Gastrointestinal Disease 1

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Gastrointestinal Disease 1
2013-02-16 18:50:30
Animal Diseases Three

Animal Diseases
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  1. What are the different types of oral diseases?
    • oral inflammation
    • periodontal disease
    • lip fold dermatitis
    • oral trauma
    • oral neoplasia
    • feline eosinophilic complex
  2. What is gingivitis?
    inflammation of the gums
  3. What is stomatitis?
    inflammation of oral mucous membranes
  4. What is glossitis?
    inflammation of the tongue
  5. What are the different types of oral inflammation?
    • gingivitis
    • stomatitis
    • glossitis
  6. What does periodontal disease affect?
    all structures involved with tooth attachment
  7. What percent of dogs and cats are affected by periodontal disease?
    60 - 80%
  8. What does periodontal disease start with?
    starts with plaque
  9. What is plaque?
    white slippery film composed of bacteria, food debris, exfoliated cells, and saliva
  10. What is dental calculus?
    mineralized plaque
  11. What is the progression of periodontal disease?
    • bacteria in plaque
    • gingivitis
    • bacterial endotoxins
    • damage tooth attachments and alveolar bone
    • tooth loss
  12. What are the clinical signs of periodontal disease?
    • asymptomatic
    • halitosis
    • reluctance to chew hard food, toys, bones
    • pawing at mouth
    • head shyness
    • oral pain
    • personality changes
    • sneezing, nasal discharge
    • increased salivation, may be bloody
    • facial swelling
    • tooth loss
    • weight loss
  13. What is halitosis?
    bad breath
  14. How do we diagnose periodontal disease?
    • complete oral exam - increased gingival sulcus
    • tartar/calculus
    • inflammation
    • dental radiography
  15. How do we treat periodontal disease?
    • dental scaling, polishing
    • subgingival curettage
    • root planing
    • extractions
    • antibiotics three days prior
    • client education
  16. What is lip fold dermatitis?
    acute or chronic inflammation of the lips
  17. What is cheilitis?
    lip inflammation
  18. What can cause lip fold dermatitis?
    • secondary to trauma, foreign body, periodontal disease, stomatitis
    • secondary to licking infected skin or wounds
    • parasitic, autoimmune, neoplasia
    • pendulous lips allow food and saliva to accumulate
  19. What are the clinical signs for lip fold dermatitis?
    • scratching or rubbing at lips
    • foul odor to breath
    • excess salivation
    • anorexia
    • perioral hair discolored
    • perioral area moist, matted with a thick yellow-brown malodorous discharge
    • perioral skin hyperemic and possible ulcerated
  20. What is the treatment for lip fold dermatitis?
    • sedate, clip hair, cleanse daily
    • treat periodontal disease, stomatitis
    • treat primary lesion
    • some may require surgical resection of the lips
  21. What do we need to educate clients about lip fold dermatitis?
    • keep lips clean and dry
    • frequent hair trimming
    • good dental hygiene
    • cornstarch may help keep areas dry - light dusting
  22. What are the different things that can cause oral trauma?
    • falls, fights, burns, blunt trauma, foreign objects, hit by car
    • mandibular symphysis fracture
    • tongue - dog fight, self trauma, foreign body, strangulation
    • needles - thread, linear foreign body
    • electrical and chemical burns
    • caustic plants and materials
    • gunshot
    • fishhooks
    • bones, sticks
  23. What are the clinical signs of oral trauma?
    • history of head trauma
    • increased salivation
    • inability to close the mouth
    • reluctant or unable to eat
    • presence of foreign body
    • pawing at mouth
    • halitosis
  24. How do we diagnose and treat oral trauma?
    • physical exam - under sedation or general anesthesia
    • radiographs
    • treatment depends on the injury
  25. Is oral neoplasia common in dogs and cats?
  26. What are the most common oral malignant tumors?
    • malignant melanomas - especially with dogs that have heavily pigmented mouths
    • squamous cell carcinomas
  27. Does oral neoplasia have a good prognosis?
  28. What are the most common benign oral tumors?
    • papillomas
    • epulis, epulides
  29. What are papillomas?
    • viral
    • pale cauliflower like growths
  30. What are epulis, epulides?
    occur in gingiva near incisors
  31. What is the treatment for oral neoplasia?
    • surgery
    • chemotherapy
    • radiation therapy
  32. What do feline eosinophilic complex look like?
    • erosions, plaques, proliferative lesions
    • indolent ulcers often on the upper lip
  33. What does indolent mean?
    lazy, slow or non-healing
  34. What causes feline eosinophilic complex?
  35. What are the lesions of feline eosinophilic complex made up of?
    an accumulation of inflammatory cells, mostly eosinophils
  36. What are the clinical signs of feline eosinophilic complex?
    • red, well circumscribed lesion
    • ulcerated, raised edges
    • may extend up to the nose
  37. What does well circumscribed mean?
    distinct edges between lesion and normal tissue
  38. How do we diagnose feline eosinophilic complex?
    • history
    • physical exam
    • biopsy
  39. How do we treat feline eosinophilic complex?
    • corticosteroids
    • laser, radiation, cryotherapy for non-responsive lesions to steroids
  40. What kind of corticosteroids can we give cats for feline eosinophilic complex?
    • Depo-Medrol - SQ and can repeat in 3 weeks
    • prednisone, dexamethasone, triamcinolone orally or injected into the lesion
  41. What do the cells in the stomach glands produce?
    • hydrochloric acid (HCL)
