Gastroenterology AI Flashcards
What is the difference between regurgitation and expectoration?
Regurgitation is the passive expulsion of food or other material from the pharynx or oesophagus, while expectoration is the expulsion of material from the respiratory tract associated with coughing.
What is the pathophysiology of regurgitation?
The oesophagus is a long tubular organ bordered by the upper oesophageal sphincter and lower oesophageal sphincter. During swallowing, the upper oesophageal sphincter relaxes to allow passage of food or liquid into the proximal oesophagus. Primary and secondary peristaltic waves move the food towards the stomach. Diseases that interrupt this process can result in regurgitation.
What are the clinical signs of regurgitation?
The regurgitant may include undigested food, digested food, or clear, frothy fluid. Weight loss and polyphagia may occur. Signs of aspiration pneumonia including lethargy, anorexia, cough, or dyspnoea may be present. Cervical oesophagus dilation and neurological abnormalities may also be observed.
What are the differential diagnoses for regurgitation?
Possible differential diagnoses for regurgitation include oesophageal disorders (megaoesophagus, oesophagitis, obstruction), alimentary disorders (pyloric outflow obstruction, hiatal hernia, gastric dilatation volvulus), neurologic disorders (central nervous system, peripheral neuropathy, dysautonomia), neuromuscular disorders (myasthenia gravis, botulism, tetanus, acetylcholinesterase toxicity), immune-mediated disorders, and endocrine disorders (hypothyroidism, hypoadrenocorticism).
What is the primary goal in managing regurgitation?
The primary goal is to provide adequate nutrition while managing the underlying disease process. In cases of primary megaoesophagus or oesophageal dysmotility, the management focuses on diet and feeding strategies, as well as potential gastrostomy feeding tube placement.
What are the recommended feeding strategies for managing regurgitation?
Patients should be fed small, frequent high-calorie meals. The consistency of the food may vary from chunky food or meatballs to a liquefied diet. Adding a tasteless thickening agent to drinking water can be attempted. Keeping the pet upright during and after feedings, using a Bailey chair or manual support, and gentle coupage may help with food movement. Some patients may require gastrostomy feeding tube placement.
Which medications are commonly used in the treatment of regurgitation?
Prokinetic drugs like cisapride and metoclopramide are controversial in dogs but may be effective in cats. Bethanechol may be effective in some dogs. Gastroprotective therapy to decrease stomach acidity (proton pump inhibitors, H2-receptor antagonists) and mucosal protectants (sucralfate) should be used in all cases.
What are the clinical signs of hiatal hernias?
The most common clinical signs of hiatal hernias are intermittent regurgitation, vomiting, and hypersalivation, often precipitated by excitement or exercise. Dyspnoea and coughing may occur with severe herniation or aspiration pneumonia.
How can hiatal hernias be diagnosed?
Survey thoracic radiographs should be obtained in all dogs with suspected hiatal hernia. A dynamic barium procedure (videofluoroscopy) is far more likely to identify intermittent herniation of the stomach and can allow assessment of oesophageal motility. Oesophagoscopy can also be used to diagnose sliding hiatal hernia.
What is the recommended medical therapy for hiatal hernias?
Proton pump inhibitors such as omeprazole are superior acid suppressants compared to H2-receptor antagonists and should be administered with sucralfate suspension to afford greater mucosal cytoprotection.
How can normal hiatal anatomy be restored in dogs with large congenital hiatal hernias?
Normal hiatal anatomy can be restored by diaphragmatic crural apposition, oesophagopexy, and left fundic tube gastropexy techniques.
What is cricopharyngeal dysphagia and how is it characterized?
Cricopharyngeal dysphagia is a rare congenital or acquired neuromuscular disorder of the upper oesophageal sphincter (UOS). It is characterized by achalasia (failure of relaxation) of the UOS or a lack of coordination between relaxation of the UOS relaxation and pharyngeal contraction (asynchrony).
What are the clinical signs of cricopharyngeal dysphagia?
Affected animals demonstrate progressive dysphagia (typically worse when drinking water) at the time of, or shortly after, weaning. Clinical signs are characterized by repeated attempts to swallow, gagging, retching, and nasal regurgitation due to food or fluid accumulation within the pharynx.
How is cricopharyngeal dysphagia diagnosed?
Video fluoroscopy is necessary to confirm the diagnosis by demonstrating the reflux of contrast material and the inability of the upper oesophageal sphincter to relax properly.
What is the treatment for cricopharyngeal dysphagia?
Surgical myotomy or myectomy of the cricopharyngeal muscle is considered as the treatment for cricopharyngeal dysphagia.
What are some possible causes of dysphagia in cats?
Possible causes of dysphagia in cats include structural abnormalities such as oral tumors, ulcers, or stomatitis, as well as neurologic disorders, neuromuscular disorders, and nervous system diseases like neuropathy.
What are some possible causes of dysphagia in dogs?
Possible causes of dysphagia in dogs include neurologic disorders, neuromuscular disorders, obstruction by a foreign body, neoplasia, inflammatory conditions, trauma, and pain.
