Chapter 2
description
Transcript of Chapter 2
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Diseases of Digestive SystemOral cavityEsophagusStomach
Small BowelLarge Bowel
LiverPancreasRectumAnus
Chapter 2
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ADVERSITY
“Adversity causes some men to break, others to break records.”
-William A. Ward
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Diseases of SI
Often involves impairment of absorptive surface of SI (what is that?)
Acute Diarrhea—one of the ____________________ seen types of diarrhea
Causes—(often accompanies acute gastritis)Diet changeStressful situationsDrug therapy
Signs (Duh?)
__________ onset± vomitingNormal appearance otherwise
DxFecal to r/o parasitesCBC (dehydration), Chem panel to r/o metabolic diseases
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Acute Diarrhea
RxFluids for dehydration, electrolyte imbalance (SQ, IV, PO)NPO x 24 h; water OK if no vomitingIntestinal absorbants/coating agents Loperamide—opiod receptor inhibitor that slows gut motilityAntibiotics (?)Bland diet after 24 h
Hills I/DBoiled chicken/rice
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Parasite Diarrhea
SignsDiarrhea___________Poor hair coatListlessness
Dx___________Tx
Anthelmintics for parasites: Fenbendazole/pyrantelAntiprotozoal medication for Giardia, Coccidia
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Giardia
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Viral Diarrhea
ParvovirusCanine distemper virusCoronavirusFeline panleukopenia virus
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Parvovirus
Seen mainly in young, ________ puppies Signs
Diarrhea, usually with bloodVomitingFebrileAnorexia, depression
Dx— _____________(enzyme-linked immunosorbent assay) testRx
IV fluidsAntidiarrheal therapyAntibiotics (Gram neg)Keep warm___________________
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Parvovirus (coyote, cats)
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Parvovirus
Client infoSick animals will infect other unprotected animalsParvo can be fatalVaccinate for protection
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Diseases of LI
Function is to________________, electrolytes; store feces
Inflammatory Bowel Disease (IBD)Signs
Diarrhea with wt loss↑ frequency of defecations, ↓ volumeTenesmus↑ mucus
DxFecal to r/o parasitesChem panel to r/o metabolic causesBiopsy of LI wall
• ↑ __________________________________
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Inflammatory Bowel Disease
Rx ________________ —a sulfa drug with anti-inflammatory effects
Most effective against colitis
Prednisone ______________, Tylosin Mesalamine—a metabolite of Sulfasalazine in LI (actions unknown) Hypoallergenic diet
Hill’s d/d, z/d, i/dHomemade diets
Client info Treatment is often prolonged Goal of Rx is to control symptoms, _________________ Animals with IBD need to be taken outside frequently for BM’s
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IntussusceptionCause usually unknown; can result from parasites, FB, infection,
neoplasiaSigns
Vom/diarrhea with or without blood Anorexia, depression
Dx Palpation of ______________ in cranial abdomen
Rx Surgical reduction/resection of necrotic bowel Restore fluid/electrolyte balance Restrict solid food x 24 h after Sx; then bland diet
x 10-24 dClient info
Recurrence is infrequent Px depends on amt of ____________ removed Puppies should be treated for parasites to prevent
intussusception
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Intussuception
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MegacolonUncommon in dogs, more common in ____________ (mostly idiopathic)
Associated with Obstipation (intestinal obstruction, severe constipation)
SignsStraining to defecate
Must be distinguished from straining to __________ in male cats
vomitingWeakness, dehydration, anorexiaSmall, hard feces or liquid feces
With or without blood, mucus
Greater than length of lumbar vertebrae
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Megacolon
DxPalpation of distended colon filled with hard, dry fecesRadiographs show colon ______________________Rectal palpation assures adequate pelvic opening
RxWarm water enema
Animals can become hypothermic
Manual removal under anesthesiaMucosal surface is delicate
Client infoEncourage water intake
• Salt food• Always provide adequate supply
High-fiber diet
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Megacolon
Surgical removal
Suture ends at arrows
