Chronic Vomiting

Question 1

Differentiate the presentation of vomiting versus regurg.

Answer 1

(Regurg → passive, often describe as the patient just lowering their head and bleh, material comes out; vomiting → active abdominal contractions, vomitus may contain bile, nausea or salivation present)

Question 2

If a patient is presented to you with only signs consistent with chronic vomiting, no other GI signs, why can you then rule out antibiotic responsive IBD?

Answer 2

(Bc abx responsive IBD causes diarrhea too)

Question 3

What are some of the parasites that can cause vomiting?

Answer 3

(Physaloptera (primarily causes vomiting), ascaris, ancylostoma, and giardia (would typically also have diarrhea))

Question 4

How does hypercalcemia induce GI signs?

Answer 4

(Causes dysmotility of the GI tract)

Question 5

What metabolic differentials are associated with weight loss with a normal appetite?

Answer 5

(Hyperthyroidism and diabetes mellitus)

Question 6

What enteropathic differentials are associated with weight loss with a normal appetite?

Answer 6

(IBD, neoplasia, and parasitism)

Question 7

Besides protein losing enteropathy, what is another explanation for hypoalbuminemia paired with hypoglobulinemia?

Answer 7

(Hemorrhage (as long as there isn’t inflammation in the body))

Question 8

When albumin hits what value should you start to worry about spontaneous effusion occurring?

Answer 8

(1.5-2 g/dL)

Question 9

What are the pros and cons of surgical vs endoscopic GI biopsies?

Answer 9

(Surgical → can get full thickness biopsies and access to all portions of the small intestines but it is invasive and there are potentially more complications (dehiscence); endoscopic → less invasive, only access stomach, duodenum, and ileum and biopsies only include mucosa maybe some submucosa)

Question 10

What cell is important to find to confirm or rule out food responsive IBD?

Answer 10

(Eosinophils)

Question 11

What type of inflammation is associated with steroid responsive IBD?

Answer 11

(Lymphoplasmacytic)

Question 12

What test would you recommend if IBD could not be differentiated from small cell lymphoma on histopathology?

Answer 12

(PCR for antigen receptor rearrangements [PARR], monoclonal is supportive of neoplasia and polyclonal is supportive of inflammation)