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Gastric Disease Flashcards

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1
Q

What are the different parts of the stomach from the esophagus to pylorus?

A 
Lower esophageal sphincter
Cardia
Fundus
Body
Antrum
Pylorus
Pyloric sphincter
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2
Q

What two parts of the stomach expand to accommodate food? What part is used for grinding?

A

Expand: Fundus and body
Grinding: Antrum

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3
Q

What are the components in the mucosa of the stomach?

A
  • Superficial epithelium
  • Lamina propria
  • Gastric glands
  • Neuroendocrine cells
  • Muscularis mucosa
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4
Q

What are the gastric glands?

A
  • Mucus neck cells
  • Parietal cells
  • Chief cells
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5
Q

What do the neuroendocrine cells release?

A
  • Enterocromagin (serotonin and histamine release)
  • Somatostatin
  • Gastrin
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6
Q

What is the submucosa comprised of?

A

Dense connective tissue, structural support, blood vessels, lymphatics, and meissner’s plexus

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7
Q

What is Meissner’s plexus?

A

Nervous layer of the submucosa

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8
Q

What is the muscularis layer?

A

Layers of smooth muscle arranged perpendicular to each other

Controlled by Auerbach’s (myenteric) plexus

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9
Q

What is the serosa?

A

Connective tissue layer on the outside of the stomach

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10
Q

What enzymes are involved with protein and fat digestion?

A

Proteins- pepsin

Fat- lipases

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11
Q

What does intrinsic factor do in dogs?

A

Vitamin and mineral absorption

Limited activity in the stomach

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12
Q

What effects gastric motility?

A
  • Migrating motility complex
  • Neural and hormonal stimulus
  • Pressure/distension
  • Nutritional content of food
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13
Q

What does fat do to motility in the stomach?

A

Slows motility

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14
Q

What are some common general pathologies in the stomach?

A
  • Inflammation (gastritis)
  • Ulceration
  • Obstruction
  • Neoplasia
  • Infection
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15
Q

What are some clinical manifestation of gastric pathology?

A

Vomiting, hematemesis, melena, retching, burping, ptylaism, weight loss, distension, pain

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16
Q

What can CBC findings tell us about gastric disease?

A

May have regenerative anemia if bleeding or leukocytosis

Usually nothing of significance

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17
Q

What are some common chemistry findings of gastric disease?

A
  • Hypochloremia, hyponatremia, hypokalemia
  • Azotemia (pre-renal)
  • Elevated BUN if bleeding
  • Metabolic alkalosis with gastric outflow obstruction
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18
Q

What are some findings on UA with gastric disease?

A

Usually nothing

May have paradoxic aciduria with gastric outflow obstruction

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19
Q

What are the pros and cons of gastric endoscopy?

A

Good for inflammation, ulcer, foreign body, and mucosal neoplasia

Bad for disease deeper than mucosa and functional assessment

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20
Q

What are two indications for surgery in the stomach?

A

Biopsy or foreign body

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21
Q

What is acute gastritis?

A
  • Inflammation of the mucosa

- Sudden onset of clinical signs

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22
Q

What things can cause acute gastritis?

A

Drugs, toxins, dietary indiscretion, intolerance, parasites, bacterial, viral, systemic illness

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23
Q

How do we typically manage acute gastritis?

A

Symptomatic and supportive care

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24
Q

How do you definitively diagnose acute gastritis?

