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242 Cards in this Set
- Front
- Back
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What can be some differentials for halitosis? Which of these differentials is most common?
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dental dz (most common)
FB oral tumor uremia GI ulcers gastric tumor |
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What is the most common oral tumor in cats?
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SCC
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Gagging localizes dz to what part of the GI tract?
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pharynx
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What are some differentials for gagging? Which of these differentials is the most common?
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dysmotility (most common)
nausea FB pharyngitis nasopharyng polyp post-nasal drip |
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What does retching mean? What could this sign indicate?
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unproductive vomiting attempts
GDV esoph obs |
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How do regurg and vomiting differ?
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vomiting (unlike regurg) has abdominal press and bile
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What is hematemesis? What could this sign indicate?
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vomiting blood
GI ulcers, GI tumor coagulopathy severe protracted vomiting |
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Does wt loss indicate sm or lg bowel diarrhea?
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sm
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Does a liquid consistency indicate sm or lg bowel diarrhea?
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sm
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What signs indicate lg bowel diarrhea?
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urgency
marked incr frequency tenesmus cow plop consistency fresh blood |
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Is vomiting usually associated w/ sm or lg bowel diarrhea?
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sm
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What can cause borborygmus?
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anything that causes inflamm of GI tract
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Melena indicates what type of blood loss?
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upper gi blood loss
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With what dz's can you observe bloody diarrhea? What is the origin of the blood?
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parvo and HGE
sm bowel origin |
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Hematochezia implies an origin from where in the gi tract?
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lg bowel
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What is dyschezia?
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painful defecation
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Normocytic, normochromic, non-regen anemia means what?
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anemia of chronic inflamm
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What is the most common cause of iron deficiency in dogs and cats?
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chronic GI blood loss
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What can cause eosinophilia in small animals?
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endoparasites
fleas (+ hairballs) inflamm bowel dz heartworm mast cell tumor Addison's in dogs |
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What can cause decr TP?
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PLE
GI blood loss |
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What should you look for in a dog w/ low Cl and a high tCO2?
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pyloric obs or GDV
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Describe the ddx for low cholesterol.
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liver failure
hypoadrenocorticism lymphangiectasia |
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What combination of findings could indicate lymphangiectasia?
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low chol + low albumin + low globulin
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What combination of findings suggest GI bleeding?
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elevated BUN
normal creatinine panhypoproteinemia |
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What would you look for on a fresh fecal smear?
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Giardia
Coccidia Tritrichomonas foetus |
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Giardia testing: which method is most specific and which method is the most sensitive?
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specific - zinc sulfate (float) --> trust a (+)
sensitive - Giardia ELISA --> trust a (-) |
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You should do abd radiographs in any animal that is _____________________.
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acutely vomiting
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In an animal w/ GI signs, what do you look for in a chest rad?
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metastases
asp pneumonia megaesoph |
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What does a dye study help r/o?
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int obs
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What does an abd US help find?
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free fluid in abd
obs FB's masses non-GI dz gi wall thickening lymphadenopathy pancreatitis |
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When palpating the abd, what should you look for?
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abd pain
abd masses int thickening palpable intussusception liver size stomach size and position rt quadrant pain |
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What is the drug category/MOA of Metaclopramide?
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central antiemetic via dopamine (D2) antagonism in CNS
also has prokinetic effects by increasing ACh release in myenteric plexus |
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What are the indications for Metoclopramide?
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renal failure
liver failure pancreatitis parvoviral enteritis |
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What are the contraindications of Metoclopramide use?
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GI obs
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What are the side effects of Metoclopramide?
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tremors
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What is the drug category/MOA of Maropitant (Cerenia)?
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blocks binding of substance P to NK-1 rec's in emetic center, CRTZ, and enteric plexus of gut
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What are the indications for Maropitant (Cerenia)?
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vomiting due to pancreatitis, renal failure, liver failure
chemotherapy-induced vomiting motion sickness |
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What drug is the most effective veterinary anti-emetic?
