Transcript Diseases of Digestive System - Dr. Brahmbhatt`s Class Handouts

Diseases of Digestive System
Oral cavity
Esophagus
Stomach
Small Bowel
Large Bowel
Liver
Pancreas
Rectum
Anus
Chapter 2
ADVERSITY
“Adversity causes some men to break,
others to break records.”
-William A. Ward
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 change
 Stressful situations
 Drug therapy
Signs (Duh?)
 __________ onset
 ± vomiting
 Normal appearance otherwise
Dx
 Fecal to r/o parasites
 CBC (dehydration), Chem panel to r/o metabolic diseases
Acute Diarrhea
 Rx
Fluids for dehydration, electrolyte imbalance (SQ, IV, PO)
NPO x 24 h; water OK if no vomiting
Intestinal absorbants/coating agents
Loperamide—opiod receptor inhibitor that slows gut motility
Antibiotics (?)
Bland diet after 24 h
 Hills I/D
 Boiled chicken/rice
Parasite Diarrhea
 Signs
Diarrhea
___________
Poor hair coat
Listlessness
 Dx
 ___________
 Tx
Anthelmintics for parasites: Fenbendazole/pyrantel
Antiprotozoal medication for Giardia, Coccidia
Giardia
Viral Diarrhea
Parvovirus
Canine distemper virus
Coronavirus
Feline panleukopenia virus
Parvovirus
Seen mainly in young, ________ puppies
 Signs
Diarrhea, usually with blood
Vomiting
Febrile
Anorexia, depression
 Dx— _____________(enzyme-linked immunosorbent assay) test
 Rx
IV fluids
Antidiarrheal therapy
Antibiotics (Gram neg)
Keep warm
___________________
Parvovirus (coyote, cats)
Parvovirus
 Client info
Sick animals will infect other unprotected animals
Parvo can be fatal
Vaccinate for protection
Diseases of LI
Function is to________________, electrolytes; store feces
Inflammatory Bowel Disease (IBD)
Signs
Diarrhea with wt loss
↑ frequency of defecations, ↓ volume
Tenesmus
↑ mucus
Dx
Fecal to r/o parasites
Chem panel to r/o metabolic causes
Biopsy of LI wall
• ↑ __________________________________
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/d
 Homemade 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
Intussusception
Cause usually unknown; can result from parasites, FB, infection,
neoplasia
 Signs
 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 d
 Client info
 Recurrence is infrequent
 Px depends on amt of ____________ removed
 Puppies should be treated for parasites to prevent
intussusception
Intussuception
Megacolon
Uncommon in dogs, more common in ____________ (mostly idiopathic)
Associated with Obstipation (intestinal obstruction, severe constipation)
 Signs
Straining to defecate
 Must be distinguished from straining to __________ in male
cats
vomiting
Weakness, dehydration, anorexia
Small, hard feces or liquid feces
 With or without blood, mucus
Greater than length of
lumbar vertebrae
Megacolon
 Dx
Palpation of distended colon filled with hard, dry feces
Radiographs show colon ______________________
Rectal palpation assures adequate pelvic opening
 Rx
Warm water enema
 Animals can become hypothermic
Manual removal under anesthesia
 Mucosal surface is delicate
Client info
 Encourage water intake
• Salt food
• Always provide adequate supply
 High-fiber diet
Megacolon
Surgical removal
Suture ends at arrows
Liver Diseases
High 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
Disease
 Acute liver failure requires
__________ of liver to be affected
 Susceptible to toxin ingestion
(portal circulation)
 Some drugs have a Hx of liver
toxicity
 _____________________________
 Phenobarbital
 others
Drug/Toxin Induced Liver Disease
 Signs
Acute onset
Anorexia
vomiting/, diarrhea/constipation
PU/PD
_________________ (maybe)
Melena, hematuria, or both
_________signs (depression,
ataxia, dementia, coma, seizures)
Drug/Toxin Induced Liver Disease
 Dx
Hx of drug administration
Painful liver on palpation
Chem panel
 ↑ ______________(alanine aminotransferase)
 ↑ Total bilirubin, ↑ blood ammonia
 ↑ Serum bile acids
 Hypoglycemia, _________________________
Radiographs show enlarged liver
Liver biopsy (unless coagulopathy suspected)
Drug/Toxin Induced Liver Disease
 Rx
Antidotes
Induce vomiting
_______________________
IV fluids
Vit K for clotting
Antibiotics
Special diets (Hill’s k/d or u/d)
Liver Tumors
Primary and metastatic tumors are not uncommon in dogs
and cats
Metastatic tumors are ___________than primary tumors
of liver
 Signs
Anorexia, lethargy, wt loss
PU/PD
Vomiting/diarrhea (?)
Abdominal distension, hepatomegaly
Jaundice
 Dx
Anemia, usually _________________
Chem Panel
 ↓ serum albumin
 ↑ serum bilirubin, bile acids
 ↓ serum glucose
 Azotemia (↑ BUN, creatinine; esp in cats)
Liver tumors
 Dx
X-ray: Heptomegaly, Ascites (?)
