ANSWERS

1. List 4 common signs of oral cavity disease.
   • Dysphagia.
   • Anorexia.
   • Pawing at the mouth.
   • Halitosis.
2. Why are animals born with a cleft palate usually euthanased?
   They are unable to suckle properly, there is commonly reflux of milk from the nostrils and aspiration pneumonia is very likely. Surgical correction is possible when the animal is older, but euthanasia is generally considered the sensible option since it is very difficult to ensure that affected animals receive adequate nutrition.
3. List 10 diseases/conditions that may affect the oral cavity, and briefly describe each.
   • Gingivitis - inflammation of the gums.
   • Stomatitis - inflammation of the mouth.
   • Periodontitis - advanced dental disease.
   • Dental caries - cavities in the teeth.
   • Calculus build up - a stony concretion (tartar) build up on the teeth.
   • Pharyngitis - inflammation of the pharynx.
   • Tonsilitis - inflammation of the tonsils.
   • Oral eosinophilic granuloma - an ulcerated lesion of unknown aetiology (cause) that is common in cats.
   • Neoplastic lesions/masses - cancerous growths (squamous cell carcinomas, fibrosarcomas and epulis are common).
   • Salivary gland mucocoele - obstruction of the salivary duct.
4. What is the name of the prescription diet that is useful as a nutritional aid to help to reduce dental plaque and tartar?
   Hills T/D (available in both canine and feline versions).
5. Explain how Hills T/D diet helps to protect against gingivitis.
   • The texture of the food allows the tooth to penetrate each piece of kibble.
   • The large kibble size means that most of the tooth is engulfed prior to splitting.
   • The fibres of the kibble are aligned so that the tooth surfaces are cleaned.
   • In chewing the fibres will wipe the accumulation of plaque and stain from the surface of the tooth, thus reducing the accumulation of tartar and the development of gingivitis.
6. State 2 common sites for oesophageal foreign bodies.
   • The thoracic inlet.
   • The heartbase.
     (narrow sites).
7. List 3 possible causes of oesophagitis.
   • Ingestion of irritants.
   • Presence of a foreign body.
   • Chronic vomiting.
8. What is the term used to describe dilation of part of or the entire length of the oesophagus?
   Megaoesophagus.
9. List 5 general signs of oesophageal disease.
   • Regurgitation.
   • Dysphagia.
   • Anorexia.
   • Coughing.
   • Malnutrition.
10. List 3 possible causes of gastritis.
    • Systemic infection.
    • Toxin ingestion.
    • Certain drugs (NSAIDs).
11. List 4 signs of gastric dilation.
    • Abdominal distension.
    • Pain.
    • Tympany.
    • Salivation.
12. List 5 general signs of gastric disorders.
    • Vomiting.
    • Abdominal pain (may adopt unusual stance such as the "praying position").
    • Dehydration.
    • Anorexia and subsequent weight loss.
    • Lethargy and depression.
13. List 10 disorders that may cause secondary vomiting.
    • Renal failure.
    • Hepatic dysfunction.
    • Ulcers.
    • Neoplasia.
    • Pancreatitis.
    • Ketoacidosis.
    • Pyometra.
    • CNS disease.
    • Motion sickness.
    • Intestinal foreign bodies.
14. A cat is to be hospitalised in order to treat chronic vomiting. The primary cause is unknown at this stage. Describe the initial treatment.
    • Ensure that the cat is kennelled in a warm, quiet environment with a comfortable bed and litter tray.
    • If the cause of vomiting is unknown, then the cat should be isolated in case the cause is infectious.
    • Food is generally withheld for 24 hours, and water for 12 hours, but the veterinary surgeon may have specific recommendations. In some cases it may be that you are asked to "test feed" the patient to establish what is vomited, how frequently and how soon the vomiting occurred following feeding.
    • Intravenous fluids will be essential.
    • Fluid, electrolyte and acid base imbalances must be corrected. The veterinary surgeon may instruct you to run tests such as PCV and blood biochemistry.
    • Antiemetic treatment such as metoclopramide may be indicated and given under the direction of the veterinary surgeon in charge of the case.
    • Other medication such as antacids, demulcents and antibiotics may be indicated and given under the direction of the veterinary surgeon in charge of the case.
    • If the patient tolerates water, and has not vomited after 24 hours, then very small quantities of a bland diet may be fed. If vomiting persists, then surgery may be required to discover/remove the cause.
    • Ensure that records are kept updated. It may be prudent to retain a sample of vomit for analysis.
15. Your cat patient in Q14 has responded well to fluid therapy and antibiotics. The veterinary surgeon has asked you to commence with feeding small quantities of a bland diet. Why would you choose Hills Feline I/D or Waltham Sensitivity Control over Hills A/D?
    Hills A/D is higher in fat and protein; whilst these properties make it ideal for the healing of tissues - it may prove to be too rich for a nauseous patient.
16. List 5 conditions in which the feeding of a hypoallergenic prescription diet might be indicated.
    • Gastrointestinal disorders (gastritis, enteritis, colitis and recovery from GI surgery).
    • Exocrine pancreatic insufficiency (EPI).
    • Acute pancreatitis (without hyperlipidaemia).
    • In dogs prone to GDV.
    • Orphaned puppies.
17. Diets such as Hills A/D are contraindicated in patients whose gastro-intestinal tracts cannot tolerate a high fat intake. Give 3 examples of diseases in which this is the case.
    • Chronic renal disease.
    • Chronic liver disease.
    • Acute pancreatitis.
18. What is the most consistent clinical sign of intestinal disease?
    Diarrhoea (caused by in increase in faecal water content).
19. Give examples of 3 viruses that may target the intestines and thus cause diarrhoea.
    • Canine parvovirus.