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Maropitant (Cerenia)
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What are the side effects of Maropitant (Cerenia)?
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uncommon
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What is the drug category/MOA of Ondansetron?
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antagonizes 5-HT3 rec's in CNS and gut
central antiemetic |
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What are the indications of Ondansetron?
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refractory vomiting
chemotherapy |
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What are the side effects of Ondansetron?
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no adverse effects on GI motility, mentation, or BP
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Why might Ondansetron be impt to certain breeds of dogs?
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P-glycoprotein substrate - potential toxicity in some Collies and other breeds lacking P-glycoprotein expression
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What is the drug category/MOA of dimenhydrinate (Dramamine)?
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H1 antagonist
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What are the indications of Dramamine?
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motion sickness, vest dz
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What is the drug category/MOA of Benadryl?
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H1 antagonist
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What are the indications of Benadryl?
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prior to chemo
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What are the side effects of Benadryl and Dramamine?
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sedation
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What is the drug category/MOA of Chlorpromazine and Prochlorperazine?
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central antiemetic w/ multiple mechanisms:
-dopamine antagonist -H1 antagonist -alpha adrenergic antagonist -anticholinergic |
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What are the indications of Chlorpromazine and Prochlorperazine?
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occasionally used for refractory vomiting in hospitalized patients
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What are the side effects of Chlorpromazine and Prochlorperazine?
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*side effects = common
sedation hypotension ileus tremors |
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What are the contraindications of Chlorpromazine and Prochlorperazine?
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not for out-patients or hypovolemic patients
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What is the drug category/MOA of Famotidine (Pepsid)?
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block histamine (H2) mediated gastric acid secretion
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Why is Famotidine preferred over Cimetidine?
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Cimetidine: drug interactions due to inhibition of cytochrome P450 metabolism of other drugs
Famotidine less drug interactions |
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What are H2 blockers indicated for?
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gastric ulcers due to:
-NSAIDS -renal failure -liver failure -mast cell tumors esophagitis |
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H2 blockers can be used as antiemetics. T or F?
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FFFF
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Vomiting is usually due to hyperacidity. T or F?
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FFFF
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What is the drug category/MOA of Omeprazole and Pantoprozole?
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inhibits H+K+ ATPase pump; directly inhibits gastric acid secretion
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How do pump blockers compare to H2 blockers?
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pump blockers are more potent antacids than H2 blockers?
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Pump blockers are indicated for what?
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bleeding gastric ulcers
erosive esophagitis preventing NSAID-induced ulcers gastrin-secreting tumors |
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Are pump blockers better for short term or long term use?
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short term
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What are the side efffects of pump blockers?
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gastric polyps
mucosal hypertrophy |
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What compound in a drug can cause lots of drug interactions?
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aluminum (and other cations)
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What is the drug category/MOA of Sucralfate?
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Al-containing polysaccharide
forms a gel that coats ulcer craters inhibits pepsin increases mucosal PGE |
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What are the indications of Sucralfate?
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gastric ulcers
reflux esophagitis |
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What are the side effects of Sucralfate?
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lots of drug interactions! (b/c of the Aluminum)
-decreases absorption of tetracycline and fluroquinolones |
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What is the drug category/MOA of Misoprostol?
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Prostaglandin (PGE1) analog
enhanced: -mucosal blood flow -epithelial turnover -mucus and bicarb prod |
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What are the indications of Misoprostol?
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decreases vomiting and ulceration associated w/ NSAIDS
speeds healing of NSAID-induced ulcers does not prevent glucocorticoid-associated ulceration |
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What are the side effects of Misoprostol?
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cramping and diarrhea
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What are the indications of Metoclopramide (as a prokinetic)?
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delayed gastric emptying
ileus (non-obstructive) pyloric hypertrophy gastro-esophageal reflux esophagostomy tubes |
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What is the drug category/MOA of Cisapride?
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prokinetic alone
5HT agonist --> incr ACh release, incr downstream motility of stomach, sm int, and colon |
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What are the indications of Cisapride?
