The Dog with an Upset Tummy.pdf

Unknown terms 10 October 2023 09:10 Vomitus - refers to the material that is expelled from the stomach through the mouth during the act of vomiting Prophylactic Melaena - the production of dark sticky faeces containing partly digested blood, as a result of internal bleeding or the swallowing of bloo...

Unknown terms 10 October 2023 09:10 Vomitus - refers to the material that is expelled from the stomach through the mouth during the act of vomiting Prophylactic Melaena - the production of dark sticky faeces containing partly digested blood, as a result of internal bleeding or the swallowing of blood. Gastroenteritis - inflammation of the stomach and intestines, typically resulting from bacterial toxins or viral infection and causing vomiting and diarrhoea. Chronic enteropathy - Chronic enteropathy in dogs is a group of complex, nonspecific gastrointestinal (GI) disorders characterized by clinical signs lasting 3 weeks or longer and for which other causes (e.g., parasites, bacterial infections, cancer, and non-GI diseases) have been excluded Omeprazole - Omeprazole reduces the amount of acid your stomach makes. It's widely used to treat indigestion and heartburn, and acid reflux. It's also taken to prevent and treat stomach ulcers. It is a proton pump inhibitor. Maropitant - Maropitant citrate (brand name: Cerenia®) is an antiemetic (drug effective against vomiting + nausea) used to treat vomiting and motion sickness in dogs and cats. It also may act as a mild pain control medication. Folate – vitamin B9, water soluble vitamin – needed to DNA and RNA and metabolise an cobalamin – vitamin B12 trypsin-like immunoreactivity (TLI) measurements - levels of trypsinogen // for diagnosis of exocrine pancreatic insufficiency the exocrine pancreas secretes trypsinogen and other zymogens into the small intestine. Because trypsinogen is produced only by the pancreas, a low serum concentration of trypsinogen (i.e., trypsin-like immunoreactivity) is diagnostic for exocrine pancreatic insufficiency (EPI). Elevated TLI concentrations are consistent with acute pancreatitis, renal disease, or malnutrition. From EPI = pancreas not secreting stuffs properly (intrinsic factor, trypsinogen, enzymes) The Dog with an Upset Tummy Page 1 exocrine pancreatic insufficiency (EPI) cobalamin binds to an intrinsic factor (protein) then it can be absorbed in the ileum intrinsic factor is made in the pancreas EPI = pancreas cant make the intrinsic factor no intrinsic factor binds to cobalamin no absorption of cobalamin in ileum chronic enteropathy – group of nonspecific GI disorders with clinical signs lasting 3 weeks or longer The Dog with an Upset Tummy Page 2 Discussion on part 2 Monday, March 11, 2024 11:14 AM Hydrolysed protein diet Proteins are already broken down in food by hydrolysis Probiotic supplement to aid digestion Limited ingredient and novel protein diets are not made with hydrolysis and are sold over-thecounter. On the other hand, hydrolyzed protein foods require a veterinary prescription. Hydrolyzed Protein Foods for Exocrine Pancreatic Insufficiency. Dogs with exocrine pancreatic insufficiency (EPI) do not produce adequate amounts of pancreatic enzymes required for food breakdown leading to impaired digestion. Rising evidence suggests that the easy digestibility of hydrolyzed protein sources can be helpful for dogs with EPI in terms of initial managing and decreasing the condition’s signs and symptoms. Probiotics Reduces inflammation Resets the bacteria in the gut Inflammatory response stimulated by digestive enzymes produced by bacteria in gut The Dog with an Upset Tummy Page 3 bacteria in gut Good bacteria The Dog with an Upset Tummy Page 4 ILOs Thursday, 7 March 2024 1:11 PM Pick two to defend you, the rest are hunting you: (Please note: the gun in question is a shotgun) Gert – 50 golden eagles and a bloke with a gun Melanie – 15 wolves and the person with the gun Ben- 10000 rats and 50 eagles Fiona- 10000 rats and 7 bulls Anatomy and Physiology Describe the stimulus for, and regulation of, gastric acid secretion (review the Overview of Gastrointestinal Physiology lecture as this is covered there). - Zoe Explain that vomiting is a complex reflex co-ordinated in the brain and describe the pathophysiological process of vomiting (covered in anatomy lecture). - Matt Define "gastric mucosal barrier", explain its role and recognise that local prostaglandin (PGE2) plays a modulatory role. - Millie Explain the roles of sphincters (upper and lower oesophageal; gastro-duodenal junction, sphincter of Oddi, ileo-caeco-colic junction, anal) within the gastrointestinal tract and state where they are located. - Tilly Define the terms "endocrine pancreatic function" and "exocrine pancreatic function". - Millie List the constituents of exocrine pancreatic secretions and their role in digestion. - Divya Describe the process of gall bladder contraction and pancreatic enzyme secretion. - Fiona Describe villi, microvilli and the gastrointestinal epithelial barrier and explain how they respond to damage. - Becca Describe the importance of the gastrointestinal microbiome, specifically it's barrier roles in protection and immunotolerance but also the potential for loss of tolerance and associated disease. - Ava Outline the site and process of folate (vitamin B9) absorption. - Lily Outline the site and process of cobalamin (vitamin B12) absorption. - Lily The Dog with an Upset Tummy Page 5 Outline the site and process of cobalamin (vitamin B12) absorption. - Lily Agents of Disease Summarise the life cycles, prevalence and clinical significance of the common gastro-intestinal parasites and protozoa in dogs and cats; to include Toxocara spp.,Strongyloides stercoralis, Ancylostoma spp., Uncinariaspp., Trichuris vulpis, Dipylidium caninum, Taenia spp., Giardia spp.,Tritrichomonas foetus, (most previously encountered in foundation and reproduction systems). - Gert Summarise the major classes of anthelmintics used for endoparasites in dogs and cats (benzimidazoles, macrocyclic lactones, pyrimidines, praziquantel). - Melanie Introductory General Pathology Define the term diarrhoea and explain the pathophysiological processes behind the different mechanisms for diarrhoea; secretory, osmotic, exudative, dysmotility. - Jen Pathology and Clinical Pathology Recognise the utility of serum folate/cobalamin assessment in investigating small intestinal disease. Divya Outline the electrolyte and acid-base changes that may occur as a consequence of persistent vomiting - Ben The Dog with an Upset Tummy Page 6 Anatomy and Physiology Thursday, March 07, 2024 2:45 PM Describe the stimulus for, and regulation of, gastric acid secretion (review the Overview of Gastrointestinal Physiology lecture as this is covered