Smallies 1 Flashcards
(103 cards)
1
Q
Define Tenesmus
A
Continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness
2
Q
Define Haematochezia
A
Passage of fresh blood through the anus, usually in or with stools
3
Q
Define Dyschezia
A
A functional condition characterised by at least 10 minutes of straining and crying before successful or unsuccessful passage of soft stools
4
Q
Define Diarrhoea
A
An increase in faecal volume, water content and frequency of defaecation
5
Q
Explain how the LI can compensate for the failure of the SI
A
The LI can reabsorb water but will not be able to compensate for nutrient absorption or digestion
6
Q
What is the difference in water content in formed and unformed stool?
A
Formed: 60-80% water
Unformed: 70-90% water
7
Q
List stool characteristics and general signs in SI disease
A
Large volume, watery, melaena, weight loss
8
Q
List stool characterisitics and general signs in LI disease
A
Urgency, tenesmus, haematochezia, small volume, increased frequency, presence or mucus/fresh blood
9
Q
Define Dysphagia
A
Difficulty swallowing
10
Q
List clinical signs of dysphagia
A
Gagging, dropping food, retching, exaggerated swallowing effort, ptyalism, fear of eating combined with a ravenous appetite
11
Q
Define ptyalism
A
Excessive salivation
12
Q
List the 5 classifications of dysphagia and explain each where the abnormality is seen
A
Oral - prehending and transporting bolus to base of tongue
Pharyngeal - transporting bolus from oropharynx
Cricopharyngel - transporting bolus through upper oesphageal sphincter
Oesophageal - transporting bolus through oesophagus
Gastro-oesophageal - transporting bolus across the lower oesophageal sphincter
13
Q
What are the 3 phases of vomiting
A
Prodromal, retching, expulsion
14
Q
Explain the 3 phase of vomiting (prodromal, retching and expulsion)
A
Prodromal - see signs of nausea (e.g. ptyalism, appetite loss, lip licking) and excessive swallowing
Retching - get retrograde duodenal contractions with rhythmic inspiratory movements against a closed glottis and dilation of the cardia/lower oesophgeal sphincter
Expulsion - reduced oesophgeal and pharyngeal tone and active expulsion of gastric/duodenal contents by contraction of abdominal muscles
15
Q
What are the possible causes of vomiting? (list categories, not specifcs)
A
Diet, stomach conditions, intestinal problems, abdominal, metabolic/endocrine, bacterial, viral, parasites, infections, toxins, iatrogenic, central/CNS
16
Q
What are dietary causes of vomiting?
A
Change of diet (planned or unplanned)
Spoiled food
Food intolerance - non immune mediated
Food allergy - immune mediated
17
Q
What are stomach condition causes of vomiting?
A
Inflammatory - gastritis (acute or chronic) or ulceration (less common but can be chronic)
Physical - FB, outflow obstruction, hiatal hernia
Functional - motility disorder
Neoplastic - adenocarcinoma, lymphoma, leiomyoma
18
Q
What are intestinal condition causes of vomiting?
A
Inflammatory - IBD (common), infectious enteritis/colitis, SIBO/ARD
Physical - FB, intusussception, volvulus
Functional - ileus, constipation
Neoplastic - carcinoma, lymphoma, leiomyoma, MCT
19
Q
What are abdominal causes of vomiting? (list by organ)
A
Pancreas - acute or chronic pancreatitis, pancreatic tumour, EPI with SIBO
Peritonitis - septic
Liver disease - cholangiohepatitis, chronic hepatis, cholecystitis, biliary obstruction
Renal - CKD, AKI, pyelonephritis, urinary tract obstruction
Uterine - pyometra, pregnancy
Prostatic disease - prostatisi, paraprostatic cyst, prostatic tumour, benign hypoplasia
20
Q
What are metabolic/endocrine causes of vomiting?