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delayed gastric emptying
gastric atony pyloric hypertrophy gastro-esophageal reflux **chronic constipation/megacolon in cats** |
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What is the drug category/MOA of Pepto-Bismol?
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protectant and adsorbent
bismuth - antibacterial salicylate - anti-inflammatory |
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What are the indications of Pepto-Bismol?
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acute sm bowel diarrhea in dogs
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Why is Pepto-Bismol not recommended for cats?
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salicylate content
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What is the drug category/MOA of Loperamide?
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synthetic opiate agonist (w/o CNS side effects)
increase segmental contractions of gut but decrease "downstream" movement incr time available for water reabsorption decr freq of bowel movements decr secretion and promote electrolyte reabsorption in ileum |
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What are the indications of Loperamide?
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short term (<48 hrs) management of acute diarrhea
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What are the contraindications of Loperamide?
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not for infectious diarrheas or obstructioin
not for cats (causes excitation) p-glycoprotein deficient breeds |
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Anticholinergics are not recommended for the control of ______________.
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diarrhea
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Esophagus is entirely striated muscle in the cat or dog?
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dog
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Is megaesoph more common in cats or dogs?
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dogs
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Name some clinical signs of megaesophagus.
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dysphagia
drooling, gagging regurg wt loss cough asp pneumonia |
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What are the definitive diagnostics for megaesophagus?
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chest rads
barium esophagram fluoroscopy |
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Congenital generalized megaesophagus occurs at about what age? What breeds are predisposed to this condition?
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onset < 10 wks old
german shepards, other breeds |
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What condition can cause congenital focal megaesophagus? What breeds are predisposed to this condition?
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PRAA
german shepards, irish setters, boston terriers, any breed |
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What are some causes of acquired focal megaesophagus?
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FB (most likely)
stricture |
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What types of conditions can cause acquired generalized megaesophagus?
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myasthenia gravis
hypoadrenocorticism idiopathic other myopathies, neuropathies |
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What are some ways in which you can manage megaesophagus?
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look for underlyting cause
upright feedings slurry, meatball, kibble treat esophagitis monitor/treat pneumonia Cisapride or metoclopramide? (to incr esoph sphincter tone) gastrostomy tube |
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What are the clinical signs of esophagitis?
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inappetance
intermittent regurg restlessness painful** repeated swallowing lip-smacking |
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Describe some causes of esophagitis.
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recent anesthesia**
FB hiatal hernia chronic gastric vomiting irritant drugs - clindamycin, doxycycline that stick @ thoracic inlet |
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What are some definitive diagnostics for esophagitis?
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barium esophagram
endoscopy hx |
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How is esophagitis treated?
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Sucralfate
Omeprazole or H2 blocker *treat early and aggressively to prevent stricture |
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What things can cause esophageal stricture?
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untreated esophagitis
esophageal FB's |
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What are the clinical signs of esophageal stricture?
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regurg
not painful unless esophagitis still present able to swallow liquids but not kibble |
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How do you diagnose esophageal stricture? How do you treat it?
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esophagram or endoscopy
tx - balloon dilation |
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Describe the metabolic causes of vomiting.
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uremia
liver dz addison's ketoacidotic diabetes hyperthyroidism drugs pancreatitis toxins HW (cats) CNS trauma |
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Describe some primary GI causes of vomiting.
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see notes
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Describe the indications for hospitalization for the patient w/ acute vomiting.
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see notes
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How is acute mild sm bowel diarrhea usually resolved?
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often self-limiting w/ food restriction for 6-12 hrs
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How do you treat sm bowel diarrhea?
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food restriction for 6-12 hrs
bland diet (not novel protein) pepto-bismol, probiotics Fenbendazole? |
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When should you hospitalize a patient w/ acute severe sm bowel diarrhea?
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fever
abd pain melena or liquid blood dehyd unresponsive or recurrent neonate |
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What are some causes of acute severe sm bowel diarrhea?
