Clin Med - GI Intro 3

drraythe's version from 2016-03-14 20:41


Question Answer
What does IBD stand for?Inflammatory Bowel Dz (INFLAMMATORY, not IRRITABLE, irritable is in ppl)
If you give an animal lactulose, what is the consistency you want their feces at to know you gave them a good dose?"Soft serve ice cream" consistency
List of the pathophysiology (of diarrhea)/ things that can happen in the intestinesLuminal disturbances
Villous atrophy
Enterocyte dysfxn
Microvillar membrane dmg
Brush border membrane dz
Mucosal barrier disruption
Mucosal inflammation
Nutrient delivery blockade
What are the 4 mechanisms of diarrhea? (Technically 5th too)(1) OSMOTIC
(5) Mixed - which is any combo of the 1st 4)
Explain the osmotic mechanism of diarrhea. What might this happen due to?This happens when there is a ↓ in solute absorption in the sm intestines. This is most often due to DIET changes bc it results in unabsorbed nutrients in the lumen. This type of mechanism can also be used to the doctors advantage as a Tx (for constipation), if the PTx is given lactulose
Explain the secretory mechanism of diarrhea...what usually czs it? Who is this form more common in?In secretory, the diarrhea is czd by the hyper-secretion of ions. It is usually due to TOXINS (bacterial or chemical), but it can also be due to intestinal inflammation, or DSS (chemical, dextran sulfate sodium). This form of diarrhea is RARE in small animals...more common in large animals
Explain the dysmotility mechanism of diarrhea-what are the different types of this mechanism? (Many)There is 1° dysmotility, but this is very rare. There is also hypermotility but this is rare also. Another form is HYPOMOTILITY (aka ileus, which is much more common). 2° dysmotility is much more common & is usually czd by things like drugs, hyperthyroidism & Exterotoxigenic (I think this is supposed to be enterotoxigenc). Also consider the type of motility which might be impaired-peristalsis vs segmental.
Explain the exudative mechanism of diarrheaThere is ↑ permeability/ damage to the mucosal barrier & there might be leakage of blood or proteins into to the lumen.
What are the possible clinical manifestations of various intestinal disorders? (As discussed in mechanisms)Diarrhea/Constipation
Weight loss
Abdominal pain
Tenesmus (straining)
What are the ways you can classify diarrhea in temporal terms?Chronic, Acute or Intermittent Chronic
What are the ways you can classify diarrhea in terms of severity?Self-limiting
Potentially fatal
Systemic dz
**(Most important) What are the ways you can classify diarrhea in terms of location?Small intestinal vs. Large intestinal or diffuse
Acute diarrhea R/Os → acute enteritis: What are the major 3 czs of acute enteritis? Give examples(1) Dietary - Allergies/changes/ Indiscretion
(2) Parasites - Helminths, Protozoa (Giardia, Tritrichomonas, Coccidia)
(3) Infectious dz - Parvo, Corona, FeLV/FIV, Bacterial overgrowth, Rickettsia
What are the 3 main r/o categories for ACUTE diarrhea?(1) Acute enteritis (see other card for specifics on this)
(2) Intussusception
(3) hypoadrenocortisism
What is the difference btwn how Corona & parvo virus cz diarrhea?Corona attacks the tips of the villi, whereas parvo attacks the crypts of the villi
What are 2 fungal dzs which can cz CHRONIC diarrhea?Pythiosis, Histoplasma
What lymphatic disorder can cz chronic diarrhea?Lymphangectasia (pathologic dilation of lymph vessels)
Which breeds have breed-specific enteropathies?Basenji
Shar Pei
What are 7 big systemic dzs which can cz a chronic diarrhea?Pancreatitis
Hepatic Dz
Renal Dz
What are 4 malabsorptive dzs which can lead to a chronic diarrhea?(1) ARE-antibiotic responsive enteropathy
(2) SIBO-small intestinal bacterial overgrowth
(3) Dietary
(4) IBD
What is the malDIGESTIVE (not malabsorptive) dz which can cz chronic diarrhea in dogs?EPI!! Exocrine pancreas insufficiency
Lots of fiber can cz what kinda diarrhea?Chronic LARGE INTESTINAL diarrhea
Which parasites can cz CHRONIC LARGE INT diarrhea?Giardia, whips
Which bacteria can cz CHRONIC LARGE INT diarrhea?Clostridium
Which dz often occurs in boxers & frenchies & which can cz CHRONIC LARGE INT diarrhea?Histiocytic ulcerative colitis (histiocytic = a tissue macrophage which stays in 1 part of the body, doesnt travel in the blood)
What can dzs can cz chronic large int. diarrhea?FeLV/FIV
**What is the VOLUME of feces like in small bowel diarrhea? Large?Small = A LOT, very very very ↑
Large = Normal to ↑
**Which type of diarrhea (small or large bowel) usually has mucus present?Small = Rarely present
Large = Frequently present
**Which type of diarrhea (small or large bowel) usually has melena?Small = May be present
Large = Absent
**Which type of diarrhea (sm or lg bowel) usually has hematochezia?Small = Absent
Large = Common
**Which type of diarrhea (sm or lg bowel) usually has Steatorrhea?(Steatorrhea = fat in feces)
Small = Present
Large = Absent
**Which type of diarrhea (sm or lg bowel) usually has undigested food?Small = May be present
Large = Absent
**Which type of diarrhea (sm or lg bowel) usually has different color?Small = Color can be variable
Large = Usually normal color
**Which type of diarrhea (sm or lg bowel) usually czs urgency for defecation?Small = Rare
Large = Usually present
**Which type of diarrhea (sm or lg bowel) usually czs tenesmus?(Tenesmus = straining)
Small = Absent
Large = Frequent
**What is the FREQUENCY of defecation for small bowel diarrhea? Large?Small = 3x is normal
Large = >3xs is normal
What is Dyschezia?Painful defecation
**Which type of diarrhea (sm or lg bowel) usually has dyschezia as a symptom?(Dyschezia = painful defecation)
Small = Absent
Large = Present
**Which type of diarrhea (sm or lg bowel) is usually accompanied w/ weight loss?Small = Weight loss usually present
Large = Rare
**Which type of diarrhea (sm or lg bowel) is usually accompanied w/ flatulence?Small = Possible
Large = Absent
**Which type of diarrhea (sm or lg bowel) is usually accompanied w/ halitosis?Small = Present
Large = Absent
If a PTx has diarrhea, what kinda questions are you gonna wanna ask about its Hx?Indoor/outdoor?
