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270 Cards in this Set
- Front
- Back
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What 2 things affects the consistency of the stool?
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1 - number of osmotically active particles
2 - duration of time feces spends in the colon -also fiber content (more volume) |
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The SI is responsible for assimilation of nutrients. A problem here is indicated by what?
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increase in volume
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The LI is responsible for storage. A problem here is indicated by what?
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increased frequency
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CRYPTS
-Do they make digestive enzymes? -Is it the site of intestinal secretion? -What do they supply the new villus with? |
-LACK digestive enzymes
-site of intestinal SECRETION -epithelial cells - cells mature as they move up the villus |
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What two things does the villus tip have/do that the crypt does not?
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-has digestive enzymes
-absorptive ability |
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What 2 things does the villus tip loose?
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proliferative capacity and secretory capacity
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What is cAMP stimulated by and what does cAMP do?
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-stimulated by many bacterial toxins
- this increases secretion and overwhelms the absorptive capability |
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What does parvo attack?
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crypts
-causing villus collapse and atrophy leading to severe malabsorptive syndrome |
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What does coronavirus attack?
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villus
-partial villus loss, but quick replacement |
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What does rotovirus attack?
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villus tip
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What happens if there is too little segmental motility?
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diarrhea
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What does peristalsis do?
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-helps move contents aborally
-helps to reduce the numbers of bacteria in SI |
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What are the 4 mechanisms of diarrhea?
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osmotic
hypersecretory increased permeability abnormal motility |
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Anything that decreases absorption of carbohydrates leads to what type of diarrhea?
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osmotic
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alpha function of the islet cells is abnormal, which an excess of glucagon production. Combination of decreased insulin and increased glucagon results in hyperglycemia and
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ketoacidosis-
sweet fruity odor of the breath |
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The increase in number of osmotic particles in the SI does what two main things?
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-keeps water in the lumen, not absorbing it
-aids SI bacterial overgrowth (SIBO) b/c bacteria are being fed carbohydrates |
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Overfeeding and ingesting of poorly digestible/spoiled food can cause what type of dirarrhea?
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osmotic
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What two main diseases may cause hypersecretory diarrhea?
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-SIBO (toxins associated with bacterial overgrowth)
-short bowel syndrome |
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What can cause increased permeability diarrhea?
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-inflamed mucosa - increases permeability (IBD, garbage enteritis)
-erosion or ulceration -PLE -increased hydrostatic pressure |
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When is abnormal motility not usually a secondary problem?
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post-op
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Give examples of when there can be abnormal motility diarrhea?
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-SIBO
-short bowel syndrome -annular tumor |
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With PEI, what percentage of loss of exocrine function must occur for diarrhea to occur?
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85%
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When does PEI develop and what is diarrhea associated with?
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2 years
-inability to absorb nutrients (carbs, fats, proteins) |
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What type of diarrhea occur with PEI?
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All four types
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Lack of what in PEI leads to malassimilation of carbs and osmotic diarrhea?
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pancreatic amylase
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What is the normal amount of fat assimilation. With PEI, what is seen in the feces?
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95%
-fat in feces = steatorrhea |
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Lack of what leads to malassimilation of fats with PEI?
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pancreatic lipase
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With PEI, malassimilation of fat leads to unabsorbed tirglycerides metabolized by intraluminal bacteria to what?
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hydroxy fatty acids
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Do fats contribute to osmotic diarrhea?
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NO!
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What 4 things do hydroxy fatty acids cause?
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1 - decreased fluid absorption
2 - increased fluid secretion (hypersecretory diarrhea) 3 - alteration of mucosal structure (increased permeability diarrhea) 4 - alteration of GI motility (abnormal motility diarrhea) |
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What is least dependent on pancreatic enzymes?
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proteins
(proteins are partially digested in the stomach) |
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What does bacteria use secondarily to increase SIBO?
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proteins
-contributes a little bit to osmotic diarrhea |
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What helps to sequester protein in the lumen of intestine?
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triglycerides
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What is the most common cause of stagnent loop syndrome?
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adenocarcinoma (intestinal tumor)
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A partial obstruction with stagnent loop syndrome leads to what?
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decreased motility and bacterial overgrowth (SIBO)
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Stagnent loop syndrome and the decreased motility that occurs with it causes deconjugation of bile acids. This leads to what 2 main things?
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-fat malassimilation
-problem with fat soluble vitamins (ADEK) |
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Bile deconjugation with stagnent loop syndrome causes what three types of diarrhea?
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-hypersecretory
-increased permeabiity -abnormal motility |
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Stagnent loop syndrome causes what types of diarrhea?
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all 4
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Stagnent loop syndrome (due to partial obstruction) may also cause what?
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Protein loosing enteropathy and GI hemorrhage
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What do bacteria produce that can be used for diagnosis of such things as stagnent loop syndrome?
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folate
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How much bowel must be removed to cause short bowel syndrome?
