Gastrointestinal Diseases 3

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kris10leejmu
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201842
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Gastrointestinal Diseases 3
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2013-02-19 18:57:05
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Animal Diseases Three
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Animal Diseases Three
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  1. What are the three different types of rectoanal diseases?
    • perineal hernia
    • perianal fistula
    • perianal gland tumor
  2. What is a perineal hernia?
    protrusion of a hernial sac in the perineal area
  3. Which animals are more prone to getting perineal hernias?
    intact male dogs over 6 - 8 years old
  4. What are the clinical signs of a perineal hernia?
    • reducible perineal swelling
    • pain on defecation
    • irregular bowel movements
    • constipation
    • rectal deviation
  5. How do we diagnose a perineal hernia?
    • history and physical exam
    • rectal exam
    • radiographs (will see a soft tissue mass in perineal area)
    • barium enema (rectal deviation)
  6. How do we treat a perineal hernia?
    • surgical:  herniorrhaphy or neuter
    • medical:  stool softeners, enemas, manual extraction of feces
  7. What kind of client education do we need to provide about perineal hernias?
    • keep stool well formed but soft to decrease straining
    • neuter to decrease size of prostate and eliminate testosterone
    • recurrence is possible
    • if surgery is done, watch for infection at the surgery site
  8. What is a perianal fistula?
    single or multiple ulcerated sinuses (draining tracts)
  9. Which animals are more prone to getting a perianal fistula?
    large breed dogs
  10. What are the clinical signs of a perianal fistula?
    • onset is insidious and goes undetected
    • excess licking of perianal area
    • fecal incontinence
    • tenesmus
    • constipation
    • perianal hemorrhage
    • foul odor and thick discharge
    • personality change
    • pain on raising tail
  11. How do we diagnose a perianal fistula?
    • history and physical exam
    • breed of dog
    • rule out anal sac disease and tumor
  12. How do we treat a perianal fistula?
    • immunosuppression
    • cyclosporine, azathioprine, prednisone - may resolve completely
    • surgical correction with concurrent anal sac removal
    • tail amputation
    • antibiotics
    • fecal incontinence is a possible sequellum to surgery
    • may recur
  13. What kind of client education do we need to provide about perianal fistulas?
    • these animals are painful
    • be careful to avoid bites when treating
    • keep area clean and dry
    • long term antibiotics
  14. What are the different types of perianal gland tumors?
    • perianal ademona
    • benign androgen dependent tumor
  15. Which animals are more prone to getting perianal gland tumors?
    older, intact male dogs
  16. What do perianal gland tumors look like?
    • ulcerate
    • hemorrhage
    • infection
    • large tumors can be obstructive
  17. What are the clinical signs of perianal gland tumors?
    • excess licking of perianal area
    • masses around anus, tailhead, inguinal regions, prepuce
    • masses ulcerated, bleeding
    • incidental finding
  18. How do we diagnose a perianal gland tumor?
    • appearance and location of mass
    • fine-needle aspirate
    • histopathology of excised mass
  19. How do we treat a perianal gland tumor?
    • neuter, excision
    • radiation therapy (effective but expensive)
