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Describe the characteristics of intestinal adenocarcinomas.
epithelial carcinoma, usually solitary intestinal mass (annular or stenosing), may metastasize
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How is intestinal adenocarcinoma definitively diagnosed?
biopsy
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What is the treatment and prognosis for intestinal adenocarcinoma?
- resection +/- anastomosis
- prognosis better for rectal than gastrointestinal, no mets-better
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What are clinical signs of intestinal neoplasia? (8)
- weight loss, vomiting, diarrhea, anorexia
- PE: normal or abdominal pain, effusion, +/-palpable mass
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What are possible consequences of intestinal neoplasia? (4)
intestinal obstruction, intussusception intestinal perforation, GI ulceration
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What are the 3 most common canine and feline GI neoplasms?
- Canine: adenocarcinoma, smooth muscle tumors, stromal cell tumors
- Feline: lymphoma, adenocarcinoma, mast cell tumor
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Describe the characteristics of intestinal lymphoma.
round cell tumor, discrete nodular masses or diffuse infiltration
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What are the 3 histologic subtypes of lymphoma?
- small cell lymphoma: older cats with chronic disease
- large cell lymphoblastic lymphoma: more aggressive, rapidly progressive
- large cell granular lymphoma: aggressive, metastatic
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Clinical signs of intestinal lymphoma. (7)
vomiting, diarrhea, anorexia, weight loss, hepatosplenomegaly, lymphadenopathy, +/- poor body condition
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Potential bloodwork findings with lymphoma. (4)
anemia, thrombocytopenia, hypoalbuminemia, hypocolbalaminemia
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How is lymphoma diagnosed? (4)
- Abdominal US: intestinal wall thickening, loss of wall layering, lymphadenopmegaly
- *****Full thickness biopsy
- FNA of enlarged lymph nodes: cytology
- Determining immunophenotype: IHC, flow cytometry, PARR
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What is the treatment and prognosis of lymphoma?
- chemotherapy (NOT surgery)
- cats better than dogs (b/c small cell lymphoma is less aggressive than large cell)
- response to treatment is best prognostic factor
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Describe the characteristic of GI mast cell tumors.
round cell tumor, often diagnosed in other abdominal organs, metastasis common
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What are possible consequences with mast cell tumors in the intestine? (1)
GI ulceration from histamine release and gastric hyperacidity
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What is the treatment and prognosis for intestinal mast cell tumors?
- surgery if possible, chemotherapy
- prognosis is guarded (but better for splenic than intestinal)
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Describe the characteristics of leimyosarcoma.
smooth muscle sarcoma, solitary mass from muscularis layer
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What is the treatment and prognosis for intestinal leiomyosarcoma?
- surgical resection
- good prognosis with complete resection
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Describe the characteristics of GI stromal tumors (GIST).
come from interstitial cells of cajal (pacemaker cells of GI tract that regulate motility and peristalsis)
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What is the treatment and prognosis for GISTs?
- complete surgical resection
- good prognosis
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Contrast clinical signs of acute versus chronic obstructions.
- Acute: vomiting, abdominal pain, depression
- Chronic: diarrhea, weight loss, PLE
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What lab abnormalities are classic for proximal intestinal obstruction?
hypochloremia, metabolic alkalosis
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What lab abnormalities commonly occur with intestinal obstructions? (8)
- hypochloremia, metabolic alkalosis, increased bicarb, hypokalemia, hyponatremia
- azotemia, hyperlactatemia, hemoconc
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Causes of intestinal obstruction. (3)
FB, intussusception, neoplasia
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How can we diagnose intestinal obstruction? (5)
- Radiographs: dilated intestinal loops, bunched/pleated intestines (linear FB), free abdominal gas, loss of serosal detail
- contrast radiography
- abdominal US
- CHECK UNDER THE CATS TONGUE
- exploratory
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If you think there might be a perforation, DO NOT give ___________ because...
barium; barium peritonitis is aweful.
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What processes might cause secondary intussusception? (4)
viral enteritis (parvo), heavy parasite burden, neoplasia, FB [any process that affects intestinal motility]
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How is intussusception diagnosed?
- Suspicious: firm, tubular structure palpated in abdomen
- Abdominal US: target-like appearance in transverse plane
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What is the treatment for intestinal intussusception?
- stabilize the animal: hydration, electrolytes, acid-base, blood glucose, analgesia
- resection and anastomosis, treat/ manage underlying cause
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What is short bowel syndrome?
- if you have to take out/ resect more than 70% of the intestine, SBS occurs, leading to maldigestion and malabsorption
- this is due to reduced mucosal surface area, intestinal hypersecretion, bacterial overgrowth, decreased transit time
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How can you manage short bowel syndrome?
change in diet, increased fiber, control for bacterial overgrowth/ dysbiosis with long term antibiotics
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