited BBB Direct stimulation to vomiting center from, CRTZ, higher CNS, vestibular center, GI tract, abdominal organs or peritoneum
You must differentiate between what situations with vomiting?
Acute vs. chronic Self limiting vs. life threatening systemic illness. GI vs. Non-GI causes
Minimum database for Self limiting vomiting?
PCV/TS/FeLV/FIV Fecal Float and smear, therapeutic de-worming Parvovirus ELISA if puppy NPO for a day Monitor for worsening signs over next day - may have to proceed to further diagnostics I usually DO NOT give anti-emetics - hide important clinical signs
Which drug should you NEVER give?
Centrine Anti-Ach Turns off gut - causes ileus! Bad for the dog! - CONSTIPATION! CX associated with Systemic Illness? Pyrexia Painful abdomen Masses Tympany Oral ulceration Icterus Ascites Wounds Melena Lethargy PU/PD Non-productive retching—GDV!
What is the only way to tell if it is vomiting over regurgitating?
Continued vomiting, non-stable patient should do what diagnostic tests?
CBC/CHEM/UA Rule in/out many non-GI causes Fecal floatation and smear Let those results and your PE guide you to further dx
What diagnostics would you do if you suspect GDV? Tx?
Radiography Blood work CBC/CHEM/UA/VBG Lactate initial vs post stabilization Emergency stabilization and surgery
What is one of the VERY best ways you can decide whether you are doing the right tx?
Decreasing Lactate Levels
TQ!!! Primary Gastrointestinal Vomiting Rule Out List?
Dietary indiscretion/Diet change Motility disorders Ulcers Allergy-food Neoplasia Inflammation/ IBD Intussusception/Hiatal hernia/GDV Infection - Bacterial, Viral, Ricketsial, Fungal/fungal-like Parasites Colitis Toxins/Drugs Foreign body/ outflow obstruction/Hairballs/Obstipation
Life Threatening Signs with vomiting?
Life Threatening Signs? Unproductive vomiting, distended abdomen, shock/collapse
What happens with GDV? Who?
Gastric Dilatation and Volvulus Air trapped, vessels obstructed, progressive Giant breed dogs predisposed
TQ!!! Non- GI Vomiting Rule Out List?
Neoplasia i.e. MCT Renal disease/failure Hepatobiliary disease Peritonitis Pancreatitis Acid/Base disorders Hypoadrenocorticism Hyperthyroidism Sepsis DKA Hypercalcemia Pyometra Heartworm Drugs - NSAIDS, Anesthetics, Chemo, Opiods, ABX Toxins CNS disease/vestibular/abdominal epilepsy
If you are pretty sure you have perforation/foreign body should you do barium study?
No go to sx, if you’re pretty sure you aren't going to want barium in gut Hx Questions to ask with vomiting?
What is the best test for Pancreatitis?
Maldigestive dxa you might have ____Cobalamine?
What can bacteria make?
Folate Consistent with over growth of
TLI stands for? What is it a test for?
Trypsin Light Immunoreactivity EPI ExoPancreatic Insufficiency
Best way to find Foreign Body?
Fingers-->Palpate Xray Ultra Sound Contrast Radiography Do not use barium if suspect perforation
Advantages of Endoscopy?
Non-invasive Visualize the mucosa biopsies - tiny
What will youdo with EVERY exploratory?
What is Physoloptera?
ONE worm will cause you to vomit till you die IH-grasshopper/cockroaches
If they keep vomitting and you dont know why what will you eventually have to do?
Biopsies Blood work and Imaging First!
Exocrine Pancreas Functions?
Digestive enzyme production - STORE INACTIVE FORM Bicarbonate production Neutralizes gastric acid Facilitates: Nutrient absorption Mucosal cell turnover Enzyme activation Inhibits Autodigestion via enzyme inhibitors Bacterial proliferation - SEVO
Where are Zymogens are activated? How?
in the intestines Cleaved from inactive to active forms by enterokinases
Defense mechanisms of exocrine pancreas?
Physical separation of zymogens Distance between the site of enterokinase release and zymogens Presence of enzyme inhibitors within the pancreas and within the circulation within acinar cells
Who gets pancreatitis the most? Age Sex Breed
Middle – Old Females Yorkies Obese
TQ!!! What HISTORY is the most helpful to dx Pancreatitis?
Hx of HIGH FAT MEAL!
What parts of body does pancreatitis cause inflammation?
What causes the Inflammatory disease with Pancreatitis?
Activation of digestive enzymes within pancreas Maintained and exacerbated by inflammatory cytokines and free radical production Vascultitis and edema Multisystem involvement Mild to Severe
What is Triaditis?