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Liver DiseasesHigh regenerative capacity; damage must be
severe for signs to appear
Vague signs early: anorexia, vom/diar, wt loss, PU/PD, fever
Drug/Toxin induced Liver DiseaseAcute liver failure requires
__________ of liver to be affectedSusceptible to toxin ingestion
(portal circulation)Some drugs have a Hx of liver
toxicity_____________________________Phenobarbitalothers
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Drug/Toxin Induced Liver Disease
SignsAcute onsetAnorexiavomiting/, diarrhea/constipationPU/PD_________________ (maybe)Melena, hematuria, or both_________signs (depression,
ataxia, dementia, coma, seizures)
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DxHx of drug administrationPainful liver on palpationChem panel
↑ ______________(alanine aminotransferase)↑ Total bilirubin, ↑ blood ammonia↑ Serum bile acidsHypoglycemia, _________________________
Radiographs show enlarged liverLiver biopsy (unless coagulopathy suspected)
Drug/Toxin Induced Liver Disease
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RxAntidotesInduce vomiting_______________________IV fluidsVit K for clottingAntibioticsSpecial diets (Hill’s k/d or u/d)
Drug/Toxin Induced Liver Disease
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Liver TumorsPrimary and metastatic tumors are not uncommon in dogs
and catsMetastatic tumors are ___________than primary tumors
of liverSigns
Anorexia, lethargy, wt lossPU/PDVomiting/diarrhea (?)Abdominal distension, hepatomegalyJaundice
DxAnemia, usually _________________Chem Panel
↓ serum albumin↑ serum bilirubin, bile acids↓ serum glucoseAzotemia (↑ BUN, creatinine; esp in cats)
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Liver tumors
DxX-ray: Heptomegaly, Ascites (?)________________ of liverAbdominocentesis may show tumor cells
RxSurgical removal is preferred treatment
Single masses have good PxMultiple nodules/Diffuse disease have poor Px
Chemotherapy doesn’t help primary tumors; better for metastatic lesions
Client infoGuarded to poor Px generallySurvival time: ___________________
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Portosystemic Shunts
Shunts form between portal circ and systemic circ allowing blood to bypass liver; Function of liver—detox blood
Congenital or acquired
By-passing liver, allows many toxins into systemic circulation___________ is most affected by the circulating toxins
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Portosystemic Shunts
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SignsDumb/numb, lethargic, depressedAtaxia, staggering_________________ (against a wall)Compulsive circling, apparent blindnessSeizures, comaBizarre behavior (esp cats)Signs often more pronounced shortly_____________
Portosystemic Shunts
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DxChem panel
↓ serum protein, albumin (liver is usually small)↓ BUN (liver converts ammonia → urea)↑ ALT (alanine aminotransferase), ALP (alkaline phosphatase)↑ blood ammonia (from protein)
X-raysSmall liverContrast material
• Inject into ______________
• By-passes liver
Portosystemic Shunts
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RxMedical management seldom very successful
Low protein diet
SxLigation of shunt
• Total ligation often causes ↑ liver BP
• ______________ may be more practical
• A second Sx can be performed after few months to close off shunt totally
Client infoPx often very good following ligationFor best results, Sx should be performed before 1 y old_______________ may develop, with relapse of signs
Portosystemic Shunts
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Feline Hepatic Lipidosis
Idiopathic (IHL) – cause unknownMost common hepatopathy in cats_____________ of any age, sex or breedStress may trigger anorexia
Diet change, BoardingIllness, Environmental change
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IHL
Anorexia prolonged for 2 weeks causes __________ between breakdown of peripheral lipids and lipid clearance within liverLipids accumulate in liver
Other mechanisms proposedEarly diagnosis and aggressive treatment
important60-65% of cases => complete recovery
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IHL
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IHL
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IHL
Clinical SignsAnorexiaObesityWt loss (as much as 25% of body weight)DepressionSporadic vomiting__________________Mild hepatomegaly+/- coagulopathies
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IHL