What are some differential diagnoses for dysphagia?
Some differential diagnoses for dysphagia include obstructive lesion (anatomic or mechanical), foreign bodies, neoplasia, inflammatory conditions, lymphadenopathy, sialocoele, lingual frenulum disorder, cricopharyngeal achalasia/asynchrony, cleft palate, TMJ disorder, trauma, pain, periodontal diseases, stomatitis, glossitis, pharyngitis, and neurologic disorders.
What diagnostic tests can be done to evaluate dysphagia?
Diagnostic tests that can be done to evaluate dysphagia include history and physical examination, complete blood count and serum chemistry profile, thyroid testing, urinalysis, survey radiographs of the head, neck, and thorax, acetylcholine receptor antibody titre (if myasthenia gravis is suspected), endoscopy, contrast videofluoroscopy motion studies, and muscle biopsy.
What is Creatine Kinase (CK) and what does an increase in CK indicate in dysphagia cases?
Creatine Kinase (CK) is an intracellular enzyme found in high concentrations in muscle cells and within the brain. An increase in CK in dysphagia cases can indicate the presence of a myopathy.
What are some possible complications of dysphagia?
Some possible complications of dysphagia include aspiration pneumonia, which should be addressed in the treatment plan.
What dietary modifications can be attempted in the treatment of dysphagia?
In the treatment of dysphagia, dietary modifications such as changes in food consistency (liquid, solid), meal frequency (smaller, more frequent), and feeding positions (upright) can be attempted.
When might placement of a feeding tube become necessary in the treatment of dysphagia?
Placement of a feeding tube may become necessary in the treatment of dysphagia if dietary adjustments are not providing adequate caloric intake for the patient.
How are smaller foreign bodies best removed?
Smaller foreign bodies are best removed with a flexible endoscope and basket, biopsy forceps, or snare retrieving forceps.
How can fish-hooks lodged in the proximal to mid-oesophagus be dislodged?
Fish-hooks that are lodged in the proximal to mid-oesophagus can be dislodged with the distal end of a rigid endoscope by inserting the open end of the scope between the shaft and hook portion and pushing aborally.
What can be done to temporarily bypass the oesophagus during feedings in animals with severe oesophagitis or necrosis?
A gastrostomy tube can be inserted during foreign body removal in animals with severe oesophagitis or necrosis to temporarily bypass the oesophagus during feedings.
What is the specific therapy for oesophagitis after foreign body removal?
Specific therapy for oesophagitis should include sucralfate suspensions and proton pump inhibitors for 7-10 days following removal of the foreign body.
When is oesophagotomy indicated during foreign body removal?
Oesophagotomy is indicated if endoscopy fails to remove the foreign body; however, it is preferable to attempt to push the foreign body into the stomach for removal via gastrotomy.
What are the clinical signs of a vascular ring anomaly?
Affected puppies and kittens usually present for regurgitation of solid foods at the time of weaning. Weight loss with failure to thrive despite a good appetite is commonly observed. The presence of a moist cough, dyspnoea, and fever suggest aspiration pneumonia. Physical examination often reveals a thin, stunted animal that is otherwise normal. Occasionally, a dilated oesophagus can be observed or palpated in the cervical region.
What can focal leftward deviation of the trachea near the cranial border of the heart be caused by in young dogs?
Reliable sign of Persistent right aortic arch (PRAA) in young dogs.
How can an oesophagram help in diagnosing vascular ring anomalies?
An oesophagram may be performed to confirm the location of oesophageal obstruction and the severity of oesophageal distension.
What is cricopharyngeal achalasia?
Cricopharyngeal achalasia is a condition characterized by dysfunction or inability of the cricopharyngeal muscle to relax, leading to difficulty in swallowing.
What are the two approaches for the treatment of cricopharyngeal achalasia?
The two approaches for the treatment of cricopharyngeal achalasia are the standard ventral midline approach with 180° rotation of the larynx and the lateral approach with 90° rotation of the larynx.
What is the procedure involved in cricopharyngeal myotomy?
Cricopharyngeal myotomy involves transecting the cricopharyngeal muscle to the level of the pharyngeal mucosa.
What is the benefit of using a closed endoscopic CO2 laser cricopharyngeal myotomy?
The closed endoscopic CO2 laser cricopharyngeal myotomy is being increasingly utilized due to reduced anesthesia time and morbidity compared to the traditional transcervical cricopharyngeal myotomy.
What is botulinum toxin and how is it used in the temporary management of cricopharyngeal achalasia?
Botulinum toxin is a neurotoxin synthesized from the bacillus Clostridium botulinum. It is injected into the cricopharyngeus muscle in 3 sites using a transbronchial needle. It weakens muscle contraction and provides temporary relief from cricopharyngeal achalasia.
What is the limited duration of botulinum toxin’s effect?
The effect of botulinum toxin lasts for about 3-4 months.
How can the effect of botulinum toxin be used to screen dogs for a permanent surgical myectomy?
The limited duration of botulinum toxin’s effect can be used to identify dogs that might benefit from a permanent surgical myectomy. Animals that respond favorably to the toxin should do well with surgical myectomy.
