L20: Chronic Vomiting In Dogs And Cats (Hill)

Question 1

Causes of dysphagia/regurge/vomiting

Answer 1

Intestinal vs. non-intestinal

• inflammation/infection
• extraluminal compression
• intraluminal obstruction
• toxin
• neuromuscular dysfx

Question 2

2 main categories of dysphagia

Answer 2

Oral (more common)

Pharyngeal (less common)

Question 3

Causes of oral dysphagia

Answer 3

Congenital: cleft lip/palate (brachycephalics)

Acquired:

• dental/gingivitis/periodontal dz
• eosinophilic and other ulcers ex. Colici (cats)
• stomatitis in cats
• benign mucosal hyperplasia (collies, boxers, drugs like cyclosporine, amlodipine)
• ranula
• vesicular dz
• FB
• retrobulbar abscess
• sialocele/sialodenitis
• craniomandibular osteopathy
• masticatory muscle myositis
• trigeminal neuritis (dropped jaw)
• neoplasia

Question 4

Chronic Ulcerative Paradental Stomatitis (CUPS)

Answer 4

• gingiva reacting to tooth tartar, or sometimes assoc. with outflow of salivary duct
• Tx: immunosuppression therapy or removing teeth

Question 5

Sialoadenitis

Answer 5

• causes inflammation behind the eye
• opening mouth can put pressure on salivary ducts and back of eyes
• can cause a form of seizures which –> chronic vomiting

Question 6

Benign neoplasia or the oral cavity

Answer 6

• epulides

- papillomas

Question 7

Malignant neoplasia of the oral cavity

Answer 7

• SCC
• Melanoma
• Fibrosarcoma

Question 8

Pharyngeal dz differentials

Answer 8

• inflammation
• compression
• luminal mass
• MOST common: neuromuscular dz: cricopharyngeal achalasia or dyssynchrony, rabies

*pharyngeal dz can look like other things ie. Trigeminal palsy

Question 9

Cricopharyngeal achalasia more common in younger or older dogs?

Answer 9

Younger

Question 10

Eval for oral dz or dysphagia

Answer 10

-Hx/PE
-watch try to eat or drink
-exam of mouth and pharynx under general anesthesia!
-look for odynophagia (painful swallowing) and when it occurs
+/- blood tests/rads/fluoro/EMG/Ab test

Question 11

Swallowing disorders and tx

Answer 11

Cricopharyngeal achalasia (failure of UES to open): sx or botox injections
Cricopharyngeal dyssnchrony (bad timing of UES opening): tx as megaesophagus

Question 12

4 causes of regurgitation

Answer 12

1) Neuromuscular dysfx
2) Intraluminal obstruction
3) Inflammatory dz
4) Extraluminal compression

Question 13

Causes of neuromuscular dysfx –> regurgitation

Answer 13

• megaesophagus (acquired or idiopathic)*
• esophageal dysmotility (+/- LarPar) due to myasthenia*, polymyositis/neuritis, SLE hypoadrenocorticism, hypothyroidism, organophosphate or lead toxicity, distemper

Question 14

Causes of intraluminal obstruction –> regurgitation

Answer 14

• FB/hairball*
• stricture*
• hiatal hernia*
• granuloma spirocerca lupi*
• tumor
• esophageal diverticulum
• gastroesophageal intussussception (stomach herniates into esophagus)

Question 15

Inflammatory diseases that –> regurgitation

Answer 15

• Esophagitis (thermal, chemical, or reflux ie. Post-anesthesia)
• Myositis
• Granuloma (fungal, bacterial, parasitic*)

Question 16

Causes of extraluminal compression that –> regurgitation

Answer 16

Vascular ring anomaly
Intrathoracic tumors (thymoma, lymphoma)
Hilar lymphadenopathy

Question 17

Dx tests for megaesophagus

Answer 17

-Chest rads
-fluoroscopy
-CBC, Chem, UA + CPK
-T4, TSH to look for hyperthyroid
+/- resting cortisol to look for Addison’s
-Cholinesterase activity if looking for organophosphate toxicity
-lead concentrations
-EMG + biopsy +/- tensilon test

Question 18

When does vomiting become chronic?