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parvo
hooks, rounds in young animals giardia, coccidia toxin ing canine distemper feline leukopenia salmonella, campylobacter, clostridia HGE |
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Salmonella, Campylobacter, and Clostridia are ______________ causes of diarrhea in dogs and cats. What are some risk factors for each?
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uncommon
Salmonella: -raw diet -contact w/ livestock Campylobacter: -shelter dogs Clostridia -pet therapy dogs -prior antibiotic admin -CCU -immunosupp drugs |
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What is HGE? What type of animals does it affect? How do you tx it?
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marked hemoconc w/ bloody diarrhea
toy breeds, urban dogs IV fluids, metronidazole |
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How is severe SI diarrhea treated?
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IV fluids
manage acidosis and hypokalemia watch for hypoglycemia, sepsis maintain oncotic pressure (colloids) |
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When should you consider antibiotics in the tx of severe SI diarrhea?
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neutropenia
fever w/ diarrhea mucosal sloughing positive enterotoxin |
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What are the general differentials for chronic sm bowel diarrhea? Hint: the 3 M's
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metabolic dz-addison's hyperthyoidism, liver dz, toxins (lead)
maldigestion malabsorption |
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What are the most common causes of sm bowel malabsorption?
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endoparasites
inflamm bowel dz PLE lymphangiectasia GI lymphoma |
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Describe the diagnostic work-up for chronic sm bowel diarrhea.
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fecal: float, smear
zinc sulfate flotation or Giardia ELISA CBC biochem panel abd radiographs abd US tests of malabsorption |
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Name the 2 major tests of malabsorption.
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serum folate
serum cobalamin (B12) |
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Where is serum folate absorbed? What would a low/high value mean?
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absorbed in duod
low - duod malabsorption high - int bact overgrowth |
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Where is serum cobalamin absorbed? What would a low value mean?
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absorbed in ileum
low - ileal malabsorption, exocrine pancreatic insufficiency, SI bact overgrowth |
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What is a cause of maldigestion primarily in dogs?
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EPI - exocrine pancreatic insufficiency
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What is the most common cause of EPI
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idiopathic pancreatic acinar atrophy
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EPI affects dogs in what age range? What breed(s)?
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young adult (rarely in older dogs)
German shepards, other breeds too |
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Describe the clinical signs of EPI.
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sm bowel diarrhea (liquid stools, wt loss)
foul-smelling steatorrhea flatulence borborygmus thin, poor haircoat **wt loss yet good appetite |
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Describe the CBC/Chem abnormalities in a patient w/ EPI.
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both usually normal
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What is the diagnostic test of choice for EPI?
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canine trypsin-like immunoreactivity (TLI)
TLI decreased in EPI |
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In a patient w/ EPI, describe the radiographic/US abnormalities that are likely to be present.
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both usually normal
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Describe the guidelines of tx of EPI.
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**powdered extract; no tablets or capsules
no preincubation needed no antacids needed |
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Prior oral pancreatic enzyme supplementation (does/does not) affect serum TLI.
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DOES NOT
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If a patient w/ EPI has an incomplete response to enzymes, you should consider that what may also be present? What should you do at this point?
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SI bact overgrowth
tx w/ tylosin or metronidazole, or fat soluble vit supp |
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In cats, EPI can form due to what? What is the main clinical sign?
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secondary to biliary sx or neoplasia
thin despite good appetite, poor haircoat |
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IBD is likely due to a disturbance in:
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mucosal permeability
mucosal immune tolerance |
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What cells/molecules are involved in mucosal immunity? How are their levels different in IBD?
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incr expression of MHC II molecules in GI tract (IBD cat)
decr expression of T regulatory cells (IBD dog) downreg of TLR's in dogs w/ IBD |
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What age/breed(s) are susceptible to IBD?
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6-8 yrs dogs and cats
*not a dz of young or old animals german shepards, rotties, others |
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What are the clin signs of IBD?
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chronic sm bowel diarrhea
wt loss, vomiting, appetite poor or ravenous thickened int's |
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Describe the abd US abnormalities in a patient w/ IBD.
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overall SI thickening
loss of normal layering suggests neoplasia |
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Abd US: muscularis thickening suggests what in cats?
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GI LSA
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How is IBD diagnosed?
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GI biopsies
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What do you need to r/o before you take int biopsies to dx IBD?
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r/o metabolic dzs! (Addison's in dogs, hyperthyroid in cats)
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What are the pros and cons for using endoscopy to diagnose IBD?
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pros:
-less invasive, no incisions, faster recovery, less expensive than sx cons: -can't get full thickness biopsy --> may miss lymphoma -cost of equip, need special training |
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What are the pros and cons for using surgical int biopsy to diagnose IBD?
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pros:
-allows full thickness biopsy -can examine and biopsy other organs -can get to jejunum and ileum cons: -invasive, more expensive, longer recovery |
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What is impt in surgically exploring an animal w/ chronic GI signs?
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get biopsy fr all 3 segments of sm int! even if they look grossly normal
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What should you try B4 int biopsy in all patients w/ high index of suspicion of IBD?
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hypoallergenic diet (about half respond well)
*hydrolyzed protein |
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What are some predictors of response to hypoallergenic diet in patients w/ IBD?
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concurrent atopic dermatitis
normal hypoechoic jejunal mucosa on abd US young (2-4 yrs) |
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When is pharmacologic management of IBD indicated?
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no response to diet trial, and histologic confirmation of IBD
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What are some drugs used to treat IBD?
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Prednisone/Prednisolone
Budesonide Cyclosporine Azathioprine Metronidazole |
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What is PLE (protein losing enteropathy)?
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subtype of sm int malabsorption w/ excessive loss of protein into gut lumen
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PLE is most common in dogs or cats?
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dogs
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What are some causes of PLE?
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severe IBD
GI lymphoma Histoplasmosis familial in Wheaten terriers |
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Describe the clin signs of PLE.
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sm bowel diarrhea
profound wt loss panhypoproteinemia ascites/pleural effusion hypercoagulable |
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What is the dx method of choice for PLE?
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full thickness biopsy
may consider endoscopy is patient is debilitated...endoscopy is less invasive |
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How does tx of PLE compare to tx of IBD?
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tx for PLE is more aggressive
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How is PLE treated?
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novel/hydrolyzed protein diet
pred + cyclosporine/azathioprine ----if severe malabsorption --> SC dexamethasone diuretics for ascites ----Spirinolactone/hydrochlorathizide low dose asprin or clopidogrel to prevent thrombosis |
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What is lymphangiectasia?
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subtype of sm int malabsorption w/ abnormal loss of protein-rich lymp into the gut lumen due to lymphatic obs
subtype of PLE |
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Give some causes of lymphangiectasia?
|
severe IBD
GI lymphoma Histoplasmosis idiopathic familial in yorkies |
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Give some clinical signs of lymphangiectasia.
|
wt loss
**panhypoproteinemia and hypocholesterolemia** |
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What are some ways to treat lymphangiectasia?
|
Dexamethasone plus cyclosporine or azathioprine
low fat diet MCT oil low dose aspirin or clopidogrel oral or IV calcium if needed calcitrol if needed |
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What dz should you suspect when you see a Yorkie w/ fluid in chest/belly + Gi signs?
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lymphangiectasia
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Describe the typical response to pancreatic enzyme powder in a dog w/ EPI.
|
very quick response! w/in days
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Weight loss (seen/not seen) with purely lg bowel diarrhea.
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NOT SEEN
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Vomiting is usually (seen/not seen) with purely lg bowel diarrhea.
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NOT SEEN
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What are some causes of acute lg bowel diarrhea (colitis)?
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dietary indiscretion (very common)
whipworms, giardia, clostridium difficile stress may accompany acute pancreatitis |
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Clostridium difficile causes (lg or sm) bowel diarrhea.
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both!
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What are the 5 F's of acute colitis?
