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GI Part 1

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sihirlifil's version from 2018-02-03 00:57

Intro

Question Answer
Patients with GI signs: 2 most important things to differentiate?1: Extra vs intra- GI causes
2: Need inpatient or outpatient care?
If GI signs are from GI cause: what is the third important step?Anatomic localization by CS, ddx, diagnostics
What are the GI signs?Dysphagia
Vomiting vs regurg
SI vs LI diarrhea
Vague: weight loss, decreased appetite
Important hx questions:What are the signs?
One or multiple?
Duration? Severity?
Dietary hx/indiscretion
Previous medical history (signalment, other pets +/- similar signs, previous GI signs or illnesses, medications, deworming, travel)
Extra-GI causes of GI signs: regurgitationRespiratory (larynx, upper & lower airway, diaphragm)
Neuromuscular
Toxicities
Extra-GI causes of GI signs: vomitingHepatobiliary
Renal
Pancreatitis
Endocrine (hyperT4, HAC)
Peritonitis/sepsis
Neurologic
CVS
Extra-GI causes of GI signs: diarrheaHepatic
Pancreatitis
EPI
Endocrine
Vascular
Extra-GI causes of GI signs: weight lossWith decreased appetite: everything on previous cards
With INCREASED appetite: DM, hyperT4, EPI
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Oral & Pharyngeal

