Gastric Diseases Flashcards by Sydney Randall

The mucosa is part of the gastric layer. Name the 5 parts that make up the mucosa.

Superficial epithelium
Lamina propria: below epithelium; loose CT, immune cells, nutritional support
Gastric glands: mucous neck cells, parietal cells (H/K ATPase pump-HCL), chief cells (digestion)
Neuroendocrine cells: Serotonin, Histamine, Somatostatin, Gastrin
Muscularis mucosa- thin muscle layer

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The following describes which gastric layer?

Dense CT, structural support; blood vessels & lymphatics; Meissner’s plexus- nervous system

Submucosa

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The following describes which gastric layer?

Layers of smooth muscle perpendicular to each other; Auerbach’s (Myenteric) plexus

Muscularis

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The follow describes which gastric layer?

CT layer

Serosa

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T/F Pepsin breaks down protein and gastric lipase breaks deals with fat digestion.

Yep. True.

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T/F The pancreas is the ONLY organ in the cat that makes intrinsic factor.

True

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T/F The pancreas is the ONLY organ in the dog that makes intrinsic factor.

False- stomach and pancreas both make it.

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What can be found on the CBC of an animal with primary gastric dz?

NSF
Regenerative anemia from bleeding
Leukocytosis

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T/F We can expect to see HYPOchloremia, HYPOnatremia and HYPOkalemia in the chemistry of an animal with primary gastric dz.

True

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If azotemia is present in the animal with primary gastric disease, where is the problem located?

Pre-renal

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What on the chemistry of an animal with primary gastric disease would suggest bleeding in upper GI tract?

BUN elevation alone or disproportionately higher than creatinine

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If metabolic alkalosis with increased bicarbonate and decreased chloride is found on the chemistry of an animal with primary gastric disease then what might this make us think?

we should CONSIDER gastric outflow obstruction

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What is the best way to evaluate for inflammation, ulcer, FB or mucosal neoplasia?

Endoscopy!

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What are the cons of endoscopy?

Disease deeper than mucosa, fxn’al assessment

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The following is associated with what?

Inflammation of mucosa
Sudden onset of clinical signs
Symptomatic and supportive care
‘Biopsy dx’ but we often presume

Acute gastritis

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How do we tx Acute Gastritis?

Treat underlying dz if known . . .

Fluids
Antacids
Anti emetics (once FB ruled out and/or vomiting protracted or severe enough to cause dehydration and electrolyte imbalances)
Pain medications
Water and bland diet reintroduction

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T/F Gastritis can induce significant mucosal changes.

True

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T/F If an animal has a FB, they will present with persistent clinical signs.

You’re not wrong but you’re also not right.

A gastric FB can present with persistent OR intermittent clinical signs.

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T/F FB’s are only found in dogs.

No, stupid. Dogs and cats.

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Dramatic gastric distension in stomach is called what?

Dilation

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Stomach twisting and moving on axis to left of fundus is called what?

Volvulus

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The following things are the resulting pathology from what condition?

Compressions of CVC --> impaired venous return to heart --> hypovolemic shock
Gastric wall necrosis
Splenic torsion or avulsion
Congestion of abdominal viscera
Endotoxic shock
DIC

Gastric Dilation and Volvulus (GDV)

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Large or small breed dogs are predisposed to GDV?

Large

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T/F Barrel chested dogs are predisposed to GDV.

True

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T/F a dog that eats fast and then plays is predisposed to GDV.

True! Aerophagia

What is the giveaway sign that tips you off that a dog has GDV?

acute, non productive retching!!! If they're doing this then O needs to bring them in ASAP!! They'll also have abdominal distension with tympany, ptyalism and could collapse. Also, tachycardia, poor pulses- consistent with hypovolemic shock. Hypothermia, depression, vtach.

For a suspected GDV patient, before we do rads, what should we give patient?

Fluid support!

The #1 most important and initial tx we do for GDV patients is what?

Aggressive fluid therapy!

All of the following are tx methods for what? ``` Sx ASAP Aggressive fluid therapy Decompression- orogastric tube Trocharization of stomach Address electrolyte disturbances ```

GDV

What is the mortality rate of GDV?

15-30%

T/F Food bloat is the same thing as GDV.

Nope! Food bloat is when they get into the cabinet and eat a shit ton of everything aka Marley. Acute vomiting or retching Abdominal dissension and discomfort Rads: profound distension of stomach- gonna look wayyy different than our boxer's glove rad we see with GDV

The following tx methods are meant to help what condition? ``` Give time- at least 24-36 hrs Fluids Withhold food Walk frequently +/- lavage +/- sx ```

Food bloat You want to give fluid because all of the gastric juices that are meant to be digesting the food are soaked up from such a huge amount of food in the stomach so give more fluids to help the digestion problem along.

All of the following explain why gastric erosions and ulcers occur except ``` Mucosal barrier injury Disruption of normal gastroprotection (PG) Increase blood flow Hypersecretion of acid Decreased mucous or bicarb ```

Increase blood flow DECREASE blood flow can explain why gastric erosions and ulcers occur

Vomiting, hematemssis and melena are CS associated with what?

Gastric erosions and ulcers

What can we expect to see on US of gastric erosions and ulcers?

+/- thickened wall or focal loss of layers or free fluid

What diagnostic method do we use to get visual confirmation of gastric erosion or ulcer?

Endoscopy**** !