________________ of liver
Abdominocentesis may show tumor cells
 Rx
Surgical removal is preferred treatment
 Single masses have good Px
 Multiple nodules/Diffuse disease have poor Px
Chemotherapy doesn’t help primary tumors; better for
metastatic lesions
 Client info
Guarded to poor Px generally
Survival time: ___________________
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
Portosystemic Shunts
Portosystemic Shunts
 Signs
Dumb/numb, lethargic, depressed
Ataxia, staggering
_________________ (against a wall)
Compulsive circling, apparent blindness
Seizures, coma
Bizarre behavior (esp cats)
Signs often more pronounced shortly_____________
Portosystemic Shunts
 Dx
Chem panel
 ↓ serum protein, albumin (liver is usually small)
 ↓ BUN (liver converts ammonia → urea)
 ↑ ALT (alanine aminotransferase), ALP (alkaline phosphatase)
 ↑ blood ammonia (from protein)
X-rays
 Small liver
 Contrast material
• Inject into ______________
• By-passes liver
Portosystemic Shunts
 Rx
Medical management seldom very successful
 Low protein diet
Sx
 Ligation 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 info
 Px often very good following ligation
 For best results, Sx should be performed before 1 y old
 _______________ may develop, with relapse of signs
Feline Hepatic Lipidosis
Idiopathic (IHL) – cause unknown
Most common hepatopathy in cats
_____________ of any age, sex or breed
Stress may trigger anorexia
Diet change,
Boarding
Illness,
Environmental change
IHL
Anorexia prolonged for 2 weeks causes
__________ between breakdown of peripheral
lipids and lipid clearance within liver
Lipids accumulate in liver
Other mechanisms proposed
Early diagnosis and aggressive treatment
important
60-65% of cases => complete recovery
IHL
IHL
IHL
Clinical Signs
Anorexia
Obesity
Wt loss (as much as 25% of body weight)
Depression
Sporadic vomiting
__________________
Mild hepatomegaly
+/- coagulopathies
IHL
Diagnosis
CBC –_________________ , stress neutrophilia,
lymphopenia
Biochem panel – Increased ALP, ALT, bilirubin,
Low albumin, Increase serum bile acids
X-rays – mild hepatomegaly
US liver hyperechoic
Liver biopsy – severely vacuolized hepatocytes
IHL
Treatment
High protein, calorie dense diet
Feeding tube usually required
NG tube for short term liquid
diets
Gastrostomy tube best
Esophagostomy tube
Tubes can remain in place
For up to _____________
IHL
 Treatment
IV fluids
__________________ SQ 15 min prior to feeding
Monitor weekly
 CE
Avoid stress in obese cats
Early intervention is essential
Any cat that stops eating is at risk
Cats do not respond well to _______________________
Pancreatic Dysfunction (Exocrine)
 Main function of Exocrine Pancreas → secretion of
___________________
 Located along duodenum
 Dig enzymes secreted in an inactive form to protect
pancreas tissue
Pancreatic Dysfunction (Exocrine)
 Pancreatitis—Inflammation of pancreas
May be chronic or acute
Develops when dig enzymes are activated within gland → ______________
More common in obese animal; _________________ may predispose animal to it
Unpredictable results; some recover well, others worsen and die
Signs
 Older, obese dog or cat with Hx of recent high-fat meal
 Depression, anorexia, ______________
 ± abdominal pain
 Shock, collapse may develop
 Diarrhea
 Often seen post-holiday
• Table scraps of ham, gravy, etc
Pancreatitis
 Dx
CBC, Chem panel
 Leukocytosis
 ↑ PCV (means what?)
 Hyperlipidemia
 ↑ serum amylase, lipase
 _____________________
 Rx
IV fluids, electrolytes
NPO 3-4 d
Antibiotics
__________________ for pain
Start back on low fat diet 1-2 d after vom stops
 Client info
Avoid obesity/overfeeding
Feed low-fat treats
Px is difficult to assess
Exocrine Pancreatic Insufficiency
The pancreas stops making dig enzymes
May occur spontaneously (G Shep) or due to chronic pancreatitis (cats)
 Signs
Wt loss
Polyphagia
_________________, pica
Diarrhea, fatty stool
Flatulence
 Dx
Normal CBC
↓ total lipids
Exocrine Pancreatic Insufficiency
 Rx
Supplement pancreatic enzymes with each meal
 Pancrezyme
 _____________________
Low fiber diet
 Client info
EPI is__________________; life-long treatment
Pancreatic enzyme replacement is expensive
With enzyme replacement, dog will regain weight, diarrhea
will stop
Must be given with every meal
Perineal Hernia
Intact male dogs; atrophy of levator ani muscle; rectum herniates
 Signs
____________ perianal swelling
Tenesmus (feeling of full colon)
Dyschezia (difficult defecation)
Urethral obstruction
 If bladder is herniated
 Dx
Rectal palpation reveals hernia sac
Intact male dogs > 8 yrs
Perineal Hernia
 Rx
Stool softeners (Colace)
Enemas
Surgical repair: Herniorrhaphy
 Castration
 Client info
Keeping stool soft may help reduce straining
 True for all dogs
_______________ recommended testosterone is suspected as
a predisposing factor
Perianal Fistula
Exact 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
Perianal Fistula
 Dx—PE to r/o anal sac disease/perirectal tumor
 Rx
 Medical—usually not successful
 Clip hair, keep clean
 Flush with saline
 Antibiotics
 Surgical—________________ because of nerves/blood vessels
 Remove infected tissue
 Cryosurgery
 Laser surgery
 Cautery
 Client info
 Painful—be cautious of biting
 many complications of Sx
• _____________________
• Anal stenosis
Perianal Gland Adenoma
 Signs
 Intact male, older
 Single or multiple masses that may ulcerate
 ______________________________________
 Pruritis in anal area
 Bleeding
 Firm nodules in perianal skin
 Dx—PE, biopsy
 Rx
 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