Question Answer
Presenting complaints include...Abnormal prehension of food
Painful mouth
Coughing
Gagging
Hematemesis
Weight loss
Ptyalism
Halitosis
Abnormal swallowing (multiple attempts, points head up, slurps)
Pt presents with oral signs, what do? (3)Thorough PE
Observe eating/drinking (different consistencies)
Sedated oral/laryngeal exam
Steps of thorough PESymmetry (observe & palpate)
Pain: careful external palpation
Look under tongue
Pterygoid bones
Cranial nerve exam
LN & Salivary gl palpation
(Areas of localization)(Teeth, tongue, salivary glands, LN, hard & soft palate, cheeks, lips, nasopharynx)
Dysphagia: where can the problem be?Getting food to back of mouth
Getting it through upper esophageal sphincter
Structural disease
Functional disease
Painful eating: localizationTooth (tooth root abscess, fracture, resorptive lesions)
Ulceration
TMJ pain
Temporal/masseter muscle pain
Pain in esophagus
Stomach pain (secretion of stomach acid during cephalic phase)
Gagging: 2 extraluminal causes?LN or salivary gl enlargement
Hypersalivation: making more saliva b/c...Pain
Irritation
Space-occupying lesion/FB
Hypersalivation: normal amount of saliva but swallowing prohibited...Physical barrier (mass)
Functional prob
Tongue dz: infectious?Granulomas
Tongue dz: acquired?FB
Tongue dz: developmental?Macroglossia
Tongue dz: inflam?eosinophilic plaques
Tongue dz: Metabolic?Ulcers 2ry to liver/kidney dz
Tongue dz: neoplastic?(she didnt write an e.g. for this one)
Functional dz of the tongue (2)Vascular (thrombus)
Neuromuscular (immune-med, inflam, infx, toxin, metab)
What is macroglossia? how to fix?Developmental/genetic disease, leads to self-trauma
Surgical repair
What is this? how can it happen?
Lingual ulcer
from caustic/electric burns, trauma, liver/kidney dz, infections
How are lingual ulcers treated?Analgesia & nutritional support
You see this in a cat mouth, what is it?
Feline Eosinophilic Granuloma Complex
Ulcers/plaques on lips, hard/soft palate, tongue
Inflammatory but idiopathic (viral underlying cause?)
How are feline eosinophilic granulomas treated?Steroids (intralesional or systemic)
Can be refractory to treatment, recurrence
Is this nasty mass cancer?
NOT NECESSARILY! Mass =/= cancer
Mass = abnormal growth of tissue. Ddx granuloma (inflammatory), benign neoplasia, malignant neoplasia
Malignant neoplasias of the tongue (4)Melanoma
SCC
Ameloblastoma
Fibrosarcoma
Lingual mass diagnosticsThorough PE
FNA of enlarged LNs
Biopsy for definitive dx
Lingual mass: other things you want to do before biopsy?Pre-ANX bloodwork
Chest radiographs
Lingual mass: TxExcisional (biopsy)
Radiation therapy
Chemo/immunotherapy
What do you see with denervation of the tongue?Atrophy
(Tongue denervation ddx)(Neuromusc dz (1y or 2ry), metab, infx, vasc, neo...)
Tx & Prog are etiology dependent
Lingual thrombus associated with which bacteria?Leptospira
Which diseases with hypercoagulability can cause lingual thromus?Severe acute pancreatitis
IMHA
HAC
T/F PLE and PLN can cause this
(lingual thrombus) True
Ways to tx lingual thrombusNutritional support (E-tube or gastric tube)
Learn to eat & drink on own
Thromboprophylaxis
Lingual thrombus: 2 thromboprophylaxis tx?Antiplatelet: clopidogrel, aspirin
Anticoagulant: rivaroxaban, heparin, warfarin
Possible salivary gland problems?Duct obstructed
Infxn/abscess
Neoplasia
Sialocele
Sialadenitis
Which 2 things can obstruct a salivary ductSialolith
Mass
What is a sialocele?Solidified saliva
Salivary gland diagnosticsFNA
+/- CT
Tx for sialocele & obstruction?Sx removal
Tx for salivary gl abscess?Sx drainage, antibx
Tx for sialadenitisPhenobarbital (so random)
(Tx for salivary gl neoplasia)(Depends on type, staging)
Where would you localize this disease?
Salivary gl
Where would you localize this disease?
Salivary gl
Possibly LN problemsInflam, infxn, neoplasia
LN disease diagnosisFNA
Infectious disease testing (other sites of infection... systemic could be tick-borne)
Staging if LSA
Where would you localize this disease?
Lymph node
Ddx for soft/hard palateFB
Abscess
Mass
Inflam (feline eosinophilic complex)
Extension of nasopharyngeal dz
H/S Palate diagnosisSedated oral/pharyngeal exam, +/- FNAs
CT
+/- retrograde rhinoscopy
+/- biopsies
What happened here?
Hard palate FB! stick!
Nasopharyngeal polyp: CS?Stertor, dyspnea
Nasopharyngeal polyp: Tx?Traction via oral cavity
If recurrence --> Ventral Bulla Osteotomy
Nasopharyngeal polyp: common complication?Transient Horner's syndrome
Cheeks/lips/gums: diagnostics for masses?Want to ddx benign vs malignant
BIOPSY
Whats wrong with this cat's mouth? How to tx?
Stomatitis (inflammatory), immune-mediated
FeLV/FIV, Calicivirus<vr>Tx: Steroids, full mouth extraction
What is this? What do you tell the owner?
Papillomavirus
Self-limiting
Is there anything you can do to get rid of papillomas?Can stimulate immune system by crushing a papilloma
Immune suppression can lead to flare up!
Pt presents with temporal and masseter muscle pain, and has trouble opening jaw & eating. His muscles are painful on palpation. Top ddx?
Masticatory Myositis
How to diagnose masticatory myositis?CK elevated
2M titer
CT to r/o other ddx
Biopsy
How to tx masticatory myositisImmunosuppression (Prednisone)
If masticatory muscle myositis progresses to chronic phase, what happens?Fibrosis & muscle atrophy... eventually trismus. Worse prognosis
Dysphagia (pharynx): structural?Masses, abscesses, FB, etc
Dysphagia (pharynx): fxnl?Rabies
Myasthenia gravis
Cricopharyngeal dyssynchrony (Goldens)
Cricopharyngeal achalasia (Min dachsund)
Inherited myopathy (muscular dystrophy) (Bouvier)
#1 Dx test for dysphagiaSedated oral & laryngeal exam to ddx structural vs fxnl disease
Dysphagia: If you can't find a structural problem via sedated oral & laryngeal exam, what next?Evaluate fxn! Barium swallow w/ fluoroscopy, endoscopy
What dis?
Malignant melanoma, causing dysphagia (structural problem ID'd via sedated oral exam)
How do you diagnose cricopharyngeal disease?Exclude other dz & localize to pharynx
Rabies vax hx
AChR Ig titer (r/o myesthenia)
Fluoroscopic swallow study
+/- CK, musc biopsy (r/o myositis)
How to tx myasthenia gravis?Neostigmine, pyridostigmine
Prognosis for focal disease better than acute fulminant MG
How to tx crichopharyngeal achalasia?Crico myotomy (great prog!)
How to tx cricoph. dyssynchronyNone besides symptomatic, nutritional :/ poor prog
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