Digestion & Metabolism 2: Gastric DZ SA Flashcards
CLINICAL SIGNS of gastric dz….
MOST COMMON sign? what 2 ways can it present?
4 other signs?
MOST COMMON sign = VOMITING
1. HEMATEMESIS = FRANK blood (RED)
2. “COFFEE GROUNDS” = DIGESTED BLOOD W/ VOMITUS (BROWN)
4 other signs?
1. ANOREXIA
2. WEIGHT LOSS
3. ABDOMINAL PAIN
4. MELENA (BLACK TARRY STOOL w/ DIGESTED BLOOD)
DYSPHAGIA vs. REGURGITATION vs. VOMITING for EJECTION TIME & ABDOMINAL RETCH?
DYSPHAGIA…
1. IMMEDIATE ejection
2. NO abdominal retch
REGURGITATION…
1. MINUTES to HOURS for EJECTION
2. RARELY TO NEVER ABDOMINALLY RETCHES
VOMITING…
1. MINUTES to HOURS for EJECTION
2. ALWAYS HAS ABDOMINAL RETCH
the ___ ____ causes VOMITING via 4 different pathways, AND THEY ARE/HOW….
there are DRUGS that can TARGET…
VOMITING CENTER
pathways?
1. CEREBRAL CORTEX = being NERVOUS/STRESSED
2. CHEMORECEPTOR TRIGGER ZONE (CRTZ) = present OUTSIDE BBB and ANTIGENS can stimulate it, like UREMIC TOXINS
3. VESTIBULAR APPARATUS = MOTION SICKNESS
4. ABDOMINAL ORGANS = STRETCH RECEPTORS
DRUGS can TARGET different receptors IN EACH PATHWAY
ANTIEMETICS…
4 types & names?
- NK-1 RECEPTOR ANTAGONISTS
–> MAROPITANT (CERENIA) - 5-HT3 SEROTONIN RECEPTOR ANTAGONISTS
–> ONDANSETRON, DOLASETRON - DOPAMINE-2 RECEPTOR ANTAGONISTS
–> METOCLOPRAMIDE - ALPHA-2 RECEPTOR ANTAGONISTS
–> CHLORPORMAZINE (THORAZINE), PROCHLORPERAZINE
MAROPITANT…
brand name?
what kind of drug?
what’s SPECIAL about our use of it?
brand name = CERENIA
type? = NK-1 RECEPTOR ANTAGONIST (anti-emetic)
we DO NOT follow FDA rules
ONDANSETRON/DOLASETRON type of drug?
5-HT3 SEROTONIN RECEPTOR ANTAGONISTS (anti-emetic)
METOCLOPRAMIDE…
brand name?
dogs vs. cats?
drug type?
works on WHAT part of the brain? what kinds of causes of vomiting is it good to combat?
most effective when given HOW?
brand = REGLAN
DOGS»_space;> CATS
DOPAMINE-2 RECEPTOR ANTAGONISTS (anti-emetic)
works on the CRTZ, so good for BLOODBORNE causes of VOMITING
most effective when given as IV CRI
CHLORPROMAZINE/PROCHLORPERAZINE drug type?
are these used often?
ALPHA-2 RECEPTOR ANTAGONISTS (anti-emetics)
NOT USED OFTEN
MELENA indicates that there’s ___ in the vomitus
BLOOD
if ACUTELY vomiting, more likely….
GI-related? (3)
EXTRA-GI? (5)
GI-related?
1. GI OBSTRUCTION (foreign body or mass)
2. INFLAMMATION (non-specific gastritis, toxin ingestion, abrupt diet change)
3. ULCERATION
EXTRA-GI?
1. IATROGENIC
2. PANCREATITIS
3. RENAL FAILURE
4. HEPATOBILIARY DZ
5. ADDISON’S DZ
indications for AGGRESSIVE diagnostic approach for…
ACUTE vomiting?
ACUTE?
1. MENTAL DULLNESS
2. FEVER
3. ABDOMINAL PAIN
4. TACHYCARDIA
CHRONIC
1. POOR BCS
2. SIGNIFICANT WEIGHT LOSS
3. ABDOMINAL MASS
4. PROTEIN-LOSING ENTEROPATHY
if we have HIGH BUN but NORMAL CREATINTINE, what does this indicate?
BLOOD being digested in the GI tract! NOT KIDNEY-CAUSED because BUN produced from BLOOD
3 HEMATOLOGICAL signs for supporting ULCERATION?
- ANEMIA
- LOW TOTAL PROTEIN
- HIGH BUN w/ NORMAL creatinine
NON-SPECIFIC GASTRITIS…
commonality?
= what is it?
2 potential causes?
history/PE tends to be…
treatment? (3)
VERY COMMON cause of acute vomiting
= gastric inflammation of an UNDETERMINED CAUSE that responds to CONSERVATIVE therapy typically
causes?
