Term
| What is the most common hepatobilliary disease in cats? |
|
Definition
|
|
Term
| When does lipidosis occur? |
|
Definition
| When accumulation of lipid exceeds the processing and excretion |
|
|
Term
ALT and ALP measure liver function.
True or False? |
|
Definition
FALSE
Liver enzymes do NOT correlate with function |
|
|
Term
All cat that get hepatic lipidosis have a recent history of being obese.
True or False? |
|
Definition
FALSE
Although it is common, not all of them have to have been obese |
|
|
Term
| How do cats with hepatic lipidosis clinically present? |
|
Definition
inappetance
weight loss
loss of muscle
**PTYALISM**
GI signs
Hepatomegaly
Icterus |
|
|
Term
| Why should you preform a PT/PTT BEFORE preforming a liver biopsy? |
|
Definition
| Because the liver makes the coagulation factors, so if it is not functioning properly then there may be difficulties clotting the blood and you may cause a hemoabdomen when preforming a biopsy |
|
|
Term
Ultrasound appearance or histopath of biopsy will confirm a diagnosis of hepatic lipidosis.
True or False? |
|
Definition
FALSE
The apparence of an ultrasound is NOT diagnostic of hepatic lipidosis (not the same as histopath confirmation) |
|
|
Term
| Ultrasound guided biopsy is contraindication with which complications of hepatic lipidosis ? |
|
Definition
| Ascites, coagulopathy, microheptica |
|
|
Term
| What diseases require a larger tissue sample than a needle biopsy? |
|
Definition
Copper storage disease (Copper quantification)
Fibrosis
Cirrhosis
|
|
|
Term
Fine needle aspirate of the liver is most optimal in cases of hepatic lipidosis in an unstable cat.
True or False? |
|
Definition
TRUE
when the animal is unstable FNA is the best option because it does not require general anesthesia |
|
|
Term
| What is the biggest part of treating hepatic lipidosis? |
|
Definition
NUTRITIONAL SUPPORT
-- feeding tubes are the easiest thing -- |
|
|
Term
| What are the requirements for removing a feeding tube when treating hepatic lipidosis? |
|
Definition
Cat must be eating 100% of its calories on its own
maintaining weight for 7 days |
|
|
Term
| Which types feeding tube used in treatment of hepatic lipidosis? |
|
Definition
PEG (Gastrotomy)
Esophagostomy tube
(the nasopharyngeal tube is only for short term, and jejunal is only if there is concurrent disease - like pancreatitis) |
|
|
Term
| What are the main mechanisms that cause peritoneal effusions? |
|
Definition
increased hydrostatic pressure (congestive heart failure)
decreased oncotic pressure
lymphatic obstruction/rupture
increased permeability |
|
|
Term
| Which breeds of dogs are most susceptible to canine hepatitis? |
|
Definition
|
|
Term
| A doberman is presented with suspected canine hepatitis, why should you not preform a FNA to diagnose? |
|
Definition
Because most of the animals presented with clinical signs indicating hepatitis have progressed to cirrhosis!
And when you are testing for cirrhosis you need a larger biopsy sample for diagnosis. |
|
|
Term
| What would cause PU/PD in a case of canine hepatitis? |
|
Definition
LOW BUN being produced by the liver
and renal medullary washout |
|
|
Term
| When presented with a icteric animal, it is best to first identify what is causing it. What is the easiest way to determine if it is prehepatic? |
|
Definition
determine if anemic
check for spherocytes
autoagglutination
-- if positive go to hemolytic disease (not hepatic) |
|
|
Term
| What are the three steps in clinical approach to icterus? |
|
Definition
1. PCV/TS/slide agglutination/smear
(rule out pre-heptic hemolysis)
2. abdominal imaging
(rule out post hepatic obstruction)
3. continue hepatic dz work up - intrahepatic cholestasis |
|
|
Term
| What are the top 3 feline hepatic differentials? |
|
Definition
Lipidosis
cholangiohepatitis
Neoplasia |
|
|
Term
Bile acids are not useful in testing hepatic function in an icteric patient.
True or False? |
|
Definition
TRUE
if an animal icteric there is already hepatic dysfunction - so it has already failed the bile acid test |
|
|
Term
Animals with resolved esophageal strictures typically have a good prognosis.
