Approach to vomiting/ regurgitation

Question 1

What is acute vomiting more likely to be caused by

Answer 1

toxic
obstructive
inflammatory
infectious

Question 2

what is chronic vomiting more likely to be caused by

Answer 2

chronic inflammatory
chronic infectious
metabolic/ endocrine
neoplastic

Question 3

List 2 causes of acute vomiting due to the cerebral cortex

Answer 3

head trauma
sudden changes in ICP- inter cranial pressure

Question 4

List 3 causes of acute vomiting linked to the vestibular system

Answer 4

motion sickness
idiopathic vesicular disease
otitis interna

Question 5

List 4 causes of chronic vomiting linked to the GI tract

Answer 5

chronic inflammatory e.g. gastritis
mucosal insult e.g. dietary intolerance
infectious
obstructive

Question 6

What is the difference between vomiting and regurgitation

Answer 6

Reg- passive motion - ejection from the oesophagus
vomiting is active - ejection of food from stomach

Question 7

define dysphagia

Answer 7

failure to prehend/ bite and initially swallow

Question 8

List 3 things that can cause dysphagia

Answer 8

Pain
failure of neuro-muscular control
obstruction

Question 9

what failures of neuro-muscular control can result in dysphagia

Answer 9

cranial nerves disease (5, 7, 9, 10, 12)
CNS disease
masticatory myositis
botulism
myasthenia gravis

Question 10

which breeds are predisposed to congenital megaoesophagus

Answer 10

Labrador
newfoundland
Shar-pei

Question 11

describe the physiology of vomiting

Answer 11

active reflex mediated via the emetic centre that can be stimulated by the CRTZ, GIT, cerebral cortex or vestibular system

Question 12

what is the CRTZ

Answer 12

chemoreceptor trigger zone

Question 13

what acute issues can trigger CRTZ voiting

Answer 13

metabolic/ endocrine disease
toxins/drugs

Question 14

what chronic issues can trigger cerebral cortex vomiting

Answer 14

neoplasia/SOL (space occupying lesions)
CNS disease

Question 15

List the chronic issues that can trigger vestibular system vomiting

Answer 15

chronic vestibular damage
otitis interna
neoplasia
cerebellar disease

Question 16

List the chronic issues that can trigger CRTZ vomiting

Answer 16

metabolic/endocrine disease

Question 17

Describe the physiology of regurgitation

Answer 17

passive expulsion of food from the pharynx or oesophagus

Question 18

what is masticatory myositis

Answer 18

antibodies form against the muscles used for mastication

Question 19

List the 3 causes of regurgitation

Answer 19

dilation of the oesophagus
obstruction - intraluminal, mural or extramural
neuro-muscular disorder

Question 20

what can previous regurgitation under anaesthetic be an indicator for

Answer 20

oesophagitis or stricture

Question 21

Name 2 mural causes of regurgitation

Answer 21

neoplasia
inflammation

Question 22

list 3 extramural causes of reguritation

Answer 22

vascular ring anomaly
hiatal hernia
space occupying lesion (neoplasia)

Question 23

what breeds are predisposed to vascular ring anomalies

Answer 23

GSD
irish setter
great dane

Question 24

what animals are predisposed to intussusception

Answer 24

juveniles and puppies with recent diarrhoea

Question 25

what breeds are predisposed to oesophageal FBs

Answer 25

terrier breed (WHWT) and spaniels

Question 26

what breeds are predisposed to GI/ intestinal FBs

Answer 26

labradors spaniels

Question 27

which are more prone to doxycycline induced oesophagitits dogs or cats

Answer 27

cats

Question 28

what is a vascular ring anomaly

Answer 28

persistant right aortic arch constricts the oesophagus

Question 29

Describe how to manage an animal with abnormal swallowing

Answer 29

trial and error different food types to find one that works well

Question 30

describe how to manage megaoesophagus

Answer 30

omeprazole feed from a height feed in small bits consider a feeding tube

Question 31

what can be a problem with giving omeprazole to animals with megaoesophagus

Answer 31

risk of worsened aspiration

Question 32

describe how to manage oesophagitis

Answer 32

pain relief feeding tube placement (bypass the oesophagus)

Question 33

how does maropitant work

Answer 33

NK1 antagonist - helps with centrally mediated vomiting

Question 34

describe how metoclopramide works

Answer 34

dopamine and histamine receptor antagonist helps with centrally mediated vomiting

Question 35

what should you rule out before giving any drugs for vomiting

Answer 35

a foreign body

Question 36

How does omeprazole work and what is it used for

Answer 36

protein pump inhibitor useful for gastric ulceration and reduction in ICP (reduced CSF production)

Question 37

How does misoprostol work and what is it used for

Answer 37

prostaglandin analogue increases mucosal blood flow and therefore healing

Question 38

when should we not use misoprostol

Answer 38

in pregnant animals

Question 39

List 4 gastroprotectants

Answer 39

omeprazole misoprostol cimetidine - H2 receptor antagonists sucralfate

Question 40

Describe how cimetidine work and what it is used for

Answer 40

histamine receptor antagonists reduce acid secretion

Question 41

how does sucralfate work and what does it do

Answer 41

polyionic surfactant binds to damage mucosa and provides a 'bandaid'

Question 42

what is misoprostol commonly used for

Answer 42

NSAID toxicity

Question 43

describe a hiatal hernia

Answer 43

diaphragm and oesophagus are poorly attached - this means as the patient breathes the diaphragm slides over the oesophagus and part of the stomach may protrude through

Question 44

how can we diagnose hiatal hernias

Answer 44

fluroscopy

Question 45

what is PPDH

Answer 45

pericardio-peritoneal diaphragmatic hernia

Question 46

which animals more commonly have PPDH cats or dogs

Answer 46

cats

Question 47

what is a pericardio-peritoneal diaphragmatic hernia

Answer 47

midline defect at birth which allows abdominal contents to herniate into the percardial sac