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SA Alimentary 2: Approach to acute gastrointestinal disease Part Brehyr -…
SA Alimentary 2: Approach to acute gastrointestinal disease Part Brehyr
Describe an appropriate diagnostic plan for acute gastrointestinal disease in dogs and cats with reference to clinical pathology and diagnostic procedures (radiography, ultrasonography and endoscopy)
HISTORY:
signalment - age, breed, entire or neutered
previous history - medication inlcuding anthelmentics, vaccination history
recent history - dietary, toxins, recent contacts, any other clinical signs
CLINICAL SIGNS:
time frame of signs
gas production
preseence of blood
other systemic signs
PHYSICAL EXAM:
consider PPE
hydration and fluid status
assess pain (localise)
palpable abnormality ie rectal exam
evidence of systemic disease
ACUTE GI DISEASE : INVESTIGATE OR NOT?
suspicion for systemic disease
known underlying disease eg diabetes mellitus
dehydrated?
suspicion for foreign body
abdominal pain
NO INVESTIGATION:
often acute vomiting and diarrhoea is self limiting
may not need speofc treatment
BLOOD TESTS:
assess for extra-GI causes and secondary effects - rule out extraGI disease befpre diagnostic tests
initial bloods - haem, biochem, electrolytes, PCV, TP, albumin
further? - acute pancreattis (cPLI), hyperthyroidosm, Addisons
WHAT CAN HAEMATOLOGY TELL US:
Increased PCV and plasma proteins -
dehydration
anaemia -
GI haemorrhage, addisons disease, chronic blood loss ie microcytic hypochromic anaemia
stress leukogram
leucocytosis -
infection/inflammation
leucopenia -
parvo-virus, sepsis
eosinophilia -
parasitic disease, eosinophilic enteritis, addisons
DIAGNOSITIC IMAGING:
look for foriegn body
radiographic sign of obstruction
take intial radiograph then serial radiographs if needed
PACREATITIS - RADIOGRAPHY:
poor sensititbity / specificity (cute vs chronic)
local peritonitis right cranial quadrant (loss of detail and ielus)
PACREATITIS - US:
Acute:
changes may be seen
may take 2-3 days for visible changes
PLI may rise first
chronic
may appear normal
abnormal findings: Pain on probe-pressure
•Abnormal size
•Reduced echogenicity
•‘Mass effect’
•Cyst / abscess / free fluid
INVESTIGATIONS - FAECAL ANALYISIS
PUPPIES WITH ACUTE HAEMORRHAGIC D+:
faecal parvovorus antigen ELISA
inhouse snap tets
repeat if sus and neg
may get false +ve for 4-8 days post live vaccination
PCR
delayed diagnosis at LAB vs in house
post mortem
useful information for other in contact puppies
LESS ACUTE:
3 day pooled sample
faecal paristitology - faecal smear
diardia antigen ELISA snap test which is 90% sensitive, 95% specific
Giardia oocysts: shedding is
intermittent - Three pooled
samples in zinc sulfate
floatation = 95% sensitiv
Colonic wash if suspicion
of Tritrichomonas
FAECAL CULTURE OR NOT?:
conisder bacterial pathogen
pyrexic, neutropenic, septic, young, raw feed. acute haemorrgaic vomiting
Describe the management and treatment options for acute gastrointestinal disease in small animals
SYMPTOMATIC TREATMENT OPTIONS
NUTRITION:
bland food - little and often
intestinal cells rewuire nutirents to recover
transiiotn to normal diet over 2-5 days
FLUID INTAKE:
fresh water
rehdryation solutions
wet or watered down food
ANTI-EMETICS:
may give one or multiple
maropitant is first line
metaclopromaide
ANALGESIA:
oral vs injectable
paracetoml, tramadol, gabapentin - oral
OTHER MEDICATION:
appetitie stimulants eg mirtazepine
anthelmentics
antiobiotcs onlt if indicated
buscopan
TREATMENT FOR FOREIGN BODIES:
Gastric
small, soft, noncaustic - attempt emesis
needles - endoscopioc
if had a full meal since tgen do not try and retirec and see if it passes
if incidental finding then likely to be embedded int he stimach wall so leave alone
gastric bones should dissolve
endoscopic or surgical retrieval if symtoamtic or too large to pass
intestinal
if obstructed or perforated then surgical resection
small or mom obtrsucted or needle then wait and see
breed, high fibre diet for bulk to help passage
ACUTE PANCREATITIS:
management
fluid support
nutritional support
prognosis is better if fed within 48 hrs
oral, tube feeding or parenteral
little and often
highly digestable
cimplex carbohydrates
low fat
Medication
antiemetics
appetite stims
analgesia
prokinetic is ileus
plasma-antipeorease activcity
Prognosis
risk of death
AHDS - management:
for hypovolaemic then use a bolus
Canine Parvovirus – Management:
Barrier nursing
• Disinfection with hypochlorite
Naso-oesophageal tube trickle
feeding, once vomiting
controlled
• Faster recovery
• Lower mortality
Aggressive fluid therapy
• IV crystalloids
• May need to use IO
• SQ NOT appropriate
• Monitor electrolytes – K+
• Monitor and supplement glucose as
necessary
Canine Parvovirus – Treatment:
control emesis
anti-emetics
antibiotics
prognosis is varaible
