Gastroenterology random quiz — Veterinaria Madrid

Question 1/10

11-year-old Miniature Schnauzer with hyperadrenocorticism and hyperlipidaemia, diagnosed with a gallbladder mucocele months ago; the owners declined surgery. It presents with acute abdominal pain, fever and jaundice. Ultrasound shows a discontinuous gallbladder wall and free fluid; the abdominal fluid is greenish, with bilirubin more than twice the serum value and degenerate neutrophils with bacteria.

What is the most appropriate management?

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A. Antibiotics and ursodeoxycholic acid; surgery if no improvement in 72 hours

Septic bile peritonitis does not resolve with medical treatment, and waiting increases mortality. Ursodiol also makes no sense with a ruptured gallbladder.

B. Percutaneous cholecystocentesis to decompress the gallbladder

The gallbladder is already ruptured; puncturing it does not resolve abdominal contamination and delays surgery.

C. Percutaneous abdominal drainage and antibiotics

A drain does not control the source of the leak or remove the necrotic gallbladder. It is insufficient as definitive treatment.

D. Stabilise (fluids, analgesia, broad-spectrum intravenous antibiotics after sampling) and emergency surgery: cholecystectomy, check the common bile duct, abdominal lavage and cultures

Correct. Septic bile peritonitis is a surgical emergency: the gallbladder must be removed, common bile duct patency confirmed and the abdomen lavaged. Its prognosis is much worse than that of sterile bile peritonitis.

lightbulb Key takeaway

Mucocele is associated with hyperadrenocorticism, hypothyroidism and hyperlipidaemia; treat them after surgery. Elective cholecystectomy in a stable dog has much lower mortality than emergency surgery after rupture: tell the owner when a mucocele is diagnosed.

Question 2/10

8-year-old Labrador Retriever that started carprofen 3 weeks ago for osteoarthritis. It now has anorexia, vomiting and jaundice, with markedly increased ALT and bilirubin. It takes no other drugs.

What is the most appropriate approach?

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A. Switch immediately to another NSAID, such as meloxicam

With active acute liver disease any NSAID should be avoided, and switching without a washout also increases gastrointestinal risk.

B. Stop carprofen, give supportive care with antioxidants and non-NSAID analgesia; never give it again

Correct. It is an idiosyncratic, non-dose-dependent reaction that usually appears in the first weeks. Most dogs recover if it is withdrawn in time, with fluids, antiemetics, nutrition and SAMe or N-acetylcysteine.

C. Halve the dose and repeat bloods in a month

Since it is not dose-dependent, reducing the dose does not prevent the injury. Continuing the drug can lead to liver failure.

D. Add prednisolone for possible immune-mediated hepatitis and continue carprofen

Combining an NSAID with a corticosteroid is contraindicated because of the risk of gastrointestinal ulceration, and the obvious cause is the drug.

lightbulb Key takeaway

Carprofen hepatotoxicity was reported more often in Labradors, but it can affect any breed. For analgesia, use gabapentin, amantadine, opioids or anti-NGF antibodies. Record the reaction in the history so the drug is not repeated.

Question 3/10

Which statement about nasoesophageal tubes is correct?

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A. It is the tube of choice for home feeding over several weeks

For prolonged home support an oesophagostomy or gastrostomy tube is preferable: they accept denser diets, are better tolerated and allow medication to be given.

B. It allows blended recovery diets and crushed tablets to be given without problems

Because of its small bore it blocks easily: it accepts liquid diets only, and giving crushed tablets through it should be avoided.

C. It requires general anaesthesia and endoscopic confirmation of its position

It is placed under local anaesthesia of the nasal cavity and, at most, light sedation. Position is confirmed radiographically (or by capnography), not endoscopically.

D. It is useful for short-term support (a few days), but is unsuitable if there are nasal or facial lesions or the swallowing reflex is absent

Correct. It is cheap, quick and does not require general anaesthesia, which makes it ideal for unstable patients over a few days. Without a swallowing reflex the risk of aspiration rises, and frequent vomiting can dislodge it.

lightbulb Key takeaway

Choose the tube according to the expected duration and the patient's stability: nasoesophageal for a few days or if anaesthesia is not tolerated; oesophagostomy for weeks and discharge home; gastrostomy if the oesophagus must be bypassed or for very long-term support.

Question 4/10

6-year-old female Dobermann with ALT 4–5 times the upper limit on several checks over 3 months, with no hepatotoxic drugs or endocrinopathy. Leishmania negative. Mildly increased post-prandial bile acids, non-specific liver ultrasound and normal coagulation.

What is most appropriate before starting specific treatment?

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A. Empirical prednisolone, because most chronic hepatitis is immune-mediated

Without a biopsy you do not know whether the cause is copper or infection. Corticosteroids do not treat copper accumulation and may worsen an infection; they also cause adverse effects that complicate the course.

