1
Q
What are the 6 perfusion parameters?
A
- Mentation
- Oral mm colour
- CRT
- HR
- Pulse quality
- Extremity temperature
2
Q
What are the perfusion parameters of severe shock?
A
- Stuporous
- White-grey mm
- > 3sec CRT
- Tachy/bradycardia
- Non-palpable pulses
- Cold extremities
3
Q
What are the perfusion parameters of mild shock?
A
- Obtunded
- Pink-pale mm
- CRT 2 sec
- HR: Tachy
- Good-fair pulse quality
- Normal extremity temp
4
Q
What are the perfusion parameters of moderate shock?
A
- Obtunded
- Ppink mm
- 2-3sec CRT
- HR: inc or cats can dec.
- Poor pulse quality
- Cooler extremity temp
5
Q
What are your 5 hydration parameters?
A
- Skin tent
- Mm
- Tear film
- Sunken eyes
- Signs of hypovolaemic shock
6
Q
What are the expected hydration parameters of 5% dehydrations?
A
- Skin tent <1sec
- MM tacky
- Normal-dec. tear film
- Eyes not sunken
- No shock
7
Q
What are the expected hydration parameters of 10% dehydrations?
A
- Skin tent >2sec
- MM dry
- Tear film Dry
- Sunken eyes
- Probably hypovol. shock
8
Q
What are the expected hydration parameters of 8% dehydration?
A
- Delayed skin tent
- Tacky mm
- Decreased tear film
- Eyes not sunken
- Possible hypovol. shock
9
Q
What 6 characteristics are used to differentiate small and large bowel diarrhoea?
A
- Frequency
- Volume
- Consistency
- Mucus
- Blood
- Tenesmus
10
Q
What are the features of large bowel diarrhoea?
A
- Frequency: increased
- Volume: decreased
- Consistency: mucoid
- Mucus: present
- Blood: undigested
- Tenesmus: yes
11
Q
What are the features of small bowel D+?
A
- Frequency: normal
- Volume: increased
- Consistency: watery
- Mucus: uncommon
- Blood: digested
- Tenesmus: no
12
Q
List 10 DDX for primary GIT cause of acute gastroenteritis?
A
D:
A: idiopathic
M:
N: neoplasia (carcinoma, lymphoma), dietary indiscretion/intolerance
I: inflammatory bowel, GIT parasites, protozoa (giardia), bacterial (Salmonella, Clostridium), viral (parvo, corona), fungal, HE
T: obstruction (FB/intussusception), toxins, gastroduodenal ulceration (NSAIDs, mastocytosis),
V
13
Q
List 7 DDx for secondary acute gastroenteritis?
A
D: renal disease (uraemia), hepatobiliary disease
A
M: Addison’s, DKA
N
I: Pyometra, prostatitis, peritonitis, pancreatitis
T
V
14
Q
What is your main DDx of interest when performing a POC abdominal US: aFast?
A
to rule out peritonitis (free abdominal fluid)
15
Q
Why would a serum bile acids or ammonia be performed?
A
if PSS was suspected
16
Q
What change in WBC would you see in a puppy with parvo or sepsis?
A
decreased - as overwhelmed
17
Q
Indications for faecal PCR
A
- Diarrhoea >3 d w/out ID cause
2. Concern for false neg. POC parvo test
18
Q
List 4 bacterial causes of acute gastroenteritis
A
Clostridia spp, Salmonella spp, E.coli, Campylobacter spp.
19
Q
What worm and protozoal causes could you rule out through faecal diagnostics?
A
- Worms: round, hook, whip, tape
2. Protozoa: giardia, coccidia
20
Q
6 Indications for hospitalisation
A
- In shock/collapsed
- Protracted vom/diarrhoea (>12h)
- Severe or Haemorrhagic V/D
- Severe abdo pain
- Concern for surgical problem (FB)
- Evidence of systemic illness (fever)
21
Q
When is a feeding tube indicated?
