CS cats Vomiting food +/- bile, inappetence

Diseases Of The Stomach Flashcards by Trenni Jefferson

What are the potential causes of gastritis?

Drugs, hyperacidity, infectious, primary gastritis, stress/ exercise induced, systemic

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Acute gastritis

CS <2 weeks
Dogs > cats
Vomiting food +/- bile, inappetence

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What are the possible causes of acute gastritis?
(Normal PE)

Dietary indiscretion
Food intolerance
Gastric FB
Stomach worm

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Tx of acute gastritis with normal PE

Small amounts of liquid
Deworm
Easily digestible diet then gradual transition to normal diet
Protectants/ absorbants

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Prognosis for for acute gastritis if PE normal

Good and self- limiting
Complete recovery
more dx if progression

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Diagnostics for acute gastritis if PE abnormal

Coagulogram with hematemesis
Abnormal US or rads
Cortisol or ACTH, total T4 (cats)
Gastric mucosal bx and histopathology

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Tx for for acute gastritis if PE abnormal

IV fluids for dehydration and abnormal electrolytes
Antiemetics (if no obstruction)- maropitant
Antacids and gastroprotectants
Deworm
Diet therapy

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Chronic gastritis

CS > 2 weeks
Idiopathic and adverse food reaction
Inflammatory
Bx required

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MOA of chronic gastritis

↑ pro inflammatory mediators
↓ immunomodulatory mediators
Inflammation

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Common causes of chronic gastritis

Metabolic disorder, parasitic, neoplasia, infectious agent

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CS of chronic gastritis

Intermittent persistent vomiting
Hematoemesis
WL
Anorexia/ hyporexia
Dermatological signs: hypersensitivity and nutritional

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Chronic gastritis differentials

Acute gastritis
Idiopathic gastritis/ dietary intolerance
Inflammatory gastritis
Pyloric stenosis
Gastric mass (neoplasia or granuloma)
Gastric mucosal hyperplasia

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Ruling out the metabolic causes of vomiting (chronic gastritis)

CBC, serum chemistry, urinalysis
Dog: cortisol/ ACTH, TLI, CPLI
Cat: total T4
Pre and post bile acids
Bile culture

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Endoparasite dx (chronic gastritis)

Fecal cytology
Sheathers
Zinc sulfate
Baerman technique
Deworm
Fenbendazole trial

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Tests for infectious causes of vomiting (chronic gastritis)

Dog: Pythian serology
Cat: Dirofilaria Ag and Ab tests, FeLV/ FIV
Histoplasma urinary Ag test

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Tests for chronic gastritis

Bx: endoscopy, laparoscopy, exploratory laparotomy
Histopathology +/- immuniphenotyping

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Inflammatory features of chronic gastritis

Lymphocytic/ Plasmacytic*
Eosinophilic
Pyogranulomatous
Suppurative
Lymphoid folliculat hyperplasia
Neoplasia

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What is lymphocytic/ plasmacytic (chronic gastritis) seen with

Seen with IBD (chr. inflamm enteritis/ CIE)
Food responsive GI dz
High exercise-induced gastroenteritis (alaskan shed dogs)

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Dx lymphocytic/ plasmacytic

Histopathology
Distinguish from lymphoma with immunophenotyping

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Eosinophilic gastritis

Infiltration of eosinophils into mucosa, lamina propria and muscularis
Definitive dx with histopathology

Dogs with eosinophilic gastritis

Young (<5y)
Rotties and shepherds predisposed
Peripheral eosinophilia seen
Leads to pyloric perforation

Cats with eosinophilic gastritis

Ragdolls and male cats predisposed
Feline eosinophilic sclerosing fibroplasia
Proliferative masses formed at pyloric sphincter
Peripheral eosinophilia common

Chronic gastritis tx

Elimination diet (limited Ag or hydrolyzed diet)
Deworm
Anti-inflammatories to immunosuppressive glucos
Cyclosporine, H2 antagonists and metoclopramide

Helicobacter tx for chronic gastritis

Amoxicillin, clarithromycin, metronidazole
Amoxicillin, bismuth sub salicylate and metro

Which helminths cause parasitic gastritis?

Ollulanus tricupis (cat) Physaloptera spp (dog)

CS of parasitic gastritis

Asymptomatic or sporadic vomiting

Dx parasitic gastritis

Xylazine induced vomiting + eval of vomitis Fecal flotation (physaloptera only) Endoscopy +/- bx

Histopathology of parasitic gastritis

Lymphoplasmacytic gastritis with hyperplasia or nodular rugal folds

Tx of parasitic gastritis

Fenbendazole (panacur) once daily for 2 days

Helicobacter pylori

Spiral bacterium in stomach of human, dog, cat Peptic ulcer formation and chronic gastritis

Gastric hypertrophy

Pyloric hypertrophy Predisposition in brachys CS of gastric outlet obstruction

DX gastric hypertrophy

Rads: pyloric outflow obstruction Endoscopy: ↑ folds of mucosa or none at all

Tx of gastric hypertrophy

Sx removal of excess mucosa and pyloroplasty

Gastric ulcers etiology

Neoplasia, drug induced (NSAIDs) and hepatic failure

Gastric erosion- ulceration

Damage to gastric mucosal barrier (GMB) Hypersecretion of H+ ions, ↓ blood flow of GMB Direct injury Interference with gastroprotective PG synthesis

What conditions have high risk of gastric ulceration

Addisons, renal and liver failure, DIC Neoplasia (MCT), gastric adenocarcinoma, gastrinoma

Non-selective PG inhibitors causing gastric ulceration

Aspirin, Flunixin meglumine, ibuprofen → associated with erosions

Glucocorticoids causing gastric ulceration

Pred, dexamethasone, prednisolone

Cyclooxygenase (COX2 selective inhibitors) causing gastric ulceration

Meloxicam, Carprofen*, deracoxib, etodolac Combined with glucos = ulcers

Idiopathic causes of gastric ulcers

Stress Spinal injury Exercise induced

Clinical findings of gastric ulcers

Hematemesis, melena, pale mm, cr. abdminal pain, weakness, inappetence, hypersalivation +/- circulatory collapse

What's seen on a CBC with perforating uclers?

Leukocytosis with left shift

Serum chemistry panel with gastric ulcer

↓ TP, albumin and globulin ↑BUN Normal creatinine and USG

Serum chemistry panel with GI obstruction

↑ HCO3 ↓ Na, Cl, K

With gastric ulcers, what seen on an US

Gastric wall thickening, peritoneal fluid or air

What is the gold standard for gastric ulcers?

Endoscopy (ulcer is visulaized)

Tx for gastric ulcers

Stabilize with IV fluids Severe cases get blood transfusions Sx removal best to tx to prevent perforations Abx, analgesia

Medical tx for gastric ulcers (reducing gastric acid secretion)

H2 antagonist Famotidine or ranitidine PPI (stops H+ secretions) Omeprazole, lanzoprazole or pantoprazole

Medical tx for gastric ulcers (mucosal protectants)

Sucralfate (provide barrier to acid and pepsin, stimulates PG) Misoprostol (stimulates mucus secretion, ↑ bicarb, promotoe blood flow and ↓ acid)