B. Liver biopsy (laparoscopic or surgical, several samples) with histology, copper staining and quantification, and culture

Correct. Chronic hepatitis can only be diagnosed histologically, and treatment depends on the cause: copper chelation, antimicrobials or immunosuppression if idiopathic. Dobermanns are predisposed to copper-associated hepatitis.

C. Ultrasound-guided fine-needle aspirate for a definitive diagnosis

Cytology does not assess architecture, type of inflammation or fibrosis, and agrees poorly with histology in hepatitis. It helps to orient, not to decide treatment.

D. Ursodeoxycholic acid and SAMe indefinitely, without further work-up

Hepatoprotectants are adjuncts and do not treat the cause. Delaying diagnosis lets the disease progress to fibrosis and cirrhosis.

lightbulb Key takeaway

Persistently increased ALT (over 2 months) without an extrahepatic cause justifies biopsy. Prednisolone is reserved for idiopathic chronic hepatitis once copper and infections have been ruled out. SAMe, silibinin, vitamin E and ursodiol (if cholestasis) are supportive treatments.

References: ACVIM Consensus Statement on the Diagnosis and Treatment of Chronic Hepatitis in Dogs (Webster et al., 2019)

Question 5/10

10-year-old female cat with idiopathic megacolon and repeated obstipation despite lactulose, cisapride and wet food. A subtotal colectomy is planned.

Which statement about the postoperative period is correct?

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A. Most will need laxatives and enemas for life, just as before

Most cats no longer need treatment, or need very little; recurrence of constipation is possible but uncommon.

B. Soft or pasty, more frequent faeces are normal during the first weeks, and they usually gain consistency

Correct. After colectomy, the remaining colon and small intestine adapt and absorb more water over time. Most cats end up with soft or formed faeces and a good quality of life.

C. Permanent faecal incontinence is the expected complication in almost all cats

The surgery preserves the rectum and anal sphincter; true incontinence is rare.

D. It must be fasted for 5 days to protect the anastomosis

Early feeding promotes healing of the intestinal mucosa; prolonged fasting is harmful, especially in a cat (risk of hepatic lipidosis).

lightbulb Key takeaway

Subtotal colectomy carries a good prognosis in feline idiopathic megacolon. Before operating, rule out causes that surgery will not correct, such as neurological lesions or pelvic narrowing from a malunited fracture, which may need a different approach.

Question 6/10

7-year-old Yorkshire Terrier with abdominal distension due to ascites and mild diarrhoea. Albumin 1.4 g/dL, low globulins and cholesterol, no proteinuria or liver disease. Intestinal biopsies show markedly dilated lacteals with mild inflammation.

What is the cornerstone of treatment?

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A. Very low-fat, highly digestible diet

Correct. Dietary fat increases intestinal lymph flow and rupture of the dilated lacteals, with loss of protein and lymphocytes. Many dogs with lymphangiectasia improve with diet alone; if inflammation is marked or there is no response, prednisolone is added.

B. High-dose furosemide to remove the ascites

The ascites is due to low oncotic pressure; aggressive diuresis can cause hypovolaemia and does not treat the cause. It improves as albumin recovers.

C. High-protein, high-fat diet to compensate for losses

Fat worsens lymphatic loss. Good protein intake is desirable, but always with very little fat.

D. Repeated plasma transfusions until albumin normalises

Enormous volumes of plasma are needed to raise albumin slightly; it is impractical and does not treat the cause. It is only used as short-term support.

lightbulb Key takeaway

Yorkshire Terriers are predisposed to protein-losing enteropathy (lymphangiectasia and crypt lesions) and may present with ionised hypocalcaemia and hypomagnesaemia causing tremors or seizures. Choose a commercial very low-fat diet (or low-fat hydrolysed diet) and monitor albumin every few weeks.

Question 7/10

3-year-old female cat with a mandibular symphyseal fracture after falling from a balcony. During anaesthesia to stabilise the fracture, an oesophagostomy tube is placed and a lateral thoracic radiograph is taken to check its position.

Where should the tip of the tube lie?

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A. Inside the stomach, so that food arrives directly

If the tube crosses the lower oesophageal sphincter it holds it open, promoting gastro-oesophageal reflux, oesophagitis and displacement of the tube with vomiting.

B. In the distal thoracic oesophagus, approximately at the level of the 7th–9th intercostal space, without crossing the cardia

Correct. In this position food reaches the stomach by gravity and peristalsis and the lower oesophageal sphincter is preserved. Always confirm it radiographically before the first feed.

C. In the cervical oesophagus, near the stoma, to reduce the risk of perforation

A tube that is too short allows food to reflux towards the pharynx, with a risk of regurgitation and aspiration, and dislodges more easily.