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finger (rectal exam)
fecal exam-float, smear, zinc sulfate, Giardia ELISA food chg fiber fenbendazole |
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Sm or lg bowel diarrhea: which is more likely to be associated w/ systemic signs?
|
sm
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What type of food is best for a patient w/ acute colitis?
|
highly digstible, low residue diet
boiled meat and rice canned pumpkin diets w/ beet pulp |
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Why is soluble and nonsoluble fiber impt for a patient w/ acute colitis?
|
soluble fiber - broken down into SCFA (energy source for colonocytes)
insoluble fiber - bulks feces and absorbs excess water |
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Which parasites are more commonly associated w/ the lg bowel?
|
whipworms, giardia
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What are some meds used to manage acute colitis?
|
Metronidazole (overused)
Loperamide (short term only) |
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Give some common causes of chronic colitis.
|
IBD
occult parasites (whipworms, Giardia) stress colitis colonic polyps Tritrichomonas foetus (young cats) |
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How do you distinguish Giardia fr Tritrichomonas foetus?
|
fecal Giardia ELISA
fecal Tritrichomonas foetus PCR differences in motility |
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What factors may predispose a cat to a Tritrichomonas foetus inf?
|
young cats (<2 yrs)
shelter/crowded places show cats |
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What is used to treat Tritrichomonas foetus inf in symptomatic cats?
|
ronidazole
|
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What would you suspect in a young Boxer or Bulldog w/ chronic colitis? What are the main clin signs?
|
Histiocytic ulcerative colitis
severe lg bowel diarrhea w/ severe urgency can have wt loss and bloody diarrhea |
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Briefly describe the pathogenesis of Histiocytic ulcerative colitis
|
invasive strains of E. coli walled off by macrophages
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How is Histiocytic ulcerative colitis treated? What is a key rule in treatment?
|
6-8 wk course of fluoroquinolones (enrofloxacin or marbofloxacin)
treat for the FULL 6-8 wks to avoid resistance |
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What is the main physical finding of Histoplasmosis? What might this finding resemble?
|
severe int thickening, could look like GI LSA
colonic granulomas |
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How is Histoplasmosis diagnosed?
|
**rectal mucosal scraping**
LN aspirate Histoplasma urine Ag test |
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How is Protothecosis diagnosed? Its GI lesions can resemble that of what other dz's?
|
**rectal mucosal scraping**, LN aspirate, UA
Histo LSA |
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How is chronic LI diarrhea treated?
|
if no response to low residue diet, fiber, and fenbendazole, consider TYLOSIN or METRONIDAZOLE
if no response to all of the above, recommend colonoscopy |
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How is IBD of the colon managed?
|
try first novel or hydrolyzed protein diet
Pred or Budesonide Azathioprine (dogs) or Cyclosporine (cats + dogs) Sulfasalazine (dogs) or olsalazine (dogs) |
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What is a risk of Sulfasalazine use in dogs? What does it treat again?
|
KCS in 15% of dogs
IBD of the colon |
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What is a perianal fistula?
|
ulcerative tracts in perianal region
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Describe the clinical signs of perianal fistulas.
|
dyschezia (painful def)
hematochezia (fresh blood) constipation scooting, licking anal area, looking at tail usually not diarrhea *painful |
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Give some differentials for perianal fistulas.
|
anal sac abscess
perineal hernia rectal or perianal tumors impingement on rectum by enlged prostate, pelvic fracture rectal polyps |
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How is a perianal fistula treated?
|
Cyclosporine (modified)
Ketoconazole allows lower dose of cyclo topical tacrolimus once in remission |
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Obstipation/megacolon occurs commonly in what type of animal?
|
older cats
|
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What are some symptoms of obstipation/megacolon?
|
infreq, rock hard stools
dyschezia, tenesmus may vomit after defecation |
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Describe some causes of obstipation.
|
chronic dehyd
hypokalemia pelvic fractures or deformity pelvic mass idiopathic (manx cats) |
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How is Obstipation/megacolon managed?
