Dysphagia, Regurgitation, & Esophagus
The type of muscle and distribution of esophageal muscles in cats and dogs respectively?
Dogs - UES - all skeletal mm - LES
Cats - UES - 2/3 skeletal - 1/3 smooth mm - LES
UES - closed for airway & LES - closed for reflux
Drug Considerations - prokinetics like cisapride and metoclopramide target smooth muscle.
Radiographs - “Herringbone” pattern of smooth mm
The definitive diagnostic test for granulomatous colitis?
Fluorescent In Situ Hybridization (FISH)
- Binds to invasive species bacterial RNA
- Breed Predilections: BOXERS & French Bulldogs (Younger)
- Also helpful w/ E. Coli associated granulomatous colitis
The unique anatomical differences in pancreatic ducts?
Dogs - SEPARATE Bile Duct & Pancreatic Duct Entry into Duodenum
Cats - SINGLE Entry for Bile Duct and Pancreatic Duct into Duodenum
50-56% of cats with pancreatitis also have TRIADITIS
The major liver enzymes and what they indicate?
ALT - cytoplasmic enzyme indicating hepatocellular damage
ALP - Hepatocytes in bile canaliculi, can be induced by steroids, bone, liver
AST - cytoplasmic and mitochondrial enzyme (irreversible damage to cell), also cardiac and skeletal muscle
GGT - Hepatocytes in bile canaliculi, Intra/Extrahepatic Cholestasis
Mild Increase = 2-3x, Moderate = 5-10x, Marked = >10x
Gold standard for chronic gastritis diagnosis and most common cellular infiltrate?
Gold Standard - Endoscopy and Histopathology (hypertrophy, atrophy, ulceration, fibrosis)
Cellular Infiltrate - LYMPHOPLASMACYTIC (51-100%)
The major characteristics that help differentiate dysphagia, regurgitation, and vomiting?
1. Effort - Vomiting is ACTIVE (centrally mediated) with prodromal nausea
2. Digested vs Undigested Food
3. Timing of ejection: dysphagia<regurg<vomit
4. Other signs: swallowing attempts, ability to drink, pain, systemic signs
The first line treatment for Chronic Inflammatory Enteritis (CIE)?
DIET TRIAL
- can aid in diagnosis (90% are food responsive)
- at least 3 (THREE) diet trials (No treats!)
- 2 weeks for initial effects, longer for remission, challenge after 14 weeks (not always needed)
The breed and genetic predilection for pancreatitis?
Schnauzers
SPINK1 Genes - Encodes pancreatic secretory trypsin inhibitor (protective protein secreted with trypsinogen)
These tests provide insight into Hepatic Function?
1. Albumin, Glucose, BUN, Cholesterol, Bile Acids
2. Serum Bile Acids (12hr fast, pre & 2hr post)
3. Ammonia - convert NH3 to urea
4. Protein C - Anti-coag protein prod in liver - PSS vs Microvascular dysplasia
5. Coagulation Testing
The three major chronic GI Parasites?
(1.) Physaloptera and (2.) Ollulanus tricuspis (Cats) - attach to gastric mucosa, visualize and treat empirically w. Fenbendazole
(3.) Phythium insidiosum - water mold parasite, histopath for definitive dx, requires sx, immunotherapy and AB’s
The major diagnostic imaging options and ancillary tests?
1. Survey Films and Contrast Esophagrams - static image but affordable & fast
2. Videofluroscopic Swallow Study (Gold Standard) - dynamic study but requires fluoroscopy and specific positioning
3. Endoscopy - Evaluate mucosal surface, FB removal, Biopsy but risk complications (perforation, hemorrhage, aspiration pneumonia, esophagitis/stricture)
4. Additonal Ancillary Tests:
- AChR Antibody titer for megaesopahgus/myasthenia gravis
- Endocrine tests - Thyroid and Adrenals
- pH monitoring systems
Treatment for Protein Losing Enteropathies?
1. Diet - Ultra Low Fat (white-fish)
2. Immunosuppressives - Prednisone, Chlorambucil, Cyclosporine
3. Antithrombotics - Clopidogril (helps with loss of anti-thrombin proteins)
4. Supplement cobalamin as needed
The diagnostic tests for pancreatitis in cats and dog?
Typical appearance on ultrasound?