D. In the duodenum, to avoid stimulating the stomach

An oesophagostomy tube is not designed to reach the duodenum. Post-pyloric feeding requires specific tubes (nasojejunal or jejunostomy) and continuous infusion.

lightbulb Key takeaway

The most common complication of an oesophagostomy tube is stoma infection: clean it daily and keep it bandaged. The tube can be used as soon as the cat recovers from anaesthesia and removed at any time; the stoma heals by second intention.

Question 8/10

3-year-old Labrador operated on 4 days ago for an intestinal foreign body (peach stone) with enterectomy and anastomosis. Before surgery his albumin was 2.1 g/dL. He did well for the first two days, but today he is dull, febrile, vomiting and has abdominal pain.

What is most likely and what do you do?

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A. Postoperative ileus: prokinetic and reassess in 48 hours

Ileus does not explain the fever, pain and deterioration after initial improvement. Waiting 48 hours with possible septic peritonitis greatly worsens the prognosis.

B. Postoperative pancreatitis: analgesia and fluids

Possible, but less likely than dehiscence at this time point and with these risk factors. Failing to rule out dehiscence is a serious error.

C. Wound infection: oral antibiotic and recheck

A superficial infection does not cause abdominal pain, vomiting and systemic depression. The abdominal cavity must be assessed.

D. Suspected dehiscence: ultrasound and abdominocentesis, and urgent laparotomy if septic peritonitis is confirmed

Correct. Dehiscence usually occurs between days 3 and 5, when suture strength depends on healing that is still weak. Hypoalbuminaemia is a risk factor, as are pre-existing peritonitis and a foreign body.

lightbulb Key takeaway

Any deterioration between days 3 and 5 after intestinal surgery is dehiscence until proven otherwise. Intracellular bacteria in abdominal fluid confirm septic peritonitis; after laparotomy, free gas may persist for days and is not enough on its own.

Question 9/10

3-month-old crossbreed puppy with parvovirus, vomiting and haemorrhagic diarrhoea. Temperature 40.1 °C, tachycardia and injected mucous membranes.

Parameter	Result	Reference
White blood cells	1,200/µL	6,000–17,000/µL
Neutrophils	300/µL	3,000–11,500/µL
Glucose	68 mg/dL	70–120 mg/dL

Which antibiotic approach is most appropriate?

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A. IV beta-lactam (ampicillin or amoxicillin-clavulanate) plus added Gram-negative cover because of the signs of sepsis

Correct. The virus destroys the crypts and the bone marrow: gut bacteria (Gram-negatives and anaerobes) translocate in the face of neutropenia. With signs of sepsis, combine the beta-lactam with a Gram-negative drug (e.g. an aminoglycoside after rehydration, or a fluoroquinolone).

B. No antibiotic, because parvovirus is a viral disease

This ignores bacterial translocation and neutropenia, which are the main causes of sepsis and death. This febrile, tachycardic puppy needs antibiotics.

C. Oral metronidazole as the sole antibiotic

With vomiting, the oral route is unreliable, and metronidazole only covers anaerobes: it leaves aerobic Gram-negatives such as E. coli uncovered.

D. Granulocyte colony-stimulating factor (G-CSF) instead of antibiotics

It has not been shown to improve survival in canine parvovirus and never replaces antibiotics in a neutropenic, septic puppy.

lightbulb Key takeaway

In parvovirus, broad-spectrum parenteral antibiotics are justified by neutropenia and the risk of sepsis, unlike acute or haemorrhagic diarrhoea without sepsis. Check the neutrophil count daily: its recovery heralds improvement.

Question 10/10

9-year-old Poodle in which several choleliths are found in the gallbladder on an ultrasound done for another reason. It has no gastrointestinal signs, bilirubin is normal, liver enzymes are normal or mildly increased and the common bile duct is not dilated.

What is the most appropriate approach?

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A. Immediate preventive cholecystectomy

Most asymptomatic choleliths cause no problems. Operating without an indication exposes the animal to unnecessary surgical risk.

B. Clinical, laboratory and ultrasound monitoring; surgery only if there is obstruction, cholecystitis, rupture or infection

Correct. In dogs, choleliths are often an incidental finding. They are treated when they cause signs: they are then removed (cholecystectomy, choledochotomy) and the stones and bile are cultured.

C. Ursodeoxycholic acid to dissolve the stones

In dogs and cats, choleliths are usually made of bile pigments and calcium carbonate, not cholesterol, so ursodiol does not dissolve them.

D. Prolonged empirical antibiotic

Without signs of infection it is not indicated and promotes resistance. If cholecystitis is suspected, bile is cultured before treating.

lightbulb Key takeaway

In cats, choleliths are more often associated with cholangitis and biliary obstruction, so look for underlying biliary disease. In either species, a common bile duct stone with dilation and rising bilirubin is surgical.