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highly digestible diet
SC fluids Lactulose (stool softener) Cisapride (prokinetic) enemas de-obstipation subtotal colectomy |
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Generally describe the exocrine pancreatic fxn.
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dig enzyme secretion
bicarb secretion secretion of factors necessary for zinc and cobalamin absorption |
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Describe the pathogenesis of pancreatitis.
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abnormal enzyme activation in gland or duct
edema, necrosis, hemorrhage local inflamm adjacent fat necrosis systemic enzyme release |
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Bacterial pancreatic inf's/abscesses are (common or uncommon) in dogs and cats.
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UNCOMMON
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Give some major risk factors for pancreatitis in dogs.
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obesity
high fat diet hyperadrenocorticism hypertriglyceridemia pancreatic duct obs fall out of tall buildings hypercalcemia drugs - Pred, K Bromide |
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Describe the signalment for pancreatitis in dogs.
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older (>7 yrs)
overwt spayed female dog *min schnauzer sm terriers, poodles, Dachshunds any breed |
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What are the clinical signs of pancreatitis in dogs?
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vomiting, anorexia
sm OR lg bowel diarrhea painful stance "prayer position" may be normal between bouts |
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What are the PE findings of acute pancreatitis?
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abd pain
dehyd feer jaundice arrhythmias dyspnea, shock |
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What are the differentials for rt cranial abd pain?
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gallbladder dz, pancreatitis
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What would you find on a CBC of a dog w/ acute pancreatitis?
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neutrophilic leukocytosis
lt shift toxic chg low TP |
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What type of pattern are you likely to see in a biochem of a dog w/ acute pancreatitis?
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cholestatic pattern:
---incr SAP>ALT ---hypercholesterolemia ---hyperbilirubinemia decr albumin decr calcium |
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What type of result is NOT reliable in the dx of acute pancreatitis?
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pancreatic enzymes
incr lipase and incr amylase can be seen in pancreatitis, but these are NOT RELIABLE |
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The best serum test for canine pancreatitis is ________________.
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canine pancreatic lipase immunoreactivity (cPLI)
>400ug/L is diagnostic of pancreatitis >200ug/L is suggestive |
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How should you interpret a SNAP cPL test?
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screening test
sensitive but not specific trust a negative! |
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Describe therapy for pancreatitis in dogs.
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NPO for 1-3 days
IV fluids vetstarch, plasma visceral analgesics - Fentanyl CRI, Butorphanol, Ketamine/lidocaine CRI antiemetics - Metoclopramide, Maropitant, Ondansetron antibiotics (usually not necc) nutritional support ASAP |
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Antibiotics are not indicated for pancreatitis unless...
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mucosal sloughing
bloody diarrhea abscessation (uncommon) |
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What are some of the more common complications of pancreatitis?
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DM (transient)
extrahepatic bile duct obs DIC acute renal failure pulm edema vent arrhythmias |
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What are some of the less common complications of pancreatitis?
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neuro signs
DM (permanent) EPI pancreatic abscess sepsis, death |
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Give some ways to prevent pancreatitis in dogs.
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low fat diet (r/d, w/d, etc)
wt loss avoid offending drugs antioxidants? |
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What is the prognosis of pancreatitis in dogs?
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varies markedly w/ severity of episodes
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What is the cause of pancreatitis in cats?
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90% idiopathic in cats
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What is "tri-iditis"?
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syndrome of pancreatitis, IBD, and cholangiohepatitis in cats (common)
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Describe the signalment of feline pancreatitis.
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any age, male or female
overweight or thin |
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Describe the clin signs in cats w/ pancreatitis.
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signs more vague in cats than in dogs
lethargy, anorexia vomiting only in 35% of cats w/ pancreatitis*** |
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How common is abd pain in cats w/ pancreatitis?
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25%
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Describe the clin path abnormalities in cats w/ pancreatitis.
