Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SMALL ANIMAL > 9.5.1: Approach to vomiting, regurgitation, and dysphagia > Flashcards

9.5.1: Approach to vomiting, regurgitation, and dysphagia Flashcards

1
Q

Vomiting is an active reflex mediated via the emetic centre. Describe the various pathways by which this can be stimulated.

A

The emetic centre can be stimulated via the:
* Chemoreceptor trigger zone (CRTZ)
* GI tract
* Cerebral cortex
* Vestibular system

This means that in vomiting, there are several systems to consider as possible causes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does the chemoreceptor trigger zone monitor and how does it achieve this?

A
  • CRTZ is full of various receptors
  • Samples the blood for endogenous substances e.g. azotaemia (renal system), ammonia (hepatic system), and inflammatory mediators.
  • Samples the bloood for exogenous substances e.g. drugs/toxins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the likely broad causes of acute vomiting?

A

Acute vomiting is most likely to be:
* Toxic
* Obstructive
* Inflammatory
* Infectious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the likely broad causes of chronic vomiting?

A

Chronic vomiting is most likely to be:
* Chronic inflammatory
* Chronic infectious
* Metabolic
* Endocrine
* Neoplastic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Dysphagia

A

a failure to prehend/bite and initially swallow. This involves the mouth and pharynx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some possible causes of dysphagia?

A
  • Pain e.g. dental disease, retrobulbar abscess, jaw fracture
  • Failure of neuromuscular control e.g. masticatory myositis, botulism, cranial nerve disease (V, VII, IX, X, XII)
  • Obstruction e.g. FB, abscessation, neoplasia, lymphadenopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Regurgitation

A

Failure to pass food down the oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some possible causes of regurgitation?

A
  • Dilatation e.g. megaoesophagus
  • Obstruction
  • Neuromuscular disease e.g,. botulism, tetanus, dysautonomia, Addison’s, peripheral neuropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the types of oesophageal obstruction and provide an example cause for each

A
  • Obstructions may intraluminal (internal), mural (wall), extramural (external)
  • Intraluminal e.g. FB, stricture secondary to oesophagitis
  • Mural e.g. neoplasia, inflammation
  • Extramural e.g. vascular ring anomaly, hiatal hernia, SOL (neoplasia)

SOL = space-occupying lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some neuromuscular disorders that may cause regurgitation?

A
  • Addison’s
  • Botulism
  • Distemper
  • Dysautonomia
  • Hypothyroidism
  • Myasthenia gravis
  • Peripheral neuropathy (may be autoimmune)
  • Tetanus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Vomiting may be caused by events in the GIT, cerebral cortex, vestibular system, or CRTZ. List some possible GIT causes of acute vomiting.

A
  • Obstructive: FB, neoplasia, parasitic constipation, intussuception, volvulus
  • Inflammatory: gastritis, gastroenteritis, colitis
  • Mucosal insult: dietary indiscretion, intolerance, sudden changes in diet, toxins
  • Infectious: bacterial/viral/parasitic cause
  • Gastric stretch (overeating)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Vomiting may be caused by events in the GIT, cerebral cortex, vestibular system, or CRTZ. List some possible causes of acute vomiting that originate in the cerebral cortex.

A
  • Head trauma
  • Sudden changes in intracranial pressure (ICP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Vomiting may be caused by events in the GIT, cerebral cortex, vestibular system, or CRTZ. List some possible causes of acute vomiting that originate in the vestibular system.

A
  • Motion sickness
  • Idiopathic vestibular disease
  • Otitis interna
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Vomiting may be caused by events in the GIT, cerebral cortex, vestibular system, or CRTZ. List some possible causes of acute vomiting that originate in the CRTZ.

A
  • Endogenous causes: any systemic metabolic or endocrine disease resulting in acute changes that will be picked up in the CRTZ e.g. DKA, Addison’s, AKI, pancreatitis, acute hepatitis, peritonitis, prostatitis, pyometra
  • Exogenous: toxins/drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Vomiting may be caused by events in the GIT, cerebral cortex, vestibular system, or CRTZ. List some possible causes of chronic vomiting that originate in the GIT.