Answer 18

> 7-14 day duration

Question 19

NON-GI causes of vomiting

Answer 19

1) Metabolic:
2) Toxins
3) Drugs
4) Neurologic
5) Other (heartworm in cats)

Question 20

Metabolic causes of vomiting

Answer 20

Uremia
Addison's
DM
Hyperthyroid
Liver dz
Electrolyte and acid/base disorders
Septicemia

Question 21

Common toxins that cause vomiting

Answer 21

Lead
Zinc
Strychnine
Antifreeze
Mycotoxins

Question 22

Common drugs that cause vomiting

Answer 22

Digitalis
Abx
Chemo drugs

Question 23

Neurologic causes of vomiting

Answer 23

Brain tumors
Encephalitis
Meningitis
Limbic epilepsy
Encephalitis
Meningitis
Limbic epilepsy
Vestibular dz
(Salivary gland infarction)

Question 24

GI causes/categories of vomiting

Answer 24

Diet: indiscretion, intolerance, allergy/hypersensitivity
Gastric: see other slide
Small Intestine: see other slide
LI: colitis, parasites, neoplasia
Abdominal: pancreatitis, peritonitis, neoplasia

Question 25

Gastric causes of vomiting

Answer 25

- gastritis (helicobacter?) - ulceration - FB - chronic GDV - neoplasia - hypertrophy - parasites (Physaloptera, Ollulanus stomach worms) - motility disorders

Question 26

SI causes of vomiting

Answer 26

- FB - IBD - Infections (pythium/histo) - neoplasia - intussusception

Question 27

Causes of gastric/duodenal ulceration +/- melena

Answer 27

``` Drugs: NSAIDs, steroids Metabolic: uremia, LIV failure Excess acid: mastocytosis (excess mast cells), gastrinoma Neurologic: spinal or brain injury Neoplasia: Lymphoma Other: peritonitis, pancreatitis, stress ```

Question 28

Gastrinoma

Answer 28

tumor in the pancreas or duodenum that secretes excess of gastrin leading to ulceration in the duodenum, stomach and the small intestine. There is hypersecretion of the HCl acid into the duodenum, which causes the ulcers

Question 29

Benign and malignant gastric neoplasms

Answer 29

Benign: - polyps - hypertrophy (young small breeds) - leiomyomas Malignant: - Adenocarcinoma - Lymphoma Tx: sx except for lymphoma

Question 30

Common cause of intussusception in older cats

Answer 30

Neoplasia

Question 31

Properties of Helicobacter infection

Answer 31

- very common in cats - usually have asymptomatic infection - causes lymphoid hyperplasia - Dx with Warthin-Starry stain on biopsy, urease test or PCR - may be cause OR result of disease, so must rule out other causes of vomiting if you see them

Question 32

Tx of helicobacter infection

Answer 32

``` "Triple therapy": -Proton pump inhibitor -Amoxicillin -Clarithromycin +/- metronidazole, bismuth ```

Question 33

Almost all causes of vomiting effect motility and most changes in motility are secondary to the underlying cause ie. Low protein

Answer 33

:)

Question 34

Signs of gastric motility disorders

Answer 34

``` Vomiting on empty stomach Vomiting bile (bilious vomiting) Bloating Inappetence Ptyalism Hairballs ```

Question 35

Dx of gastric motility disorders

Answer 35

- Dx of exclusion; rule out other causes with CBC, Chem, Rads - radio-labeled food/liquid with gamma camera - Food + 5% Barium delayed emptying - Barium impregnated plastic spheres (BIPS) - Endoscopy of stomach after fasting to look for delayed emptying

Question 36

BIPS

Answer 36

Barium impregnated plastic spheres | -radiopaque markers fod dx of GI obstructions and motility problems

Question 37

Tx of gastric motility disorders

Answer 37

- Tx gastritis, underlying dz - metoclopramide - Cisapride - Feed q8-12hr including late at night - Octreotide/Lidocaine for ileus

Question 38

FISH test

Answer 38

Fluorescence In Situ Hybridization | -maps the genetic material in cells to visualize specific genes or portions of genes; can look for neoplasia

Question 39

PARR test

Answer 39

PCR for Antigen Receptor Rearrangements - amplifies DNA and can tell if majority of cells are derived from the same original clone (consistent with neoplasia) or multiple clones (consistent with reactive process) - used to look for lymphoma

Question 40

Do phenobarb trial if suspect salivary adenomatosis

Answer 40

:)

Question 41

History of chronic vomiting patient

Answer 41

- distinguish dysphagia vs. regurge v. Vomiting - characterize abnormalities and secondary effects - duration - progression, response to therapy