9.5.2: Gastric disease Flashcards
Acute gastric disease differentials
- Trauma (e.g. FB)
- Toxin: dietary indiscretion, drugs
- Inflammatory = acute gastritis: immune-mediated or infectious
- Vascular: dilatation (+volvulus)
What are some possible causes of acute gastritis?
Acute gastritis may be immune-mediated or infectious.
Immune-mediated
* Dietary indiscretion
* Idiopathic (lymphocytic plamascytic / eosinophilic)
Infectious
* Bacterial e.g. helicobacter
* Viral (as part of gastroenteritis)
* Fungal unlikely
* Parasitic (part of gastroenteritis)
* Protozoal (part of gastroenteritis)
True/false: most cases of acute gastritis are self limiting.
How can you support these cases?
True
Treat these patients as follows:
* Time
* Reduce toxin exposure
* IVFT if necessary
* Anti-emetics e.g. maropitant
* Reduce acid damage: highly digestible diet. Specific medications probably not indicated at this stage.
Risk factors and diagnostics for acute gastritis caused by foreign body
Risk factors
* Scavenger
* Acute, severe vomiting
* Abdo pain or palpable obstruction
Diagnosis
* Plain/ contrast radiography
* Ultrasonography
* CT
* Endoscopy
Treat by removal!
Differentials for chronic (3+ week) gastric disease
- Inflammatory: immune mediated or infectious
- Neoplastic: lymphoma, carcinoma, benign e.g. polyp, gastrinoma
- Metabolic: billous vomiting, gastric ulceration, secondary gastroparesis
- Degenerative: chronic hypertrophic pyloric gastropathy, pyloric stenosis
Differentials for chronic gastritis
Immune mediated:
* Dietary indiscretion
* Idiopathic (lymphocytic plasmacytic / eosinophilic)
Infectious
* Bacterial: Helicobacter
What are the main diagnostics for chronic gastric disease?
- Bloodwork - look for underlying cause - least invasive and expensive
- Ultrasound
- Plain/ contrast radiography
- (CT)
- Gastroscopy + biopsy - most invasive and expensive
Causes and treatment of gastroparesis
Causes
* May be primary and present with any other gastric disease
* May be secondary to hypokalaemia, hyper/hypocalcaemia, significant illness, opioid usage
Treatment
Prokinetics: metoclopramide / cisapride
Causes of mucosal barrier disruption
- Usually a progression of acute to chronic gastritis (immune mediated or bacterial infection)
- Metabolic diseases e.g. hepatic diseases, uraemia -> portal hypertension which backs up -> increased pressure / damage to gastric vasculature -> less mucus and bicarbonate produced
- Reduced perfusion and prostaglandin production (e.g. NSAIDs, steroids, post-surgery)
- Neoplasia: MCT, gastrinoma
When should you consider Helicobacter as a differential? What should you treat it with?
- Consider if non-responsive to standard medications and diet
- Pathogenicity is unclear in animals - in humans it causes chronic gastritis
- In humans triple therapy: amoxiclav + metronidazole + proton pump inhibitor
Clinical signs of mucosal barrier disruption
- Chronic vomiting
- Haematemesis
Diagnostics and treatment for mucosal barrier disruption
Diagnostics
* Ultrasound - thickened gastric wall on ultrasound, reduced motility, lymphadenopathy
* Endoscopy - may look similar to gastric neoplasia, biopsy for definitive diagnosis
Treatment
* Symptomatic
* Diet / antibiotics / immunosuppressive
Detailed treatment plan for mucosal barrier disruption
- Treat underlying cause: hypoallergenic diet, antibiotics for Helicobacter, immunosuppressives for immune-mediated disease
- Reduce toxin exposure
- IVFT if needed
- Anti-emetics e.g. maropitant, (ondansetron, metoclopramide)
- Reduce acid secretion: highly digestible diet, proton pump inhibitors / H2 antagonists / antacids / synthetic prostaglandins / sucralfate
- Prokinetics e.g. cisapride, metoclopramide
What is the most effective way to stop acid production?
Proton pump inhibitors - they block the common pathway
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Clinical findings and diagnostics for gastric ulceration
Clinical sigs, diagnosis, treatment and prognosis of carcinoma
Clinical signs, diagnostics, treatment and prognosis of lymphoma
