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THRALL - Thom > 46 - Stomach > Flashcards

46 - Stomach Flashcards

1
Q

Omental anatomy

Greater and lesser omentum attachments and associated ligaments

A

Greater: Superficial aspect -> Originates from greater curvature of stomach and duodenum, extending cadudally to level of urinary bladder, and folding back. Gastrosplenic ligament is large part, attaching hilus of spleen to greater curvature and fundus

Lesser: small, extends from liver to lesser curvature and cranial duodenum. Hepatogastroligament is large part.

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2
Q

In the dog, where is the pyloric sphincter typically located?

A

In right cranial quadrant, 10-11th rib

May be closer to midline than in adults

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3
Q

What is the normal reported rugal fold thickness for dogs (2-50kg)?

A

1-8mm

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4
Q

What is one advantage and one disadvantage of pnemogastrography? What is the normal dose?

A

Endoscropy can immediately follow, however US cannot

6-12ml/kg

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5
Q

What is the dose for iodinated contrast gastrography?

A

600-700mg/iodine per kg

CARE: If ionic, risk of pulmonary oedema if aspirated

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6
Q

What is the normal rate of gastric emptying in the dog?

A

Should start in 15 mins. Complete in 1-4 hours based on barium studies

HOWEVER, 7-15 hours reported in barium emptying in normal dogs. Emptying times for individual dogs repeatable

4 hours with moist food, up to 16 hours for dry!

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7
Q

Normal US gastric wall thickness (Dog and cat)

No gastric peristaltic waves per min

A

3-5mm; 2-5mm

4-5 per min

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8
Q

What volume of air is needed to perform “virtual endoscopy” of the stomach?

A

500-700cm3 (7-10kg dog)

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9
Q

What is the gold standard method for documenting gastric emptying time?

A

Scintigraphy!

Still high variability

BIPS Emptying times longer than scinti.

Scinti useful for gastric bleeding

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10
Q

List the types of hiatal hernia

A

1) SLIDING (Movement of oesophagus / stomach cranially)
2) PARAOESOPHAGEAL (cranial movement of stomach adjacent to oesophagus)
3) Combination of 1 and 2 (?+- involvement of other organs)

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11
Q

Gastroesophageal intussusception usually requires predisposing disease. List 3 examples

A

Chronic vomiting, megaoesophagus, dilation of oesophageal sphincter

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12
Q

List 8 factors assocaited with GDV

A

Large breed,

Increased thoracic depth to height ratio,

Food volume,

Splenectomy,

Increased age,

Reduced body condition,

Gastric FB,

(Diaphragamatic hernia in small brachys and cats)

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13
Q

What RX feature is suggestive of 360 GDV?

A

Small vena cava ???!

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14
Q

How does pneumatosis relate to prediction of gastric wall necrosis? Sp, sn

A

High Spec, low sens

Radiographs are a poor predictor of gastric wall necrosis generally

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15
Q

List 5 potential causes of chronic pyloric obstruction

A

Neoplasia,

Inflammation / fibrosis,

Hypertrophic pyloric stenosis,

Pylorospasm,

Mucosal antral hypertrophy,

(Pancreatic / duodenal disease - can cause similar presentation!)

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16
Q

List 4restrictive causes (annular constriction) of pyloric stenosis

A

Hypertrophic pyloric stenosis,

Pylorospasm,

Fibrosis / inflammation,

Neoplasia

17
Q

List 3 obstructive causes of pyloric stenosis

A

FB,

mucosal inflammation / hypertrophy,

Some mural disease of antrum

18
Q

List (and describe) 3 “signs” assocaited with restrictive pyloric obstruction

A

Beak sign: Tapering column of contrast in pyloric sphincter (only fills entrance);

String sign: Thin column through sphincter

Tit sign: Sharp, pointed outpouching of antrum along lesser curvature as peristaltic wave pushed contrast medium into pouch adjacent to mass

19
Q

What gastric wall measurements have been described in hypertrophic pyloric stenosis?

A

Musclaris thickening: >3mm in mild-moderate, >8mm in severe

20
Q

What does zinc do if ingested!

A

Intravascular haemolysis. Euro cents and US pennies after 1982, along with other sources.

21
Q

Which breed (with which condition) are overrepresented fotr gastroruodenal ulceration?

A

Dachys with disc prolapse

Also sled and working dogs, poorly understood mechanism

22
Q

Which modality that we dont use is good for GI bleeding! And which agents are used

A

Scinti!

Labelled RBCs might be better thatn sulfur colloid as they circulate longer, allows identification of intermittent or chronic bleeding.

23
Q

List 8 types of malignant gastric tumour

A

LSA,

Carcinoma,

Adenocarcinoma,

GIST,

Leiomyosarcoma,

Fibrosarcoma,
MCT

Histiocytic sarcoma

24
Q

Most common gastric tumours dog / cat

A

Adenocarcinoma (dog) -> Most commonly pyloric, and frequently spreads to liver and regional nodes.

LSA (Cat) -> lesions in SI and stomach should prompts consideration of LSA

25
Q

US features of gastric neoplasia (inc wall thickening, loss of layering, altered echo, and altered motility) described with 4 listed other weird causes…

A

Pythiosis,

zygomycosis,

Eosinophilic gastritis,

Actinomyces gastritis

26
Q

What does gastric “Pseudolayering” refer to?

A

Reported in gastric carcinoma -> layers of tumour cells within wall

Centrally moderately echogenic zone between 2 lesser echogenic lines

27
Q

Maximal reported gastric wall thickening with neoplasia in dogs and cats?

A

10-27mm dogs,

8-25mm cats

28
Q

What disease of working / sled dogs is an important differential for gastric disease!

A

Exercise induced gastritis -> high morb / mort

29
Q

Which 2 diseases may cause gastric wall mineralisation?

A

Renal disease (Uraemic gastropathy):

Features: Mucosal mineralisation and wall thickening

Schistosomiasis (Heterobiliharzia americana)

Features: Gulf coast and south atlantic states. DIffuse linear mineralisations throughout small intestinal tract. Circumferential mineralisation on US of SM and musc in SI.

30
Q

What is the normal gastric axis?

A
  • Perpendicular to spine, parallel to ribs, or between these two angles
31
Q

Gas distribution in stomach

A
32
Q

How do rugal folds appear in the pylorus?

A
  • Smaller and more spiral
33
Q

Detail negative contrast gastrography technique

A
  • 6-12ml/kg air using orogastric tube / or drinking carbonated liquid
  • Should palpate moderately distended
  • Immediately: LL and VD -> most useful for pyloric outflow
  • Follow with others as required
34
Q

Detail technique for positive contrast gastrography

A
  • Fast for 12-24hrs
  • Orogastric tube preferable, or via buccal fold (aspiration risk)

DOSES:

8-12ml/kg Barium (small-medium)

5-7ml/kg (Large)

12-20ml/kg (cats

  • Gently turn patient to coat mucosa
  • Immediately: 4 view rads
  • Followed by LL and VD: 15, 30, 45, 1h, 2h, 3h, 4h or UNTIL COMPLETE EMPTYING

=> note small amount of mucosal covering for several hours may be seen

35
Q

Normal positive gastrography features

A
  • Rugal folds - vary based on projection / dose
  • Gastric emptying within 15mins in most normal patients
  • Generally empty within 1-4hrs in dogs -> rapid emptying not important, slow emptying may be pertinent
  • NOTE DOSE VOLUME AFFECTS RATE OF EMPTYING!

THRALL - Thom (40 decks)

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