1. Clinical Manifestations of GI Disorders

A ________ ________ is of utmost importance to get you on the correct diagnostic path.

good history

difficulty in eating/swallowing

dysphagia

What does dysphagia commonly occur secondary to?

O
M
F
T
N

• oral pain

• masses

• foreign objects

• trauma

• neuromuscular dysfunction

What is this showing?

stomatitis

What are the types of neurogenic dysphagia?

P
P
C

• prehensile

• pharyngeal

• cricopharyngeal

inability to pick up food or food dropping from the mouth

prehensile dysphagia

What should be a concern if an animal is displaying prehensile dysphagia?

rabies

In prehensile dysphagia, with what cranial nerves are their deficits in?

CN V, VII, IX, and XII

What do pharyngeal and cricopharyngeal dysfunction usually result in? Why?

regurgitation; there are swallowing defecits

abnormal bacterial growth, especially pathogenic oral bacteria (anaerobes and gram negatives)

halitosis

How can halitosis present clinically?

T
C
O

• tissue necrosis

• calculus/periodontal disease

• oral/esophageal retention of food

What is this showing?

halitosis

excessive salivation

ptyalism

What is ptyalism usually associated with? What else can it be associated with?

nausea; toxins and sour/bitter tastes

saliva “leaks” from the mouth, as the patient is too painful or unable to swallow

pseudopytalism

expulsion of material from the stomach or intestines

vomiting

Vomiting is an ________ process with _________ ________ and ________ ________.

active; abdominal motion; prodromal nausea

expulsion of food, water, and or saliva from the mouth, pharynx, or esophagus

regurgitation

What type of process is regurgitation?

passive

What does regurgitation have to be differentiated from?

vomiting or expectoration

Is prodromal nausea associated with regurgitation?

no

Is prodromal nausea associated with vomiting?

usually

Is retching associated with regurgitation?

no

Is retching associated with regurgitation?

no

Is food material produced with regurgitation?

±

Is food material produced with vomiting?

±

Is bile produced with regurgitation?

no

Is bile produced with vomiting?

±

Is blood produced with regurgitation? If yes, what type of blood?

±; undigested

Is blood produced with vomiting? If yes, what type of blood?

±; digested or undigested

What amount of material is associated with regurgitation?

any amount

What amount of material is associated with vomiting?

any amount

What is the time relative to eating when it comes to regurgitation?

anytime

What is the time relative to eating when it comes to vomiting?

anytime

Is there distention of the cervical esophagus with regurgitation?

rare

Is there distention of the cervical esophagus with vomiting?

no

What is the pH of the regurgitated material?

>/= 7

What is the pH of the vomited material?

</= 5 or >/= 8

What is vomiting most commonly associated with?

M
I
G
G
T

• motion sickness

• ingestion of emetogenic substances (drugs, toxins)

• GI obstruction

• GI inflammation (colitis)

• triggering of chemoreceptor trigger zone (CRTZ)

If the patient is regurgitating and is also dysphagic, what should be considered?

oral, pharyngeal, or cricopharyngeal disease

If the patient is regurgitating, but is not dysphagic, what are some of the most likely causes?

E
E
G
M

• esophageal strictures (cicatrix)

• esophagitis

• gastroesophageal reflux (GERD)

• megaesophagus

expulsion of material from the respiratory tract that can be confused with regurgitation or vomiting

expectoration

What is expectoration generally associated with? Why?

coughing; coughing in dogs often stimulates a gag reflex and possible vomiting

expulsion of digested blood or fresh blood

hematemesis

True or false: In hematemesis, few flecks of fresh blood can be present due to vigorous vomiting.

true

What is this showing?

hematemesis

excessive fecal water

diarrhea

It is important to distinguish between ________ and ________ diarrhea, as well as if it is ________ or ________ intestinal in origin.

acute; chronic; large; small

What is acute diarrhea most commonly due to?