A
Hyperthyroidism Azotaemia Hypoadrenocorticism Diatbetic ketoacidosis Hypercalcaemia Hepatic encephalopathy - congenital PSS
21
Q
What are bacterial causes of vomiting
A
Salmonella Clostridium perfringens E.coli Campylobacter jejuni Yersinia
22
Q
What are viral causes of vomiting?
A
Parvovirus/feline panleucopenia Coronavirus (FIP) FeLV FIV Distemper Canine Adenovirus Rotavirus
23
Q
List parasitic causes of vomiting?
A
Worms - toxocara, taenia, uncinaria, trichuris
Protozoa - isospora, cryptosporidium, giardia, tritrichmonas
24
Q
List toxin causes of vomiting?
A
Ethylene glycol, raisins, theobromine, lead, lilies, ivy, conkers, adder bites
25
List drug (iatrogenic) causes of vomiting?
Antibiotics, NSAIDs, cyclosporine, digoxin
26
List central/CNS causes of vomiting?
```
Motion sickness
Idiopathic vestibular disease
Encephalitis
Limbic epilepsy
Tumours
```
27
What are the indications to induce emesis?
Gastric decontamination after toxin ingestion
| Foreign body ingestion
28
What are the contraindications of inducing emesis?
```
Caustic substance ingestion
Lethargy/debilitation
Dyspnoea
Neurological signs
Abdominal surgery
Spinal injury
```
29
Names drugs used to induce vomiting
Apomorphine - dopamine agonist
A2A - medetomidine or xylazine
Hydromorphone + midazolam
30
List reasons for ptyalism that is unrelated to nausea
Oropharyngeal disease
PSS
Salivary gland disease e.g. siadenitis
31
What points from a history should make you worry about a vomiting case?
```
Several days duration
Rapid deterioration
Persistent vomiting and/or inappetence
Haematemesis
Profuse SI diarrhoea
Weight loss
```
32
What physical examination findings should make you worry about a vomiting case?
```
Weak, collapsed,
MM: dry/tacky, pale or congested
Tachycardia, bradycardia, arrhythmias
Weak and thready pulses
Hypothermia or pyrexia
Abdominal pain or distention
Melaena or haemorrhagic diarrhoea
```
33
What screening tests can you do for a vomiting case?
Blood tests - haematology/CBC, biochemistry, electrolytes
| Urinalysis - dipstick, USG, sediment exam +/- culture
34
What diagnostic imaging can you do for a vomiting case?
Radiograph - abdominal +/- thorax (mets, aspiration)
| Ultrasound - abdomen +/- guided biopsy
35
When is endoscopy indicated and contraindicated in a vomiting case?
Indications - chronic disease
| Contraindications - acute disease (unless confirming presence of an ulcer or FB)
36
What patient preparation is required for endoscopy?
Starve the patient - not performed 'on the day'
| Ideally after radiographic study
37
What specific disease tests can be used for a vomiting case?
```
TT4
Pancreastic lipase immunoreactivity
ACTH stim
FeLV/FIV
Serum cobalamin
Serum folate
Pre and post prandial bile acid
```
38
/what supportive care and stabilisation can be done for a vomiting case?
Fluid therapy +/- electrolyte replacement
Anti-emetics (if no obstruction or history of toxin ingestion)
Gastroprotectants
Prokinetics
Nutrition
Nursing care
39
Describe the ideal anti-emetic drug
Broad spectrum activity - peripheral and central
Minimal CVS side effects - these patients may be dehydrated or haemodynamically unstable
Wide therapeutic index - clearance mechanisms may be compromised (e.g. renal/hepatic)
Minimal CNS side effects (sedation) - reduces risk of aspiration
Minimal negative effects on GI motility - reduces risk of ileus
40
What is Maropitant and discuss pros and cons of its use
Selective NK1 receptor antagonist
Effective against peropharal and central pathways
Advantages:
- Has analgesic properties so useful for painful conditions e.g. pancreatitis
- Suitable for cats and dogs
- Comes in oral and injectable forms
Disadvantages:
- Pain at injection site
- Can only use for 5 days (injection) or 14 days (oral)
41
What is Metoclopramide and discuss pros and cons of its use
Dopamine, 5-HT3 and H1 receptor antagonist
More central than peripheral effects
Variable prokinetic effects
Advantages:
- Suitable for cats and dogs
- Comes in oral and injectable forms
Disadvantages:
- Short acting (CRI may be best?)