True or false? |
|
Definition
|
|
Term
| What are the three locations for esophageal foreign bodies to get lodged? |
|
Definition
1) thoracic inlet
2) base of heart
3) diaphragmatic inlet |
|
|
Term
| Which type of congenital megaesopagus is more common: acquired or idiopathic? |
|
Definition
|
|
Term
| What are the therapies for treating megaesophagus? |
|
Definition
Elevated feeding
Small frequent meals
bulky vs gruel food
tx of aspiration pneumonia
tx of myasthenia gravis |
|
|
Term
| What is the difference in composition between the cat and dog esophagus? |
|
Definition
Dogs = all striated muscle
Cats = striated muscle, distal 1/3 smooth muscle |
|
|
Term
| What are the primary causes of esophagitis? |
|
Definition
FOREIGN BODIES
GASTROESOPHAGEAL REFLUX** most common**
ingestion of chemical irritants
acute, persistant vomiting |
|
|
Term
| What are some causes of gastroesophageal reflux? |
|
Definition
anesthesia
hiatal hernia
use of anticholinergic drugs |
|
|
Term
| What are the primary locations of foreign body obstruction in the esophagus? |
|
Definition
BASE OF THE HEART (most common)
Thoracic inlet
esophageal hiatus |
|
|
Term
| What is the treatment protocol for esophageal foreign body? |
|
Definition
EMERGENCY SITUATION
Removal of foreign body
(surgical or endoscopic)
assessment of esophageal damage
soft diet
abx if perforation |
|
|
Term
| What is the esophageal parasite that has been found primarily in the tropics and subtropics, but also kansas and Canada? |
|
Definition
|
|
Term
| What is the treatment strategy for esophageal strictures? |
|
Definition
BALLOON catheter
soft diet
H2 blockers or omeprazole
corticosteroids to reduce fibrosis
*surgical resection is a last resort* |
|
|
Term
| What is the most common congenital esophageal defect in both dogs AND cats? |
|
Definition
| Persistant Right Aortic Arch (PRAA) |
|
|
Term
| What creates the vascular ring in PRAA (persistant right aortic arch)? |
|
Definition
Ligamentum arteriosum
pulmonary artery
aorta
base of heart |
|
|
Term
What two conditions are associated with regurgitation and gurgling when breathing?
What is the radiographic difference between the two? |
|
Definition
PRAA (persistant right aortic arch)
- will have esophagus dilated anterior to base of heart
Megaesophagus
- entire esophagus dilated |
|
|
Term
What is megaesophagus?
What causes it? |
|
Definition
It is esophageal dilation associated with hypomotility
it is most often idiopathic, but can be associated with neuromuscular disease, or secondary to other disorders. |
|
|
Term
Congenital idiopathic megaesophagus:
What is the mechanism?
What breeds seem predisposed?
How do you treat it ?
What is the prognosis? |
|
Definition
defect in reflex arc for swallowing or swallowing center in the brain stem
- great danes, irish setters, german shepards
- feed vertically, small, frequent, firm meals. (promotility drugs have minimal effect)
- guarded to poor prognosis |
|
|
Term
| Acquired megaesophagus is predisposed by what disease factor? |
|
Definition
neuromuscular or immune mediated disorders
- may be focal myasthenia gravis |
|
|
Term
| What is the most common cause of regurgitation? |
|
Definition
|
|
Term
| What are the top three etiologies for megaesophgus? |
|
Definition
Idiopathic/hereditary
myasthenia gravis and SLE
Polymyositis and polymyopathy
(but there are many MANY more) |
|
|
Term
| What are the types of esophageal peristaltic waves? What is their significance? |
|
Definition
Primary - sensor from esophageal lumen = weak
Secondary - motor sensor in brain = strong |
|
|
Term
Regurgitation is passive, whereas vomiting is active.
True or False? |
|
Definition
|
|
Term
| Regurgitation is the hallmark sign of what type of disease? |
|
Definition
|
|
Term
| Where is the vomiting center located? |
|
Definition
|
|
Term
| What can stimulate the vomiting center? |
|
Definition
Chemoreceptor trigger zone
visceral afferents
higher brain centers (increased CSF pressure)
vestibular system |
|
|
Term
Vomiting can still occur if the vomiting center of the brain is destroyed, from visceral afferents.
True or False? |
|
Definition
FALSE
if the vomiting center of the brain is missing there is no centrally mediated coordination to eject the stomach contents |
|
|
Term
Vomiting can be associated with GI and NON GI related conditions.
True or False? |
|
Definition
|
|
Term
The chemoreceptor trigger zone is within the Blood brain barrier so drugs will not effect it.
