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103 Cards in this Set
- Front
- Back
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What do you bifurcate oropharggeal dysphagia into?
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structural or functional
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What are causes of structural orophargeal dysphagia?
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-trauma
-FB -gingivitis/stomatitis - neoplasia - granuloma - ranula/phargeal mucocele - nasophargeal polyp |
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Where can the neuro problems originate with functional oropharygeal dysphagia?
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1 - mucosal receptors in the mouth, tongue or pharynx
2 - Cranial Nerves (5,7,9,10, 12) 3 - medullary swallowing center 4 - NMJ 5 - striated muscle |
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What are common CS of oral phase dysphagia?
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1 - hard time lapping water or getting food
2 - excessive salivation 3 - chompping of food 4 - loss of food from mouth |
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CS of pharygeal phase and cricopharygeal phase dysphagia are very similar - waht are they?
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1 - weight loss
2- loss of food thru nose or mouth 3 - aspiration pneumonia - cricopharygeal may see repeated swallowing attempts |
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Why is cricopharygeal phase dysphasia not quite achalasia?
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because achalasia means failure of a sphincter to open, BUT here it can open, just does not coordinate with a wave of transport
-it opens randomly, not in coordination with pharygeal contractions -food often encounters a closed door |
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What is the RX for cricopharygeal dysphagia?
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myotomy
- prognosis is good unless animals also have pharygeal and esophageal motility deficits |
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What are the steps to diagnosing dysphagia?
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1 - rule out structural problem
2 - Neuro Exam and other neuro tests if positive 3 - fluoroscopy if neuro tests are negative --> need to refer for this (start with liquid, then food) |
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Decreased esophageal motility can result from defects in ANY portion of the peristaltic reflex pathway. Name 4 causes?
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1 -striated muscle
2 - NMJ 3 - medulla 4 - peripheral nerves |
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What is the cause of idiopathic decreased esophageal motility?
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sensory ascending pathway is the defect
-stretch mechanoreceptors are not stimulated therefore causing decreased peristalsis |
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What is the number one cause of regurgitation?
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Secondary myasthenia gravis
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What are the 2 bifurcated causes of gastric retention/delayed gastric emptying?
What are the 3 main CS? |
1 - outflow obstruction
2 - gastric motility disorder (chronic vomiting, weight loss, post-prandial abdominal distention and discomfort) |
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What are 3 general causes of outflow obstruction?
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1- FB
2 - pyloric hypertrophy 3 - neoplasia (gastric/proximal duodenal neoplasia like adenocarcionma or extraluminal) |
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What plan do you use to diagnose outflow obstruction?
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chronic vomiting plan
- bifurcate into systemic and GI - US first (look for mass/neoplasia) - second endoscopy (food retention despite prolonged fast and obstructed pyloric canal) |
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What are the 2 forms of chronic pyloric hypertrophic gastrophathy?
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1 - mucosal (most common)
2 - muscular -often mixed |
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What breeds are predisposed to chronic pyloric hypertrophic gastropathy?
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-middle aged, small breeds
- poodles and shiz tzu |
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What is a typical signs on rads with chronic pyloric hypertrophic gastropathy?
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beak sign - air in atral cavity with tapering
-food in distended stomach |
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What is seen on barium rads with chronic pyloric hypertrophic gastropathy that is highly suspicious of the disease, although not diagnostic?
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-narrowed and blunted pyloric canal
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What is seen on abdominal US with CPHG?
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thick and hypoechoic muscular layer --> suggestive of the disease
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What is the number one tool you would reach for when suspect of chronic pyloric hypertrophic gastropathy?
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endoscopy - with biopsy
-if neoplasia - would use FNA with US |
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What are causes of gastric motility disorder or hypomotility?
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1 - idiopathic
2- sympathetic stimulation 3 - hypokalemia 4 - anticholinergics (opioids) 5 - gastritis and ulcer disease |
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What is the treatment for delayed gastric emptying?
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- metoclopramide (good for stomach and proximal duodenum)
- cisapride (works thru entire GI tract) --> causes release of ACH from enteric nervous system and smooth muscle contration |
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What are presentations of disease with Salmonella?
