Term
| What classifies chronic vomiting animal? |
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Definition
| Vomiting for more than 5-7 days and has failed to respond to symptomatic treatment |
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Term
| What sort of questions do you need to ask in regard to history in relation to the chronically vomiting animal? |
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Definition
Description of episodes (duration, frequency relationship to ingestion of feed etc)
Signalment
Medication
Other possible causes (FB, toxin) |
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Term
| What are the 6 steps for the investigation of chronic vomiting? |
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Definition
Hx
Physical exam
Routine lab tests
Standard radiographs
Dx of non-GIT causes
Further imaging |
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Term
| What are some possible causes of vomiting with blood? |
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Definition
Drugs
Coagulopoathy
Ulcer
HypoA
Neoplasia |
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Term
| What are some causes of vomiting seen with no blood or obvious obstruction? |
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Definition
| Renal failure, hepatic disease, pancreatitis, peritonistis, DM, hyperthyroidism, Gastritis, ulceration, IDB, colitis, parasites, neoplasia, FB, intussuception |
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Term
| What are some of the signs of nausea in companion animals? |
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Definition
| Depression, shivering, hiding, yawning, licking the lips, increased saliva |
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Term
| Why is prolonged anorexia a bigger problem in cats compared to dogs? |
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Definition
Cats are unable to down regulate their urea cycle of transamineases (protein to energy) in times of starvation, i.e. they are constantly undergoing catabolism and have a limited ability to conserve protein.
So protein malnutrition occurs really fast in cats
The other huge issue (esp in fact cats) is hepatic lipidosis, is where shit loads of fat goes to the liver (triggered by the increased need of glucose).The fat accumulates in the liver and impededs the function of the liver, leading to liver failure |
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Term
| How do you deal with hepatic lipidosis in cats? |
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Definition
| you need to get a high hat, high energy feed into the cat, but do not force feed as cats develop food aversion quickly. |
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Term
| How can you determine the hydration state of an animal? |
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Definition
'Skin tent' is the most common measure, but that won't show up an signs of dehydration until 5%, and then it is rather minor.
If there is a history of vomiting of diarrhoea, assume there is at least 5% dehydration.
Dry mucous membranes will earn you 6%
Dry MM and skin turgour goes 7%
The addition of sunken eyes = 8-10%
and extremely dry MM is going to be greater than 12%
PCV looking for haemoconcentration (increased in proportion to protein) is also a sign |
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Term
| What are some of the limitations of in house lab testing? |
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Definition
Lack of skill of the opperator, machine not being calibrated properly
Not a full range of testing |
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Term
| What does SIRS stand for? |
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Definition
| Systemic inflammatory response syndrome |
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Term
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Definition
| A complex clinical response to a nonsepcific insult of either infectious or non-infectious origin. The more criteria they fit, the higher the chance of mortality |
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Term
| What are the criteria of SIRS? |
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Definition
Temp between 37.7 and 39.7
Elevated HR (>60 dog)
Increased resp rate (>40)
WBC between 4000 and 1200/ul (dog), 5000-19500/ul (cat)
>10% bands (dog) >5% bands (cat) |
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Term
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Definition
| A systemic inflammatory response to infection, but not necessarily a widespread infection |
|
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Term
| What are some microbial products that can cause sepsis? |
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Definition
Endotoxins, exotoxins, peptidoglycans, superantigens and fungal cell walls
These induce systemic inflammation |
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Term
| What are the possible sequelae to SIRS? |
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Definition
Multiple organ dysfunction syndrome
