Chronic Vomiting Flashcards
What is chronic vomiting?
continuous or intermittent vomiting for >2 weeks
What are 9 primary GI diseases that can cause chronic vomiting?
- chronic gastritis
- IBD
- food-responsive enteropathy
- parasites
- pyloric hypertrophy
- gastric dysmotility
- gastric/duodenal ulcers
- GI neoplasia
- bilious vomiting
What are 7 systemic disease that can lead to chronic vomiting?
- CKD
- hepatobiliary disease
- pancreatitis
- hypoadrenocorticism
- hyperthyroidism
- DM - usually DKA
- mastocytosis (cats!)
What are the 3 most common causes of chronic gastritis?
- food hypersensitivity
- Helicobacter
- idiopathic
How does food hypersensitivity affect the GIT? What treatment is needed?
lymphoplasmacytic infiltrate in GIT
strict hydrolyzed or novel protein diet for at least 2-3 weeks –> no treats or flavored medications!
What is the most common sign of Helicobacter infection? How is it diagnosed?
chronic vomiting
- rapid urease test (CLO)
- cytology of gastric mucosa and/or histopath with silver stain –> lymphocytic/lymphoplasmacytic follicular hyperplasia
(can be incidental finding!)
What treatment is recommended for chronic vomiting caused by Helicobacter?
Amoxicillin + Clarithromycin + Omeprazole for 3 weeks
What parts of the GIT are affected by IBD? How is it diagnosed? What treatment is recommended?
SI +/- LI
mucosal or full thickness biopsy –> lymphoplasmacytic or eosinophilic inflammation
hydrolyzed/novel protein diet +/- immunosuppression (prednisone, azathioprine, cyclosporine)
What are the 3 most common gastric neoplasias?
- adenocarcinoma (DOGS) - lesser curvature; vomiting, weight loss/emaciation, anorexia, hematemesis
- lymphoma (CATS) - gastric and SI; small cell form can appear similar to IBD
- leiomyosarcoma
What 4 parasites can cause chronic vomiting?
- Physaloptera - only small burden needed (fecals not helpful), prophylactic deworming with Pyrantel - eating cockroaches
- Ollulanus (cats) - shelters, batteries
- Giardia - zinc sulfate floatation, Ag SNAP, treat with Fenbendazole AND Metronidazole
- Aascarids
In what animals are chronic foreign bodies most common?
cars - hair ties
- rare, usually acute and self-limiting
How can signalment be used to provide initial clues to the cause of chronic vomiting?
- YOUNG - parasitism, dietary indiscretion, FB
- OLD - neoplasia, IBD
What history is important to gather in case of chronic vomiting?
- ensure patient is truly vomiting
- diet
- drug/toxin exposure
- travel, vaccination, and deworming status
- frequency, timing in relation to eating, and character of vomit –> blood = damage to mucosa, ulceration
What are common findings on physical exam in patients experiencing chronic vomiting?
- weight loss - malabsorption
- appetite - eating well –> hyperthyroidism, DM
- signs of systemic disease - icterus
- abdominal palpation - masses, FB, thickened intestines
What 2 intial diagnostics are commonly performed in cases of chronic vomiting? What is recommended following stabilization?
- CBC/chem/UA - r/o systemic disease
- fecal - parasites
diet and deworming trials + further testing (abdominal radiographs + U/S + endoscopy)
What diet trials are recommended in cases of chronic vomiting?
- hydrolyzed protein
- novel protein
What dewormers are recommended for trials in cases of chronic vomiting?
- Pyrantel
- Fenbendazole
When are plain and contrast abdominal radiographs most helpful in cases of chronic vomiting?
PLAIN - FB, masses, typically low yield and can miss partial obstructions
CONTRAST - motility disorders, FB, pyloric hypertrophy, neoplasia, can miss lesions
When are abdominal ultrasounds most useful when diagnosing chronic vomiting? What 4 advantages does it have over radiographs?
FB, masses, thickened intestinal tract, enlarged LN
- non-invasive
- can see structure and size of abdominal organs
- can asses layers of GIT and motility
- can be used to perform FNA or trucut biopsy
What are the main 2 uses of endoscopy when diagnosing chronic vomiting? What limitation does it have?
- observing gatric/duodenal mucosal lesions
- used to obtain biopsies
cannot reach passed stomach, proximal small intestine, +/- ileum + can miss extraluminal lesions
What purpose do exploratory celiotomies have in cases of chronic vomiting?
- identify and remove FB
- collect full thickness biopsies for inflammatory disease or neoplastic diseases (partial thickness from endoscopy)
- address pyloric hypertrophy
- evaluate other abdominal organs
invasive!
What is happening in the bottom ultrasound of the small intestine?
infiltrative disease with muscularis thickening compared to mucosa –> IBD vs neoplasia
What is occuring in the abnormal stomach to the right?
thickened lesser curvature with ulcerated mass
- gastric adenocarcinoma
What does gastric dysmotility lead to? What are 3 clinical signs?
delayed gastric emptying
- vomiting up of food >8 hrs after eating - projectile with pyloric stenosis
- abdominal distention/bloat
- abdominal discomfort
What is the difference between structural and functional gastric dysmotility? What diagnostics are used?
STRUCTURAL - mass, polyp, pyloric hypertrophy, or FB cause outflow tract obstruction
FUNCTIONAL - inflammation, infection, idiopathic
What diagnostics are used for gastric dysmotility? If no structural disease is found, what 2 treatments ar recommended?
AUS + endoscopy + mucosal biopsy
- low-fat diet in small, frequent meals
- prokinetics - Metoclopramide, Cisapride, Erythromycin
What is pyloric hypertrophy? In what patients is it most commonly seen?
stenosis of pyloric canal associated with mucosal and/or muscular hypertrophy
older (>8 y/o) small breed dogs - Lhasa Apso, Shih Tzu
How is pylroic hypertrophy diagnosed? What treatment is recommended?
contrast radiography, U/S, endoscopy, biopsy - appreciate enlarged mucosal folds that surround the pyloric orifice
surgical correction of hypertrophy
What is gastric ulceration? What are 5 most common signs?
defect in gastric wall from muscularis to deeper layers
- vomiting
- hematemesis
- coffee ground vomitus
- melena
- anemia- pale MM
What are 4 common causes of gastric ulceration? How is it diagnosed? Treated?
- drugs - NSAIDs, steroids
- systemic disease
- Gi inflammation
- neoplasia - gastrinoma
AUS, endoscopy - observe masses or thickening
treat underlying disease + PPI, Sucralfate
What is bilious vomiting syndrome? What treatment is recommended?
vomiting bile early in the morning due to reflux of duodenal fluid into the gastric lumen, causing mucosal irritation and dysmotility
- Metoclopramide
- late evening antacid
- late evening small meals
