ACVECC > GI > Flashcards

GI Flashcards

(58 cards)

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1
Q

Gastric Inhibitory Peptide

A

Stimuli: protein, fat, carbs
Site of secretion: K cells of duodenum and jejunum

Stimulates insulin release

**Inhibits gastric acid secretion

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2
Q

Secretin

A

Stimuli: acid & fat
Site of secretion: S cells of duodenum, jejunum and ileum

Stimulates pepsin secretion, pancreatic bicarb secretion, biliary bicarb secretion, growth exocrine pancreatic CK

** inhibits gastric acid secretion

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3
Q

Gastrin

A

Simulus: protein, distention, nerve
Site secretion: G cells in antrum, duodenum & jejunum

Stimulates gastric acid secretion, mucus growth

inhibited by acid

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4
Q

Cholecystokinin

A

Stimulus: protein, fat, acid
Site of secretion: I cells in duodenum, jejunum and ileum

Stimulates pancreatic enzyme secretion, pancreatic bicarb secretion, GB contraction, growth of exocrine pancreas

** Inhibits gastric emptying

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5
Q

Pyloric Glands

A
  • Mainly secrete mucus
  • Small amount pepsinogen
  • Gastrin secretion
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6
Q

Pepsinogen

A
  • Precursor to pepsin –> helps break down proteins
  • Stimulated by Ach release from gastric enteric nervous plexus or acid in the stomach
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7
Q

Oxytonic glands

A
  • Compose 80% stomach (fundus)
  • mucus (neck) cells: release mucus
  • cheif cells - release pepsinogen
  • parietal cells: secrete hydrochloric acid & intrinsic factor
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8
Q

4 motility patterns

A
  1. Segmental: circular smooth m
  2. peristalsis: longitudinal smooth m
  3. intestinointestinal inhibition: reflex inhibition of peristalsis due to distention of segment
  4. Migrating motility complex: slow propulsive contact to sweep debris during fasting
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9
Q

motilin

A

Stimuli: fat, acid, nerve
Site of secretion: M cells in duodenum and jejunum

Stimulates gastric motility, intestinL MOTILITY

  • ERYTHROMYCIN binds
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10
Q

Somatostatin

A

Stimuluis: acid, lipid, bile
Site of secretion: D cells in intestine and pancreas

Action: inhibits gastrin, VIP, GIP, secretin, motilin

**Stops alls ecretions
**Paracrine action

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11
Q

Serotoninergic receptors

A
  1. 5HT1P: intitiates peristalsis and secretory reflexes
  2. 5HT3: activates extrensic N sensory –> nausea & vomiting
  3. 5HT4: increased PREsynaptic release of Ach & calcitonin gene related peptide
    - increase PSNS transmission
    - Cisapride
    -Doesnt work if nerve is degenerated
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12
Q

Risk factors of abdominal compartment syndrome

A
  1. Dec abdominal wall compliance
  2. increase intra-abdominal luminal content
  3. increased abdominal content
  4. capillary leak syndrome
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13
Q

Innervation GIT

A

PSNS
-Vagus: upper GI - 75% afferent, 25% efferent
-Pelvic N: distal transverse colon to rectum

SNS
- T1-L3 cord segments: short preganglion: celiac, mesenteric, hypogastric
-50% aff, 50% efferent
*Signal may bipass myenteric - muscle & mucosa

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14
Q

Aldosterone effect on colon

A
  • Stimulates synthesis of Na channels
  • increased Na absorption
  • Increase K excretion

-Proximal 1/2 colon (distal 1/2 storing)

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15
Q

Nutrients from colon and their source

A
  • Short chain fatty acids: esp acetate, propionate, & butyrate
  • Source: cellulose, pectin, henocellulose
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16
Q

Predominant source ammonia GIT

A

Distal intestine/colonic bacteria have urease action on urea or dietary amines

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17
Q

intra-abdominal hypertension

A

Sustained or repeated pathologic evaluation of IAP of >12 mmhg

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18
Q

Abdominal compartment syndrome

A

Sustained increase in IAP of >20 mmHg ( with or w/o APP <60 mmHG) associated with new organ dysfunction or failure

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19
Q

Factors influencing intra-abdominal pressure

A

body position
Body condition
Pregnancy
Increased abdominal wall tone
Pain
Anxiety
External abdominal pressure application
Belly bandages
volume infusate

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20
Q

Physiologic Effects intra-abdominal hypertension

A
  1. Hemodynamic Effects: INcreased CVP, RAP, PCWP, MAP, SVR
    - Due to increased catecholamines & volume shifts –> CO transient increase then decrease due to drop in venous return
  2. Renal: decreased GFR - oloiguria & anuria
  3. Pulmonary: Decreased pulmonary compliance –> inadequate negative thoracic pressure
  4. CNS: increqased ICP –> increased intrathoracic P –> increased blood volume in thhe compliant system
    - CS: obtunded, CN deficits, vomiting, seizures
  5. Visceral: dec blood flow to hepatic, portal, intestinal and gastric
    - Bacterial translocation Risk
  6. Systemic: Increased ADH, Aldosterone, Renin, and increased catecholamines
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21
Q

