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GI Pathology 3 Flashcards

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1
Q

what is the appearance of segmental anomalies (ex. atresia) in the GI tract?

A

distention oral to the atresia and small/empty aboral segment

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2
Q

what typically causes segmental anomalies

A

segmental ischemia in utero, which results in necrosis

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3
Q

what is the most common type of segmental anomaly in horses and cows? where does it occur?

A

atresia coli ; along spiral colon in calves, anywhere along colon in horses

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4
Q

atresia ani is hereditary in what species (2)

A

calves and pigs

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5
Q

what causes atresia ani

A

failure of perforation of the membrane separating the anus ectoderm from the hindgut endoderm; rectal atresia

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6
Q

what is congenital colonic aganglionosis (lethal white foal syndrome)

A

a codominant trait involving overo x overo breeding resulting in defective neural crest migration and no myenteric plexus development -> no GI motility -> stenosis of small colon - distention, colic and death within 2d of birth

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7
Q

acute GI obstruction usually involves the ____________ whereas chronic GI obstruction usually involves the ______________

A

upper SI (duodenum and jejunum); ileum and colon

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8
Q

what types of diseases can cause functional GI obstruction aka adynamic ileus

A

peritonitis, pain, ischemia (also surgery and peritonitis)

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9
Q

describe strangulation obstruction in GI tract

A

simultaneous obstruction and ischemia of the GI (ex. a pedunculated lipoma in horses that wraps around the GI)

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10
Q

T/F regardless of cause, the consequences of GI obstruction are similar

A

T

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11
Q

what are consequences of GI obstruction

A

fluid and gas distention and ileus oral to obstruction; pressure ischemia; perforation (secondary to pressure ischemia)

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12
Q

what is the difference in metabolic disruptions between an upper GI and lower GI obstruction

A

upper GI: metabolic alkalosis (due to vomiting and loss of acid)

lower GI: metabolic acidosis (due to anorexia -> anaerobic respiration -> lactate production)

also, metabolic disruptions in upper GI obstructions are worse than metabolic disruptions in lower GI obstruction

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13
Q

why do lower GI obstructions tend to be more chronic

A

we still get some fluid absorption proximal to the obstruction, so the distention is slower

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14
Q

what are sequelae to cecum/colon obstruction in horses

A

ischemia -> rupture

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15
Q

what types of things cause acquired stenosis in the GI tract

A

mural abscess/hematoma, neoplasia, post-ulcerative fibrosis

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16
Q

T/F GI foreign bodies can be obstructive by themselves or may become the nidus for enterolith formation

A

T

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17
Q

what type of foreign body is common in cats? what happens?

A

linear foreign body; FB gets attached at base of tongue/pylorus -> peristalsis around foreign body causes plication -> eventually will saw through mucosa

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18
Q

T/F fecal impaction can occur in any species

A

T

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19
Q

what commonly causes colon impaction in:
- dogs
- cats

A

dogs: prostatic neoplasia; pain (inflammation, neoplasia)
cats: spinal cord problems in Manx cats; megacolon from persistent obstipation

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20
Q

what causes colon impaction in horses (there are multiple things!)

A
  • sites of narrowing (ex. pelvic flexure, entering small colon)
  • dehydration
  • coarse hay
  • dental disease (not chewing)
  • sandy soil
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21
Q

colon impaction in horses can be formed from (3), all of which predispose to what 2 problems

A

sand, feed, feces; torsion and displacement

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22
Q

what is a sequelae to sand impaction in horses

A

chronic colitis (because the sand is coarse and irritating to the mucosa)

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23
Q

what types of things can cause extrinsic compression of the GI tract, forming obstruction (7)

A
  • neoplasia
  • abscess
  • peritonitis
  • adipose necrosis
  • adhesions
  • pedunculated lipomas (horses especially)
  • intestine stuck in a hernia
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24
Q

