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Diseases/ Digestion

diseases of digestion veterinary medicine

QuestionAnswer
What is lymphatic plasmacytic stomatitis? atypical immune response of unknown etiology
What are lymphatic plasmacytic stomatitis signs? inflamed gums, often with minor calculus
What contributes to lymphatic plasmacytic stomatitis? many cats have underlying disease that interferes with local immunity in gingava; cats should be screened for disease
Who is predisposed to lymphatic plasmacytic stomatitis? siamese, himalayans, abyssinians
What is the treatment of lymphatic plasmacytic stomatitis? clean teeth, antibiotics, oral antiseptics, daily brushing w/ antibacterial solutions, hard diet, rechecks
What to do if lymphatic plasmacytic stomatitis recurs? extract all premolars, molars, and retained roots; if still recurs remove remaining teeth; give steroids
What is oral neoplasia? common neoplasia, melanomas and squamous cell carcinomas most common, also fibrosarcomas
Who gets oral neoplasia? older animals
Who is at risk for oral neoplasi? males have increased risk for melonoma and fibrosarcoma
Who is at greater risk for melonoma? dogs with pimented oral mucosa
What is common with oral neoplasia? benign neoplasms (papilomas, epulides)
What are oral neoplasia melanomas? rapidly growing tumors charcterized by early bone involvement; may metastatize to lungs
What is oral neoplasia squamous cell carcinoma? ulcerative, erosive neoplasms *invade bone and metastisize to regional lymph nodes
What is treatment for oral neoplasia? surgical removal, chemo, radiation *poor prognosis*
Diseases of Stomach: What is gastritis? common cause of vomiting in dogs
What are causes of acute gastritis? *gastric indiscretion(garbage),spoiled food, change in diet, food allergy; infection (bacterial, viral, parasitic); toxins; foreign object ingestion
What is physiologic cause of gatritis? mucosa is damaged, inflammation occurs, signs develop
What are signs of gastritis? anorexia, acute vomiting, +/- dehydration, +/- painful abdomen
How do you diagnose gastritis? based on HX and PE; cbc/chem (cbc may indicate stress leukogram and dehydration)
What is treatment for gastritis? *NPO 24-36 hrs, fluid therapy, feed low fat diet, ie, hills i/d, cottage cheese, chicken/rice; *antiemetics(chlorpromazine, metoclopramide, cerinia)
Who is prone to Gastric Dilation/Volvulus (GDV)? disease of dogs 2-10, large and giant breed, deep chested
What is the cause of Gastric Dilation/Volvulus? unclear mechanism: diet and exercise; delayed gastric emptying, pyloric obstruction, aerophagia, and engorgement possible gastric dysrhthmias; *filling w/ air causes dilation (bloat) *air filled stomach twisting on it axis causes volvulus
What is physiology of Gastric Dilation/Volvulus? enlarged stomach pushes against diaphragm, breathing difficult,blocks venous return thru hepatic portal vein & caudal vena cava; increased pressure on gastric wall causes ischemia/necrosis; Spleen may be involved; hypovolemic, edotoxic shock may result
What are signs of Gastric Dilation/Volvulus? signs weakness, collapse, depression, nausea, non-productive retching, hypersalivation, abdominal pain and distension, increased hr and resp
How to diagnose Gastric Dilation/Volvulus: HX and PE demonstrates weak,shocky animal (long crt, abnormal mm);xray;ecg may show vent.arrhthmia/sinus tach; cbc/chem for correction of electrolye and pH imbalances,& fluid therapy
How do you treat Gastric Dilation/Volvulus? *emergency!* decompress stomach(18 g needle), stabilize patient, prep for surgery *stomach tube* treat shock (fluids) *bicarbonate (if total carbon dioxide <12 mEq) *IV antibiotics targeted against gram-/anaerobes; cefoxtin, ampicillin
How to treat Gastric Dilation/Volvulus: (cont) *potassium supplement if < 3 mEq; monitor ECG; treat v-tach w/ lidocaine or procanimade;surgery follow-up care
How to prevent Gastric Dilation/Volvulus: avoid feeding one lg meal; limit exercise after eating; feed high quality, protein, low fat diet; avoid easily fermentable food; DZ has 15-18% mortality rate; *gastropexy no guarantee against future episodes*
Diseases of Small Intestine: What is acute diarrhea? What causes it? What are the signs? most common diarrhea; change in diet, drug therapy, stressful situations causes disruption of normal bacterial flora *signs* abrupt onset diarrhea, +/-vomiting
How to diagnose acute diarrhe: rule out other causes (MDB); fecal sample- direct and float; HCT to monitor hydration
How do you treat acute diarrhea? supportive and symptomatic:fluid and electrolyte therapy, NPO 24-48 hrs, water if no vomiting, pepto bismol or loperamide, antibiotics, bland low-fat diet for 3-5 days
