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52 Cards in this Set
- Front
- Back
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What are the 2 pathways involved in the vomiting reflex
Which is the more common one? |
Humoral pathway
Neural pathway Neural is more common in dogs and cats |
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What is the humoral pathway triggered by?
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blood borne triggers: uremic toxins, severe liver disease, digoxin toxicity, endotoxemia, apomorphine
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What is the neural pathway triggered by?
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GI infection, GI inflammation, GI toxicity, GI malignancy
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What are he 4 components of the emetic reflex?
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visceral receptors in the GI tract
vagal and sympathetic afferent neurons CRTZ vomiting center in medulla |
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apomorphine is a/an ________
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D2 agonist
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Cerenia is a/an _______
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NK-1 antagonist (competes with substance P)
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dipenhydramine is a/an _______ and it works on the ________
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H1 histaminergic antagonist
works on vomiting center |
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metaclopramide is a __________, ________ and ____________
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D2 antagonist
weak 5-HT3 antagonist weak 5-HT4 agonist |
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chlorpromazine is a _____ and _____
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D2 dopaminergic antagonist
M1 cholinergic antagonist alpha-2 adrenergic antagonist |
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ondansetron/dolasetron is a __________
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5-HT3 antagonist
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Cisapride is a _________ and _________
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strong 5HT4 agonist
weak 5HT3 antagonist |
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Indications for anti-emetics?
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-vomiting is intractable
-risk of aspiration pneumonia -onset of acid-base disorder -onset of electrolyte disorder -no evidence of obstruction -client doesn't want definitive dx |
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5 diagnostics for a patient with self-limiting vomiting
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PCV/TS
Azostick USG Abd radiographs fecal float/centrifugation +/- wet prep |
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vomiting patient: warning signs of illness
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fever
melena weakness pain vomiting one empty stomach hematemesis pale or congested MMs abdominal organomegaly |
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causes of hematemesis
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GI neoplasia (adenocarcinoma, lymphoma, gastrinoma)
NSAIDS + corticosteroids uremic gastritis pancreatitis severe IBD liver disease infection (salmon poisoning, salmonella, histoplasmosis, parvo) toxin ingestion foreign body addison's disease HGE: clostridium perfringens/difficle |
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What does the chem panel help you rule in/out for a chronically vomiting patient?
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CRF
DKA liver disease hypercalcemia electrolyte abnormalities hyperthyroidism +/- addisons |
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5 liver function parameters
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BUN
glucose albumin bilirubin cholesterol |
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causes of chronic vomiting in the cat
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IBD
hyperthyroidism hepatobiliary disease pancreatitis CRF Gi malignancy |
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What are the 2 triple therapies for Helicobacter?
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1) clarithromycin, metronidazole, ranitidine
2) metronidazole, ampicillin, bismuth subsalicylate |
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What are the 3 components of managing IBD
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Elimination diet: single protein source
Antibiotics: metronidazole or tylosin Immunosuppressive drugs: prednisone |
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What are add-on drugs for IBD tx after prednisone/prednisolone for
-cats -dogs What durg is used for patients with refractory IBD? |
cats: chlorambucil
dogs: azathioprine refractory: cyclosporine |
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Definition of hypoallergenic diet
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have proteins with MW <18 Kd
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List of drugs used to decrease acid secretion
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H2 receptor antagonists
misoprostol omeprazole sucralfate (anticholinergics) |
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How does sucralfate work?
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The sulfated sucrose is attracted to the charge on the ulcer bed electrostatically --> creates bandaid
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Name 2 Ach M1 receptor antagonists; how do they work?
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pirenzepine
telenzepine bind selectively to the Ach receptors on the parietal cell....no adverse systemic effects like atropine |
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How does Omeprazole/Lansoprazole work?
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H+ K+ ATPase inhibitor
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How does misoprostol work?
When is it used? |
prostaglandin E1 analogue
Used with NSAID toxicity or heavy use stimulates mucosal blood flow, decreases gastric acid secretion |
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Rank H2 receptor anatagonists in terms of potency from most potent to least potent
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Nizatidine
Famotidine Ranitidine Cimetidine |
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Which H2 receptors have prokinetic activity?
What is the MOA of the prokinetic activity? |
Nizatidine and Ranitidine
MOA is anatgonism of acetylcholinesterase, so more Ach is available to promote motility |
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Which H2 receptors have Cyt P450 inhibition?
Which do not? |
Cimetidine +++
Ranitidine + famotidine and nizatidine do not inhibit cyt P450 |
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signs of small bowel diarrhea
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normal to increased stool volume
melena normal to slightly increased frequency (2-4x) no urgency no tenesmus weight loss/vomiting more common |
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signs of large bowel diarrhea
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marked increase in frequency (10-20x a day)
urgency tenesmus scant stool volumes hematochezia + mucous weight loss and vomiting less common |
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what is special about cryptosporidium?
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it's acid fast
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What kind of diarrhea does Tritrichomonas foetus cause?
How do you dx? (4 ways) |
chronic large bowel diarrhea in cats
Dx -direct wet prep -fecal culture Inpouch -histopathology on colon -PCR |
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2 breeds predisposed to tritrichomonas foetus?
What are the clinical signs? how do you treat? |
Abyssinians and bengals
BAR, normal appetite, semi-formed large bowel diarrhea +/- fresh blood/mucous, malodoeous, dribble feces, anus red, swollen, painful tx with ronidazole |
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Indications for fecal culture
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>1 animal in a household has diarrhea
onset after kenneling acute onset of bloody diarrhea with or without sepsis public health |
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best way to dx C perfringens?
Drugs to treat C perfringens? |
enterotoxin detection (ELISA) + PCR for entertoxin gene
ampicillin, metronidazole, tylosin |
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drugs to treat C difficile?
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metronidazole, maybe enrofloxacin
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drugs to treat campylobacter
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azithromycin
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definition of IBD
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spectrum of GI disorders associated with chronic inflammation of the GI tract of unknown etiology
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3 components of IBD
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luminal antigens
genetic susceptibility environmental triggers |
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low serum B12 levels indicate:
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malabsorption in the ileum
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low serum folate levels indicate:
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malabsorption in the jejunum
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Historical pattern of B12/folate in SIBO
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low serum B12 and high serum folate
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Indications for a hypoallergenic diet
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-animal has severe IBD
-animal allergic to multiple allergens -complicated dietary history -elimination diet for dx and management of food hypersensitivity |
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3 indications for tylosin
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management of colitis
management of SIBO/ARD treatment of C perfringens |
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what do you need to worry about being decreased with intestinal IBD...
what does it do normally? |
B12 levels
important for DNA replication in the intestinal crypts |
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definition of a probiotic
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viable micro-organism given orally that are able to colonize distal small bowel or colon and exert a beneficial effect
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What beneficial effects do probiotics have?
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replace bad bacteria with good
immunomodulatory effects to affect the integrity of the epithelial tight junctions |
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what is a pre-biotic?
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a poorly digestible carbohydrate source given as part of the diet; a substrate for probiotics
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How does sulfasalazine work?
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broken down in colon to sulfapyridine and mesalamine by colonic bacteria
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What are the characteristics of histiocytic ulcerative colitis ?
what is the cause? what is the treatment? |
-boxers <2 years
plasma cells, lymphocyes, PAS + macrophages -caused by enteroinvasive E. coli -treat with enrofloxacin |