What is the purpose of adding commercial food thickeners such as ‘Thick-It’ in the management of cricopharyngeal achalasia?
Adding commercial food thickeners can help identify the optimal consistency of food and water for dogs with cricopharyngeal achalasia.
What are the four main types of dysphagia?
The four main types of dysphagia are oral dysphagia, pharyngeal dysphagia, cricopharyngeal dysphagia, and oesophageal dysphagia.
What are the causes of dysphagia?
The causes of dysphagia can be associated with neurological or muscular abnormalities, neoplasms, foreign bodies, strictures, or traumas.
What is oral dysphagia characterized by?
Oral dysphagia is characterized by abnormalities with prehension, mastication, lubrication, and transportation of food from the tongue to the pharynx.
What are some possible causes of oral dysphagia?
Mechanical interference, foreign bodies, fractures, periodontal disease, stomatitis, gingivitis, tumours, or neurological defects involving the cranial nerves can cause oral dysphagia.
What is pharyngeal dysphagia characterized by?
Pharyngeal dysphagia is characterized by the inability to propel the food bolus from the oropharynx, through the hypopharynx, and to the proximal esophagus.
What are some common causes of pharyngeal dysphagia?
Common causes of pharyngeal dysphagia include neuropathy of cranial nerves V, VII, or XII, neoplasia, or pharyngeal dysfunction.
What is cricopharyngeal dysphagia?
Cricopharyngeal dysphagia is the abnormal transportation of a bolus through the proximal esophageal sphincter, either due to inadequate opening/relaxation or abnormal timing of its opening/relaxation.
What are some possible causes of cricopharyngeal dysphagia?
Cricopharyngeal dysphagia can be caused by neuromuscular diseases like myasthenia gravis, hypoadrenocorticism, or hypothyroidism, and it can also be a heritable trait in certain breeds like the Golden Retriever.
What are the clinical signs that can help differentiate regurgitation from dysphagia and vomiting?
The clinical signs that can help differentiate regurgitation from dysphagia and vomiting are: oropharyngeal regurgitation, abdominal effort, prodromal nausea, character of food ejected, timing of food ejected, swallow attempts after a single bolus, ability to drink, and pain on swallowing.
What should be performed before investigating oesophageal disease?
Before investigating oesophageal disease, a complete history should be taken, followed by a thorough physical examination, neurological examination, routine haematology and biochemistry tests, and plain and contrast radiography.
What can be revealed by plain and contrast radiography in patients with oesophageal disease?
Plain and contrast radiography can reveal oesophageal foreign bodies, megaoesophagus, strictures, thoracic masses, hiatal and diaphragmatic hernias. It can also show complications such as aspiration pneumonia or pneumothorax.
What is the best method for visualizing intraluminal disorders in the oesophagus?
Endoscopy is the best method for visualizing intraluminal disorders in the oesophagus, including foreign bodies, oesophagitis, strictures, neoplasia, and gastroesophageal reflux.
What tests can be considered for diagnosing oesophageal disease?
Tests that can be considered for diagnosing oesophageal disease include ACTH stimulation test, T4/TSH test, acetylcholine receptor antibodies test, and the Tensilon test.
What is oesophagitis?
Oesophagitis is an acute or chronic inflammatory disorder of the oesophageal mucosa that can cause a secondary motility disorder and regurgitation.
What is the most common cause of high-grade oesophagitis and stricture formation in dogs?
Gastroesophageal reflux during anesthesia represents the most common cause of high-grade oesophagitis and stricture formation in dogs.
What are the clinical signs of oesophagitis?
The clinical signs of oesophagitis can include anorexia, dysphagia, odynophagia, regurgitation, hypersalivation, and coughing (with concurrent aspiration pneumonia).
What is the chemoreceptor trigger zone (CRTZ) and where is it located?
The CRTZ is a region in the floor of the fourth ventricle and it lacks a blood-brain barrier, allowing it to sample chemical stimuli in the blood.
What are the dominant receptors in the CRTZ?
The dominant receptors in the CRTZ are serotonin type 3 (5-HT3) receptors and dopamine type 2 (D2) receptors.
Where are the peripheral receptors that initiate vomiting stimuli?
Peripheral receptors that initiate vomiting stimuli are found throughout the body, including in the duodenum, peritoneum, bile ducts, uterus, prostate, and kidneys.
What role does vestibular stimulation play in vomiting?
Vestibular stimulation feeds into the CRTZ before activating the emetic centre in dogs, but it appears to act directly on the emetic centre in cats.
Which receptors are found on the smooth muscle of the gastrointestinal tract and vagal afferent neurons?
5HT3 and NK1 receptors are found on the smooth muscle of the gastrointestinal tract and vagal afferent neurons.
What drug is a potent stimulator of emesis in dogs but has little to no effect in cats?
Apomorphine is a potent stimulator of emesis in dogs but has little to no effect in cats.
What type of receptors are more important in emesis in cats?
