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Flashcards in Oesophageal diseases and vomiting lecture Deck (34):
1

3 most common causes of oesophageal disease

Oesophagitis
Oesophageal FB
Mega-oesophagus

2

How can oesophageal diseases be categorised?

Anatomic - vascular ring anomaly, cricopharyngeal disease, hiatal hernia, diverticulum
Obstruction - mural (stricture), luminal (FB), extraluminal (mass)
Oesophagitis - trauma, reflux (anaesthesia), irritation
Motility disorders - megaoesophagus, neuropathy, myopathy

3

What is an oesophageal disorder?

Failure of transport and/or reflux

4

Clinical signs of regurgitation (6)

-hypersalivation
-odynophagia
-anorexia (uncommon)
-dysphagia
-nasal discharge
-coughing

5

How is vomiting different to regurgitation (4)?

Vomiting = abdominal effort, prodromal nausea, usually digested food, no swallowing pain, (alkaline or acidic)

Regurgitation = passive, no prodromal nausea, undigested food, possibly painful, no prodromal nausea

6

How do you diagnose oesophageal disease? (5)

PE normal usually, upper oesophageal palpation, lung auscultation, underlying concurrent disease, BCS

7

Which investigations are normally focused on with oesophageal disease? (3)

-Diagnostic imaging (plain then contrast radiography)
-Haematology and biochemistry - others too
-Endoscopy

8

Will plain radiography be able to rule out the 3 main causes of oesophagitis?

No - will show radio-opaque FB and mega-oesophagus but not oesophagitis. It WIll allow you to determine if problem is functional or structural.

9

What are the common causes of mega-oesophagus?

-Idiopathic (dogs)
-MG (generalised or focal)
-Thymoma
-Hypoadrenocorticism

10

Other, rarer causes of megaoesophagus?

-Polyneuritis
-polymyositis
-dysautonomia (cats)
-CNS disease
-botulism/tetanus
-SLE
-lead/thallium toxicity
-Hypothyroidism

11

How does aspiration pneumonia show up on a radiograph?

Alveolar lung pattern = the lungs fill with fluid (aspirated and inflammatory) which appears white.

12

What are the 3 main causes of oesophagitis?

-Chemical injury
-Gastro-oesphageal reflux
-Oesophageal FBs

13

Name one medication that can cause chemical injury-induced oesophagitis?

Doxycycline

14

What are the treatment options for oesophagitis? (3)

-Dietary (small meals, high protein, low fat, +/- fastric feeding tube)
-Sucralfate liquid (provides chemical bandage)
-Gastric acid secretion inhibitors (H2 blocker or proton pump inhibitor)

15

Serious treatment complication of oesophagitis?

Stricture

16

Where do oesophageal FB lodge? (3)

Thoracic inlet, heart base, hiatus

17

How is it best to remove an oesophageal FB?

-Endoscopic retrieval or push to stomach (usually this)
-Consider emergency referral

18

What diseases is the symptom of vomiting associated with? (5)

-GIT/abdominal,
-systemic
-neuro
-metabolic/endocrine
-toxicity

19

Where do most vomiting pathways converge? (2)

-Vomiting centre (brainstem)
-CRTZ (chemoR trigger zone) for blood borne substances

20

Primary (GIT causes of vomiting =? (4 most common; Others)

MOST COMMON =
-Dietary (acute: indiscretion, intolerance or hypersens.)
-Infection (acute: parasites)
-Inflammatory disease (chronic: gastritis, IBD, ulceration)
-Obstruction (acute: FB)

OTHERS=
-Infection (acute: parvo)
-Neoplasia (chronic)
-Obstruction (acute: neoplasia, gastric hypertrophy)
-Motility disorders/gastric volvulus (acute)

21

List some secondary metabolic causes of vomiting (6)

-Uraemia (i.e. CRF thus PU/PD)
-Addison's
-Hepatic disease
-pancreatitis
-toxin ingestion (acute)
-drugs

22

How do you go about a workup of dogs and cats with A.) acute vomitting? B.) chronic vomiting?

A.) Radiograph for blocking FB. Otherwise treat symptomatically and fasting

B.) Bloodwork (hame/biochem to ID organ disease); Urinalysis (concentrating ability of kidney); Imaging (radiography for obstruction, ultrasound for other organ involvement); endoscopy (if no answers).

23

What is the commonest cause of gastric ulceration?

Iatrogenic - NSAIDs

24

Other causes of gastric ulceration? (5)

-Neoplasia
-Inflammation
-Systemic
-Hypotension
-Other/idiopathic

25

What causes gastric acid secretion?

-Parietal cells - H+
-Vagus --> Ach --> M2 receptor on parietal cell
-Mast cell --> histamine -->H2 receptor on parietal cell
-Food (esp. aa) and antral distension --> G-cell (antrum) --> gastrin --> gastrin R on parietal cell

26

Name 3 pharmacological ways acid secretion can be regulated

- Antihistamines
-Proton pump inhibitors (Omeprazole)
-Anti-cholinergics

27

SUCRALFATE:
what is it made of?
What happens in acid?
What does it do?

-Aluminium hydroxide and sucrose octasulfate
-Dissociates in acid: sucrose octasulgate reacts with HCl and is polymerised to viscous sticky susbtance that binds to porteinacious exudate usually found at ulcer sites.
-Forms protective barrier (stimulates HCO3-, mucuos and PG secretion)

28

What are cimetidine/ranitidine and famotidine examples of ?

H2 R antagonist --> inhibits gastric acid and has some gastric prokinetic activity.

-Frequently usedd for any kind of V/R, no EBVM for cats/dogs, relatively expensive, 2-3/day

29

How does Omeprazole work? When do you use it (3)?

Proton pump inhibitor: binds parietal cells irreversibly blcks H+/K+ ATPase.
Use for gastric hyperacidity, GI ulcers and erosions, Zollinger-Ellison syndrome (gastrinoma).
Long duration of activity

30

Name 3 anti-emetic drugs.

Metoclopramide, Ondansetron, Maropitant

31

When do you use anti-emetics?

If V is debilitating, pain, marked fluid/electrolyte loss

32

How does metoclopramide work?

PABA derivative --> central and GI effects
CENTRAL: Antagonises D2 and 5HT3 receptors in CRTZ
GI: Peripheral cholinergic effects

33

How does Ondansetron work?

-5-HT3-serotonergic antagonist
-expensive, best for chemo-induced nausea/V
-also good for pancreatitis

34

Where and how does maropitant work?

-NK- R antagonist (centrally and peripherally) which is involved in eliciting the last step in the pathway before V
-Stops binding of SP
-V potent - can mask underlying diseases
-useful for any sort of V