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Digestive System Exam 2 > Small Animal Gastric Disorders (Winston) > Flashcards

Small Animal Gastric Disorders (Winston) Flashcards

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1
Q

List the general indications for using Anti-Emetic Drug Therapy:

A
  1. Symptomatic control of vomiting (short-term basis)
  2. Profuse vomiting which results in fluid, electrolyte, or acid-base imbalance
  3. Motion sickness** most common
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2
Q

Anti-Emetic Drug Therapy:
- Appetite stimulant in cats
- Non-selective serotonin antagonist (5-HT3, 5-HT2) alpha 2 adrenergic blocker

A

Mirtazapine (Remeron)

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3
Q

What are the “big categories” when thinking of gastric disease?

A
  • Inflammation
  • Ulceration
  • Neoplasia
  • Obstruction
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3
Q

What are the “big categories” when thinking of gastric disease?

A
  • Inflammation
  • Ulceration
  • Neoplasia
  • Obstruction
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4
Q

List the clinical manifestation of gastric disease:

A
  • Vomiting
  • Hematemesis
  • Melena
  • Retching
  • Burping
  • Hypersalivation
  • Abdominal distension
  • Abdominal pain
  • Weight loss
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5
Q

Predominant features: Sudden onset of vomiting; otherwise healthy
Clinical presentation:

A

Acute gastric

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6
Q

Predominant features: Chronic vomiting of food or bile; usually otherwise healthy
Clinical presentation:

A

Chronic gastric

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7
Q

Predominant features: Vomiting, hematemesis, melena, +/- anemia
Clinical presentation:

A

Ulceration or erosion

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8
Q

Predominant features: Nonproductive retching, abdominal distention, tachycardia
Clinical presentation:

A

Gastric-dilation volvulus

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9
Q

Predominant features: Acute to chronic vomiting of food > 10 hrs after eating
Clinical presentation:

A

Delayed gastric emptying

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10
Q

Predominant features: Chronic vomiting, weight loss, +/- hematemesis, +/- anemia
Clinical presentation:

A

Neoplasia

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11
Q

Definition:
Syndrome marked by vomiting presumed to be due to gastric mucosal insult or inflammation

A

Gastritis

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12
Q

What are some known causes of gastritis?

A
  • Diet-related factors
  • Foreign Bodies
  • Drugs, toxins, chemicals
  • Systematic disease
  • Infectious agents (bacterial, viral, fungal)
  • Bilious Vomiting Syndrome
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13
Q

What is the most common form of gastritis?

A

Idiopathic Gastritis

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14
Q

(T/F) A specific underlying cause of gastritis is often determined

A

False, underlying cause of gastritis is often NOT determined

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15
Q

What is the treatment for acute gastritis?

A

Symptomatic, supportive therapy and signs resolve

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16
Q

Clinical signs:
- Chronic intermittent vomiting of food or bile
- Weight Loss (common)
- +/- small or large bowel diarrhea
These clinical signs are from …

A

Chronic Gastritis

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17
Q

(T/F) In cats with really defused inflammatory bowel disease, their ONLY clinical sign can be vomiting

A

True

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18
Q

Chronic Gastritis: Food Sensitivity

  • Proven immunologic basis
  • Dietary proteins (carbohydrates too)
A

Food Allergy

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19
Q

Chronic Gastritis: Food Sensitivity

-Abnormal response to food or additive (not immunologic)
- Lactose, additives, histamine, toxins, others

A

Food Intolerance

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20
Q

Consider food sensitivity if the patient has concurrent ______________ disease

A

Dermatologic

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21
Q

Chronic Gastritis:
- Microaerophilic, spiral, Gram (-) Negative, urease activity
- Located within the stomach
- Present in many species
- Normal gut microbe vs pathogen?
- Infection does not equal disease

A

Helicobacter spp.

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22
Q

Helicobacter spp. in small animals:
- If clinical, what is more likely …
a. Gastritis
b. Gastritis Ulcers

A

a. Gastritis

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23
Q

Helicobacter spp. in small animals:
Treat or Ignore?

A

Treat only if biopsy confirmed infection AND gastritis
- Combination tx: Amoxicillin + Metronidazole + Clarithromycin +PPI

