GI3- Txt of Intestinal Dz

  1. Acute diarrhea is usually ___________, except in specific cases when...
    self-limiting; a specific etiology is known (parasites) [deworming is never wrong, give fluids if necessary]
  2. What should you not do with an animal with diarrhea?
    do not withhold food (unless intractable vomiting)
  3. What is a recommendation that vets have historically made for animals with acute diarrhea that is no longer recommended?
    giving rice and chicken instead of dog food
  4. What are specific bacterial or protozoal enteropathogens for which antibiotics are indicated? (3)
    Clostridium, Giardia, E. coli
  5. Antibiotic- responsive diarrhea is aka _____________; effects that antibiotics are thought to have in these cases include...
    intestinal dysbiosis; immunomodulatory effects, specific alteration of gut flora.
  6. What are the most commonly used antibiotics with acute diarrhea? (2)
    Metronidazole, Tylosin
  7. What findings on the GI panel are associate with intestinal dysbiosis?
    low cobalamin, high folate
  8. When are antibiotics NOT indicated? Why?
    uncomplicated, non-infectious diarrhea; may adversely affect normal GI flora, may promote antibiotic resistance
  9. What are options for diet trials? (4)
    novel ingredient, hydrolyzed, highly digestible, home-cooked
  10. Describe what "hydrolyzed diet" means.
    • reduced protein size--> reduced allergenicity (gut can't recognize it as an antigen anymore)
    • the carbohydrates are intact
    • typically highly digestible
  11. The highly digestible diets generally have low _________, so this can lead to...
    fiber (and fat); animal's small bowel signs improve, but they start have large bowel signs (b/c the fiber is so low)--> add metamucil
  12. Describe typical "highly digestible" diets.
    ~90% digestible, low-to-moderate in fat, NOT novel ingredient or hydrolyzed
  13. When are "low fat diets" useful?
    in dogs with fat intolerance, certain PLEs
  14. What are Dr. Parker's opinions on home-cooked diets?
    no inherent benefit, most recipes do not provide complete and balance nutrition (get a vet nutritionist on board), can formulate a novel ingredient diet, typically excellent digestibility
  15. Fiber is a component of ____________ but it is unique because...
    dietary carbohydrate; resists enzymatic digestion in the SI.
  16. Fiber can benefit animals with...
    diarrhea AND constipation.
  17. What are 2 characteristics of fiber that can be quantified?
    solubility and fermentability
  18. Sources of soluble and insoluble fiber.
    • Soluble: oatbran, barley, nuts, seeds, beans, lentils, fruits, veggies
    • Insoluble: whole wheat, whole grain, veggies, wheat bran
  19. Describe the mechanism and consequences of soluble fiber.
    binds excess water in intestine, reducing water content in stool, increasing viscosity, slowing GI transit time
  20. What are the results of fermentation in the intestines?
    short-chain fatty acids,which benefit colonocyte health and reduce colonic pH, impeding pathogen growth
  21. What happens when you have too many short-chain fatty acids?
    osmotic diarrhea (too much soluble fiber)
  22. Describe the mechanisms of insoluble fiber.
    bulking agent, stretching of intestinal wall, stimulating peristalsis
  23. What can cause low cobalamin?
    chronic enteropathies and EPI
  24. How does cobalamin deficiency contribute to intestinal disease? (2)
    villous atrophy, mucosal inflammation
  25. Cobalamin isĀ supplemented by what means?
    parenterally, orally (brand new product)
  26. What are criteria for efficiency of probiotics? (2)
    live microorganisms, adequate amounts
  27. What are the purported benefits of probiotics? (3)
    establish healthy intestinal microflora, compete with pathogenic bacteria to colonize intestinal mucosa, support immune system
  28. What is a prebiotic?
    non-digestible dietary substances that get fermented and enhance good flora (like fiber....)
  29. What are criteria for classification as a prebiotic? (3)
    resistance to digestion in GI tract, fermentable, selective for stimulation of "good" flora
  30. What drugs decrease GI motility?
    • opioids (loperamide), anticholinergics (atropine)
    • NOT INDICATED IN THE MAJORITY OF CASES, atropine may cause ileus
  31. List immunosuppressive agents.(5)
    • corticosteroids (Pred, Budesonide)
    • Azathioprine
    • Cyclosporine
    • Chlorambucil
    • Mycophenelate mofetil
  32. Side effects of corticosteroid use. (4)
    PU/PD, polyphagia, muscle atrophy, insulin resistance (with chronic use)
  33. Describe the unique characteristics of Budesonide.
    steroid with high topical activity and low systemic activity, rapidly metabolized in liver, well-tolerated, used for GI and respiratory disease
  34. What is the most common second line drug for immunosuppression with IBD?
  35. What are side effects of azathioprine? (3)
    hepatotoxicity, BM suppression (don't use in cats!!!), GI upset
  36. What is Chlorambucil?
    alkylating chemotherapy agent, adjunctive therapy for refractory IBD and GI lymphoma, monitor CBC (BM suppressant)
  37. What are mycophenelate side effects?
    transient GI upset, generally well-tolerated immunosuppressant
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GI3- Txt of Intestinal Dz
vetmed GI3