Gastric diseases Flashcards
What is the pacemaker of the stomach?
The pacemaker of the stomach is the interstitial cells of Cajal (ICCs), located in the greater curvature of the stomach near the mid-region (gastric antrum).
These specialized cells generate slow waves, which regulate the rhythmic contractions of the stomach, aiding in digestion and gastric motility.
gastric acid is especially needed for the absorption of
the absorption of minerals such as calcium and iron require a low pH
gastric hypomotility is defined as
ingesta remaining in the stomach for 8 or more hours
Give low fat diet to aid digestion.
Main 4 signs of gastric disease:
- Vomiting
- Anorexia
- Weight loss
- Melena
Localization of vomiting. (3)
Stomach
Small intestine (can even be large intestine related)
Extragastrointestinal
Diet for cats with pancreatitis.
Cats need 10x more fats than dogs.
Cats with pancreatitis do NOT require a low fat diet like dogs with it do.
Hydrolyzed diets can be chosen for cats if needed.
Diagnosing gastric dz. (6)
- anamnesis/examination
- blood samples (most acute gastric dz do not yet change bloods but chronic can cause electrolyte changes or hypoglycemia in puppies, increased LAC in GDV)
- X-ray
- ultrasound
- endoscopy
- diagnostic laparotomy
All of the pictured cases had the same signs.
Vomiting due to metabolic disturbances can cause what biochemical changes? (5+)
Hemoconcentration vs anemia
Imbalance in electrolytes
Acid-base imbalances
✓ Metabolic alkalosis (can indicate obstruction of the stomach which causes acid sequestration in the gastric lumen)
✓ Metabolic acidosis (vomiting, + diarrhea causes bicarbonate loss)
Dehydration
Pre-renal azotemia
3 antiemetics
Maropitant
Ondansetron
Metoclopramide
Maropitant mechanism and dose.
- Neurokinin 1 (NK-1) receptor antagonist
- Inj 1 mg/kg/day
- PO 2 mg/kg/day (acute cases)
- Use lower doses for liver patients.
Ondansetron mechanism, dose and route.
- Not technically approved for vet use.
- 5-HT3-receptor antagonist
- 0.1 – 0.2 BID-QID IV
- Low bioavailability PO in dogs (less 10%)
- Can cause decreased intestinal motility?
Metoclopramide mechanism, dose and route.
- Antiemetic and also prokinetic
- Injectable approved for vet usage
- Dopamine receptor antagonist
- 0.5-1 mg/kg/day, divided in 2 or 3 doses IM IV or 1-2 mg/kg/24h constant rate infusion
Antacids and small animal gastroenterology.
Antacids have no true indications in small animal gastroenterology!
Sucralfate mechanism, dose and route.
- adheres to damaged gastric mucosa for hours
- may interfere with other PO medications
- 0.5 – 1 g/dog PO TID-QID
- Give 30-45 min before food
Name 2 prokinetics:
cisapride
metoclopramide
3 gastric acid blocker groups:
Histamine2 receptor antagonists
Proton pump inhibitors (PPI)
Prostaglandin analogues
Name 3 Histamine2 receptor antagonists.
- cimetidine
(5-10 mg/kg PO or IV for dogs) - famotidine
(1mg/kg q12h, gastric rebound hyperacidity if used for longer time) - ranitidine
(0.5 – 5 mg/kg q8-12 h, prokinetic effect?)
Name 4 Proton pump inhibitors (PPI) and indications for use (4).
ome-, esome-, lanso-, pantoprazole
- 1.25 mg/kg q12 h PO and IV
Are the most potent gastric acid inhibitors.
Indications: erosive esophagitis // gastric ulcers due to NSAIDs//mast cell tumours and gastrinoma.
- NB rebound gastric acid hypersecretion if given for a long time
- NB PPIs must be tapered down in dogs and cats after prolonged use (50% per week)
Name 1 Prostaglandin analogue used as a gastric acid blocker.
Effects of it?
- misoprostol (1-5 μg/kg PO q 8 h)
- increases gastric mucus & bicarbonate production
- prevents NSAID-induced gastric ulcers
- inhibits proton pump
Tx of acute gastritis. (3)
- fluid therapy (e.g. Ringers lactate, NOT NaCl as it’s not enough)
- modify diet, the GI tract needs nutrients (low fat, easily digested)
- gastroprotectants
- kaolin pectin 2-3x/day if diarrhea (give 1-2 h after food cause it coats the GI tract mucosa)
Possible causes of chronic gastritis. (5)
Do Histology!