- Rarely causes extrapyramidal side effects (agitation, ataxia, aggression)
Now replaced by Maropitant unless using aCRI
42
Explain how dogs and cats are normally resistant to bacterial gastritis
Very acidic environment
Monogastric stomach is a barrier to infection and prevents colonisation of the SI
Very few things can survive past the stomach
Sterile environment
43
Give reasons for disruption to the gastric barrier to bacterial gastritis
Neonates - barrier functions not yet well developed
| Abnormal gastric environment - food related or antacids (iatrogenic)
44
How is the stomach protected from gastric ulceration from stomach acid?
the gastric mucosal barrier has tight intercellular junctions, a bicarbonate-rich mucous layer and local prostaglandins controliing mucosal blood flow, bicarb production and mucus.
It is also dynamic tissue so can have rapid epithelial turn over
45
What are causes of gastric ulceration associated with failure of the mucosal barrier?
acid hypersecretion
direct physical injury e.g. FB
reduction of prostaglandins e.g. COX inhibitors (NSAIDs)
46
What are benign causes of gastric ulceration?
```
Iatrogenic e.g. NSAIDs
Metabolic/endocrine e.g. Addisions, azotaemia,
Complication of IBD
SHock and sepsis
Stress
```
47
What are malignant causes of gastric ulceration?
Primary gastric neoplasia e.g. adenocarcinoma, lymphoma
Gastrinoma
MCT
Ulcerative intestinal tumours
48
What are physical causes of gastric disease?
FB - can cause gastritis, ulceration, obstruction, performation
Obstructive mass lesions e.g. neoplastic, inflammatory, granuloma, polyp
Gastric dilation +/- volvulus
49
What are function causes of gastric disease?
Gastric motility disorders
Stasis - often associated with chronic gastritis/IBD, ulceration, infiltrating neoplasia or pancreatitis
Metabolic causes of stasis e.g. hypokalamia, hyper/hypocalcaemia
50
What are neoplastic causes of gastric disease?
```
Carcinoma
Lymphoma
Leiomyoma
Meiomyosarcoma
Fibrosarcoma
```
51
What is bilious vomiting syndrome (+ signalment and common presentation)
Common in dogs
Chronic intermittent bilious vomit
Typically early morning on an empty stomach
52
List clinical signs associated with gastric disease in dogs and cats
Vomiting, salivation, burping, retching, reflux, poor appetite, melaena, weight loss, halitosis, abdominal pain (lethargy, depression, praying position), bloating
53
What are the clinical signs for chronic gastritis?
chronic intermittent vomiting - food or bile
loss of appetite
diarrhoea
Clinical signs wax and wane, may gte occasional flare ups
54
What are the clinical signs for GDV?
acute onset in dogs
unproductive retching
distended and painful abdomen
if prolonged will get circulatory problems leading to a crisis
55
What are the clinical signs for gastric ulceration?
```
Seen in dogs more than cats
Poor appetite
Salivation
Abdominal pain
Haematemesis
Melaena
Weight loss
Anaemia
```
56
Outline the investigations for gastric disease
Signalment, full clinical history, thorough physical examination then screening tests e.g. blood, urine and imaging
57
What are the clinical signs and diagnostic test findings of pyloric outflow obstruction?