    • cryosurgery
    • estrogen therapy if unable to survive anesthesia
  20. What kind of client education do we need to provide about perianal gland tumors?
    • most respond well to neutering alone especially if the tumors are small
    • suspect adenocarcinoma if tumors fail to regress
    • neutering at a young age can prevent the problem
  21. What do hepatocytes do?
    • produces bile to emulsify or break down fat
    • gluconeogenesis
  22. How many functions can the liver carry out?
    1500
  23. Is the liver able to regenerate?
    yes
  24. The injury to a liver must be _____ before lab tests reveal a disease.
    severe
  25. What are the different types of liver diseases?
    • acute toxin induced liver disease
    • chronic toxin induced liver disease
    • infectious canine hepatitis
    • hepatic lipidosis
    • hepatic neoplasia
    • congenital portosystemic shunt
  26. With acute toxin induced liver disease, acute failure happens when _____ of functional mass is injured.
    70 - 80%
  27. Why is the liver most susceptible to ingested toxins?
    due to portal venous blood from the stomach and intestines
  28. What is an acute toxin induced liver disease usually due to?
    a drug overdose
  29. What are some drugs that can cause acute toxin induced liver disease? (don't need to memorize the list).
    • acetaminophen
    • phenobarbital
    • antifungals
    • anabolic steroids
    • NSAIDs
    • diazepam (cats)
    • caparsolate
    • diethylcarbamazine
  30. What are the clinical signs of an acute toxin induced liver disease?
    • acute onset of signs
    • vomiting, diarrhea, constipation
    • PU/PD
    • jaundice
    • melena, hematuria
    • CNS - depression, ataxia, dementia, blindness, seizures, coma
  31. How do we diagnose acute toxin induced liver disease?
    • history of drug administration or accidental ingestion
    • painful liver, hepatomegaly
    • increased ALT, ALKP, bilirubin, bile acids, ammonia
    • hypoglycemia
    • coagulopathy
    • radiographs
    • ultrasound
    • liver biopsy (beware of coagulopathies, run clotting profile prior to biopsy)
  32. How do we treat acute toxin induced liver disease?
    • antidotes if available
    • induce vomiting
    • activated charcoal PO
    • supportive therapy - aggressive fluid therapy, glucose, vitamin K, antacids, antibiotics, nutritional support
