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Small Animal Medicine II > Gastroenterology - Vomiting > Flashcards

Gastroenterology - Vomiting Flashcards

1
Q

What are the vomiting phases?

A

Phase 1 - nausea
Phase 2 - retching
Phase 3 - forceful expulsion

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2
Q

What occurs during phase 1 of vomiting?

A

Nausea

  • hiding or seeking attention
  • ptyalism, yawning, shivering, tachycardia, pallor
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3
Q

What occurs during phase 2 of vomiting?

A

Retching

  • abdominal muscles, chest wall, and diaphragm contract
  • deep inspiratory movements
  • respiratory center inhibited
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4
Q

What occurs during phase 3 of vomiting?

A

Forceful Expulsion

  • force arise from contraction of abdominal muscles and diaphragm
  • stomach, esophagus, and sphincter relax
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5
Q

Describe the mechanism of “motion sickness”

A

inner ear/labyrinth stimulation
> dopamine and serotonin released from CRTZ activation
> Ach released from emetic center

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6
Q

What is stimulated with chemo-agent induced emesis?

A

5-HT3 and CRTZ

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7
Q

How does uremia cause emesis?

A
  • decreased gastrin clearance > ulcers and gastritis
  • toxins crossing BBB > stimulate central and peripheral receptors
  • activates CRTZ via dopaminergic receptors
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8
Q

Describe the physiological pathway of emesis

A
  • activation of chemoreceptors and mechanoreceptors
  • stimulation of visceral afferent receptors
  • direct stimulation of cerebral cortex and limbic system, or, vestibular system stimulation
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9
Q

What is the CRTZ?

A

Chemoreceptor Trigger Zone

  • stimulated by vestibular system
  • free nerve endings bathed in CSF
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10
Q

How does intestinal inflammation stimulate emesis?

A

direct afferent input to vomiting center

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11
Q

What are the effects of opioids?

A

stimulation of CRTZ
increased vestibular sensitivity
gastric stasis
impaired intestinal motility and constipation

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12
Q

What are the possible differentials for acute vomiting?

A
  • toxin
  • dietary indiscretion
  • medication
  • diet change
  • foreign body
  • pancreatitis
  • Addisonian crisis
  • acute manifestation of chronic disease
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13
Q

What are the possible differentials for chronic vomiting?

A
  • intermittent foreign body
  • organ failure/dysfunction
  • chronic pancreatitis
  • primary gastric disease
  • primary small intestinal disease
  • atypical Addisons, hyperthyroidism
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14
Q

What tests are included in the “Big 4”?

A

PCV
Total solids
Blood glucose
AZO stick

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15
Q

What diagnostics can be done for the vomiting patient?

A
  • CBC, Chem, UA
  • fecal
  • coagulation profile
  • baseline cortisol
  • PLI to assess for pancreatitis
  • radiographs, ultrasound, endoscopy
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16
Q

What should be looked for on an abdominal radiograph of a vomiting patient?

A
  • GDV
  • GI or urinary obstruction
  • large mass
  • pyometra
  • effusion
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17
Q

What should be looked for on a chest radiograph of a vomiting patient?

A
  • aspiration pneumonia
  • dilated esophagus
  • diaphragmatic hernia
18
Q

What should be looked for on an abdominal ultrasound of a vomiting patient?

A
  • obstruction
  • large or small mass lesions
  • alteration in lining of stomach or SI
  • pancreatitis
  • other organ problems
19
Q

What is the purpose/benefit of doing an endoscopy on a vomiting patient?

A
  • visual exam of esophagus, sphincters, stomach, and duodenum
  • remove foreign bodies
  • biopsy tissue
20
Q

What therapy should be done for an acutely vomiting, but not ill, patient?

A
  • medical: fluid therapy, diet modification, and time
  • no water for 6 hours, then small frequent amounts
  • if no vomiting, small meals every 4-6 hours
21
Q

What therapy should be done for acute or chronic vomiting patient that is ill?

A
  • IV fluids
  • antacids, mucosal protectants
  • pain management
  • nutritional support
22
Q

Which fluids are used for maintenance?

A

Normosol
Plasmalyte
LRS
Sodium Chloride 0.9%

23
Q

What is the mechanism of histamine receptor antagonists?

Name some drugs

A
  • affect gastric parietal cell receptors
  • limit acid secretion with mild to little effect on pH
  • Famotidine, Ranitidine, Cimetidine
24
Q

What is the mechanism of proton pump inhibitors?

Name some drugs

A
  • inhibits transport of hydrogen ions into the stomach
  • inhibits the hepatic cytochrome P-450 mixed function oxidase system
  • Pantoprazole, Omeprazole
25
Q

What is the main mechanism of action of antiemetic drugs?

A

block/compete with neurotransmitters at the receptor sites associated with emesis

26
Q

What is Scopalamine?

What does it do?

A

M1-Cholinergic receptor antagonist

  • crosses BBB
  • causes excitement in cats
27
Q

What are possible side effects of M1-Cholinergic receptor antagonists?

A

sedation and hypotension

28
Q

Name some M1-Cholinergic receptor antagonists

A

Phenothiazines

Propantheline and Isopropamide

29
Q

Are Histamine antagonists used in cats?

Why or why not?

A

no because cats do not have histamine receptors on their CRTZ

30
Q

What are some histamine antagonists?

A

Diphenhydramine
Meclizine - vestibular disease
Cyproheptadine - appetite stimulation

31
Q

What type of drug is Metoclopramide?

What are the effects and side effects?

A
  • D2-Dopaminergic antagonist
  • stimulates movement of distal esophagus
  • 5-HT3 antagonist and 5-HT4 agonist
  • side effects: constipation and mentation change
32
Q

Is Metoclopramide more effective in dogs or cats? Why?

A

more effective in dogs

- cats have fewer dopamine receptors

33
Q

What type of drugs are Ondansetron and Dolasetron?

What are their side effects?

A
  • 5-HT3 Serotonin antagonists
  • effect receptors in GIT and CRTZ
  • side effects: dry mouth, fatigue, constipation
34
Q

What type of drug is Maropitant?
What is the mechanism of action?
What are the side effects?

A
  • NK-1 receptor antagonist
  • competes with substance P
  • s/e: ataxia, anorexia, diarrhea, injection soreness, and bradycardia with high dose
35
Q

Describe the action of Sucralfate/Carafate

A
  • stimulates PG E2
  • reacts with HCl to form a paste that sticks to ulcers
  • inactivates pepsin and binds bile acids
36
Q

What is Misoprostal?

What are does it do?

A
  • prostaglandin analog
  • treat/prevent gastric ulcers
  • direct action on parietal secretion of gastric acid
37
Q

What is Octreotide?

What does it do?

A
  • stomatostatin analog

- treatment of insulinomas and gastrinomas

38
Q

What are some examples of prokinetics?

A
  • Metoclopramide
  • Cisapride
  • Ranitidine
  • Erythromycin
39
Q

What is cyproheptadine?

What is it used for?

A
  • H1 receptor blocker
  • serotonin antagonist
  • appetite stimulation
40
Q

What is a tricyclic antidepressant?

What is it used for?

A
  • 5-HT3 antagonist

- increases NE and appetite

Small Animal Medicine II (15 decks)

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