Acute respiratory distress syndrome |
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Term
| What is meant by hyperdynamic and hypodynamic responses in relation to sepsis? |
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Definition
In Dogs:
Hyper - characterised by fever, brick red MM, tachycardia, bounding pulse
Hypo - hypotension, pale MM and hypothermia |
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Term
| What clin path do you expect to see in cases of sepsis in dogs? |
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Definition
| hyper or hypo glycemia, hypoalbuminaemia, azotaemia, hyperbilirubinaemia, ncreased ALT and ALP, left shift leucosis, possible coagulopathy |
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Term
| What responses are common in sepsis in cats? |
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Definition
| Bradycardia, hyperthermia, abdo pain, urination, shock |
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Term
| What are the choices are available for the anaemic cat? |
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Definition
| If the cat is anaemic to the point where it might need fluids, look into a blood transfusion. At any rate, an isotonic crystaloid would be best (Hartmanns) |
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Term
| What are the recommendations for dehydration fluid therapy in a cat? |
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Definition
Acute dehydration - fluids ofver 1-4 hrs
Chronic dehydration - rehydrate over 4-12 hrs
Isotonic crystaloids best, Hartmanns |
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Term
| What should you give to a cat that is dehydrated and hypoprotenemic? |
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Definition
Colloids to maintain colloid osmotic presure id albumin is <15g/L
The best thing to give would be plasma or whole blood, synthetic colloids are also available (increases blood volume more than volume delivered) |
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Term
| What is the protocol for a barium swallow? |
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Definition
- Withhold food for 24hr (liquid ok)
- Ideal that the lower intestine is free of faeces, laxatives or enema may be needed
- Barium concentration is 80-100% w/w
- Give 6-12ml/kg higher end dose for cats
- Syringe feed if want to look at oesophagus, orgastric tube if not
- ACP is a useful sedative cos it doesn't stuff with gastic function
- Cats, can use diazepam and ketamine
- Always do plain radiographs 1st
- Serial radiography (-, 15, 30, 45, 60, 90 and 180 min)
- Final rad 12hr post to ensure total clearance |
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Term
| What are the passage times in dogs for a barium swallow? |
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Definition
Immediate, stomach
15 min Stomach duodenum
30 min, stomach, duodenum, jejunum
60 min, as above
120 min, stomach + all SI
4 hr, Small bowel and colon |
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Term
| What are the passage time in cats for a barium swallow? |
|
Definition
Immediate - Stomach
5 min - stomach, duodenum, jejunum
30 min, all small bowel
60 min, small bowel, colon |
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Term
|
Definition
| Barium-impregnated polypropylene spheres |
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Term
| What are BIPS useful for? |
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Definition
| They are capsules that you give to the dog/cat. You then radiograph the animal and track the little balls progress. It is awesome because the small ones can get through some obstructions,while the larger ones get stuck. |
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Term
| What is the difference between vomiting and regurgitation? |
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Definition
Vomiting is usually proceeded by the cat swallowing or licking its lips (showing signs of nausea) and is an 'active' process (often includes abdominal contrations)
Regurgitation is 'passive' expulsion of food or fluid. The material is often more tube-like and is covered with frothy saliva. |
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Term
| What are the sites in the brain that regulate vomiting? |
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Definition
The chemoreceptor trigger zone (CRTZ)
The vomiting centre |
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Term
| How do the CRTZ and the vomiting centre relate and then cause vomiting? |
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Definition
The CRTZ is located on the floor of the 4th ventricle and is located outside of the blood brain barrier, so it is able to response to noxious substances/toxins in circulation.
When activated, the CRTZ send electrical impulses to the vomiting centre.
The vomiting centre is amde up of sensory, motor and control nuclei which exist in the pontine reticular formation of the brainstem.
It is activated by strech receptors in the GIT, vestibular apparatus, CRTZ and higher control centres (fear, anxiety, pain).
