GI 2

Question 1

True or False: A few flecks of blood in vomit can be normal

Answer 1

True

Question 2

Which GI specific diagnostics can you use if a patient is showing signs of urgency markers?

Answer 2

• Abdominal radiography (but more sensitive for FBs, not chronic GI cases)
• Abdominal ultrasound (better for chronic conditions)
• Endoscopy (with partial biopsies)
• Surgical biopsies (laparotomy/laparoscopy) (very efficient)
• GI blood panel (folate, cobalamin, TLI, PLI)
• Fecal float

Question 3

Which GI specific test should not be used to diagnose urgency markers?

Answer 3

Fecal culture

Question 4

What is a common infectious cause of chronic vomiting?

Answer 4

Helicobacter pylori

Question 5

True or False: GI disease caused by Helicobacter pylori will be resolved with a therapeutic trial

Answer 5

False

Question 6

What type of bacteria is Helicobacter pylori?

Answer 6

Gram-negative, urase producing bacteria

Question 7

True or False: Helicobacter pylori does not cause GI ulcerations in animals

Answer 7

True (however it does in humans)

Question 8

True or False: Helicobacter pylori can be present in both healthy and vomiting dogs

Answer 8

True (seen in 67-100% of healthy dogs and 74-100% of vomiting dogs)

Question 9

Which species of Helicobacter is most common in cats?

Answer 9

Helicobacter heilmannii

Question 10

How can vomiting caused by Helicobacter pylori be diagnosed?

Answer 10

Endoscopic or surgical gastric biopsy (bacteria will be visible in histopathology)

Question 11

True or False: A urease test is not sensitive for presence of Helicobacter pylori

Answer 11

True (don’t use this test)

Question 12

How can vomiting caused by Helicobacter pylori be treated?

Answer 12

Metronidazole, famotidine (H2 receptor antagonist), amoxicillin (maybe omeprazole)
There you go, now there is finally an indication for metronidazole and famotidine!

Question 13

What is the prognosis of infection with Helicobacter pylori?

Answer 13

Recurrence is common but 90% of dogs and cats respond after 14 days of treatment

Question 14

What is a common cause of chronic vomiting in brachycephalic breeds?

Answer 14

Hypertrophy of the pyloric mucosa (causes a gastric outflow obstruction)

Question 15

What does hypertrophy of the pyloric mucosa lead to?

Answer 15

Delayed gastric emptying

Question 16

What is the typical presentation for chronic vomiting caused by delayed gastric emptying?

Answer 16

• Vomiting up food 8-16 hours after eating
• Abdominal distension

Question 17

How can pyloric hypertrophy be treated?

Answer 17

• Surgically
• Dietary modifications (low fat GI diet)

Question 18

What is the prognosis of delayed gastric emptying conditions?

Answer 18

Fair, but many idiopathic cases result in recurrent bloat or GDVs

Question 19

What are some causes of gastric ulcers?

Answer 19

• NSAIDs and glucocorticoids
• Decreased blood flow (shock, anesthesia)
• Hypersecretion of acid (mast cell tumors, gastrinomas)
• Exercise-induced (sled dogs)
• Addison’s disease

Question 20

Which class of NSAIDs are less ulcerogenic?

Answer 20

COX-2 selective agents

Question 21

What are the clinical signs of gastric ulcers?

Answer 21

• Hematemesis
• Melena
• Shock

Question 22

How can gastric ulcers be diagnosed?

Answer 22

• Chemistry (elevated BUN)
• CBC (regenerative anemia, lack of stress leukogram in Addison’s disease)
• Radiographs
• Ultrasound
• Endoscopy (can visualize gastric ulcers in antrum)
• Surgical biopsy

Question 23

How can true gastric ulcers be treated?

Answer 23

• PPIs (omeprazole, pantoprazole)
• GI coating medications (sucralfate)
• Antiemetics
• Antibiotics (if needed)
• Pain controls (opioids)

Question 24

What is bilious vomiting syndrome?

