SAM II Exam I Material - Gastrointestinal Flashcards by Chris Bessette

This is a specific antidote used in Tylenol toxicity

N-acetyl cysteine

N-acetyl cysteine treats acetaminophen (Tylenol) poisoning by binding the poisonous forms of acetaminophen that are formed in the liver

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Considering the risks and diagnostic value of each biopsy technique, which biopsy method is the best option for dogs with non-infiltrative/neoplastic liver disease?

FNA
Menghini tru-cut
Laparotomy/laparoscopy

Laparotomy/laparoscopy

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T/F: If you note microcytic, hypochromic anemia in a yorkshire terrier, this can be an indicator of poor iron metabolism associated with portosystemic shunts

True

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What is the drug of choice for treatment of histiocytic ulcerative colitis?

enrofloxacin

Since histiocytic ulcerative colitis is a bacterial infection, it is antibiotic responsive. Enrofloxacin is typically effective. It is critical to treat for at least 8 weeks (even if the patient feels normal by week 2). Stopping antibiotics before 8 weeks has been associated with recurrence of infection and resistance to enrofloxacin.

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Lady, a 6-year-old Labrador has been under your care for CH for 2 months. Today she presents like this. What do you recommend as the first line of treatment?

Drain all the fluid by abdominocentesis
Spironolactone at 2 mg/kg/day
Furosemide at 2 mg/kg/day
Colloid like hetastarch

Spironolactone at 2 mg/kg/day

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T/F: ALT and AST are very liver-specific

False

ALT is very liver specific*
AST is also from skeletal muscle and cardiac muscle*

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T/F: Both cats and dogs with acute pancreatitis will regularly demonstrate abdominal pain

False

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T/F: The current combination of tests with the best test accuracy for the diagnosis of acute pancreatitis is cPL and abdominal ultrasound

True

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What is the specific treatment for aflatoxicosis?

Plasma & Vitamin K

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T/F: Xylitol toxicosis is associated with hyperglycemia

False

Xylitol stimulates insulin release and results in hypoglycemia

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What is the role of H₂ blockers and proton pump inhibitors in the medical treatment of esophagitis?

neutralize acid secretion

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T/F: Concurrent IBD, cholangiohepatitis and pancreatitis are common in cats

True

These concurrent diseases are referred to collectively as triaditis

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What liver disease is associated with the highest mortality rate in cats?

hepatic lipidosis

Lipid accumulation in hepatocytes eventually results in loss of hepatic function.

Increased triglyceride deposition associated with starvation due to mobilization of fatty acids from lipid stores
Insufficient insulin – fat stores used for energy

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Is the following clinical sign more associated with small bowel diarrhea or large bowel diarrhea:

weight loss and protein loss

small bowel (often in chronic)

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What is the mechanism of action of lactulose in resolving hepatic encephalopathy?

Laxative
Purgative
Resolves dysbiosis
Ion trapping
Resolves alkalosis

Ion trapping

lactulose acidifies the GIT and traps ammonia; decreases absorption of harmful substances by increasing GIT transit

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Current evidence based medicine supports the diagnosis of specific therapy for acute pancreatitis. Which therapy in dogs is not specifically indicated?

Crystalloid resuscitation
Fentanyl CRI
Broad spectrum antibiotics
Maropitant, NK1 receptor antagonist

Broad-spectrum antibiotics

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Which of these is/are classic feature(s) of small bowel enteritis in contrast to large bowel enteritis?

mucous
tenesmus
dyschezia
hematochezia
low volume
hypocobalaminemia

hypocobalaminemia

hypocobalaminemia is more characteristic for small intestinal enteritis

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T/F: Both cats and dogs will have obvious ultrasonography changes in acute pancreatitis in >70% of cases

False

Cats are more prone to chronic pancreatitis than acute pancreatitis and it’s difficult to diagnose chronic pancreatitis on ultrasound

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T/F: Steroids are indicated for treatment of hepatic lipidosis in cats

False!

