Kinh Nghiệm Chăm Sóc Vẹt Và Cho Vẹt Ăn Gì Tốt Nhất? ? Cho Vẹt Ăn Gì Để Khỏe Mạnh Nói Hay
The Diagnostic Process for Gastrointestinal Diseases
Gastrointestinal signs (vomiting, diarrhea, regurgitation, weight loss, decreased appetite, abdominal distension and abdominal pain) are easily observed by clients and are often the reason for them bringing their pet to their veterinarian.
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Addison’s disease (hypoadrenocorticism) is more likely to occur in young animals.Infectious diseases such as parvovirus and/or GI parasitism are more common in young animals.Look for evidence of possible congenital abnormalities such as megaesophagus (especially if regurgitation is present).
2. Older animals
Gastrointestinal cancer (lymphoma) is a common cause of vomiting in older animals (but it is possible at any age).Hyperthyroidism is a common cause of vomiting in older cats.Renal failure is a common cause of vomiting in older dogs or cats.Sex
Female dogs are more likely to have Addison’s disease than male dogs.
Breed Predispositions
1. Large breed dogs
Standard poodles: Addison’s diseaseGerman Shepherd dogs
– Megaesophagus +/- persistent right aortic arch (PRAA)
– Exocrine pancreatic insufficiency +/- inflammatory bowel disease
– Gastric dilatation-volvulus (GDV)
Golden retrievers or Labrador retrievers
– Gastrointestinal or multicentric lymphoma
– Splenic or hepatic hemangiosarcoma
2. Small breed dogs
Yorkies or Maltese
– Protein-losing enteropathy (PLE) +/- inflammatory bowel disease
– Portosystemic shunt (PSS)
Miniature poodles: Addison’s diseaseMiniature schnauzers: Pancreatitis
Physical Examination Findings
Body Condition – in the Context of Appetite
1. Thin?
Thin despite a good appetite: Major differentials include esophageal diseases (such as megaesophagus), primary gastrointestinal disease (inflammatory bowel disease versus gastrointestinal lymphoma versus severe gastrointestinal infection), exocrine pancreatic insufficiency (EPI), hyperthyroidism (cats), or diabetes mellitus.Thin with a poor appetite: Major differentials include primary gastrointestinal disease and chronic kidney disease.
2. Normal weight (or overweight)?
Normal weight (or overweight) with a good appetite: Large intestinal diseasesNormal weight (or overweight) with a poor appetite: Diseases outside of the gastrointestinal tract such as pancreatitisAbdominal Palpation
1. Abdominal pain?
PancreatitisGastrointestinal obstruction (obstructive mass; gastrointestinal FB, intussusception)
2. Abdominal distention?
Enlarged stomach (gastric dilatation or gastric-dilatation volvulus)Enlarged abdominal organsAbdominal fluid (protein-losing enteropathy, pancreatitis)
3. Abdominal mass?
Gastrointestinal origin
– Enlarged stomach
– Gastrointestinal foreign material obstruction
– Intussusception
– Gastrointestinal tumor
Origin outside the gastrointestinal tract
– Enlarged pancreas
– Mass/tumor in an organ outside of the gastrointestinal tract
Extra-Abdominal Abnormalities
1. Oral exam – foreign material? Oral masses? Oral ulcers?
2. Throat exam – dilated esophagus? Thyroid slip?
3. Thoracic auscultation: Muffled lung sounds can be a sign of diaphragmatic hernia.
4. Peripheral lymphadenopathy? Dogs with gastrointestinal lymphoma can also have multicentric lymphoma. (However, normal peripheral lymph nodes do not rule out the possibility of gastrointestinal lymphoma.)
Laboratory
CBC/Chem/lytes, Urinalysis
1. Elevated kidney values along with unconcentrated urine can lead to a diagnosis of chronic kidney disease as the cause of the gastrointestinal signs.
2. Elevated liver values can be present in dogs with portosystemic shunt, liver failure, pancreatitis, and/or gallbladder disease.
3. Low sodium and high potassium +/- glucose can be a sign of Addison’s disease. Patient may have normal bloodwork and still have Addison’s disease. Dogs with atypical Addison’s disease can have normal Na/K and lack of a stress leukogram. Dogs with Addison’s disease typically have intermittent clinical signs.
4. Assess for concurrent problems that could affect treatment decisions
Fecal Flotation, Fecal Smear, Fecal PCR
1. Gastrointestinal parasites – can be a concurrent problem or can be the cause of the clinical signs; most of the gastrointestinal parasites are easy to diagnose
2. Giardia – can be hard to diagnose
Imaging
Abdominal Radiographs
1. Assess serosal detail
2. Assess the shape, position, and relationship of the abdominal organs
3. Look for gastrointestinal foreign material and/or gastrointestinal obstruction. Gastric foreign material may be easier to diagnose with radiographs.
Abdominal Ultrasound
1. Check for abdominal fluid (abdominal ultrasound is sensitive for this).
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2. Assess the thickness, motility, and layering of the gastrointestinal tract: Thickened intestines can be a sign of gastrointestinal inflammation (IBD), gastrointestinal neoplasia (lymphoma vs carcinoma vs other), or gastrointestinal infection (pythiosis) and location of the thickening can be helpful for planning follow-up diagnostics and plan (upper GI endoscopy vs. colonoscopy vs. both vs. exploratory laparotomy).
3. Look for gastrointestinal foreign material and/or gastrointestinal obstruction: Small intestinal foreign material and obstruction may be easier to diagnose with ultrasound.
4. Assess the extra-gastrointestinal organs for structure, nodules, or masses.
5. Assess the pancreas for signs of pancreatitis (ultrasound is more sensitive).
Chest Radiographs
1. Assess the esophagus
2. Check for concurrent aspiration pneumonia
Special Labs
GI Panel (B12/folate/TLI/PLI)
1. Low B12 +/- low folate are screening tests for primary gastrointestinal disease.
2. Elevated PLI is diagnostic for pancreatitis (but a normal PLI does not rule it out).
3. Low TLI is diagnostic for exocrine pancreatic insufficiency.
Baseline Cortisol
Screening test for Addison’s disease. If baseline cortisol > 2 ug/dL, this rules out Addison’s disease.
ACTH Stimulation Test
This is the definitive means to rule in or rule out Addison’s disease. If pre-ACTH and post-ACTH cortisol are 2 ug/dL, Addison’s disease is ruled out.
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Advanced Diagnostics
Upper Gastrointestinal Endoscopy +/- Colonscopy and Endoscopic GI Biopsies
1. Less invasive
2. The mucosal surface is visualized and assessed
3. Colonic tissue can be biopsied and colonic tissue samples can be submitted for tissue culture and fluorescence in situ hybridization (FISH) for diagnosis of granulomatous histiocytic colitis.
Exploratory Laparotomy and Gastrointestinal Biopsies
1. The gastrointestinal biopsies are full thickness and larger samples