What is the most important part of the GI workup?
A thorough history
What is the difference between dietary indiscretion and dietary intolerance?
Dietary indiscretion:
- Recent and sudden diet change
- Feeding a low-quality poorly digestible diet
- Usually acute
Dietary intolerance:
- Considered an “allergy”
- Inability to digest or difficult digestion
- Usually chronic
- Usually no urgency markers
What is the most common cause of dysphagia?
Oral, laryngeal, or upper esophageal disease
What is considered acute GIT upset?
Persistent for several days (often self-limiting)
What is considered chronic GIT upset?
Lasting more than 2-3 weeks
Name seven differentials for regurgitation
- Megaesophagus
- Esophagitis
- Hiatal hernia
- Ring anomalies
- GERD
- Neoplasia
- Foreign body
List eight primary GIT conditions
- Dietary indiscretion
- Dietary allergy
- Foreign body
- Anaphylaxis (dogs)
- Chronic enteropathy (IBD)
- Infectious (Campylobacter, Clostridium, Salmonella, Helicobacter, parvovirus)
- HGE
- Neoplasia
List eight secondary GIT conditions
- Acute or chronic pancreatitis (dogs)
- Addison’s (especially poodles)
- GDV or other torsions (colic, mesentery)
- Peritonitis (bile vs. uroabdomen vs. GI perf/septic)
- Hyperthyroidism
- DKA
- Prostatitis or pyometra
- Hepatic encephalopathy
True or False: GI ulcers are common in dogs and cats
False
When can you consider a therapeutic trial for cases of vomiting, diarrhea, and anorexia?
If there are no GI urgency markers
Name the 8 GI urgency markers that would warrant diagnostics
- Unstable patient (hypovolemia, hypotension, hypoperfusion)
- Marked or rapid weight loss
- Abdominal pain
- Hypoproteinemia
- Abdominal effusion
- Prolonged anorexia (> 1-2 days in cats)
- Intractable (uncontrollable) vomiting
- Age (not absolute but may be more urgent in geriatric patient)
If you have one or more of the following - work up the patient
Name three markers that are not necessarily indicative of an urgent GI workup
- Chronic vomiting
- Chronic diarrhea
- Acute hematochezia
If no other urgency markers are present, therapeutic trials can be considered
What is the most common cause of vomiting and diarrhea in cats and dogs?
Due to something they eat!
What are the six steps of therapeutic treatment for acute GIT disorders?
- Check for urgency markers
- Eliminate simple diseases (ex. parasitic)
- Eliminate dietary factors (try a diet trial)
- Treat symptoms/consequences (nausea, dysbiosis)
- Hydration (stable patients with no urgency markers are allowed to be dehydrated)
- Follow up with more diagnostics if this does not resolve
When should you use a GIT diet versus an elimination diet?
- GIT is for acute conditions (bland diets, GI LF)
- Elimination diet (ex. HA, d/d) is for chronic conditions
True or False: The efficacy of metronidazole in the use of acute diarrhea has never been proven
True
Which medication should be used for anti-parasite treatment for young cats and dogs?
Fenbendazole (treats roundworms, hookworms, whipworms, and Giardia)
When can you use an NPO trial?
Only for cases of acute vomiting that have no GI urgency markers
NOT for acute diarrhea
What are the steps to an NPO trial?
Goal is to “reset” the GIT
- NPO for 12 hours (no food or water)
- Give SMALL amounts of water every 2 hours for 6 hours
- Give SMALL amounts (meatballs, teaspoons) of GI diet in 4-6 meals per day for 2-3 days
- If desired, reintroduce old diet gradually over several days
If there is vomiting at any point over the NPO trial, do further diagnostics
True or False: Sucralfate and antacids are almost never a good use for GIT symptoms
True. There is almost never a use for antacids or sucralfate for GIT conditions. These are for the treatment of GI ulcers which animals rarely get.
What conditions are the exception to using antacids for?
- Gastroesophageal reflux disease (GERD)
- Esophagitis
- GI ulceration
Which commonly prescribed medications for GIT conditions have no actual proof of efficacy?
Famotidine and sucralfate (plus it makes cats vomit)
When can you consider sending a patient home with SQ fluids?
If patient is ≤ 5% dehydrated or ≤ 25 kg
What should you do if a therapeutic trial fails?
- Consider medical imaging (radiographs or ultrasound)
- Consider a CBC/Chem/urinalysis panel
- Consider GI panel and endocrine testing
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Neuro 141
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Neuro 2 & 330
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Ortho 179
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Ortho 231
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Ortho 331
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Ortho 422
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Head and Neck56
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Cardiology60
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GI 142
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GI 249
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GI 334
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Dentistry 127
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Dentistry 245
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Dentistry 344
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Abdominal Surgery 1 + 255
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Abdominal Surgery 336
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Abdominal Surgery 465
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Liver 152
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Liver 225
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Pancreas33
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Oncology 1 & 283
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Immune 170
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Resp 1 & 2100
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Resp 341
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Repro surgery92
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Infectious75
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Diabetes Mellitus75
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Thyroid Disorders62
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Adrenal Gland Disorders42