Vomiting 6-8 hours after food
Hypocaloraemia, hypokalaemia, metabolic alkalosis
Distended food filled stomach on radiograph
58
Briefly desribe the key points of a diet trial
Must try for at least 6 weeks
Use a single source of protein and single source of CHO
Use novel or hydrolysed protien
59
Name examples of gastroprotectants
Polyaluminium sucrose sulphate
Bismuth subsalicylate
Kaolin products
60
When are antacids used and list examples
USed for gastric ulceration, chronic gastritis and reflux oesophagitis
Proton pump inhibitors - omeprazole
H2 blocker - ranitidine
Aluminium hydroxide
61
When are corticosteroids considered for therapy for gastric disease?
For chorinc gastritis or IBDwhen there has been no response to diet and gastroprotectants
62
What is feline triaditis?
Multiorgan inflammatory disease affecting the liver, pancreas and small intestine
63
When is surgical intervention indicated for gastric disease?
Pyloric outflow obstruction
FB (if can't be removed endoscopically)
Perforated ulcers
Tumour resection e.g. leiomyoma
64
What are the advantages of radiography for the GIT?
```
Gives global overview
Can assess adjacent thorax and skeleton
Good for detecting gas or mineralisation
Useful for acute conditions
Cheap and widely available
```
65
What are teh disadvantages of radiography for the GIT?
```
Superimposition of structures
Lack of inherent radiographic contrast (cr thorax)
Soft tissue and fluid appear the same
Magnification
Less useful for chronic conditions
```
66
List challenges of radiography and how to avoid them
Low inherent constrast (soft tissue/fluid/fat) --> low kV
Minimising scatter --> low Kv, collimation, use of grid
Movement blur --> chemical and physical restraint
PAtient prep --> fasted for 24 hrs, empty bladder
67
What are the uses of contrast studies in the GIT?
Document function by taking sequential still images or using real time readiography (fluoroscopy)
68
List examples of contrast studies for the GIT and liver
GIT: barium swallow (fluroscopy), gastrography (air, barium or double contrast), barium series, barium enema, pneumocolon
Liver: mesenteric portovenography (water soluble iodine)
69
What structures can you see on radiography?
Liver, stomach, spleen, kidneys, small intestine, caecum, colon, urinary bladder, prostate gland, diaghragm, body wall, sublumar musculature, thoracolumabar/lumbar vertebrae, caudal ribs, part of bony pelvis
70
What can you not see on radiography (normally)?
Adrenal glands, gall bladder, ovaries, uterus, mesentary, meseteric LN, omentum, pancreas, abdominal aorta, abdominal vena cava
71
What are teh advantages of GIT ultrasonography?
```
Assess internal architecture and vasculature
Real time assessment
Good soft tissue definition
Accurate measurement
FNA/biopsy guidance
```
72
What are the disadvantages of GIT ultrasonography?
Limited field fo view
Difficult if large amounts of gast present
Very equipment and operator dependent
73
What is the order of radiopacites (from most lucent structures to most opaque)?
```
Gas - most lucent (black)
Fat
Soft tissue/fluid
Bone/mineral
Metal (most opaque)
```
74
Describe the radiographic appearance of the liver
Roughly triangular with smooth distinct margins
Soft tissue opacity
Demarcated by the diaphragm cranially and stomach caudally
Ventral lobe has a fairly shape angle and is contained in the costal arch
75
How does hepatomegaly appear radiographically?
projection of caudoventral margin well beyond costal arch
rounding of caudoventral angle
caudal displacement of stomach axis
76
How does a small liver appear radiographically?
Cranial displacement of the stomach
| Absence of caudoventral angle
77
Describe ultrasonography of the liver (technique and what you see)
Majority of the liver is examined from the ventral abdomen immediately caudal to the xiphisternum
Fan the probe from left to right and cranial and caudal
Reference point is the diaphragm (hyperechoic line)
Portal veins are ventral to hepatic veins and have hyperechoic walls (hepatic veins don't have hyperechoic walls)
Cannot normally see hepatic arteries or bile ducts
Will see gall bladder - hypoechoic
78
Describe ultrasonography of the spleen (technique and what you see)
Splenic head lies on the left and is triangular - fairly fixed
Tail is more mobile - often on the left in cats but may extend to the right in dogs
More densely textured that the liver (more echogenic)
Well defined capsule with a smooth outline
Anechoic vessels can be seen entering hilus
79
How does the stomach appear radiographically?