A
Place a feeding tube for enteral nutrition if extended period of anorexia (generally >3d): feed despite ongoing vom, regurgitation
22
Q
Indications to use anti-emetics
A
- Existing aspiration pneumonia/risk: mentally depressed/exhausted, impaired gag reflex, dyspnoeic for
- Protracted nausea (ptyalism, lip licking)
- Not self-limiting vom
23
Q
List 3 antiemetics
A
Maropitant
Ondansetron
Metoclopramide
24
Q
Indications for antacids
A
- Reduce gastric acidity
2. Useful if existing gastric ulceration/erosion (haematemesis, endoscopy)
25
What are two risks of antacids admin?
1. Dysbiosis
| 2. Increase risk of aspiration pneumonia
26
2 examples of Gastric protectants
sucralfate
| barium
27
4 indications for surgery
1. Suspect intestinal obstruction
2. Particular rad abnormalities(Gas distended intestinal loops, stacked loops consistent w/ mechanical ileus, Pneumoperitoneum, Pyometra)
3. Particular abdominocentesis abnormalities (Septic, suppurative abdominal fluid (intracellular bacteria))
4. When all else fails
28
What are two 'imitators' of GIT pain?
1. Spinal disease w/ pain (IVDD)
| 2. Lead poisoning
29
List the possible body systems to investigate in an acute abdomen case.
1. GIT
2. Uro-genital
3. Spleen
4. Hepatobiliary
5. Pancreas
6. Peritoneum
30
List 4 DDx for pancreas origin pain
1. Acute pancreatitis
2. Pancreatic abscess
3. Pancreatic infarction
4. Neoplasia
31
List 5 DDx for peritoneum origin pain
D
A
M
N: neoplasia (carcinomatosis)
I: Peritonitis (Septic, Sterile, Sclerosing encapsulating)
T: Herniation esp. secondary strangulation: perineal (spontaneous), inguinal, abdominal wall (w/ trauma), evisceration, penetrating wounds
V
32
List 5 DDx for splenic pain origin
```
D:
A:
M
N: neoplasia (HAS, others) *haemoabdomen
I: splenitis, splenic abscess
T: splenic torsion
V: splenic vein thrombosis
```
33
List DDx for hepatobiliary pain
D:
A
M
N: hepatobiliary neoplasia
I: acute hepatitis/cholangiohepatitis, Necrotizing cholecystitis, bile peritonitis, hepatic abscess
T: Biliary mucocoele, Gall stones (cholecystoliths) +/- obstuction
V: liver lobe torsion
34
List 3 radiographic indications for surgery
1. GDV
2. GIT obstruction
3. Septic peritonitis
35
2 changes to abdominal fluid biochemistry with septic peritonitis
1. Low Glucose: BG to fluid glucose different >20mg/dL (glucose will be consumed by bacteria thus will be lower than in blood).
2. High Lactate: fluid lactate >2.5mmol/L
36
What opioids are recommended for acute abdo?
1. Fentanyl CRI 2-5ug/kg/hr IV: ideal dt short duration of action, thus easy to titrate
2. Methadone 0.1-0.4mg/kg IV (or IM, SC) q4-6hrs
37
DDx for primary GI disease
D
A: pyloric hypertrophy
M
N: neoplasia - small intestinal lymphoma, adenocarcinoma, MCT
N: nutrition - food responsive enteropathy
I: infections -parasites - toxocara canis/cati, infection w/ helicobacter pylori
I: inflammatory - IBD, lymphocytic plasmacytic gastritis
T: jejunal FB, trichobezoar
V
38
How does pancreatitis presentation differ between cats and dogs?
In dogs looks a lot like primary GI disease and in cats looks more secondary GI
39
Cats w/ hyperthyroidism can look..
like they have primary GI disease; intermittent V+ over long periods and otherwise well
40
EPI can look like
primary GI disease
41
7 signs to pursue diagnostics
1. V+ severe and persistent (>2wks)
2. No or incomplete response to symptomatic therapy
3. Animal regurgitating
4. Can palpate GI abnormality
5. Other systemic signs are present eg. PU/PD, icterus
6. Animal appears systemically unwell
7. Systemic signs clearly preceded the V+
42
tests for pancreatitis
pancreatic lipase immunoreactivity (cPLI, fPLI)
CBC
Abdo US
43
tests for liver disease
ALT, ALP, GGT, bilirubin, bile acids
| Abdo US
44
Azotaemia parameters
BUN, creatinine, phosphate, USG
45
investigating DKA
blood and urine glucose + ketones
46
investigating hypercalcaemia
serum calcium - total and ionised
47
investigation hypoA
Na+, K+, baseline cortisol, ACTH stim. test
48
investigating hyperthyroidism in cats
total T4
49
clear bile suggestive of?
