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3. Cat & Dog > Gastroenterology Pt. 3 > Flashcards

Gastroenterology Pt. 3 Flashcards

1
Q

causes of acute regurgitation (6)

A

-FB (esophagus)
-Acute esophagitis (caustics, previous vomiting, previous FB)
-Esophageal dysmotility, megaesophagus
-Esophageal stricture (more chronic)
-Hiatal hernia (more chronic)
-Addison’s disease

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2
Q

common types of esophogeal foreign bodies

A

¡ Bone is most common
*Also: Gristle, rawhide, fish hooks

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3
Q

signs of esophageal foreign body

A

¡ Hypersalivation, odynophagia (painful swallowing), repetitive swallowing, halitosis

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4
Q

breed overrepresented for esophogeal foreign bodies

A

¡ Westies over-represented

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5
Q

Locations where we may see an esophogeal foregin body on a radiograph

A

¡ Immediately caudal to larynx
¡ Cervical esophagus
¡ Thoracic inlet
¡ Base of heart
¡ Cranial to diaphragm
> Radiograph not as dramatic as may expect

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6
Q

acute complications of an esophageal foreign body

A

¡ Aspiration pneumonia
* Cough, tachy/dyspnea, nasal discharge, fever

¡ Esophageal perforation
* Tachy/dyspnea, fever

¡ Airway obstruction
* Trachea compressed at base of heart
* Especially puppies
* Choking, dyspnea, cyanosis, CP arrest, cannot expand lungs after intubation

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7
Q

esophageal foreign body treatment

A

¡ Emergency
¡ Refer for endoscopic retrieval or surgery

¡ Sucralfate liquid, pink lady (viscous lidocaine & aluminum hydroxide), famotidine/omeprazole, analgesia
¡ Feed as usual?
¡ Surgery
> If endoscopy unsuccessful
> Caudal esophageal FB may often be removed by gastrotomy
> Thoracotomy
* Likely needed if esophageal perforation

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8
Q

ESOPHAGEAL FOREIGN BODY: PROGNOSIS

A

¡ Prognosis good in most cases
> Chronic complication:
* Esophageal stricture (cicatrix) = 10% risk
* More likely if perforation or surgery >Continue to regurgitate
>Confirmed with esophagram, endoscopy

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9
Q

gastric mucosal barrier consists of what? what happens if there is a disturbance to any of these?

A

¡ Gastric mucosal barrier consists of:
> Bicarbonate-rich mucus
> Mucosal cells
> Blood supply

¡ Disturbance to any of these:
> Damage by gastric acid and pepsin
> Risk for ulceration

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10
Q

what are the protective mechanisms and aggressive factors that prevent or contribute to GI ulceration

A

Imbalance between:

¡ Protective mechanisms:
- Decreased mucous secretion
- Decreased bicarb secretion
- Decreased prostaglandins
- Decreased mucosal blood flow

¡ Aggressive factors:
- Direct injury
- Increased gastric acid secretion

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11
Q

3 broad classifications of GI bleeding

A
  • overt
  • Occult
  • Obscure
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12
Q

what is overt GI bleeding?

A
  • Grossly visible
  • Hematemesis, hematochezia, melena
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13
Q

what is occult GI bleeding?

A
  • Hemorrhage that is not visible
  • Manifested as positive fecal occult
    blood test or iron deficiency anemia
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14
Q

what is obscure GI bleeding

A
  • Recurrent GI bleeding in which a source cannot be identified
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15
Q

localization of GI bleeding: two categories

A

¡ Upper GI bleeding: bleeding oral to duodenojejunal junction
¡ Lower GI bleeding: bleeding aboral to ligament of Treitz

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16
Q

hematemesis: what are the signs, what is the source and localization? differential diagnosis?

A

Vomiting of blood:
¡ Frank blood (fresh)
¡ Coffee ground vomiting
- Black pigment: hematin = oxidized heme
¡ Source of blood: GI bleeding or swallowed blood
¡ Localization of GI bleeding: Upper
¡ Differential diagnosis: hemoptysis

17
Q

melena: what are the signs, what is the source and localization? differential diagnosis?

A

¡ Black, tarry stools
¡ Required amount of blood:
> Dogs: 350-500mg hemoglobin/kg
¡ Source: GI bleeding or swallowed blood
¡ Localization: upper GI > lower GI
> Lower GI and delayed transit time
¡ Differential diagnoses: medications (ferrous sulfate, activated charcoal, bismuth suspensions), raw food, blueberries

18
Q

hematochezia: what are the signs, what is the source and localization? differential diagnosis?

