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| Question | Answer |
| when is vomiting classed as chronic? | After 7 days |
| how can vomiting and regurgitation be differentiated? | regurgitation is instant with no prodromal phase, its a passive process the food is often a sausage shape and undigested. Vomiting has a prodromal phase (depressed, hyper salivation and cats often vocalise), the vomiting will involve lots of stomach contractions and will include bile |
| what do coffee granules in the vomit represent? | blood |
| what particular signs should be assessed in an animal that has been chronically vomiting? | palpate the stomach and intestines, are there any thickening or masses. The hydration status of the animal should be assessed (CRT, HR, skin tenting eyes etc). Signs of systemic disease should be looked for, for example; pyrexia, ascities, arrthymias, masses and oral ulcers. |
| what are the three inputs into the vomiting centre of the medulla? | chemo response trigger zone cerebral input vestibular input Vagosympathetic input |
| what feeds into the vagosympathetic system? | GIT, pancreas, liver, kidneys and pancreas |
| what are the differentials for chronic vomiting? | -Diabetes ketoacidosis -Renal failure -Pancreatitis -Hyperthyroidism -Hepatobiliary disease -Hypoadrenocorticism -Drug/toxin exposure -Chronic gastritis -Helicobacter -FB -Gastric ulceration -Gastric neoplasia -Pyloric hypertrophy -Motility disorder -IBD -Neoplasia -Intussuseption -Ulceration |
| What should be the first step in an animal which is clinically well but been chronically vomiting? | trial on hypoallergenic food (cats more likely to respond to this |
| what are the anti emetic drugs available? | -neurokinin 1 antagonist (maropitant) -Anti-dopaminergics (metoclopramide) -seratonin antagonists (ondesterone) -phenothiazines (chlopramizine) |
| what are pro kinetic drugs? | anti dopenergics (metoclopramide) and seratonin agonists (cispride) |
| what drugs are contra indicated in suspected fb? | maropitant and metaclopramide |
| where does metaclopramide attach to, in order to produce the anti emetic effect? | CRTZ |
| where does maropitant bind to in order to produce its anti emetic effects | centeral and peripheral effects |
| where does ondesterone bind to, to produce its anti emetic effects and whats the added bonus? | centeral effects in the cats and peripheral actions on dogs. It relieves nausea |
| Which is the only licences H2 antagonist? | Cimitidine |
| what are the positives and negatives of ranitidine? | Prokinetic effects, although if given IV may cause hypotension. |
| when is sulcralphate most useful? | in oesophageal reflux |
| intussuseption | |
| how can the oesophagus and stomach pathology be detected? | -U/S (looking for thickenings) -endoscopy (good up to the duodenum) -fluoroscopy |
| what are the signs of oesophagitis? | Vomiting and or regurgitation, anorexia, hyper salivation |
| what are common causes of oesophagitis? | -doxycycline use -intubation -gastric reflux |
| what is the gold standard for oesophagitis diagnosis? | endoscopy |
| what is the treatment of oesophagitis? | requent small meals, and 5-21 days of therapy depending on the severity. The therapy consists of; PPI/H2 blockers, broad specrum antibiotics, metoclopramide and sulcralfate. |
| What is the most common cause of chronic vomiting in the dog? | gastritis |
| what is the best way to treat gastritis? | diet modification and immunosuppression |
| what are the 4 species of bacteria which are associated with gastritis? | Helicobacter pylori helicobacter felis helicobacter Heilmannii helicobacter Bizzozeronii (first two affect cats second two dogs) |
| How is helicobacter diagnosed? | Biopsy with PCR |
| How is helicobacter treated? | its hard to eradicated, the best options is amoxicillin, famotidine and metronidazole |
| whats the most common type of gastric neoplasia in a dog? | adenocarcinoma (70%) |
| which type of dog is most likely to get gastric neoplasia? | belgian shepherds, collies and staffies. |
| what are signs of gastric neoplasia? | chronic vomiting, hypersalivation, anorexia and weight loss |
| How should gastric neoplasia be diagnosed? | would suspect after palpation and U/S biopsy (surgically or endoscopically) |
| how should a gastric tumour be treated? | excision, if it is just a polyp then COX-2 inhibitors may be used |
| whats the most common GI tumour in cats? | lymphoma |
| How is GI lymphoma best diagnosed in the cat? | biopsy by surgery, it can be done by endoscopy although not as sensitive |
| how should a high grade GI lymphoma be treated in the cat? | Chemo |
| what is the main worry for a cat with GI lymphoma? | the tract may perforate |
| whats the supposed survival time of a cat undergoing chemo with a high grade lymphoma? | 6-10 months, although 35% survive >2 years |
| what is a positive prognostic factor for a cat with a GI lymphoma? | negative FeLV test |
| What may be the best treatment for a low grade GI lymphoma in a cat? | predinsalone and chlorambucil |
| what is the prognosis of a low grade lymphoma in a cat? | 23 months |
| At what time is the stomach said to have delayed gastric emptying? | after 8hours |
| what may caused delayed gastric emptying? | -electrolyte abnormalities -post anaesthetic -peritonitis -dysautinomia -intramural disease -extramural compression -FB |
| which breed of dogs may have a congenital delayed gastric emptying? | boxers and boston terriers |
| how should acute diarrhoea be treated? | rice and chicken (or other low fat diet which will be readily absorbed and so reduce the amount of diarrhea), probiotics and some people advocate starving them. |