  33. What drugs can cause chronic toxin induced liver disease?  (don't need to memorize the whole list)
    • anticonvulsants
    • glucocorticoids
    • diethylcarbamazine
    • methimazole
    • antifungals
    • NSAIDs
  34. What are the clinical signs of chronic toxin induced liver disease?
    • same as acute but happening over a longer period of time
    • vomiting, diarrhea, constipation
    • PU/PD
    • jaundice
    • melena, hematuria
    • CNS signs
  35. How do we diagnose chronic toxin induced liver disease?
    • history of long term drug use
    • increased ALT, ALKP, bile acids
    • decreased albumin, cholesterol
    • liver biopsy
  36. How do we treat chronic toxin induced liver disease?
    • stop administering the drug
    • low protein diet
    • supportive therapy
    • antibiotics if needed
    • feeding tube if needed
  37. What is infectious canine hepatitis?
    canine andenovirus 1 - hepatic necrosis in dogs
  38. How do dogs get infectious canine hepatitis?
    • oronasal transmission
    • virus replicates in the tonsils and lymph nodes
    • localized in the liver
  39. What are the clinical signs of infectious canine hepatitis?
    • usually in dogs under 1 year old
    • fever over 103
    • petechial hemorrhages
    • hepatomegaly
    • corneal opacities in blue eyes
  40. How do we diagnose infectious canine hepatitis?
    • CBC - will see thrombocytopenia
    • increased ALT
    • serum titer increased and going higher
  41. How do we treat infectious canine hepatitis?
    • supportive therapy
    • force feeding
    • blood transfusion
  42. What is cholangiohepatitis and which animal is most common in?
    • bile duct and liver inflammation
    • common hepatobiliary disorder in middle age to older cats
  43. What do we commonly see with cholangiohepatitis?
    pancreatitis
  44. What are the clinical signs of cholangiohepatitis?
    • vomiting, diarrhea
    • anorexia, weight loss
    • fever
    • icterus
    • hepatomegaly
    • many patients present in end-stage disease
  45. How do we diagnose cholangiohepatitis?
    • increased ALT, ALKP
    • normal to increased bile acids
    • hypoalbuminemia
    • late stage - decreased BUN
    • radiographs - will see hepatomegaly
    • liver biopsy is a definitive diagnosis
  46. How do we treat cholangiohepatitis?
    • long term antibiotics
    • ursodeoxycholic acid
    • prednisone
    • fluids
    • nutritional support
    • vitamin therapy
  47. What kind of client education do we need to provide about cholangiohepatitis?
    • prognosis variable
    • treatment may be prolonged
    • may be permanent liver damage
    • repeat biopsy to assess response
  48. What is the most common hepatopathy in cats?
    hepatic lipidosis
  49. What is thought to be a trigger of hepatic lipidosis?
    stress in adult, obese cats
  50. What is hepatic lipidosis?
    accumulation of fat within the hepatocytes
  51. What does hepatic lipidosis result in?
    hepatic failure
  52. What can hepatic lipidosis be caused by?
    prolonged caloric restriction in obese cats
  53. Do we know the exact cause of hepatic lipidosis?
    no
  54. What are the clinical signs of hepatic lipidosis?
    • anorexia
    • obesity, weight loss of more than 25% of body weight
    • depression
    • icterus
    • hepatomegaly
    • salivation
    • concurrent pancreatitis
  55. How do we diagnose hepatic lipidosis?
    • increased ALT, ALKP, bilirubin, bile acids
    • hypoalbuminemia
    • radiographs - will see mild hepatomegaly
    • ultrasound
    • liver biopsy is a definitive diagnosis
  56. How do we treat hepatic lipidosis?
    • often reversible
    • fluid and electrolyte therapy
    • aggressive nutritional support (parenteral nutrition, nasogastric/gastrotomy tube, force feed)
    • high protein, caloric dense diet
    • six feeding per day until the stomach adjusts to food and then decrease to three feedings per day
    • antiemetics
    • diazepam, metoclopramide to stimulate appetite
    • when the cat is eating well on its own, pull the feeding tube
  57. What kind of client education do we need to provide about hepatic lipidosis?
    • prevent obesity
    • avoid stress in obese cats
    • early intervention is best
    • cats do not do well with frequent diet changes
    • cure rate is 60 - 65%
  58. How do portosystemic shunts work?
    • vascular communication between the portal and systemic circulation
    • blood bypasses the liver
    • blood that carries toxins from the GI tract will bypass the liver and not be detoxified
  59. What does the liver look like in portosystemic shunts?
    liver is small and atrophied
  60. What are the two different types of portosystemic shunts?
    • intrahepatic
    • extrahepatic
  61. When do clinical signs of a portosystemic shunt usually show up?
    by 6 months of age
  62. What are the clinical signs of a portosystemic shunt?
    • behavior change
    • depression, stupor, coma
    • blindness, seizures
    • head pressing, circling, pacing
    • poor body stature
    • underweight, retarded growth
    • neurologic changes are due to systemic toxins
    • hepatic encephalopathy
    • may be worse after a high protein meal
  63. How do we diagnose a portosystemic shunt?
    • low serum proteins
    • increased liver enzymes
    • decreased BUN
    • increased bile acids
    • hyperammonemia
    • radiographs (will see small liver, portography to see the shunt)
    • rectal scintography
  64. What is a rectal scintography?
    • radioactive material is placed in the colon
    • crosses the mucosa into the portal circulation
    • quantify the amount of blood shunting away from the liver
  65. How do we treat a portosystemic shunt?
    • surgical ligation
    • medical therapy - lactulose, oral antibiotics, dietary modifications, high quality proteins, increase dietary fiber
  66. What is the prognosis for a portosystemic shunt?
    • some patients have a normal life expectancy
    • normal hepatic function may not return even with surgery
    • prognosis is highly variable without surgery
  67. What are the two functions of the pancreas?
    • exocrine
    • endocrine
  68. What are the endocrine functions of the pancreas?
    • insulin:  causes glucose in blood to be absorbed into body cells and lowers blood glucose
    • glucagon:  opposite effect to insulin - raises blood glucose
  69. What are the exocrine functions of the pancreas?
    • secretes digestive enzymes into the duodenum (amylase, lipase, protease)
    • secretes bicarbonate to neutralize stomach acid
  70. Amylase and lipase leak from the _____ into the _____ and are cleared by the _____.
    • pancreas
    • bloodstream
    • kidneys
  71. What are pancreatic enzymes used for?
    to measure pancreatic health
  72. What are some common problems with the pancreas?
    • pancreatitis
    • exocrine pancreatic insufficiency
    • inflammation of the pancreas (acute or chronic)
    • pancreatic autodigestion
    • inflammation causing tissue damage in multisystemic involvement which often leads to death
