Gastroenterology Pt. 1 Flashcards
examples of non-specific GI signs
¡ Usually accompany more specific signs
¡ Occasionally the only signs
- Lethargy(depression)
- Non-localizablepain
- Hyporexia(inappetence),anorexia
- Dehydration
- Weightloss
if client says patient is vomiting, what should we wondder?
– Is it vomiting or regurgitation?– Is it GI or extra-GI in origin?
vomiting vs regurgitation: basic difference / way to differentiate
Vomiting active, regurgitation passive
Look at signs:
abdominal effort
Prodromal nausea
Character of ejected food
Timing of food ejected
Swallow attempts of a single bolus
Ability to drink
Pain on swallowing
Associated signs
vomiting vs regurgitation: abdominal effort
Regurgitation: none
vomiting: marked
vomiting vs regurgitation: prodromal nausea
Regurgitation: none
vomiting: present
vomiting vs regurgitation: character of ejected food
Regurgitation: undigested food (typically)
vomiting: usually digested
vomiting vs regurgitation: timing of food ejected
Regurgitation: variable
vomiting: variable
vomiting vs regurgitation: Swallow attempts of a single bolus
regurgitation: usually single
vomiting: single
vomiting vs regurgitation: ability to drink
regurgitation: variable
vomiting: normal
vomiting vs regurgitation: pain on swalling
regurgitation: possible
vomiting: absent
vomiting vs regurgitation: associated signs
regurgitation: dyspnea, cough
vomiting: +/- systemic signs
what type of problem may accompany esophogeal motility problem
dysphagia (difficulty swallowing)
what often accompanies vomiting in cats
-retching
why is quality of expelled material of limited utility to differentiate regurgiation from vomiting?
¡ Quality of expelled material somewhat limited utility because esophageal reflux may move stomach contents into esophagus
¡ Degree of digestion
¡ Digested versus fresh blood
¡ pH
¡ Bile
if in doubt about regurgitation vs vomiting…
¡ If in doubt – thoracic radiographs
gastrointestinal vs extra-gastro-intestinal causes of vomiting
- vestibular system acts on chemoreceptor trigger zone…
- higher CNS centres…
- vagal and sympathetic visceral afferents…
>all act on the vomiting centre in medulla
>motor impulses to upper GI tract and diaphragm/abdominal muscles
differential diagnoses for acute vomiting
¡ “Acute gastritis”
¡ GI foreign body (always a DDx)
¡ Acute pancreatitis (always a DDx)
how do we diagnose acute gastritis
- Self-limiting vomiting
- Diagnosis of exclusion
- Occasionally endoscopic biopsy
6 causes of acute vomiting
-FB (stomach, intestinal)
-Acute gastritis (infectious, toxin, drugs, dietary indiscretion, other)
-Ileus
-Pancreatitis
-Renal failure, acute or chronic
-Addison’s disease
Remember to think of GI and extra-GI causes
6 causes of acute regurgitation
-FB (esophagus)
-Acute esophagitis (caustics, previous vomiting, previous FB)
-Esophageal dysmotility, megaesophagus
-Esophageal stricture (more chronic)
-Hiatal hernia (more chronic)
-Addison’s disease
Remember to think of GI and extra-GI causes
in a case of acute vomiting, do we go with conservative management versus work-up and hospitalization?
-can start with conservative management
-Small volume frequent oral fluids, ice chips, SC fluids
- “Bland diet”
§ If any worsening of signs -> work-up and hospitalization
what does conservative management of acute vomiting entail?
¡ Small volume frequent oral fluids, ice chips, SC fluids
¡ “Bland diet”
>Easily digested, reduced fat & fibre (see Diarrhea)
Ø Commercial – numerous “prescription” GI diets
Ø Home-made – e.g. cottage cheese, boiled chicken/hamburger, rice, potato
What about use of antiemetics in conservative management? when is it ok? concerns?
¡ Okay to use so long as short-term & recheck
¡ Concerns
* Promoting obstruction (metoclopramide)
* Masking foreign body (Cerenia product warning)
* Masking more serious disorder
Factors promoting workup and/or hospitalization for acute vomiting
¡ Vomiting moderate-to-severe
¡ Duration > 72 hours, especially if moderate-to-severe
¡ Known exposure to foreign material or toxin
¡ Older animal, especially if no previous GI history
¡ Owner desires, even though overkill (always offer)
¡ Depression, impression that animal is sick
¡ Fever
¡ Moderate-to-severe dehydration
¡ Shock
¡ Moderate-to-severe abdominal pain
¡ Abdominal distension, especially if breed prone to GDV
¡ Hematemesis, melena (proximal GI tract bleeding)
¡ Abdominal mass
¡ Any sign suggesting an extra-GI cause
lab workup for vomiting? purpose of this?
Routine CBC & biochemistry profile for vomiting and/or diarrhea (acute & chronic)
Purpose of lab work is to:
1) Help rule-out non-GI causes of V/D
eg. Kidney, pancreatic, or liver disease
2) Characterize severity of dehydration and electrolyte imbalances resulting from V/D
3) Potentially localize GI lesion (not often)
4) Often does not help with specific diagnosis of cause of GI signs
will labwork often help with specific diagnosis of cause of GI signs?
Often does not help with specific diagnosis of cause of GI signs
how useful is radiology for work-up in acute vomiting case?
¡ Common and useful in work-up of acute vomiting
purpose of barium with radiology for acute vomiting
Use barium only to detect delayed gastric emptying and intestinal obstruction
* Use of barium much lower where ultrasound available
* Barium may prevent endoscopy
what do we look for in a radiograph in a vomiting case?
- normal pyloris?
-foreign material? - ileus - distended loops of intestine (can be obstructive or inflammatory)
- Plication with small gas bubbles– linear FB (watch out for normal plications in cats)
- GDV – gas-distended stomach with “shelf”
should we interpret thickness of intestines to diagnose cause of vomiting? why?
Do NOT interpret thickness of intestines: appearance of thickness depends upon fat outside intestinal wall and fluid inside lumen
when is ultrasound useful in a vomiting case
¡ Utility in animals with acute vomiting
- Gastric emptying and ileus
vAssessment of motion
vFluid accumulation - Thickness of stomach wall and intestines
vMore useful in chronic vomiting
vAssess for ulceration - Assessment for foreign material
¡ < radiology for gastric foreign bodies
¡ Excellent for small intestinal foreign bodies
Gastric foreign body management options
Each approach has risks & benefits
* Induce vomiting if recently witnessed
* May pass on its own
* Endoscopy
* Surgery
induced vomiting for gastric foreign body: when to use, risks
Induce vomiting if recently witnessed
vSmall risk of aspiration
vSmall risk getting stuck in esophagus
pros and cons of letting GI foreign body pass on its own
Maypassonitsown
vBut less complicated Sx if not obstructed or perforated (sharp FB)
pros and cons for endoscopy for gastric foreign body management
vMinimally invasive
vMay take longer than gastrotomy
vSome objects difficult to grasp/too large
con for surgery for GIU foreign body
- More invasive