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T/F: Both cats and dogs will frequently have cholangitis and enteritis accompanying pancreatitis

False

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T/F: When using maropitant as an anti-emetic in acute liver disease, it is standard to decrease the recommended dose by ~25%

True

Maropitant is metabolized in the liver, so we generally decrease the dose by ~25% in our acute liver disease patients

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Which of these is not a good treatment for IBD in these cats?

Budesonide
Prednisolone
Metronidazole
Chlorambucil
Azathioprine

Azathioprine

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The most common form of pancreatitis in cats is:

chronic pancreatitis

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When submitting a liver biopsy, what special stain would you request if you want to confirm cirrhosis and fibrosis?

Masson’s trichome

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T/F: **Hepatic encephalopathy (HE)** can occur in acute or chronic liver disease as well as portosystemic shunts

**True**

**Corneal edema** is a hallmark feature of:

**infectious canine hepatitis**

A Cairn Terrier is admitted to the ICU with acute abdomen. Blood glucose levels are normal. SNAPcPL is abnormal. Abdominal US shows multiple hypoechoic lesions with thickened capsule in the left pancreatic limb, measuring 2-4 cm diameter. The most likely diagnosis is: * Pancreatic pseudocyst * Insulinoma * Pancreatic carcinoma * Cysts * Pancreatic Abscess * Metastatic hemangiosarcoma

**Pancreatic Abscess**

In confirming ***Helicobacter* spp**. infection of the stomach mucosa, which is the test with the best sensitivity and the quickest turn-around time? * Endoscopic biopsy with histopathology * Endoscopic biopsy and urease test * Urea breath test * Endoscopy with cytobrush for cytology

**Endoscopy with cytobrush for cytology**

What are two differentials for **lymphocytic cholangitis** in cats?

**FIP, lymphoma**

What is the most common cause of extrahepatic biliary obstruction in dogs?

**pancreatitis**

Only measurable and most reliable index of hepatic encephalopathy (HE):

**ammonia**

T/F: A dog that has acute abdomen, elevated ALT and abnormal cPL (SNAP) - the definitive diagnosis is **acute pancreatitis**

**False** * The SNAP cPL has a 91% sensitivity and a 77% specificity, so a positive test should be confirmed.* * If negative, unlikely to have acute pancreatitis* * If positive, you should send away for quantitative test (Spec PLI)*

What is the drug of choice for treatment of large bowel IBD in the dog?

**Sulfasalazine**

A dog presents with an enlarged left anal gland ~2x size of the right. The animal does not appear to be systemically ill. How would you treat?

**Express, lavage and infuse with topical antibiotic and steroid ointment**

Which is not an end stage complication of **chronic pancreatitis**? * Pancreatic acinar atrophy (PAA) * Exocrine pancreatic insufficiency (EPI) * Diabetes mellitus

**Pancreatic acinar atrophy PAA**

Ultrasonographic changes of **acute pancreatitis** include all, except: * Peripancreatic hyperechogenicity * Pancreatic hyperechogenicity * Duodenal corrugation * Peritoneal anechoic fluid

**Pancreatic hyperechogenicity**

A Doberman in Finland presents with weight loss, 2 x TN ALT, with abnormal BAS. You diagnose chronic hepatitis (CH) tentatively. What is the best course of action? * Start liver supportive care * Start prednisolone as Dobermans suffer from immune mediated CH * Biopsy the liver after a PT/aPTT screen

**Biopsy the liver after a PT/aPTT screen**

3 month old Shar Pei. What is the diagnosis? * Esophageal FB * Spirocercosis * Vascular ring anomaly * Sliding hiatal hernia

**Sliding hiatal hernia**

What are the first choice analgesics used to treat **pancreatitis**?