there). - Zoe STIMULUS FOR GASTRIC ACID SECRETION Cephalic phase Gastric phase The Dog with an Upset Tummy Page 7 Regulation of gastric acid secretion SUMMARY STIMULI Peptides in stomach detected causes release of gastrin to stimulate parietal cell secretion Thought, smell , sight, chewing of food causes gastrin to be released and The Dog with an Upset Tummy Page 8 Thought, smell , sight, chewing of food causes gastrin to be released and stimulates parietal cell secretion of hcl in stomach RECEPTORS Gastrin –stimulated by both gastric and cephalic phases which go on to then stimulate --> Histamine Also Ach from parasympathetic (vagus) nerve REGULATION Inhibited by somatostatin – receptors inhibit adenylyl cyclase Low ph inhibits release of gastrin Explain that vomiting is a complex reflex co-ordinated in the brain and describe the pathophysiological process of vomiting (covered in anatomy lecture). - Matt Stimuli such as pain, chemicals such as opioids or anaesthesia trigger receptors such as mechanoreceptors, chemoreceptors or the chemical trigger zone, this causes a signal to be sent to the vomiting centre resulting in the below physical changes and process's involved in vomiting. 1. 2. 3. 4. 5. 6. 7. 8. Postural changes Salivation stimulation - to protect oesophageal tract and teeth from stomach acid Respiratory muscles - inhibited in inspiration Glottis closes, larynx raised Soft palate lifted Diaphragm and abdominal muscles contract Intragastric pressure raised against constricted lower oesophageal sphincter LOS relaxes, gastric contents expelled aka vomiting Define "gastric mucosal barrier", explain its role and recognise that local prostaglandin (PGE2) plays a modulatory role. - Millie Gastric mucosal barrier - a protective layer of mucus and other substances that lines the stomach's inner surface, shielding it from the corrosive effects of gastric acid and other digestive enzymes. PGE2 (local prostaglandin*) Sensitised immune cells will secrete prostaglandins in response to an invasion of the gut by a microbe Direct interaction with the ENS (enteric nervous system) and GI endocrine/paracrine cells to increase fluid secretion and motility in the stimulated area Pathogenic microbe as a result is washed downstream and passed in faeces Disruptions in the mucosal barrier, such as reduced mucus production, alterations in blood flow, or decreased prostaglandin synthesis, can lead to conditions like gastric ulcers. *local prostaglandin = a compound that acts as a signalling molecule and exerts its effects on nearby cells and tissues (either autocrine or paracrine) Cunningham, J. G. (2020) Cunningham’s textbook of veterinary physiology. Sixth edn. Edited by B. G. Klein. St. Louis, Missouri: Elsevier. Explain the roles of sphincters (upper and lower oesophageal; gastro-duodenal junction, sphincter of Oddi, ileo-caeco-colic junction, anal) within the gastrointestinal tract and state where they are located. - Tilly Role of sphincters in the GI tract : Circular muscular valves ensuring the one way direction of gastrointestinal contents - they regulate the flow of substances. Location of sphincters : The Dog with an Upset Tummy Page 9 Sphincter Location Role Upper Oesophagus Sphincter At the end of the pharynx (throat) Protects the entrance of food to the oesophagus Swallowing reflex open of this sphincter Carries food from throat to the stomach Lower Oesophagus Sphincter At the bottom of oesophagus, connecting to stomach. Allows food to pass into stomach Prevents stomach acid from washing back up into oesophagus Gastric-duodenal junction Between stomach and duodenum (first part of small intestine) Allows partially digested food to pass from stomach into duodenum Sphincter of Oddi Located where the pancreatic duct and common bile duct are connected to the duodenum. Pancreatic duct delivers digestive enzymes from the pancreas Common bile duct delivers bile from gallbladder (Where the accessory organs empty into the duodenum) Ileo-caeco-colic junction Between small intestine and the large intestine Also known as 'ileocecal sphincter' Moves partially digested food from the ileum (last part of small intestine) into the large intestine Anal sphincter Located at the opening of the rectum (end Regulates defecation of GI tract) Has inner and outer muscles Inner sphincter = involuntary and prevents stool from leaking out Outer sphincter = predominantly voluntary (only sphincter that is voluntary) and allows the animal to pass or hold stool on demand Sphincters: Where They're Found and Purpose (verywellhealth.com) Define the terms "endocrine pancreatic function" and "exocrine pancreatic function". - Millie Endocrine - involves the secretion of hormones directly into the bloodstream to regulate various physiological processes throughout the body. Exocrine - involves the secretion of digestive enzymes and bicarbonate into the digestive tract to aid in the digestion and absorption of nutrients. List the constituents of exocrine pancreatic secretions and their role in digestion. - Divya constituent of exocrine pancreatic secretion secreted from? role in digestion digestive enzymes: PROTEASES (trypsin, chymotrypsin, elastase) exocrine acinar ic cells digest protein into peptides trypsin --> activates all other proteases in the small intestine for digestion cleaves interior polypeptide bonds digestive enzymes: PROTEASE: CARBOXYPEPTIDASE beta cell digest proteins digestive enzymes: PANCREATIC LIPASE exocrine acinar cells hydrolysis/digestion of fat or triglycerides into monoglycerides/glycerol and fatty acids digestive enzymes: PHOSPHOLIPASE ? digest phospholipids cleaves terminal amino acids cleaves ester bonds digestive enzymes: AMYLASE exocrine acinar cells enzymes: RIBONUCLEASE exocrine acinar cells hydrolysis/digestion of polysaccharides starch/glycogen to maltose (disaccharide of glucose) produces short fragments breaks down RNA cleaves to nucleotides enzymes: exocrine acinar DNA The Dog with an Upset Tummy Page 10 enzymes: DEOXYRIBONUCLEASE exocrine acinar cells DNA cleaves to nucleotides bicarbonate (+ water) epithelial cells neutralise stomach acid coming into the small lining small intestine from the stomach pancreatic ducts SECRETIN (not pancreas) small intestine epithelial layer cells detection of low pH in duodenum,, passes through blood stream,, acts on ductile cells in the pancreas,, increases secretion of bicarbonate into ducts The Dog with an Upset Tummy Page 11 exocrine = not endocrine so no hormones sources: http://www.vivo.colostate.edu/hbooks/pathphys/digestion/pancreas/exocrine.html#:~:text=Pancreatic%20juice%20is%20composed%20of,cells%20lining%20small%20pancreatic% 20ducts. liver + pancreas lecture week 19 wed async Describe the process of gall bladder contraction and pancreatic enzyme