Small Ani. Med 2- Intestinal Dzs 2

wilsbach's version from 2016-02-27 19:31

bloating/gas ctd

Question Answer
Gastric stasis: Vomiting food more than ___ hours after eating12
Gastric stasis-- what are possible Electrolyte imbalances which can cause this?Na/K, Ca imbalances (affect nn and mm)
why do you want to check Urea/creatinine in a bloat pt? Uremia can lead to gastric stasis
what endocrine derangement can lead to gastric stasis?Hypothyroidism-- check T4/TSH (hypothyroidism leads to mm weakness/ dec in overall metabolic rate)
why would you want to check NH3 / bile acids in gastric stasis?these might indicate hepatic encephalopathy which would affect gastric motility
what drugs might cause gastric stasis?Anticholinergic drugs and narcotic analgesics
how can you dx outflow obstruction? (2)(1) Survey abdominal radiographs (look for radiopaque foreign body , gastric distension with food) (2) Exploratory laparotomy & biopsies
why do we give Erythromycin in gastric motility issues? what should you NOT give it with and why? what are some downsides to it?Motilin receptor agonist (inc motility). NOT concurrently with cisapride! (will cause an arrhythmia) Downsides: tachyphylaxis (aka less effective over time) and it is often CHERRY flavored (vomiting in animals)
Simethicone--> what do we use this for, when should you NOT use this? orally administered anti-foaming agent used to reduce bloating, discomfort or pain caused by excessive gas. Avoid in renal failure !!!
what are carminatives?herb or preparation intended to either prevent formation of gas in the gastrointestinal tract or facilitate the expulsion of said gas, thereby combatting flatulence. (ex: simethione)
what are common comorbidities of flatus in cats?chronic diarrhea or vomiting, abdominal distention, chronic idiopathic GI problems
what contributes MOST to GI tract gasAerophagia (air to flatus within 15 to 30 min)
4 risk factors for aerophagia?(1) Brachycephalic breeds (2) Vigorous exercise (3) Rapid & competitive eating (4) elevated feeding
Increased gas ≠ odoriferous gasyep
what are 3 Dietary substances which can inc gas?(1) Soluble fiber (Legumes, oats, prune, bananas, apples, broccoli, carrots, potatoes, psyllium) (2) Protein (sulfuramino acids) (3) Indigestible oligosaccharides
what are two endogenous substances which increase gas?Mucin & Bile acids
what is the component of gas which causes odor?Hydrogen sulfide
what are the two goals of Dietary management to try to dec gas?decrease bacterial fermentation, reduce aerophagia
what is the dietary carb which causes the least amount of flatulence?rice
Decreasing bacterial fermentation--> what changes should you make?Change to highly digestible food, Change protein and carbohydrate sources, Reduce dietary protein, consider rice (least gas-causing carb), Eliminate supplements, Eliminate sources of lactose, Avoid ingredients known to enhance flatulence
what are some methods for Reduce aerophagia?Feed several small meals per day, Eliminate competitive eating, Feed mixture moist + dry food, Surgical correction (brachycephalic breeds), Avoid strenuous exercise
what can you do after meals to help reduce flatus?Walk dog after meals
avoid which carminative in cats?bismuth subsalicylate
Carminatives (gas reducing agents) (9)(1) Simethicone (2) Bismuth subsalicylate (not in cats) (3) Activated charcoal (4) Zinc acetate (5) Yucca schidigera preparations (6) pancreatic enzymes (7) α-galactosidase (Beano) (8) probiotics (9) Nonabsorbable antibiotics
Summary plan for controlling flatus has what 6 things?(1) Control aerophagia (2) Decrease intestinal gas production (3) Decrease noxious gas substrates (4) Increase activity/exercise level / avoid stress (5) Evaluate for chronic GI disease (6) Consider carminatives
what is Irritable bowel syndrome?Recurrent, acute episodes of abdominal pain ,+ borborygmi +/- diarrhea
what are possible etiological causes of irritable bowel syndrome?Primary motility disorders, Visceral hyperalgesia (abnormally heightened sensitivity to pain), Psychosomatic disorders, Undiagnosed food intolerance, Undiagnosed inflammatory disease
what are the 6 main components of a therapy plan for irritable bowel syndrome?antispasmodics, anticholinergics, smooth-muscle relaxants, Anxiolytics, dietary modification (low fat, high/low fiber), Central analgesics
IBS-- what is an antispasmodic agent youd consider?Loperamide=opiate agonist, decreases peristaltic activity and inhibits secretion
IBS-- what is an anticholinergic youd consider?Hyoscine butylbromide= buscopan
IBS-- what is a smooth-muscle relaxant youd consider?mebeverine
IBS-- how might you want to modify their diet?low fat, high fiber (perhaps low fiber)
IBS-- what are Central analgesics you might consider to tx the visceral pain?tricyclic antidepressants, 5-HT 3 antagonists (Ondansetron)

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