What are the ways in which we tx gastric erosions and ulcers?

``` Tx primary dz Mucosal healing- sucralfate PPI Pain management Transfusion Analgesia ```

Helicobacter gastritis: helicobacter is a spiral gram - bacteria that can cause acute or chronic vomiting. We tx with Clarithromycin, Amoxicillin and Metronidazole. T/F Resistance has been documented.

True

T/F Gastric pythiosis is a tropical disease.

Yeah, true. It's caused by oomycete- P. insidious and causes chronic vomiting, thickened gastric outflow tract and pyogranulomatous inflammation

T/F Gastric pythiosis is fatal in all dogs.

True. It's fatal af.

Quick parasite review: | Name the roundworms in dogs and roundworm in cat.

T. canis and T. cati Visual or fecal dx Tx: Fenbendazole or Pyrantel pamoate

How big is the Physalloptera worm in cats and dogs ?

2-6 cm Difficult to see on fecal float; may see on endoscopy Tx: Pyrantel pamoate

What species is Ollulanus tricuspi found in?

Cats. triCuspi Cats 0.7-1 mm long Seen on biopsy, gastric juice eval, vom eval Tx: Fenbendazole

The following CS describe what condition? *Lip licking (owner's will say animal has "look of concern")*, *hard swallow*, ptyalism, *halitosis*, esophagitis

Gastric Esophageal Reflux

How do we tx gastric esophageal reflux?

PPI Tx primary dz Sucralfate

How do we diagnose inflammatory gastritis?

ENDOSCOPY or SURGICAL BIOPSY DX

What is the most common thing we find in inflammatory gastritis? (idk how to word that, send help)

``` #1= lymphoplasmacytic Infiltrate of inflammatory cells in mucosa and lamina propria (often SI) ```

The following 4 things describe the way in which we tx what? 1. Antacid/ gastroprotectants 2. Diet trial w hypoallergenic or novel protein diet 3. Empiric deworming (Fenbendazole, Pyrantel Pamoate) 4. Immune Modulation- tapering dose once clinical response is achieved (Prednisone, Prednisolone, Cyclosporine)

Lymphoplasmacytic & eosinophilic gastritis

How long does a food trial last for an animal with lymphoplasmacytic or eosinophilic gastritis ?

At least 2 weeks. Make sure you give them this diet ONLY and no treats etc

We give Prednisone or Prednisolone to cats?

Prednisolone to cats bc they're bad at converting Prednisone to Prednisolone in their bodies

The following clinical signs describe what condition? Chronic vomiting, *marked mononuclear (lymphocytes, macrophages etc) cell infiltrate*, *thinning of gastric mucosa*, *atrophy of gastric glands*

Atrophic gastritis

What breed of dog is predisposed to atrophic gastritis?

Norwegian Lundehund

The following clinical signs describe what condition? *chronic vomiting- projectile, hours after eating not uncommon*, *diffuse or focal hypertrophy of mucosa Or muscularis OR both*, *associated with hypergastrinemic conditions (decreased clearance from renal or liver dz; gastrin secreting tumor), *pronounced in pyloric outflow regions*

Hypertrophic gastropathy

What age and breed can we frequently see hypertrophic gastropathy in?

Older, small breeds (Lhasa Apso, Shih tzu)

How do we tx hypertrophic gastropathy?

Tx underlying dz; +/- surgical resection of thickened tissue

Pyloric stenosis and/or hypertrophy is commonly seen in what breeds?

Boxers, Boston Terriers, English Bulldog, Siamese cats

What are some characteristics associated with pyloric stenosis and/or hypertrophy?

Muscular thickening of pyloric sphincter, delayed gastric emptying - vomiting several hours after a meal, poor weight gain, depression, dehydration

A gastrinoma causes chronic vomiting and thickened gastric wall, hypertrophy of pylorus and gastric ulceration. What is the pathology behind it?

Tumor in pancreas of APUD cells (or duodenum or ectopic) | Stimulates hyper secretion of gastric acid

What is a very good tip off for dx'ing gastrinoma ?

low pH of gastric juice + high gastrin level *gastrin levels can be assessed - run 48 hours or more off antacids bc obviously the antacids are gonna change pH level of gastric juice

How do we tx gastrinomas?

Surgical removal of tumor but often mets at time of dx soooo that's a bummer PPI- BID dosing Octreotide- inhibits gastrin Guarded to poor prognosis

Leimyoma and adenomatous polyps are ________ kinds of neoplasia.

Benign

Plz name the 4 kinds of malignant gastric neoplasia.

1. adenocarcinoma (70% of all canine) 2. lymphosarcoma (most cats) 3. leiomysarcoma 4. gastrinoma

Delayed gastric emptying motility disorders are secondary to inflammation, infection, obstruction, electrolyte disturbance, meds (opioids) and sx. Cisapride is one of the drugs we use to tx it but what's something we should be aware of with Cisapride?

Compounding pharmacies

Clicker question: a 5 YO MN lab present for acute onset retching, no previous history of illness, rads show a stomach severely distended w food. The best initial tx would include: A. emergency sx B. send home and monitor C. admit to the hospital for supportive care and monitoring D. lavage stomach

C. admit to the hospital for supportive care and monitoring This guy gorged on a whole bunch of food so we don't want to just send him home and tell O to give him water bc there's nowhere for that water to go in his belly. It's best if we keep him for a little while and administer fluids which will go to the GIT and help the digestive process along.