secretion. - Fiona When you consume food, the stomach releases a hormone that causes the muscles around the gallbladder to contract and release the bile. Agonists like cholecystokinin(CCK) and acetylcholine(Ach) cause contraction of gall-bladder smooth muscle through signal transduction, which increases intracellular calcium levels. so initiates the contractile machinery. Cholecystokinin(CCK) has several functions at this stage of the digestive process: -It stimulates your gallbladder to contract and release bile into your small intestine. (“Cholecystokinin” means to “move the gallbladder.") -It stimulates your pancreas to release pancreatic enzymes (stimulus: products of digestion in the lumen of small intestine) Apart from digestive enzymes, pancreas also secretes bicarbonate ions (HCO3-). This is started when a hormone called Secretin is released from the small intestine after the detection of an increase of H+ ions. Secretin stimulates the release of bicarbonate from the pancreas from the duct cells. These ions combine with the H+ ions in the small intestine to form carbonic acid (H2CO3), and eventually breakdown as CO2 and H2O. The Dog with an Upset Tummy Page 12 Lecture slides : Gastrointestinal block, week 19, Wednesday, The liver and prancreas Efron, D.T. (2023) What causes a gallbladder attack?, Johns Hopkins Medicine. Available at: https://www.hopkinsmedicine.org/health/conditions-anddiseases/what-causes-a-gallbladder-attack (Accessed: 09 March 2024). professional, C.C. medical (2024) Cholecystokinin: Hormone function & definition, Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/body/23110-cholecystokinin (Accessed: 09 March 2024). Describe villi, microvilli and the gastrointestinal epithelial barrier and explain how they respond to damage. - Becca Villi - lining the small intestine, they are finger like projections which will increase the surface area for absorption. Microvilli - cells found on the epithelium of the villi, which increase the surface area even more. These will form the brush border of the villi. Gastrointestinal epithelial barrier - (or intestinal epithelial barrier) is composed of… - Epithelial cells Tight junctions Mucus layer (with antimicrobial proteins AMPs and secretory immunoglobulin A molecules sIgA) Inner lamina propria (containing innate and adaptive immune cells) The Dog with an Upset Tummy Page 13 Interspersed between the enterocytes are goblet cells, which will secrete mucus at the brush border surface, acting as the first line of physical defence. It can be damaged by many factors, including cytokines, diet and diseases. With a damaged gastrointestinal epithelial barrier, the ability to act as selectively permeable barrier is limited, so harmful antigens and microorganisms may be able to get into the blood. Immune cells from the inner lamina propria, including T cells, B cells, macrophages and dendritic cells stimulate an immune response to a damaged intestinal epithelial barrier. https://www.chp.edu/our-services/transplant/intestine/education/about-small-large-intestines#:~:text=Microvilli%3A%20The%20cells%20on%20the,cell%20can%20absorb%20more%20nutrients. https://www.savemyexams.com/dp/biology_sl/ib/16/revision-notes/6-human-physiology/6-1-digestion--absorption/6-1-2-villi--absorption/ https://www-sciencedirect-com.bris.idm.oclc.org/science/article/pii/B9780323552271000302 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6104804/ Describe the importance of the gastrointestinal microbiome, specifically it's barrier roles in protection and immunotolerance but also the potential for loss of tolerance and associated disease. - Ava The importance of the gastrointestinal microbiome in protection and immunotolerance: The gastrointestinal tract is home to the largest microbial population in the body. Most of the microorganisms in animals' guts have a symbiotic relationship with the animals, their hosts. The gut microbiota plays significant roles in the development of the gut immune system and has a substantial impact on the maintenance of immune tolerance beginning in early life. Beneficial microbes in the gut help to train the immune system to tell them apart from the unhelpful, pathogenic types. The gut is the largest immune system organ, containing up to 80% of the body’s immune cells. These cells help to clear out the many pathogens that pass through it every day. Helpful gut microbes also compete directly with unhelpful types for real estate and nutrients, preventing them from taking up too much territory. Some of the chronic bacterial infections that can affect your GI tract, including C. difficile and H. pylori, are directly related to having a diminished gut microbiome. Short-chain fatty acids, the by-products of helpful gut bacteria, have important benefits for the immune system. They help maintain the gut barrier, keeping the bacteria and bacterial toxins inside from escaping into the bloodstream. They also have anti-inflammatory properties. Loss of tolerance and associated disease Anaerobic gut bacteria help break down indigestible fibres in the digestive tract and produce essential nutrients. These organisms are only helpful within their natural microbiome. If these bacteria stray beyond the colon, they can be harmful. Colon bacteria that manage to creep up and settle in the small intestine can interfere with digestive processes there. Colon bacteria that invade the colon wall can cause an infection in the body. Healthcare providers use the term ‘dysbiosis’ to refer to an unbalanced or unhealthy gut microbiome. Dysbiosis means: The Dog with an Upset Tummy Page 14 1. A loss or deficit of beneficial bacteria. 2. Overgrowth of potentially pathogenic (bad) bacteria. 3. Loss of overall bacterial diversity. Conditions directly related to gut dysbiosis include: Infections. Invasive pathogens can cause temporary or chronic infections in the gut. They can cause diarrhoea, inflammation (colitis) and toxic damage to the gut lining. Some types even directly invade the gut barrier, threatening to escape into the bloodstream and go systemic. Dysbiosis weakens the gut’s defences against these pathogens. SIBO. Small intestinal bacterial overgrowth is dysbiosis in the small intestine. It means certain types of bacteria there are overgrown, using too many resources and producing too many byproducts. In some cases, bacteria from the large intestine have migrated and settled in the small intestine (where they don’t really belong). This can be a result of slow gut motility. Inflammatory bowel disease. IBD is a collection of autoimmune conditions in the gut that includes ulcerative colitis, microscopic colitis and Crohn’s disease. Gut dysbiosis is one of the criteria for diagnosing IBD. Atherosclerosis. Certain less-desirable gut bacteria contribute to cardiovascular