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Vomiting & Diarrhea Flashcards

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1
Q

List four “inputs” to the vomiting center

A
  • abdominal viscera
  • CRTZ
  • vestibular apparatus
  • cerebral cortex
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2
Q

Top extra-GI causes of V/D in dogs

A
  • pancreatitis
  • liver failure
  • kidney failure
  • hypoadrenocorticism
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3
Q

Top extra-GI causes of vomiting and diarrhea in cats

A
  • pancreatitis
  • liver failure
  • kidney failure
  • hypoadrenocorticism
  • hyperthyroid (V/D)
  • heartworm disease (V)
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4
Q

Most important primary GI rule outs

A
  • GI obstruction (foreign body)
  • parvovirus if puppy
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5
Q

Most important extra-GI rule outs

A

acute pancreatitis or other organ system failure

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6
Q

Large bowel vs. small bowel diarrhea

A

Small:

  • increased appetite-unless sytemic illness
  • weight loss
  • large volume but normal frequency

Large:

  • normal appetite
  • no weight loss
  • increased frequency
  • tenesmus
  • frank blood/mucus
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7
Q

Components/steps to history in V/D cases

A
  1. Make sure to correctly identify problem
  2. If diarrhea, determine small or large bowel
  3. Determine if the problem is acute or chronic
  4. Establish how severe the V/D is
  5. Assess whether primary or extra-GI disease seems most likely
  6. Diet and enviroment
  • diet change or dietary indiscretion
  • foreign body/toxin access
  • potential for GI pathogens
  • vaccination/deworming Hx
  • current meds
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8
Q

Ddx for panhypoproteinemia

How will you differentiate?

A
  • PLE
  • Blood loss

Differentiate with PCV; if patient not anemic, blood loss likely not the issue!

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9
Q

Ddx for low albumin and normal globulin

A
  • PLN
  • liver failure
  • vasculitis
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10
Q

What should you do if you r/o extra-GI causes and determine the problem is small bowel diarrhea?

A

rule out EPI with a TLI

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11
Q

Fiber supplementation is often helpful to treat what?

A

chronic large-bowel diarrhea

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12
Q

Abdominal radiographs are really good for?

A

ruling in obstruction

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13
Q

What are some breeds predisposed to IBD or lymphangiectasia?

A
  • yorkies
  • soft-coated wheaten terriers
  • lyndehunds
  • basenjis
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14
Q

What are some possible causes of PLE?

A
  • moderate to severe IBD or lymphangiectasia
  • neoplastic infiltrate of GI tract (e.g. lymphoma)
  • fungal or heavy parasitic infection (e.g. pythium, histoplasmosis, ancylostomiasis, strongyloides)
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15
Q

PLE-complications

A
  • thoracic and/or abdominal effusion (secondary to low albumin)
  • thromboembolism secondary to loss of antithrombin III
  • ionized hypocalcemia (due to deficiency/malabsorption of vitamin D)
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16
Q

Components of a minimum database for infectious V/D

A
  • FeLV/FIV test-cats
  • wet mounts
  • centrifugation flotation
  • Giardia SNAP test
  • treat with fenbendazole
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17
Q

What should you include in your minimum database for infectious V/D if large bowel diarrhea

A
  • culture or PCR(preferred) for T. foetus - cats
  • rectal scraping cytology
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18
Q

An infectious agent PCR panel might be really helpful when the patient is showing what signs?

A
  • systemic illness
  • fever
  • leukocytosis
  • bloody diarrhea
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19
Q

What treatment considerations are there for lymphocytic/plasmacytic IBD?

A
  • fenbendazole/metronidazole
  • elimination diet/treatment response trials
  • parenteral B12 if low
  • steroids +/- cytotoxic agent
    • ​cyclosporine or azathioprine (dog)
    • chlorambucil (cat)

​

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20
Q

What additional diagnostics would you consider if you found neutrophilic IBD?

A
  • fenbendazole/metronidazole
  • elimination/diet/treatment response trials
  • parenteral B12 if low
  • antibiotics
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21
Q

Treatment considerations if you found eosinophilic IBD?

A
  • fenbendazole/praziquantal
  • elimination diet/treatment response trials
  • parenteral B12 if low
  • steroids +/- cytotoxic agent
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22
Q

Treatment considerations if you found granulomatous IBD

A
  • fenbendazole/metronidazole
  • elimination diet/treatment resopnse trials
  • parenteral B12 if low
  • antibiotics with intracellular activity (e.g. Baytril)
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23
Q

Treatment considerations if you find lymphangiectasia

A
  • Fenbendazole/metronidazole
  • parenteral B12 if low
  • ultra low-fat diet
  • steroids +/- cytotoxic agent
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24
Q

If an animal has polyphagia + weight loss + diarrhea, what does your differential list consist of?