**buprenorphine/methadone**

Breeds predisposed to **chronic pancreatitis** include all except: * English Cocker Spaniel * Eurasier * Cavalier King Charles Spaniel * Boxer * Collie

**Eurasier**

6 month old FS dachshund. Spayed 2 weeks prior. PC: BAR but regurgitating. Most likely diagnosis? * Idiopathic megaesophagus * Vascular ring anomaly * Esophageal FB * Esophageal stricture

**Esophageal stricture**

What is the treatment of choice for **esophageal strictures**?

**Balloon Dilation**

T/F: The most important treatment aspect with **hepatic lipidosis** in cats is nutritional support

**True**

T/F: Trypsin‐like immunoreactivity (TLI) is very sensitive and specific for **exocrine pancreatic insufficiency (EPI)**

**True**

What drug is indicated for treatment of **myasthenia gravis**?

**pyridostigmine**

A 4-year-old German Shepherd has body odor and perineal microabscesses on inspection. What is the mainstay of therapy for this dog?

**Cyclosporin** *This dog most likely has perianal fistula*

Is the following clinical sign more associated with small bowel diarrhea or large bowel diarrhea: ## Footnote **melena**

**small bowel**

A 12 week old Boston terrier presents to your clinic with the complaint of projectile vomiting. Based on the signalment, what is the most likely diagnosis? * Gastric lymphoma * Gastric adenocarcinoma * Pythiosis * Antral pyloric stenosis

**Antral pyloric stenosis** *pyloric stenosis typically causes persistent vomiting in young animals (especially brachycephalic dogs and Siamese cats) but can be found in any animal. These animals usually vomit food shortly after eating. The vomiting is sometimes described as “projectile.” Animals are otherwise clinically normal, although some pets may lose weight.*

A 6 week old GSD presents to your clinic with vomiting. The dog is otherwise bright, alert, with a good appetite. Based on the most likely differential, what is the most appropriate diagnostic test? * Hematology * Biochemistry * Parvo fecal snap test * Thoracic radiographs * Echo for VSD

**Thoracic radiographs**

Which is a more sensitive test: **ammonia tolerance** or **resting ammonia**?

**ammonia tolerance** *\*\*ammonia is an encephalotoxin so must be sure that basal/resting concentrations are within resting range\*\**

Is the following clinical sign more associated with small bowel diarrhea or large bowel diarrhea: ## Footnote **mucous**

**large bowel**

T/F: Histopathology is the ONLY way to diagnose **lymphocytic cholangitis**

**True**

What is the most common cause of **extrahepatic biliary obstruction [EHBO]** in cats?

**tumors and inflammatory disease (FIP) of biliary tract, pancreas or both**

What breed is especially susceptible to the toxic effects of **carprofen**?

**Labradors**

What is the typical treament protocol for cats with **lymphocytic cholangitis**?

**prednisolone, chlorambucil, methotrexate**

This immunosuppressive agent has ~100% response rate when used in the treatment of **perianal fistula**:

**Cyclosporin**

What is the most common **GI neoplasia** in cats?

**lymphoma**

Is the following clinical sign more associated with small bowel diarrhea or large bowel diarrhea: ## Footnote **large, bulky, watery stool**

**small bowel**

Maggie, a 6-year-old, FS Shih Tzu, visits your practice for a routine health screen. She has been diagnosed with idiopathic epilepsy and is on phenobarb. She is otherwise healthy. Biochemistry detects 10 x TN ALKP, 8 x TN ALT. Which is the correct statement? * This is enzyme induction from phenobarbitone * The liver enzymes are prognostic of phenobarb damage * Recommend liver function testing and US/biopsy * Immediately discontinue phenobarb

**Recommend liver function testing and US/biopsy** *We know that phenobarbitone can be responsible for enzyme induction (specifically ALKP), but this is allowable within a certain range. Generally if ALKP is less than 5x normal, it is simple induction. However, if the enzymes are significantly elevated (as in this example), you must consider that there is phenobarbitone toxicity*

Which of the following would NOT be considered part of a therapeutic plan for **perianal fistulae**? * cyclosporine * tacrolimus * antibiotics * hypoallergenic diet * diphenoxylate

**diphenoxylate** *diphenoxylate is a motility modifier;* *prolongs intestinal transit time and is principally used to symptomatically treat diarrhea*

What is the main cause of **Exocrine Pancreatic Insufficiency** in cats?

