Oesophageal diseases and Vomiting Flashcards Preview

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Flashcards in Oesophageal diseases and Vomiting Deck (26):
1

Clinical signs of regurgitation

hypersalivation
odynophagia (pain on eating)
anorexia
Dysphagia (difficulty swallowing)
nasal discharge
coughing

2

Regurgitation vs. Vomiting - Vomiting

Abdominal effort
Prodromal nausea
Usually digested food
No swallowing pain

3

Regurgitation vs. Vomiting - regurgitation

Passive event
No prodromal nausea
Undigested food
Possibly painful

4

diagnosis

signalment
history
PE - usually normal for oesophageal disease

5

diagnosis - investigations

Haematology & biochemistry
Other blood tests, urine analysis etc.
Diagnostic imaging - Plain radiography, Contrast radiography
Endoscopy

6

DDx for regurgitation - 3 most common

Oesophagitis
Oesophageal foreign body
Mega-Oesophagus

7

DDx for regurgitation - anatomic

Vascular ring anomaly, cricopharyngeal disease, hiatal hernia, diverticulum

8

DDx for regurgitation - obstruction

Mural (stricture)
Luminal (FB)
Extraluminal (mass)

9

DDx for regurgitation - oesophagitis - causes

trauma, reflex, irritation

10

DDx for regurgitation - motility disorders

Megaoesophagus, neuropathy, myopathy

11

mega-oesophagus - common causes

Idiopathic megaoesophagus (dogs)
Myasthenia gravis (generalised or focal)
Thymoma
Hypoadrenocorticism

12

aspiration pneumonia

Regurgitation is not associated with reflex closure of the
larynx
Airway is unprotected
Aspiration pneumonia is common
Potentially life-threatening
oesophageal dysfunction & laryngeal paralysis is a bad combination

13

oesophagitis - causes

Chemical injury - corrosive agents, medications
gastro-oesophageal reflux - General Anaesthesia, hiatal hernia, persistent vomiting, poorly positioned feeding tubes
Oesophageal foreign bodies (FBs)

14

oesophagitis - treatment

Dietary – small meals, high protein-low fat food to minimise reflux +/- gastric feeding tube
Sucralfate liquid – chemical bandage
Inhibitors of gastric acid secretion

15

oesophagitis - possible serious complication

strictures

16

oesophageal FB

Lodge at thoracic inlet, heart base, hiatus
Bones, fish hooks, toys, needles, sticks
Endoscopic retrieval or push to stomach
Potential for mucosal damage/perforation
Should be considered an emergency
Needs endoscopy

17

primary causes of vomiting

Dietary (acute) - indiscretion, intolerance, hypersensitivity
Infection (acute) - parasites, parvovirus
Inflammatory disease (chronic) - gastritis, IBD, ulceration
Neoplasia (chronic)
Obstruction (acute) - neoplasia, foreign body, gastric hypertrophy
Motility disorders/gastric volvulus (acute)

18

secondary causes of vomiting

Uraemia
Addison’s disease (adrenocortical insufficiency)
Hepatic disease
Pancreatitis
Toxin ingestion (acute)
Drugs

19

regulation of acid secretion - drug types

prevents gastric ulcers
anti-histamines
anti-cholinergics
proton-pump inhibitors

20

sucralfate

Oesophageal and gastric ulceration
Aluminium hydroxide and sucrose octasulfate
Dissociates in acid
Sucrose octasulfate reacts with HCl and is polymerised to viscous sticky substance that binds to proteinacious exudate usually found at ulcer sites
Protective barrier
Stimulates HCO3 - mucus & prostaglandin secretion

21

Cimetidine/Ranitidine/Famotidine

HA (H2) receptor antagonist
inhibition of gastric acid
some gastric prokinetic activity
Used frequently to treat any sort of regurgitation/vomiting
No evidence that there is any efficacy in dogs or cats

22

omeprazolne

Proton pump inhibitor
Binds parietal cells, irreversibly blocking H+/K+ ATPase - inhibits the transport of H+ into the stomach
gastric hyperacidity
GI ulcers and erosions
Zollinger-Ellison syndrome (gastrinoma)
Long duration of activity – once daily dosing

23

Anti-Emetic Therapy

Used if vomiting is debilitating - pain, marked fluid and/or electrolyte loss
management of the underlying disease
Cause cannot be determined in all patients
Anti-emetic therapy may not always be desirable
Vomiting can be protective

24

metoclopramide

Para-aminobenzoic acid (PABA) derivative with central and GI effects
Antagonises D2-dopaminergic & 5-HT3 receptors in the CRTZ & peripheral cholinergic effect
Upper GI prokinetic agent

25

ondansetron

5-HT3-Serotonergic antagonist
expensive
Best anti-emetic for chemotherapy-induced nausea and vomiting
Also good for pancreatitis

26

maropitant

Neurokinin-1 receptor antagonist
Central and peripheral effects
Stops the binding of substance P
Very potent: Careful, masks underlying diseases!
licensed for use in dogs- soon also cats
useful in any kind of vomiting