Chronic Vomiting Flashcards
(31 cards)
What is chronic vomiting?
continuous or intermittent vomiting for >2 weeks
What are 9 primary GI diseases that can cause chronic vomiting?
- chronic gastritis
- IBD
- food-responsive enteropathy
- parasites
- pyloric hypertrophy
- gastric dysmotility
- gastric/duodenal ulcers
- GI neoplasia
- bilious vomiting
What are 7 systemic disease that can lead to chronic vomiting?
- CKD
- hepatobiliary disease
- pancreatitis
- hypoadrenocorticism
- hyperthyroidism
- DM - usually DKA
- mastocytosis (cats!)
What are the 3 most common causes of chronic gastritis?
- food hypersensitivity
- Helicobacter
- idiopathic
How does food hypersensitivity affect the GIT? What treatment is needed?
lymphoplasmacytic infiltrate in GIT
strict hydrolyzed or novel protein diet for at least 2-3 weeks –> no treats or flavored medications!
What is the most common sign of Helicobacter infection? How is it diagnosed?
chronic vomiting
- rapid urease test (CLO)
- cytology of gastric mucosa and/or histopath with silver stain –> lymphocytic/lymphoplasmacytic follicular hyperplasia
(can be incidental finding!)
What treatment is recommended for chronic vomiting caused by Helicobacter?
Amoxicillin + Clarithromycin + Omeprazole for 3 weeks
What parts of the GIT are affected by IBD? How is it diagnosed? What treatment is recommended?
SI +/- LI
mucosal or full thickness biopsy –> lymphoplasmacytic or eosinophilic inflammation
hydrolyzed/novel protein diet +/- immunosuppression (prednisone, azathioprine, cyclosporine)
What are the 3 most common gastric neoplasias?
- adenocarcinoma (DOGS) - lesser curvature; vomiting, weight loss/emaciation, anorexia, hematemesis
- lymphoma (CATS) - gastric and SI; small cell form can appear similar to IBD
- leiomyosarcoma
What 4 parasites can cause chronic vomiting?
- Physaloptera - only small burden needed (fecals not helpful), prophylactic deworming with Pyrantel - eating cockroaches
- Ollulanus (cats) - shelters, batteries
- Giardia - zinc sulfate floatation, Ag SNAP, treat with Fenbendazole AND Metronidazole
- Aascarids
In what animals are chronic foreign bodies most common?
cars - hair ties
- rare, usually acute and self-limiting
How can signalment be used to provide initial clues to the cause of chronic vomiting?
- YOUNG - parasitism, dietary indiscretion, FB
- OLD - neoplasia, IBD
What history is important to gather in case of chronic vomiting?
- ensure patient is truly vomiting
- diet
- drug/toxin exposure
- travel, vaccination, and deworming status
- frequency, timing in relation to eating, and character of vomit –> blood = damage to mucosa, ulceration
What are common findings on physical exam in patients experiencing chronic vomiting?
- weight loss - malabsorption
- appetite - eating well –> hyperthyroidism, DM
- signs of systemic disease - icterus
- abdominal palpation - masses, FB, thickened intestines
What 2 intial diagnostics are commonly performed in cases of chronic vomiting? What is recommended following stabilization?
- CBC/chem/UA - r/o systemic disease
- fecal - parasites
diet and deworming trials + further testing (abdominal radiographs + U/S + endoscopy)
What diet trials are recommended in cases of chronic vomiting?
- hydrolyzed protein
- novel protein
What dewormers are recommended for trials in cases of chronic vomiting?
- Pyrantel
- Fenbendazole
When are plain and contrast abdominal radiographs most helpful in cases of chronic vomiting?
PLAIN - FB, masses, typically low yield and can miss partial obstructions
CONTRAST - motility disorders, FB, pyloric hypertrophy, neoplasia, can miss lesions
When are abdominal ultrasounds most useful when diagnosing chronic vomiting? What 4 advantages does it have over radiographs?
FB, masses, thickened intestinal tract, enlarged LN
- non-invasive
- can see structure and size of abdominal organs
- can asses layers of GIT and motility
- can be used to perform FNA or trucut biopsy
What are the main 2 uses of endoscopy when diagnosing chronic vomiting? What limitation does it have?
- observing gatric/duodenal mucosal lesions
- used to obtain biopsies
cannot reach passed stomach, proximal small intestine, +/- ileum + can miss extraluminal lesions
What purpose do exploratory celiotomies have in cases of chronic vomiting?
- identify and remove FB
- collect full thickness biopsies for inflammatory disease or neoplastic diseases (partial thickness from endoscopy)
- address pyloric hypertrophy
- evaluate other abdominal organs
invasive!
What is happening in the bottom ultrasound of the small intestine?
infiltrative disease with muscularis thickening compared to mucosa –> IBD vs neoplasia
What is occuring in the abnormal stomach to the right?
thickened lesser curvature with ulcerated mass
- gastric adenocarcinoma
What does gastric dysmotility lead to? What are 3 clinical signs?
delayed gastric emptying
- vomiting up of food >8 hrs after eating - projectile with pyloric stenosis
- abdominal distention/bloat
- abdominal discomfort