A
  • not feeding enough
  • malassimilation
    • ​EPI
    • small intestinal malabsorption
  • hyperthyroidism
  • diabetes mellitus
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25
Etiology of EPI
* autoimmune lymphocytic (dogs) * chronic pancreatitis (cats, dogs)
26
What breed is predisposed to EPI?
GSD
27
What are the predominant clinical signs of EPI?
weight loss +/- small bowel diarrhea
28
Top PRIMARY GI disease differentials for ACUTE V/D
* dietary indiscretion/hypersensitivity * acute gastritis or gastroenteritis (HGE, parvo, parasitic, bacterial, protozoal) * drug-induced * obstruction (FB, GDV, intussusception) * GI ulcers
29
Anti-emetics that work at the vomiting center
* Chlorpromazine (alpha antagonist) * Maropitant (NK1 antagonist) * Ondansetron-cats (5-HT3 antagonist)
30
What anti-emetics act on the abdominal viscera?
* maropitant * ondansetron-dogs
31
What anti-emetics are effective at the CRTZ?
* Maropitant * Chlorpromazine * Metaclopramide-dogs
32
HGE etiology
* intestinal anaphylaxis; possible role of *C. perfringens*?
33
What finding increases suspicion for HGE?
high PCV with normal TP
34
Treatment for HGE
aggressive fluid therapy + abx with anaerobe activity (ampicillin, metronidazole)
35
Ddx for acute vomiting-primary GI dz
Dietary factors/indiscretion * overeating/gluttony * abrasive material * toxins(caustic agents, plants, mycotoxins,bacterial) * food sensitivity (intolerance or allergy Inflammatory/infectious * Gastritis (dietary indiscretion, food sensitivity, foreign body) * Enteritis/enterocolitis * HGE * parvo, others * Parasitic (ascarids, hookworms, roundworms) * Gastrduodenal ulcers Obstructive/ischemic * gastric or intestinal FB * GDV * intestinal intussusception
36
Ddx for acute vomiting-extra-alimentary disease
* acute pancreatitis * hepatobiliary (acute hepatopathy, cholangitis, biliary obstruction) * genitourinary (acute renal failure, nephroliths, prostatitis, pyometra) * peritonitis * septicemia * endocrine (hypoadrenocorticism, DKA, hyperthyroidism) * neuro (vestibular dz) * motion sickness * drugs (chemo, abx)
37
Ddx for chronic vomiting-primary GI disease
Inflammatory * chronic gastritis * Bilious vomiting syndrome * idiopathic chronic gastritis * food sensitivity * neoplasia (adenocarcinoma, LSA) * drugs (NSAIDs, steroids) * chronic enteritis/enterocolitis * IBD * neoplasia(adnenocarcinoma, LSA) * gastroduodenal ulcers Partial or recurrent obstruction * gastric FB * GI neoplasia * chronic intestinal intussusception * recurrent constipation
38
Ddx for chronic vomiting-extra alimentary tract disease
* chronic pancreatitis * genitourinary (chronic renal failure, chronic prostatitis) * hepatobiliary (chronic hepatopathy, cholecystitis, biliary obstruction) * endocrine disease (hypoadrenocorticism, hyperthyroidism)
39
Ddx for hemamesis/melena
Coagulopathy * thrombocytopenia GI erosions/ulcers * idiopathic chronic gastritis * IBD * parasites (hookworms) * GI neoplasia (gastric, duodenal) * gastric hyperacidity disorders (MCT) * drugs (NSAIDs, steroids) * miscellaneous * acute pancreatitis * hypoadrenocorticism * renal failure * liver failure * ischemic (DIC, shock, heat stress, thromboemboli) * neuro (spinal cord trauma in conjunction with corticosteroid use)
40
Always perform what in cats 7 years and older with chronic V/D?
T4 test
41
What are some other reasons besides pancreatitis that amylase/lipase could be increased?
* dehydration * renal failure * gastroenteritis * corticosteroids-may increase serum _lipase_
42
Usefulness of PLI
* detects lipase of pancreatic origin only * most sensitive test of dx canine and feline pancreatitis
43
The presence of what other findings along with V/D might indicate performing basal cortisol to screen for hypoadrenocorticism in dogs?
* low Na/K ratio * hypercalcemia * eosinophilia * lack stress leukogram
44
Characteristics of a hypochloremic metabolic alkalosis
* high pH or TCO2 * high bicarb * positive base excess * low chloride
45
When should you consider upper GI endoscopy?
* animals with chronic vomiting, diarrhea, or weight loss where initial laborartory and imaging studies failed to ID cause * acute or chronic vomiting where there is potentially retrievable foreign body * persistent upper GI bleeding
46
Main drawbacks to endoscopy
* does not evaluate entire GI tract (i.e. can miss lesions in listal duodenum, jejunum, and ileum) * endoscopic biopsies are only mucosa +/- submucosa
47
Characteristics of a good elimination diet
* highly digestible * gluten and lactose free * protein restricted * single source CHO and protein * novel protein source or hydrolyzed protein
48
When to consider exploratory laparotomy