Alpha2 receptors are more important in emesis in cats, as demonstrated by the effectiveness of xylazine, an alpha2 agonist, as an emetic in cats.
What are some possible causes or aetiologies of vomiting?
Possible causes or aetiologies of vomiting include metabolic/endocrine disorders, intoxicants, drugs, abdominal disorders, dietary causes, gastric disorders, disorders of the small intestine, disorders of the large intestine, and central nervous system disease.
What is the definitive therapy for Persistent Right Aortic Arch (PRAA)?
The definitive therapy for PRAA is surgical ligation and transection of the ligamentum arteriosum via a left intercostal approach.
What is the recommended treatment for animals with severe debilitation from malnutrition due to PRAA?
Animals with severe debilitation from malnutrition will require enteral nutritional support via gastrostomy tube feedings prior to surgery.
What is the most common cause of regurgitation in dogs?
Megaoesophagus is the most common cause of regurgitation in dogs.
Which breeds are predisposed to congenital idiopathic megaoesophagus in dogs?
Familial predisposition has been suggested in the Irish Setter, Great Dane, German Shepherd, Labrador Retriever, Chinese Shar-Pei, Newfoundland, Miniature Schnauzer, and Fox Terrier breeds.
In which breed of cats is congenital megaoesophagus more commonly seen?
Congenital megaoesophagus in cats is rare, although Siamese cats are predisposed.
What is the underlying cause of acquired secondary megaoesophagus (ASM)?
The underlying cause of ASM is unknown, but a defect in the afferent neural response leading to reduced responsive to oesophageal distension is suspected.
What is the major cause of ASM in dogs?
Myasthenia gravis accounts for 25-30% of ASM in dogs.
What are some diseases that could cause an acquired secondary megaoesophagus?
Some diseases that could cause an acquired secondary megaoesophagus include Systemic Lupus Erythematosus (SLE), Polymyopathies, Polyneuropathies, botulism, distemper, neoplasia, severe oesophagitis, Addison’s disease, thymoma, pituitary dwarfism, lead toxicity.
What are some distinguishing factors between vomiting and regurgitation?
Some distinguishing factors between vomiting and regurgitation include the presence of prodromal signs of nausea, abdominal contractions (retching), and the presence of bile in vomit episodes.
What do owners typically report when their pet regurgitates?
Owners typically report that the animal simply lowers its head and material is expelled during regurgitation.
Can bile be present in regurgitation?
In rare instances, bile may be present in regurgitation due to reflux of bile from the stomach into the esophagus prior to regurgitation.
What are the distinguishing factors in the material produced during vomiting and regurgitation?
During vomiting, animals may produce undigested food or digested-appearing food. Regurgitation may also involve the regurgitation of digested-appearing food.
What should be considered if there is uncertainty in distinguishing vomiting from regurgitation?
If there is uncertainty in distinguishing vomiting from regurgitation based on the episode description alone, the rest of the history and physical examination should be used for further evaluation.
What is the timing of the episodes relative to feeding in vomiting and regurgitation?
Both vomiting and regurgitation can occur anytime relative to feeding.
What does the dipstick analysis of vomit reveal?
The dipstick analysis of vomit can reveal a pH level of ≤5 or ≥8 and the presence or absence of bile.
What is the key difference in abdominal contractions between vomiting and regurgitation?
Abdominal contractions (retching) are usually present during vomiting, while they are not usually present during regurgitation.
What is the definitive diagnostic procedure for oesophageal stricture?
Oesophagoscopy
What are the clinical signs of oesophageal stricture?
Progressive regurgitation, dysphagia, odynophagia, regurgitation, salivation, anorexia, coughing, and weight loss.
How can oesophagitis be diagnosed?
Oesophagitis can be diagnosed through endoscopy and oesophageal biopsy or by observing the appearance of the oesophageal mucosa.
What can be used to increase lower oesophageal sphincter pressure and enhance gastric emptying?
Prokinetic agents such as cisapride or metoclopramide.
What is the purpose of using proton pump inhibitors (PPIs) in the treatment of oesophagitis?
PPIs are used to suppress gastric acid and have superior acid suppressive effects compared to H2-receptor antagonists.
What is the most common cause of oesophageal strictures?
Oesophageal strictures are most commonly caused by Gastro-oesophageal Reflux (GOR) during general anaesthesia.
How are benign strictures treated?
Benign strictures are best treated by mechanical dilation using balloon dilation.
What is the purpose of sucralfate in managing reflux oesophagitis?
Sucralfate binds to damaged and eroded oesophageal mucosa, providing an effective protective barrier.
How is the position of the balloon catheter visualized during the dilation procedure?
The position of the balloon catheter is visualized through the endoscope or via fluoroscopy.
What is the purpose of using an inflating device with a manometric pressure gauge during balloon dilation?
The purpose is to slowly increase the pressure to the specified level recommended by the manufacturer.
What is the recommended duration for keeping the balloon inflated during the stricture dilation?
The balloon is kept inflated for 60-90 seconds.
What are the potential complications of dilatation techniques?
The potential complications include bleeding and the risk of perforation.