risk by producing a byproduct called trimethylamine N-oxide (TMAO). This byproduct builds up in arteries, contributing to atherosclerosis (hardening of arteries). Cleveland Clinic (2023) What Is Your Gut Microbiome?, Cleveland Clinic. Available at: HYPERLINK "https://my.clevelandclinic.org/health/body/25201-gut-microbiome"https://my.clevelandclinic.org/health/body/25201-gut-microbiome. Ingenta (Firm : 1998-2007) and ScienceDirect (Online service) (198AD) Journal of Autoimmunity. Bull, M.J. and Plummer, N.T. (2014) ‘Part 1: The Human Gut Microbiome in Health and Disease’, Integrative medicine (Encinitas, Calif.), 13(6), pp. 17–22. Available at: HYPERLINK "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566439/"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566439/. Outline the site and process of folate (vitamin B9) absorption. - Lily Importance – Produces RBC and WBC in bone marrow, especially important during growth. Site – Proximal small intestine Process – Converted into folate monoglutamates by enzymes folate reductase in the jejunal mucosa then into the blood stream. Reference list Geng, C. (2021). Folate (vitamin B9): Foods, deficiency symptoms, benefits, and more. [online] www.medicalnewstoday.com. Available at: https://www.medicalnewstoday.com/articles/287677#:~:text=Folate%20is%20an%20essential%20B [Accessed 7 Mar. 2024]. Milman, N. (2012). Intestinal absorption of folic acid - new physiologic & molecular aspects. The Indian journal of medical research, [online] 136(5), pp.725–8. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573592/#:~:text=In%20the%20diet%2C%20folates%20exist [Accessed 7 Mar. 2024]. Visentin, M., Diop-Bove, N., Zhao, R. and Goldman, I.D. (2014). The Intestinal Absorption of Folates. Annual Review of Physiology, [online] 76(1), pp.251–274. doi:https://doi.org/10.1146/annurev-physiol-020911-153251. Outline the site and process of cobalamin (vitamin B12) absorption. - Lily Importance – Aids in the formation of RBC and DNA, help develop brain and nerve cells. Site – Distal ileum Process – Vitamin B12 is combined with intrinsic factor (protein) in the stomach which is then absorbed in the distal ileum (gut) and released into the blood stream. Reference list Boston, 677 H.A. and Ma 02115 +1495-1000 (2019). Vitamin B12. [online] The Nutrition Source. Available at: https://www.hsph.harvard.edu/nutritionsource/vitamin-b12/#:~:text=Vitamin%20B12%2C%20or%20cobalamin%2C%20is [Accessed 7 Mar. 2024]. nhs.uk. (2017). Vitamin B12 or folate deficiency anaemia - Causes. [online] Available at: https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiencyanaemia/causes/#:~:text=Vitamin%20B12%20is%20combined%20with [Accessed 7 Mar. 2024]. The Dog with an Upset Tummy Page 15 Agents of Disease Thursday, March 07, 2024 2:46 PM Summarise the life cycles, prevalence and clinical significance of the common gastro-intestinal parasites and protozoa in dogs and cats; to include Toxocara spp.,Strongyloides stercoralis, Ancylostoma spp., Uncinariaspp., Trichuris vulpis, Dipylidium caninum, Taenia spp., Giardia spp.,Tritrichomonas foetus, (most previously encountered in foundation and reproduction systems). - Gert Name Prevalence Clinical Significance Gert's Notes Toxocara canis/cati Direct or Indirect, Canids/Felids are the definitive host respectively. Infection can occur via ingestion of eggs, ingestion of paratenic hosts or transmitted from mother to offspring. Common globally Zoonotic T.canis and T.cati are different species but act largely exactly the same. Strongyloides stercoralis Parasitic or Free-living life cycles. Parasitic: parasitic worms develop into adult females and embed into the submucosa of the small intestine where they produce eggs via parthenogenesis (parasitic males do not exist). Offspring can be parasitic or free-living Free-living: Freeliving worms can be male or female and reproduce sexually to produce parasitic offspring. After being excreted as larvae these worms never enter another host. Broadly distributed in tropical and subtropical climates. Has been reported in summer months in temperate climates. Typical direct life cycle. Found worldwide in warm, moist environments where larvae can survive outside the host. Ancylostoma Spp. Aka Intestinal hookworms Life Cycle prevalence is highest Infection called in developing Toxocariasis countries in both humans and animals. Mostly asymptomatic, though involvement can cause damage and even death. Primarily a human parasite but dogs can also serve as a definitive host. T.canis can be transmitted to offspring via placenta or mammary while T.cati can only be transmitted to offspring via mammary. There is a closely related species, S.fuelleborni, that has non-human primates as it's Hosts may experience definitive host. a rash where larvae Most common in penetrated the skin places with poor and irritation of the sanitation, rural and respiratory tract. May remote communities, experience diarrhoea, institutional settings abdominal pain, and among socially constipation. marginalised groups. Otherwise largely asymptomatic. 75% of patients with chronic infection have elevated WBCs and IgE levels Adults live in the lumen of the small intestine, typically the distal jejunum. They Distribution of A. release eggs into the ceylanicum is not faeces that develop fully known but it is A.ceylanicum is zoonotic and can be found in Humans, dogs and cats. A.caninum is a common dog hookworm. The Dog with an Upset Tummy Page 16 Uncinaria spp faeces that develop into larvae. Larvae become infective after 5-10 days, penetrate the skin and travel to the jejunum via the blood stream, where they attach to the lumen and mature into adults. fully known but it is endemic to south east asia and the pacific islands '' Main canine Symptoms include hookworm in cooler abdominal pain, regions of the world. anorexia and nausea due to the worm Historically infected being hooked onto dogs in Canada and the intestinal wall. northern USA, but Can also infect cats has decreased as A.caninum became prevalent Direct lifecycle T.vulpis infects dogs No clinical signs are all around the world. seen in light infection however the more It is one of the most severe the infection, the more clinical common intestinal parasites in mature signs. dogs. Symptoms include inflammation and bleeding of the caecum and colon, diarrhoea and weight loss. Aka Northern Hookworm Trichuris vulpis Larvae are ingested and embed themselves in the wall of the intestine where they then release eggs via faeces Dipylidium caninum A.tubaeforme infects cats worldwide Symptoms include abdominal pain, anorexia and nausea due to the worm being hooked onto the intestinal wall. Indirect lifecycle World wide. Parasite Most infections are is common amongst asymptomatic. Tapeworm larvae