When activated, motor impulses are transmited to the GIT tract (CN V, VII, IX, X, XII to the upper GIT and the vagosympathetic trunck to the lower GIT)
Spinal nerves go to the diaphragm and the adbo muscles |
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Term
| What are some drugs that can control vomiting in the same catagory as ACP (anti-emetics)? |
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Definition
ACP - 0.01-0.05mg/kg SC
Prochloperazine - 0.1-0.5 mg/kg SC or IM
Chlorpromazine - 0.3-0.4 mg/kg SC or IM |
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Term
| Where do most anti-emetics act and what are their contraindications? |
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Definition
On the CRTZ and vomiting centre
Do not use with hypotension or previous sedation |
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Term
| What is the dose and contraindications of using Metoclopramide to control vomiting? |
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Definition
Meta]oclopramide - 0.2-0.4 mg/lh PO or SC or IM
Alters motility, acts on CRTZ and the smooth muscle of the GIT
Side effects/contraindications:
Increases detrusor muscle contractility
Movement disorders |
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Term
| How are gastric ulcers formed? |
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Definition
| A result of a defect in the GI mucosa allowing the acid and bile acids to cause damage to underlying structures. This is a self perpetuating problem. |
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Term
| What are some potential causes of damage to the mucosa? |
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Definition
Use of NSAIDs (common) causes direct damage tot he mucosa and inhibits the gastro-protective prostiglandins (COX-1 inhibitor)
Corticosteroids - Causes decrease in mucosal growth and an increase in acid secretion
Liver insuffciency (more common in dogs) - decreases in gastric mucus, epithelial renewal and blood flow increase in bile acids and acid
Neoplasia
Inflammatory bowel
Helicobacter
Extreme exercice (dog sledding) - redistrabution of blood flow |
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Term
| What are some of the supportive therapies for gastric ulcers? |
|
Definition
Nutrition - nothing by mouth for 24-48hrs
- Feed small amounts of low fat food 6-12 hrs after vomiting is done
- Consider parental or enteral nutrition if animal is in low BCS
Fluids/Electrolytes - prevent dehydration
- Include maintenance and losses in volume as well as deficit
- Use 0.9% isotonic saline if electrolyte status is unknown |
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Term
| What drugs are useful in the tx of ulcers? |
|
Definition
Antacids - anti-secretory drugs
- Rantiidine - 0.5mg/kg PO, SC, IV
- Cimetidne - 5-10mg/kg
- Proton pump inhibitors
- Omeprazol - 0.05-1mg/kg
Protectants - sucralfate - cats 250mg bid-tid
- dogs 500mg - 1g tid and qid
- Sytnthetic prostiglandins
- Misoprostol 2-5ug/kg PO tid-qid
Antiemetics - Prokinetics
- Metoclopramide
- Erythromycin - 0.5-1mg/g PO |
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Term
| When do you need to consider surgical intervention for gastric ulcers? |
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Definition
|
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Term
| What diagnostic things would you use to diagnose an outflow obstruction? |
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Definition
CBC and biochem (to rule out other dx)
Imaging - radiographs, contrast, ultrasonaography
Endoscopy
Abdotap
Exlap
Path findings |
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Term
| What is inflammatory bowel disease? |
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Definition
| A group of GOT diseases characterised by inflammatory cellular infiltrates in the lamina propria of the small or large intestine |
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Term
| What are the clinical signs of IBD? |
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Definition
VOmiting
SI diarrhoea (Large volume, watery, melena)
Thickened bowel loops
LI diarrhoea (Mucoid stool, increased frequency, tenesmus, Haematochezia )
Abdominal pain
Excessive borborygmi and flatulence
Weight loss
Altered appetite
Hypoproteinaemia |
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Term
| What is needed for definitive diagnosis of IBD? |
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Definition
Intestinal biopsy
May need a full thickness sample (collect surgically) |
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Term
| What is the treatment for IBD? |
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Definition
Exclusion diet, antiparasitics, antibacterials
all fail?