- Idiopathic (diagnosis of exclusion; e.g. hypo diet that doesn’t see response)
- Lymphocytic plasmacytic eosinophilic gastritis
of which plain LP is “easiest”
- Granulomatous (worst one)
Other forms:
- atrophic (indicates very chronic, bad prognosis)
- hypertrophic gastritis (Basenji)
3 clinical signs of chronic gastritis.
- vomiting (bile/food/blood)
- anorexia
- weight loss
Tx the primary cause!
Tx of Idiopathic lymphocytic plasmacytic gastritis. (5)
- anthelminthics
- diet (low fat, hydrolyzed)
- prednisolone
- azathioprine (Fel chlorambucil is safer!)
- cisapride prokinetic
7+ causes of gastric ulcers/erosions:
- NSAIDs
- Corticosteroids
- Stress (sepsis, shock, neurological diseases)
- Paraneoplastic syndrome
- IBD
- Liver and kidney diseases
- Foreign body
- Others like severe uremia.
Complication: peritonitis !
Erosions are just smaller than full ulcers.
5 clinical signs of gastric ulcers/erosions:
- vomiting (not always!)
- melena
- anorexia
- abdominal pain
- sepsis
Erosions are just smaller than full ulcers.
Diagnosing gastric ulcers/erosions require: (3)
- XRay (w iodine based contrast media)
- Ultrasound
- Endoscopy (but not with perf!)
Tx of gastric ulcers/erosions require: (7)
- Fluid therapy
- Antiemetics
- Pain treatment
- Sucralfate
- Omeprazole etc.
- Surgery
- Low fat or hydrolyzed diet. Start frequent feeding with small amounts ASAP.
Gastric obstruction can be due to: (6)
Foreign body
GDV
Gastric antrum mucosal hypertrophy
(breed predisposition!)
Hypertrophic gastritis
Pythiosis (fungal)
Other causes like duodenal intussusception
Define Pythiosis.
Pythiosis in dogs is a severe, often fatal disease caused by the waterborne pathogen Pythium insidiosum, which thrives in warm, stagnant water.
Pythium insidiosum is not a true fungus but rather an oomycete, which is a protist. Oomycetes were once classified as fungi due to their filamentous growth and spore production, but they are now recognized as more closely related to algae.
leads to gastrointestinal or cutaneous forms of the disease.
Symptoms include vomiting, diarrhea, weight loss, and intestinal masses in the gastrointestinal form, while the cutaneous form presents as non-healing wounds, ulcerations, and swelling.
Treatment is difficult, typically involving aggressive surgical removal of infected tissue and antifungal medications, though prognosis remains poor, especially if diagnosed late.
Found in the americas.
Risk factors for GDV. (5)
- breed
- age (avg 7 years old)
- genetics
- feeding (feeding once per day is a risk as well as before exercise)
- other factors (hx of splenectomy predisposes)
Clinical symptoms of GDV: (6-7)
- distended abdomen
- anxiety, restlessness
- salivation
- depression, weakness
- painful abdomen
- tachycardia, arrhythmia
Diagnosis of GDV involves: (3)
- Physical examination
- X-ray (LAT R)
- Blood samples
Tx of GDV. (6)
- decompression – tube/gastrocentesis with trocarization
- fluid therapy
- corticosteroids, prednisolone for blood vessel wall stabilization, works against free radicals
- AB
- lidocaine for arrhythmias
- OPERATION!
Post-op complications of GDV. (3)
- Ischemia – reperfusion injury
- Arrhythmias
- Electrolytes, acid-base imbalances
Give antiemetics and prokinetics. You must monitor for 72 hours post op as recovery is critical period.
Prevalence of gastric tumors.
< 1%
- Dogs: adenocarcinoma, leiomyosarcoma, lymphoma, carcinoid, stromal tumors (GIST), adenoma, leiomyoma, hypertrophy.
- Cats: lymphoma! (Usually diffuse in cats tho), leiomyoma, adenoma, hypertrophy
GIST stands for gastrointestinal stromal tumor. It is a type of tumor that arises from the interstitial cells of Cajal (ICCs), which are the pacemaker cells of the gastrointestinal (GI) tract.
Signs of gastric tumor. (5)
Chronic vomiting
Anorexia
Weight loss, weakness
Melena
Icterus
What specific infectious disease can cause acute vomiting in dogs?
Leptospirosis can cause acute vomiting.
Duration of anorexia in cats to become life-threatening?
2-3 days of total anorexia is life threatening to cats due to hepatic lipidosis.
Super low blood potassium can cause this unspecific sign
diarrhea
prevalence of GDV in previously pexied dogs?
prevalence of recurring GDV in dogs with hx of GDV but no pexy?
4-6% prev of GDV in pexied dogs
76% GDV recurrence rate if not pexied in surgery