Answer 24

Chronic intermittent vomiting of bile secondary to reflux into stomach

Question 25

How can you treat bilious vomiting syndrome?

Answer 25

Feed a meal late at night +/- give antacids (if no response, consider additional workup to rule out other conditions)

Question 26

True or False: Benign gastric neoplasia is more common than malignant

Answer 26

False. Malignant is far more common

Question 27

What is hemorrhagic gastroenterocolitis (HGE)?

Answer 27

An acute hypersensitivity reaction characterized by a mixture of vomiting, small and large bowel diarrhea, and hematochezia

Question 28

How can HGE be treated?

Answer 28

- NPO trial if vomiting - Gastro diet and probiotics - Shock treatment if severe (IV fluids)

Question 29

Clinical signs typically show up ____ days after infection with parvovirus

Answer 29

4-7 days

Question 30

What other condition can parvovirus lead to?

Answer 30

Intussusception

Question 31

How can parvovirus be diagnosed?

Answer 31

- CBC (leukopenia, anemia) - Chemistry (panhypoproteinemia) - Fecal antigen ELISA (can take up to 10-12 days after infection to become positive so retest!)

Question 32

Which virus can cause cerebellar hypoplasia in kittens?

Answer 32

Panleukopenia

Question 33

Which virus in cats can mutate to cause FIP?

Answer 33

Feline coronavirus (otherwise mostly causes self-limiting diarrhea)

Question 34

How can giardia be diagnosed (two)?

Answer 34

- 3x zinc sulfate floats - ELISA or PCR

Question 35

How can giardia be treated?

Answer 35

- Fenbendazole - Metronidazole (less effective)

Question 36

What is Antibiotic-Responsive Diarrhea (ARD)?

Answer 36

A dysbiosis in the small intestine that causes diarrhea

Question 37

What causes Antibiotic-Responsive Diarrhea (ARD) (four)?

Answer 37

- Local IgA deficiency - Abnormal GI tract (motility disorder) - Chronic enteropathies (IBD, EPI) - Acute enteropathies

Question 38

How can Antibiotic-Responsive Diarrhea be treated?

Answer 38

- Metronidazole or tylosin - Diet change - Cobalamin SQ if needed

Question 39

True or False: Cobalamin and folate testing is not very sensitive or specific

Answer 39

True

Question 40

Which diseases can cause hypocobalaminemia (two)?

Answer 40

- ARD - IBD

Question 41

Which disease can cause increased folate levels?

Answer 41

ARD

Question 42

How can pancreatitis be diagnosed?

Answer 42

A high pancreatic lipase immunoreactivity (PLI) test

Question 43

What is exocrine pancreatic insufficiency (EPI)?

Answer 43

A condition characterized by the insufficient synthesis and secretion of pancreatic enzymes?

Question 44

EPI is typically _________ in dogs and _________ in cats

Answer 44

Primary, secondary

Question 45

How can EPI be diagnosed?

Answer 45

A low trypsin-like immunoreactivity (TLI) test result

Question 46

How can EPI be treated (three)?

Answer 46

- Pancreatic enzyme supplementation WITH FOOD - Cobalamin supplementation (monthly injection) as needed - High-quality diet

Question 47

What is the prognosis of EPI?

Answer 47

Good to excellent

Question 48

What is the difference between proton pump inhibitors, GI protectants, and H-2 antagonists? When is it appropriate to use which?

Answer 48

Proton pump inhibitors (ex. omeprazole or pantoprazole) - Reduce stomach acid production directly - Used to treat esophagitis, gastric ulcers, and hiatal hernias GI protectants (ex. sucralfate) - Binds to areas of inflamed or ulcerated gastric mucosa - Used to treat esophagitis and gastric ulcers H-2 antagonists (famotidine, ranitidine) - Reduces stomach acid production indirectly - Used to treat Helicobacter

Question 49

For which GIT conditions only is treatment with metronidazole indicated?

Answer 49

- ARD - Helicobacter infection - Giardia (less effective but can be an option) - EPI (if patient isn't responding well to tylosin)