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Small Animal Medicine > Gastro - Vomiting and Regurgitation > Flashcards

Gastro - Vomiting and Regurgitation Flashcards

1
Q

What are the three most common causes of esophageal disease?

A

Esophagitis, esophageal foreign body, and mega-esophagus

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2
Q

What anatomic abnormalities lead to esophageal disease?

A

Vascular ring anomaly, cricopharyngeal disease, hiatal hernia, and diverticulum

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3
Q

What type of obstructions lead to esophageal disease?

A

Mural, luminal, or extraluminal obstruction

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4
Q

What can cause esophagitis?

A

trauma, foreign bodies, reflux (anesthesia), and irritation

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5
Q

What motility disorders lead to esophageal disease?

A

megaesophagous, neuropathy, and myopathy

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6
Q

Esophageal disorders are characterized by what?

A

Failure of transport and/or reflux

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7
Q

What are some clinical signs of regurgitation?

A

Hypersalivation, odynophagia, anorexia, dysphagia, nasal discharge, and coughing

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8
Q

Vomiting and regurgitation are two very different processes but often get confused. Describe vomiting.

A

Vomiting is an abdominal effort, there is prodromal nausea, usually digested food, no swallowing pain

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9
Q

Vomiting and regurgitation are two very different processes but often get confused. Describe regurgitation.

A

Passive event, no prodromal nausea, undigested food, possibly painful

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10
Q

What are the ‘right’ questions to ask in regards to vomiting or regurgitation?

A

Is there abdominal effort? Is it digested food that is brought up? What is the relation to eating? Are there swallowing difficulties? Pain on eating?

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11
Q

What should be done during physical examination when you are trying to determine the cause of vomiting and/or regurgitation?

A

Esophageal palpation, lung asucultation, determine underlying or concurrent disease, and determine body condition

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12
Q

What diagnostic tests are important for esophageal disease diagnosis?

A

Hematology and biochemistry, diagnostic imaging and endoscopy

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13
Q

What are the common causes for mega-esophagus?

A

Idiopathic megaesophagus, myasthenia gravis, thymoma, and hypoadrenocorticism

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14
Q

What are the rare causes of mega-esophagus?

A

Polyneuritis, polymyositis, dysautonomia, CNS disease, botulism/tetanus, systemic lupus erythematosus, lead/thallium toxicity, and hypothyroidism

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15
Q

Why is aspiration pneumonia a common complication of regurgitation?

A

Because regurgitation is not associated with reflex closure of the larynx leaving the airway unprotected

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16
Q

What chemical irritants can cause esophagitis?

A

corrosive agents and medications like doxycycline

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17
Q

Gastroesophageal reflux can lead to esophagitis. What can cause gastroesophageal reflux?

A

general anesthesia, hiatal hernia, persistent vomiting, and poorly positioned feeding tubes

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18
Q

How is esophagitis treated?

A

Dietary modifications, sucralfate liquid, and inhibit gastric acid secretion

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19
Q

What dietary modifications need to be made for treatment of esophagitis?

A

small meals, high protein-low fat food to minimize reflux +/- a gastric feeding tube

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20
Q

What gastric acid secretion inhibitors are most useful in cases of esophagitis?

A

proton pump inhibitors - omeprazole

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21
Q

What is a possible, serious complication, of esophagitis treatment?

A

strictures

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22
Q

Where do esophageal foreign bodies like to lodge themselves?

A

At the thoracic inlet, heart base, or hiatus

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23
Q

How are esophageal foreign bodies treated?

A

endoscopic retrieval or push into the stomach

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24
Q

Are esophageal foreign bodies considered emergencies?

A

yes - there is a potential for mucosal damage/perforation

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25
Q

What three pathophysiologic things can induce vomiting?

A

the chemoreceptor trigger zone, vagal and sympathetic afferents in the stomach acting on the brainstem, and the cortex acting on the brainstem

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26
Q

What can act on the chemoreceptor trigger zone to cause vomiting?

A

drugs, toxins, uremia, infections, and motion sickness

27
Q

What are some primary acute causes of (GI) vomiting?

A

Dietary, infection, obstruction, and motility disorders/gastric volvulus

28
Q

What are some primary chronic causes of vomiting?

A

Inflammatory disease and neoplasia

29
Q

What primary causes of vomiting are the most common?