are cats and dogs. Aka Flea Tapeworm ingested by Flea Pets may exhibit Rare in humans but behaviour to relieve larvae and remain cases have been with the flea as it anal pruritis (itching) matures. reported from every such as dragging anal The infected fleas are inhabited continent. region across grass or carpet. then ingested by the definitive host and Most striking feature tapeworm larvae attach to small is the passing of intestine where they proglottids develop into adults. Adult tapeworms produce eggs in segments called proglottids that are detached and exit via the faeces. The Dog with an Upset Tummy Page 17 Pretty sure that tape worms have both male and female reproductive organs and self fertilize but will confirm this Taenia Spp. Indirect lifecycle Found worldwide Infection due to consumption of undercooked / raw meat Eggs are released in proglottids in faeces, and contaminate grass/soil that is ingested by a paratenic host (species of paratenic host depends on species of parasite). The parasitic larvae then move from the digestive system via the blood into the muscle tissue and form cysts. Contaminated meat is then eaten by definitive host and larvae attach to the intestine and mature. Certain species are more prevalent in poorer communities Mild abdominal and communities with close contact symptoms with paratenic hosts. Again most striking symptom is the presence of proglottids in faeces Species can have between 1,000 – 2,000 proglottids each containing 50,000 – 100,000 eggs Definitive host = Final host, parasites reach sexual maturity and reproduce Paratenic host = aka intermediate host, parasite larvae infect this host and wait to be transported (through being ingested or other means) to definitive host Canids = Members of the Canidae family, includes dogs, wolves, coyotes, foxes, etc Felids = Members of the Felidae Parthenogenesis = "virgin birth" asexual reproduction in animals Spp = Several Species, all of them do pretty much the same thing Proglottids = A segment of a tapeworm that contains a uterus full of eggs. These segments are detached to release eggs into faeces. Summarise the major classes of anthelmintics used for endoparasites in dogs and cats (benzimidazoles, macrocyclic lactones, pyrimidines, praziquantel). - Melanie Benzimidazoles For nematodes (roundworms) and trematodes, limited activity against cestodes (tapeworms) Includes mebendazole, flubendazole, fenbendazole, oxfendazole, oxibendazole, albendazole, albendazole sulfoxide, thiabendazole, thiophanate, febantel, netobimin, and triclabendazole Those in orange = effective against liver flukes Those underlined = most effective (longest half life, not rapidly metabolized to inactive products) In dogs and cats, fenbendazole, febantel, oxfendazole, and flubendazole are used to treat roundworms, hookworms, and tapeworms. However, treatment must be given for 3 days. Mebendazole and oxibendazole have caused acute hepatic injury in dogs and are generally no longer used in this species. Macrocyclic lactones (avermectins and milbemycins) Products or chemical derivatives of soil microorganisms belonging to the genus Streptomyces Avermectins in commercial use: ivermectin, abamectin, doramectin, eprinomectin, selamectin Potent, broad antiparasitic spectrum at low dose levels Active against many immature nematodes (including hypobiotic larvae) and arthropods Single therapeutic dose can persist in concentrations sufficient to be effective against new The Dog with an Upset Tummy Page 18 Single therapeutic dose can persist in concentrations sufficient to be effective against new nematode infections for prolonged periods after treatment After administration -> extensively distributed throughout body and concentrate particularly in adipose tissue Ivermectin, selamectin, moxidectin, and milbemycin oxime: used in dogs for prevention of heartworm disease (Dirofilaria immitis) and control of GI roundworms (eg common inestinal nematodes such as Toxocara) Pyriidines Pyrantel = a pyrimidine-derivative anthelmintic agent for the oral treatment of various parasitic worm infections Pyrantel pamoate or embonate: effective against common GI nematodes, except for whipworms Oxantel, a phenol analogue of pyrantel, is combined w pyrantel in some anthelmintic preparations for dogs to increase activity against whipworms Praziquantel High efficacy against cestode parasites at relatively low dose rates but no effect on nematodes The PO (by mouth) (5 mg/kg), SC (subcutaneous) (5.8 mg/kg), or spot-on (cats, 12 mg/kg) administration of praziquantel in dogs and cats is 100% effective against Dipylidium caninum, Taenia spp, and Echinococcus spp (both adult and immature forms) The Dog with an Upset Tummy Page 19 Introductory General Pathology Thursday, March 07, 2024 2:46 PM Define the term diarrhoea and explain the pathophysiological processes behind the different mechanisms for diarrhoea; secretory, osmotic, exudative, dysmotility. - Jen Diarrhoea is a common gastrointestinal symptom characterised by the frequent passage of loose or watery stools and can be caused by various mechanisms: 1. Secretory Diarrhoea: Pathophysiology: Secretory diarrhoea occurs when there is an increase in fluid secretion into the intestinal lumen, leading to excess fluid accumulation and watery stools. Mechanism: Results from stimulation of secretory pathways by toxins (e.g. cholera toxin) or by infectious agents (e.g. enterotoxigenic Escherichia coli (ETEC)) which activate chloride ion channels, leading to increased secretion of chloride and water into the intestinal lumen. 2. Osmotic Diarrhoea: Pathophysiology: Osmotic diarrhoea occurs when unabsorbed solutes, such as nonabsorbable sugars or poorly absorbed ions, draw water into the intestinal lumen by osmosis, resulting in osmotic imbalance and watery stools. Mechanism: Usually caused by ingestion of substances that can’t be fully absorbed by the intestine (e.g. lactose in individuals with lactose intolerance). These substances increase the osmotic pressure in the intestine, leading to water retention and diarrhoea. 3. Exudative Diarrhoea: Pathophysiology: Exudative diarrhoea is characterised by the presence of blood, mucus, or inflammatory fluid in the stool due to damage to the intestinal mucosa. Mechanism: This type of diarrhoea can result from inflammatory conditions such as inflammatory bowel disease (e.g., Crohn’s disease, ulcerative colitis), infections, or ischemic injury (reduced blood supply and hence reduced oxygen and nutrients) to the intestinal mucosa. The damage disrupts the integrity of the mucosal barrier, allowing fluid and inflammatory exudates to leak into the intestinal lumen, leading to diarrhoea. 