Flashcards in Oesophageal diseases and vomiting lecture Deck (34):
3 most common causes of oesophageal disease
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
What is an oesophageal disorder?
Failure of transport and/or reflux
Clinical signs of regurgitation (6)
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
How do you diagnose oesophageal disease? (5)
PE normal usually, upper oesophageal palpation, lung auscultation, underlying concurrent disease, BCS
Which investigations are normally focused on with oesophageal disease? (3)
-Diagnostic imaging (plain then contrast radiography)
-Haematology and biochemistry - others too
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.
What are the common causes of mega-oesophagus?
-MG (generalised or focal)
Other, rarer causes of megaoesophagus?
How does aspiration pneumonia show up on a radiograph?
Alveolar lung pattern = the lungs fill with fluid (aspirated and inflammatory) which appears white.
What are the 3 main causes of oesophagitis?
Name one medication that can cause chemical injury-induced oesophagitis?
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)
Serious treatment complication of oesophagitis?
Where do oesophageal FB lodge? (3)
Thoracic inlet, heart base, hiatus
How is it best to remove an oesophageal FB?
-Endoscopic retrieval or push to stomach (usually this)
-Consider emergency referral
What diseases is the symptom of vomiting associated with? (5)
Where do most vomiting pathways converge? (2)
-Vomiting centre (brainstem)
-CRTZ (chemoR trigger zone) for blood borne substances
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)
-Infection (acute: parvo)
-Obstruction (acute: neoplasia, gastric hypertrophy)
-Motility disorders/gastric volvulus (acute)
List some secondary metabolic causes of vomiting (6)
-Uraemia (i.e. CRF thus PU/PD)
-toxin ingestion (acute)
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).
What is the commonest cause of gastric ulceration?
Iatrogenic - NSAIDs
Other causes of gastric ulceration? (5)
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
Name 3 pharmacological ways acid secretion can be regulated
-Proton pump inhibitors (Omeprazole)
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)
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
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
Name 3 anti-emetic drugs.
Metoclopramide, Ondansetron, Maropitant
When do you use anti-emetics?
If V is debilitating, pain, marked fluid/electrolyte loss
How does metoclopramide work?
PABA derivative --> central and GI effects
CENTRAL: Antagonises D2 and 5HT3 receptors in CRTZ
GI: Peripheral cholinergic effects
How does Ondansetron work?
-expensive, best for chemo-induced nausea/V
-also good for pancreatitis