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60%
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What occurs with short bowel syndrome?
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malassimilation of carbs, fats, and proteins, leading to all 4 types of diarrhea
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What sphincter is a barrier to bacteria in the colon and helps to reduce SIBO?
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illel-colic sphincter
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Where are bile acids normally absorbed?
what happens if they reach the colon? |
in the ileum
they are deconjugated and leads to fat malassimilation and formation of hydroxy fatty acids (leads to 3 types of diarrhea) |
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What are 3 of the most common reassons for acute diarrhea in dogs?
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-antibiotics
-dietary indescretion -parasites (number one) |
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What do you look at on PE on a dog with acute diarrhea?
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1 - dehydration
2 - fever 3- abdominal pain 4 - gas/fluid filled intestines 5 - thickend bowel wall 6 - abdominal mass |
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What do you loose more of in diarrhea than vomiting?
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K
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What parasites can be pot life-threating for acute diarrhea?
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hooks, giardia, whips
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What helps you decide if diarrhea is self-limiting or life-threating?
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1 - clinical findings
2 - experience 3- knowledge of DD 4 - degree of dehydration, abdominal pain, depression 5 - presence of vomiting 6 - abdominal mass 7 - systemic signs 8- signalment |
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What tests would you perform on a self-limiting diarhea?
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1 - fecal exam x 3
2 - direct fecal exam 3 - fecal/rectal cytology 4 - PCV/TP |
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What tests would you use for life-threatening diarrhea?
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1 - fecal exam x 3
2 - fecal/rectal cytology 3 - CBC, chem profile, UA 4 - survey abdominal rads 5 - direct fecal exam |
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What additional tests would you do for the following diseases?
acute pancreatitis: distemper: lepto: FeLV/FIV |
acute pancreatitis:amylase/lipase, abdominal US
distemper: conjunctival scrape, CSF tap lepto: serology, darkfield urine FeLV/FIV: ELISA, IFA |
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What is the therapeutic plan for self-limiting diarrhea?
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1 - correct underlying prob (GI parasites, drug administration, dietary insescretion, bacteria)
2 - NPO for 12 hours or longer if vomiting 3 - SQ fluids 4 - dietary management 5 - motility modification to decrease diarrhea |
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What is the main class of drugs given for motility modification and when are they contraindicated?
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opioids
-toxin or infectious disease |
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What 2 drugs are given for motility modification?
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-loperamide
-diphenoxylate |
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What are the major functions of opioids for motility modification?
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-increased segmentation
-decreased peristalsis (minor - increase fluid absp, decrease fluid secr, and increase anal tone) |
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What class do you NOT want to use for motility modification?
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anticholinergics (decrease segmentation)
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What is the signalment for HGE?
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schnauzer, dachshund, poodle, yorksire terrier
-middle aged |
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What is the MAIN clinical sign of HGE?
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hemorrhagic vomiting and diarrhea
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What does the laboratory data look like with HGE?
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-increased PCV
-DIC -anemia and hypoproteinemia LATER |
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Increased PCV with HGE causes...
what else happend? |
cardiac arrythmias
-hypoxia -sepsis (due to compromised mucosal barrier) and hypersecretion and free - radiacal formation |
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What is the treatment for HGE?
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-fluids - shock dose until less than PCV 60%
-broad spectrum antibiotics |
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What is the signalment for parvo?
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unvaccinated puppies, Dobermans, rotties
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Most infections of parvo are what?
Severe disease presents with what clinical signs? |
most are sub-clinical or mild
-acute vomiting and diarrhea |
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Trace pathogenesis of parvo.
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-ingestion
-virus replication in oropharynx lymphoid tissue -viremia by 3-5 days -virus is spread to rapidly diviging cells -cypts cells --> villous collapse, malabsorption and PLE -vomiting and diarrhea occur at 5-6 days -fecal exreation peaks by day 6 |
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What is common with parvo?
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secondary bacterial infection due to altered mucosal barrier
-sepsis --> hypoglycemia |
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What are the main clinical signs with parvo?
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-lethargy, anorexia
-vomiting, profuse hemorrhagic diarrhea, pyrexia, depression, dehydration -abdominal pain, gas filled bowel loops, thickened intestinal wall |
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What is the definitive diagnosis of parvo?
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fecal antigen testing via ELISA
-MLV can cause a false positive (4-10 days post vaccination) |
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Why should abdominal radiographs be taken with parvo?
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to eliminate presence of SI obstruction
- signs of parvo are gas/fluid distention, flocculation of barium, irregular mucosa |
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What is the treatment for parvo?
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-IV fluids
-antibiotics (ampicillin, gentamicin, enrofloxacin) IV bolus of 25% glucose -LRS with 2.5% dextrose and potassium supplementation -treat GI parasites with ivermectin SQ -antiemetics -motility modification opiods after stopping vomiting -severe cases - blood transfusion (treat anemia and hypoproteinemia) |
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How do you disinfect for parvo?
