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91. Stomach Flashcards

1
Q

what is the incisor angularis

A

angular notchmid point of lesser curvatureseparates antrum from cardianear area of the papillary process of the liver

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2
Q

blood supply of the stomach from the first branch of the aorta

A
  1. CELIAC artery from aorta—–hepatic (feeds liver/GB, R gastric, gastroduodenal—cranial pancreaticoduodenal, R gastroepiploic)—–left gastric—–splenic (feeds L limb pancreas, L gastroepiploic, short gastrics)
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3
Q

innervation of the stomach

A

parasym from vagussump from celiac plexus

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4
Q

3 layers of the muscular stomach layer

A

longitudinal–from esophagus to duodenuminner circular–part of LES sphincter/cardia; extends through thick greater curvature (function—grinding); NOT present in fundsoblique–in body and fundus

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5
Q

mucosal layer of stomach

A
  1. columnar surface epithelium2. glandular lamina propria3. thin lamina muscularis mucosa
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6
Q

Types of glands in the stomach

A
  1. cardiac glands: in cardia, antrum– SEROUS secretion2. pyloric glands: in pyloris, body–MUCUS secretion3. gastric glands: in fundus, body–parietal, chief, mucous neck, and endocrine cells
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7
Q

Gastric glands cell types and function

A

parietal cells: OXYNTIC, maintain acid pH by pumping H into lumen and make intrinsic factor (mucoprotein) that binds B12 for absorption in distal SIchief cells: secrete pepsinogen (converted to pepsin in acid environment)–breaks down proteinsmucous neck cells: secrete mucus to protect other gland cells from the action of enzymes and acidendocrine cells: produce gastrin, histamine, serotonin

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8
Q

T/Fthe decreased motility in the funds in response to gastric filling directly slows gastric emptying time

A

TRUEafter removal of fundus the rate of gastric emptying is greatly increased

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9
Q

T/Fgastric emptying rate of kibble/solid food is greatly influenced by coordination of contraction btwn pylorus & antrum; whereas the emptying of liquid is more influenced by fundus

A

TRUEgastric emptying rate of kibble/solid food is greatly influenced by coordination of contraction btwn pylorus & antrum; whereas the emptying of liquid is more influenced by fundus

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10
Q

healing characteristics of GI

A

–constant renewalwhen mucosa injured superficially–repaired by migration of epithelium (wo proliferation)when mucosa injured deeper (erosion)–repaired by epithelial regeneration and proliferation

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11
Q

define gastric ulcer and how does it heal

A

injury that extends into the SUBMUCOSAheals by fibrotic repair process

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12
Q

in contrast to other healing tissues, what makes collagen in the stomach after injury

A

fibroblasts AND smooth muscle cells make collagen

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13
Q

episodes of gastric reflux while under GA according to Wilson et al AJVR 2006

A

> 50% dogs have refluxBUTonly 14% go noticedtherefore a large amount of “silent regurgitation” occursmay predispose to esophagitis and esophageal stricture

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14
Q

recommendations of fasting prior to GA/surgery according to Savvas et al 2009 Vet Anesth Analgesia

A

small amount of canned food 3 hours prior to surgery to decrease gastric acidity and clinical impact of GER while having minimal to no impact of gastric volume

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15
Q

location and function of parietal cells

A

oxyntic cellsfx: acid, intrinsic factor productionlocation: BODY

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16
Q

location and function of mucus neck cells

A

fx: mucus productionlocation: BODY, ANTRUM

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17
Q

location and function of chief cells

A

fx: pepsinogen productionlocation: BODY

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18
Q

location and function of surface GI epithelium

A

fx: mucus, bicarbonate productionlocation: DIFFUSE

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19
Q

location and function of GI endocrine cells

A

fx: histamine, gastrin, serotonin productionlocation: BODY

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20
Q

Lavage fluid temperature recommendations based on JAAHA 2005 Nawrocki et al

A

99-102 Froom temp lavage sign decrease body temphi temp (110 F) lavage sign incr body temp–may result in vasodilation, hypotensionand increase adhesion formation–potentially detrimental to organ systems to be too hot