What is the role of transendoscopic administration of triamcinolone in the stricture dilation procedure?
It has been associated with a reduced rate of re-stricture formation.
What technique can be used to administer triamcinolone into the submucosa of the stricture site?
The transbronchial aspiration needle can be threaded down the biopsy channel of the endoscope.
Which medication, when applied topically at the stricture site, has been shown to be beneficial for preventing re-stricture?
Topical mitomycin C (5 mg of mitomycin C using a soaked gauze sponge that is placed endoscopically).
What is the success rate of treatment by dilation for oesophagitis?
Studies indicate a success rate of 77-88% for treatment by dilation.
What diagnostic test should be done to screen for causes of Acquired Secondary Megaoesophagus?
An AChR antibody titre for acquired Myasthenia Gravis
When should the AChR antibody titre test be repeated in dogs with an initial titre in the ‘grey-zone’?
4-8 weeks later
What diagnostic procedures should be considered based on the individual case presentation?
Oesophagoscopy, electromyography, nerve conduction velocity, and muscle and nerve biopsy
Is there a proven association between megaoesophagus and hypothyroidism?
No
What is the treatment of idiopathic megaoesophagus and acquired forms that fail to respond to specific medical therapy?
Supportive and symptomatic
What feeding position should be recommended to assist passage of ingesta into the stomach?
Elevated or upright position (e.g., Bailey chair)
What is the most common form of hiatal hernia?
Type I sliding hiatal hernia
Which breeds have documented congenital sliding hiatal hernias?
Chinese Shar-Pei, Chow Chow, English Bulldogs, French Bulldogs, Pugs, and Boston Terriers
What is the first phase of swallowing called?
Oral preparatory phase
Which cranial nerves are involved in the oral phase of swallowing?
Cranial nerves V, VII, and XII
What happens during the pharyngeal phase of swallowing?
The soft palate elevates, larynx and hyoid move forward, epiglottis retroflexes, vocal folds close, and muscles of the pharynx contract.
Which cranial nerves are involved in the pharyngeal phase of swallowing?
Cranial nerves V, VII, IX, and X
What is the last phase of swallowing called?
Oesophageal phase
Which cranial nerve is involved in the oesophageal phase of swallowing?
Cranial nerve X
What is dysphagia defined as?
Difficulty swallowing
What are some potential causes of delayed gastric emptying?
Delayed gastric emptying can be caused by gastric outflow obstruction or gastric hypomotility.
What should be included in the dietary history when evaluating a vomiting patient?
A complete dietary history should be obtained, including past and current diets. Recent diet changes or opening a new bag or can of food may be the cause of vomiting.
What should be considered when assessing the patient’s medication history?
The medication history should include information about drugs, supplements, nutraceuticals, and alternative therapies that could be associated with vomiting.
What are some important factors to consider when evaluating the patient’s physical examination?
During the physical examination, important factors to consider include patient demeanor, body condition, posture, oral examination, assessment of each body system, vital signs, percentage dehydration, and abdominal palpation for evidence of pain, effusion, or organomegaly.
What investigations are usually performed for a vomiting patient with mild clinical signs?
For a vomiting patient with mild clinical signs, a minimalistic approach is usually appropriate. Faecal examination may identify parasitic causes of vomiting. Abdominal radiographs are performed if there is a clinical suspicion of surgical disease or if vomiting does not resolve with initial treatment.
What can abdominal radiographs help identify in a vomiting patient?
Abdominal radiographs can help identify surgical diseases such as suspected foreign body ingestion or conditions where vomiting does not resolve with initial treatment.
What are some clinical signs of GDV?
Some clinical signs of GDV include anxiety and looking at the abdomen, standing and stretching, drooling, distended abdomen, unproductive retching, weakness, and collapse.
What are some common findings on clinical examination of a GDV patient?
Common findings on clinical examination of a GDV patient include tachycardia, pallor of the mucous membranes, weak pulses, and possible abdominal distension.
What are the typical hematologic changes seen in a GDV patient?
The hematologic changes in a GDV patient are usually restricted to an increase in packed cell volume associated with hypovolemia, and a stress leukogram may also be present.
What acid-base disturbance is commonly seen in a GDV patient?
Metabolic acidosis is the most common acid-base disturbance seen in a GDV patient, and hypokalemia is usually present as well.
What are some common clinicopathologic findings on bloodwork of a GDV patient?
Common clinicopathologic findings on bloodwork of a GDV patient include pre-renal azotemia secondary to systemic hypotension, increased serum ALT and AST levels due to hypoxic damage, and elevated total bilirubin levels due to cholestasis.
Why is it important to measure plasma lactate in a GDV patient?
Measuring plasma lactate levels in a GDV patient can help determine the presence of gastric necrosis, prognosis, and the need for aggressive therapy. A good finding is a decrease of more than 43-50% within 12 hours.
What changes can occur to the coagulation profile in a GDV patient?
As the condition progresses, changes to coagulation factors can occur, including thrombocytopenia, prolonged PT and/or APTT, and increased levels of fibrinogen, which suggest the development of disseminated intravascular coagulation.