stomach issue
50
yellow/green bile suggestive of?
duodenum
51
brown, fetid, large volume vomit suggests?
intestinal obstruction
52
'coffee grounds'/haematemesis suggests
ulceration/neoplasia
53
vom of a meal >12hrs after ingestion suggests
delayed gastric emptying
54
Primary small intestinal GIT dz DDx
D
A: antimicrobial responsive enteropathy, food responsive enteropathy
M:
N: neoplasia
I: inflam/infiltrative, parasites (ancylostoma caninum, toxocara canis/cati), giardiasis, salmonella
T: obstruction
V:
55
Primary large intestinal GIT dz DDx
```
D
A:
M
N: neoplasia, diet related
I: inflam/infiltrative lymphocytic plasmacytic colitis, parasites trichuris vulpis (whip), tritrichomonas (cats), clostridia, campylobacter
T: obstruction (bone fragments)
V:
```
56
Tests for secondary GI causes of diarrhoea (primarily small bowel)
1. Trypsin-like immunoreactivity (TLI) to rule out EPI
2. Liver disease - ALT, ALP, GGT, Bilirubin, Bile acids, Abdo US
3. HypoA - Na+, K+, baseline cortisol, ACTH stim
4. HyperT (cats) - total T4
5. Toxaemia - CBC
57
3 GI helminths
toxocara, ancylostoma, trichuris
58
1 cat and 1 dog GI enteric protozoa
dog - giardia
| cat - tritrichomonas
59
there is a faecal snap test for which enteric protozoa?
giardia (Idexx)
60
tx for giardia
fenbendazole, drontal plus for 3d
61
what info do you gain by investigation folate and cobalamin serum levels?
- decreased cobalamin --> EPI, bacterial dysbiosis, ileal dz, + common in cats w/ IBD
- decreased folate --> prox. SI dz
- inc. folate --> bacterial dysbiosis w/ EPI
62
empirical anti-parasitic treatment
1. pyrantel or equivalent plus praziquantel OR
| 2. fenbendazole trial
63
duration of dietary trial for possible food response enteropathy?
2-4weeks
64
empirical tx of SI D+ (for antibiotic responsive enteropathy)
1. Tylosin 20mg/kg q12h PO 4-8wks
| 2. Metronidazole 10-15mg/kg PO BID
65
3 indications that you should biopsy the GIT
1. Severely affected w/ systemic manifestations (anorexia)
2. Presence of hypoalbuminaemia, hypoglobulinaemia suggests a PLE
3. Abnormalities on abdo US - changes to GI wall layers
66
Gastric/intestinal biopsies are necessary to provide a dx for which (5) dz?
1. gastritis (diff. types)
2. IBD (colitis - endoscopy)
3. Infiltrative dz; neoplasia, fungal (histoplasmosis)
4. lymphagiectasia in SI
5. Breed-assoc. enteropathies
67
benefits of endoscopic biopsies
- minimally invasive
| - direct visualisation of oesophagus, stomach, prox duodenum, colon + ileum
68
what can you not reach via endoscope?
jejunum
69
3 indications for lap. surgical biopsy
1. endoscopic biopsy not avail
2. focal dz in mid-intestine suspected
3. if more widespread intra-abdo disease (cats!!)
70
what is the complication rate of lap. sx biopsies?