    • pepsinogen
    • gastin
    • mucus and bicarbonate ion
  42. What is pepsinogen?
    breaks down protein, stimulates more HCL and gastrin to be released
  43. What is gastrin?
    a hormone that stimulates release of mucus and HCL
  44. What does mucus and bicarbonate ions do in the stomach?
    reduce acidity due to HCL and helps to protect the lining of the stomach
  45. What are some stomach diseases?
    • acute gastritis
    • immune mediated inflammatory bowel disease
    • gastric ulcers
    • gastric dilatation and volvulus
    • gastric neoplasia
  46. What is acute gastritis?
    • inflammation of the stomach
    • inflammation and mucosal damage occur in response to gastric mucosal insult
  47. What can cause acute gastritis?
    • spoiled food
    • diet change
    • food allergy, intolerance
    • infection
    • toxins, drugs, plants
    • organ failure
    • foreign body
  48. What are the clinical signs of acute gastritis?
    • variable appetite, anorexia
    • vomiting, maybe diarrhea
    • may have dehydration
    • may have painful abdomen
    • may have increased salivation
  49. What do we need to note about the history of a dog with possible acute gastritis?
    • diet change
    • toxin ingestion
    • infection
    • parasites
    • treats given
  50. How do we diagnose acute gastritis?
    • history and physical exam
    • CBC, serum profile, urinalysis
    • radiographs, contrast radiology
    • fecal 
    • endoscopy
  51. How do we treat acute gastritis?
    • most cases are self-limiting and do not require treatment
    • NPO for 8 - 36 hours
    • fluids - IV, SQ, may add KCL
    • antiemetics - metoclopramide
    • antacid - cimetidine
    • protective - sucralfate
    • antibiotics - metronidazole
    • once vomiting stops, place animal on a bland diet
  52. What kind of diet should an animal have with acute gastritis?
    • boiled rice
    • boiled hamburger
    • boiled chicken
    • Hill's i/d
    • be sure to avoid high fat foods
  53. What kind of client education should we provide a client that has an animal with acute gastritis?
    • avoid abrupt diet changes
    • if pet vomits when fed, NPO for another 8 to 24 hours
    • avoid table scraps
    • avoid giving pet objects that can be chewed into smaller pieces and swallowed
    • if vomiting continues, recheck at the vet clinic
  54. What does IBD stand for?
    immune mediated inflammatory bowel disease
  55. What is considered IBD and how does it occur?
    • chronic gastritis, enteritis, and colitis
    • accumulation of inflammatory cells within the GI mucosa
  56. Which animal is IBD the most common in?
    most common in cats but can occur in dogs as well
  57. Do we know the cause of IBD?
    no its idiopathic
  58. What is IBD linked to?
    linked to chronic antigenic stimulation by parasites, diet, bacteria, neoplasia
  59. What are the clinical signs of IBD?
    • chronic vomiting and/or diarrhea
    • weight loss
    • straining to defecate, melena, hematochezia
    • palpate thickened bowel loops
  60. How do we diagnose IBD?
    • CBC, serum profile, urinalysis
    • eosinophilia may be present
    • fecal, fecal culture, check for numbers and type of bacteria