What imaging technique is used to confirm a GDV and differentiate between torsion and dilation?
Radiography is used to confirm a GDV and differentiate between torsion and dilation. Right lateral radiographs typically reveal a gas-filled fundus and a separate gas-filled structure above the fundus known as the pylorus (appearing as a ‘double bubble’). A soft tissue band separating the two gas-filled compartments is highly supportive of GDV.
What are the techniques commonly used for gastropexy?
The techniques commonly used for gastropexy are belt-loop gastropexy and incisional gastropexy.
What post-operative complications can occur after a splenectomy?
Post-operative complications after a splenectomy can include ventricular dysrhythmias, gastrointestinal hypomotility, electrolyte disturbances (specifically hypokalaemia), aspiration pneumonia, gastritis, peritonitis, reperfusion injury, Disseminated Intravascular Coagulation (DIC), Thromboembolic disease (PTPE), and systemic Inflammatory response Syndrome (SIRS).
What should be included in the post-operative management for patients with gastric dilatation-volvulus (GDV)?
The post-operative management for patients with GDV should include intensive nursing care monitoring vitals, urine output, and weight; analgesia with opioids; gastroprotectants; gastric motility enhancers (such as metoclopramide); fluids; feeding with a highly digestible and energy dense product; ECG monitoring; blood pressure monitoring; and electrolyte, haematology, acid base status, and coagulation testing (if concerns over DIC).
What is the overall mortality rate of patients with GDV?
The overall mortality rate of patients with GDV is 10-15%.
What are the types of gastric neoplasms that can occur in dogs and cats?
The types of gastric neoplasms that can occur in dogs and cats include leiomyosarcoma, lymphoma, fibrosarcoma, rare anaplastic sarcoma, gastric extramedullary plasmacytoma, adenocarcinoma, squamous cell carcinomas, mast cell tumors, gastrointestinal stromal tumors (GIST tumors), polyps, and leiomyomas.
What is the most common gastric neoplasm in dogs?
The most common gastric neoplasm in dogs is malignant adenocarcinoma, accounting for 47-72% of all canine gastric malignancies.
What is the most common gastrointestinal neoplasm in both cats and dogs?
The most common gastrointestinal neoplasm in both cats and dogs is lymphoma.
What is the difference between small-cell lymphoma and large-cell lymphoma in feline gastric lymphoma?
In feline gastric lymphoma, small-cell lymphoma is more localized to the GI tract and carries a better prognosis than large-cell lymphoma.
What is the recommended dosage of prednisolone for treating gastritis?
The recommended dosage of prednisolone for treating gastritis is 1 to 2 mg/kg/day PO, tapered to every other day at the lowest dosage that maintains remission over 8 to 12 weeks.
When can a combination of a test diet and prednisolone be started in patients with moderate to severe lymphoplasmacytic gastritis?
A combination of a test diet and prednisolone can be started in patients with moderate to severe lymphoplasmacytic gastritis if they are HLO-free and show no evidence of lymphoma on gastric biopsies.
What may be instituted if ulceration or erosion is detected in gastritis patients?
Antacids and mucosal protectants may be instituted if ulceration or erosion is detected in gastritis patients.
Which medications can be used as adjunctive prokinetic agents for delayed gastric emptying?
Metoclopramide, cisapride, and erythromycin can be used as adjunctive prokinetic agents for delayed gastric emptying.
What is the safer alternative to azathioprine in cats for managing inflammatory bowel disease and small-cell lymphoma?
Chlorambucil is a safer alternative to azathioprine in cats for managing inflammatory bowel disease and small-cell lymphoma.
How is diffuse eosinophilic gastritis of undefined aetiology usually approached?
Diffuse eosinophilic gastritis of undefined aetiology is usually approached as described for lymphoplasmacytic gastritis.
What is the treatment for antral hypertrophy in brachycephalic dogs?
Antral hypertrophy in brachycephalic dogs is treated with surgery.
What are some risk factors for developing gastric dilatation and volvulus (GDV)?
Some risk factors for developing GDV include advancing age, lean body condition and deep/narrow thoracic conformation, first-degree relative with a history of GDV, stress and aggressive/fearful behavior, once daily feeding, rapid consumption of dry food, previous splenic disease, and increased gastric ligament laxity. Certain breeds also have a higher risk of GDV.
According to the course notes, is there any conclusive evidence to show that one PPI is clinically more effective than another for the treatment of gastric ulceration in dogs or cats?
No, there is no conclusive evidence in dogs and cats to show that one PPI is clinically more effective than another for the treatment of gastric ulceration.
Based on evidence from studies in humans and research animals, how often should PPIs be administered for treating acid-related gastric ulceration?
Based on evidence from studies in humans and research animals, PPIs administered twice daily are superior to other gastroprotectants for treating acid-related gastric ulceration.
What is the consensus opinion regarding the tapering of PPIs in dogs and cats after prolonged use?
The consensus opinion is that PPIs should be tapered in dogs and cats after prolonged use of >3-4 weeks.