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bleach 1:30 ratio
virus is shed for 1-2 weeks and can stay in environment for 5-6 months |
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What is the vaccination protocol for parvo?
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-start at 6 weeks
-every 3-4 weeks until week 18 |
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Why doesn't parvo vaccine completely protect a puppy?
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there is a 1-3 week window where the puppy's maternal antibodies prevent immune resposne to vaccination but does not protect the puppy from virus exposure
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How do cats get feline parvo?
Where does it replicate? |
ingestion OR inhalation (unlike dogs)
- lymphoid tissue of oropharynx, bone marrow, SI and LI crypts CNS or fetus |
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What is different about feline parvo from canine?
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large bowel involment with feline (hematochezia, tenesmus, mucus)
-vomiting and diarrhea are not as profuse -oral ulceration in some cats |
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Are there any commercial available kits for feline parvo?
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no
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What are classical clin path signs with feline parvo?
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panleukopenia
DIC -electrolyte changes are milder, but proportional to the severity of clinical signs |
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What is different about the treatment of parvo in kittens vs. puppies?
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-could give fluids SQ because losses from vomit and diarrhea are not that bad
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What is the vaccination protocol for kittens for parvo?
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-at 8 to 10 weeks, repeated at 12-14 weeks
-yearly booster |
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What type of obstruction presents more acutely and severe?
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proximal intestine because more CRTZ
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During obstruction, what increases and what decreases?
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secretion increases
absorption decreases |
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With a complete obstruction, what is the order of stasis?
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1 - lymphatic and capillary
2 - venous stasis as intraluminal pressure increases |
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During obstruction, what 2 things are trapped in the bowel?
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fluid and gas (swallowed air, fermentation)
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What are the clinical signs for a high complete obstruction?
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vomiting, loss of gastric secretions, electroylte imbalances and severe dehydration
-die in 3-4 days |
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What are the clinical signs for a low complete obstruction?
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-met acidosis, nonspecific signs, intermittent anorexia, lethargy, occasional vomiting
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Mechanical obstruction causes ischemia to what first?
What is the order of affected layers? |
mucosa - because it gets 85% of blood flow
mucosa, submucosa (main holding layer), muscularis, serosa -perforation can occur |
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With mechanical obstruction, what is intestinal wall edema due to?
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increased capillary pressure)
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How do you diagnose mechanical SI obstruction?
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rads - dilated and plicated
-can use barium -can use US -use radiographs in series and always repeat before surgery |
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What locations of a FB would you really not want to do surgery?
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stomach (vomit or endo) or colon (pass)
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When should surgery for a FB be preformed?
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-severe vomiting/dehydration
-suspect peritonitis secondary to perforation -linear FB (usually have perforations) -failure to pass in 36 hours -no movement in 8 hours |
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What are the most difficult areas of the intestine for resection and anastamosis?
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-asending duodenum (pancreas)
-duodenal colic ligament (mesentary is short and it is hard to manipulate) |
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Where do the majority of perforations with linear FBs occur?
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1 - at the junction of the ascending and descending duodenum (short mesentary is not mobile)
2 - proximal border of the jejunum b/c mesentary is short |
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How long do you give antibiotics for a linear FB and why would you discontinue?
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-give for 24 hours bc clean contaminated
-discontinue to look for peritonitis or aspiration pneumonia |
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Postoperative management of a linear fb removal is a prokinetic. What is the BEST prokinetic and name some other good things.
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Best - feed orally (canned as soon as you can - every 4 hours)
-metaclopramide to decrease chances of illeus formation |
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How long will it take the SI to heal after resection and anastamosis?
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3-5 days - after 5 days ok (shorter than LI)
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Where is the highest incidence of canine neoplasia?
feline? |
colon and rectum
feline - SI (lymphoma associated with FeLV) -majority are intramural and malignant |
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What is the most common intestinal neoplasia of dog and cat?
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dog - adenocarcinoma (napkin ring) --> infiltrative, ulcerative, proliferative
cat - lymphosarcoma diffuse, nodular |
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How would you treat a feline lymphosarcoma that is not having clinical signs?
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medically
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Is chemo helpful with intestinal neoplasia?
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no
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What are the 2 most common sites for intucusseption?
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illeocolic
jejuno-jejunal |
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What are causes of intucucepption?
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enteritis (parasitic - whips, parvo, bacterial)
postop (ileus, adhesions, anastomosis) |
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What is a common signalment with intussusception?
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young puppies
cats with FB |
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What pattern will intussusception have with:
rads US |
rads - obstructive patterns
US - target |
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When would you use enteroplication?
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if reoccurance of intussusception
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What are three causes of intestinal strangulation?
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1 - intussusception
2 - hernia (diaphragmatic, inguinal, abdominal) 3 - mesenteric volvulus --> euthanize |
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What is intestinal strangulation similar to?