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24
What is a stomach worm (nematode) of dogs and cats?
Physaloptera rara
25
Is a fecal examination for Physalotera rara reliable or unreliable?
Unreliable - because of intermittent shedding
26
Chronic Gastritis Classic presentation: Morning vomiting of bile-stained fluid, otherwise healthy
Bilious Vomiting Syndrome
27
What is the best management for bilious vomiting syndrome?
- Late-night meal - Others: Metoclopramide, acid suppression
27
What is the best management for bilious vomiting syndrome?
- Late-night meal - Others: Metoclopramide, acid suppression
28
(T/F) For chronic gastritis diagnostic approach, it is better to biopsy only after therapeutic trials
True
29
What is the most likely read in a biopsy from a chronic gastritis case?
Lymphoplasmacytic inflammation
30
If you see eosinophils in the biopsy, what might you consider?
- Parasites - Really bad food allergies
31
What is the prognosis for Chronic Gastritis?
Good - Lifelong special diets or medications likely required
32
Gastric Mucosal Barrier Defense Mechanisms: - Mucus layer - HCO3- secretion
Pre-epithelial defenses
33
Gastric Mucosal Barrier Defense Mechanisms: - Cell membranes and tight junctions - Ion pumps (remove H+) - Epithelial restitution
Epithelial defenses
34
Gastric Mucosal Barrier Defense Mechanisms: - Mucosal blood flow
Post-epithelial defenses
35
Role of Prostaglandins Arachidonic Acid can go into ...
- COX-1 (housekeeping) - COX-2 (Inflammation)
36
Role of Prostaglandins - Gastrointestiinal mucosal integrity - Platelet aggregation - Renal Function - TXA2, PGI2, PGE2
COX-1 (housekeeping)
37
Role of Prostaglandins - Inflammation - Mitogenesis - Bone Formation - Other functions? - PGI2, PGE2
COX-2 (inflammation)
38
- High concentrations in mucosal cells - Stimulates mucus and HCO3 secretion - Promotes epithelial cell restitution - Inhibits acid secretion
Prostaglandins - Mucosal Cytoprotection
39
What things protect the mucosal integrity?
- HCO3 - Mucus - Blood Flow
40
What things are damaging to mucosal integrity?
- Acid - Hypoxia (low levels of oxygen in body tissues) - Bile/Enzymes - NSAIDS
41
What are some of the clinical associations with gastroduodenal ulcers?
- Drugs, Chemicals, Toxins - NSAIDS - Steroids - Increase gastric secretion - Kidney failure - Mast cell tumor - Releases more histamine - Liver disease - Local Disease - Gastric neoplasia - "Stress" Conditions - Other - Spinal cord disease - Hypoadrenocorticism - Lead toxicity
42
- Acute or chronic vomiting - Evidence of GI bleeding - Hematemesis - Melena - Pale MM - Anorexia and weight loss - Abdominal pain, fever, collapse, shock -> septic peritonitis - Other -> depending on the underlying cause These are clinical signs of ...
Gastroduodenal Ulcers
43
If there is evidence of bleeding elsewhere, what are we doing first?
Running a COAGs
44
Gastroduodenal Ulcers If you have: - Normal Albumin - Low Globulin this may indicate ...
young age
45
Gastroduodenal Ulcers If you have: - Low Albumin - Normal Globulin this may indicate ...
- Liver Failure - Protein-losing nephropathy (PLN) - Increased vascular permeability
46
Gastroduodenal Ulcers If you have: - Low Albumin - Low Globulin this may indicate ...
- Protein-losing enteropathy (PLE) - Blood Loss
47
Gastroduodenal Ulcers - Microcytic, hypochromic, minimally regenerative anemia - Thrombocytosis - Decreased Iron saturation, low serum ferritin --> Chronic Bleeding This is describing ...
Iron deficiency anemia
48
(T/F) You must avoid the concurrent use of NSAIDs and steroids or NSAIDs together
True
49
What causes intermittent pyloric outflow obstruction?
Gastric foreign body
50
List some things that can lead to Hair Balls (trichobezoars):
- Excess hair ingestion - Long haired cats - Excess grooming - Fleas - Other pruritic skin disease - Altered upper GI motility - 2 to IBD - Dietary intolerance - Other
51
What is a common cause of hairball vomiting (shorthaired cat)?
Diet-responsive GI disease
52
(T/F) Cats relatively lack "housekeeper contractions" sweeping from the stomach and distal intestines
False, cats have inter-digestive migrating motor complexes only in distal SI
53
What is the most common cause of delayed gastric emptying?
Mechanical gastric outflow obstructions
54
Delayed Gastric Emptying - Weak or ineffective gastric contractions
Functional gastric motility disorders
55
Delayed Gastric Emptying: Barium in the stomach after _______ hrs confirms delayed gastric emptying
12-24
56
Definition: - Gastric distention with air + volvulus (twisting) of the stomach on its axis - Caudal vena cava compression impaired venous return to heart Hypovolemic shock
Gastric Dilation-Volvulus
57
- Non-productive retching and salivation - Abdominal distension and tympany - Tachycardia - Pallor - Shock -> Hypothermia, depression, etc ... These are clinical signs of ...
Gastric Dilation-Volvulus (GDV)
58
What are the clinical presentations of gastrointestinal bleeding?
- Vomiting - Hematemesis - Melena - +/- anemia (iron deficiency) --> microcytic, hypochromic anemia
59
Why does hypochloremic metabolic alkalosis occur with pyloric obstruction?
Pyloric obstruction leads to "gastric vomiting" (No bicarbonate from duodenal content) --> Net loss of HCL
60
Net loss of H+ --> Metabolic alkalosis _____ pH & ____ HCO3
Increases, Increases
61
Fluids: - Lots of chloride for hypochloremia - Acidifying fluid for alkalemia
0.9% Saline supplement with KCL
62
(T/F) NSAIDs inhibit the production of prostaglandins, which are essential for maintaining the gastric mucosal barrier integrity
True
63
List potential complications of administering NSAIDs:
Ulcers and erosions
64
What should you be suspicious of if a patient's serum biochemistry profile reveals a metabolic alkalosis?
Pyloric outflow obstruction
65
After stabilization of the patient for GDV, a ______________ abdominal radiograph should be performed to confirm the diagnosis
right lateral
66
(T/F) GDV is a surgical emergency
True
67
What must be differentiated from GDV (right lateral abdominal radiograph)?
Food Bloat - most cases will resolve in 24-48 hrs with supportive care
68
(T/F) Malignant tumors are more common than benign
True - Gastric neoplasia tends to affect older dogs and cats

Digestive System Exam 2 (11 decks)

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