Gastro - Vomiting and Regurgitation Flashcards
What are the three most common causes of esophageal disease?
Esophagitis, esophageal foreign body, and mega-esophagus
What anatomic abnormalities lead to esophageal disease?
Vascular ring anomaly, cricopharyngeal disease, hiatal hernia, and diverticulum
What type of obstructions lead to esophageal disease?
Mural, luminal, or extraluminal obstruction
What can cause esophagitis?
trauma, foreign bodies, reflux (anesthesia), and irritation
What motility disorders lead to esophageal disease?
megaesophagous, neuropathy, and myopathy
Esophageal disorders are characterized by what?
Failure of transport and/or reflux
What are some clinical signs of regurgitation?
Hypersalivation, odynophagia, anorexia, dysphagia, nasal discharge, and coughing
Vomiting and regurgitation are two very different processes but often get confused. Describe vomiting.
Vomiting is an abdominal effort, there is prodromal nausea, usually digested food, no swallowing pain
Vomiting and regurgitation are two very different processes but often get confused. Describe regurgitation.
Passive event, no prodromal nausea, undigested food, possibly painful
What are the ‘right’ questions to ask in regards to vomiting or regurgitation?
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?
What should be done during physical examination when you are trying to determine the cause of vomiting and/or regurgitation?
Esophageal palpation, lung asucultation, determine underlying or concurrent disease, and determine body condition
What diagnostic tests are important for esophageal disease diagnosis?
Hematology and biochemistry, diagnostic imaging and endoscopy
What are the common causes for mega-esophagus?
Idiopathic megaesophagus, myasthenia gravis, thymoma, and hypoadrenocorticism
What are the rare causes of mega-esophagus?
Polyneuritis, polymyositis, dysautonomia, CNS disease, botulism/tetanus, systemic lupus erythematosus, lead/thallium toxicity, and hypothyroidism
Why is aspiration pneumonia a common complication of regurgitation?
Because regurgitation is not associated with reflex closure of the larynx leaving the airway unprotected
What chemical irritants can cause esophagitis?
corrosive agents and medications like doxycycline
Gastroesophageal reflux can lead to esophagitis. What can cause gastroesophageal reflux?
general anesthesia, hiatal hernia, persistent vomiting, and poorly positioned feeding tubes
How is esophagitis treated?
Dietary modifications, sucralfate liquid, and inhibit gastric acid secretion
What dietary modifications need to be made for treatment of esophagitis?
small meals, high protein-low fat food to minimize reflux +/- a gastric feeding tube
What gastric acid secretion inhibitors are most useful in cases of esophagitis?
proton pump inhibitors - omeprazole
What is a possible, serious complication, of esophagitis treatment?
strictures
Where do esophageal foreign bodies like to lodge themselves?
At the thoracic inlet, heart base, or hiatus
How are esophageal foreign bodies treated?
endoscopic retrieval or push into the stomach
Are esophageal foreign bodies considered emergencies?
yes - there is a potential for mucosal damage/perforation
What three pathophysiologic things can induce vomiting?
the chemoreceptor trigger zone, vagal and sympathetic afferents in the stomach acting on the brainstem, and the cortex acting on the brainstem
What can act on the chemoreceptor trigger zone to cause vomiting?
drugs, toxins, uremia, infections, and motion sickness
What are some primary acute causes of (GI) vomiting?
Dietary, infection, obstruction, and motility disorders/gastric volvulus
What are some primary chronic causes of vomiting?
Inflammatory disease and neoplasia
What primary causes of vomiting are the most common?
Dietary, infection (parasites), inflammatory disease, obstruction (foreign body)
What are the secondary causes of vomiting?
Uremia, Addison’s disease, hepatic disease, pancreatitis, toxin ingestion, and drugs
Which of the secondary causes of vomiting the most common?
They all are quite common, but often vomiting is not the only sign
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?
Blood work (1st), urinalysis (2nd), and imaging (3rd)
If there is still no answer, then possible endoscopy
What neoplasias cause gastric ulceration?
lymphoma, carcinoma, leiomyoma/sarcoma
What inflammatory causes lead to gastric ulceration?
gastritis
What iatrogenic causes lead to gastric ulceration?
NSAIDs
What systemic problems can cause gastric ulceration?
Hypoadrenocorticism, liver dysfunction, uremia, mast cell tumor (hyperhistaminemia), and gastrinoma (hypergastrinemia)
What hypotensive processes can cause gastric ulceration?
Shock, disseminated intravascular coagulation, and sepsis
What idiopathic processes can lead to gastric ulceration?
stress or spinal injury
For chronic cases of vomiting, what must you do in order to treat it?
find the underlying cause
For acute cases of vomiting, what is the indicated treatment?
fasting and symptomatic treatment is often indicate
What three types of drugs can be used to regulate acid secretion?
Anti-histamine, anti-cholinergics, and PPIs
How does sucralfate work?
It reacts with HCl and is polymerised to viscous sticky substance that binds to proteinacious exudate usually found at ulcer sites
What does sucralfate form in the stomach?
a protective barrier
What does sucralfate stimulate?
It stimulates HCO3, mucus and prostaglandin secretion
When is use of sucralfate indicated?
esophageal and gastric ulceration
What type of drugs are cimetidine/ranitidine/famotidine?
They are HA (H2) receptor antagonists
What do the HA receptor antagonists do?
They inhibit gastric acid and have some gastric prokinetic activity
When are HA receptor antagonists used?
to treat any sort of regurgitation/vomiting
Is there any evidence that HA receptor antagonists are efficacious?
no - there is no evidence that there is any efficacy in dogs or cats
What type of drug is omeprazole?
a proton pump inhibitor
How does omeprazole work?
It binds to parietal cells, irreversibly blocking H/K ATPase, thereby inhibiting the transport of H into the stomach
What are the indicated uses for omeprazole?
gastric hyperacidity, GI ulcers and erosions, and Zollinger-Ellison syndrome
What is the omeprazole duration of action?
it is long - only need one daily dosing
When is anti-emetic therapy used?
If vomiting is debilitating - pain or marked fluid and/or electrolyte loss
Why is anti-emetic treatment not always desirable?
Because vomiting can be a protective process
What type of drug is metoclopramide?
It is a Para-aminobenzoic acid (PABA) that has central and GI effects
What does metoclopramide do?
It antagonises D2-dopaminergic and 5-HT3 receptors in the CRTZ and peripheral cholinergic effect
What type of agent is metaclopramide?
upper GI prokinetic agent
What type of drug is ondansetron?
5-HT3-Seerotonergic antagonist
What is ondansetron the best anti-emetic for?
Chemotherapy-induced nausea and vomiting
Also good for pancreatitis
What type of drug is Maropitant?
A neurokinin-1 receptor antagonist
What does maropitant do?
It stops the binding of substance P
It has central and peripheral effects
Why do you have to be careful when using maropitant?
It is very potent because it masks underlying diseases
What is maropitant useful for?
Any kind of vomiting