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21
Q

suture materials in acid pH <2 polydiaxanone, polyglecaprone 25, polyglyconate

A

polydiaxanone: half life was 10x shorter in pH 2 vs 7Half livespolydiaxanone: 12 dayspolyglyconate: 75 dayspolyglecaparone: 15 dayssupports maxon (polyglyconate) or monocryl (polyglecaparone) in gastric surgery

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22
Q

T/Fuse of skin stapling device for gastropexy provided results similar to hand sewn belt loop gastropexy with regard to tensile strength

A

TRUEuse of skin stapling device for gastropexy provided results similar to hand sewn belt loop gastropexy with regard to tensile strength

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23
Q

types of gastropexies

A

–incisional–belt loop (strength similar to circumcostal)–base greater curve–skin stapling device–GIA stapler–laparoscopic assisted–total laparoscopic stapled (sign weaker at 7 days but no diff in 30 d)–endoscopically assisted–incorporating–to linea alba; no incision–circumcostal (mechanically strongest–109N)–base lesser curve–gastrocolopexy–greater curve to transverse colon; scarified (no incision)–tube gastropexy

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24
Q

criteria to determine gastric viability

A
  1. thickness2. pulsation–evidence of serosa capillary perfusion3. peristalsis4. serosa color5. incise into seromuscular layer to look for bleeding6. fluorescin dye (58% accurate)7. scintigraphy (80% accurate)8. laser doppler flowmetrysubjective criteria 85% accurate
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25
incisional gastropexy size and layers
4-5 cm seromuscular layer of gastric antrumcorresponding incision into peritoneum and transverse abdominis muscle (lateral or ventral lateral); 2-3 cm caudal to rib RIGHT sided for the prevention of GDV
26
pyloric surgical options to treat pyloric luminal obstructions
1. Fredet--Ramstedt pyloromyotomy: LONG PARTIAL incision through SM; does NOT penetrate (can't get bx); left open with mucosa/submucosa bulging2. Heineke--Milkulicz pyloroplasty: LONG FULL THICKNESS incision closed transversely; can obtain biopsy3. Y-U Advancement pyloroplasty
27
compare pyloromyotomy (FR) vs pyloroplasty (HM) in terms of gastric emptying
Gastric emptying of solids was significantly enhanced in dogs undergoing pyloroplasty, but pyloromyotomy did not significantly change gastric emptying relative to preoperative values (other studies reported no change to slowed gastric emptying)
28
types of gastro--intestinal anastomoses
BILLROTH 1 (gastroduodenal)--pylorectomy with gastroduodenal anastomosisBILLROTH 2 (gastrojejunal)--partial gastrectomy/pylorectomy with gastrojejunal anastomosis--jejunum is attached to stomach in a side to side fashion (Roux en Y is end to side anastomosis)--poor px+/- biliary diversion procedures with either
29
4 types of hiatal hernia
I. sliding: GE junction moves cranial ** most common, congenital, english bulldogs, shar peis (can also be acquired in dogs with BCAS)II. paraesophageal : portion of stomach (fundus) moves into caudal thorax next to esophagusIII. combo of sliding and paraesophagealIV: herniation of other abdominal organs (other than the stomach) into the thoracic cavityOther differential: GASTROESOPHAGEAL INTUSSUSCEPTION (without displacement of the gastroesophageal junction)
30
T/F2/3 of dogs do not have an abdominal esophagus
TRUEPratschke et al 2004 Vet Surgery8/12 (67%) no abdominal portion of esophagus
31
surgical correction for hiatal hernia
--recommend treated medically for 30day--diaphragmatic hiatal reduction (phrenoplasty)--left sided gastropexy (to body wall)--left sided esophagopexy (to diaphragm)
32
complications to billroth procedures
--vomiting--anorexia, weight loss, cachexia--pancreatitis--biliary obstruction/leakage/peritonitis--dehiscence/leakage/peritonitis--gastric dumping/ulceration--malabsorption
33
hypertrophic pylorogastropathy
pyloric outflow obstructioncongenital--muscular in origin, brachy breeds females