According to the course notes, should PPIs be administered concurrently with other agents that require an acid milieu for oral absorption?
According to the course notes, PPIs should not be administered concurrently with other agents that require an acid milieu for oral absorption.
What are some of the cytoprotective effects of Misoprostol?
Misoprostol has cytoprotective effects caused by increased bicarbonate secretion, decreased pepsin content of gastric secretion, preservation of tight junctions among epithelial cells, increased mucus layer, increased mucosal blood flow, and improvement of mucosal regenerative capacity.
Is Misoprostol effective for preventing GUE associated with the administration of glucocorticoids in dogs and cats, according to the course notes?
According to the course notes, there is no evidence that Misoprostol decreases GUE from glucocorticoids in dogs and cats.
What is the mechanism of action of Sucralfate in acid-peptic disease?
The mechanism of action of Sucralfate in acid-peptic disease is multifactorial. It forms stable complexes with protein in damaged mucosa where there is a high concentration of protein.
According to the course notes, what is the comparative benefit of using Proton pump inhibitors (PPIs) and Sucralfate for management of GUE?
According to the course notes, Proton pump inhibitors (PPIs) are superior to Sucralfate for management of GUE.
What can cause the development of ulcers in the gastric mucosal barrier?
Severe insult to the mucosal barrier from drugs, foreign bodies, or neoplasia.
When acid reaches the submucosal layer, what happens?
Mast cells are degranulated and histamine is released.
What is the most predictable cause for gastric erosion and ulceration?
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) or glucocorticoids, either alone or in combination with intervertebral disc disease.
Which drugs can cause gastric erosions and ulcers in healthy dogs?
Flunixin meglumine, aspirin, and ibuprofen.
What are COX-2 selective agents and how are they different from other NSAIDs?
COX-2 selective agents are drugs that block ‘inducible’ cyclooxygenase (COX-2) and are less ulcerogenic in dogs. They include carprofen, meloxicam, deracoxib, and etodolac.
What are some risk factors for gastric erosion or ulceration?
Uraemia, hepatic failure, hypoadrenocorticism, hypotension, and high doses of glucocorticoids.
What clinical findings are associated with gastric erosions or ulcers?
Vomiting, haematemesis (frank blood or digested blood with a ‘coffee ground’ appearance), melaena, abdominal pain, and anaemia.
What can be observed in cats and dogs with chronic kidney disease (CKD) related gastric damage?
In dogs and cats with CKD, mucosal oedema, vasculopathy, and mineralization correlated to the degree of azotaemia and calcium phosphorus product can be observed.
What are some possible causes of gastritis in dogs and cats?
Possible causes of gastritis in dogs and cats include dietary allergy or intolerance, parasitism, reaction to bacterial antigens, and unknown pathogens.
What is the most common form of gastritis in dogs and cats?
The most common form of gastritis in dogs and cats is mild to moderate superficial lymphoplasmacytic gastritis with concomitant lymphoid follicle hyperplasia.
What is the prevalence of gastric Helicobacter spp. infection in healthy pet dogs?
Gastric Helicobacter spp. infection is highly prevalent in 67% to 100% of healthy pet dogs.
What are the potential pathogenic effects of gastric Helicobacter spp. infection in dogs and cats?
The pathogenicity of gastric Helicobacter species is largely unknown in veterinary medicine.
How should symptomatic patients with biopsy-confirmed Helicobacter spp. infection and gastritis be treated?
Symptomatic patients with biopsy-confirmed Helicobacter spp. infection and gastritis should be treated with a combination of metronidazole, amoxicillin, and famotidine.
What are the recommended treatments for lymphocytic-plasmacytic gastritis?
Mild lymphoplasmacytic gastritis without follicular hyperplasia and evidence of Helicobacter like organisms (HLO) should be initially treated with diet, including novel protein sources or commercial hydrolysed diets.
What substances may be present in diets used to treat lymphocytic-plasmacytic gastritis?
Diets used to treat lymphocytic-plasmacytic gastritis may contain substances such as menhaden fish oil or antioxidants that can potentially alter inflammation.
What was the response rate of dogs and cats to treatment with metronidazole, amoxicillin, and famotidine?
In an uncontrolled clinical trial, clinical signs responded to treatment in 90% of 63 dogs and cats, with 74% of the re-endoscoped animals showing no evidence of Helicobacter spp. in gastric biopsies.
What are the factors that should be considered when adjusting the rate and volume of fluids during fluid therapy?
The rate and volume of fluids should be adjusted according to patient assessment, including heart rate, pulse quality, mucous membrane colour, and capillary refill time.
Why should hypokalaemia be carefully monitored and supplemented appropriately after fluid therapy?
Hypokalaemia is common after fluid therapy and should be carefully monitored and supplemented appropriately.
What type of analgesics should be titrated to effect in the case of GDV?
Opiate analgesics should be titrated to effect in the case of GDV.
What are the two methods for performing gastric decompression?
Gastric decompression can be performed by orogastric intubation with a well-lubricated stomach tube or a 16-g catheter can be used to trocarise the stomach.