4. Dysmotility Diarrhoea: Pathophysiology: Dysmotility diarrhea occurs when there is impaired intestinal motility, resulting in abnormal transit times and inadequate mixing and absorption of luminal contents. Mechanism: This type of diarrhoea can be caused by conditions that affect gastrointestinal motility, such as irritable bowel syndrome (IBS), intestinal pseudo-obstruction, or certain medications. Dysmotility can lead to rapid transit of luminal contents through the intestine, reducing the time available for absorption and resulting in diarrhoea. Semrad, C.E. (2012) Approach to the patient with diarrhea and malabsorption, Goldman’s Cecil Medicine. Edited by L. Goldman and A.I. Schafer. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152045/ (Accessed: 11 March 2024). The Dog with an Upset Tummy Page 20 Pathology and Clinical Pathology Thursday, March 07, 2024 2:47 PM Recognise the utility of serum folate/cobalamin assessment in investigating small intestinal disease. - Divya ○ folate = natural form of vitamin B9, naturally water soluble vitamin B, absorbed in jejunum ○ cobalamin = vitamin B12, absorbed in ileum useful for diagnosing and characterizing some malabsorptive disorders of the small intestine ↑ [FOLATE] = good absorptive function of JEJUNUM (proximal/middle part of small intestine) ↑ [COBALAMIN] = good absorptive function of the ILEUM (distal/last part of small intestine) ↑ [FOLATE] + ↓ [COBALAMIN] = exocrine pancreatic insufficiency,, bacterial overgrowth in jejunum exocrine pancreatic insufficiency (EPI) pancreas secretions are decreased cobalamin binds to an intrinsic factor (protein) then it can be absorbed in the ileum intrinsic factor is made in the pancreas EPI = pancreas cant make the intrinsic factor no intrinsic factor binds to cobalamin no absorption of cobalamin in ileum bacterial overgrowth can come after EBI bacteria compete for cobalamin: so more of it is used by the bacteria less of it is absorbed in ileum the bacteria multiply bacteria make FOLATE explaining the high folate, low cobalamin low FOLATE levels are less researched and much less common sources: https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/ The Dog with an Upset Tummy Page 21 https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/ https://www.nhs.uk/medicines/cyanocobalamin/ https://www.vet.cornell.edu/animal-health-diagnostic-center/testing/protocols/metabolic-function https://www.svslabs.nz/wp-content/uploads/2021/11/FOLATE-AND-COBALAMIN-IN-CATS-AND-DOGS-1.pdf Outline the electrolyte and acid-base changes that may occur as a consequence of persistent vomiting Ben There will be a loss of fluid that contains chloride, potassium, sodium, and bicarbonate. If there is to be chronic vomiting, there would be a significant decrease in the concentrations of these electrolytes, inevitably causing issues within the body. Not only is there a loss of fluid, there is a significant amount of acid loss too as the vomited contents come directly from the stomach. This could result in metabolic alkalosis- this is a disease state where the body's pH is elevated to above 7.45. This could result in issue for the cardiovascular and nervous systems. The Dog with an Upset Tummy Page 22 ILOs 2 Thursday, March 07, 2024 6:12 PM Pathology and Clinical Pathology Summarise the difference between acute and chronic pancreatitis. Melanie Acute Pancreatitis Sudden, with no previous appearance of the condition before. Can become life threatening to other organs if inflammation spreads. Neutrophils and macrophages = predominant cell type Treatment: identification and management of underlying causes and risk factors, supportive care, and symptomatic care Chronic Pancreatitis Developed over time, slowly, and often without symptoms. Can result from repeated bouts of acute pancreatitis. Characterized by an inflammatory infiltration of the exocrine pancreas that is associated with permanent changes, mainly pancreatic fibrosis and/or pancreatic atrophy Inflammation is often lymphocytic and/or plasmacytic Clinical signs are usually nonspecific and mild, including lethargy, anorexia, and in some cases loose stools. Often associated w other inflammatory conditions of abdominal organs, most notably intestinal tract (inflammatory bowel disease), liver (chronic hepatitis in dogs and chronic cholangitis in cats), kidneys (nephritis). Treatment: same as acute, but with monitoring of progression, and, if there is no improvement, trial therapy with an immunosuppressive agent https://www.vin.com/apputil/content/defaultadv1.aspx?pId=12886&catId=57100&id=7054718 Explain the link between chronic pancreatitis and exocrine pancreatic insufficiency (EPI). - divya chronic pancreatitis: inflammation of pancreas, leading to damage to pancreatic cells that make enzymes EPI: pancreas doesn't secrete (enzymes etc). properly chronic pancreatitis is the most common cause of EPI pancreatitis' destruction of acinar cells = less enzymes secreted = symptoms of EBI exacerbated pancreatitis' inflammation cuases narrowing of pancreatic ducts = less enzymes into digestive tract = symptoms of EBI exacerbated https://my.clevelandclinic.org/health/diseases/8103-pancreatitis (will update after wrap up) Agents of Disease List the bacteria within the faecal flora that can act as potential pathogens, but are usually asymptomatic in dogs and cats and therefore do not usually require antimicrobial therapy. - Becca The faecal flora within the intestine is comprised of low populations of potentially pathogenic organisms. These include: - Phyla Fusobacteria - Bacteroidetes - Firmicutes - Proteobacteria The Dog with an Upset Tummy Page 23 - Proteobacteria - Actinobacteria Others common bacteria include samonella, campylobacter and e.coli. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5645859/#:~:text=Another%20study%20evaluated%20the% 20microbiota,2009)%20(Fig. https://www.ncbi.nlm.nih.gov/books/NBK7670/ Clinical Application Describe how to differentiate between vomiting and regurgitation and identify the likely site of the problem (oesophageal or primary gastric or extra-gastrointestinal disease). - Tilly Vomiting = Ejection of contents of the stomach and small intestine Regurgitation = Ejection of contents of the oesophagus. What sort of process is it? What does it consist When does it happen ? of? Vomiting Active - animal is usually heaving and retching Usually partially digested food, sometimes yellow bile Can occur at any point in day and overnight. If there is an obstruction that prevents food from moving down intestinal tract, they may vomit a few hours after eating. Regurgit Passive - animal ation lowers head and expels food without effort Usually undigested Usually right after eating food -animal food, often covering will often try and re-consume it with mucus Site of the problem : Regurgitation = oesophageal Vomiting = primary gastric (stomach) Vomiting = extra-gastrointestinal disease (such as pancreatitis, kidney failure, liver failure, bladder obstruction/ rupture, Addison's disease (hypoadrenocorticism), canine distemper, canine parvovirus) Vomiting pets | Veterinary Teaching Hospital | Washington State University (wsu.edu) Explain the clinical significance (or lack of) of gastric helicobacter in dogs and cats. Ben Pharmacology and Therapeutics Discus the pharmacology of the commonly used emetics (apomorphine, xylazine) and antiemetics/prokinetics (maropitant, metoclopramide, ondansetron, cisapride) in veterinary medicine with reference to the physiological mechanisms underlying emesis. - Millie, Matt Matt, I will do the antiemetics/prokinetics Thankyou Emetic drugs are used in Monogastric animals such as : Apomorphine is an opioid drug that acts as a central dopamine agonist to directly stimulate the CRTZ. Therefore, it is less effective in cats than in dogs. It can be administered PO, IV, or SC; the IM route is not as effective. (chemical trigger zone) The Dog with an Upset Tummy Page 24 Xylazine is an alpha-2 adrenergic receptor agonists used primarily for their sedative and analgesic action. They are fairly reliable emetics in cats (~50% will vomit), where they stimulate the CRTZ. (chemical trigger zone) Emesis should occur in 5–10 minutes. Antiemetics/prokinetics - these drugs inhibit the vomiting reflex, by peripheral and/or CNS. Those that act on the CNS can have a narrow or broad spectrum of activity, depending on which neurotransmitter they block, and at which site they act. Maropitant Antiemetic used in dogs and cats Very effective, broad spectrum Blocks NK1 (substance P) receptors – the final common pathway in the vomiting center Metoclopramide Antiemetic used in dogs At low doses, is a D2 dopamine receptor antagonist At high doses is a 5-HT3 receptor antagonist Effective against emetic substances that stimulate the chemoreceptor trgger zone (CRTZ) in dogs Ondansetron Used in humans and dogs Blocks 5-HT3 receptors Not liscneced Cisapride Most effective GI prokinetic Stimulates GI 5-HT4 receptors Results in contraction of oesophageal smooth muscle, lower oesophageal sphincter tone, decreased pyloric tone, peristaltic waves in the stomach, duodenum, jejunum and colon Is used for gastro-oesophageal reflux and GI muscle motility disorders in dogs Available for use in dogs but not humans due to differences in myocardial physiology of the heart British Small Animal Veterinary Association (2020) Bsava manual of canine and feline gastroenterology. Third edn. Edited by E. J. Hall, D. A. Williams, and A. Kathrani. Quedgeley, Gloucester: British Small Animal Veterinary Association (BSAVA manual series). Identify in which species the emetics and antiemetics are commonly used and identify whether they have a veterinary product license with reference to the prescribing cascade. - Ava Emetics and antiemetics are most commonly used in dogs and cats in practice. Rodents, horses and rabbits cannot vomit. May give one or multiple anti-emetics. Dogs: Maropitant first line - NK1 receptor antagonist Metoclopramide in addition if needed - D2 receptor antagonist at low doses, 5-HT3 receptor antagonist at higher doses Ondansetron sometimes used - Selective 5-HT receptor antagonist Cats: Maropitant most common Ondansetron if maropitant ineffective (uncommon in first opinion practice) Cats do not have dopamine receptors in central sites like dogs so Metoclopramide has poor efficacy as anti-emetic Prescription cascade is the process whereby the side effects of drugs are misdiagnosed as symptoms of another problem, resulting in further prescriptions and further side effects and unanticipated drug interactions, which itself may lead to further symptoms and further misdiagnoses. Therefore, emetics and anti-emetics are licensed to make sure they are safe and effective for specific animals. Check if an animal medicine is licensed (no date) GOV.UK. Available at: https://www.gov.uk/checkanimal-medicine-licensed. [Withdrawn] The prescribing cascade for veterinary medicines (VMGN 13) (no date) GOV.UK. Available at: https://www.gov.uk/government/publications/the-prescribing-cascade-for-veterinary-medicinesvmgn-13. Ask an Expert The Dog with an Upset Tummy Page 25 Outline the concerns regarding antimicrobial resistance and the extreme global health impact this is likely to have. - jen, fiona Antimicrobial resistance (AMR) poses several concerns for veterinarians and animals: 1. Treatment Challenges : Difficulties in treating bacterial infections in animals due to antimicrobial resistance. This can lead to treatment failures, prolonged illness, and increased morbidity and mortality among animal patients. 2. Limited Treatment Options : As resistance to antimicrobial drugs increases, veterinarians may face a reduced arsenal of effective antibiotics for treating infections in animals, complicating management of common bacterial diseases in both companion animals and livestock. 3. Increased Costs: The need for alternative, often more expensive antimicrobial drugs or treatment regimens can lead to increased healthcare costs for animal owners. This financial burden may affect access to veterinary care and compliance with treatment recommendations. 4. Zoonotic Transmission : Antimicrobial-resistant bacteria in animals can pose a risk of transmission to humans, especially through direct contact with pets, livestock, or contaminated environments. This could lead to difficult-to-treat infections in humans and contribute to the spread of AMR within communities. 5. Food Safety Concerns: AMR in food-producing animals can compromise food safety by contaminating animal products with resistant bacteria. Consumption of such products can increase the risk of foodborne illnesses in humans, further exacerbating public health concerns related to AMR. 6. Veterinary Public Health: Veterinarians play a crucial role in safeguarding public health by promoting responsible antimicrobial use in animals, conducting surveillance for AMR, and educating animal owners about the risks of antimicrobial resistance. Failure to address AMR in veterinary medicine can have broader public health implications. 7. Regulatory Pressures: Regulatory agencies may impose restrictions on the use of certain antimicrobial drugs in animals to mitigate the risk of AMR. Veterinarians must comply with regulations regarding antimicrobial prescribing practices, antimicrobial stewardship, and reporting of resistant infections. 8. Impact on Animal Welfare: AMR can affect animal welfare by prolonging suffering and reducing effectiveness of treatment options for infectious diseases. Veterinarians must consider the welfare implications of antimicrobial resistance when making treatment decisions for animal patients. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death. Antimicrobial resistance has significant costs for both health systems and national economies overall. For example, it creates need for more expensive and intensive care, affects productivity of patients or their caregivers through prolonged hospital stays, and harms agricultural productivity. Antimicrobial resistance is a problem for all countries at all income levels. Its spread does not recognize country borders. Contributing factors include lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals; poor infection and disease prevention and control in homes, healthcare facilities and farms; poor access to quality and affordable vaccines, diagnostics and medicines; lack of awareness and knowledge; and lack of enforcement of relevant legislation. People living in low-resource settings and vulnerable populations are especially impacted by both the drivers and consequences of the resistance. The Dog with an Upset Tummy Page 26 Antimicrobial resistance (2024) World Health Organization. Available at: https://www.who.int/news-room/factsheets/detail/antimicrobial-resistance#:~:text=As%20a%20result%20of%20drug,severe%20illness%2C%20disability% 20and%20death. (Accessed: 11 March 2024). Antimicrobial Resistance in Veterinary Medicine: An Overview (2020) International journal of molecular sciences. Available at: https://www.ncbi.nlm.nih.qov/p mc/articles/PMC7139321/ (Accessed: 11 March 2024). Antimicrobial resistance in veterinary medicine (no date) Antimicrobial resistance in veterinary medicine | European Medicines Agency. Available at: https://www.ema.europa.eu/en/veterinary-regulatory-overview/antimicrobialresistance-veterinary-medicine#:~:text=Antimicrobial%20use%20in%20animals%20can,antimicrobials%20for% 20treating%20human%20disease. (Accessed: 11 March 2024). Professionalism and Spectrum of Care Discuss the importance of keeping accurate contemporaneous notes and your responsibilities when completing insurance forms. - Zoe Patient Care Continuity: Clinical records document essential information about the patient, including clinical findings, test results, treatment plans, and outcomes. These records ensure continuity of care, allowing different practitioners to understand the patient’s history and make informed decisions. Legal Defense: Contemporaneous clinical records play a pivotal role in defending veterinary actions. They provide powerful evidence of the circumstances of a case, what was said, and what was done. When disputes arise, well-documented records can be crucial for organizations like the Veterinary Defense Society (VDS) to defend their members1. Client Communication: Detailed records help maintain effective communication with clients. They allow practitioners to track discussions, treatment options, and informed consent. Clients have the right to request copies of their clinical records, which should be provided upon request1. GDPR Compliance: Client records, including contact details and financial information, fall under the General Data Protection Regulation (GDPR). Individuals have the right to access these records through subject access requests. Practices must respond within one month and usually cannot charge a fee for providing this information1. Quality Assurance and Audits: Practices generate reports for internal quality assurance, audits, and significant event reviews. These reports often relate to specific animals and their owners. If not anonymized, personal data within these reports may be disclosable under GDPR1. Transfer of Clinical Records: Following GDPR, explicit consent from clients is now required before transferring clinical records to another practice, unless all personal data is redacted1 13.6 Clinical and client records should be made at the time of the events being recorded or as soon as possible afterwards. There may however be justifiable reasons to retrospectively amend clinical records, for example, in order to correct an inaccurate entry or to include additional information. In such cases, the amendment, the details of the person making the amendment and the date on which it is made should be clearly marked. Any correction should, where possible, be noted alongside the relevant entry. Care should be taken not to obliterate the original entry. This is to avoid giving rise to allegations that the amendments have been made unprofessionally or dishonestly. 13.10 In some cases, clients may consider that information contained within the records, that is not their personal data, is inaccurate or incorrect and may request that the information be corrected. If a client objects to or complains about an entry in their records, veterinary surgeons and veterinary nurses should discuss the client’s concerns with them and make a record of the discussion. It should be noted, however, that diagnosis and clinical opinion is a matter of clinical judgement and should not be changed solely at the client’s request. There is no obligation to amend professional opinion. If, however, the veterinary surgeon or veterinary nurse agrees that the records should be amended due to errors or factual inaccuracies, the advice above should be followed. The Dog with an Upset Tummy Page 27 9.33 Veterinary surgeons must act with integrity in all dealings with an animal insurance policy. They must complete claim forms carefully and honestly. A veterinary surgeon who acts dishonestly or fraudulently may be liable to criminal investigation and/or disciplinary action. Code of Professional Conduct for Veterinary Surgeons Outline the RCVS Code of Conduct recommendations for dealing with client complaints. - Lily The RCVs recommendations for dealing with client complaints is to follow to the Code on Conduct, the relevant sections can be found below: Veterinary surgeons must certify facts and opinions honestly and with due care Veterinary surgeons must not engage in any activity or behaviour that would be likely to bring the profession into disrepute or undermine public confidence in the profession. They also offer support (vetlife) when dealing with a complaint and have a whole segment of the complaint process, however this doesn't contain advice. If a complaint has been made against a surgeon the RCVs has the legal obligation to investigate and take further actions if necessary. Reference list Anon, (n.d.). Information for veterinary surgeons. [online] Available at: https://www.rcvs.org.uk/concerns/a-concern-hasbeen-raised-about-me/information-for-veterinary-surgeons/ [Accessed 11 Mar. 2024]. Rcvs.org.uk. (2017). Supporting guidance - Professionals. [online] Available at: https://www.rcvs.org.uk/settingstandards/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/supporting-guidance/ [Accessed 11 Mar. 2024]. The Dog with an Upset Tummy Page 28