34
why have brachycephalic dogs been reported to have a high incidence of pyloric hypertrophy and subsequent stenosis
repiratory difficultsincreased intragastric Psecondary stimulation and secretion of gastrin, gastric acid, CCK, secretin which have a trophic effect on pyloric mucosa63/73 hypertrophy22/73 stenosis
35
diagnosis of delayed gastric emptying from suspect pyloric outflow obstruction
survey films show retention of gastric contents after a fast of > 8 hrscontrast studies may show obstruction and/or "apple core" effect in area of pylorusAB USEndoscopy
36
% of gastric FB that could not be removed with scope and required gastrotomy
10/36~30%(**different from esophageal FB in what <10% required surgery once pushed in stomach)
37
% of gastrointestinal FB that have hypoCl
50% regardless of location
38
most common gastric neoplasia in dogs and cats
DOGS--gastric adenocarcinoma (malignant and epithelial)CATS--LSAothers: leiomyoma/myosarcoma, extramedullary plasmacytoma, FSA
39
mets reported with gastric adenocarcinoma in dogs
70-80% of dogs have metsregional nodes, liver and lung most common
40
where does gastric carcinoma most often appear? and what are the forms of disease?
pyloric antrum or along the lesser curvature1. diffuse (linitis plastica--leather bottle)2. ulcerative3. discrete polypoid mass
41
differentiating gastrointestinal stromal tumors and sarcomas (leiomysocarcoma)
GIST---ckit POSITIVE CKIT IS NOT PRESENT IN LEIOMYOSARCOMAS
42
pythium
fungal--aquatic oomycete in SE USAsevere transmural thickening gastric outflow commonly affectedpoor px < 30 days mST
43
general prognosis for surgical treatment of gastric tumors
poor33 days post pylorectomy and billroth 1 in dogs with malignancies75% already have mets
44
cats px with gastric lymphoma
depends on tumor class and gradelow grade MST 700 days with chemo
45
most common causes of gastric ulceration in small animals
--hepatic disease--neoplasia--renal disease--NSAID--GCCassociated with decr PG production, decr gastric blood flow, excess acid production, decr bicarb/mucus protection
46
renal and hepatic pathophys to gastric ulcer formation
hypergastrinemia from decreased clearance or increased secretiondecreased clearance of gastrin +/- histamine (both of which increase acid)
47
2 mechanisms of NSAID induced gastric ulceration
1. direct topical effect of weak acid, lipid soluble NSAID2. systemic COX inhibition resulting in decreased PG GI protection
48
decreasing COX effect on PG production
inhibit COX decrease PG productiontherefore, decr GI blood flow, decr mucus/bicarb secretion, decr epithelial turnoveris a result of both COX 1 and COX 2 inhibition (historically thought of as just cox 1 inhibitory effect)
49
histamine (H2) receptor antagonist for treatment of gastric ulcers
least potentcimentidine (q8hr dosing, inhibits p450)ranitidine (prokinetic)famotidine (most potent)
50
proton pump (H/K+) inhibitors for treatment of gastric ulcers
block H+/K+ ATPaseinhibits H+ release into the lumendecreases gastric acidityDRUG ABSORBED IN ALKALINE ENVIRONMENT (in prox duodenum)
51
sucralfate MOA for treatment of gastric ulcers
sulfated dissacharide aluminum hydroxidein the acidic stomach it breaks into its componentssucrose becomes thick paste like "bandaid" may stimulate local PG releaseq6 hr
52
misoprostol MOA for treatment of gastric ulcers
analogue of PGE1increases mucusincreases bicarbincreases gastric blood flow30 minute half life therefore frequent dosing needed
53
most common cause of gastric perforation
neoplasia NSAID administration
54
what is a gastrinoma
distant tumor affecting the stomachtumor of the non-beta pancreatic islet cellshypersectretion of gastrin from antral G cells leading to hyperacidity and ulceration
55
list risk factors for GDV
--breed predisposition (large to giant breed)--large thoracic depth to width ratio--affected first degree relative --feeding fewer meals per day--rapid eating--aggressive/fearful/anxious temperament--decreased food particle size --incr hepatogastric ligament length--stress or exercise after a meal