A
  • Obstructive: pyloric FB, neoplasia, parasitic obstruction, constipation
  • Chronic inflammatory: gastritis, gastroenteritis, colitis, chronic enteropathy
  • Mucosal insult: dietary intolerance
  • Infectious: chronic bacterial/viral/protozoal infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Vomiting may be caused by events in the GIT, cerebral cortex, vestibular system, or CRTZ. List some possible causes of chronic vomiting that originate in the cerebral cortex.

A
  • Neoplasia/SOL
  • CNS disease

SOL: space occupying lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Vomiting may be caused by events in the GIT, cerebral cortex, vestibular system, or CRTZ. List some possible causes of chronic vomiting that originate in the vestibular system.

A
  • Chronic vestibular damage
  • Otitis interna
  • Neoplasia
  • Cerebellar disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Vomiting may be caused by events in the GIT, cerebral cortex, vestibular system, or CRTZ. List some possible causes of chronic vomiting that originate in the CRTZ.

A
  • Endogenous causes: any systemic metabolic or endocrine disease resulting in acute changes that will be picked up in the CRTZ e.g. DKA, Addison’s, AKI, chronic renal failure, chronic pancreatitis, electrolyte disturbances, acid-base disturbances, hyperthyroidism (cats)
  • Exogenous causes: drugs and toxins are less likely when vomiting is chronic rather than acute
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which tetracycline can cause oesophagitis in cats?

A

Doxycycline

20
Q

Describe your approach to a case of vomiting

A
  1. Differentiate vomiting (active) from regurgitation/dysphagia (passive)
  2. History (e.g. recent medications)
  3. Signalment clues
  4. Physical exam –> other clinical signs may be suggestive of a cause
21
Q

How could you differentiate vomiting from dysphagia/regurgitation?

A
  • Vomiting is active, dysphagia/regurgitation is passive
  • Vomiting usually associated with retching, abdominal effort, and noise
  • Regurgitation is associated with less noise and no retching
  • Timing after food for each can be variable so don’t rely on this.
  • Look at the food - does it look partially digested?
22
Q

What are some history questions/clinical exam findings that might help you in a case of vomiting?

A
  • Recent medication e.g. doxycycline
  • GI disease: dietary changes/scavenging, FB risk? Access to toxins? Worming regime? Concurrent diarrhoea/constipation?
  • Neuro abnormalities: any behavioural changes/ataxia/cranial nerve deficits?
  • Pain
  • BCS and musculature especially masticatory muscles - helps ascertain if acute/chronic cause
  • Signs of systemic disease e.g. PUPD, jaundice
23
Q

One of these dogs walks in. It is a puppy. The owner reports has been struggling to keep food down. What are you suspicious of and what might be your next step?

A
  • Breeds pictured: Lab, Newfoundland, Shar Pei
  • These breeds are at higher risk of congenital megaoesophagus
  • Possible next step: more thorough history taking to ascertain what the owner means by “struggling to keep food down” i.e. is this true vomiting or instead regurgitation?
24
Q

Which dog breeds are at higher risk of congenital and acquired megaoesophagus?

A

Great Danes, GSDs, Irish Setters

25
Q

The following breeds are all more likely to have which anatomical abnormalities that could lead to regurgitation?

A

Breeds pictured: Great Dane, GSD, Irish Setter
At increased risk of:
* congenital and acquired megaoeophagus
* vascular ring anomaly e.g. PRAA

PRAA: persistent right aortic arch. This wraps around the oeosphagus, leading to regurgitation.

26
Q

Which species are most at risk of doxycycline-induced oesophagitis?

A

Cats

27
Q

Which of the following are most likely to present with an intusseception?
a) older animals
b) younger animals
c) middle-aged animals

A

b) younger animals

28
Q

A labrador puppy presents with an acute history of vomiting. The most likely cause is:
a) intestinal neoplasia
b) gastric/intestinal foreign body
c) vascular ring anomaly
d) congenital megaoesophagus

A

b) gastric/intestinal foreign body
* Remember that labradors are idiots and eat everything.
* Labs are more at risk for congenital megaoesophagus, but we might expect a more chronic presentation, and this would be associated with regurgitation rather than vomiting.

