Diseases Of The Stomach Flashcards
What are the potential causes of gastritis?
Drugs, hyperacidity, infectious, primary gastritis, stress/ exercise induced, systemic
Acute gastritis
CS <2 weeks
Dogs > cats
Vomiting food +/- bile, inappetence
What are the possible causes of acute gastritis?
(Normal PE)
Dietary indiscretion
Food intolerance
Gastric FB
Stomach worm
Tx of acute gastritis with normal PE
Small amounts of liquid
Deworm
Easily digestible diet then gradual transition to normal diet
Protectants/ absorbants
Prognosis for for acute gastritis if PE normal
Good and self- limiting
Complete recovery
more dx if progression
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
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
Chronic gastritis
CS > 2 weeks
Idiopathic and adverse food reaction
Inflammatory
Bx required
MOA of chronic gastritis
↑ pro inflammatory mediators
↓ immunomodulatory mediators
Inflammation
Common causes of chronic gastritis
Metabolic disorder, parasitic, neoplasia, infectious agent
CS of chronic gastritis
Intermittent persistent vomiting
Hematoemesis
WL
Anorexia/ hyporexia
Dermatological signs: hypersensitivity and nutritional
Chronic gastritis differentials
Acute gastritis
Idiopathic gastritis/ dietary intolerance
Inflammatory gastritis
Pyloric stenosis
Gastric mass (neoplasia or granuloma)
Gastric mucosal hyperplasia
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
Endoparasite dx (chronic gastritis)
Fecal cytology
Sheathers
Zinc sulfate
Baerman technique
Deworm
Fenbendazole trial
Tests for infectious causes of vomiting (chronic gastritis)
Dog: Pythian serology
Cat: Dirofilaria Ag and Ab tests, FeLV/ FIV
Histoplasma urinary Ag test
Tests for chronic gastritis
Bx: endoscopy, laparoscopy, exploratory laparotomy
Histopathology +/- immuniphenotyping
Inflammatory features of chronic gastritis
Lymphocytic/ Plasmacytic*
Eosinophilic
Pyogranulomatous
Suppurative
Lymphoid folliculat hyperplasia
Neoplasia
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)
Dx lymphocytic/ plasmacytic
Histopathology
Distinguish from lymphoma with immunophenotyping
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)