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-complete intestinal obstruction
-septic shock, hypovolemia, decreased motility, mucosal sloughing, increased bacteria) HIGH morbidity |
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Why is risk of dehiscence high in the LI in the first 3-4 days?
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collagen lysis exceeds collagen synthesis due to bacterial flora in the colon
-takes 7-8 days to heal |
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How do you aid optimal healing in the LI?
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1 - good blood supply
2 - accurate mucosal apposition 3 - minimal surgical trauma 4 - tension-free anastamosis |
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What is the main holding force of the LI in the first 4 days?
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suture material
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What is the main blood supply to the colon?
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-illeocolic (branch of cranial mesenteric)
-caudal mesenteric (branches into left colic and cranial rectal) -vasa recta |
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Preoperative ways to reduce colonic bacterial numbers.
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1 - starvation
2 - laxatives 3 - enemas (NOT with megacolon and not less than 3 hours before surgery) 4 - antibiotics (second generation cephalosporins, aminoglycosides, metronidozole) |
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What are the secondary causes of megacolon in cats?
-secondary to colonic inertia -secondary to outlet obstruction |
-colonic inertia: prolonged distension, neurologic trauma, congenital dysfunction, endocrine disease, idiopathy
-outlet obstruction: pelvic fracture malunion, LI strictures or neoplasia, anal atresia or stricture, extraluminal mass or FB |
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In megacolon in cats, what happen when the feces forms a concrete mass and is too large and painful to pass?
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prolonged distention leads to smooth muscle damage and nerve damage
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What is the typical presention of cats with megacolon?
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-obstipation
-constipation -pelvic trauma -chronic disease -unkempt -distended colon |
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What are common rule outs for megacolon in cats?
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-drugs
-perineal hernias -diet -colorectal masses -strictures |
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What is the medical management protocol for megacolon in cats?
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1 - evacuate the colon (under general anesthesia - enema, digital)
2 - stool softeners 3 - Lactulose 4 - prokinetic drugs 5 - low residue diets |
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What is removed/done during surgical management of megacolon in cats?
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- pelvic reconstruction (within 6 months)
- subtotal or total colectomy |
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What is preserved with a subtotal colectomy
What are the disadvantages to this? |
illeocecal valve
-increases tension at anastamosis -have to leave some colon - reformation may occur |
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How long should you leave animals on antibiotics after colectomy and why?
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7 days - contaminated surgery
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What is the best way to attach the large colon to the small illeum?
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spatulated closure
- antimesenteric incision |
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How many days can an owner expect heir cat to have tenesumus after surgery of megacolon?
diarrhea? |
7 days
-weeks - 2 months to start forming solid stool |
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What are the major complications to a colectomy?
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dehisance - BIGGEST (tension, preservation of blood supply)
recurrance - leave too much colon formation of megarectum - once this happend there is only medical management of euthanasia |
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What are the main causes of rectal prolapse?
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-heavily parasitized animals that have severe tenesmus and diarrhea
-post op tenesmus after anal or perineal surgery |
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How do you decide whether to do surgery on a prolapsed rectum?
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surgery if necrotic and can't reduce; repeat offender (colopexy)
-sutures are inside the lumen |
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What is the colon pexyed to?
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transversus abdominus
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If rectal prolapse happens often, what 3 things should you check for?
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1 - anal sacs for anal saculitis
2 - perineal hernias 3 - prostate |
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How do you non-surgically treat a prolapsed rectum?
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reduce, lube, hold it in with finger
-epidural/anesthesia -purse string suture (3 days) -hyperosmolar solution to draw out edema |
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What is the most important thing when treating rectal prolaspe?
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finding the cause
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What is a perineal hernia?
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seperation of the pelvic diaphram
-rectum, pelvic contents, abdominal contents |
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What is the signalment for perineal hernias?
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intact dogs, with short, broad tails
-most cats with megacolon have them |
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What makes up the muscles of the pelvic diaphragm?
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1 - external anal sphincter
2 - levator ani (medially) 3 - coccigious (lateral) |
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What supplies the perineal areas?
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-internal pudendal artery and nerve
-pudendal nerve is important in maintaining incontinence |
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What breeds are predisposed to perineal hernias?
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boston terrier
welsh corgies boxer pekingese collie poodle |
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What is the average age of dogs with pernineal hernias?
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9 years
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What is the history of dogs with perineal hernias?
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-rectal prolaspe from straining
-swelling (lateral to anus) -tenesumus -fecal incontinence (if herniated, looses neurological function) |
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When is a perineal hernia a emergency?
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-retroflexed bladder into hernia causing ueremia and necrotic bladder
-septicemia/bowel entrapment |
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What are commonly found things on PE of a perineal hernia?
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-perineal swelling
-enlarged prostate -rectal deviation |
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How is a perineal hernia typically diagnosed?