SPEC fPLI / SPEC cPLI - Gold Standard
SNAP fPL / SNAP cPL - In Clinic
Biopsy/Histopath - Can be unrewarding
High protein Transudate abdominal effusion
Ultrasound: Enlarged HYPOECHOIC Pancreas and HYPERECHOIC Mesentery (Reverse Oreo)
1. Classification:
Congenital (80%): Intrahepatic - Large Breed, Extrahepatic - Small Breed.
Aqcuired (20%) - usually multiple and due to liver failure
2. Treatment - Low protein diet, lactulose, antibiotics.
Surgical Attenuation (GS) - Ameroid constrictor, cellophane band, occluders, coil embolization
Chronic Gastritis (Helicobacter-associated) diagnosis and Treatment?
1. Diagnosis - Accurate - biopsy, Rapid Urease test*, Endoscopic brush sample & microscopy
2. TRIPLE THERAPY
Amoxicillin (AB), Metronidazole (AB), Omperazole (PPI)
The treatments for cricopharyngeal achalasia, megaesophagus, esophagitis/strictures?
1. Cricopharyngeal Achalasia - Botulinum toxin A, myotomy/myectomy
2. Congenital/Idopathic Megaesophagus - Sildenafil & SC. Acquired Secondary - Treat underlying cause & SC
3. Esophagitis - Diet (smaller, less fat, & hydrolyzed), PPI’s, Sucralfate, Cisapride. Stricture - Mechanical Dilation & Triamcinalone (reduces fibrosis)
The key ultrasound findings in Protein Losing Enteropathy (PLE)?
1. Hyperechoic striations (75% sensitive & 96% specific)
2. Ascites (due to leakage)
*Lymphangiectasia - dilation of lymph vessels and disruption/rupture of lacteals
*Conditionally approved* Treatment for pancreatitis in dogs and MOA?
Panoquell (fuzapladib)
Leukocyte function-associated antigen Type 1 (LFA-1) activation inhibitor - Blocks activation and adhesion of neutrophils into pancreatic tissue
3 day IV to reduce systemic inflammation
These proteins regulate copper levels in the body? The breeds predisposed to issues wth this along with genetic variation?
1. Proteins: ATP7A (intestine and absorption) & ATP7B (liver and excretion)
2. Bedlington Terrier (COMMD1 deletion & 2x ATP7B)
Labs (ATP7B aa substitution)
Primary cause of chronic gastritis in cats along with predilections and treatments?
Eosinophilic sclerosing fibroplasia
Dx: biopsy of solitary mass w/ eosinophilic infiltrates
RAGDOLLS AND MALE CATS
Tx: Surgical removal of mass and immunomodulation
The most common esophageal neoplasias in cats and dogs with prognosis?
Cats - Squamous Cell Carcinoma - Poor Prognosis
Dogs - Fibrosarcoma and Osteosarcoma - Poor Prognosis
Typically linked to Spirocera lupi
Environmental Shed -> Dung Beetle to L3 -> transport host & ingestion -> L3 into stomach mucosa -> arteries -> Aorta -> esophagus where mature into adult worms and reproduce (5-6 month lifecycle)
What anti-diarrheal and enema treatments must be avoided in cats?
1. Anti-diarrheal: Bismuth Subsalicylate (PEPTO = PEP-NO). Lack liver enzyme to break down salicylates
2. NO Phosphate containing enemas. Severe electrolyte imbalance (High Phos, Low Calcium, High Sodium). Weakness, Lethargy, Vomiting, Tremors/Seizures, Cardiac Arrest
Diagnosis and treatment of Exocrine Pancreatic Insufficiency (EPI)?
Trypsin-like immunoreactivity (TLI) - Gold Standard
Treatments
1. Pancreatic enzyme replacement therapy (PERT) - Common complication of oral bleeding
2. Diet Modification - Highly digestible/hydrolyzed
3. Cobalamin and intrinsic factor supplementation
Hepatic Lipidosis Diagnosis and Treatment?
1.) BW - elevated ALP, Hyperbillrubinemia
U/S & Histopath - Enlarged hyperechoic liver w/ vacuolar changes (lipid accumulation)
2.) Treatment - Aggressive nutrition support (feeding tube), high protein, calorie dense, L-carnitine.
Fluids, anti-emetics, S-adenosyl, Cobalamin
Gastric dysmotility diagnosis and treatment?
1. Rule out mechanical obstruction.
2. Radionuclide scintography or qualitative trans abdominal ultrasound (evaluate filling and measure contractions)
Tx: Prokinetic Drugs: Cisapride, Metoclopramide, Erythromycin.
Diet Modification: *Early Enteral Nutrition (Do not rest bowel >48hr)