5 - Vomiting And GI Disease Flashcards
What are the four components of the emetic reflex
Visceral receptors, vagal and sympathetic afferent neurons, chemoreceptor trigger zone, emetic center
What are the 2 pathways trigger the emetic center
Humeroal pathway and neural pathway
The humoral pathway via
Chemoreceptor trigger zone
Humoral pathway has to do with
Blood borne substances
Neural pathway is involved with
Inflammation, infection, malignancy, or toxicity of GI tract
How do we get input to the emetic center
Chemoreceptor trigger zone, vestibular apparatus, cerebral cortex, abdominal viscera
Chemoreceptor trigger zone drugs`
Chemo drugs, bacterial toxins, opioids
Chemoreceptor trigger zone metabolic waste product
Uremic. Toxins, ammonia, ketones
Motion sickness come from
Vestibular appparatus
Vestibular input path through cat
Directly through emetic center
Vestibular input path dog
CRTZ
Sight smell and thoughts acts where in emetic reflex
Cerebral cortex
Most common when inducing vomiting is where
Abdominal viscera
Antiemetic therapy indication
Not suffering from obstruction or toxicity and vomiting is severe/ persistent
If an animal is vomiting severely / persistent you are putting animal at risk of what if you use antiemetic therapy
Aspiration pneumonia or an electrolyte disturbance
Maropitant is what type of drug
Anti nausea
Maropitant prevent vomiting mediated via
CRTZ and emetic center
Maropitant also works
In abdominal viscera
Best drug for chemo induced vomiting
Maropitant
Ondansetron may be better anti nausea medication than
Maropitant
Is the oral bioavailability of ondansetron good
In people yes and less than 10% in dogs
what are some side effects of ondansetron
P-glycoproteins substrate, sedation, fecal incontience
Metoclopramide is more often used for
Prokinetic effects
Metoclopramide is not a
great antiemetic or anti nausea
Side effect of metoclopramide
Restlessness, spasms, aggression , hyperactivity, sedation, DRUG INTERACTIONS
Steps of approach to vomiting patient - 5
1: vomiting, regurgitation, and Dysphagia 2: chronicity 3: frequency 4: severity 5: GI differential
What are the 2 ways to differentiate GI
Extra gastrointestinal or primary gastrointestinal
Extra GI causes
Hepatic , renal, endocrine, pancreatitis, CNS, motion sickness, pyometra, drugs
Acute primary GI
obstructive, nutritional, neoplastic, infectious, iatrogenic, toxic
Chronic primary gastrointestinal differentials
Inflammatory, infectious, neoplastic, anomalous
If patient is mild, acute, uncomplicated cases, how can you approach
Sympotmatically
If patient severe, recurrent or chronic cases how do u treat
Diagnostic work up
If milf acute how what tetanus
PCV/TS, fecal
Therapy for mild acute cases
Easily digestible low residue diet , antiemetic medications maybe
Acute vomiting cases should resolve
48 hours
Bilious Vomiting Sundrome
Vomiting of bile stained material - morning
Bilious vomiting syndrome is often seen in dogs that are fed
Once a day
Treatment for bilious vomiting syndrome
2 - 3 small meals, late night snack, acid supresant
Acute gastritis underlying cause
Not usually identified
Pathophysiology of acute gastritis
Ingestion of substances that disrupt gastric mucosal barrier, decreased mucosal blood flow, ischemia
Clinical signs of acute gastritis
Mild and self limiting, sudden onset of vomiting, +/- Hematemesis, melena, anemia
How do you DX acute gastritis
History
How do you treat acute gastritis with diet
Small frequent feedings with easily digestible diet - low fat and fiber
How do you treat acute gastritis if concerns for translocation
Antibiotics
How do you treat acute gastritis if Hematemesis
Acid suppressants
With acute gastritis confirm no evidence of
Gastric outflow obstruction
Example of histamine receptor antagonist
Cimetidine, ranitidine, famotidine
PPP inhibitor examples
Omperazole, esomperaole
PPI are more effective at
Increasing gastric pH
Chronic gastritis
Chronic indlammatory changes within gastric mucosa with clinical signs of gastritis
Clinical signs of Chronic gastritis
Chronic vomiting, decreased appetite, weight loss, melena, Hematemesis
DX chronic gastritis
Rule out extra GI, stomach worms, abdominal imaging , endoscopy, histopathy
Treatment for chronic gastritis
Treat underlying cause , cytoptroective agents , diet trials or immunosuppressants
Elimination diet trial
Hydrolyzed, novel protein diet
Drugs that cause ulcer
NSAID, steroids
Endocrine problems that can cause ulcer
Hypoadrenocoritcism
Clinical signs of ulcer
Vomitous with partially digested or fresh blood, melena, abdominal pain, anorexia
Suspicion of gastric ulcer with
- thickening , loss of mucosa, increase BUN, Hematemesis
Treat gastric ulcer
Underlying cause, blood transfusion?, acid suppressants and cytoprotective agents
Cytoprotective agents
Sucralafate and Misprostol
Sucralfae can inhibit
Absorption of other drugs
Sucralfate acts how
Selective binding of proteins at damaged site and forms protective barrier
Misprostol
Synthetic analog of prostaglandin E1
Misprostol can cause
GI distress
Pyloric stenosis
Hypertrophy of the circular muscle fibers in the pylorus
Pyloric stenosis is seen in what breed
Brachycephalic dogs
C/s of pyloric stenosis
Vomiting, following ingestion of solid food , gastric distention and weight loss
How do you DX pyloric stenosis
Endoscopic exam, thickening of pylorus on ultrasound, serum gastrin
TX of pyloric Stenosis
Pyloromyotomy or pyloroplasty
Most common neoplasia in cats
Lymphoma
Most common neoplasia in dog
Adenocarcinoma