Causes of Parasitic Diarrhea: Toxocara canis, Toxascaris leonina , and Toxocara cati (roundworms), Trichuris vulpis,(whipworms) Ancylostoma caninum, Isopora spp (coccidia), Capillaria aerophila, Giardia spp, Tritrichomonas foetus
Causes of Viral Diarrhea: parvovirus, distemper, coroavirus, feline panleukopenia
What are Chronic Enteropathies? *chronic small intestinal inflammatory bowel disease (IBD);dogs/cats *chronic antigenic stimulation of the intestinal lumen (many causes) infiltration of lamina propria w/ lymphocytes and plasma cells (damage to mucosa and abnormal intestinal absorption)
What are Chronic Enteropathies signs? often non specific; chronic intermittent vomit/,+/- diarrhea, listlessness, weight loss, older animals, Borborygmus (gas sounds in intestine), halitosis, flatulence, signs progressive over time
How to diagnose Chronic Enteropathies: PE often normal, edema or ascities if protein losing enteropathy, MDB, fecal, x-ray, endoscopy/biopsy (looking for lymphotic-plasmacytic infiltrates)
How do you treat Chronic Enteropathies? prednisone, azathioprine, metronidazole, intestinal protectants (sucralfate, H2 blockers), vitamin therapy to replace fat-soluable vitamins, dietary modifications, limit carb, avoid lactose, low-fat diets, good quality protein diet, hypoallergenic diet
Chronic Enteropathies TX (cont) treatment can be long and expensive, often not cured, monitor dogs and cats on long term anti-inflammatory therapy
Diseases of Large Intestine--What is large inflammatory bowel disease? very similar to small intestine diseases, excessive number of inflammatory cells in mucosa, unknown etiology, likely multi factorial, colonic inflammation disrupts mucosal integrity and results in decreased absorption of water and electrolytes
What are the signs of large inflammatory bowel disease? diarrhea w/o weight loss, increased frequency of defecation w/ decreased fecal volume, tenesmus, hematochezia (frank blood), increased mucus, +/- dyschezia; +/- mild fever
How do you diagnose large inflammatory bowel disease? MDB, fecal, x-ray, colonoscopy with biopsy; histo will show lymphocytes and plasma cells in large intestinal lamina propria
How do you treat large inflammatory bowel disease? sulfasalizine (caution with cats);Keratoconjunctivitis-KCS *(may cause dry eye in dog with long term use) , prednisone, metronidazole, azathioprine, tylosin, mesalamine(sim to sulfasalazine , anti inflammatory drug w/free radicals)
What is diet recommendation for large intestinal inflammatory bowel disease? hypoallergenic diets; low fat diets with high fiber; goal is to control signs; may have frequent defecation chronically
What is the cause of Intussusception? unknown, but can result from parasites, foreign bodies, infections, neoplasia
What is Intussusception? occurs when smaller, proximal segment of intestine at ileocolic junction invaginates into larger, more distal segment of large intestine, telescoping effect causes partial to complete blockage and compromises blood supply, causing necrosis
What are signs of Intussusception? vomiting , anorexia, depression, diarrhea (often bloody)
How to diagnose Intussusception: palpation of sausage-like mass in cranial abdomen; ultrasound shows multi-layered concentric rings representing large intestinal wall layers
How do you treat Intussusception? surgical reduction or resection of necrotic bowel, fluids and electrolytes; broad spectrum antobiotics, post surgery; no solid food for 24 hrs, then bland diet for 10-24 days to allow healing intestinal walls
What is the prognosis for Intussusception? recurrence infrequent, prognosis depends on extent of damage, common in puppies with heavy parasitic infestation
What is Megacolon? Who is prone? fairly common in cats(middle-age to older cats); can occur from hypokalema, hypothyroidism, pelvic deformities; 62% of cases are idiopathic; believed to involve a defect in neurostimulation for colon evacuation
What are signs of megacolon? straining to defecate, vomiting, weakness, dehydration, anorexia, small hard feces +/- blood, mucus
How to diagnose megacolon? PE, distended colon is filled with firm, packed feces,x-ray show colon width greater than length of lumbar vertebra, MDB;(possible dehydration, increased HCT)
What is treatment for megacolon? stool softeners, Ducolax, docusate, lactulose, enemas, Cisapride, correct dehydration and electrolyte imbalances, to protect against sepsis thru damaged colonic wall, treat any underlying disease; antibiotics to prevent sepsis
How to give enemas for megacolon or constipation? lubricated red rubber feeding tube inserted and enema solution injected; pre-fabricated pet enemas include warm, soapy water (avoid docusate(emollient); mineral oil(lubricant) hexachlorophene);
WHAT NOT TO DO re: enemas for megacolon or constipation: *DO NOT USE PHOSPHATE ENEMAS IN CATS OR SMALL DOGS *DO NOT MIX DOCUSATE AND MINERAL OIL
Explain docusate enema for megacolon or constipation. docusate possesses wetting and emulsifying properties, salts reduce surface tension & allow water and fat to penetrate ingesta and formed feces; may have an effect on cells of colonic mucosa allowing the cells to more easily secrete water into lumen
Explain use of mineral oil in enema for mega colon or constipation. lubricates feces and reduces water reabsorption out of the lumen
Why is using mineral oil and docusate together in enema for megacolon or constipation contraindicated? contraindicated because docusate will act as a surfacant on the mineral oil, allowing it to be absorbed by the colonic mucosa, and the mineral oil will prevent water from getting to feces
What diet is indicated for megacolon? increase fiber, soft canned food, salt food to increase water intake
Explain surgery for megacolon? subtotal colectomy if refractory to medical and dietary management; rehydrate and correct electrolyte imbalances before anesthsia
Cautions during surgery for megacolon. use caution when removing feces from colon manually; use well lubricated gloved finger, x-ray after to ensure empty colon; use soothing cream post-evacuation, make sure patient is kept clean and dry
Diseases of Rectum/Anus What is perineal hernia? Who does it affect? common in intact older male dogs >8; atrophy of levator ani muscle causes herniation of rectum and pelvic organs into ischiorectal fossa
What are the signs of perineal hernias? perineal swelling, tenesmus, dyschezia, constipation, possible urethral obstruction if bladder involved
What is treatment of perineal hernias? with stool softeners and enemas palliatively until surgical correction via herniorraphy
What are perianal fistulas (anal fistula)? single or multiple ulcerated sinuses that involve perianal tissue often large breed dogs
What are the signs of perianal fistulas? causes pain, bleeding, self mutilation, dyschezia, anal stenosis, tenesmus, incontinence, licking perianal area, foul odor to anal area
What is treatment of perianal fistula? cyclosporin +/- ketoconazole, tacrolimus 0.1% topical, prednisone, azathioprine stool softeners(lactolose) antimicrobials (adjunct for seconary dermatitus)
What type of surgery for perianal fistula? debride ulcers and diseased tissue, possibly cryosurgery; may use medical tx first to decrease the size of the fistulas then surgery
Diseases of the Liver What is cholangiohepatitis? common hepatobiliary disorder of cats, less in dogs; complex of disorders that involve cholangitis, cholangiohepatitis, and biliary cirrhosis: bile duct inflammation leads to hepatocyte involvement, progresses to cirrhosis
What is cholangiohepatitis (cont) and who it affects. cause unknown; ascending biliary infections from GI tract and immune-mediated causes have been suggested; Persian cats predisposed; sometimes occurs in conjuction with pancreatitis and IBD in cats (Triaditis)
What are the signs of cholangiohepatitis? anorexia, depression, weight loss, vomiting, dehydration, fever, jaundice, ascites, hepatomegaly
How to diagnose cholangiohepatitis. cbc--neutraophilia w/ left shift; mild, regenerative anemia
What does chemistry testing for cholangiohepatitis reveal? mild to moderate increase in ALT, normal to increased ALP, mild to moderate increase in GGT, normal to increased fasting serum bile acids, hypoalbuminemia,(later stages), decreased BUN(later stages)
What other diagnostic tests do you do for cholangiohepatitis? Xrays: hepatomegaly or choleliths may be observed
What might a liver biopsy of cholangiohepatitis show? cellular infiltrates in or near bile ducts; +/- portal triad fibrosis (definative diagnosis)
What is treatment for cholangiohepatitis? antibiotics, ursodeoxycolic acid, prednisone, fluid and electrolyte corrections, vitamin and nutritional support, S-adenosylmethioonie
What is prognosis for cholangiohepatitis? prognosis uncertain and variable tx may be prolonged and expensive permanent damage to liver my occur
What is Feline Hepatic Lipidosis? idiopathic, most common hepatopathy in cats adult, obese cats any age , sex, breed
What are Feline Hepatic Lipidosis triggers? stress, diet changes, boarding, illness, enviro. change resulting in anorexia if anorexia >2 weeks; imbalance occurs between breakdown of peripheral lipids and lipid decreased BUN(later stages)
What are the signs of Feline Hepatic Lipidosis? anorexia, depression, weight loss, spoadic vomiting, hepatomegaly, possible bleeding tendencies (petechiae, bleeding from gums)
How to diagnose Feline Hepatic Lipidosis: CBC -nonregenerative anemia; stress neutrophilia, lymphopenia