**chronic pancreatitis**

T/F: If a cat presents with ptyalism, **hepatic encephalopathy [HE]** should be on the top of your rule-out list

**True**

What is the "gold-standard" diagnostic modality for ***Tritrichomonas foetus***?

**Fecal PCR**

Treatment for **chronic pancreatitis** includes all _except_: * Low fat diet (ultra low fat or low residue * Analgesia (acetaminophen/tramadol) * Pancreatic supplement (for postprandial pain) * Antibiotic (enrofloxacin) * Steroids - immunosuppressive treatment

**Antibiotic (enrofloxacin)**

A 9-year-old Persian presents to your clinic with anorexia and icterus. The abdomen is painful and the liver enlarged. Ultrasound findings are shown here. Biopsy confirms neutrophils periportal but not beyond the limiting plate. Dx? * Chronic lymphocytic cholangitis * Acute suppurative cholangitis * Hepatic lipidosis * Cholelith

**Acute suppurative cholangitis**

A 2 year old MN bengal cat presents with a 14 day history of green, malodorous stool, tenesmus and mucus in the stool. The cat is otherwise healthy with normal hematology and biochemistry. The previous vet treated with antibiotics and a bland diet - no response. ## Footnote **What is the most likely differential?**

***T. foetus***

What is the most important component of treatment in a cat with **hepatic lipidosis**?

**Tube feeding!** ## Footnote *Nutritional support is the most important component. However, you don't want to force-feed a cat because it may develop a food aversion because cats are assholes like that and value their pride over their health.*

Quinn, a 2-year-old, MN Cockapoo in ICU is being treated for onion toxicity and has received a blood transfusion for anemia. He is now icteric. Which statement is correct regarding liver function? * A bile acid stim test is indicated to confirm liver dysfunction * An abdominal US excluding EHBO is sufficient to confirm liver dysfunction * There is no liver dysfunction, this is all pre-hepatic hemolysis

**An abdominal US excluding EHBO is sufficient to confirm liver dysfunction**

T/F: Pancreatic lipase immunoreactivity (PLI) may have the greatest diagnostic value for **pancreatitis** in both the dog and the cat

**True** * If negative PLI, unlikely to have acute pancreatitis * If positive PLI, you should send away for quantitative test * SPEC PLI is a quantitative test with 95% specificity * Not effected by renal failure or steroids, but very expensive

What is the role of **sucralfate** in the medical treatment of esophagitis?

**diffusion barrier to peptic mucosal damage**

Which is not a short-term prognosticator in the case of biliary mucoceles? * Hyperlactatemia * Hypotension * GB rupture * Anemia

**GB rupture**

T/F: **ALKP** is very liver-specific in the dog and cat

**False** *_ALKP is very liver-specific in the CAT._* *In the dog, increased ALKP could be from the intestines, kidneys, placenta, bone, drug-induced, etc.*

Bubbles, a 13-year-old English Cocker Spaniel presents with a history of recurrent AP, DM, and now chronic diarrhea with weight loss. You are concerned about end-stage EPI. What factors influence your diagnostic tests at this stage? * Age and comorbid DM, surgical biopsy may increase morbidity * Concurrent pancreatitis may affect cTLI * Concurrent EPI may affect cPL * All of the above

**All of the above**

Is the following clinical sign more associated with small bowel diarrhea or large bowel diarrhea: ## Footnote **tenesmus**

**large bowel**

Which of the following factors has NOT been implicated as an etiology of acute pancreatitis? * Hypercalcemia * Corticosteroids * Trauma and surgery * Hypertriglyceridemia * Phenobarbitone * Canine babesiosis

**Corticosteroids**

The most common cause of EPI in the cat is:

**chronic pancreatitis**

A 7-year-old M/N German Shepherd presents to you with a history of painful defecation. On physical exam, you note these lesions. What is your diagnosis?