56
breeds at highest risk for GDV
Great Danes Gordon SetterIrish SettersWeimaranersSt PoodlesSt. BernardBassett Hounds
57
EKG abnormalities in dogs with GDV
40-70%
58
Key points on pathophysiology of GDV
1. cardiovascular dysfunction: shock, decr preload, blood loss, arrhythmias2. respiratory: pressure on diaphragm3. gastric necrosis4. bacterial translocation5. reperfusion injury
59
Lactate SN/SP if > 6 mmol/L according to dePapp et al 1999 JAVMA
plasma lactate in GDV dogs > 6.0 mmol/L was 61% SN/ 88% SP for gastric necrosis99% dogs with < 6.0 mmol/L survived, but only 60% dogs > 6.0 mmol/L survive
60
Lactate according to Zacher et al 2010
90% of dogs with initial serum lactate concentrations of 9.0 mmol/L or less survived vs with 54% of dogs with initial lactate concentrations of 9.0 mmol/L or moreIn the group of dogs with initial lactate concentrations of 9.0 mmol/L or more, the response to resuscitative therapy (measured by the posttreatment lactate concentration), absolute change in lactate concentration, and percentage change in lactate concentrations were evaluated relative to survival. Survival rates were significantly lower for dogs with posttreatment lactate concentrations above 6.4 mmol/L, absolute changes in lactate concentration of 4 mmol/L or less, and percentage change in lactate concentrations of 42.5% or lesscare must be taken when applying specific cutoff values to individual patients because the values of survivors and nonsurvivors overlap
61
average recurrence rate of GDV following circumcostal vs belt loop vs gastrocolopexy gastropexy
circumcostal 4.3%(ranged anywhere from 0-7% based on different studies)belt loop 0%gastrocolopexy 15%
62
benitez et al 2013 JAAHA recurrence GDV following incisional gastropexy
~10% recurrent GD< 5% (4.8%) probably of GDV recurrence though no dogs in the study had recurrent GDV
63
Factors associated with increased mortality following GDV surgery
1. duration clinical signs >6 hr2. concurrent gastrectomy/splenectomy or splenectomy needed3. hypotensive4. gastric wall necrosis5. pre op peritonitis/sepsis6. pre op cardiac arrhythmias7. DIC
64
T/FIncreased duration of time from presentation to surgery has been associated with an overall decrease in the mortality rate.
TRUEMackenzie JAAHA 2010Increased duration of time from presentation to surgery has been associated with an overall decrease in the mortality rate. This decrease in mortality presumably reflects that time spent stabilizing the patient with aggressive fluid support; gastric decompression is critical and positively impacts survival.
65
positive predictors of survival for dogs with initial lactate > 9 mmol/L based on Zacher et al
based on serial lactate measurements--absolute change in lactate > 4 mmol/L (86% survive)--% changes in lactate >42.5% (100% survive)--final lactate < 6.4 mmol/L (91% survive)
66
myoglobinemia and GDV prognosis according to Adamik et al JVECCS 2009
myoglobin cut off 168 ng/mL60% SN84% SP fir survival>168 50% survived<168 90% survived
67
T/Fsurvival following GDV was NOT influenced by the presence of bacteremia
TRUEseen in 43% GDV patients and 40% OHE control patients
68
T/Flidocaine treatment had no significant difference in mortality rate or post op complications
TRUEbut they were in hospital longer
69
prophy gastropexy decreases risk of GDV by how much
29 fold
70
Mayhew et al Vet Surgery 2009compared total laparoscopic gastropexy using two different techniques for gastropexy suturing with laparoscopic-assisted gastropexy.
Laparoscopic-assisted gastropexy was performed in a significantly shorter time than either total laparoscopic gastropexy technique and required less specialized equipment. Activity, as measured by accelerometry postoperatively, was significantly reduced for the first 4 days after surgery in dogs that underwent laparoscopic-assisted gastropexy compared with dogs that underwent total laparoscopic gastropexy.

TnJ (128 decks)

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