20% - wound breakdown, septic peritonitis
71
advantages of surgical biopsy
- Evaluate entire abdo
- can target areas that look abnormal
- can sample all SI
- full thickness biopsies
72
Disadvantages of surgical biopsies
- morbidity of ex lap
- concern in hypoalbuminaemic dogs
- higher risk of dehiscence thatn w/ endoscopy
73
tritrichomonas causes?
chronic large bowel D+ in cats
74
Trichuris can mimic..
hypoA - causes large bowel D+
75
Ancylostoma causes...
anaemia, small bowel D+ in dogs
76
Toxocara canis/cati causes...
ill-thrift, pot belly, V+, small bowel D+
77
melena is a sign of...
high GI bleeding (gastric/duodenal ulceration/neoplasia)
78
causes of local ulcerative GI dx and haematemesis
```
D: IBD - lymphocytic plasmacytic infiltrate
A: NSAIDs, corticosteroids
M
N: neoplasia - gastric carcinoma
I: Helicobacter infection, gastritis
T: gastric FB
V
```
79
systemic causes of haematemesis
- renal failure (uraemia)
- pancreatitis
- hypoA
- liver failure (rare)
- hyperacidity - gastrinoma, MCT
- haemostatic disorder
80
5 parts of haematemesis tx
1. Hospitalisation + investigation
2. ID and Tx primary cause
3. IVFT
4. PPIs - pantoprazole IV, omeprazole PO
5. Gastric protectants - sucralfate 1g/dose q12h PO
81
DDX for gastric dysmotility and delayed emptying
- gastric +/- pyloric hypertrophy --> pyloric stenosis
- gastric neoplasia
- FB in stomach (or lodged in pylorus)
- compression of the pylorus by external masses (eg. liver, neoplasia)
- can see w/ chronic gastritis/ IBD
82
3 histological classifications of IBD
- lymphocytic-plasmacytic enteritis (LPE)
- eosinophilic enterocolitis
- granulomatous enterocolitis
83
CS of IBD
- rel to anatomical location; vom (cats), anorexia, weight loss, chronic/small bowel d+ (dogs)
- abdo pain, intestinal bleeding, borborygmus
+/- oedema/effusions
84
what are oedema and effusions associated with IBD?
protein loss - secondary lymphangiectasia
85
what is often assoc. w/ IBD in cats?
often assoc. w/ other lymphocytic-plasmacytic inflammation
ie. cholangiohepatitis + pancreatitis
Triaditis
86
what may IBD in cats progress to?
may co-exist or progress to intestinal small cell lymphoma
87
how do dog and cat presentations of IBD differ?
cats vom and dogs shit
88
what is your first step in tx IBD in dogs?
Dietary trial 'hypoallergenic'
| - should see response in 2wks
89
what tx do you trial after diet in canine IBD?
antimicrobials --> tylosin, metronidazole
90
You have trialed a hypoallergenic diet and tylosin in a dog with IBD with no response -- what are you next plans of action?
1. Immunosuppressives: prednisolone 1-2mg/kg q12h PO x14d tapering over time.
+/- azathioprine, cyclosporine (if poor response or BIG doggo to reduce pred dose)
91
how does your treatment of feline and canine IBD differ?
1. Both have the dietary trial first but cats don't trial antimicrobials --> straight to immunosuppressives.
2. Cats also NEVER add azathioprine, use chlorambucil instead.
3. Also add cobalamin (Vit.B12) in cats
92
What grading is used with GIT lymphoma?
1. Low grade = small cell
2. Medium -grade = lymphoblastic
3. high-grade = B-cell > T-cell
93
how can you differentiate low-grade alimentary lymphoma in cats from IBD?
req. combo of morphological and immuno-phenotyping techniques +/- PCR
94
Tx of low grade alimentary lymphoma (LGAL) in cats
- pred + chlorambucil
95
what are boxers predisposed to re. large bowel diarrhoea
histiocytic colitis
96
What are your 3 empirical therapies for dogs w/ large bowel diarrhoea + tenesmus?
1. Fenbendazole 50mg/kg q24h 3-5d
2. Feed: novel protein for 4-6wks
3. Add soluble fibre - metamucil 1tsp/5kg/meal
97
CS of histiocytic ulcerative colitis in boxers
- severe large bowel signs: profound weight loss and severe haematochezia
98
tx. of granulomatous histiocytic ulcerative colitis
enrofloxacin 10mg/kg q24h PO 8-12wks
99
mild constipation tx
1. microlax enema
2. warm water/saline enema w/ lubricant
* always follow up and ensure that defaecation occurs
100
Describe process of deobstipation
manual removal of faeces w/ the animal under GA often necessary after rehydration. All obstipated animals, broad spec antimicrobials for possible bacteraemia, initial enema (water lubricant) to begin faecal softening. GA w/ ETT (huge risk of aspiration), warm saline enema w/ lubricant jelly via soft feeding tube/10 French urinary catheter into the colon. Mannual breakdown of faeces by transbadominal massage/instruments. Remove fragments via anus. Rads to document success.