Variable size and shape due to variable amounts of gast/fluid/ingesta
Rugal folds often seen as parallel lines
Gastric axis should be parallel to the ribs and perpendicular to the spine
80
Where goes gas and fluid sit in the stomach in RLR, LLR, VD and VD views?
RLR: fluid in pylorus
LLR: gas in pylorus
DV: gas in fundus
VD: fluid in fundus
81
How does the small intestine appear radiographically?
Duodenum identifiable by location - fixed
Cats tend to have less intestinal gas than dogs
Roughly even diameter throughout - no more than 1.6x height of L5 in dogs
82
How does the colon and rectum appear radiographically?
Often easy to identify because they are filled with faeces
83
What are the 5 layers seen in the GIT wall with an ultrasound?
```
Lumen
Mucosa
Submucosa
Muscularis
Serosa
```
84
What are two reasons of abnormal stomach wall thickening with ultrasound?
Neoplasia - loss of layering and decreased echogenicity
| Severe gastritis - obsuring layers, typically hyperechoic mucosa
85
What are reasons for small intestinal wall thicking seen on ultrasound?
IBD - wall layers maintained
| Can be normal
86
What are the 4 views with an AFAST scan?
Diaphragmatico-hepatic
Spleno-renal
Cysto-colic
Hepato-renal
87
What does AFAST stand for?
Abdominal Focused Assessment with Sonography for Trauma
88
What are clinical signs of dysautonomia?
```
Dry mouth and nose
Constipation and urine retention
Regurgitation
Dilated pupil
Bradycardia
```
89
List clinical signs of oesophageal disease
```
Anorexia
Dysphagia
Salivation (ptyalism)
Aspiration pneumonia
Weight loss
```
90
Compare regurgitation and vomiting
Regurgitation - variable time after eating, passive process (no abdominal retching), froth/saliva, may just look like food compressed into tubular shapes
Vomiting - nausea, active process (abdominal retching), bilious fluid (yellow)
91
Why should you take both lateral view when radiographing to check for aspiration pneumonia?
It has lobar distribution so may not show up on one view. You may not be able to see anything if the aspiration is within the recumbent lung
92
What is the test of choice for Myasthenia Gravis?
Acetyl choline receptor antibody
93
Where is a common site for foreign bodies to lodge in the oesophagus?
Thoracic inlet
94
Why is fluoroscopy useful for investigating oesophageal disease?
Excellent technique for assessing swallowing and oesophageal motility disorders. It is a way to see real time motility of the oesophagus
95
Oesophageal strictures are associated with...
reflux during anaesthesia and/or major surgery
| severe persistent vomiting
96
What is an iatrogenic cause of oesophageal stricture in cats?
Doxycycline
97
What is the 'normal' clinical history for rabies?
Bite wound in the preceeding 3 weeks to 6 months
98
What are early clinical signs of rabies?
Anorexia, depression, mild ataxia
99
What clinical signs do you see as rabies progesses?
Hyperesthesia, hypermetria, regional pruritus, recumbency, coma, death
100
What are the 3 forms of rabies?
Furious, dumb, paralytic
101
What species if furious rabies common in and list clinical signs
```
Most common form in dogs
Signs:
- recumbency
- biting and aggression
- convulsions
- exaggerated response to tactile stimuli
- vocalisation
```
102
What species if dumb rabies common in and list clinical signs
```
Most common form in horses
Signs:
- depression, febrile
- ataxia, drooped head
- profuse salivation, yawning, tongue falccidity
```
103
What species if paralytic rabies common in and list clinical signs
most common form in cattle
Signs:
- lameness, paraparesis, recumbency, salivation