    • FeLV/FIV testing in cats
    • definitive diagnosis:  endoscopy with biopsy
  61. What are the different ways to treat IBD?
    • hypoallergenic diets
    • treat for parasites
    • immunosuppressive doses of prednisone
    • for cats:  methlyprednisolone (injectable)
    • if non-responsive try:  azathioprine or cyclophosphamide
    • for bacterial overgrowth:  metronidazole, sulfasalazine
    • reduce dose of corticosteroids to the lowest effective dose
  62. What kind of client education do we need to provide for IBD?
    • diagnosis of IBD requires a full lab work-up
    • definitive diagnosis is based on biopsy
    • therapy is required for life
    • may require special diet for life, must stop all flavored vitamins, treats, and table food
    • immunosuppressive drugs have side effects such as:  PU/PD, polyphagia, weight gain, skin and urinary tract infections, may shorten life span
  63. What are the two different types of gastric ulcers?
    gastric erosive or ulcer disease
  64. What are gastric erosions?
    penetrate only into the mucosal layer
  65. What are gastric ulcers?
    penetrate past the mucosa into connective tissue, maybe muscularis, may perforate
  66. What can cause gastric ulcers?
    • NSAIDS
    • corticosteroids
    • hepatic and renal insufficiency
    • uremic toxins
    • addison's disease
    • foreign bodies
    • helicobacter spp
    • stress
  67. What are the clinical signs of gastric ulcers?
    • asymptomatic
    • vomiting
    • may have pale mucous membranes
    • anemia
    • abdominal pain
    • septicemia if perforated
    • weight loss
    • anorexia
  68. What does the vomit look like in an animal who has gastric ulcers?
    • "coffee grounds"
    • frank blood
    • melena
  69. How do we diagnose gastric ulcers?
    • CBC to look for anemia
    • hypoproteinemia from blood loss
    • radiology:  survery, barium, or iodine if perforation is suspected
    • endoscopy with biopsy
    • surgical exploration for a biopsy
  70. How do we treat gastric ulcers?
    • fluid therapy
    • blood transfusions
    • anti ulcer drugs
    • antibiotic therapy for helicobacter spp associated ulceration
    • perforations to stabilize animal and do exploratory surgery
  71. What are some different types of antiulcer drugs?
    • H2 blockers such as cimetidine
    • omeprazole
    • protectants such as sucralfate
    • prostaglandins such as misoprostol to prevent ulcers from NSAIDs
  72. What kind of client education do we need to provide for gastric ulcers?
    • do not use NSAIDs or steroids without veterinary supervision
    • limit stress on the animal
  73. What is GDV?
    gastric dilatation and volvulus
  74. What is gastric dilation?
    overdistension of the stomach with ingesta, gas, or fluid
  75. What is gastric volvulus?
    twisting of the stomach on its long axis
  76. What does gastric volvulus do?
    occludes the passage of gastric contents through the esophagus or duodenum
  77. How can GDV affect the heart?
    blocks return of blood to the heart causing myocardial ischemia
  78. How can GDV affect the stomach?
    increases pressure in the stomach causing ischemia of the gastric wall or necrosis of the gastric wall