  73. What type of animals is pancreatitis more prevalent in?
    obese animals
  74. What kind of diets cause pancreatitis?
    high in fat
  75. What kind of drugs can cause pancreatitis?
    • furosemide
    • azathioprine
    • sulfonamides
    • tetracyclines
    • prednisone
  76. Is pancreatitis predictable?
    no
  77. What is the prognosis of pancreatitis?
    some recover and some die
  78. Is pancreatitis painful?
    yes
  79. What are the clinical signs of pancreatitis?
    • history of fatty meal
    • vomiting
    • depression
    • anorexia
    • dehydration
    • fever
    • abdominal pain (right cranial)
  80. How do we diagnose pancreatitis?
    • no single test is definitive
    • history and physical exam
    • lab tests 
    • ultrasound
    • radiographs may be normal or may have a "ground glass" appearance to right cranial abdomen
  81. What kind of lab results will we get with pancreatitis?
    • increased ALT, ALKP
    • increased bilirubin
    • increased amylase, lipase, but they could be normal
  82. What are the treatment goals with pancreatitis?
    • maintain fluid, electrolyte balance
    • maintain integrity of circulatory system
    • reduce pancreatic secretions
    • relieve pain
    • manage complications
  83. How do we treat pancreatitis?
    • eliminate predisposing factors such as drugs
    • fluids, electrolytes as needed
    • antiemetics
    • NPO for 48 - 96 hours
    • restrict fat when eating again
    • analgesics
    • pancreatic replacement enzymes for 1 - 2 months
    • may reduce drive on pancreas to secrete
    • may reduce pancreatitis induced discomfort
  84. What kind of client education do we need to provide about pancreatitis?
    • most mild cases do well if high fat foods are avoided
    • yorkies are at high risk
    • increased risk of severe pancreatitis:  diabetes mellitus, obesity, cushing's, hypothyroid, GI tract disease, epilepsy
  85. Do cats typically get "classic" pancreatitis?
    no
  86. What are the clinical signs of pancreatitis in cats?
    • vague
    • non-specific
  87. How do we diagnose pancreatitis in cats?
    • ultrasound may be most useful
    • TLI - trypsiniogen-like immunoassay
  88. How do we treat pancreatitis in cats?
    • fluids
    • nutritional support of hepatic lipidosis
    • may be treated with pancreatic enzyme replacement
    • antibiotics
  89. What does EPI stand for?
    exocrine pancreatic insufficiency
  90. What is EPI?
    progressive failure to secrete adequate quantity of digestive enzymes
  91. When do clinical signs occur with EPI?
    occur when 85 - 90% of the secretory capacity of the pancreas is lost
  92. What can EPI be associated with?
    pancreatitis (especially in cats)
  93. What does reduced secretions due to EPI lead to?
    malabsorption
  94. EPI causes a failure of digestion in the _____.
    small intestines
  95. What does EPI affect?
    small intestines mucosa
  96. What are the clinical signs of EPI?
    • occurs under 2 years old
    • predominantly german shepherds
    • BAR
    • history of weight loss, ravenous appetite
    • poor quality hair coat with oily shine on perineum
    • diarrhea
  97. What kind of diarrhea does EPI cause?
    • voluminous, soft, rancid odor
    • semi-formed to cow pie
    • may resolve when fasted or fed a low-fat diet
    • flatulence, borborygmus
    • abdominal discomfort
  98. How do we diagnose EPI?
    • serum TLI - trypsinogen-like immunoassay - most reliable and commonly used
    • sensitive and specific for EPI
    • detects trypsin and trypsinogen
    • levels will be decreased
  99. How do we treat EPI?
    • replace digestive enzymes
    • strict dietary routine
    • low fat, highly digestible food
    • vitamin supplementation
    • antibiotic for bacterial overgrowth - metronidazole
  100. What kind of client education do we need to provide for EPI?
    • monitor body weight weekly
    • EPI may never be adequately controlled
    • life long treatment
    • may fail to regain full body weight though diarrhea and polyphagia is resolved
    • enzyme treatment (may be expensive and must be given with every meal)
  101. What is EPI in cats usually due to and what else may it cause?
    • usually due to pancreatitis
    • may accompany diabetes mellitus
  102. How do we treat EPI in cats?
    • pancreatic enzyme replacement
    • antibiotics for bacterial overgrowth on intestines 
    • life long therapy

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