**Perianal fistulas**

T/F: For the diagnosis of **congenital PSS**, fasting and postprandial serum bile acid level determinations are recommended to enhance detection ability

**True** *this is because it is relatively common for fasting values to be well within normal limits and for postprandial values to be as high as 10- to 20-fold higher than normal postprandial values.*

When submitting a liver biopsy, what **special stain** would you request if you want to confirm copper accumulation?

**rhodanine**

What is the most sensitive diagnostic test for **acute pancreatitis** in dogs?

**cPL**

What signalment is associated with **acute pancreatitis** in dogs?

**Usually small breed dogs; overweight, middle-aged females; history of fatty meals; post ischemia – canine babesiosis**

What is a chronic complication of **acute pancreatitis**? * Pleural effusion * Hypocalcemia * Pseudocyst * Coagulopathy

**Pseudocyst** *A pancreatic pseudocyst is a collection of fluid containing pancreatic enzymes and debris in a nonepithelialized sac. Pseudocysts have been recognized in association with pancreatitis in cats and dogs, although they appear to be rare*

Name the three disease entities involved with **feline triaditis**:

**pancreatitis, cholangiohepatitis, and inflammatory bowel disease (IBD)**

T/F: Elevated amylase and lipase are diagnostic for **pancreatitis** in the dog

**False** *Elevated amylase and lipase are compatible with pancreatitis in the dog but are not diagnostic or pathognomonic since they can be elevated with gastrointestinal or liver disease or azotemia. And dogs with normal amylase and lipase values may have pancreatitis.* ***\*\*Amylase and lipase are of no value in the cat\*\****

Jimmy is diagnosed with EPI, most likely from PAA. What treatments do you NOT recommend? * Low fat diet prescription diet * Cobalamin supplementation * Pancreatic enzyme-enteric coated * Metronidazole, 28 day course * Antacid treatment, to increase gastric pH

**Low fat diet prescription diet**

An icteric patient presents. Which of the following diagnostic tests is NOT indicated? * Bile acids * Packed cell volume * Serum biochemistry profile * Abdominal ultrasound * Urinalysis

**Bile acids**

You are managing a 6-month-old Yorkshire terrier with neurological signs, microcytosis, and ammonium biurate crystalluria. How would you investigate for PSS? * Ammonia tolerance test * Bile acid stim * Urea, Alb, Gluc * Liver biopsy

**Bile acid stim**

Bobby is referred to your clinic for further investigation of liver disease. He is weak, with non-specific signs of pain. Biochemistry shows ALP (2 x TN), AST (4 x TN). What should you also test? * Liver enzymes: ALKP, GGT, Abdominal US * Muscle enzymes: CK, LDH, EMG and Toxo titres, 2M Ab assays

**Muscle enzymes: CK, LDH, EMG and Toxo titres, 2M Ab assays** *This dog has a much higher AST than ALT, so consider the possibility that this dog has polymyositis. This demonstrates that AST and ALT are _not_ liver-specific*

A dog presents with ptyalism, odynophagia, firm enlarged mandibular salivary glands. What is the treatment of choice?