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- localized GI (acute vomiting and diarrhea)
- systemic illness (prexia, septicemia, neutropenia, - can localize to an area such as respiratory) |
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How do you diagnose Salmonella?
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culture - blood or feces (need gram quantities)
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What is the treatment for Salmonella localized to the GI tract?
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supportive care
-NOT antibiotics because prolongs the carrier state |
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What is the treatment for Salmonella septicemia?
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-antibiotics for 10 days from Culture and Sensitivity
- or can try - GET Ca -gentamicin enrofloxacin TMS Chloramphenicol Amoxicillin |
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What disease are asymptomatic carriers more common - Salmoneela or Campylobacter?
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Camplobacter - as much as 50%
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Where is disease commonly with Camplobacter?
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GI
-acute diarrhea -acute vomiting -fever, anorexia, depression |
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How do you diagnose Camplobacter?
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- direct saline fecal exam - motile spiral bacteria are suspicious
-fecal /rectal cytology - gull shaped - culture to confirm diagnose as you are treating |
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When submitting Camplobacter for a culture, what should you be careful of?
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- needs special transport medium
-microaerophilic |
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How do you treat Camplobacter?
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based on Culture and Sensitivity
- Erythromycin is number one best guess for 7-10 days - number one SE of this is vomiting |
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What amount of patients with SI chronic diarrhea will have abnormal palpation?
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1%
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What are findings of abnormal abdominal palpation?
What are the initial differentials for an abnormal abdominal palpation? |
1 - severe wall thickening
2 - dialated loop 3 - intestinal mass 1. stagnent loop syndrome 2. neoplasia - nodular or diffuse (lymphoma) 3. obstruction - FB or intussuception 4 - severe IBD |
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What is the initial diagnostic plan for an abnormal abdominal palpation?
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1 - survey rads
2 - Abdominal US --> high yield 3 - 3-view thoracic 4 - FNA/percutaneous biopsy 5 - maybe barium 6 - explore -- can confirm and treat - don't really use endoscopy except in the case of gardenhoses |
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In what senario would you use endoscopy to diagnose an abnormal palpation?
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thick bowel wall that feels like a garden hose - can't have a full thickness biopsy because will come apart
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What is stagnent loop syndrome?
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partial SI obstruction leading to intestinal stasis and SIBO - one of the main causes of SIBO in dogs and cats
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What are the most causes of stagnent loop syndrome?
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1 - FB
2 - intestinal tumor |
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What are the common CS to stagnent loop syndrome?
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-chronic small bowel diarrhea and weight loss are the most common
-also dehydration, dilated loop of bowel, abdominal mass |
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How do you diagnose stagnent loop syndrome?
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1 - abdominal palpation or
2 - work up for chronic SI diarrhea -if neg. endoscopy --> need to move on and ask whyand do barium or US |
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What is PLE associated with?
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- damaged barrier or dilated lymphatics
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What are causes of malabsorption?
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1 - lymphangectasia
2 - histo 3 - IBD 3 - Diffuse lymphoma |
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What are CS of PLE?
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1 - chronic SI diarrhea - COMMON
2 - weight loss - COMMON -signs associated with decreased albumin --> peripheral edema, abdominal distention, dyspnea - absent GI sounds also vomiting |
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What does the lab work look likewith PLE?
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- PAN hypoprotein - decreased albumin and globulin
-decreased Ca - maybe lymphopenia and hypocholesterolemia if there is lymphangectasia |
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Increased loss of protein into the SI occurs with what?
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-increased permeability, inflammation, erosion, ulceration, or venous congestion or lymphatic obstruction
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what are the 6 differentials for hypoproteinemia?
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1 - PLE
2 - Glomerulonephritis/amyloidosis 3 - hepatic failure 4 - chronic hemorrhage 5 - starvation 6 - burns |
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What proteins will be lost with PLE?
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both albumin and globulin
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What proteins will be lost with glomeruloneprhiris /amyloidosis?
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- hypoalbuminemia initially then globulins as the holes in the filter get bigger
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What proteins will be lost with liver failure?
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- liver fails to make albumin and globulin, but increased gammaglobulins because of decreased function of reticuloendothelial function
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What proteins will be lost with chronic hemoorhage - what else with this?
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- both albumin and globulin
-anemia will parallel protein loss |
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What proteins will be lost with starvation?
this includes: lack of intake, GI parasites, SIBO, malabsorption, pancreatic disease |
- serum proteins are maintained until the end stage because the liver maintains the ability to make them
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The diagnostic plan for PLE is chronic SI diarrhea. If GI signs are mild, what should you rule out and what tests should you do?
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- other causes of protein loss:
1 - UA or protein: creatine ratio 2 - liver function tests 3 - fecal alpha-1 antiprotease |
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When would you reach for a fecal alpha1 - antiprotease test?
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When hypoprotein and signs of diarrhea are minimal or absent and ruled out urinary or other causes of protein loss
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What is fecal alpha-1 antiprotease and what does it tell you?
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- a antiprotease that prevents premature activation of trypsin by binding activated trypsin
- it will not be digested by proteolytic enzymes and go out in the feces - can tell if an animal is dumpting a lot of protein into the bowel |
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What are some causes of SIBO?
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1 - stagnent loop syndrome - most common
2 - PEI 3- Malabsorptive disorders 4 - Idiopathic - treat with antibiotics and will go away (common in young GSD) |
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How do you diagnose SIBO?
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1 - quantitative SI bacterial culture (don't often do
2 - Serum Unconjugated COlic Acid (SUCA) 3- Practically --> 3 week antibiotic trial 4 - ideally would want to evaluate primary SI disorder causing chronic SI diarrhea |
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Where are conjugated bile acids absorbed?
Where are unconjugated absorbed? What makes them this way? |
ileum
- jejunum - bacteria deconjugate them --> this is the reason why we use the SUCA test |
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What is the therapeutic plan for SIBO?
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-treat underlying condition
- antibiotics therapy for three weeks - MATT-C -metronizole - ampicillin - tetracyclin -tylosin clindamycin |
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What is the diagnostic plan for SI neoplasia?
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- US with 3 view thoracic rads
-- FNA and biopsy -enodoscopy for LSA |
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What 2 forms can adenocarcinoma (malignant epithelial tumor or older animals) be in?
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1 - solitary mass
2- annular mass |
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What are key features of SI adenocarcinoma?
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- invasive and met. to
-regional LN, liver, lungs, and mesentery |
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Is endoscopy helpful in diagnosing a SI Adenocarconoma?
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no - not long enough
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What areas does SI lymphoma hit?
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- LLLSK
- liver, LI, LN of mesentery - stomach -kidney |
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What three forms does SI lymphoma come in?
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1 - diffuse mucosal infiltration --> chronic SI diarrhea and lymphangectasia with hypoprotein
2 - single or multiple masses 3 - annular mass |
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Is endoscopy helpful with diagnosing lymphoma in a cat?
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yes
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When is surgical treatment an important adjunct when treating lymphoma?
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1 - obstruction
2 - peritonitis (perforation) 3 - severe ulceration and bleeding |
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What is the treatment for cats with lymphocytic form of lymphoma - diffuse small cell?
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- prednisone and chlorambucil --> respond well to mild, oral home therapy and generally have a good prognosis (20 months survival)
-others have a POOR prog. |
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What is the treatment for Histo?
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itraconazole
-amphotericin B if unstable |
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What 2 things cause ascites?
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1 - portal hypertension
2 - hypoalbuminemia |
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What things cause increased portal hypertension?
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- distortion and obstruction of sinusoids due to inflammation, infiltration, or fibrosis
- increased portal blood flow volume |
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Name 6 toxins that add to hepatiencephalopathy?
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1 - AA
2 - ammonia 3 - SCFA 4 - mercaptains 5 - GABA 6- endogenous benzodiasepeins |
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What is the normal ratio of AA?
What maintains this normal ration? |
3:1 branched to aeromatic
- the liver |
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What happens when the ratio of AA is 1:1 branched to aeromatic as a result of abnormal liver function?
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more aeromatic AA leads to increased production of inhibitory and false NT --> depression, stupor, ect.
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What effect do SCFA have and what do they interfere with?
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- barbituate like effect
- interfere with metabolism of ammonia and mercaptans |
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How are mercaptains made?