Immunosuppressive medication |
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Term
| What is the standard approach for an exlap? |
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Definition
Incision from the xiphoid to the pubis (in male dogs, you move laterally around the penis)
Systematic exploration of the abdo cavity
- Cranial quadrant (Diaphragm, liverm gallbladder, stomach, pylorus, proximal duodenum, spleen, pancreas, arteries)
Caudal quadrant (Colon, bladder, prostate, uterine horns, inguinal rings)
Intestinal tract (palapate from duodenum to descending colon)
Explore the gutters (Mesenteric baskets, palpate the kidneys, adrenal gland, ureter, overies) |
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Term
| What dictates bowel integrity? |
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Definition
| Blood flow and therefore oxygenation |
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Term
| What are signs of the bowel being viable? |
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Definition
| Pulse, peristalsis, pink in colour |
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Term
| If removing a FB from the bowel surgically, where should you cut? |
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Definition
| Distal to the FB and into healthy tissue |
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Term
| What are the indications for an intestinal resection? |
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Definition
| Intestinal neoplasia, intussusceiption, ischaemia, trauma, perforated or ulcerated tissue where viability is questioned. |
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Term
| What margins are required for the removal of an intestinal neoplasia? |
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Definition
|
|
Term
| How much gut can animals have removed? |
|
Definition
|
|
Term
| What is the procedure for removing a section of bowel? |
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Definition
Clamp and ligate all vessels in the area
Cut perpendicular or at a slight angle to the length of the bowel
Intestinal anastomosis is then preformed with staples or sutures. |
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Term
| What suture pattern and needle should you use for an end to end anastomosis? |
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Definition
| Continuous suture (faster) with 3-0 or 4-0 absorbable mono-filament on a taper or taper=cut needle |
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Term
| How do you prevent leaking of the anastamosis? |
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Definition
| You can inject dye into the lumen of the bowel or use a serosal patch, or cover the suture line with omentum |
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Term
| What are the classifications of lymphosarcoma? |
|
Definition
Multicentric (most common)
Mediastinal
Gastrointestinal
Cutaneous
Extranodal (Eyes, CNS, bones, heart, hidneys, bladder, nasal cavity) |
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Term
| What are the stages of lymphosarcoma? |
|
Definition
1-5
1 - single node of lymphoid tissue
2 - Involvement of many lymphnodes in a regional area
3 - Generalised node involvement
4 - Liver or spleen involvement
5 - Manifestation in the blood and involvement of the bone marrow or other organs |
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Term
| How do you distinguish from pre renal, renal and post renal azotaemia? |
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Definition
Pre- BUN:Cr >20
Renal- BUN:Cr <15, signs of renal disease,
Post- Caused by inability to urinate, history helps. Renention of urine often leads to hyperkalaemia
Might have to ask someone to clarify |
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Term
| What treatment is recommended for lymphosarcoma? |
|
Definition
Surgical removal of larger lesions coupled with chemotherapy
If there is just a single large lesion surgery and radiotherapy |
|
|
Term
| What is the mean survival rate without treatment? |
|
Definition
|
|
Term
| What do most chemotherapy drugs target? |
|
Definition
| Rapidly dividing cells (such as neoplasia, but also gut mucosa) |
|
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Term
| What are the advantages and disadvantages of single agent therapy? |
|
Definition
| Cheap, requires fewer hospital visits, relapse usually drug resistant, rarely works in cats |
|
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Term
| What are the advantages and disadvantages of multi-agent therapy? |
|
Definition
| Better response rates, different MOAs cover different catagories, decrease resistance, decrease toxicity, more expensive, time consuming, side effects |
|
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Term
| What are the 2 stages of chemotherapy? |
|
Definition
| Induction and maintenance |
|
|
Term
| What are some examplez protocol for lymphocytic lymphoma? |
|
Definition
Chlprabucil and pred
COP - cyclophospamide, vincritsine and pred |
|
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Term
| What are some examplez protocol for lymphoblastic lymphoma? |
|
Definition
Supportive care is often essential as the animal is usually seriously ill at the time of diagnosis
The most common tx are multidrug protocols such as
-Rotating sequentail tx of vincritine, L-aspataginase, pred, cyclospophamide, doxorubicin over 25weeks
- CHOP (Cyclophospamids, doxorubicinm vincristine, pred) |
|
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Term
| What are the main classes of chemotherapeutic drugs? |
|
Definition
Antimiotics - disrupt the mitotic spindle (vinca alkaloids and taxanes - paclitaxel docetaxel)
Alkylating agents - Act to bind DnA, inserts alkyl group to interfere with cell functions (Cyclophosphadamine, chlorambucil, CCNU)
Antiobiotic agents (doxorubricin)
Antimetabolics - Target S phase (methotrexate) |
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