Pancreatitis Cholangiohepatitis Inflammatory Bowel Dz
CX of Pancreatitis?
Depression Anorexia Vomiting Diarrhea Shock Abdominal pain +/- Icterus Prayer position Any or none
Who can exibit VERY non-specific signs?
Cats even less specific
Additionally, What can the results of pancreatitis lead to? (i.e. you digested your pancreas)?
Hepatic Lipidosis Diabetes mellitus Thromboembolism Toxoplasmosis - can go wild DIC
What position is a sign of pancreatitis?
Acute Pancreatitis Bloodwork: Chemistry results?
Hysper or Hypoglycemia Hypocalcemia Elevated liver enzymes Esp ALP Bile duct obstruction Hypercholesterolemia/ Hypertriglyceridemia/ hyperlipidemia Bilirubinemia Renal or pre-renal azotemia Amylase and Lipase
Acute Pancreatitis Bloodwork: CBC?
Hemoconcentration Anemia Thrombocytopenia Neutrophilia w/ left shift UA Bilirubinuria Hemoglobinuria Concentrated USG
Dx of Acute Pancreatitis: Classic changes?
Clinical Signs History Blood work Cytology Imaging Advanced Testing
What Cytology can you do to confirm dx acute pancreatitis?
DPL • DX peritoneal lavage
What might you see on diagnostic imaging to suggest acute pancreatitis?
Ground-glass appearance = loss of cranial abdomen detail
On Advanced testing what can you look for to confirm acute pancreatitis?
TLI - Trypsin-like immunoreactivity PLI - Pancreatic Lipase immunoreactivity—PLI
Why is TLI helpful in dx of acute pancreatitis?
May elevate prior to amylase and lipase PLI more helpful than TLI, also it is species specific
How sensitive/specific is PLI in Dogs? Cats? How is test run?
Dogs = 82% Cats = 100% Sensitive & Specific Snap test available (CPL)
What is the Test of choice for Pancreatitis?
If you suspect Pancreatitis should you confirm dx or tx the patient for pancreatitis before confirmation?
What might you see on radiographs with pancreatitis
Loss of cranial abdominal detail
What might you see on Abdominal Ultrasound with Pancreatitis?
Duedonum looks like bacon with ileus Decreased peristalsis Mixed pancreatic echogenicity Peripancreatic hyperechogenicity Cranial abdominal mass Free abdominal fluid - Ca+fat = soap
Where does Parvo like to hit the intestines?
Crypts (Paneth and Stems)
Where does Corona Virus hit the intestines?
How much of the small intestines are Duodenum? feature?
10% length Major and minor papilla (dogs)
Villi, microvilli, mucosal folds Increase the surface area by how many times?
600X Crypt/villus unit
Which part is the Majority of SI?
Where in SI is Ileum?
Last 12 inches
What are the SI reasons the dxa occura?
decreased surface area & decreased function = no where for water to go = dxa! Luminal disturbances Villous atrophy Enterocyte dysfunction Microvillar membrane damage Brush border membrane disease Mucosal barrier disruption Hypersensitivity Mucosal inflammation Neoplasia Nutrient delivery blockade
Why do we give Lactulose?
Constipated Cats PSS Dogs
What are the mechanisms of dxa? (2)
Osmotic Secretory Describe Osmotic Dxa? Decreasee solute absorption - water goes with it Diet - unabsorbed nutrients in lumen
Osmotic dxa is often caused by?
Medicines Decreased solute absorption
Who gets secretory dxa?
Horses the most
What causes secretory dxa?
Hyper-secretion of ions Toxins - Bacterial or chemical Intestinal inflammation Rare in small animals
What does administration of DSS cause?
Hypermotility (rare) Hypomotility/ileus
What type of dysmotility is the most common?
What are the causes of secondary dysmotility?
Hypomotility (more common)
Peristalsis vs Segmental
What dysmotility is more common, hyper or hypomotility?
What causes exudative dysmotility?
Damage to mucosal barrier
Leakage of blood proteins
Clinical manifestation of intestinal dz is? (2)
Either Dxa or Constipation
What must you evaluate History and PE to determine?
Chronic vs. acute chronic intermittent
Self-limiting potentially fatal systemic disease.
Small intestinal vs. Large intestinal or Diffuse
Can you lose enough fluid from dxa to die?
TQ!!! What is the most important thing to determine with small animals regarding DXA?
Small Intestinal vs Large Intenstinal
Causes of Acute enteritis?