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with bacterial metabolism of sulfur containing AA (like methionine)
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What do toxic levels of mercaptains do and what do they do for ammonia?
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- toxic levels cause coma
- mercaptains decrease conversion of ammonia to urea in the liver and thus increase ammonia levels |
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What is the most potent inhibitory NT?
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GABA!
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What is the CNS receptor for GABA complexed with?
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receptor for benzodiazepine and barbituates
-so don't use valium in a animal with hepaticencephalopthy |
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What would you use to treat seizures in an animal with HE?
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propofol
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What is glutamic acid converted to in CNS?
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GABA
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Ensogenous benzodiazepines are increased in animals with what?
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PSS
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HE is managed with a diet of ID. Three things help to decrease signs of HE. They are:
1 - highly digestable protein restriced level 2 - branched chain AA 3 - controlled meth and aromatic AA How are these helpful? |
1 - reduced ammonia formation
2 - try to get back ratio of 3:1 brnached to areomatic 3 - decrease production of mercaptains and help liver maintain ratio of AA |
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What level is increased in steroid hepatopathy
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AP
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What is the hypothesis behind vaculolar hepatopathy?
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1 - stress assoicated with disease causes
2 - hypercortisolemia 3 - which increased AP |
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When should you suspect vaculolar hepatopathy?
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if dog has NOT been given corticosteroids and does not have adrenal gland disease -- and increased AP
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What is hepatic microvascular dysplasia?
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absence or dysplasia of terminal portal veins (smallest)
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What breed commonly gets hepatic microvascular dysplasia?
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Carin terrier
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What is seen on histopath with a gallbladder mucocele?
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- cystic mucosal hyperplasia
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What breed is predisposed to a gallbladder mucocele?
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cocker spaniels
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What were top CS of animals with a gallbladder mucocele??
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vomiting, anorexia, lethargy , abdominal pain , icterus
- sometimes pyrexia - 25% |
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What were lab findings with a gallbladder mucocele?
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- increased AP and ALT x 6.5
- increased bilirubin x 7.5 - leukocytosis -left shift |
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What is the medical management for a gallbladder mucocele?
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- bile thinners (ursodiole)
-hydrophiilc bile acids -antibiotics |
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What breeds are predisposed to copper associated hepatitis?
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- bedlinton terriers --> breeders have gotten rid
- west highland white terrier - skye terrier -dalmation - lab retrievers -dobermans? (from cholestasis, not genetic) |
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What are the 3 forms of copper assoicated hepatitis?
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1 - severe hepatic failure and death in young after stress
2 - chronic hepatitis 3 - asymptomatic carrier - pass on gene |
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What does it mean when the following copper levels are found?
>350? >2000? |
>350 -- affected
>2,000 -- toxic - helping the liver to necrose |
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DNA linked markers can be done for copper associated hepatis? What do the following mean?
1/1 1/2 2/2 |
1/1 - 90% unaffected
1/2 - 95% carrier 2/2 - 72% affected |
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What is the treatment for copper assoicated hepatitis?
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1 - D. Penicillamine 30 min prior to meals - chelator among other things
2 - Trientine - chelator 3 - zinc acetate - decreases intestinal absorption 4 - ascorbic acid - increases excretion in the urine 5 -copper restricted diet |
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What is the general trend of hepatic neoplasia?
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-metastatic and malignant
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What are the 4 common hepatic neoplasias?
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1 - hepatocellular carcinoma
2 - hepatocellular adenoma 3 - biliary carcinoma 4 - lymphoma |
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Where might primary tumor sites be with hepatic neoplasia?
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spleen - silent, mass, hemoperitoneum
pancreas - weight loss, icterus, vomiting stomach and intestine mammary mass |
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What is the prognosis for hepatocellular adenoma?
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good - benign
- usually a single large mass |
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What sex gets hepatocellular carcinoma more in the liver? Where does it met?
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maledogs
-liver, lungs, LN, omentum |
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What sex more often gets biliary carcinoma?
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female older dogs - dogs and cats get it
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Are younger or older animals affected by hepatic lymphoma?
What is the treatment? |
younger
chemo |