A

Biopsy

typically presumptive

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25
What is the diagnosis based on?
History, clinical findings, and trial/response to symptomatic care
26
What treatments can be pursued in cases of acute gastritis?
- Fluids - Antacids - Antiemetics - Pain medications - Water and bland diet
27
T/F: Gastritis doesn't typically induce significant mucosal changes.
False
28
How do gastric foreign bodies typically present?
Obstructive lesions with intermittent or persistent clinical signs More common in younger animals
29
What is very important when working up an animal with a suspected FB?
Taking a great history
30
How do you diagnose a gastric FB?
History and radiographs/US/endoscopy
31
How do you treat gastric FB?
Removal with endoscopy or surgery
32
What is a poor prognostic indicator for GDV?
Necrosis
33
What is the pathology associated with GDV?
- Compression of CVC and hypovolemic shock - Gastric wall necrosis - Splenic torsion or avulsion - Congestion of abdominal viscera - Endotoxic shock - DIC
34
What things predispose animals to GDV?
Large breeds Barrel chested breeds Eats fast and plays right after Mass in the abdomen (increased weight and torsion)
35
What are some clinical signs of GDV?
``` Acute, non-productive retching Ptyalism Abdominal distension with tympany Collapse Tachycardia with poor pulses Hypothermia, depression, ventricular tachycardia ```
36
What is the radiographic finding of a dog with GDV?
Right lateral boxing glove or popeye arm appearance
37
How is GDV treated?
- Agressive fluid therapy - Decompression via orogastric tube or trocharization - Address electrolyte disturbances - Surgery
38
What is the mortality rate of GDV?
15-30% More if gastric necrosis, resection, or splenectomy
39
What is the long term therapy to prevent GDV?
Bloat bowl and rest after eating
40
What is food bloat?
Severe distension of the stomach with food directly after eating
41
How does an animal with food bloat typically present?
Acute vomiting or retching, abdominal distension and discomfort Radiographs- profound distension of stomach with food
42
How do you treat food bloat?
``` Wait (24-36 hours) Fluids Withhold food Frequent walking Pain management Consider lavaging and surgery ```
43
What can gastric erosion and ulceration due to?
- Mucosal barrier injury - Disruption of normal gastroprotection - Decrease blood flow - Hypersecretion of acid - Decreased mucous or bicarb
44
What are erosions and ulcerations secondary to?
``` Neoplasia (gastrinoma and mast cell) Hypovolemic shock, hypotension Trauma Medication (NSAID or steroids) Uremic gastritis ```
45
What are some common findings in animals with erosions and ulcerations?
Vomiting, hematemesis, melena, anemia, increased BUN Radiographs may show defects with contrast studies Ultrasound may show thickened wall, loss of layering, or free fluid Endoscopy will show visual confirmation
46
How do you treat gastric erosions and ulcerations?
``` Treat underlying disease Suralfate PPI Pain management Transfusion if severe anemia Analgesia ```
47
What are the characteristic of helicobacter?
Spiral gram negative bacteria May be normal flora- pathogenicity associated with involvement of inflammatory gastric crypts
48
How does helicobacter gastritis typically present?
Acute or chronic vomiting
49
How do you definitively diagnose helicobacter gastritis?
Gastric biopsy showing mucosa infiltration with bacteria
50
How do you treat helicobacter gastritis?
Clarithromycin, amoxi, metronidazole x2weeks Resistance has been documented
51
What is gastric pythiosis?
Infection with an oomycete (P. insidiosum) in the stomach
52
How does gastric pythiosis typically present?
Chronic vomiting and a thickened gastric outflow tract Characterized by pyogranulomatous inflammation
53
What are the round worms that can be found in the stomach and how do you diagnose/treat them?
Toxocara canis/cati, physaloptera, ollulanus tricuspi Visual or fecal diagnosis; biopsy Fenbendazole or pyrantel
54
How does gastric esophageal reflux present?
Chronic vomiting | Lip licking, hard swallowing, ptyalism, halitosis, esophagitis
55
What is gastric esophageal reflux typically secondary to?
Primary gastric or small intestinal disease
56
How is esophageal reflux diagnosed?
Clinical signs and history, can see mucosal erosion on endoscopy
57
How do you treat esophageal reflux?
PPI, treatment of primary disease, sucralfate
58
How does inflammatory gastritis present?
Chronic vomiting
59
T/F: The inciting cause of inflammatory gastritis is rarely identified.
True
60
How do you diagnose inflammatory gastritis?
Endoscopy or surgical biopsy Infiltration of inflammatory cells in mucosa and lamina propria
61
What is the most common infiltrate in inflammatory gastritis?
Lymphoplasmacytic Eosinophilic and mast cells are also found
62
How do you treat inflammatory gastritis?
Antacid and gastroprotectants Diet trial Empiric deworming Immune modulation with corticosteroids or cyclosporine
63
How does atrophic gastritis present?
Chronic vomiting Mononuclear cell infiltrat with thinning of gastic mucosa and atrophy of gastric glands
64
How do you treat atrophic gastritis?
Same as inflammatory disease
65
What breed is predisposed to atrophic gastritis?
Norwegian lundehund
66
How does hypertrophic gastropathy present?
Chronic projectile vomiting hours after eating Diffuse or focal hypertrophy of mucosa and/or muscularis with inflammatory infiltrates
67
What is hypertrophic gastritis associated with?
Hypergastrinemic conditions- decrease clearance from renal or liver disease or gastrin secreting tumors
68
Where is hypertrophic gastritis typically most pronounced?
Pyloric outflow region
69
What breeds is hypertrophic gastritis most commonly seen in?
Older small breed dogs
70
How do you treat hypertrophic gastropathy?
Treat the underlying disease with surgical resection of thickened tissues if indicated
71
What is pyloric stenosis?
Congenital or acquired muscular thickening of pyloric sphincter delaying gastric emptying
72
What are the clinical signs of pyloric stenosis?
Vomiting several hours after a meal Poor weight gain, aspiration pneumonia, depression, dehydration
73
How do you treat pyloric stenosis?
Medical management of systemic effects (dehydration and acid-base) Surgical correction (pyloromyotomy)
74
What are come acquired causes of pyloric stenosis?
Inflammation and neoplasia
75
What is a gastrinoma?
A tumor in the pancrease of the APUD cells that stimulates hypersecretion of gastric acid
76
What are the clinical signs of a gastrinoma?
Chronic vomiting Thickened gastric wall, hypertrophy of pylorus, gastric ulceration
77
How do you diagnose a gastrinoma?
Assess gastrin levels- low pH of juice with a high gastrin level Nuclear medicine studies Biopsy
78
How do you treat a gastrinoma?
Surgical removal but has often metastasized at time of diagnosis PPI Octreotide (inhibition of gastrin) Guarded to poor prognosis
79
What are the benign neoplasms found in the stomach?
Leiomyoma and adenomatous polyps
80
What are the malignant neoplasms found in the stomach?
Adenocarcinoma Lymphosarcoma Leiomyosarcoma Gastrinoma
81
What is delayed gastric emptying motility disorders?
Any disorder that causes the stomach to not empty as fast as it should aka GERD or bilious vomiting syndrome
82
What is GERD typically due to?
Inflammation, infection, obstruction, electrolyte disturbances, opioids, or surgery Diffuse gastritis/gastroenteritis, pancreatitis, NM disease, pylori stenosis, foreign body, idiopathic
83
How long should a normal stomach take to be empty?
8 hours Can take longer if stressed
84
How do you treat GERD?
Gastric motility promoters Cisapride, metoclopramide, erythromycin, ranitidine, lower protein and fat diets

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