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rectal exam - under sedation
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What is recommended along with a herniorrhaphy?
why |
castration b/c perineal hernias are common in male, intact dogs due tot he following and can reoccur:
1 - intact males have BPH and have to strain to urinate which weakens the muscles 2 - testosterone receptors on the muscles are absent therefore causing them to atrophy 3 - male dogs, the prostate releases relaxin, causes pelvic diaphram to relax and weakens |
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What are the 2 surgical approaches to repairing a perineal hernia?
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1 - traditional anastamosis and reapposition - failure is 90% bc muscle is weak
2 - internal obturator transposition |
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What is the most common complication of repairing a perineal hernia?
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1 - recurrence - most common
2 - infection or abcess 3- sciatic nerve entrapment 4 - bladder dysfunction 5 - fecal incontinence -mucosal eversion |
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What are causes of abcesses after perinal hernia surgery?
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-passed a suture thru the rectum or anal sac
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What is long term treatment for dogs with perineal hernias?
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stool softners
low residue diets |
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What is the most commonly associated breed with perianal fistulas?
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German Shepards
Irish Setters |
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What are the clinical signs of a perianal fistula?
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-painful
-dyschezia -hematochesia -licking -pain on tail movement -maybe diarrhea |
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What are surgical treatments that have been used for perianal fistulas?
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1- cryosurgery
2 - excision w/ healing from second intention 3 - fulguration - cautery to cauterize deep tracts 4 - anoplasty - cut out and suture back together 5 - tail amuputation - change microenvironment |
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Perianal fistulas are mainly medically managed now. How?
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-cyclosporine (immunosuppressive)
-tacrolimus (topical) -diet modification |
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Is there a cure for perianal fistula?
|
no
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What is the most common perianal tumor and what % does it make up?
|
perianal adenoma
-90% |
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What is the CURE for perianal adenoma?
|
castration - because it is hormone dependent
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What do you do if you are presented with a female dog that you think may have a perianal adenoma?
|
biopsy to make sure it is not a adenocarcinoma
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What do perianal adenomas look like on cytology?
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-adenomas will have a hepatoid cell appearance on cytology
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What is concurrently seen with perianal adenomas?
|
testicular interstitial cell tumor
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What is the signalment for anal sac disease?
|
toy breeds, small dogs
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What are clinical signs of anal sac disease?
|
-scooting
-biting or licking perineum -must differentiate neoplasia from fungal |
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How do you treat mild anal sac disease?
|
-periodic flushing (under sedation)
-infusion with antibiotic/steroids (Panalog) -low residue diet |
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How do you manage abcesses BEFORE doing surgery to remove anal sacs for anal sac disease?
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-0.05% CHLORohexadine
-10% povidone iodine -oral antibiotics |
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What are the 2 techniques used to take out the anal sacs?
|
open - higher risk of infection and incontinence, but easier
closed - technically harder, low risk of infection -always submit to pathology |
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What causes hepatic encephalopathy in dogs with PSS?
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-toxins that are normally deactivated in the liver enter the systemic circulation
-hepatotrophic substances from the pancrease and intestines do not reach the liver, resulting in hepatic atrophy |
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How many lobes does the liver have in a dog and what lie next to the gallbladder?
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6
- quadrate and right medial fuse |
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How are PSS classified? What percentage do they occur?
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-intrahepatic (35%)
-extrahepatic (65%) |
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What fetal structure is most often associated with intrahepatic shunts?
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-failure of the dutcus venosus to close
(normally forms a shunt on the left side of the liver) |
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Congenital extrahepatic shunts are normally from what vessel?
|
from the portal vein to the systemic circulation
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What is the signalment for an extrahepatic shunt?
|
congenital or acquired
-more in dogs -diagnose at a young age (less than 1 year) -yorkshire terrier (70%) -miniature schnauzer -poodles -pekingese 20% of ALL PSS are acquired PSS from liver disease |
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What is the signalment for an intrahepatic shunt
|
-usually congenital (failure of ductus venousus to form)
-less than one year -large breed dogs (German Shepards, Golden Retriever, Labs, Samoyeds) |
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What is the history of a dog with a PSS?
|
-failure to grow, anorexia, weight loss, depression (hepatic encephalopathy), vomiting, PU/PD, young dogs that develop stones made of ammonium urate, prolonged anesthesia event
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What is the history of a cat with PSS?
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-ptyalism - most common
-aggression -hepatic encephalopathy - esp. after a high protein diet iris color is brown |
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What are the most common PE findings of a dog with PSS?
|
-microhepatica
-cryptorchid umbilical hernia -enlarged kidneys (increased GFR) |
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In cats with an A-V fistula, what is felt on PE?
|
Bruit - put hand on abdomen and it feels like there is a very fast heart in the abdomen
|
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What are lab findings of animals with PSS?
|
-microcytosis with normochromic anemia (iron def), even though there is plenty of iron in the animal
-leukocytosis - bacteremia -LOW BUN -LOW GLUCOSE -hypoproteinemia (including albumin) -increased ALT, AST, ALK Pos |
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What are the most reliable tests for diagnosing PSS?
|
-liver function tests and nuclear scintigraphy
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What is the most consistent finding on plain abdominal radiographs with PSS?
|
microhepatica
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What are disadvantages and advantages of positive contrast portography to diagnose a PSS?