| if there is fresh blood in the faeces where is it likely to have originated from? | the large intestine |
| If there is melanea where is it likely to have originated from? | the small intestine |
| if the animal is loosing weight with a long term diarrhoea what is likely to be affected? | the small intestine |
| If there is a lot of diarrhoea more than usual faecal production, what is the likely origin? | small intestine |
| If there is a lot of flatulence associated with the diarrhoea whats the likely origin? | small intestine |
| If there is a mucoid coat to the diarrhoea where is it likely to have originated from? | the large intestine |
| what questions should be asked of an owner with a dog with chronic diarrhoea? | -has it been the same or changing -what does the faeces look like? -have diet modifications been attempted -any recent medications? -are there any in contact animals which are displaying similar signs? |
| what should be payed attention to in an animal with chronic diarrhoea? | hydration status, peripheral lymph nodes, cardiac auscultation, abdominal palpation, rectal examination and temperature assessment. |
| What are the common extra intestinal causes of diarrhoea? | -pancreatic disease -hypoadrenocarticism -liver disease -renal disease -hyperthyroidism |
| what are the most common intestinal causes of chronic diarrhoea? | parasitic disease, infectious disease, food responsive diarrhoea, intestinal neoplasia, parasites, idiopathic inflammatory bowel disease and antibiotic responsive diarrhoea (aka small intestinal bacterial overgrowth) |
| whats the best course of action to diagnose a chronic diarrhoea? | -Diet trial -antibiotic trial -gastrointestinal biopsies -diagnostic imaging -urinalysis and blood work -faecal parasitology (and bacteriology?) |
| How much does faecal parasitology cost? | £75!!!!!!!!!!!!!!!! |
| what will be highlighted with faecal parasitology? | toxocara ova, truchuris, uncinaria ova and giardia oocysts |
| What are the alternatives to parasitology for testing for Giardia and whats the negatives of it? | -SNAP test, negatives include not very sensitive and it costs £35!!!!! |
| If parasitology cannot be afforded what is the cheap option? | panacure (fenbendazole trial) for 5 days |
| when is it a good idea to take bloods before parasitology in a chronic diarrhoea case? | -if there is blood in the faeces (looking at red cell morphology for microcytosis/hypochromasia) -eosinophillia may be present with hyperadrenocorticism or parasites (note that with diarrhoea low protein and low cholesterol are common findings on blood) -neutrophilia will indicate infection |
| What are the three species of campylobacter and whats the problem with sampling for them? | -jejuni -coli -upsenalis they are common in healthy dogs so not necessarily causative |
| if salmonella is the suspected problem what antibiotic should be used? | flouroquinolones as resistance to other drugs has been recognised |
| What should be looked at on U/S in chronic diarrhoea? | pancreatitis, assessing intestinal motility, neoplastic walls and striation of mucosal layering |
| which two breeds commonly have absorption problems? | schnauzers and yorkies |
| what vitamin is important for enterocytes? | Vitamin B12 |
| what tests are important for a cat with chronic diarrhoea? | -corona virus (isolation) -FIV/FeLV (snap tests, isolation) |
| How does FeLV cause diarrhoea most commonly? | per acute eneterocolitis or lymphomas |
| If a cat has diarrhoea as a result of corona virus what is the suspected problem? | a concurrent panleukopenia infection |
| when are antibiotics indicated for diarrhoea? | -acute haemorrhagic diarrhoea |
| What animals tend to get antibiotic responsive diarrhoea? | large breed dogs (cats hardly ever get it!) |
| which antibiotics should be tried for acute haemorrhagic diarrhoea? | metronidazole, oxytet or tylosine For a minimum of 4 weeks!!!! |
| if planning to biopsy the intestine how should the animal be prepared? | -multiple enemas -fast for 24 hours!! |
| how is the diagnosis of idiopathic IBD made? | diagnosis of exclusion; histological exclusion of parasitic disease, dietary responsive disease and antibiotic responsive diarrhoea |
| what is idiopathic IBD caused by? | a combination of; break down in immunetollerence, disrupted mucosa, GI organism inbalance and genetics |
| How do cats with IBD often present? | vomiting |
| what is sulphasalazine? | anti inflammatory and free radical scavenger, it may be beneficial in large intestinal diarrhea. |
| what is kaolin? | a faeces binder (note it won't correct diarrhoea or electrolytes) |
| what are the two forms of IBD? | lymphocytic and eosinophilc |
| does lymphocytic or eosinophilic IBD carry a better prognosis? | Lymphocytic has a better prognosis |
| With granulomatous IBD what is the treatment? | immuno supressive steroids (not dexamethasone) 2mg/kg in dogs and 3 mg/kg in cats |
| What is Chlorambucil and whats it used for? | -chemotherapy drug, a nitrogen mustard alkylating agent -can be used for immune mediated disorders; The pemphigus diseases, Eosinophilic granuloma complex, Inflammatory bowel disease, Immune-mediated haemolytic anemia, Immune-mediated platelet destruction or for chemo if at a higher does |
| what is the common presentation of histolytic ulcerative colitis? | In boxers <2 yo (or french bulldogs/mastiffs) commonly and in the LI |
| what are the main symptoms of histolytic ulcerative colitis and whats the best treatment? | -enrofloxacin -collitis, D+ and anorexia |
| what is Trochomonus foetus? | a protozoal disease |
| how should Trochomonus foetus be treated? | rondiazole (not licensed) and try probiotics too |
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