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Small Animal Medicine II > Chronic Vomiting > Flashcards

Chronic Vomiting Flashcards

1
Q

What is chronic vomiting?

A

continuous or intermittent vomiting for >2 weeks

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2
Q

What are 9 primary GI diseases that can cause chronic vomiting?

A
  1. chronic gastritis
  2. IBD
  3. food-responsive enteropathy
  4. parasites
  5. pyloric hypertrophy
  6. gastric dysmotility
  7. gastric/duodenal ulcers
  8. GI neoplasia
  9. bilious vomiting
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3
Q

What are 7 systemic disease that can lead to chronic vomiting?

A
  1. CKD
  2. hepatobiliary disease
  3. pancreatitis
  4. hypoadrenocorticism
  5. hyperthyroidism
  6. DM - usually DKA
  7. mastocytosis (cats!)
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4
Q

What are the 3 most common causes of chronic gastritis?

A
  1. food hypersensitivity
  2. Helicobacter
  3. idiopathic
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5
Q

How does food hypersensitivity affect the GIT? What treatment is needed?

A

lymphoplasmacytic infiltrate in GIT

strict hydrolyzed or novel protein diet for at least 2-3 weeks –> no treats or flavored medications!

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6
Q

What is the most common sign of Helicobacter infection? How is it diagnosed?

A

chronic vomiting

  • rapid urease test (CLO)
  • cytology of gastric mucosa and/or histopath with silver stain –> lymphocytic/lymphoplasmacytic follicular hyperplasia

(can be incidental finding!)

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7
Q

What treatment is recommended for chronic vomiting caused by Helicobacter?

A

Amoxicillin + Clarithromycin + Omeprazole for 3 weeks

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8
Q

What parts of the GIT are affected by IBD? How is it diagnosed? What treatment is recommended?

A

SI +/- LI

mucosal or full thickness biopsy –> lymphoplasmacytic or eosinophilic inflammation

hydrolyzed/novel protein diet +/- immunosuppression (prednisone, azathioprine, cyclosporine)

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9
Q

What are the 3 most common gastric neoplasias?

A
  1. adenocarcinoma (DOGS) - lesser curvature; vomiting, weight loss/emaciation, anorexia, hematemesis
  2. lymphoma (CATS) - gastric and SI; small cell form can appear similar to IBD
  3. leiomyosarcoma
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10
Q

What 4 parasites can cause chronic vomiting?

A
  1. Physaloptera - only small burden needed (fecals not helpful), prophylactic deworming with Pyrantel - eating cockroaches
  2. Ollulanus (cats) - shelters, batteries
  3. Giardia - zinc sulfate floatation, Ag SNAP, treat with Fenbendazole AND Metronidazole
  4. Aascarids
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11
Q

In what animals are chronic foreign bodies most common?

A

cars - hair ties

  • rare, usually acute and self-limiting
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12
Q

How can signalment be used to provide initial clues to the cause of chronic vomiting?

A
  • YOUNG - parasitism, dietary indiscretion, FB
  • OLD - neoplasia, IBD
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13
Q

What history is important to gather in case of chronic vomiting?

A
  • 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
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14
Q

What are common findings on physical exam in patients experiencing chronic vomiting?

A
  • weight loss - malabsorption
  • appetite - eating well –> hyperthyroidism, DM
  • signs of systemic disease - icterus
  • abdominal palpation - masses, FB, thickened intestines
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15
Q

What 2 intial diagnostics are commonly performed in cases of chronic vomiting? What is recommended following stabilization?

A
  1. CBC/chem/UA - r/o systemic disease
  2. fecal - parasites

diet and deworming trials + further testing (abdominal radiographs + U/S + endoscopy)

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16
Q

What diet trials are recommended in cases of chronic vomiting?

A
  • hydrolyzed protein
  • novel protein
17
Q

What dewormers are recommended for trials in cases of chronic vomiting?

A
  • Pyrantel
  • Fenbendazole
18
Q

When are plain and contrast abdominal radiographs most helpful in cases of chronic vomiting?

A

PLAIN - FB, masses, typically low yield and can miss partial obstructions

CONTRAST - motility disorders, FB, pyloric hypertrophy, neoplasia, can miss lesions

19
Q

When are abdominal ultrasounds most useful when diagnosing chronic vomiting? What 4 advantages does it have over radiographs?

A

FB, masses, thickened intestinal tract, enlarged LN

  1. non-invasive
  2. can see structure and size of abdominal organs
  3. can asses layers of GIT and motility
  4. can be used to perform FNA or trucut biopsy
20
Q

What are the main 2 uses of endoscopy when diagnosing chronic vomiting? What limitation does it have?

A
  1. observing gatric/duodenal mucosal lesions
  2. used to obtain biopsies

cannot reach passed stomach, proximal small intestine, +/- ileum + can miss extraluminal lesions

21
Q

What purpose do exploratory celiotomies have in cases of chronic vomiting?

A
  • 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!

22
Q

What is happening in the bottom ultrasound of the small intestine?

A

infiltrative disease with muscularis thickening compared to mucosa –> IBD vs neoplasia

23
Q

What is occuring in the abnormal stomach to the right?

A

thickened lesser curvature with ulcerated mass

  • gastric adenocarcinoma
24
Q

What does gastric dysmotility lead to? What are 3 clinical signs?

A

delayed gastric emptying

  1. vomiting up of food >8 hrs after eating - projectile with pyloric stenosis
  2. abdominal distention/bloat
  3. abdominal discomfort
25
Q

What is the difference between structural and functional gastric dysmotility? What diagnostics are used?

A

STRUCTURAL - mass, polyp, pyloric hypertrophy, or FB cause outflow tract obstruction

FUNCTIONAL - inflammation, infection, idiopathic

26
Q

What diagnostics are used for gastric dysmotility? If no structural disease is found, what 2 treatments ar recommended?

A

AUS + endoscopy + mucosal biopsy

  1. low-fat diet in small, frequent meals
  2. prokinetics - Metoclopramide, Cisapride, Erythromycin
27
Q

What is pyloric hypertrophy? In what patients is it most commonly seen?

A

stenosis of pyloric canal associated with mucosal and/or muscular hypertrophy

older (>8 y/o) small breed dogs - Lhasa Apso, Shih Tzu

28
Q

How is pylroic hypertrophy diagnosed? What treatment is recommended?

A

contrast radiography, U/S, endoscopy, biopsy - appreciate enlarged mucosal folds that surround the pyloric orifice

surgical correction of hypertrophy

29
Q

What is gastric ulceration? What are 5 most common signs?

A

defect in gastric wall from muscularis to deeper layers

  1. vomiting
  2. hematemesis
  3. coffee ground vomitus
  4. melena
  5. anemia- pale MM
30
Q

What are 4 common causes of gastric ulceration? How is it diagnosed? Treated?

A
  1. drugs - NSAIDs, steroids
  2. systemic disease
  3. Gi inflammation
  4. neoplasia - gastrinoma

AUS, endoscopy - observe masses or thickening

treat underlying disease + PPI, Sucralfate

31
Q

What is bilious vomiting syndrome? What treatment is recommended?

A

vomiting bile early in the morning due to reflux of duodenal fluid into the gastric lumen, causing mucosal irritation and dysmotility

  • Metoclopramide
  • late evening antacid
  • late evening small meals

Small Animal Medicine II (57 decks)

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