True or False? |
|
Definition
FALSE
it is located on the floor of the 4th ventricle, and OUTSIDE the BBB.
this means drugs, toxins, electrolyte changes and metabolites IN THE BLOOD will all effect it |
|
|
Term
| How would you differentiate GI and non GI causes of vomiting? |
|
Definition
CBC, chem screen
plasma protein
lipase
urinalysis |
|
|
Term
| What are some secondary effects of persistent or severe vomiting? |
|
Definition
Dehydration
prerenal azotemia
electolyte disturbances
(HYPOchloridemia, HYPOkalemia, sometimes hyponatremia)
Metabolic alkalosis = gastric vomiting only
Metabolic acidosis = bicarb loss associated with small intestines (secreted in duodenum) |
|
|
Term
| What are some non intestinal causes of vomiting? |
|
Definition
Canine distemper
Leptospirosis
Acute pancreatitis
Ketoacidotic diabetes mellitus
adrenocortical insufficiency
hepatic disease
renal failure
drug toxicity
vestibular disturbances
pyometra
CNS diseases
Peritonititis
Malignancies |
|
|
Term
| What determines the therapeutic approach to vomiting? |
|
Definition
| Depends on duration and severity of disease |
|
|
Term
What is the primary treatment strategy for vomiting?
What drugs should and should not be used? |
|
Definition
ID and remove cause of vomiting
With-hold food (NPO)- ice cubes for water
fluid therapy
NO oral meds, coating agents, anticholinergics
YES to centrally acting anti-emetics (phenothiazines like acepromazine, or metaclopramide)
abx only if infection present |
|
|
Term
| What are some common causes of chronic vomiting ? |
|
Definition
**IBD
metabolic disease (liver, kidneys)
endocrinopathy (addisons disease)
Gastroduodenal ulcerations
pyloric obstruction
gastric neoplasia
hairballs
parasites |
|
|
Term
| What is the best method for diagnosing gastritis? |
|
Definition
| Gastroscopywith mucosal biopsy of the stomach |
|
|
Term
Corticosteroids are ulceragenic and are contraindicated in animals with possible GI ulcers or erosions.
True or False? |
|
Definition
|
|
Term
| What drugs should not be used when treating chronic gastritis? |
|
Definition
CORTICOSTEROIDS
ABX (except flagyl)
Anticholinergics |
|
|
Term
| What drugs should be used in the treatment of chronic gastritis? |
|
Definition
~Cimetidine - H2 agonist, decreases hyperchloridemia
~ metronidazole (flagyl) if immune mediated reaction suspected |
|
|
Term
| What are the most common primary gastric tumors in cats and dogs? |
|
Definition
Cats = lymphoma (FeLV negative)
Dogs = adenocarcinoma |
|
|
Term
Most cats with alimentary lymphoma are FeLV positive.
True or False? |
|
Definition
|
|
Term
How are gastric tumors diagnosed?
What is the treatment?
What is the prognosis? |
|
Definition
Diagnosed through gastroscopic examination and mucosal biopsy
TX - surgical resection (if not metastasis), chemotherapy
Prognosis - POOR |
|
|
Term
A full panel should always be run to rule out extragastric causes of vomiting. What testing would be needed for these potential causes:
peritonitits
chronic pancreatitis
chronic renal disease
hepatic disease
hypoadrenocorticism
feline hyperthyroidism
ketoacidotic diabetes mellitus |
|
Definition
peritonitits - xrays, ab tap
chronic pancreatitis - serum lipase
chronic renal disease - azotemia
hepatic disease - bile acid testing
hypoadrenocorticism - ACTH stimulation
feline hyperthyroidism - Total T4
ketoacidotic diabetes mellitus - UA ( glucosuria, ketouria) |
|
|
Term
| What is the database that should be preformed to rule out all causes of vomiting? |
|
Definition
Radiographs
CBC/Chem/UA
t4 (cats)
ACTH stimulation
lipase
bile acids |
|
|
Term
| What are the signs of gastric retention? |
|
Definition
| Postprandial vomiting when the stomach should be emptied (10+ hours after eating) |
|
|
Term
| What are the causes of gastric retention? |
|
Definition
Pyloric obstruction
pyloric antral hypertrophy
extrinsic masses
reduced motility (decreased sympathetic tone) |
|
|
Term
Any disruption of gastric mucosal barrier can result in GI ulcers.
True or False? |
|
Definition
|
|
Term
| What are the causes of gastric ulcers? |
|
Definition
**Drugs (corticosteroids, asprin, NSAIDS- prostaglandin inhibitors)
*altered gastric blood flow (hypovolemia, DIC endotoxemia)
*locally agressive neoplasia
*Renal disease (uremic ulcers)
*liver disease
toxic chemicals
physical stresses
gastroduodenal reflux (bile acids and pancreatic enzymes) |
|
|
Term
| What are the clinical sings of gastric ulcers? |
|
Definition
Vomiting - primary sign, not always with blood
ab pain
melena
halitosis (with no oral cavity disease)
**physical exam findings my be unremarkable** |
|
|
Term
Gastric ulcers can be diagnosed by measuring serum gastrin levels.