Vx & deworming status?
Access to garbage?
Travel Hx?
Previous episodes?
Diet/changes in diet?
Duration? Severity?
Response to previous therapy?
What are the 4 main parts of the minimum database you're gonna wanna collect on a dog w/ diarrhea?(1) Complete physical exam
(2) Observation of defecation attempts
(3) Fecal evaluation
For your complete physical exam for the minimum database for your diarrhea workup, what 3 things must you especially remember to do?(1) RECTAL & ORAL EXAM! **esp dont forget to look under the tongue
(2) CAREFUL abdominal palpations (look for thickened bowel loops, masses, effusions, pain)
What are some reasons you'd want to observe the animal's defection attempts when it has diarrhea?To look for Dyschezia, tenesmus & evaluate the fresh feces
When doing a fecal evaluation, what are some observations you can make about the feces before starting to run tests on them?You can look at color, consistency, odor (might indicate something about malabsorption), blood, steatorrhea
What might odor tell you about the diarrhea?It might clue you in for malabsorption, depending.
Steatorrhea might indicate what?Malabsorption, such as EPI or lymphagectasia
Fecal evaluation → what tests might you want to run?Fecal flotation
Maybe culture
Maybe look for Parvo
Do a α-protease-inhibition
What are 3 different types of fecal flotations you can do?Sheathers
Zinc sulfate
Giardia Ag
Baermann (good for larvae-A fecal sample is suspended in water in the bowl of the glass for a period of at least 8 hours, giving larvae in the sample an opportunity to move out of the feces & into the water through random movement. The larvae are unable to swim & fall to the bottom of the hollow stem of the glass where they can be collected & examined microscopically)
What are 2 types of cytology you can do w/ your fecal evaluation?A direct smear OR you can do a rectal scraping
If you are doing a fecal smear, how much diversity of "bugs" are you expecting?There should be lots of different types!! If there is only 1 predominant type, then you can basically dx on the smear alone
If you see spore-forming rod shaped bacteria on your fecal smear, what do you think?CLOSTRIDIAL OVERGROWTH! There’s your problem!
Why would you look for albumin & globulin levels in your CBC/chem/etc tests for diarrhea?If low, might have a protein-losing enteropathy
What acid/base & electrolyte imbalances can result from diarrhea which you should check w/ your CBC/chem etc?Diarrhea czs a lot of loss of bicarbonate & sodium, which results in a metabolic acidosis & then this czs HYPERkalemia!
Additional diagnostics → Abdominal Radiographs → what are some things you'd wanna look for if you decided to do rads?FB, masses/effect
Free fluid/gas
Ileus (barium contrast radiography is another option)
Additional diagnostics → Abdominal Ultrasound → what can you look for or DO when you decide to do an abdominal ultrasound?Wall layers
are some things you can look for. Ultrasound can also help guide for FNA (fine needle aspirate) & BIOPSY (biopsy)
Additional tests → GI PANEL! What are the 4 things a GI panel looks at closely?(1) PLI
(2) TLI
(3) Cobalamin
(4) Folate
What can cobalamin levels tell you about the diarrhea?Cobalamin can be ↓ w/ malabsorpitve dzs
What can folate levels tell you about the diarrhea?Folate ↑ w/ intestinal bacterial overgrowth (*bc BACTERIA PRODUCE FOLATE)
What are some pros/cons to endoscopy as a tool for assessing diarrhea?PROS: Minimally invasive, can eval. Mucosa, Home sooner/ Less expensive, Directed biopsies & can initiate some therapies sooner. Great for Gastric, duodenal & colonic observation & mucosal biopsy
CONS: Limited for most of the SI (anatomically, wall layers), may have to proceed to Sx anyway
What are some pros & cons to Sx as a tool for assessing diarrhea?PROS: Biopsy of more sites, Full thickness biopsy, Evaluate all abdominal organs, Potential for correction (eg obstructions)
CONS: Risk of dehiscence, Longer recovery time, more expensive
What can TLI tell us about diarrhea?Might indicate if the diarrhea is due to EPI