46 - Stomach Flashcards
Omental anatomy
Greater and lesser omentum attachments and associated ligaments
Greater: Superficial aspect -> Originates from greater curvature of stomach and duodenum, extending cadudally to level of urinary bladder, and folding back. Gastrosplenic ligament is large part, attaching hilus of spleen to greater curvature and fundus
Lesser: small, extends from liver to lesser curvature and cranial duodenum. Hepatogastroligament is large part.
In the dog, where is the pyloric sphincter typically located?
In right cranial quadrant, 10-11th rib
May be closer to midline than in adults
What is the normal reported rugal fold thickness for dogs (2-50kg)?
1-8mm
What is one advantage and one disadvantage of pnemogastrography? What is the normal dose?
Endoscropy can immediately follow, however US cannot
6-12ml/kg
What is the dose for iodinated contrast gastrography?
600-700mg/iodine per kg
CARE: If ionic, risk of pulmonary oedema if aspirated
What is the normal rate of gastric emptying in the dog?
Should start in 15 mins. Complete in 1-4 hours based on barium studies
HOWEVER, 7-15 hours reported in barium emptying in normal dogs. Emptying times for individual dogs repeatable
4 hours with moist food, up to 16 hours for dry!
Normal US gastric wall thickness (Dog and cat)
No gastric peristaltic waves per min
3-5mm; 2-5mm
4-5 per min
What volume of air is needed to perform “virtual endoscopy” of the stomach?
500-700cm3 (7-10kg dog)
What is the gold standard method for documenting gastric emptying time?
Scintigraphy!
Still high variability
BIPS Emptying times longer than scinti.
Scinti useful for gastric bleeding
List the types of hiatal hernia
1) SLIDING (Movement of oesophagus / stomach cranially)
2) PARAOESOPHAGEAL (cranial movement of stomach adjacent to oesophagus)
3) Combination of 1 and 2 (?+- involvement of other organs)
Gastroesophageal intussusception usually requires predisposing disease. List 3 examples
Chronic vomiting, megaoesophagus, dilation of oesophageal sphincter
List 8 factors assocaited with GDV
Large breed,
Increased thoracic depth to height ratio,
Food volume,
Splenectomy,
Increased age,
Reduced body condition,
Gastric FB,
(Diaphragamatic hernia in small brachys and cats)
What RX feature is suggestive of 360 GDV?
Small vena cava ???!
How does pneumatosis relate to prediction of gastric wall necrosis? Sp, sn
High Spec, low sens
Radiographs are a poor predictor of gastric wall necrosis generally
List 5 potential causes of chronic pyloric obstruction
Neoplasia,
Inflammation / fibrosis,
Hypertrophic pyloric stenosis,
Pylorospasm,
Mucosal antral hypertrophy,
(Pancreatic / duodenal disease - can cause similar presentation!)
List 4restrictive causes (annular constriction) of pyloric stenosis
Hypertrophic pyloric stenosis,
Pylorospasm,
Fibrosis / inflammation,
Neoplasia
List 3 obstructive causes of pyloric stenosis
FB,
mucosal inflammation / hypertrophy,
Some mural disease of antrum
List (and describe) 3 “signs” assocaited with restrictive pyloric obstruction
Beak sign: Tapering column of contrast in pyloric sphincter (only fills entrance);
String sign: Thin column through sphincter
Tit sign: Sharp, pointed outpouching of antrum along lesser curvature as peristaltic wave pushed contrast medium into pouch adjacent to mass
What gastric wall measurements have been described in hypertrophic pyloric stenosis?
Musclaris thickening: >3mm in mild-moderate, >8mm in severe
What does zinc do if ingested!
Intravascular haemolysis. Euro cents and US pennies after 1982, along with other sources.
Which breed (with which condition) are overrepresented fotr gastroruodenal ulceration?
Dachys with disc prolapse
Also sled and working dogs, poorly understood mechanism
Which modality that we dont use is good for GI bleeding! And which agents are used
Scinti!
Labelled RBCs might be better thatn sulfur colloid as they circulate longer, allows identification of intermittent or chronic bleeding.
List 8 types of malignant gastric tumour
LSA,
Carcinoma,
Adenocarcinoma,
GIST,
Leiomyosarcoma,
Fibrosarcoma,
MCT
Histiocytic sarcoma
Most common gastric tumours dog / cat
Adenocarcinoma (dog) -> Most commonly pyloric, and frequently spreads to liver and regional nodes.
LSA (Cat) -> lesions in SI and stomach should prompts consideration of LSA
