1. “Winning (success) takes work!” “The will to win is not nearly as important as the will to prepare to win.” -Bobby Knight

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

3. Esophageal Disease Esophageal obstruction Ingestion of _______________object (bones, play objects) Degree of damage depends on size, shape, time in esophagus Surgical removal is least desirable → _______________________  Signs Exaggerated swallowing movements Increased salivation restlessness Retching Anorexia Hx of chewing on foreign objects Esophageal endoscopy

4. Esophageal Obstruction Dx  Endoscopy  Radiography 6-mo old St Bernard What is your diagnosis?

5. Esophageal Obstruction 3 mo kitten What is your diagnosis?

6. Esophageal Obstruction 2 yr old cat What is your diagnosis?

7. Esophageal Obstruction 8 yr male cat

8. Interesting stuff 7 mo old Pug

9. Esophageal Obstruction Dx: Radiographs and endoscopy Rx  Prompt removal is important  ____________x 24 h to allow for healing  Resume feeding with soft foods  Remove using______________, Sx Client info  Limit access to bones and small objects  Strings and needles are hazards for cats  Px is good if serious damage to esophagus can be prevented

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

11. Mucosa -> muscularis -> serosa

12. Stomach Diseases Acute Gastritis  Commonly seen in ___________(cats to lesser degree) Spoiled food ____________ Food allergy Infections (bacterial, viral, parasitic) Toxins (chemicals, plants, drugs, organ failure) Foreign objects  Signs Anorexia Vomiting (+/- dehydration) ________________________ Hx of diet change, toxin ingestion, infection, parasites

13. Acute Gastritis Dx  Hx and PE  CBC, Chem Panel to assess dehydration, metabolic imbalance, organ failure Rx  NPO until vomiting stops 4-6 sips of water q1h Fluid therapy (SQ or IV)  Gradually start feeding ______________(Hill’s I/D, boiled chicken/rice)  Antiemetics ________________ (Cerenia) Metoclopramide (Reglan): caution with foreign bodies  Coating agents Sucralfate  _______________ (famotidine, ranitidine, cimetidine)  Antibiotics—often prescribed, rarely needed (flora disrupted: forti flora)

14. Acute Gastritis Client info  Avoid abrupt changes in diet Gradually mix new food in with old (1 wk)  If pet vomit 2-3 times,_____________ ; if it continues see vet  Dogs and cats do not need variety  Avoid objects that can be swallowed (treat like a baby)

15. Immune-Mediated Inflammatory Bowel Disease (Chronic gastritis, Enteritis, Colitis) Seen in____________, less common in dogs Accumulation of __________________ in lining of stomach, SI, LI Signs  Chronic vomiting, wt loss  Diarrhea, straining to defecate, ____________in stool Dx  Fecal to r/o parasites  CBC, Chem panel, urinalysis to r/o metabolic disorder  FeLV, FIV to r/o those diseases  Endoscopy stomach SI and colon, and ___________ for definitive diagnosis

16. Rx  What is the Rx for any Immune-mediated Disease?  ______________—immunosupressant (organ transplants)  _______________________—inhibits immune system response  ________________ —a sulfa drug with anti-inflammatory/ antibacterial effects Most effective against colitis  Metronidazole  Prednisone  _____________________ diet Free from preservative, additives Highly digestible protein (rabbit, lamb, duck, chicken) Homemade diets with rice base Some commercial diets are available Immune-Mediated Inflammatory Bowel Disease (Enteritis, Colitis)

17. Inflammatory Bowel Disease  Client info Definitive dx is through biopsy _____________________ (special diet, frequent medical monitoring) Immunosupressive drugs have side-effects (PU/PD/PP, wt gain, skin/urinary infections) Use lowest dose that provides effect

18. Gastric Ulceration Usually a result of long-term NSAIDs (aspirin, ibuprofen, phenylbutazone) Signs  Vary from asymptomatic to ___________  Anemia, edema  ________________________  Anorexia  Abdominal pain  Septicemia if perforation occurs Dx  X-ray using ______________ (Ba) to show ulceration in stomach lining (caution if perforation is suspected)  Endoscopy

20. Gastric Ulceration Rx  Fluid therapy for dehydration  NPO (as before)  Coating agents/antacids  Cimetidine— ______________ (↓ HCl production)  Omeprazole—↓ HCl production (proton-pump inhibitor) Client info  Do not use NSAIDs without veterinary supervision  Give NSAIDs with meal/antacids

21. Gastric Dilatation/Volvulus Primarily a disease of _________, ____________dogs (2-10 yrs) Dilation—gas filled; Volvulus—twisted along longitudinal axis Food/exercise? Etiology unknown Signs  Abdominal pain/distension  Weakness, collapse, depression, nausea, salivation  Increased __________– may lead to arrhythmias Dx  PE shows dilation, poor perfusion (↑ cap refill)  X-rays show air filled stomach- ________________________  ECG may show vent arrhythmia or sinus tachycardia  CBC and Chem panel necessary to assess electrolyte levels

22. Gastric Dilatation/Volvulus

24. Rx  Goals ____________ stomach Pass stomach tube 18 gauge needle Stabilize patient (fluids, electrolytes, ECG) Rx for shock  IV fluids  Corticosteroids Antibiotics Prepare for Sx R lateral view

25. Gastric Dilatation/Volvulus

26.  Sx: Laparoscopic correction and surgical correctionLaparoscopic correction surgical correction  FYI FYI  Post-Op ECG Blood pressure Pain management Monitor urine output Antibiotics Maintain fluids (oral, IV)

27. Client info  __________________ meals  Limit exercise after meals  Feed high-quality protein diet  Tack-down procedure not 100% preventative Gastric Dilatation/Volvulus

28. Gastric Neoplasia Most common malignant neoplasia in dogs is ____________; in cats ______________________________ Signs  Wt loss  Vomiting w/ or w/o blood  Obstruction  Usually seen in older animals Dx  Endoscopy and biopsy for diagnosis  X-ray with Barium contrast

29. Rx  _________________ is TOC (treatment of choice) Many tumors are too far advanced (inoperable)  Chemotherapy  Radiation less successful for gastric tumors Client info  Px is poor; gastric neoplasia is a fatal disease  Supportive care, control of vom, good nutrition are needed for these animals Gastric Neoplasia