Dietary Parasitic Infectious Intussusception Hypoadrenocorticism
Dietary Causes of Acute enteritis?
Dietary - Allergies/changes/ Indescretion
Parasitic Causes of Acute enteritis?
Protozoa (Giardia, Tritrichomonas, Coccidia)
Infectious Dz Causes of Acute enteritis?
Causes of Chronic Enteritis?
Same as Acute
Breed Specific Enteropathies
Malabsorptive Dzs & Maldigestive Dzs
What fungal infections cause chronic enteritis?
What breeds are prone enteropathies causing chronic enteritis?
Systemic diseases causing chronic enteritis?
Antibiotic Responsive Enteropathies
What is Lymphangectasia?
Dialation of the lacteals don't absorb things as well
What Malabsorptive diseases cause chronic enteritis?
ABE/SIBO - Antibiotic Resistant Enteropathies Dietary IBD
What Maldigestive diseases cause chronic enteritis?
ExoPancreatic Insufficiencies - TLI test
Causes of LARGE INTESTINAL Dxa?
Parasites - Giardia, whips
Histiocytic ulcerative colitis
Describe Histocytic Ulcerative Colitis?
Who is prone?
How to cure?
Antibiotic Responsive Enteropathy (ARE)
Prone - Boxers, Frenchies
Cure - Enrofloxin
TQ!!! Differentiating Small Bowel vs. Large bowel diarrhea: What is the volume of Small Bowel vs Large Bowel Dxa?
Small = A LOT MORE Large = normal to Increased
TQ!!! Differentiating Small Bowel vs. Large bowel diarrhea: Mucus?
Small: not so much Large: YES - Frequent
TQ!!! Differentiating Small Bowel vs. Large bowel diarrhea: Melena?
Small: Maybe Large: Nope
TQ!!! Differentiating Small Bowel vs. Large bowel diarrhea: Hematochezia?
TQ!!! Differentiating Small Bowel vs. Large bowel diarrhea: Steatorrhea?
Small: Yes Large: Nope
TQ!!! Differentiating Small Bowel vs. Large bowel diarrhea: Undigested Food?
Small: Maybe Large: Nope
TQ!!! Differentiating Small Bowel vs. Large bowel diarrhea: Color?
Small: variable Large: usually normal - already digested
TQ!!! Differentiating Small Bowel vs. Large bowel diarrhea: Defecation Urgency?
Small: Rare Large: Usually
TQ!!! Differentiating Small Bowel vs. Large bowel diarrhea: Defecation Tenesmus?
Small: Nope Large: Frequent
TQ!!! Differentiating Small Bowel vs. Large bowel diarrhea: Defecation Frequency?
Small 3 X Normal Large: > 3X Normal
TQ!!! Differentiating Small Bowel vs. Large bowel diarrhea: Defecation Dyschezia (painful)?
Small: Nope Large: Yes
TQ!!! Differentiating Small Bowel vs. Large bowel diarrhea: weight loss?
Small: Usually Large: Rare
TQ!!! Differentiating Small Bowel vs. Large bowel diarrhea: Flatulence?
Small: Can be Large? Absent
TQ!!! Differentiating Small Bowel vs. Large bowel diarrhea: Halitosis?
Small: Yes Large: Nope
History taking for Dxa?
Vaccination and deworming status
Access to garbage
Response to previous therapy
Complete Physical exam for DXA do you have to do a rectal?
Oral exams - Esp. under the tongue
What can you find on Careful abdominal palpation?
Thickened bowel loops
May have to observe defecation attempts: what will you look for?
Tenesmus - urge to go w/ empty bowel
Fecal Evaluation for?
Color Consistency Odor +/- malabsorption Blood Steatorrhea +/- malabsorption
TQ!!! Fecal Tests to Run on Dxa Patients?
Cytology +/- Parvo - puppy < 6 mo with dxa or vom +/-
Culture - salmonella in horses
SA not that common
alpha-protease inhibitor - PLE
What should you run for fecal float?
Sheather's Zinc sulfate or Giardia Ag
Baermann - larval lung worm
What Cytology should you run on fecal for dxa?
Direct smear – histoplasmosis
Rectal scraping Blood work for Dxa?
Min DB - CBC/CHEM/UA/VBG /FeLV/FIV/Parvo
Additional Diagnostics for Dxa?
Contrast Radiography Barium
What will Cobalamin levels be with malabsorpitve diseases?
What will Folate levels be with intestinal bacterial overgrowth?
Can initiate some therapies sooner
Limited for most of the SI anatomically - Dog into Duad,
Cats into Jej Mucosal Biopsy )(Bx)