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Describe the characteristics of intestinal adenocarcinomas.
epithelial carcinoma, usually solitary intestinal mass (annular or stenosing), may metastasize
How is intestinal adenocarcinoma definitively diagnosed?
What is the treatment and prognosis for intestinal adenocarcinoma?
- resection +/- anastomosis
- prognosis better for rectal than gastrointestinal, no mets-better
What are clinical signs of intestinal neoplasia? (8)
- weight loss, vomiting, diarrhea, anorexia
- PE: normal or abdominal pain, effusion, +/-palpable mass
What are possible consequences of intestinal neoplasia? (4)
intestinal obstruction, intussusception intestinal perforation, GI ulceration
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
Describe the characteristics of intestinal lymphoma.
round cell tumor, discrete nodular masses or diffuse infiltration
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
Clinical signs of intestinal lymphoma. (7)
vomiting, diarrhea, anorexia, weight loss, hepatosplenomegaly, lymphadenopathy, +/- poor body condition
Potential bloodwork findings with lymphoma. (4)
anemia, thrombocytopenia, hypoalbuminemia, hypocolbalaminemia
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
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
Describe the characteristic of GI mast cell tumors.
round cell tumor, often diagnosed in other abdominal organs, metastasis common
What are possible consequences with mast cell tumors in the intestine? (1)
GI ulceration from histamine release and gastric hyperacidity
What is the treatment and prognosis for intestinal mast cell tumors?
- surgery if possible, chemotherapy
- prognosis is guarded (but better for splenic than intestinal)
Describe the characteristics of leimyosarcoma.
smooth muscle sarcoma, solitary mass from muscularis layer
What is the treatment and prognosis for intestinal leiomyosarcoma?
- surgical resection
- good prognosis with complete resection
Describe the characteristics of GI stromal tumors (GIST).
come from interstitial cells of cajal (pacemaker cells of GI tract that regulate motility and peristalsis)
What is the treatment and prognosis for GISTs?
- complete surgical resection
- good prognosis
Contrast clinical signs of acute versus chronic obstructions.
- Acute: vomiting, abdominal pain, depression
- Chronic: diarrhea, weight loss, PLE
What lab abnormalities are classic for proximal intestinal obstruction?
hypochloremia, metabolic alkalosis
What lab abnormalities commonly occur with intestinal obstructions? (8)
- hypochloremia, metabolic alkalosis, increased bicarb, hypokalemia, hyponatremia
- azotemia, hyperlactatemia, hemoconc
Causes of intestinal obstruction. (3)
FB, intussusception, neoplasia
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
If you think there might be a perforation, DO NOT give ___________ because...
barium; barium peritonitis is aweful.
What processes might cause secondary intussusception? (4)
viral enteritis (parvo), heavy parasite burden, neoplasia, FB [any process that affects intestinal motility]
How is intussusception diagnosed?
- Suspicious: firm, tubular structure palpated in abdomen
- Abdominal US: target-like appearance in transverse plane
What is the treatment for intestinal intussusception?
- stabilize the animal: hydration, electrolytes, acid-base, blood glucose, analgesia
- resection and anastomosis, treat/ manage underlying cause
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
How can you manage short bowel syndrome?
change in diet, increased fiber, control for bacterial overgrowth/ dysbiosis with long term antibiotics