29
Q

You suspect a puppy has an intusseception. What information from the history might make you even more suspicious of this?

A

Recent history of diarrhoea

30
Q

Radiography will be best utilised to detect which causes of vomiting?
a) inflammatory disease
b) obstructive disease
c) metabolic disease

A

b) obstructive disease

31
Q

You suspect a systemic disease/metabolic cause of your canine patient’s vomiting. What specific blood tests could you do and what would each test for?

A
  • cPLI - Pancreatitis
  • AChR - Myasthenia gravis
  • Basal cortisol - Addison’s
  • T4/TSH - Hypothyroidism
32
Q

Management and prognosis of megaoesophagus

A
  • Feed from height over 5-10 mins
  • Feed small balls of food rather than large amounts
  • Consider placing a feeding tube
  • Treat any concurrent/underlying disease e.g. hypoT, PRAA
  • Prognosis is often poor for chronic regurgitation
33
Q

Management of oesophagitis

A
  • Provide pain relief
  • Place a feeding tube that bypasses the oesophagus e.g. a PEG tube
34
Q

Management of oesophageal FB

A
  • Could attempt removal via endoscopy
  • If very challenging -> consider referral because if you rupture the oesophagus the animal will need a thoracotomy
35
Q

True/false: it is appropriate to give any anti-emetic to the acutely vomiting patient, and instruct the owners to return the following day if the vomiting has not stopped.

A

False although this does happen in practice.
* If an animal has a FB, for example, giving an anti-emetic may mask this (animals with FBs cannot be relied upon to vomit “through” the anti-emetic).
* Some anti-emetics e.g. metoclopramide have prokinetic effects which could lead to GI rupture if a FB is present.
* Sometimes anti-emetics may be appropriate but this should be decided on based on history, case presentation and understanding of the risks.

36
Q

Name some anti-emetics available in small animal practice

A
  • Maropitant
  • Metoclopramide
  • Ondansetron
37
Q

Mode of action of maropitant

A
  • NK1 antagonist
  • Helps with centrally mediated nausea (e.g. of metabolic cause/related to CRTZ or vestibular system)
38
Q

Mode of action of metoclopramide

A
  • D2 receptor antagonist and 5-HT3 receptor antagonist
  • Dual effect on CRTZ and lower oesophageal sphincter
  • Has a prokinetic effect so if FB is present, could lead to GI rupture❗️
39
Q

Mode of action of ondansetron

A
  • 5-HT3 receptor antagonist
  • Effective against centrally mediated nausea (acts on CRTZ)
40
Q

What gastroprotectants are available in small animal practice?

A
  • Omeprazole
  • Misoprostol
  • H2 receptor antagonists e.g. cimetidine
  • Sucralfate
41
Q

Mode of action and uses of omeprazole

A
  • Proton pump inhibitor -> leads to reduced H⁺ secretion
  • Useful for gastric ulceration
  • (Also reduces CSF production so can be used in syringomyelia)
  • Long term use leads to dysbiosis in 3-4 weeks❗️
42
Q

Mode of action, uses and contraindications of misoprostol

A
  • Prostaglandin analogue -> increased mucosal blood flow and therefore healing (e.g. of ulcers)
  • Primarily used in NSAID toxicity
  • Do not use in pregnancy❗️
43
Q

Mode of action and uses of H2 receptor antagonists such as cimetidine

A
  • Reduces acid secretion
  • Questionable efficacy - not much research in small animal
44
Q

Mode of action and uses of sucralfate

A
  • Polyionic surfactant (anion) binds to damaged mucosa (where the positively charged proteins are exposed)
  • There is weak evidence for its use in oesophagitis
  • Probably not that helpful in gastric ulceration
  • Use the liquid rather than tablet form
45
Q

In a case with chronic vomiting, what might influence your decision to put in a feeding tube? What should you consider?

A
  • BCS loss -> good idea to consider feeding tube
  • Try to use this to bypass the problem if you can: NO/NG tube vs O tube vs PEG tube

SMALL ANIMAL (90 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions