Approach to vomiting/ regurgitation Flashcards
What is acute vomiting more likely to be caused by
toxic
obstructive
inflammatory
infectious
what is chronic vomiting more likely to be caused by
chronic inflammatory
chronic infectious
metabolic/ endocrine
neoplastic
List 2 causes of acute vomiting due to the cerebral cortex
head trauma
sudden changes in ICP- inter cranial pressure
List 3 causes of acute vomiting linked to the vestibular system
motion sickness
idiopathic vesicular disease
otitis interna
List 4 causes of chronic vomiting linked to the GI tract
chronic inflammatory e.g. gastritis
mucosal insult e.g. dietary intolerance
infectious
obstructive
What is the difference between vomiting and regurgitation
Reg- passive motion - ejection from the oesophagus
vomiting is active - ejection of food from stomach
define dysphagia
failure to prehend/ bite and initially swallow
List 3 things that can cause dysphagia
Pain
failure of neuro-muscular control
obstruction
what failures of neuro-muscular control can result in dysphagia
cranial nerves disease (5, 7, 9, 10, 12)
CNS disease
masticatory myositis
botulism
myasthenia gravis
which breeds are predisposed to congenital megaoesophagus
Labrador
newfoundland
Shar-pei
describe the physiology of vomiting
active reflex mediated via the emetic centre that can be stimulated by the CRTZ, GIT, cerebral cortex or vestibular system
what is the CRTZ
chemoreceptor trigger zone
what acute issues can trigger CRTZ voiting
metabolic/ endocrine disease
toxins/drugs
what chronic issues can trigger cerebral cortex vomiting
neoplasia/SOL (space occupying lesions)
CNS disease
List the chronic issues that can trigger vestibular system vomiting
chronic vestibular damage
otitis interna
neoplasia
cerebellar disease
List the chronic issues that can trigger CRTZ vomiting
metabolic/endocrine disease
Describe the physiology of regurgitation
passive expulsion of food from the pharynx or oesophagus
what is masticatory myositis
antibodies form against the muscles used for mastication
List the 3 causes of regurgitation
dilation of the oesophagus
obstruction - intraluminal, mural or extramural
neuro-muscular disorder
what can previous regurgitation under anaesthetic be an indicator for
oesophagitis or stricture
Name 2 mural causes of regurgitation
neoplasia
inflammation
list 3 extramural causes of reguritation
vascular ring anomaly
hiatal hernia
space occupying lesion (neoplasia)
what breeds are predisposed to vascular ring anomalies
GSD
irish setter
great dane
what animals are predisposed to intussusception
juveniles and puppies with recent diarrhoea
what breeds are predisposed to oesophageal FBs
terrier breed (WHWT) and spaniels
what breeds are predisposed to GI/ intestinal FBs
labradors
spaniels
which are more prone to doxycycline induced oesophagitits dogs or cats
cats
what is a vascular ring anomaly
persistant right aortic arch constricts the oesophagus
Describe how to manage an animal with abnormal swallowing
trial and error different food types to find one that works well
describe how to manage megaoesophagus
omeprazole
feed from a height
feed in small bits
consider a feeding tube
what can be a problem with giving omeprazole to animals with megaoesophagus
risk of worsened aspiration
describe how to manage oesophagitis
pain relief
feeding tube placement (bypass the oesophagus)
how does maropitant work
NK1 antagonist - helps with centrally mediated vomiting
describe how metoclopramide works
dopamine and histamine receptor antagonist
helps with centrally mediated vomiting
what should you rule out before giving any drugs for vomiting
a foreign body
How does omeprazole work and what is it used for
protein pump inhibitor
useful for gastric ulceration and reduction in ICP (reduced CSF production)
How does misoprostol work and what is it used for
prostaglandin analogue
increases mucosal blood flow and therefore healing
when should we not use misoprostol
in pregnant animals
List 4 gastroprotectants
omeprazole
misoprostol
cimetidine - H2 receptor antagonists
sucralfate
Describe how cimetidine work and what it is used for
histamine receptor antagonists
reduce acid secretion
how does sucralfate work and what does it do
polyionic surfactant
binds to damage mucosa and provides a ‘bandaid’
what is misoprostol commonly used for
NSAID toxicity
describe a hiatal hernia
diaphragm and oesophagus are poorly attached - this means as the patient breathes the diaphragm slides over the oesophagus and part of the stomach may protrude through
how can we diagnose hiatal hernias
fluroscopy
what is PPDH
pericardio-peritoneal diaphragmatic hernia
which animals more commonly have PPDH cats or dogs
cats
what is a pericardio-peritoneal diaphragmatic hernia
midline defect at birth which allows abdominal contents to herniate into the percardial sac