D
P
I

• diet

• parasites

• infectious disease

What is chronic diarrhea most commonly due to?

P
I
N
I

• parasites

• infiltrative disease

• neoplasia

• immune mediated disease

Is weight loss expected with small intestinal diarrhea?

yes

Is weight loss expected with large intestinal diarrhea?

it is uncommon

Is polyphagia expected with small intestinal diarrhea?

sometimes

Is polyphagia expected with large intestinal diarrhea?

rare to absent

What is the frequency of bowel movements with small intestinal diarrhea?

often near normal

What is the frequency of bowel movements with large intestinal diarrhea?

sometimes very increased but often normal

What is the volume of feces when it comes to small intestinal diarrhea?

often increased, but can be normal

What is the volume of feces when it comes to large intestinal diarrhea?

sometimes decreased (because of the increased frequency) but can be normal

What blood is associated with small intestinal diarrhea?

melena (rare)

What blood is associated with large intestinal diarrhea?

hematochezia (sometimes)

Is there usually mucus in the feces with small intestinal diarrhea?

uncommon

Is there usually mucus in the feces with large intestinal diarrhea?

sometimes

Is there tenesmus associated with small intestinal diarrhea?

uncommon (but may occur later in chronic cases)

Is there usually mucus in the feces with large intestinal diarrhea?

sometimes

Is vomiting associated with small intestinal diarrhea?

may be seen

Is vomiting associated with large intestinal diarrhea?

may be seen

What are the different categories of chronic small intestinal diarrhea?

M
M

• maldigestion

• malabsorption

When it comes to chronic small intestinal diarrhea, what are the different types of malabsorption?

N
P

• non-protein losing

• protein losing

What are important things to do when it comes to chronic large intestinal diarrhea?

E
T
F

• evaluate rectal and colonic mucosa first (neoplasia, fungal disease)

• therapeutic trials

• further diagnostics

What is the fecal score scale?

1-7

What fecal score is ideal?

2

Describe a 1 fecal score.

H
I
R
N

• hard and dry

• individual pellets

• requires much effort to expel from the body

• no residue left on the ground when picked up

Describe a 2 fecal score.

F
S
L

• firm but not hard

• segmented in appearance

• little or no residue on ground when picked up

Describe a 3 fecal score.

L
L
M
L

• log shaped

• little or no visible segmentation

• moist surface

• leaves residue on ground, but holds form when picked up

Describe a 4 fecal score.

V
L
L

• very moist and soggy

• log shaped

• leaves residue and loses form when picked up

Describe a 5 fecal score.

V
P
L

• very moist but has a distinct shape

• piles rather than distinct logs

• leaves residue and loses form when picked up

Describe a 6 fecal score.

H
P
L

• has texture but no defined shape

• present as piles or spots

• leaves residue when picked up

Describe a 7 fecal score.

W
N
F

• watery

• no texture

• flat puddles

What fecal score is this?

1

What fecal score is this?

2

What fecal score is this?

3

What fecal score is this?

4

What fecal score is this?

5

What fecal score is this?

6

What fecal score is this?

7

fresh blood in/on the feces

hematochezia

With what disease is hematochezia associated with?

large bowel disease

digested blood that is coal black (not dark brown or green)

melena

With what disease is melena associated with?

small bowel or upper GI disease

What is this showing?

hematochezia

What is this showing?

melena

ineffectual or painful straining at urination or defecation

tenesmus

True or false: You must differentiate tenesmus between urination and defecation, especially in cats.

true

painful or difficult elimination of feces from the rectum

dyschezia

infrequent and difficult evacuation of feces

constipation

What can be some causes of constipation?

D
B
D
O
W

• drugs

• behavioral

• dietary

• obstruction

• weakness

What is this animal most likely suffering from?

constipation

intractable constipation

obstipation

What is an example of obstipation?

megacolon in cats

What is this showing?

obstipation