**Phenobarbitone**

A 10 year old MN Pit Bull presents with shifting forelimb lameness and a history of regurgitation and odynophagia. On clinical examination you palpate enlarged mandibular salivary glands and firm thickening of the radial metaphyseal area. What is the most likely etiology? * Bronchoalveolar carcinoma * Panosteitis * Spirocercosis * Idiopathic sialadenitis

**Spirocercosis**

A 10-year old, MN, Golden Retriever presents to your clinic with PU/PD. Biochemistry detected a 4 x TN ALKP and mild hypoglycemia (BG 3.4 mmol/L, RI 3.5-5.5 mmol/L). Ultrasound detects the lesion shown below. What is your tentative diagnosis? * Lymphoma * Hepatocellular carcinoma * Hemangiosarcoma * Biliary cystadenoma

**Hepatocellular carcinoma**

What is the most common hematologic finding in dogs with **severe pancreatitis**?

**neutrophilia with a left shift **

Trigger, a 5 year old intact male GSD presents to your clinic for a primary complaint of weight loss. The owners report his appetite is great although his bowel movements smell horrible. On exam, you note he is BAR, has a poor hair coat and BCS = 1.5/5. What is your tentative dx? * EPI * Pancreatitis * Insulinoma * Acute hepatitis

**EPI**

When submitting a liver biopsy, what **special stain** would you request if you want to confirm amyloid accumulation?

**congo red**

A 1-year-old male labrador from Alabama has a history of projectile vomiting. You ultrasound the abdomen and find this abnormality at the pylorus cross-section. Considering the signalment and history, what is the tentative diagnosis? * Acquired antral pyloric hyperplasia * Congenital pyloric stenosis * Pythiosis * Intussusception

**Pythiosis**

The most accurate blood test for diagnosing **pancreatitis** in cats:

**Feline Spec PL**

What is the role of **metoclopramide** in the medical treatment of esophagitis?

**to improve tone of caudal esophageal sphincter**

An otherwise healthy 4-year-old border collie. PC: regurgitation. What is your diagnosis? * Vascular ring anomaly * Sliding hiatal hernia * Idiopathic megaesophagus * Esophageal FB

**Idiopathic megaesophagus**

Silkworm, a 2 year-old overweight, MN, DSH is presented to your clinic for anorexia. Biochemistry tests detect 2 x TN ALKP. Which interpretation is correct? * ALKP has many isoenzymes. This is not liver specific * ALKP is liver specific for the cat and Silkworm has hepatic lipidosis * Increased ALKP is not significant, due to the long half-life and it is ‘too sensitive’

**ALKP is liver specific for the cat and Silkworm has hepatic lipidosis**

Do we see **abdominal contractions** in vomiting or regurgitation?

**Vomiting!** ## Footnote * Vomiting is associated with abdominal contractions!* * Regurgitation is a passive process.*

Current feeding recommendations indicate enteral or partial parenteral nutrition as soon as vomiting is under control. What diet should be fed? * Intestinal bland diet * Hypoallergenic diet * Novel protein diet * Low fat diet

**Low fat diet**

Midge, a 4-year-old Fox terrier has weight loss, mild hypoalbuminemia. There is microhepatica. How would you confirm liver failure? * Bile acid stim * Ammonia tolerance test * Low albumin, urea, glucose * Prolonged PT/aPTT

**Ammonia tolerance test**

The most specific marker of liver function:

**Bile Acids Stimulation Test** *\*\*Not helpful in hepatic/post hepatic jaundice\*\**

What is the treatment protocol for **feline suppurative cholangitis**?

**Broad-spectrum antibiotics** (Clavamox & cephalosporins) ## Footnote *Also supportive care, vitamin K, SAMe, UDCA*

Which of the following is FALSE about **chronic liver disease**? * No improvement after 6 months or longer * Progresses to fibrosis and cirrhosis * Cause is often indicated from bacteria or viruses * Copper accumulation can cause chronic liver disease

**Cause is often indicated from bacteria or viruses**

Which is the parameter associated with the worst outcome (prognosticator) in CH? * Normal liver enzymes * Copper concentration \> 1500 * Ascites with hypoalbuminemia * Prolonged PT/aPTT

**Prolonged PT/aPTT**

Enteral nutrition for cats with HL should be supplemented with which essential amino acid (11) to assist mitochondrial fatty acid oxidation? * L-carnitine * Arginine * Taurine * Methionine

**L-carnitine**

You are asking an owner about the incidence of vomiting in their dog. They describe it as happening quickly after eating and it is often undigested food. ## Footnote **Do you think this is vomiting or regurgitation?**

**Regurgitation**

On ultrasound, you note retrograde dilatation of the common bile duct and gall bladder and tortuous common bile duct. What is your diagnosis?