DiagnosisCBC –_________________ , stress neutrophilia,
lymphopeniaBiochem panel – Increased ALP, ALT, bilirubin,
Low albumin, Increase serum bile acidsX-rays – mild hepatomegalyUS liver hyperechoicLiver biopsy – severely vacuolized hepatocytes
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IHL
TreatmentHigh protein, calorie dense dietFeeding tube usually required
NG tube for short term liquid
dietsGastrostomy tube bestEsophagostomy tube
Tubes can remain in placeFor up to _____________
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IHL
TreatmentIV fluids__________________ SQ 15 min prior to feedingMonitor weekly
CEAvoid stress in obese catsEarly intervention is essentialAny cat that stops eating is at riskCats do not respond well to _______________________
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Pancreatic Dysfunction (Exocrine)
Main function of Exocrine Pancreas → secretion of ___________________
Located along duodenumDig enzymes secreted in an inactive form to protect
pancreas tissue
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Pancreatitis—Inflammation of pancreasMay be chronic or acute
Develops when dig enzymes are activated within gland → ______________More common in obese animal; _________________ may predispose animal to itUnpredictable results; some recover well, others worsen and die
SignsOlder, obese dog or cat with Hx of recent high-fat mealDepression, anorexia, ______________± abdominal painShock, collapse may developDiarrheaOften seen post-holiday
• Table scraps of ham, gravy, etc
Pancreatic Dysfunction (Exocrine)
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PancreatitisDx
CBC, Chem panelLeukocytosis↑ PCV (means what?)Hyperlipidemia↑ serum amylase, lipase_____________________
RxIV fluids, electrolytesNPO 3-4 dAntibiotics__________________ for painStart back on low fat diet 1-2 d after vom stops
Client infoAvoid obesity/overfeedingFeed low-fat treatsPx is difficult to assess
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Exocrine Pancreatic Insufficiency
The pancreas stops making dig enzymes
May occur spontaneously (G Shep) or due to chronic pancreatitis (cats)
SignsWt lossPolyphagia_________________, picaDiarrhea, fatty stoolFlatulence
DxNormal CBC↓ total lipids
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RxSupplement pancreatic enzymes with each meal
Pancrezyme_____________________
Low fiber diet
Client infoEPI is__________________; life-long treatmentPancreatic enzyme replacement is expensiveWith enzyme replacement, dog will regain weight, diarrhea
will stopMust be given with every meal
Exocrine Pancreatic Insufficiency
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Perineal Hernia
Intact male dogs; atrophy of levator ani muscle; rectum herniates
Signs____________ perianal swellingTenesmus (feeling of full colon)Dyschezia (difficult defecation)Urethral obstruction
If bladder is herniated
DxRectal palpation reveals hernia sac
Intact male dogs > 8 yrs
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RxStool softeners (Colace)EnemasSurgical repair: Herniorrhaphy
Castration
Client infoKeeping stool soft may help reduce straining
True for all dogs
_______________ recommended testosterone is suspected as a predisposing factor
Perineal Hernia
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Perianal FistulaExact etiology unknown; thought to start as an inflammation of _______,
_____________ glands around anus
Bacteria grow well in the moist, warm region of these glands
Infection invades into deeper tissues
Most commonly affects __________________ (84% of dogs diagnosed)
Signs Intact male, older (>8 y) Tenesmus Dyschezia, pain on exam Fecal incontinence Bleeding, foul odor of perianal area
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Dx—PE to r/o anal sac disease/perirectal tumor Rx
Medical—usually not successfulClip hair, keep cleanFlush with salineAntibiotics
Surgical—________________ because of nerves/blood vesselsRemove infected tissueCryosurgeryLaser surgeryCautery
Client infoPainful—be cautious of bitingmany complications of Sx
• _____________________
• Anal stenosis
Perianal Fistula
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Perianal Gland AdenomaSigns
Intact male, older Single or multiple masses that may ulcerate
______________________________________
Pruritis in anal area Bleeding Firm nodules in perianal skin
Dx—PE, biopsyRx
Surgical removal Radiation Cryosurgery Castration—causes regression of tumors
Client info Gently cleanse area daily with baby wipes Castration at early age helps prevent it