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increases in:
SAP>ALT cholesterol bilirubin glucose cholestatic pattern decreases in: potassium albumin calcium |
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Albumin and lipase (are/are not) useful in diagnosing pancreatitis in cats. Is this like or unlike dogs?
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NOT USEFUL in dogs or cats
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What is the diagnostic test of choic for feline pancreatitis?
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fPLI - feline pancreatic lipase
-fairly sens and spec low serum cobalamin |
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What is the imaging of choice for feline pancreatitis?
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abd US
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What kind of therapy is best for cats w/ pancreatitis?
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IV fluids w/ KCl
NPO ONLY IF VOMITING aggressive nutritional support |
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What complications can arise in cats w/ pancreatitis? Which is most common?
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secondary hepatic lipidosis - common
secondary DM - less common EPI - uncommon in cats |
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A low fat diet can prevent pancreatitis in cats. T or F?
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F - no evidence
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What are the clin/PE signs of pancreatic adenocarcinoma?
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vomiting, lethargy
wt loss poor appetite*** icterus cranial abd mass*** |
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In terms of pancreatic adenocarcinoma, what should you NEVER do?
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NEVER euth based on mass alone, because pancreatitis can resemble pancreatic adenocarcinoma grossly - always get cytology and/or biopsy
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What is the prognosis of pancreatic adenocarcinoma?
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poor, highly malignant - euth recommended
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What part of the body is best to look at to see if there is jaundice?
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sclera
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Patients w/ hepatic encephalopathy have what type of neurologic abnormalities?
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symmetric non-localizing
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What will you find on the CBC of a patient w/ a hepatobiliary disorder?
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leukocytosis w/ lt shift
toxic chg microcytic anemia** target cells** |
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What are the hepatocellular enzymes?
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ALT
AST |
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What are the cholestatic enzymes?
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SAP (ALP)
GGT |
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What liver biochem value is ALWAYS SIG if it is high?
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ALP
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What types of things cause ALT to be elevated?
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hepatocyte damage, inflamm, or death
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What value should you look at next if ALT is normal and AST is high?
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CK...if also high, could indicate mm dz
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Serum SAP is sensitive in (dogs or cats) and specific in (dogs or cats) for hepatobiliary dz.
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sensitive in dogs
specific in cats |
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What types of conditions cause increase of SAP? Which causes the highest increase?
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cholestasis**
drugs (dogs) growth bone dz hyperthyroidism in cats |
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SAP isoenzymes are generally (useful or not useful) in distinguishing underlying cause of SAP induction.
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not useful
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In what cases would a fold increase SAP > fold increase GGT?
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hepatic lipidosis in cats
anticonvulsant induction (phenobarb) in dogs |
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SAP and GGT both increase to same degree (fold-increase) with __________.
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cholestasis
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Give the BIG FIVE indirect markers of liver fxn.
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albumin
bilirubin BUN cholesterol glucose |
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If bilirubin is increased, what should be ruled out?
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pre-hepatic jaundice
hepatic post-hepatic |
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Give a condition that would result in a low/high cholesterol.
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decr: cirrhosis or PSS
incr: cholestasis |
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What finding in the UA can suggest PSS?
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ammonium biurate crystals
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What finding in the UA is non-specific, but common in liver dz?
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dilute urine
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What UA finding in a cat is always to be considered abnormal?
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bilirubinuria
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What is an early and sensitive marker for liver dysfxn?
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elevated serum bile acids
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Bile acids increase before or after bilirubin rises?
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BEFORE
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Bile acids can't distinguish bet. what two conditions?
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hepatic and post-hepatic jaundice
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Blood ammonia and bilirubin are more or less sensitive than bile acids?
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LESS
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What imaging technique is useful for liver dz?
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abd US
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What are some indications for a liver biopsy?
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persistently elevated bile acids
persistent increases in liver enzymes, esp ALT acute hepatopathy hepatic mass to diagnose and stage chronic hepatitis to diagnose or stage neoplasia to screen for breed-related hepatopathies |
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What are some precautions for a liver biopsy?
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coag panel w/ platelet count
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