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SA DX & TX II > Exam 1 - Vomiting Patient > Flashcards

Exam 1 - Vomiting Patient Flashcards

1
Q

what should you consider in a brachycephalic breed that is vomiting?

A

pyloric hypertrophy

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2
Q

what should you consider in an older cat that is vomiting?

A

hyperthyroidism

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3
Q

what differentials are you considering in a young animal with vomiting?

A

panleuk in kittens, parvo, parasites, & congenital disease

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4
Q

what differentials should you consider in a cattery/shelter with an outbreak of vomiting patients?

A

FeLV, FIV, FIP

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5
Q

what is the biggest difference between vomiting & regurgitation?

A

vomiting is an active process while regurgitation is a passive process

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6
Q

T/F: vomiting is not always caused by gi disease

A

true

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7
Q

why is an oral exam important in vomiting cats?

A

linear foreign bodies trapped at the tongue

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8
Q

why look at the patient’s skin, signs of pruritus, or signs of allergic dermatitis?

A

may point to food-responsive dermatitis

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9
Q

when is a more aggressive diagnostic plan warranted in a vomiting patient?

A

abdominal pain or other concerning findings on physical exam (abdominal mass, etc), intractable vomiting, biochemical abnormalities, depressed, hematemesis, & chronic disease refractory to diet

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10
Q

how is vomiting classified?

A
  1. duration of signs - acute or chronic
  2. likely cause - primary gi (GDV, gastric tumor, dietary indiscretion) or non-gi disease (systemic/secondary - addison’s, CKD, liver disease)
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11
Q

what are the 4 basic groups that fall under primary gi disease for patients with acute vomiting?

A
  1. dietary indiscretion/intolerance
  2. infectious/inflammatory - gastroenteritis, parvo, helminths
  3. obstruction - GDV, intussusception, FB
  4. gi ulceration - NSAIDS, gastric lymphoma, & mast cell tumors
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12
Q

what are the 6 main groups that fall under non-gi diseases that cause acute vomiting?

A
  1. acute pancreatitis
  2. endocrine - DKA, addison’s, & hyperthyroidism
  3. acute organ failure
  4. drugs/toxic plants
  5. CNS disease
  6. infectious/other - prostatitis, pyometra, peritonitis, & septicemia
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13
Q

what are the 5 main groups of primary gi disease that cause chronic vomiting?

A
  1. IBD/bilious vomiting
  2. gi neoplasia - adenocarcinoma, leiomyosarcoma, GIST, & mast cell tumor
  3. mechanical/functional obstruction - gastric FB, pyloric stenosis, & dysmotility
  4. gi ulceration
  5. infectious - parasitism, histoplasma, pythium, FeLV/FIV, & FIP
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14
Q

what are the 4 main groups of non-gi disease that cause chronic vomiting?

A
  1. chronic inflammation/infection - pancreatitis, prostatitis, pyelonephritis, cholangitis
  2. endocrine - addison’s & hyperthyroidism
  3. chronic organ failure
  4. HWD in cats
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15
Q

what should you do if you do an exploratory surgery and you find no obvious cause of the vomiting?

A

complete exam of the abdomen - get biopsies from stomach, duodenum, jejunum, ileun, mesenteric lymph node, liver, pancreas

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16
Q

what are the main components of treating vomiting?

A

identify & remove/treat offending agent

dietary restriction or modification

17
Q

how is diet modification done in animals with acute vomiting?

A

short periods of dietary restriction while getting control of vomiting (be careful in cats)

once vomiting is controlled, give a highly digestible diet with high moisture in small frequent meals

18
Q

how is diet modification done in animals with chronic vomiting?

A

highly digestible low fat diets in dogs, hypoallergenic, or novel protein

enteral feeding tubes may be needed to facilitate nutrition

19
Q

what is the general therapeutic approach of symptomatic treatment for vomiting?

A

anti-emetics - if vomiting is intractable & mechanical obstruction is ruled out

anti-nausea drugs - not all anti-emetics eliminate nausea

other treatments - acid suppressants (upper gi bleed), NSAID toxicity (misoprostol), prokinetics for motility disorders, & appetite stimulants

20
Q

what is the tmax of cerenia?

A

1-2 hours - rapidly absorbed

21
Q

what animals have fda approval for using cerenia?

A

dogs over 4 months can get injectable SQ/IV or oral, dogs older than 2 months can have SQ or oral, & cats older than 4 months injectable SQ

22
Q

what is cerenia an effective anti-emetic for?

A

CKD, chemotherapy (doxo & cisplatin), motion sickness in dogs, & emetic drugs (opioids, alpha 2s in cats, & emetogen - give minimum 2 hours prior)

give cerenia prior to pre-meds

23
Q

T/F: cerenia can be ineffective against nausea depending on the emetogenic stimulus

A

true - nausea still present after alpha-2, opioid administration, & cisplatin

24
Q

what is the mechanism of action of cerenia?

A

NK-1 antagonist - inhibits substance p in the central nervous system

25
Q

what is the mechanism of action of ondansetron & dolasetron?

A

5HT3 antagonists - peripheral & central in the CRTZ, vomiting center, & abdominal viscera

26
Q

when are 5HTs antagonists useful in vomiting patients?

A

best for acute chemotherapy-induced nausea & vomiting

27
Q

what is a common side effect of ondansetron?

A

sedation

28
Q

what is a disadvantage of ondansetron in terms of dosing?

A

poor bioavailability in dogs & cats so thrice daily dosing

29
Q

what is the mechanism of action of metoclopramide?

A

dopamine-2 (low dose) & 5HT3 antagonist (high dose)

30
Q

T/F: metoclopromide is effective in cats as an anti-emetic

A

false

31
Q

what is metoclopromide useful for in vomiting patients?

A

visceral-induced vomiting such as parvo virus in dogs - may have some pro-motility effects

32
Q

what drug has the largest indication of use in cats as an appetite stimulant?

A

mirtazipine

33
Q

what is the mechanism of action of mirtazapine?

A

presynaptic a2-adrenergic receptor & post-synaptic 5HT3 & 5HT2 antagonist

anti-nausea, anti-emetic, pro-kinetic

34
Q

what are the side effects associated with mirtazapine?

A

vocalization & nervousness

reduced frequency with liver & kidney disease

35
Q

what are some differentials for chronic vomiting with gi bleeding, both gi & extra-gi?

A

gi - gi ulceration, NSAIDS, neoplasia, IBD

extra gi - addison’s, neoplasia (gastrinoma, pancreatic carcinoma), & liver failure

SA DX & TX II (62 decks)

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