What would chem tests of Feline Hepatic Lipidosis show? greatly increased ALP, increased ALT, AST, hyperbilirubinemia, hypoalbuminemia, increased serum bile acids
What would other diagnostic tests of Feline Hepatic Lipidosis show? x-rays--mild hepatomegaly; ultrasound--hyperechoic liver; histopathology--severly vacuolized hepatocytes
How to treat Feline Hepatic Lipidosis: high protein, high calorie diet, feeding tube, (for up to 2 mos), IV fluids-potassium supplementation, metaclopramide sq 15 min before feeding if vomiting occurs, wean cat off feeding tube
How to prevent Feline Hepatic Lipidosis: avoid stress in obese cats, early intervention essential, a cat that usually eats well and just stops is at risk, prevent obesity; treatment may be long and $$; cure rate 60-65%,
What are Portosystemic shunts? ductus venosus remains patent (open) after birth, and the blood from abdominal viscera will continue to bypass liver, and liver is unable to filter deleterious and toxic substances
What are the signs of Portosystemic shunts? anorexia, depression, lethargy, weakness, ataxia, head-pressing, circling, pacing, blindness, seizures, coma, hypersalivation 9cats) and bizarre, aggressive behavior in cats
Portosystemic shunts more signs: vomiting, diarrhea, stunted growth, PU/PD/ urate urolithiasis, hematuria, ammonium biurate crystals in sediment, dilute urine
Diagnostics for Portosystemic shunts: cbc: microcytosis, target cells, poikilocytosis, mild regenerative anemia xray microhepatia
More diagnostics for potosystemic shunts: chem: hypoproteinemia, hypoalbuminemia, decreased BUN, mildly increased ALT< ALP, increased serum bile acids, hyperammonemia x-ray: microhepatia
How to treat Portosystemic shunts: medical management seldom successful, low protein diet, lactilose, metronidazole, fluids, surgical ligation of shunt is preferred *beware of hypertension* 2nd surgery possible
What is prognosis for Portosystemic shunt? excellent after surgical ligation surgery yields best results if dog is less than one year; relapses may occur (more common in cats) animals with partial ligations of shunt may require low protein diet to avoid clinical signs of hepatic encephalopathy
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Diseases of Pancreas What is pancreatitis? infl. of pancreas acute/chronic; digestive enzymes are activated within the gland, causes autodigestion, gland becomes inflammed,=tissue damage, high fat diets predispose, assoc w/ hepatic lipdosis, drugs , parasites, tumors, trauma may cause pancreatitis
What are the signs of Pancreatitis? older, obese dog/cat w/ hx of recent fatty meal; anorexia, vomiting, depression,+/-diarrhea, dehydration fever +/-painful abdomen,shock and collapse may develop
How to diagnose pancreatitis? increased serum trypsinogen-like immunoreactivity, (pancrease specific test) serum canine pancreatic lipase immunoreactivity (cPLI), and feline (fPLI)
What dianostics test for pancreatitis show: cbc: leukocytosis, increased PCV; chem: azotemia, increased ALT, mild hypocalcemia, hyperlipemia, normal to increased amylase and lipase
What is treatment of pancreatitis? (supportive care is mainstay)fluids and electrolyte balance; potassium; NPO 3-4 days if vomiting; antiemetics if vomiting; analgesia: Buprenorphine in cats butorphanol in dogs; +/- antibiotics enroflaxin, trimethaprim-sulfa gluccocorticoids
What is Exocrine Pancreatic Insuffciency (EPI) ? pancreas loses acinar cells followed by inadequate production of digestive enzymes; usually asymptomatic until 85-90% of secretory ability has been lost;lack of normal pancreatic secretions affect mucosal lining of small intestine and decrease absorption
totally useless facts about pancreas young german shepherds have genetic predisposition to pancreatic acinar atrophy; in cats EPI often caused by chronic pancreatitis
What are signs of exocrine pancreatic insufficiency? mild to marked weight loss, polyphagia, coprophagia, pica, diarrhea, fatty stool, foul smelling poop, flatulence
How to diagnose exocrine pancreatic insufficiency? cbc normal; increased ALT; decreased total lipid; serum trypsin-like immunoreactivity levels are decreased (fTLI and cTLI)
How to treat exocrine pancreatic insufficiency: supplement pancreatic enzymes, give pancrezyme or Viokase-V; chopped raw ox or pig pancreas; low fiber diet with high digestibility; med chain triglyceride oil; vitamins; antibiotic therapy; +/- prednisone
What is the prognosis for exocrine pancreatic insufficiency? EPI irreversible, requires life long treatment; expensive (pancreatic enzyme replacements) give with every meal; most animals will regain wt. and diarrhea will resolve
Created by: kfoster43