Gastric Diseases

Question 1

ENDOSCOPY PROS AND CONS

Answer 1

+: Best way to evaluate for inflammation, ulcer, foreign body, mucosal neoplasia -: Disease deeper than mucosa, functional assessment

Question 2

ACUTE GASTRITIS

Answer 2

• Inflammation of Mucosa - Sudden onset of clinical signs - Symptomatic and supportive care - ‘Biopsy diagnosis’ but we often PRESUME

Question 3

GASTRIC FOREIGN BODY

Answer 3

Obstructive lesion – intermittent or persistent clinical signs DOG & CAT More common in young animals but any age Rule out other causes & systemic disease & TAKE A GREAT HISTORY Diagnosis: Radiographs +/- U/S +/- Endoscopy Treatment: Remove with endoscopy or surgery

Question 4

GASTRIC EROSIONS AND ULCERS

Answer 4

Mucosal barrier injury Disruption of normal gastroprotection (PG) Decrease blood flow Hypersecretion of acid Decreased mucous or bicarb SECONDARY TO Neoplasia: gastrinoma, mast cell tumor Hypovolemic shock, hypotension Trauma Medication induced – NSAID, Steroids Uremic gastritis+/- vomiting, hematemesis, melena Anything else associated with underlying disease +/- Anemia, elevated BUN Radiographs – NSF but may seen defects with contrast studies Ultrasound - +/- thickened wall or focal loss of layers or free fluid *** Endoscopy – visual confirmation

Question 5

HELICOBACTER GASTRITIS

Answer 5

Acute or Chronic Vomiting Spiral Gram Negative Bacteria Can be normal  Pathogenicity assessed based on involvement in inflammatory gastric disease  Based on pathology read out of infiltrative nature into crypts/pits Treatment – 2 weeks Clarithromycin 7.5 mg/kg BID Amoxicillin 30 mg/kg BID Metronidazole 10 mg/kg BID * Resistance has been documented

Question 6

GASTRIC PYTHIOSIS

Answer 6

Chronic Vomiting Oomycete - P. Insidiosum Tropical disease Thickened gastric outflow tract Pyogranulomatous inflammation

Question 7

GASTRIC ESOPHAGEAL REFLUX

Answer 7

CHRONIC VOMITING Lip licking, hard swallow, ptyalism, halitosis, esophagitis Secondary to primary gastric or small intestinal disease Diagnosis: clinical signs, history Treatment PPI Treat primary disease Sucralfate

Question 8

INFLAMMATORY GASTRITIS

Answer 8

1 = Lymphoplasmacytic  Also Eosinophilic, mast cells, other

Chronic vomiting Inciting cause rarely identified ENDOSCOPY or SURGICAL BIOPSY DIAGNOSIS Infiltrate of inflammatory cells in mucosa and lamina propria (often small intestine) 

Question 9

What is the #1 inflammatory gastritis?

Answer 9

Lymphoplasmacytic

Question 10

LYMPHOPLASMACYTIC & EOSINOPHILIC GASTRITIS

Answer 10

THERAPY
Antacid/Gastroprotectants
Diet trial with hypoallergenic or novel protein diet

At least 2 weeks , can try more than 1 diet
Empiric deworming (Fenbendazole, Pyrantel Pamoate)
Immune Modulation – tapering dose once clinical response achieved

Prednisone (dog) Prednisolone (cat) Cyclosporine

Question 11

ATROPHIC GASTRITIS

Answer 11

Chronic Vomiting
Marked mononuclear (lymphocytes, macrophages, etc.) cell infiltrate Thinning of gastric mucosa
Atrophy of gastric glands

Tx:
As for other inflammatory disease Treat for Helicobacter is present

Progression to ACA noted in the norweign lundhound

Question 12

HYPERTROPHIC GASTROPATHY

Answer 12

Chronic Vomiting – projectile, hours after eating not uncommon Diffuse or focal hypertrophy of mucosa OR muscularis OR both Inflammatory infiltrates

Associated with hypergastrinemic conditions  Decreased clearance from renal or liver disease
 Gastrin secreting tumor

Pronounced in pyloric outflow region

Breeds: Older, small breeds (Lhasa Apso, Shih Tzu)

THERAPY
 Treat underlying disease
 +/-Surgical resection of thickened tissue

Question 13

PYLORIC STENOSIS AND/OR HYPERTROPHY

Answer 13

Congenital
 Boxers, Boston Terriers, English Bulldog AND Siamese Cats

 Muscular thickening of pyloric sphincter

 Delayed gastric emptying – vomiting several hours after a meal

 CXS also include poor weight gain, aspiration pneumonia, depression, dehydration

 Medically treat systemic effects of dehydration and acid-base imbalance  Surgical correction

Acquired
 Inflammation
 Neoplasia – direct or secondary to (Gastrinoma)

Question 14

GASTRINOMA

Answer 14

RARE..

Chronic Vomiting

Thickened gastric wall, hypertrophy of pylorus, gastric ulceration

PATHOLOGY
 Tumor in pancreas of APUD cells (or duodenum or ectopic)  Stimulates hypersecretion of gastric acid

DIAGNOSIS
 Gastrin levels can be assessed – run 48 hours or more off antacids

 Low pH of gastric juice + High gastrin level  Nuclear medicine studies
 Biopsy

TREATMENT

 Surgical removal of tumor but often mets at time of diagnosis  PPI – BID dosing
 Octreotide – inhibits gastrin
 Guarded to poor prognosis

Question 15

NEOPLASIA

Answer 15

BENIGN
Leimyoma Adenomatous polyps

MALIGNANT
Adenocarcinoma – 70% of all canine Lymphsarcoma – most cats; diffuse vs mass lesions Leiomysarcoma
Gastrinoma

Question 16

DELAYED GASTRIC EMPTYING MOTILITY DISORDERS

Answer 16

• GERD
• Bilious Vomiting Syndrome

Secondary to inflammation, infection, obstruction, electrolyte disturbance, meds (opioids), surgery

 Diffuse gastritis or gastroenteritis  Associated with pancreatitis

 NM disease  Pyloric stenosis  Foreign Body  Idiopathic

Stomach should empty in 8 hours; sometime longer especially if stress (in hosp) Rule out other causes

Radiography +/- contrast studies on fasted patient

TREATMENTS
Cisapride
Metoclopramide Erythromcyin
Ranitidine
Lower protein and fat diets

Question 17

A 5 year old male neutered lab presents for acute onset retching. No previous history of illness. Rads show a stomach severly distended with food. what is the best initial dx?

Answer 17

Admit to the hopsital for supportive car and monitoring