diseases of digestive system oral cavity esophagus stomach small bowel large bowel liver pancreas...

Diseases of Digestive SystemOral cavityEsophagusStomach

Small BowelLarge Bowel

LiverPancreasRectumAnus

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 changeStressful situationsDrug therapy

Signs (Duh?)

__________ onset± vomitingNormal appearance otherwise

DxFecal to r/o parasitesCBC (dehydration), Chem panel to r/o metabolic diseases

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

Parasite Diarrhea

SignsDiarrhea___________Poor hair coatListlessness

Dx___________Tx

Anthelmintics for parasites: Fenbendazole/pyrantelAntiprotozoal medication for Giardia, Coccidia

Giardia

Viral Diarrhea

ParvovirusCanine distemper virusCoronavirusFeline panleukopenia virus

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___________________

Parvovirus (coyote, cats)

Parvovirus

Client infoSick animals will infect other unprotected animalsParvo can be fatalVaccinate for protection

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

• ↑ __________________________________

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

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

Intussuception

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

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

Megacolon

Surgical removal

Suture ends at arrows

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

Drug/Toxin Induced Liver Disease

SignsAcute onsetAnorexiavomiting/, diarrhea/constipationPU/PD_________________ (maybe)Melena, hematuria, or both_________signs (depression,

ataxia, dementia, coma, seizures)

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

RxAntidotesInduce vomiting_______________________IV fluidsVit K for clottingAntibioticsSpecial diets (Hill’s k/d or u/d)

Drug/Toxin Induced Liver Disease

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)

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: ___________________

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

SignsDumb/numb, lethargic, depressedAtaxia, staggering_________________ (against a wall)Compulsive circling, apparent blindnessSeizures, comaBizarre behavior (esp cats)Signs often more pronounced shortly_____________

Portosystemic Shunts

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

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

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

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

IHL

IHL

IHL

Clinical SignsAnorexiaObesityWt loss (as much as 25% of body weight)DepressionSporadic vomiting__________________Mild hepatomegaly+/- coagulopathies

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

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 _____________

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 _______________________

Pancreatic Dysfunction (Exocrine)

Main function of Exocrine Pancreas → secretion of ___________________

Located along duodenumDig enzymes secreted in an inactive form to protect

pancreas tissue

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)

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

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

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

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

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

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

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

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