**Extrahepatic Biliary Obstruction [EHBO]**

Increased **ammonia** is not seen until more than \_\_\_% hepatic capacity is lost

**70%** ## Footnote *Increased ammonia is not seen until more than **_70%_** hepatic capacity is lost*

In the majority of cases of acute liver failure, how does the liver appear on ultrasound?

**diffusely hy**_po_**echoic**

Diagnosis?

**persistent right aortic arch (PRAA)**

What is not a result of **acute pancreatitis**? * Local inflammation and necrosis * Cytokine storm * SIRS * Loss of endocrine and exocrine function * Systemic dissemination of activated enzymes

**Loss of endocrine and exocrine function** *Loss of endocrine and exocrine function happens with chronic pancreatitis*

T/F: Hy**_po_**glycemia is uncommon in dogs

**True** *Most commonly seen associated with shunts, fulminant failure, young/small dogs*

The most common form of pancreatitis in dogs is: * Acute pancreatitis * Chronic pancreatitis * Acute on chronic

**Acute on chronic**

What is the diagnostic modality of choice for **Extrahepatic Biliary Obstruction [EHBO]**?

**Ultrasound!** *sediment, choleliths, wall thickeneing, EHBO, emphysema of the wall, pericholecystic fluid*

What are the two leading complications associated with **biliary mucoceles**?

**hy**_per_**adrenocorticism and hy**_per_**lipidemia** *Additional risk factors:* * *Breed: Shetland sheepdog (PC def), mixed breed, Bichon frise, Miniature and toy poodles, West Highland white terriers, Dachshund, German shepherd and Cocker spaniel* * *Age: 11 years (3‐17) with no gender over represented* * *Endocrinopathies: **hyperadrenocorticism** (21%), diabetes mellitus (6%), hypothyroidism (12%)* * *Pancreatitis (12%)* * *Gallbladder dysmotility (10%)* * *High fat diet (10%)* * *PLN (6%)* * *Gallbladder neoplasia (5%)* * ***Hyperlipidaemia (21%)***

T/F: Surgery is the definitive treatment for **biliary mucoceles**

**True** * You are not likely to have much luck if you try to medically manage these patients!* * And remember, whenever you remove a gallbladder, the most important thing for you to do is to ensure patency of the common bile duct!!*

Pain or difficulty in **swallowing** is termed:

**dysphagia**

Tilly, a 7 year old FS Chinese crested presents to you with this mass under the chin. It is soft and painless on palpation and does not seem to be attached to any underlying tissues. Diagnosis? * Sialadenitis * Sialocele * Thyroid carcinoma * Pharyngeal stick injury

**Sialocele**

How do you confirm **sialocele**?

**"drip-test"** *aspirate honey-coloured tenacious fluid*

A dog presents with chronic small intestinal diarrhea and you suspect the cause is parasitic. The owner has some financial constraints, so you recommend a 5-day course of \_\_\_\_\_\_\_\_\_\_\_

**fenbendazole**

What is the most common **pancreatic neoplasia** in cats?

**adenocarcinoma**

\_\_\_\_\_\_\_\_\_\_\_ is most common tumor affecting pleural space

**mesothelioma** *Mesothelioma is most common tumor affecting pleural space. Laparoscopy or laparotomy is typically required to make a definitive diagnosis.*

SAM II Exam I Material - Gastrointestinal Flashcards

(124 cards)