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DisAdvantages:
-anesthetized patient -long procedure -hemorrhages Advantages: -intrahepatic extrahepatic liver biopsy |
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What is the most sensitive and specific test for diagnosing PSS?
|
transcolonic scintigraphy
-non-invasive -sedation only -easy and cheep |
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What is the down side to transcolonic scintigraphy?
|
does not distinguish type of shunt
-isolation because radioactive -surgery - 60 hours post scan |
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What is directly linked to the prognosis of the animal following PSS surgery?
|
how stable animal is before surgery
-need to decrease the absorption of toxins produced by bacteria in the GI tract |
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What type of fluid therapy don't you want to use with a PSS?
|
LRS (lactate is converted to bicarb in the liver ans can't do this)
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Why do most dogs with PSS appear worse after a blood transfussion of whole blood?
|
bc in ammonium citrate and a dog with a shunt can not metabolize the ammonia
-so use packed red cells if give a transfusion |
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What type of supportive care would you give to an animal with a PSS?
|
1 - fluids (0.9% saline or with 2.5% dextrose)
2 - packed RBCs 3 - protein restricted diet (L/D or K/D) 4 - neomycin 5 - phenobarb or potassium bromide to pre-emptively treat seizures 6 - lactulose enema or oral 7 - enemas (lactulose or betadine) |
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Why would you give neomycin to an animal with a PSS and why is it not toxic?
|
to decrease the ammonia producing bacteria in the GI tract
-it is an aminoglycocide but it is not absorbed form the GI tract |
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What does lactulose do for an animal with a PSS?
|
acidifies the colon and changes the ammonia to ammonium which is NOT absorbed in the colon
-TRAPS ammonium also an osmotic cathartic that reduces intestinal transit time and decreases production and absorption of ammonia |
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Any vein entering the caudal vena cava cranial to what vein may be considered an anomalous vessel.
|
phrenicoabdominal veins
|
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During surgery (a ventral midline celiotomy), how do you ID the shunting vessel?
|
1- right and left gutters
2 - epiploic foramen (dorsally is the caudal vena cava, ventrally is the portal vein, and caudally is the hepatic artery) 3 - omental bursa 4 - any vessel cranial to phrenicoabdominal vein |
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Dogs with PSS often have ammonium urate stones. Will you see these on rads?
|
no
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How are extrahepatic shunts ligated?
What else should you do when you are in the abdomen for a shunt ligation? |
-ameroid ring (takes 6-8 weeks to thrombose) or MEDICAL GRADE celophane banding (takes 4-6 weeks to thrombose)
biopsy the liver |
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What is the normal portal pressure in dogs?
What about dogs with a PSS? |
8-13 cm H2O
-portal pressure is closer to that of systemic circulation (caudal vena cava is 0-5) |
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How does an ameroid ring work?
|
placed around vessel and casein expands as it absorbs body fluids - stainless steel ring prevents expansion out
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Intrahepatic shunts often have what on the liver?
|
soft spots - if pinch this soft spot up, portal pressure goes up
-can also use contrast portography to help locate |
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What is a real complication with intrahepatic shunt ligation?
|
anesthesia
|
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What do you occulude an intrahepatic shunt with?
what is the max pressure you want? |
silk or polypropelene to create an inflammatory response
-don't want >10mm above baseline |
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What can occur after PSS surgery?
What are the signs to look for? |
portal hypertension
-look like they have parvo (diarrhea, vomiting, abdominal pain,) |
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What happens with portal hypertension following PSS surgery?
|
-pooling of blood in SI because liver can't handle all of the blood
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What is the 6 week medical management following PSS surgery?
|
- low protein diet
- lactulose -antibiotics |
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-bile acids should be taken at the end of six weeks following PSS. if they are high, this means what?
|
- ameroid or cellophane did not close
-collateral circulations formed |
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What is a common complication with intrahepatic shunts?
|
bleeding - greater mortality (hemorrhage is the most common cause of death)
-Extrahepatic (14-21%) -Intrahepatic (25-35%) |
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What is more common in cats post op for PSS?
|
seizures
-give RI of phenobarb |
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Is hepatic microvascular dysplasia a surgical or medical disease?
