GI3- Intestinal Obstruction

  1. Describe the characteristics of intestinal adenocarcinomas.
    epithelial carcinoma, usually solitary intestinal mass (annular or stenosing), may metastasize
  2. How is intestinal adenocarcinoma definitively diagnosed?
  3. What is the treatment and prognosis for intestinal adenocarcinoma?
    • resection +/- anastomosis
    • prognosis better for rectal than gastrointestinal, no mets-better
  4. What are clinical signs of intestinal neoplasia? (8)
    • weight loss, vomiting, diarrhea, anorexia
    • PE: normal or abdominal pain, effusion, +/-palpable mass
  5. What are possible consequences of intestinal neoplasia? (4)
    intestinal obstruction, intussusception intestinal perforation, GI ulceration
  6. 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
  7. Describe the characteristics of intestinal lymphoma.
    round cell tumor, discrete nodular masses or diffuse infiltration
  8. 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
  9. Clinical signs of intestinal lymphoma. (7)
    vomiting, diarrhea, anorexia, weight loss, hepatosplenomegaly, lymphadenopathy, +/- poor body condition
  10. Potential bloodwork findings with lymphoma. (4)
    anemia, thrombocytopenia, hypoalbuminemia, hypocolbalaminemia
  11. 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
  12. 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
  13. Describe the characteristic of GI mast cell tumors.
    round cell tumor, often diagnosed in other abdominal organs, metastasis common
  14. What are possible consequences with mast cell tumors in the intestine? (1)
    GI ulceration from histamine release and gastric hyperacidity
  15. What is the treatment and prognosis for intestinal mast cell tumors?
    • surgery if possible, chemotherapy
    • prognosis is guarded (but better for splenic than intestinal)
  16. Describe the characteristics of leimyosarcoma.
    smooth muscle sarcoma, solitary mass from muscularis layer
  17. What is the treatment and prognosis for intestinal leiomyosarcoma?
    • surgical resection
    • good prognosis with complete resection
  18. Describe the characteristics of GI stromal tumors (GIST).
    come from interstitial cells of cajal (pacemaker cells of GI tract that regulate motility and peristalsis)
  19. What is the treatment and prognosis for GISTs?
    • complete surgical resection
    • good prognosis
  20. Contrast clinical signs of acute versus chronic obstructions.
    • Acute: vomiting, abdominal pain, depression
    • Chronic: diarrhea, weight loss, PLE
  21. What lab abnormalities are classic for proximal intestinal obstruction?
    hypochloremia, metabolic alkalosis
  22. What lab abnormalities commonly occur with intestinal obstructions? (8)
    • hypochloremia, metabolic alkalosis, increased bicarb, hypokalemia, hyponatremia
    • azotemia, hyperlactatemia, hemoconc
  23. Causes of intestinal obstruction. (3)
    FB, intussusception, neoplasia
  24. 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
    • exploratory
  25. If you think there might be a perforation, DO NOT give ___________ because...
    barium; barium peritonitis is aweful.
  26. What processes might cause secondary intussusception? (4)
    viral enteritis (parvo), heavy parasite burden, neoplasia, FB [any process that affects intestinal motility]
  27. How is intussusception diagnosed?
    • Suspicious: firm, tubular structure palpated in abdomen
    • Abdominal US: target-like appearance in transverse plane
  28. What is the treatment for intestinal intussusception?
    • stabilize the animal: hydration, electrolytes, acid-base, blood glucose, analgesia
    • resection and anastomosis, treat/ manage underlying cause
  29. 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
  30. 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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GI3- Intestinal Obstruction
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