T/F functional obstruction of the GI can be segmental or diffuse

A

T

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25
what is the difference between torsion and volvulus
torsion is around the long axis of organ (twisting arm); volvulus is bending of the organ around the mesenteric axis (bending arm) volvulus more common than torsion
26
what are causes of mesenteric volvulus? what species is this especially common in
ingestion of rocks, highly fermentable diet, rapid eating in suckling ruminants (gas production/hypermotility) especially common cause of sudden death in pigs
27
what is the gross appearance of a mesenteric volvulus
distended abdomen full of dilated, red-black SI (segmental lesion)
28
intussusception involves telescoping of one segment (called the _______________) into another segment (called the __________________)
intussusceptum; intussuscipiens
29
intussusception typically occurs: a) oral to aboral b) aboral to oral
oral to aboral
30
how many layers does an intussusception have
3
31
what are consequences of intussusception
- partial to complete obstruction - blood in feces - adhesions, which eventually cause necrosis and gangrene - tension/compression of mesenteric veins, which eventully causes infarction of the intussusceptum
32
what is the typical age/cause of intussusception
usually young animals (especially dogs); associated with linear foreign body, parasites, enteritis, surgery, mural lesions, agonal
33
infectious causes of intussusception usually form intussusception between what two segments of GI
cecocolic intussuception
34
dogs usually get what type of intussusception
ileo-colic
35
what is the term for displacement outside of the body cavity
eventration
36
what predisposes to cecal and colonic dilation, tympany and torsion
- cows within 2m postpartum - high concentrate rations (increased VFA -> atony -> distention -> rotation)
37
what are consequences of cecal and colonic dilation, tympany and torsion
- compression of organs - compression of venous return - compression of diaphragm - hypovolemia and acidosis
38
what is a consequence of cecal and colonic dilation in SURVIVING horses
laminitis (condition causes acidosis -> acidosis causes ulceration -> endotoxin absorption -> laminitis)
39
why is the horse colon so prone to displacement
it is only attached near the cecum
40
what happens in a right dorsal displacement in horses
the pelvic flexure ends up pointing cranially instead of caudally -> pulls the right colons ventral to the cecum -> right colons become distended with gas, float, and twist
41
on what side of the body can we appreciate right dorsal displacement in horses
left
42
what predisposes to right dorsal displacement in horses
pelvic flexure impaction, torsion
43
what are sequelae to right dorsal displacement in horses
impaction and colic
44
what is another name for left dorsal displacement in horses
nephrosplenic entrapment
45
what happens in left dorsal displacement in horses
left colons move dorsally between the spleen and body wall -> get stuck between kidney and spleen -> rotate so that the ventral colon becomes dorsal
46
what are sequelae to left dorsal displacement in horses
impaction, colon ischemia, compression of splenic vein get intermittent colic unless impacted (which will cause full blown colic)
47
what is a common cause of colic that leads to venous infarction
colonic volvulus (rotation of the right ventral colon)
48
what is necessary for a right ventral colon volvulus to cause obstruction -> ischemia -> enterotoxemia
rotation > 360 degrees
49
what is a sequelae to colonic impaction that occurs postmortem
diaphragmatic rupture due to pressure from trapped gas/ingesta
50
what is an example of an internal hernia through a NATURAL foramen
herniation of intestines through the epiploic foramen in horses
51
what usually causes omental/mesenteric hernia
a traumatic tear that traps intestines
52
what is an external hernia
a hernial sac (natural or acquired) of peritoneum that is covered by skin and soft tissue
53
what does an external hernia usually contain
omentum, intestine, sometimes other organs
54
fixation/incarceration of an external hernia causes
stenosis/adhesions/distention of trapped structures -> necrosis -> obstruction -> perforation -> peritonitis
55
what causes ventral abdominal wall hernias in horses/cows
occurs spontaneously during late pregnancy or can be traumatic
56
ventral abdominal wall hernias = herniation into: (muscle/subcutis/skin)
subcutis
57
T/F umbilical hernias are common, congenital, and sometimes heritable
T
58
what causes an umbilical hernia to form? what predisposes?
patency of the umbilical ring after birth (usually should close); omphalitis predisposes
59
in what signalment/species are inguinal hernias most common
old, male dogs with prostatic enlargement and obstipation
60
what causes a perineal hernia to form