1. SPOILED FOOD
2. SUDDEN DIET CHANGE
history/PE tends to be BENIGN
treatment?
1. NPO for 12-24 HOURS
2. BLAND DIET for 2-3 DAYS
3. GRADUAL REINTRODUCTION of ORIGINAL DIET
PARIETAL cells…
where are they located?
what do they produce/how?
mediated by what 3 chemicals?
inhibited by WHAT DRUGS?
location?
–> present in the STOMACH
what do they produce/how?
–> help produce GASTRIC ACID via HYDROGEN-POTASSIUM ATPase that EXCRETES H in EXCHANGE FOR K
MEDIATED BY…
1. GASTRIN
2. ACh
3. HISTAMINE
INHIBITED by PROTON PUMP INHIBITORS
GASTRIC ULCERATION/EROSION…
caused GENERALLY by… (2)
specific causes w/ reasons? (8)
caused GENERALLY by…
1. ANY INCREASE IN GASTRIC ACID PRODUCTION
2. or DECREASED BARRIER FUNCTION
SPECIFIC causes?
1. NSAIDs = causes INHIBITION of PG synthesis
- MSTs = release HISTAMINE which INCREASES GASTRIC ACID PRODUCTION
- ADDISON’S = NO GCCs DECREASE MUCOSAL BLOOD FLOW –> GI MUCOSAL BARRIER DYSFUNCTIONAL
- GASTRINOMA = increased GASTRIN production by MALIGNANT PANCREATIC CELLS
- CKD = HYPERGASTRINEMIA from KIDNEYS or UREMIC TOXINS DEGRADE MUCOSA
- LIVER DZ = PORTAL HYPERTENSION leads to DECREASED GI mucosal blood flow
- NEOPLASIA/IBD
- TRAUMA = foreign bodies
GASTRIC ULCERATION/EROSION…
5 common clinical signs?
DEFINITIVE diagnosis is ____ & REQUIRES ____/____
other diagnoses? (2)
clinical signs?
1. V+
2. HEMATEMESIS
3. MELENA
4. ANOREXIA
5. ABDOMINAL PAIN (cranially)
DEFINITIVE diagnosis is INVASIVE & requires ENDOSCOPY/SX
diagnosis?
1. CLINICAL SIGNS (high index of suspicion can be enough for tx)
2. RESPONSE TO THERAPY
TREATMENT of GASTRIC ULCERATION/EROSION…
6 overall
hints: underlying diseases, drugs continuing, 2 kinds of drugs, food
- treat UNDERLYING DZ process
- DISCONTINUE ULCEROGENIC meds
- SYMPTOMATIC/SUPPORTIVE therapy (fluids, antiemetics, analgesics)
- NUTRITION
–> no food 12-24 hours or until V+ stops
–> LOW FAT LOW PROTEIN - DECREASE GASTRIC ACIDITY via DECREASING PRODUCTION (proton pump inhibitor)
- PROTECT THE ULCER FROM ACIDIC ENVIRONMENT
H-K ATPase ANTAGONISTS…
AKA?
2 examples/routes they’re given?
blocks ____ ____ step in….
drug of choice for WHAT?
AKA PROTON PUMP INHIBITORS
2 examples?
1. OMEPERAZOLE = ORAL route mostly
2. PANTOPRAZOLE = INJECTABLE route mostly
blocks FINAL COMMON step in ACID PRODUCTION
drug of choice for GASTRIC ULCER
FAMOTIDINE….
type of drug?
often used with WHAT ROUTE for WHAT PROBLEM while waiting for what?
HISTAMINE-2 RECEPTOR ANTAGONIST
often used as CRI for animal with ACUTE GASTRIC ULCERATION while waiting for PROTON PUMP INHIBITORS to be effective
MISOPROSTOL
type of drug?
indications? (2)
CONTRAindication?
SYNTHETIC PROSTAGLANDIN
indications?
1. protective against NSAID-INDUCED ULCERATION in DOGS
2. can help PREVENT gastric ulceration
CONTRAindication?
–> NOT GOOD FOR OTHER CAUSES OF ULCERATION
SUCRALFATE…
aims to do WHAT?
3 things it does/pathophys?
aims to PROTECT GASTRIC ULCERS
3 pathophys?
1. binds to NECROTIC PROTEINS at the BASE OF AN ULCER in ACIDIC pH
2. helps act as a DIFFUSION BARRIER against H+ IONS
3. INCREASES MUCOUS and LOCAL PROSTAGLANDIN PRODUCTION
BARIUM can occasionally be used to….
PROTECT ULCERS
not much research
gastric ULCERATION/EROSION INDICATIONS for SX to RESECT it? (3)
- if stomach PERFORATES
- animal having INTRACTABLE BLOOD LOSS (needing transfusions)
- FAIL TO RESPOND TO MEDICAL MANAGEMENT WITHIN 5-7 DAYS
