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48 Cards in this Set
- Front
- Back
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What is the aetiology of HGE |
Unknown |
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What animals get HGE |
Young to middle aged small breed dogs |
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What is the presentation of HGE |
Acute onset explosive raspberry jam diarrhoea Plus depression, anorexia |
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What is the characteristic lab changes for HGE |
PCV 60% + , TP normal or slighly raised, may even be down - the PCV increase is haemoconcentration, but as protein is being lost it does not rise in accordance |
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How do you diagnose HGE |
By exclusion - parvo, GI infection, parasites |
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Treatment of HGE |
Aggressive fluid therapy as the gut needs to be well perfused to avoid translocation and sepsis Colloids if needed from protein loss Antiemetics and gastrprotectants if needed Antibiotics if needed for translocation of bacteria |
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Prognosis of HGE |
Excellent with good treatment |
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Differential diagnoses for regurgitation - 4 categories |
Pharyngeal FB/neoplasia Megaoesophagus - M. Gravis, hypoAC, congenital, idiopathic Oesophagitis - drugs, reflux (idiopathic, hiatal hernia, GA associated) Mechanical oesophageal obstruction (FB, stricture, neoplasia, vascular ring anomalies) |
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What is the main concern regarding regurgitation |
Aspiration pneumonia
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Empiric treatment for regurgitation |
H2 receptor antagonist/proton pump inhibitors to reduce chance of secondry oesophagitis High calorie small frequent meals fed upright with a consistency tailored to the individual |
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What are the predisposing factors to mesenteric torsion |
Young dog GSD Exercise after meal Underlying cause of GIT irritation eg EPI (GSD), parasies, FB, IBD, often no cause identified |
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What are the findings of PCV & TS for the following situations - haemoconcentration/dehydration |
Both up |
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What are the findings of PCV & TS for the following situations : protein loss (icluding peritonitis) |
PCV normal/increased, TS normal/decreased |
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What are the findings of PCV & TS for the following situations : HGE |
PCV up, TS noraml or down |
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What are the findings of PCV & TS for the following situations : Haemorrhage |
Both down |
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Name two causes of a pure transudate |
Portal venous obstruction Hypoalbuminaemia |
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What are the gross appearance, protein and cellularity of a pure transudate |
Grossly clear TP under 2.5 g/dl Low cellularity under 500cell/ul - non degenerate neurtorphils, reactive mesothelial cells |
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When does a modified transudate occur |
Passive congestion of viscer aand impaired lympatic drainage e.g neoplasia, liver disease, RHS CHF including tamponade |
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What are the gross appearance, cellularity and TP characteristics of a modified transudate |
Appearance serous to serosanguinous TP 2.5-5 g/dl Moderate cellularity 300-5500 cells/ul - RBCS, non degenerate neutrophils, macrophages, mesothelial cells, lymphocytes |
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What are the gross appearance, cellularity and TP characteristics of an exudate |
Cloudy TP over 3 g/dl Cells over 5000-7000 cells/ul - predominantly neutrophils plus intracellular bacteria if septic |
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What does AFAST stand for |
Abdomen focussed assessment with sonography for trauma |
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What is the main goal fo aFAST |
Identifiation of free abdominal fluid |
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What are the views in an AFAST |
"DH" Subxiphoid view for hepatodiaphragm interface, gall bladde, pericardial sac, pleural space "SR" L flank view for splenorenal interface and between spleen and body wall "CC" Midline bladder "HR" R flank hepatorenl interface and areas between intestinal loops, right kidney, body wall |
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What order do you do the AFAST views in |
DH first, then non dependent flank, then CC then dependent flank |
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Name the 3 classes of drugs that reduce stomach acid and their MOA |
H2 receptor antagonists - reduce acid excretion by competitive blocking of histamine receptor Proton pump inhibitors - irreversibly (cf H2RA) inhibit H secretion into stomach Prostaglandin analogues - inhibit acid secretion |
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What are the advantages and disadvantages of each class of drugs that reduce stomach acid |