A

¡ Bright red-coloured stools
¡ Source of blood: GI bleeding
¡ Localization: lower GI > upper GI
> Upper GI and increased transit time
¡ Differential diagnoses: food containing red food colouring, large amounts of beets, perineal wound, anal sac abscess

19
Q

causes of GI ulceration

A

¡ Drugs
* NSAIDS – most important in dogs
> NEVER give meloxicam/other NSAIDS to a vomiting dog
* Corticosteroids – important co-factor

¡ Primary GI
* Neoplasia – adenocarcinoma, lymphoma
* Foreign body
* Inflammatory bowel disease (uncommon)
* Fungal infection (rare)

¡ Secondary GI:
* Pancreatitis
* Liver failure
* Kidney failure
* Hypoadrenocorticism (Addisons)
* Mast cell tumour
* Systemic disease (GI ischemia + stress)
* Pancreatic gastrinoma (rare)

20
Q

use of radiographs and ultrasound for GI bleeding

A

¡ Radiographs unremarkable
> Most useful to identify foreign body

Ultrasound:
¡ Can identify some ulcerations
¡ Local thickening of gastric wall
¡ Loss of layering, wall defect
¡ Fluid accumulation in stomach
¡ Reduced gastric motility

21
Q

diagnostics for stomach bleeding

A

¡ Exploratory Surgery
¡ Flexible Endoscopy
¡ Capsule endoscopy (ALICAM, PillCam)

22
Q

diagnostics for duodenal bleeding

A

¡ Exploratory Surgery
¡ Flexible Endoscopy
¡ Capsule Endoscopy

23
Q

diagnostics for jejunal bleeding

A

¡ Exploratory Surgery
¡ Capsule Endoscopy

24
Q

capsule endoscopy vs flexible endoscopy vs surgery - differences in diagnostic methods for GI bleeding

A

Capsule:
-visualization
-no biopsy
-non-invasive
-available
-Dx only

Flexible:
- visualization
- biopsy mucosa
- smaller biopsies
- minimally invasive
- more expensive
- less available
- Dx and occasional Tx

Surgery:
- palpation
- biopsy all layers
- bigger biopsies
- invasive
- most expensive
- available
- Dx and Tx

25
Q

options for medical treatment of GI ulceration

A

Inhibit gastric acid secretion:
¡ Block H2 receptor – ranitidine, famotidine
¡ Block proton pump – omeprazole, pantoprazole
¡ Block intracellular cAMP – misoprostol

Neutralize gastric acids:
¡ Al(OH)3, Mg(OH)2, CaC03
¡ Limited use except in uremia

Protect cells:
¡ Sucralfate

Increase local prostaglandins:
¡ Misoprostol (synthetic PGE1 and PE2)
* Many beneficial effects (pH, mucus, blood flow)

26
Q

significanace of helicobacter for gastritis

A

¡ H. pylori a major cause of gastritis and ulcers in humans (although many asymptomatic)
¡ Role in gastritis in dogs and cats?
¡ Vast majority of dogs asymptomatic
* >80% serologic positive

27
Q

how to diagnose helicobacter GI? what is the ‘best’?

A

Cytology:
- Gastric brush cytology
¡ Least expensive
¡ Most practical, fastest turnaround
¡ More sensitive than urease or histopathology

Rapid urease test

Histopathology

Culture:
¡ Not routinely conducted

28
Q

use of rapid urease test for helicobacter dianosis? how to tell number in sample? when may we see false + or -?

A

¡ Detects the presence of urease produced by Helicobacter in a biopsy
¡ Rate at which the gel changes from yellow to magenta is proportional to the number
of Helicobacter in the sample
¡ No colour change within 24 hours= negative test
¡ False positives can be due to presence of other urease producing bacteria
¡ False negatives due to patchy distribution

29
Q

what does helicobacter look like with histopathology?

A

¡ Spiral bacteria (within the mucus covering the surface epithelium, the gastric pits,
glandular lumen and the parietal cells)
¡ Gastritis observed in infected dogs «&laquo_space;H. pylori infected humans
¡ Modified Steiner’s silver stein

30
Q

when will we consider helicobacter for gastitis?

A

¡ Rule-out other causes chronic vomiting
¡ If no other cause found + organisms

31
Q

treatment for helicobacter

A

¡ Veterinary protocols adapted from humans
* Humans: amoxicillin, metronidazole, clarithromycin
* H2 blocker, proton pump inhibitor [Helicobacter proliferate in acid environment]
* Pepto-Bismol

32
Q

Gastric neoplasia broad categories? always with vomiting?

A

¡ Adenocarcinoma
¡ Lymphoma
¡ Leiomyoma
¡ Leiomyosarcoma

¡ May occur without vomiting

33
Q

BENIGN CAUSES OF CHRONIC VOMITING

A

¡ Eating too quickly

¡ Billious vomiting syndrome in dogs
> Vomiting in morning - otherwise fine
* Any age
* Add meal at bedtime
* Low fat diet
* Prokinetic drugs

34
Q

What is delayed gastric emptying? delayed gastric emptying is often present with what? analagous to what?

A

Reduced/altered gastric motility

¡ Often present and expected with disorders causing acute vomiting
¡ Analogous to intestinal ileus

35
Q

delayed gastric emptying can cause vomiting how long after feeding? what type of vomiting?

A

¡ Sometimes > 8-10 hours after feeding
¡ Sometimes projectile

36
Q

what pyloric issues can lead to delayed gastric emptying?

A

¡ Congenital pyloric stenosis
* Brachycephalic dogs
* Siamese cats

¡ Acquired pyloric stenosis
* Idiopathic (small breed dogs)
* Chronic use of omeprazole
* Pancreatic gastrinoma (rare)

¡ Chronic foreign body
¡ Pyloric or antral tumour

37
Q

DELAYED GASTRIC EMPTYING- DIAGNOSIS AND TREATMENT

A

¡ Barium study
¡ Abdominal ultrasound
¡ Endoscopy
- most useful for identifying foreign bodies
¡ Surgery
- Biopsy
- Response to pyloroplasty

3. Cat & Dog (33 decks)

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