True or False? |
|
Definition
FALSE
Best diagnosis is via endoscopy
also resting gastrin is rarely elevated, better measurement would be of calcium or secretin stimulation |
|
|
Term
| What drugs should and should not be used to treat gastric ulcers ? |
|
Definition
YES: parental antacid therapy (H2 blocking *Cimetidine**)
Omeprazole (inhibits H+ secretion)
*Sucralfate (AL salt, ion in acid, proteinacous adhesion to ulcer that protects and inactivates pepsin)
kaopectate
misoprostil (PGE analog- protective)
Antiemetic phenothiazine, metoclopramide
NO :
oral antacids
Steroids |
|
|
Term
| Why should H2 blockers be administered prior to Sucralfate when treating gastric ulcers? |
|
Definition
Because the sucralfate will slow the absorption of other drugs
so for optimal effectiveness give the H2 blockers first |
|
|
Term
| What is the cause of GDV? |
|
Definition
|
|
Term
Patients with GDV often present with abdominal distention, vomiting, increased respiratory effort and possible hypovolemic shock.
True or False? |
|
Definition
FALSE
they cannot vomit because the stomach is twisted, but the rest is true.
They present with ab distention, RETCHING, increased resp effort, hypovolemic shock if progresses (weak pulse, tachycardia, prolonged CRT, collapse) |
|
|
Term
The ability to pass a stomach tube does not rule out GDV.
True or False? |
|
Definition
|
|
Term
| What is the pathophysiology of GDV? |
|
Definition
stomach dilates without being able to empty!!
gas and fluid accumulation causes venous congestion and can progress to hypovolemic shock |
|
|
Term
| What causes GDV tissue injury? |
|
Definition
| GDV causes tissue hypoxia and when reperfused it runs the risk of reperfusion injury from oxygen free radicals |
|
|
Term
| What would be seen radiographically with a GDV? |
|
Definition
*use right lateral view*
- pylorus moves cranial and dorsal to the fundus
- pillar of tissue may separate fundus from pylorus (double bubble) |
|
|
Term
| What is the primary step in treating GDV? |
|
Definition
|
|
Term
| What are the steps in treating GDV? |
|
Definition
Decompress stomach ASAP
database (cbc/chem)
fluids
steroids
deferoximine (reduce reperfusion injury)
**animal should be stabilized**
THEN surgery |
|
|
Term
| What is the most significant factor in preventing death of an animal with GDV? |
|
Definition
| interval of time between onset of signs and the vigorous initiation of therapy |
|
|
Term
Recurrence of GDV is more likely if gastroplex is not preformed.
True or False? |
|
Definition
|
|
Term
| What is the difference between dysphagia, regurgitation and vomiting? |
|
Definition
Dysphagia - difficulty swallowing
regurgitation - passive reflux of undigested food
vomiting - active centrally coordinated ejection of food |
|
|
Term
| What is the radiographic appearance of intestinal obstructions? |
|
Definition
- gas or fluid distention of bowel
- delayed transit of contrast material
- fixation or displacement of bowel loops
- luminal filling defects
- foreign bodies in lumen
- plication of small bowel with linear foreign bodies |
|
|
Term
| What is the radiographic appearance of a cat with a linear foreign body? |
|
Definition
|
|
Term
| What is the difference between simple and strangulated intestinal obstructions? |
|
Definition
| strangulated has a loss of vascular supply |
|
|
Term
| What are the 4 mechanisms of diarrhea? |
|
Definition
1) Osmotic - impaired absorption of fluid
2) Secretory - influx of fluids and electrolytes
3) abnormal mucosal permeability - exudate
4) alterationsin motility - uncommon |
|
|
Term
| What are the characteristics of small bowel diarrhea? |
|
Definition
increased volume
watery
loss of body weight
malabsorption or maldigestion
melena**
flatulence |
|
|
Term
| What are the characteristics of large bowel diarrhea? |
|
Definition
increased frequency and urgency
mucous
hematochezia
discomfort |
|
|
Term
| Panhypoproteinemia and diarrhea are indicative of ....? |
|
Definition
Protein losing enteropathy
(not a diagnosis) |
|
|
Term
| What are some extraintestinal causes of diarrhea? |
|
Definition
Feline hyperthyroidism
FIV
Renal Disease
Hypoadrenocorticism
liver disease |
|
|
Term
| What is the best test for diagnosing Exocrine Pancreatic Insufficiency? |
|
Definition
| Trysin-like immunoreactivity assay |
|
|
Term
Which of the following is NOT a cause of PLE?
A) Histoplasmosis
B) intestinal lymphangiectasia
C) Severe lymphoplasmacytic
D) E. coli infection
E) Intestinal lymphosarcoma |
|
Definition
|
|