-Where are the shunting vessels with this disease? |
medical
-shunting vessels are in the capillary beds |
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What is the only way to truely diagnose microvascular dysplasia?
|
biopsy
-because portogram and scintigraphy will be normal |
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What % of patients presented to your practice will have periodontal disease?
|
70-90%
|
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What is enamel formed by and when does it stop?
|
ameloblasts
-stops prior to tooth eruption |
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What is the enamel thickness in a cat?
dog? |
cat - <0.1 to 0.3 mm
dog - <0.1 mm |
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What substance makes up the bulk of the tooth?
|
dentin
|
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What is dentin made by and when?
|
odontoblasts throughout the life of the tooth
- 72% mineral, 18% collagen, 10% water |
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What does cementum cover?
|
the outer surface of the root
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What is attached to the cementum?
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periodontal ligament and gingiva
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Where is cementum produced?
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at apex of the root
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What is the periodontal ligament?
|
connective tissue which fills the space between the tooth and alveolar bone
-composed of principle fibers - collagen bundles in various shapes and orientations |
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What are the functions of the periodontal ligament?
|
1 - shock absorption
2 - transmits occlusal forces 3 - attaches teeth to bone 4 - supplies nutrients 5 - provides tactile and proprioceptive information |
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What is the normal sulcus depth in a cat?
in a dog? |
cat - 1 mm
dog - less than 3 mm |
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What is the term for the following meaning in dentistry:
-towards the cheeks -towards the front edge of the tooth towards the midline |
-buccal
-mesial |
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What is the dental formula for a dog (deciduous)?
|
2 x (i3/3, c 1/1, pm 3/3) = 28
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What is the dental formula for a dog (adult)?
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2 x (I3/3, C 1/1, PM 4/4, M2/3) = 42
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What is the dental formula for a cat (adult)?
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2 x (I3/3, C 1/1, PM 3/2, M 1/1) = 30
|
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What is the dental formula for a cat (deciduous)?
|
2 x ( i 3/3, c 1/1, pm 3/2) = 26
|
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When do the following canine deciduous teeth erupt?
-primary incisiors -canines premolars |
-primary incisiors = 4-6 weeks
-canines = 3-5 weeks premolars = 5-6 weeks |
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When do the following canine adult teeth erupt?
-primary incisiors -canines premolars molars |
-primary incisiors = 3-5 months
-canines = 3-4 months premolars = 4-6 months molars = 5-7 months |
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When do the following cat deciduous teeth erupt?
-primary incisiors -canines premolars |
-primary incisiors = 3-4 weeks
-canines = 3-4 weeks premolars = 5-6 weeks |
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When do the following cat adult teeth erupt?
-primary incisiors -canines premolars molars |
-primary incisiors = 3-4 months
-canines = 4-5 months premolars = 4-6 months molars = 5-7 months |
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What is gingivitis?
|
initial process of periodontal disease
-swollen or inflammed gingival margins (w/wo hemorrhage) -most often due to bacterial plaque |
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How fast do plaque start to colonize teeth after cleaning?
|
24-36 hours
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Is plaque a food residue?
|
no
|
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What is normal oral flora?
|
aerobic, gram positive
|
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What is gingivial inflammatory response to plaque?
|
vaculitis, edema, collagen loss
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What breeds are at increased risk of gingivitis?
|
toy breeds, brachycephalic (crowding of teeth)
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What is PD1?
|
just gingivitis (red and inflammed)
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What is PD 2?
|
<25% attachment loss or at most stage one furcation
|
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What is PD 3?
|
25-50% attachment loss or stage 2 furcation (can slide probe into furcation)
|
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What is PD 4?
|
>50% attachment loss or stage 3-4 furcation
|
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What are the main steps to dental cleaning?
|
1 - client communication
2 - anesthesia 3 - oral exam and planning 4 - gross calculus removal 5 - subgingival calculus removal - most important 6 - periodontal probing 7 - exam for missed plaque and calculus (apply disclosing solution or air dry) 8 - periodontal diagnositics and treatment (rads and exam) 9 - polishing 10 - sulcus irrigation 11 - final charting 12 - client education and home care |
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How is stage 1 or 2 PD treated?
|
dental cleaning with perioperative antibiotics only
|
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How do you treat stage 3 periodontal disease with pockets of 3-6 mm in dogs and 2-4 mm in cats?
|
same as stage 1-2 PLUS
-closed root planing and subgingival curettage -antibiotic gel (Doxirobe) instilled in prepared pockets -plus/minus follow-on oral antibiotic therapy |
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How do you treat stage 4 PD with greater than 6 mm in dogs and 4 mm in cats of periodontal pockets?
|
-as in Stage 3, with addition of:
-open or surgical root planing (open flap curettage) or -extraction if needed -bone grafting or Consil placement if necessary |
|
|
What is recommended when treating all forms of PD?
|
barrier sealant such as Oravet to delay reattachement of plaque
|
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When should antibiotic therapy be indicated in threatment of PD and what antibiotics are indicated?
|
-if evidence of osteomyelitis is present on radiographs
- should cover pathogenic oral flora (clindamycin and clavulanic acid/amoxicillin) |
|
|
What are oral rinses you can use for treating PD?
|
chlorhexidine, CET, Zn ascorbate
|
|
|
What product may decrease plaque by 70-80%?
|
water additive - healthy mouth
-approved by VOHC |
|
|
What are the 5 main categories of feline dental disease?
|
1 - periodontal disease
2 - tooth resorption 3 - fractured teeth 4 - feline gingivitis/stomatitis syndrome 5 - oral neoplasia |
|
|
What causes tooth resorption?