weakening of perineal muscles combined with pressure from straining
61
what does a perineal hernia usually contain?
usually only fat, sometimes bladder (can obstruct)
62
what tissues are most likely to herniate in a diaphragmatic hernia? Is strangulation common or rare
intestines and liver; rare
63
T/F in males, an inguinal hernia can progress to a scrotal hernia
T (leads to testicular degeneration, castration, complication)
64
T/F in females, an inguinal hernia can cause uterine herniation and strangulation
T
65
through what two structures can an inguinal hernia form
external and internal inguinal rings
66
what are the 2 types of inguinal hernias
direct and indirect
67
describe direct inguinal hernias
tear in the peritoneum causes the hernia; less common; life-threatening; most frequent in foals due to the pressure of parturition
68
describe indirect inguinal hernias
contents contained in tunica vaginalis and still within the peritoneum; congenital in young animals (most common in male dogs); acquired and commonly idiopathic in adults (common in bitches)
69
place the following in order of which occurs first to last following blood flow disruptions to the intestines a) b) c) d) e) f) Options: - ischemic lesions visible histologically - colon damage, necrosis - loss of tunica muscularis contractility - disintegration beginning - complete loss of crypts - epithelial loss and hemorrhage
a) ischemic lesions visible histologically (within mins) b) epithelial loss and hemorrhage (within 1-3h) c) colon damage, necrosis (within 1-4h) d) disintegration beginning (2-4h) e) complete loss of crypts (4-5h) f) loss of tunica muscularis contractility (4-6h)
70
what part of the GI tract (i.e. epithelium, crypts, muscularis, etc.) is last to die following an ischemic insult
muscularis
71
what two things are needed for reperfusion injury
- incomplete necrosis - transient ischemia
72
what happens following ischemic injury to the GI tract in the following scenarios: 1) crypts are preserved 2) crypts are lost 3) incomplete ischemia
1) crypts are preserved: regeneration in 1-2 weeks as long as muscularis mucosa is not necrotis; inflammation will persist until the epithelium is restored 2) crypts are lost: ulceration and inflammation; healing eventually occurs by granulation and re-epithelialization from surviving nearby mucosa (unless ulcers are covering a large area); may see strictures in surviving animals 3) full-thickness necrosis; proliferation of anaerobes; gangrene and endotoxemia
73
what is the most common cause of GI ischemia
venous infarction
74
grossly, how can we identify where infarction of a vein occurs in the GI tract
sharp demarcation of pale tissue with surrounding edema, congestion and hemorrhage
75
what is the appearance of a venous infarct in the GI tract when you open the lumen of the GI tract
bloody, gaseous contents with green-black gangrene
76
what is a sequelae of venous infarction in the GI tract regardless of whether rupture or not
septic peritonitis
77
what species do we see arterial thromboembolism in
horses (usually associated with emboli from infected thrombi)
78
where do we see arterial thromboembolism in the GI tract
watershed regions with limited collateral circulation
79
describe shock gut (species it is commonly in, what is it, consequences, appearance)
commonly in dogs; hypoxia due to reflex vasoconstriction and capillary dilation; get pooling of blood, hypotension and microthrombi; appearance is congested SI mucosa with hemorrhagic contents
80
in horses, NSAID injury to the GI from reduced perfusion is best appreciated where
right dorsal colon
81
what are consequences of giving NSAIDS in horses and dogs
- microvascular damage/vasoconstriction leading to mucosal ischemia - GI ulceration - congestion and edema to erosions and ulcerations
82
in what species do we see malassimilation and GI protein loss
mainly dogs, also horses and cats
83
what are consequences of malassimilation and protein loss
diarrhea, weight loss, hypoproteinemia
84
T/F amyloidosis can occur in the GI tract with severe systemic amyloidosis
T (usually not visible grossly)
85
what are consequences of GI amyloidosis
protein loss
86
describe lymphangiectasia
often due to acquired lymphatic obstruction (ex. neoplasia); causes malabsorption of fats; can see lymphatic and lacteal dilation +/- lipid filled macrophages on histology; affected animals develop ascites and edema
87
in what species do we tend to see idiopathic IBD
dogs and cats
88
why is IBD hard to diagnose
overlap between pathology and normal variation; lesions are often mild in comparison to clinical signs; inflammation can be hard to tell apart from early lymphoma
89
what causes intestinal encephalopathy and in what animals
usually in horses with colitis -> due to excessive production of ammonia in the colon
90
what are the consequences of rectal prolapse in any species