101
long-term medical management recurrent constipation
1. Removal or inciting causes (drugs, bones, concurrent disease)
2. Dietary manipulation, laxatives and prokinetics (lactulose syrup, polyethylene glycol and cisapride (compounded) most common drugs for megacolon)
102
indications for subtotal colectomy
w/ recurring obstipation that responds poorly to exhaustive medical therapy.
103
highest incidence of acute pancreatitis occurs in...
middle-aged, obese, sedentary female dogs
104
US findings of acute pancreatitis
pancreatic enlargement, changes in echodensity, hyperechoic abdominal fat
105
treatment of acute pancreatitis (dogs)
1. feed as soon as V+ subsides - tubes/freq.small meals of high-CHO restricted fat
2. Parenteral fluids
3. anti-emetics + prokinetics
4. pain relief
5. antimicrobials in severe cases (septic/abscess) - enrofloxacin, amoxiclav
**long term restricted fat diet
106
possible sequelae to acute pancreatitis
- chronic recurrent pancreatitis
- EPI
- DM
107
CS w/ pancreatitis in cats
usually non-specific: anorexia, lethargy +/- fever/hypothermia, weight loss, vom, abdo pan often absent, may deteriorate signs of shock w/ acute form.
108
treatment of acute pancreatitis in cats
1. IVFT + lytes
2. Feeding: tube + antiemetics
3. Broad-ABs if indicates
4. Dx/tx concurrent disease ie. triaditis
109
what is EPI?
failure of pancreatic acini to produce enzymes and bicarbonate
110
Pancreatic acinar atrophy is classically seen in what dog breed?
german shepherd
111
CS of EPI
i. Voluminous SI diarrhoea: but can be just increased faecal bulk
ii. Weight loss, poor hair coat
iii. Ravenous appetite
112
DX of EPI
serum TLI (fasted!)
113
4 arms of management of EPI
1. Pancreatic enzyme supplement
2. Restricted fat diet, feed smaller meals 2-3x daily
3. Cobalamin supp
4. Control bacterial dysbiosis which can complicate EPI
114
what is the most common cause of maldigestion?
EPI
| But can also see w/ loss or impaired bile salt activity dt ileal/liver disease
115
how does maldigestion affect appetite?
normal to greatly increased
116
give an example of disruption to luminal absorption...
dysmotility in hyperthyroidism resulting in malabsorption
117
give an example of disruption to mucosal absorption...
deficiency of brush border or enterocyte defects secondary to IBD
118
give an example of disruption to transport absorption...
lymphatic obstruction -- primary lymphangiectasia or lymphagiectasia secondary to IBD or neoplasia
119
how can right sided congestive heart failure cause malabsorption?
portal hypertension
120
what are the major secondary causes of malabsorption?
1. hyperT
| 2. liver disease (can cause maldigestion dt lack of bile salts and malabsorption dt portal hypertension)
121
is diarrhoea usually a feature of malutilisation?
no
122
what are some possible causative conditions of malutilisation?
- diabetes mellitus
- congestive heart failure
- hyperT
- neoplasia (cachectin...)
123
give an congenital cause of PLE
congenital lymphangiectasia
124
give 2 acquired causes of PLE
severe IBD, intestinal neoplasia (lymphoma)
125
4 ddx for hypoalbuminaemia
- reduced production: chronic liver disease, malassimilation
| - increased loss; haemorrhage, PLE, severe exudative skin disease
126
which protein in lost via glomerular disease?
albumin only
127
4 ddx for hypoglobulinaemia
- failure of colostral transfer (foals)
- immunodeficiencies dz (rare)
- globulins lost w/ albumin (haemorrhage, PLEs, severe exudative skin dz)
128
list 3 important diagnostics to rule out extra GIT causes of hypoalbuminaemia
1. check urine for protein loss (urine protein:creatinine >2)
2. check liver function - bile acids stim. test
3. check PCV to look for evidence of haemorrhage
PC Vet
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