  79. The endotoxins from the GI tract activate inflammation due to GDV.  What does this cause?
    hypovolemic and endotoxic shock
  80. What is the prognosis of GDV?
    • life-threatening
    • survival is dependent on early recognition and treatment
  81. Which animals and what age of animals are mostly at risk for GDV?
    • large and giant breed dogs, and deep chested dogs
    • usually occurs between the age of 2 - 10 years old but can occur at any age
  82. What are the risk factors for GDV?
    • age, breed, conformation
    • laxity of gastric ligaments
    • large volume of food or water
    • delayed gastric emptying
    • postprandial exercise
    • accumulation of gas
    • failure of normal vomiting or eructating reflex
  83. What is it called when there is an accumulation of gas in the stomach?
  84. What are the clinical signs of GDV?
    • acute, non-productive retching
    • hypersalivation
    • abdominal pain, distension
    • increased heart rate and respiratory rate
    • weakness, collapse
    • depression
    • nausea
    • mucous membranes are brick red from endotoxins
  85. How do we diagnose GDV?
    • history and physical exam
    • arrhythmias - PVCs
    • radiographs: right lateral
  86. What do radiographs look like if there is gastric dilation?
    enlarged gas, ingesta, fluid filled stomach
  87. What do radiographs look like if there is gastric volvulus?
    compartmentalization between pylorus and fundus (double bubble)
  88. What are the goals of treatment for GDV?
    • manage or prevent shock
    • decompression of stomach
    • fluid therapy
    • stabilize and prepare dog for surgery if needed
  89. How do we decompress the stomach in the case of GDV?
    • trocar - 16 to 18 g needle inserted into area of tympany
    • orogastric tube (patient may need to be sedate)
    • temporary gastrotomy tube
    • gastric lavage
  90. What kind of surgery would we do for GDV?
    • gastropexy:  cutting a flap from the stomach and stitching it to the abdominal wall to keep stomach from twisting
    • gastric resection if gastric tissue not viable
    • splenectomy is spleen not viable
  91. What kind of post-op care do we need to provide a patient after GDV surgery?
    • EKG for at least 24 hours to look for myocardial ischemia and arrhythmias
    • lidocaine/procainamide as needed for arrhythmias
    • blood pressure monitor
    • antibiotic pre and post op
    • turn frequently to prevent skin and muscle damage and to prevent atelectasis
    • maintain body temp
    • nutritional supply
  92. What kind of client education do we need to provide for GDV?
    • feed several smaller meals a day, not one large meal
    • limit exercise after eating
    • mortality rate is 15 - 18%
    • even after surgical correction GDV may reoccur
    • average hospital stay is 3 - 7 days
  93. Which animals does gastric neoplasia commonly occur in?
  94. What causes gastric neoplasia in cats?
    associated with FeLV in cats
  95. Which type of gastric neoplasia is the most common in dogs?
  96. Which type of gastric neoplasia the most common in cats?
    • lymphosarcoma
    • may be in a discrete mass
    • may be diffused in the mucosa
  97. What are the clinical signs of gastric neoplasia?
    • chronic and progressive vomiting - may be bloody
    • weight loss
    • obstruction
    • melena
    • hematochezia
  98. How do we diagnose gastric neoplasia?
    • history, minimum data base
    • physical exam, abdominal palpation
    • radiographs
    • ultrasound
    • gastroscopy
    • surgery
  99. What will we see on radiographs of gastric neoplasia?
    • abdominal films may be normal
    • thoracic films may show metastases
    • barium - outflow obstruction
  100. What will we see on an ultrasound of gastric neoplasia?
    thickened stomach wall or mass
  101. What will we see on a gastroscopy of gastric neoplasia?
    • masses
    • erosions
    • ulcers - biopsy
  102. Why do we do surgery to diagnose gastric neoplasia?
    gastrotomy with biopsy
  103. How do we treat gastric neoplasia?
    • surgical removal if it is not too advanced
    • chemotherapy
    • radiation is usually not successful
    • supportive care to control vomiting, maintain nutrition, keep animal comfortable