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Year 4 Small Animal Studies > Internal Medicine: Gastroenterology: Approach to Vomiting > Flashcards

Internal Medicine: Gastroenterology: Approach to Vomiting Flashcards

1
Q

What is the difference between primary and secondary vomiting?

A

Primary vomiting
* Underlying gastric disease

Secondary vomiting
* non GI-diease

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2
Q

What causes vomiting?

A
  • Chemoreceptor trigger zone
  • Pharynx
  • Stomach
  • Duodenum

Causes the vomiting centre to:

  • Contract pylorus
  • Relax stomach
  • Contract abdominal M
  • etc
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3
Q

What could cause vomiting secondary to systemic/metabolic diease

A
  • Infections- distemper, lepto
  • Pyo
  • Renal failure
  • Hepatic diease
  • Drugs- digoxin, erythromycin
  • Hypoadrenocorticism
  • CNS disease
  • Motion sickness
  • Vestiublar disease
  • Neoplasia

Etc

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4
Q

What can cause chronic vomiting?

A
  • Inflammatory bowel disease
  • Intestinal neoplasia
  • Small intestinal obstruction
  • Pancreatitis
  • Peritonitis

Primary gastric disease- chronic gastritis, retention disorders, ulcers, neoplasia

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5
Q

What is the pathophysiology of gastric disease?

A
  • Gastric outflo obstruction
  • Gastroparesis
  • Disruption of mucosal barrier
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6
Q

How is chronic vomiting diagnosed?

A
  • Distinguish vomiting vs regurgitatoin
  • Eliminate secondary causes
  • Abdominal imaging- radiograph, US
  • Gastroscopy
  • Symptomatic therapy
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6
Q

How is chronic vomiting diagnosed?

A
  • Distinguish vomiting vs regurgitatoin
  • Eliminate secondary causes
  • Abdominal imaging- radiograph, US
  • Gastroscopy
  • Symptomatic therapy
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7
Q

What may be found on physical examination woth chronic vomiting?

A

Oral examination
* Ulcers
* Linear foreign body

Abdominal palpation
* Pain
* Foreign body, intra-abdominal mass
* Distended stomach or bowel

Rectal examination
* Diarrhoea
* Melaena

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8
Q

What are possible causes of chronic gastritis?

A
  • Aetiology usually unknown
  • Sometimes generalised IBD
  • Chronic gastric paratism
  • Hairballs in cats
  • Spiral bacteria
  • Immune-mediated
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9
Q
  1. What are the signs of chronic gastritis?
  2. How is it diagnosed?
A
  1. Intermittent chronic vomiting, periodic early morning vomit with bile, poor appetite, gastric bleeding
  2. Lab changes non-specific, imaging findings non-specific, gastroscopy and biopsy
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10
Q

How is chronic gastritis treated?

A
  • Removal of aetiological agent if known
  • Diet- multiple small meals, low fat diet, hypoallergenic
  • Acid blocker
  • Corticosteroids?
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11
Q

What may cause bilious vomiting?
How is it treated?

A
  • Often occurs in dogs fed once daily
  • Vomiting occurs overnight or in the morning
  • Bile-stained fluid

Diagnosis- rule out other causes

Tx
* Feed more often, late meal
* Prokinetics

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12
Q

What can cause gastric retention disorders?

A

Retention of food for > 8h causing delayed vomiting of food

  • Anatomical outflow obstruction
  • Functional disorder- primary motility disorder, inflammatory disease
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13
Q

What can cause anatomical outflow obstructions?

A
  • Pyloric stenosis
  • Neoplasia, polyp
  • CHPG
  • Foreign body

Chronic hypertrophic pyloric gastropathy

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14
Q

How are the following disease treated?
1. Pyloric stenosis
2. CHPG

A
  1. Pyloromyotomy/pyloroplast
  2. Surgery
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15
Q

How are functional causes of gastric retention treated??

A
  • Treat underlying inflammatory disease
  • Prokinetics- metoclopramide
16
Q

What can cause haematemesis?

A
  • Generalised bleeding
  • Swallowed blood- oropharyngeal, nasal, pulmonary
  • Severe gastritis
  • Gastric ulcer
  • Gastric neoplasia
  • Duoedenal disease
17
Q

What is a peptic ulcer?
What are the aetiologies?

A

Peptic ulcer- ulcer in stomach or duodenum

Aetiology
* Drugs
* Head and spinal injuries
* Gastritis
* Metabolic- liver disease, uraemia
* Mastocytosis
* Gastrinoma
* Spiral bacteria- heliobacter

18
Q

How are gastric ulcers treated?

A
  • Treat identifiable primary cause
  • Sucralfate
  • Acid blockers
  • ABs?
  • H2 receptor antagonists- block stimulation of HCL secretion
  • Proton pump inhibitors- omeprazole

Triple therapy

19
Q

How can ulcers be prevented?

A

Limited protective effect
* H2 atagonists
* PPIs
* Sucralfate

Protective
* Synthetic PGE

20
Q

What treatment can be for helicobacter causing gastric ulcers?

A

Triple therapy
* Two antibiotics plus an acid blocker
* 3 antibiotics- amoxicillin, metronidazole, clarithromycin

21
Q

What gastric neoplasia can affect dogs and cats?

A

Dogs
* Adenocarcinoma
* Lympgoma
* Polyps
* Leiomyoma

Cats
* lymphoma
* Adenocarcinoma

22
Q

What are the characterisitcs of gastric adenocarcinoma?

When should it be suspected?

A
  • Infiltrate gastric wall
  • Often lesser curvature of stomach
  • Metastasis to LN and liver

Older animal with
* Chronic vomiting
* Anorexia and weight loss
* Haematemesis and melaena
* Anaemia
* Drooling saliva

Year 4 Small Animal Studies (97 decks)

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