- what is the typical signalment? |
activation of odontoclasts
-in cats over 2 years of age (60% in cats over 6 had at least one) |
|
|
What teeth are most commonly involved with feline tooth resorption?
|
premolar and molar
|
|
|
Where are tooth resorption lesions seen in cats?
|
- at or below the cemento-enamel junction , usually on the buccal aspect of the medial and distal edges
-or further apically around the root (involving canine) |
|
|
What is stage 1 tooth resorption?
|
lesion into cementum; hard to detect clinically or radiographically
|
|
|
What is stage 2 tooth resorption?
|
lesion into cementum, progressing coronally (+/_ apically into dentin)
|
|
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What is stage 3 tooth resorption?
|
reabsorption advances into the pulp cavity
|
|
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What is stage 4 tooth resorption?
|
extensive structural damage with loss of integrity and possible tooth fracture
|
|
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What is stage 5a tooth resorption?
|
crown is missing with varying degrees of root presence (intact, resorbing or ghost)
|
|
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What is stage 5b tooth resorption?
|
crown is intact with roots extensively resorbed or missing, filled in by alveolar bone
|
|
|
What are the 3 possible treatment options for tooth resorption?
|
-fluoride treatment and prophylaxis (grade 1)
-restoration (filling - Z100) -extraction - most by the time you see them |
|
|
What would a biopsy of gingivits/stomatitis show?
|
lymphocytes
-plasmacytes -varying degrees of PMNs |
|
|
What are other differentials for gingivitis/stomatitis?
|
periodontal disease
oral neoplasia eosinophilic granuloma complex |
|
|
Is gingivitis/stomatitis refractory to routine dental cleaning?
|
yes!
|
|
|
What is long term medical management for gingivitis/stomatitis?
|
antibiotics (clindamycin, metronidazole, clavulanic acid/amoxicillin, enrofloxacin)
corticosteroids (pred, methylpred) cyclosporine |
|
|
What is the surgical treatment for stomatitis?
|
full mouth tooth extration caudal to canine teeth with meticulous removal of all roots
|
|
|
What is exodontics?
|
tooth extraction
|
|
|
Name some indications for tooth extraction with advanced periodontal disease?
|
1 - mobile teeth
2 - periapical abcess 3 - oronasal fistula |
|
|
What causes an oronasal fistula?
|
deep maxillary periodontal pocket
-usually palatal aspect of maxillary canine teeth |
|
|
Which teeth are most commonly damaged?
|
canine and 108/208 (maxillary PM4)
|
|
|
What teeth are most commonly persistently deciduous teeth?
|
-maxillary canines (it is usually distal to permanent counterpart)
(persistent deciduous mandibular is usually labial to counterpart) |
|
|
What is dental caries?
|
a microbial disease of calcified tissues of the tooth (usually on lg. molar occulusive surfaces)
-maxillary or mandibular M1 |
|
|
What are the dental erosive lesions?
|
-dog - enamel hypoplasia
-cat - tooth resorption |
|
|
What is a periapical abcess?
|
infection and resorption of the apex of the root due to pulp exposure following crown damage
|
|
|
What is the most common place for a periapical abscess in the dog and where will it present?
|
-single, distal root of maxillary PM4
-fistulous tract under the eye |
|
|
When extracting a tooth, what do you need to severe when extracting the tooth?
|
gingival attachment with #15
|
|
|
What should be done after tooth extraction to the alveolar socket?
|
should be debrided
|
|
|
What should be done with the alveolar sockets following extraction?
|
covered with a tissue flap and sutured with NO tension
|
|
|
What are the percentages for mild, moderate, severe, shock dehydration?
|
-mild - 5-6%
-moderate - 7-9% -severe - 10-12 % -shock - 13-15% |
|
|
What is the rate for replacement of maintenance fluids?
break that down into insensible and sensible losses. |
44-66 ml/kg/day
insensible - 12-22 ml/kg/day sensible - 30-44 ml/kg/day |
|
|
If you don't have time to calculate maintenance and have to set the infusion pump for maintenance, what do you set it to?
|
2 ml/kg/hour
|
|
|
How do you know what to replace on-going losses with?
|
estimate volume lost x 2 because often underestimate it
|
|
|
How much potassium should you administer if serum K is >3.5?
|
20 mEq/L over 24 hours
|
|
|
How much K do you give if serum K is <2.0?
between 3.0-3.5? between 2.0-2.5? |
80 mEg/L/24 hours
-28 -60 |