How is hydrochloric acid made

A
  • Regulated by enterochromaffin like cells –> histamine
    Made in parietal cells
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22
Q

Clostridium perfingens

A
  • Gram +, anaerobic, spore forming bacilli
  • 5 biotypes & 4 toxin genra
    -All biotypes can harber enterotoxin (CPE)
  • Type A: Acute hemorrhagic diarrhea syndrome (CPE)

Diagnosis: no gold standard
- Fecal ELISA CPE
- PCR for strains

Treatment: Ampicillin, erythromycin, metronidazole*, +/- tylosin

** Can have bacterial resistance

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23
Q

C. Diffecile

A
  • Gram +, anaerobic, spore forming bacilli
  • 3 toxins:
    A & B –> typically present together
    Binary toxin - unclear significance
  • PCR Ag ELISA

Treatment: metronidazole +/- ampicillin

**Potentially zoonotic
** May cause acute severe diarrhea syndrome or subclinical

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24
Q

Enteric E coli infections

Study These Flashcards
A
  • Gram -, nonspore rods
  • 7 pathotypes:
    Enteropath
    enterohemorrhagic
    enterotoxic
    necroptoxigenic
    enteroinvasive
    enteroaggragative
    Adherent-invasive

** Unclear role of illnes - except AIEC

25
Pathophysiology of Pancreatitis
- trypsinogen activated early to trypsin—>trypsin activates kallirenin-kinin system --> activates inflammatory cascade--> Increased ROS --> vasodilation, decreased BP, ARF, microvascular thrombosis & DIC - Local ischemia + phospholipase A2 + ROS --> Disrupt cell membrane--> hemorrhage, necrosis, increased cap permability & intitate arachidonic acid cascade - Elastase--> degrades vascular elastin--> increased vascular permeability - Chymotrypsin --> acitvates xanthine oxidase--> ROS - Phospholipase A2 -- degrades surfactent--> ALI/ARDS
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Additional treatment for severe acute pancreatitis
1. FFP - contains alpha2 macroglobulins, which may aid in binding of proteases and help clear them ( controversial) 2. Low dose dopamine- in cats decreases vascular permeability - unsure if helps in dogs ** metoclopramide dopamine antagonist! 3. Nutrition: +/- cobalamin in cats 4. icalcium if clinical 5. Glycemic control
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Viral enteritis
CPV2 + panleukopenia: SEVER (attack crypts) Rotavirus + coronavirus - attacks tips of villi (less severe)
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HGE
PCV at least 60%, normal TS - INcreased PCV due to splenic contraction - Normal to decreased TS due to loss in GI and redistribution +/-c. perfingens playing tole - May be due to abnormal immune response, endotoxin or diet changes
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PLE
- Associated with different disease: lympho-plasmacytic, eosin, or granulomatous lymphangectasia, diffuse fungal or lymphosarcoma - MOA: inflammation --> loss of GI barrier --> enterocyte & Tight junction disrupted
30
Granulomatous colitis
- AKA histiocytic ulcerative colitis of boxers (also seen in fenchies and border collies - Severe large bowel diuarrhea + weight loss + inappetance - BW: dec Albumin +/- chronic anemia - Diagnosis: FISH stains: adherent-invasive e coli (AIEC) Tx: fluoroquinolones for 8 weeks
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Pancreatitis with TLI & CPE
Trypsin like immunoreactivity - suggestive - also increased in azotemia & GI disease Pancreatic Elastase-1(CPE) - helpful of severe
32
Salmonella
- Gram +, facultative anaerobic, nonspore forming bacilli - Diagnosis: culture + PCR + clinical signs ( lethargic, fever, anorexia then vomiting, abdominal pain & diarrhea) Treatment: - only supportive unless systemically ill - Abx: ampicillin + enrofloxicin if systemically ill ** zoonotic **No abx if immunocompromized owner
33
Campylobacter GI illness
- Gram -, aerophilic rods - Rare cause of diarrhea in dogs--> usually young if it does Diagnosis: fecal real time PCR culture Treatment: self limiting - If decreased immune function or febrile/hemorrhagic diarrhea --> antibiotics (macrolides recommended; fluoroquinolones there is increased resistance in human med) ** possibly zoonotic--> in humans can progress to immune mediated disease (Guillain-barre syndrome)
34
Differentials for acquired megaesophagus
-Idiopathic - Myasthenia gravis - Addisons - Toxins: lead & thalium - Inflammatory: immune mediated polymyositis, preneoplastic myositis, lupus, dermatomyositis - Peripleural neuropathy: larpar/GOLLP - Severe esophagitis - Esophageal dysmotility of terriers--> resolves as they get older
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Congenital megaesophagus & breeds