What precautions should be taken when passing an orogastric tube for gastric decompression?
When passing an orogastric tube, measure the tube from the patient’s chin to their xiphoid prior to introducing the tube to prevent stomach perforation. Standing the dog on its hindlimbs can aid with placing the orogastric tube.
Where should percutaneous gastrocentesis be performed in the abdomen?
If percutaneous gastrocentesis is performed, it should be done on the right-hand side of the abdomen.
What are the two most common ECG abnormalities seen with GDV?
The two most common ECG abnormalities seen with GDV are Ventricular tachycardia and Ventricular premature complexes.
When should arrhythmias associated with GDV be treated?
Arrhythmias associated with GDV should be treated if associated with weakness, syncope, or heart rates >150 beats per minute.
What is the purpose of a homemade non-spicy, fat-restricted, bland diet?
The purpose is to introduce a diet that is easy on the stomach and helps resolve vomiting.
What are some examples of food that can be included in a homemade non-spicy, fat-restricted, bland diet?
Boiled chicken and rice, low-fat cottage cheese, and rice in a 1:3 ratio.
How should the food be given when introducing a homemade non-spicy, fat-restricted, bland diet?
The food should be given little and often.
What agents are often administered to pets with acute vomiting or diarrhea?
Bismuth subsalicylate (Pepto-Bismol), kaolin-pectin, sucralfate, activated charcoal, and magnesium, and aluminium- and barium-containing products.
What is the underlying cause for the development of gastric erosions and ulcers?
An imbalance between gastric acid secretion and gastric mucosal barrier protection.
What are the four main layers of the stomach?
Serosa, muscular layers, submucosa, and mucosa.
What cells can be found in the gastric pits of the fundic area of the stomach?
Parietal cells, chief cells, and mucosal neck cells.
What is the role of the pyloric sphincter?
The pyloric sphincter prevents solid food from entering the duodenum.
What tests can be done to identify systemic or metabolic diseases?
Complete blood count, serum biochemistry profile, and urinalysis
How can obstruction be diagnosed using intestinal radiographs?
Measurements can be taken to help diagnose obstruction by comparing the width of the look of the intestine with the height of the midbody of L5.
What discussions should be held with the owner prior to surgery for an obstruction?
Anaesthesia related complications, wound complications, intestinal dehiscence, peritonitis, and death should be discussed.
What diagnostic testing should be done for chronic vomiting if a cause is not found?
Ultrasonography, a bile acid profile, pancreatic lipase testing, and ACTH stimulation testing should be considered.
What are the clinical manifestations of gastric disease?
Vomiting, haematemesis, melaena, retching, burping, hypersalivation, abdominal distension, abdominal pain, or weight loss.
What is the diagnostic approach for primary gastric disease?
The diagnostic approach initially focuses on historical and physical findings, with clinicopathologic testing and diagnostic imaging employed in patients with systemic involvement or chronic signs.
How can signalment help in diagnosing gastric disorders?
Age and breed can be helpful in the diagnosis of certain gastric disorders.
What clinicopathologic tests can help differentiate primary GI disease from non-GI disease?
Blood and urine samples, rapid evaluation of microhaematocrit (PCV), total solids (TS), blood glucose, blood urea nitrogen (BUN), urine specific gravity, glucose, ketones and protein, and plasma concentrations of sodium (Na) and potassium (K) can help differentiate.
How rare are abnormalities in complete blood count (CBC) with primary gastric disease?
Abnormalities in complete blood count (CBC) are infrequent with primary gastric disease.
What are some clinical signs of gastric cancer in dogs?
Some clinical signs of gastric cancer in dogs include sudden anorexia, vomiting blood, and weight loss.
What are some clinical signs of gastric cancer in cats?
Some clinical signs of gastric cancer in cats include lethargy, anorexia, and rapid weight loss.
What physical examination findings may be present in cases of gastric cancer?
In some cases of gastric cancer, mild cranial abdominal discomfort may be present during physical examination.
What might be evident in the biochemistry results if ulceration is present?
If ulceration is present, hypoproteinaemia may be evident in the biochemistry results.
What imaging techniques can be used to assess gastric cancer?
Radiographs and ultrasound can be used for imaging in cases of gastric cancer.
What visual signs may indicate gastric adenocarcinoma during endoscopy and biopsy?
Visual signs of gastric adenocarcinoma during endoscopy and biopsy may include mottled and purple appearance to the mucosa, deep pigmentation of the mucosa, loss of normal stomach landmarks, ulceration, an obvious mass, rigidity, and boarding of the mucosa.
What should be done if severe gastritis is suspected during biopsy?
If severe gastritis is suspected during biopsy, multiple samples must be collected to gain representative samples and differentiate it from neoplasia.
What is the most common form of treatment for gastric cancer?
Surgery is the most common form of treatment for gastric cancer.
What are the possible causes of increased PCV and TS?
Dehydration
What is the possible cause of normal PCV and increased TS?
Hyperglobulinaemia
What is the possible cause of decreased PCV and normal TS?
Acute haemorrhage
