Gastro - Vomiting and Regurgitation

Question 1

What are the three most common causes of esophageal disease?

Answer 1

Esophagitis, esophageal foreign body, and mega-esophagus

Question 2

What anatomic abnormalities lead to esophageal disease?

Answer 2

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

Question 3

What type of obstructions lead to esophageal disease?

Answer 3

Mural, luminal, or extraluminal obstruction

Question 4

What can cause esophagitis?

Answer 4

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

Question 5

What motility disorders lead to esophageal disease?

Answer 5

megaesophagous, neuropathy, and myopathy

Question 6

Esophageal disorders are characterized by what?

Answer 6

Failure of transport and/or reflux

Question 7

What are some clinical signs of regurgitation?

Answer 7

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

Question 8

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

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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?

Question 11

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

Answer 11

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

Question 12

What diagnostic tests are important for esophageal disease diagnosis?

Answer 12

Hematology and biochemistry, diagnostic imaging and endoscopy

Question 13

What are the common causes for mega-esophagus?

Answer 13

Idiopathic megaesophagus, myasthenia gravis, thymoma, and hypoadrenocorticism

Question 14

What are the rare causes of mega-esophagus?

Answer 14

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

Question 15

Why is aspiration pneumonia a common complication of regurgitation?

Answer 15

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

Question 16

What chemical irritants can cause esophagitis?

Answer 16

corrosive agents and medications like doxycycline

Question 17

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

Answer 17

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

Question 18

How is esophagitis treated?

Answer 18

Dietary modifications, sucralfate liquid, and inhibit gastric acid secretion

Question 19

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

Answer 19

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

Question 20

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

Answer 20

proton pump inhibitors - omeprazole

Question 21

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

Answer 21

strictures

Question 22

Where do esophageal foreign bodies like to lodge themselves?

Answer 22

At the thoracic inlet, heart base, or hiatus

Question 23

How are esophageal foreign bodies treated?

Answer 23

endoscopic retrieval or push into the stomach

Question 24

Are esophageal foreign bodies considered emergencies?

Answer 24

yes - there is a potential for mucosal damage/perforation

Question 25

What three pathophysiologic things can induce vomiting?

Answer 25

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

Question 26

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

Answer 26

drugs, toxins, uremia, infections, and motion sickness

Question 27

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

Answer 27

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

Question 28

What are some primary chronic causes of vomiting?

Answer 28

Inflammatory disease and neoplasia

Question 29

What primary causes of vomiting are the most common?

Answer 29

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

Question 30

What are the secondary causes of vomiting?

Answer 30

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

Question 31

Which of the secondary causes of vomiting the most common?

Answer 31

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

Question 32

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?

Answer 32

Blood work (1st), urinalysis (2nd), and imaging (3rd) If there is still no answer, then possible endoscopy

Question 33

What neoplasias cause gastric ulceration?

Answer 33

lymphoma, carcinoma, leiomyoma/sarcoma

Question 34

What inflammatory causes lead to gastric ulceration?

Answer 34

gastritis

Question 35

What iatrogenic causes lead to gastric ulceration?

Answer 35

NSAIDs

Question 36

What systemic problems can cause gastric ulceration?

Answer 36

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

Question 37

What hypotensive processes can cause gastric ulceration?

Answer 37

Shock, disseminated intravascular coagulation, and sepsis

Question 38

What idiopathic processes can lead to gastric ulceration?

Answer 38

stress or spinal injury

Question 39

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

Answer 39

find the underlying cause

Question 40

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

Answer 40

fasting and symptomatic treatment is often indicate

Question 41

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

Answer 41

Anti-histamine, anti-cholinergics, and PPIs

Question 42

How does sucralfate work?

Answer 42

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

Question 43

What does sucralfate form in the stomach?

Answer 43

a protective barrier

Question 44

What does sucralfate stimulate?

Answer 44

It stimulates HCO3, mucus and prostaglandin secretion

Question 45

When is use of sucralfate indicated?

Answer 45

esophageal and gastric ulceration

Question 46

What type of drugs are cimetidine/ranitidine/famotidine?

Answer 46

They are HA (H2) receptor antagonists

Question 47

What do the HA receptor antagonists do?

Answer 47

They inhibit gastric acid and have some gastric prokinetic activity

Question 48

When are HA receptor antagonists used?

Answer 48

to treat any sort of regurgitation/vomiting

Question 49

Is there any evidence that HA receptor antagonists are efficacious?

Answer 49

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

Question 50

What type of drug is omeprazole?

Answer 50

a proton pump inhibitor

Question 51

How does omeprazole work?

Answer 51

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

Question 52

What are the indicated uses for omeprazole?

Answer 52

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

Question 53

What is the omeprazole duration of action?

Answer 53

it is long - only need one daily dosing

Question 54

When is anti-emetic therapy used?

Answer 54

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

Question 55

Why is anti-emetic treatment not always desirable?

Answer 55

Because vomiting can be a protective process

Question 56

What type of drug is metoclopramide?

Answer 56

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

Question 57

What does metoclopramide do?

Answer 57

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

Question 58

What type of agent is metaclopramide?

Answer 58

upper GI prokinetic agent

Question 59

What type of drug is ondansetron?

Answer 59

5-HT3-Seerotonergic antagonist

Question 60

What is ondansetron the best anti-emetic for?

Answer 60

Chemotherapy-induced nausea and vomiting | Also good for pancreatitis

Question 61

What type of drug is Maropitant?

Answer 61

A neurokinin-1 receptor antagonist

Question 62

What does maropitant do?

Answer 62

It stops the binding of substance P | It has central and peripheral effects

Question 63

Why do you have to be careful when using maropitant?

Answer 63

It is very potent because it masks underlying diseases

Question 64

What is maropitant useful for?

Answer 64

Any kind of vomiting