* ALWAYS when GI obstruction or septic peritonitis is suspected * when lab tests and imaging studies fail to reveal a cause for chronic vomiting or diarrhea; esp. if endoscopy unavailable * focal mural masses/thickenings are found (resections may be needed) * imaging studies show that abnormalities are most prominent in the distal SI * need to examine abdominal organs besides the gut (e.g. liver, pancreas)
49
Name the four mechanisms of diarrhea
1. osmotic 2. secretory 3. permeability 4. motility
50
Name two breeds particularly predisposed to parvovirus
* Rottweiler * Doberman pinscher
51
Name two breeds clasically predisposed to PLE
* soft-coated wheaten terriers * yorkshire terriers
52
Miniature schnauzers predisposed to what causes of diarrhea
* HGE * hyperlipidemia * pancreatitis
53
German shepherds are predisposed to what causes of diarrhea or dyschezia
* EPI * antibiotic-responsive diarrhea * IBD * perianal fistulae
54
Many small-breed dogs are predisposed to what cause of diarrhea?
HGE
55
Ddx for acute diarrhea-primary GI disease
Dietary factors/indiscretion * overeating * sudden diet change * toxins/food poisoning * food sensitivity Inflammatory/infectious (enteritis, enterocolitis, and/or colitis) * HGE * parvo, other viruses * parasites (ascarids, hookworms, whipworms) * sharp/traumatic foreign material Partial obstruction/ischemia * intussusception
56
Ddx for acute diarrhea - extra alimentary
* acute severe pancreatitis (segmental colitis) * hypoadrenocorticism (more often **chronic**) * sepsis, toxemias * drugs (commonly abx)
57
Ddx for chronic **small bowel** diarrhea-primary GI disease
Dietary * food sensitivity (intolerance/allergy) Idiopathic chronic enteropathies * IBD * food-responsive diarrea * antibiotic responsive diarrhea * lymphangiectasia Infiltrative/infectious * intestinal neoplasia (LSA, adenocarcinoma, mastocytosis) * parasites (ascarids, hookworms, giardia) Partial obstructions * chronic intussusception * intestinal neoplasia (LSA, adneocarcinoma, leiomyoma/myosarcoma)
58
Ddx for chronic **small bowel** diarrhea-extra alimentary
* EPI * hepatobiliary (liver failure) * genitourinary (renal failure) * endocrine * hypoadrenocorticism-dogs * hyperthyroidism-cats
59
Do extra-GI causes of diarrhea usually result in large or small bowel diarrhea?
small
60
Ddx for chronic **large bowel** diarrhea-primary GI dz
Dietary * fiber responsive colitis * food sensitivity (intolerance/allergy) Idiopathic chronic enteropthies * IBD * FRD * ARD Infiltrative/infectious * colonic/rectal neoplasia (adenocarcinoma, LSA) * parastic (whipworm, tritrichomonas) Obstructive/ischemic * chronic intussusception (ileocolic, cecocolic) Secondary to chronic small bowel diarrhea
61
What might be an extra-alimentary cause of chronic large bowel diarrhea?
renal failure ("uremic colitis)
62
Ddx for PLE
* IBD * intestinal neoplasia-esp. LSA * lymphangiectasia
63
Ddx for weight loss despite good appetite
Malabsorption/maldigestion * chronic SI dz * EPI Endocrinopathies (excessive catabolism) * DM * hyperadrenocorticism-dogs * hyperthyroidism-cats PLN
64
Ddx for constipation/dyschezia
Dietary * ingested indigestible material (bones, cat litter, plant) Painful/inflammatory * colitis/proctitis * prostatitis * anal sac disease (sacculitis, adenocarcinoma) * perianal fistulae * spinal disease/back pain * pelvic/hip/hind limb pain Obstructive * perineal hernia * prostatomegaly (prostatitis, adenocarcinoma) Motility disorder * idiopathic megacolon * lumbosacral spinal cord disease Miscellaneous * Dehydration-chronic renal failure
65
Low cobalamin is seen with what diseases?
EPI, ileal disease
66
Low folate is seen with what disease
proximal small intestinal disease
67
Cause of increased folate
common with high dietary intake +/- bacterial overgrowth
68
Why is fecal alpha-1 protease inhibitor useful?
It is a protein with a similar molecular weight to albumin, but is NOT degraded in the feces. It can be assayed to detect or confirm the presence of PLE. It can detect subclinical PLE in susceptible populations (predisposed breeds) before the become hypoproteinemic, and is useful to monitor response to therapy.
69
What antibiotics are commonly used in antibiotic response trials?
tylosin, metronidazole
70
Histiocytic ulcerative colitis ("Boxer colitis") is treated with what?
enrofloxacin
71
If diarrhea continues despite appropriate therapy for EPI, what is a good next step?
antibiotic response trial
72
Why are survey films always indicated in constipation cases?
evaluate pelvic structures, lumbosacral spine, prostate, and look for abdominal masses and foreign material
73
Why do liver and kidney dis
74
Famotidine MOA
H2 blocker
75
Omeprazole MOA
PPI
76
Maropitant MOA
NK1 antagonist
77
chlorpromazine MOA
alpha-adrenergic receptors
78
Metaclopramide MOA
dopamine receptors
79
Ondansetron MOA
Serotonin receptor antagonist
80

Companion Animal Med & Surgery (12 decks)

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