ischemia and edema; can slough and eventually form strictures
91
what causes jejunal hematoma
when loops of jejunum become obstructed by a mural (wall) hemorrhage -> eventually develop mucosal tears -> blood in lumen
92
what species gets duodenitis-proximal jejunitis (aka proximal enteritis)
horses
93
describe proximal enteritis in horses
it is an upper SI ileus of unknown cause; results in fibrinous enteritis or ulceration of the duodenum; can lead to stricture and/or peritonitis in chronic cases
94
what are signs of proximal enteritis in horses
depression, nasogastric reflux, gastric distention, occasional gastric rupture
95
why is it important to submit live, untreated animals early in the course of disease to diagnose GI disease
because many agents are transient or cause lesions that are easily destroyed by autolysis
96
what is always the term for an initial diagnosis of neonatal diarrhea in pigs, ruminants and horses
undifferentiated diarrhea (lots of co-infection and overlap in clinical signs)
97
if you suspect GI disease, how should you conduct your postmortem
collect GI samples first; fix in formalin ASAP
98
what is the peritoneum lined by
mesothelium
99
in comparison to epithelium, how does mesothelium heal
free-floating progenitors; healing is even through defect (not edges in); hyperplasia and metaplasia is common
100
what are roles of the peritoneum
lubrication; immune-surveillance; regulation of inflammation; healing
101
what usually causes disease of the peritoneum
secondary to disease of organs within the peritoneal cavity
102
how can we differentiate antemortem peritoneal fluid accumulation from postmortem accumulation
red, clots on exposure to air = postmortem
103
what is the normal appearance of ascites
watery, clear, straw color
104
what issues from liver disease can worsen ascites
hypoproteinemia and sodium retention
105
describe a congenital pleuroperitoneal diaphragmatic hernia
herniation of organs into the chest that results in respiratory distress, incarceration most common in dogs
106
describe peritoneopericardial diaphragmatic hernia
usually seen in small animals; occurs when diaphragm does not fuse/form properly; herniation of organs into the pericardium
107
acquired hernias are often
diaphragmatic
108
how can we confirm bladder rupture
compare creatinine level in the recovered contents to serum
109
how can we confirm that a traumatic hernia developed AM not PM
look for fibrin, hemorrhage, inflammation, etc.
110
how do diaphragmatic hernias differ between small and large animals
small animals: usually muscular portion; signs of respiratory distress/obstruction/fluid accumulation large animals: usually tendinous portion (especially horses over other animals); signs of colic instead of respiratory distress
111
what typically causes uroperitoneum
rupture secondary to urolithiasis in neonates
112
how can we confirm that digesta in the abdomen occurs AM and not PM
hemorrhage, exudate (fibrin), redness/congestion
113
what causes pneumoperitoneum
perforated intestines or body wall
114
what are spontaneous causes of hemoperitoneum
splenic torsion/rupture; GDV; coagulopathy; tumors; ruptured uterus or uterine artery in mares
115
abdominal fat necrosis in small animals is associated with
pancreatitis (looks like white spots with surrounding hemorrhage)
116
massive fat necrosis is a poorly understood condition of
older, fat, channel island cows
117
what is steatitis
peroxidation of adipose throughout the body that causes inflammation and pain
118
what is steatitis related to
high PUFA; low tocopherol (vitamin E) diets (vitamin E deficiency in rancid fatty diets)
119
is peritonitis more common in large or small animals
large
120
what are the possible outcomes of peritonitis
1) resolution 2) persistence in localized abscesses 3) fibrosis
121
what are consequences of peritonitis
1) ileus -> adhesions 2) sequestration of fluids and electrolytes in peritoneum/gut 3) absorption of bacterial toxins into lymphatics -> peracute death
122
what promotes fibrosis (4)
ischemia, foreign material, necrosis, sepsis
123
mesotheliomas are common/rare and are always benign/malignant
rare; malignant
124
describe mesothelioma
common in dogs/cows; usually spreads by implantation; often blocks lymphatics; can affect peritoneum, pericardium and pleura; variable gross appearance that can look like peritonitis or carcinoma
125
what is the most common peritoneal intestinal tumor in old horses
lipoma
126
although lipomas are always benign, why can they be an issue
if they become pedunculated they can cause strangulation
127
T/F carcinomas and sarcomas can implant on the peritoneum
Τ
128
what nematodes are incidental inhabitants of the peritoneum in ruminants
Setaria
129
what parasite causes peritoneal hemorrhage in horses
S. edentatus
130
what migratory parasites can cause peritonitis in ruminants
flukes
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