A

Dietary, infection (parasites), inflammatory disease, obstruction (foreign body)

30
Q

What are the secondary causes of vomiting?

A

Uremia, Addison’s disease, hepatic disease, pancreatitis, toxin ingestion, and drugs

31
Q

Which of the secondary causes of vomiting the most common?

A

They all are quite common, but often vomiting is not the only sign

32
Q

I know this has been asked already.. but I will ask again. What diagnostics are important for working up dogs and cats with chronic vomiting?

A

Blood work (1st), urinalysis (2nd), and imaging (3rd)

If there is still no answer, then possible endoscopy

33
Q

What neoplasias cause gastric ulceration?

A

lymphoma, carcinoma, leiomyoma/sarcoma

34
Q

What inflammatory causes lead to gastric ulceration?

A

gastritis

35
Q

What iatrogenic causes lead to gastric ulceration?

A

NSAIDs

36
Q

What systemic problems can cause gastric ulceration?

A

Hypoadrenocorticism, liver dysfunction, uremia, mast cell tumor (hyperhistaminemia), and gastrinoma (hypergastrinemia)

37
Q

What hypotensive processes can cause gastric ulceration?

A

Shock, disseminated intravascular coagulation, and sepsis

38
Q

What idiopathic processes can lead to gastric ulceration?

A

stress or spinal injury

39
Q

For chronic cases of vomiting, what must you do in order to treat it?

A

find the underlying cause

40
Q

For acute cases of vomiting, what is the indicated treatment?

A

fasting and symptomatic treatment is often indicate

41
Q

What three types of drugs can be used to regulate acid secretion?

A

Anti-histamine, anti-cholinergics, and PPIs

42
Q

How does sucralfate work?

A

It reacts with HCl and is polymerised to viscous sticky substance that binds to proteinacious exudate usually found at ulcer sites

43
Q

What does sucralfate form in the stomach?

A

a protective barrier

44
Q

What does sucralfate stimulate?

A

It stimulates HCO3, mucus and prostaglandin secretion

45
Q

When is use of sucralfate indicated?

A

esophageal and gastric ulceration

46
Q

What type of drugs are cimetidine/ranitidine/famotidine?

A

They are HA (H2) receptor antagonists

47
Q

What do the HA receptor antagonists do?

A

They inhibit gastric acid and have some gastric prokinetic activity

48
Q

When are HA receptor antagonists used?

A

to treat any sort of regurgitation/vomiting

49
Q

Is there any evidence that HA receptor antagonists are efficacious?

A

no - there is no evidence that there is any efficacy in dogs or cats

50
Q

What type of drug is omeprazole?

A

a proton pump inhibitor

51
Q

How does omeprazole work?

A

It binds to parietal cells, irreversibly blocking H/K ATPase, thereby inhibiting the transport of H into the stomach

52
Q

What are the indicated uses for omeprazole?

A

gastric hyperacidity, GI ulcers and erosions, and Zollinger-Ellison syndrome

53
Q

What is the omeprazole duration of action?

A

it is long - only need one daily dosing

54
Q

When is anti-emetic therapy used?

A

If vomiting is debilitating - pain or marked fluid and/or electrolyte loss

55
Q

Why is anti-emetic treatment not always desirable?

A

Because vomiting can be a protective process

56
Q

What type of drug is metoclopramide?

A

It is a Para-aminobenzoic acid (PABA) that has central and GI effects

57
Q

What does metoclopramide do?

A

It antagonises D2-dopaminergic and 5-HT3 receptors in the CRTZ and peripheral cholinergic effect

58
Q

What type of agent is metaclopramide?

A

upper GI prokinetic agent

59
Q

What type of drug is ondansetron?

A

5-HT3-Seerotonergic antagonist

60
Q

What is ondansetron the best anti-emetic for?

A

Chemotherapy-induced nausea and vomiting

Also good for pancreatitis

61
Q

What type of drug is Maropitant?

A

A neurokinin-1 receptor antagonist

62
Q

What does maropitant do?

A

It stops the binding of substance P

It has central and peripheral effects

63
Q

Why do you have to be careful when using maropitant?

A

It is very potent because it masks underlying diseases

64
Q

What is maropitant useful for?

A

Any kind of vomiting

Small Animal Medicine (100 decks)

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