- Congenital form due to sensory dysfunction where distention of vagal afferent defective Breeds: wire haired foxhounds, minischnauzers, GSD, great danes, irish setters, Labs, Newfies, Sharpeis Siamese
36
Increased BUN:Crea ratio
- Anything > 20 - DDX: GI hemorrhage, fever, burns, infections, starvation, steroid administration
37
Vomiting Center
- Stimulated by vagal and sympathetic impulses of GI inflammatory or overdistention - Triggered by vestibular, CTZ & cerebellum CTZ: area posterna of 4th ventrical lacks BBB --> drugs may stimulate
38
Central trigger zone receptors
** Activated by apomorphine, uremic toxins, hepatotoxins, endotoxin, & cardiac glycosides D2: dopaminergic H1: Histamine Alpha2: Adrenergic 5HT3: Serotonin M1: Muscarinic-ACh NK1: neurokinin ENK mu,beta: opiates *8Vestibular system directly activates
39
Vestibular nausea receptors
- Motion stimulates H1: histamine M1: muscarinic-ACh NMDA: glutamate Vestibular --> CRTZ (dogs) ---> directly stimualtes vomit center in cats
40
Vomit center receptors
Alpha2:adrenergic 5HT1A: serotonin
41
Cerebral cortex vomiting receptors
Anticipation/stimulates anxiety: W2 - benzo ENKmu -- opiates --> both directly sitmulate vomit center
42
Gut vomiting receptors
- Stimulated by vomiting center 5HT3(serotonin)--> afferent to vomit center Efferents: 5HT4:serotonin D2: dopamine M2:muscarinic MOT:motilin
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SI obstruction on rads
Cats >2x height of L2 Dogs >1.6 height of L5
44
Septic peritonitis findings (sensitivity and specificitiy
Dogs: BG >20mg/dL 100% sens/spec Lactate >2 mmol/L 100% sens/spec Cats: BG>20 86%sens, 100% spec Lactate >2 not preported
45
Uroabdomen Findings
K Fluid:blood - Dogs: 1.4:1 - Cats 1.9:1 CREA fluid:blood - Dogs&cats: 2:1
46
Regurgitation
- passive ejection of food - Assd with esophageal or pharyngeal disease
47
Osmotic diarrhea
Increased luminal osmoles--> draws fluid into intestinal lumen
48
Secretory diarrhea
Net increased in intestinal fluid secretion (actual increase or due to net decreased absorption)
49
Altered Permeability diarrhea
Normally intestines semipermable, if macroscopic or microscopic damage, see increased permeability through epithelial cells or gap junctions ** Increased risk of bacterial translocation
50
Small bowel vs large bowel
Small: - mucus uncommon - blood uncommon - normal to increased stool volume - +/-- melena - increased to normal frequency - uncommon to have urgency or tenesmus Large: - mucus common - blood common - normal to decreased stool volume - no melena - increased frequency - common urgency, common tenesmus
51
Deranged motility diarrhea
Increased peristaltic contractions or decreased segmental contractions
52
Infectious causes of diarrhea
- Parasites: acyclostoma sp, toxocara, toxoascaris, trichuris - Bacteria: salmonella, campylobacter, C diff, C perfingens, enteropathogenic ecoli - Viral: parvo, panleuk - Fungal: histo, pythium, cryptococc - Protozoa: tritrich, giardia, cryptosporidium, isospera - Rickettsial: Neorickettsia species - Algal: prototheca - SIBO- controversial
53
Diarrhea diagnostics
CBC/chem/ua Screen GT4, addisons, occults liver disease Fecal, zinc sulfate (giardia), direct Fecal culture, enterotox screen Parvo ELISA Exfoliative rectal cytology --> fungi, algea, neoplastic TLI for EPI Folate & cobalamin if suspected SIBO AUS Biopsy
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Primary GI diarrhea causes
Food intolerance/allergy INfectious IBD Lymphangectasia
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Extra GI diarrhea causes
- Hepatobilliary: dec albumin--> dec biliary salts - Pancreatic Disease: EPI, pancreatitis--> obstructive CBD, SI, inflamm LI -CHF R sided: intestinal & hepatic congestion - Endocrine disorders: HyperT4, addisons, sometimes hypoT4 - noncirrhotic portal hypertension - Post CPA - Septic diarrhea - bacterial endotoxin impairs colonic water & Na absorption --> inc small and large motility
56
Secondary closures of septic peritonitis
1. Jackson pratt: 1 if small dog, 2 if large; decreased risk nosocomial, less intensive care, dec risk eviseration 2. Vacuum assd peritoneal lavage: Cd 1/3-2/3 incision reapposed losely & subatmospheric P cranial extent incision 3. Open drainage: rectus abdomen loosely closed with 1-6 cm gaps --> reassemble sterile bandages with an outer layer impermeable to water - Change 2x/ day in 1st 24 hours, then daily
57
Diagnostic peritoneal lavage
Dialysis or larege bore catheter--> instill 22ml/kg warm, sterile saline then retreive sample and submit for culture DPL counts 500-10500 with nondegen neuts normal post op to 3 days DPL count: predominately degenerative neut with count >/=5K indicates peritonitis
58
IAP clases & recommendations
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