    • Canine distemper.
    • Feline panleukopaenia.
20. Name 2 types of bacteria that invade and damage the intestinal mucosae.
    • Salmonella spp.
    • C jejuni (Campylobacter).
21. What is the name of the inflammatory disease of the large bowel characterised by diarrhoea or loose motions with fresh blood and/or mucus?
    Colitis.
22. Give examples of 2 prescription diets suitable for the feeding of dogs with gastrointestinal signs resulting from dietary sensitivity.
    • Hills Canine D/D.
    • Waltham Canine Sensitivity Control.
23. A client telephones the surgery and is very concerned as her 3 year old bull terrier is passing blood in his faeces. Why is it important to differentiate whether the blood is fresh (frank blood) or old blood (malaena - the stools will be dark or black in colour)?
    Fresh blood is usually a sign of colitis and is not generally considered to be as serious as dark blood which usually is indicative of small intestinal bleeding and may indicate a condition of a far more severe origin.
24. List 4 possible causes of intestinal obstruction.
    • Foreign body.
    • Intusseception.
    • Intestinal neoplasia.
    • Stricture.
25. List 4 possible causes of colonic impaction.
    • Hair balls.
    • Obstruction by the ingestion of a foreign body such as bone.
    • Fracture of the pelvis.
    • Prostatic enlargement.
26. List 3 general signs of disorders of the large intestine.
    • Diarrhoea.
    • Constipation.
    • Tenesmus.
27. What is meant by dyschezia?
    Difficult or painful passage of faeces from the rectum.
28. List 8 factors that may prove important in the control of chronic constipation.
    • Enemata (Micralax, soapy water).
    • Oral laxatives (liquid paraffin, Katalax).
    • Elimination of foods such as bones from the diet.
    • Regular grooming (to avoid furballs).
    • Removal of any inciting cause.
    • Increase exercise (to increase muscular tone).
    • Increase the fibre proportion of the diet.
    • Increase the moisture proportion of the diet.
29. What is the term used to describe inflammation of the liver?
    Hepatitis.
30. By what other term might jaundice be known?
    Icterus.
31. What blood parameters commonly indicate liver dysfunction?
    • ALT.
    • ALP.
    • Bilirubin.
32. List, and briefly describe the 3 main types of jaundice.
    • Pre-hepatic - an increased breakdown of rbcs as seen in autoimmune haemolytic anaemia, incompatible blood transfusions and leptospirosis.
    • Hepatic - the liver is unable to conjugate bilirubin. The primary cause is hepatitis, which may be viral or toxic. Cirrhosis and neoplasia of the liver may also cause hepatic jaundice.
    • Post hepatic - the liver is able to conjugate bilirubin but cannot excrete it. This is usually due to obstruction of the bile duct.
33. List 6 possible causes of an obstructed bile duct.
    • Neoplasia of the pancreas.
    • Neoplasia of the bile duct itself.
    • Neoplasia of the duodenal opening.
    • Ruptured bile duct.
    • Pancreatitis.
    • Gall stones.
34. What is cirrhosis of the liver?
    The end stage of chronic liver disease in which the liver becomes shrunken, fibrosed and unable to carry out its functions normally.
35. State 2 prescription diets designed for dogs with liver disease.
    • Waltham Canine Hepatic Support.
    • Hills Canine L/D.
36. What is the name given to an accumulation of fluid in the abdomen?
    Ascites.
37. What is the name given to describe the sampling of fluid from the abdominal cavity?
    Paracentesis.
38. List 8 signs of liver disease.
    • Anorexia.
    • Vomiting.
    • Weight loss (stunted growth in young animals).
    • Weakness.
    • Polyuria/polydipsia.
    • Ascites.
    • Orange urine (hyperbilirubinuria).
    • CNS signs (due to hepatic encephalopathy).
39. Name any 2 tests that are reliable indicators of hepatic dysfunction in the cat.
    • Fasting and post prandial bile acids.
    • Fasting ammonia.
    • Bromsuplhalein (BSP) retention.
    • Indocyanin green retention.
40. Why are NSAIDs potentially toxic in cats?
    The feline liver has a relative deficiency of glucuronyl transferase. This enzyme is essential for glucuronide conjugation which is the major route of excretion of NSAIDs. Reduced activity of glucuronyl transferase greatly increases the half-life of NSAIDs, potentiating their toxicity.
41. A kitten is brought to the surgery suffering from intermittent ptyalism, ataxia and blindness. What is the most likely diagnosis?
    Portosystemic shunt.
42. State 4 serum biochemical abnormalities that might be expected in a cat with hepatic lipidosis.
    • Hyperbilirubinaemia.
    • Raised ALT.
    • Raised SAP.
    • Coagulation abnormalities.
43. State the diet of choice for a cat suffering from hepatic lipidosis.
    Highly digestible, concentrated diet e.g. Hills A/D.
44. What is the most common presenting sign reported in adult cats with acquired liver disease?
    Anorexia.
45. What are the 2 main causes of maldigestion?
    • Exocrine pancreatic insufficiency.
    • Bile salt deficiency.
46. Give 3 causes of malabsorption.
    • Digestive defect.
    • Mucosal abnormality.
    • Lymphatic obstruction.
47. Animals suffering from malabsorption are systemically well, but may suffer from certain clinical signs. Can you list them?
    • Hyperphagia.
    • Chronic diarrhoea.
    • Coprophagia.
    • Weight loss.
48. State the dietary requirements of an animal suffering from malabsorption.
    • High protein (of a high biological value).
    • High carbohydrate.
    • Low fat.
49. An animal with putty coloured faeces is likely to be suffering from what?
    Maldigestion (exocrine pancreatic insufficiency).