H2RAs : Pro - work straight away. Con - less effective than PPIs. PPIs : Take 2-5 days for maximum acid suppression, but are more effective than H2RAs. PG analogue : con - abortion, diarrhoea for 2-5 days, expensive, shortest duration of action (frequent administration) pro also is mucosal protectant by increased mucus secretion, increased bicarb secretion and increased mucosal blood flow. |
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Name the specific drugs in each class of drugs that reduce stomach acid |
H2RAs : cimetidine, ranitidine (least potent), nizatidine, famotidine (most potent, longest acting) PPIs : omeprazole (oral only), pantoprazole (IV only) PG analogue - misoprostol |
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How does sucralfate work |
Adheres to lining of stomach including ulcers and acts as a physical barrier to gastric acid |
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What are the adverse effects of sucralfate |
Occasionally causes constipation, slows absorption of some drugs, only oral formulation |
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Name 3 anti-emetics and their mechanism of action |
Maropitant : neurokinin-q receptor antagonist blocking substance P in CNS Ondansetron : blocks serotonin receptors Metoclopromide : antidopaminergic and serotonin blocker |
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What are the advantages and disadvantages of the 3 antiemetics |
Maropitant : pro is very safe and efficacious, con pain on injection Ondansetron : pro is very safe and efficacious Metoclpromide : pro can have other effects reduce reflux increased gastric emptying but not at the usual dose though, con less effective especially for cats, not for renal dysfunction where failure to excrete can cause behavioural changes and apparent hallucinations |
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Name 4 prokinetic drugs |
Cisapride Erythromycin Metoclopromide Misoprostol |
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What is the function of and pros / cons cisapride |
Cisapride enhances gastric emptying plus increases oesophageal sphincter tone. Pros : very effective Cons : needs to be compounded, PO only |
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What is the function of and pros/cons erythromycin |
Erythromycin promotes LI and SI peristalsis and increases oesophageal sphincter tone Con - tolerance |
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What are the pros and cons of metoclopromide as a prokinetic |
Pro - available as injection and CRI Con - less effective than some others eg cisapride |
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Which of the prokinetics is a side effect working to your advantage |
Misprostol - a prostaglandin analogue used to reduce acid secretion and gastroprotectant, but also causes diarrhoea which is the prokinetic effect being exploited here as a treatment for constipation because it enhances colonic motility |
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What are the 4 things that kill GDVs |
Most common : untreated gastric dilation blocking venous return to heart causing severe obstructive shock 2nd is severe gastric necrosis +/- perforated stomach Occasionally is sepsis Rarely is arrhythmias |
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What is the usual signalment/hx of a GDV |
Large breed deep chested dog Exercise after eating Anxious/fearful One meal a day (stretched gastric ligaments) |
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What are the 3 arrhythmias associated with GDV |
Accelerated idioventricular rhythm VPCs Ventricular tachycardia |
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Why do GDVs get arrhythmias -2 |
Reduced coronary blood flow and myocardial ischaemia may establish ectopic foci of electrical activity Also circulating cardiostimulatory substances eg epinephrine and cardioinhibitory substances eg TNFalpha also may be implicated |
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What is the most common post op complication for GDVs |
Inappetance |
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What are 4 reasons post op GDVs are inappetant |
Pain or too much opiate Perfusion poor (check lactate) Anxious Nausious |
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When should you take action with an inappetant GDV around supplemental feeding |
12-24hours post op if not vomiting then syringe a bit of a/d to give them the idea. 24-36 hours pot op then nasogastric tube |
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What should you do with a post op GDV who is vomiting / regurgitating |
Vomtign - no food, yes meds Regurg - yes food will help stop reflux |
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When do you treat a post op GDV arrhythmia |
HR over 180 Pulse less than 60 Cardiovascular compromise eg syncope, weakness, pale mms, low BP R on T phenomenon (shark tooth ECG) |
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What is the goal when treating a GDV arrhythmia |
To control the rate, not to correct the arrhythmia |
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When do you discharge a GDV |
When they are comfortable, eating and moving around, usually 36-48h post op |
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What are the discharge notes for GDV |
Home meds: tramadol if needed Nutrition - initially 3-4 small meals per day for 5-7 days then BId for life with no exercise after meals |
