1. Diseases of Digestive System Oral cavity Esophagus Stomach Small Bowel Large Bowel Liver Pancreas Rectum Anus Chapter 2

2. ADVERSITY “Adversity causes some men to break, others to break records.” -William A. Ward

3. 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

4. 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

5. Parasite Diarrhea Signs  Diarrhea  ___________  Poor hair coat  Listlessness Dx ___________ Tx  Anthelmintics for parasites: Fenbendazole/pyrantel  Antiprotozoal medication for Giardia, Coccidia

6. Giardia

7. Viral Diarrhea Parvovirus Canine distemper virus Coronavirus Feline panleukopenia virus

8. 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  ___________________

9. Parvovirus (coyote, cats)

10. Parvovirus Client info  Sick animals will infect other unprotected animals  Parvo can be fatal  Vaccinate for protection

11. 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 ↑ __________________________________

12. 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

13. 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

14. Intussuception

15. 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

16. 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

17. Megacolon Surgical removal Suture ends at arrows

18. 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

19. 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)

20. 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

21. Rx  Antidotes  Induce vomiting  _______________________  IV fluids  Vit K for clotting  Antibiotics  Special diets (Hill’s k/d or u/d) Drug/Toxin Induced Liver Disease

22. 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)

23. 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: ___________________

24. 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

25. Portosystemic Shunts

26. 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

27. 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

28. 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 Portosystemic Shunts

29. 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

30. 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

31. IHL

33. Clinical Signs  Anorexia  Obesity  Wt loss (as much as 25% of body weight)  Depression  Sporadic vomiting  __________________  Mild hepatomegaly  +/- coagulopathies

34. 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

35. 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 _____________

36. 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 _______________________

37. Pancreatic Dysfunction (Exocrine) Main function of Exocrine Pancreas → secretion of ___________________ Located along duodenum Dig enzymes secreted in an inactive form to protect pancreas tissue

38. 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 Pancreatic Dysfunction (Exocrine)

39. 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

40. 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

42. 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 Exocrine Pancreatic Insufficiency

43. 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

44. 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 Perineal Hernia

45. 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

46. 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 Fistula

47. 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