GI: gastric disease

Question 1

What two enzymes are produced by the stomach to aid in digestion?

Answer 1

Pepsin, gastric lipase

Question 2

A small amount of instrinsic factor is produced by what cells in the dog stomach?

Answer 2

Parietal cells and cells at the base of the antral glands

Question 3

What breeds are predisposed to hypertrophic gastropathy?

Answer 3

Shih Tzu, Basenji

Question 4

What breed is predisposed to atropic gastritis?

Answer 4

Lundehund

Question 5

Prior to measuring serum gastrin, omeprazole/famotidine must be discontinued for how many days?

Answer 5

1 week

Question 6

What non-gastric diseases can cause an increase in gastrin?

Answer 6

Renal and hepatic dysfunction

Question 7

A gastric pH<3 with an increased serum gastrin raises concerns for that disease process?

Answer 7

Gastrinoma (Zollinger-Ellison)

Question 8

Mast cell tumors and hyperhistaminemia can induce gastric acid secretion. What would the serum gastrin level be?

Answer 8

Low

Question 9

In patients with achlorhydria, what would serum gastrin and gastric pH be?

Answer 9

pH >3 with increased serum gastrin (in humans, pH <2.5 with gastrin >1000 is diagnostic)

Question 10

If a gastrinoma is suspected, what IV infusions can be given for further investigation?

Answer 10

Secretin or Ca - neither of these lead to release of gastrin in a normal animal, but both lead to gastrin release from a gastrinoma (highest 2 and 5 minutes after secretin, 60 min after Ca)

Question 11

What are 3 consequences of a gastrinoma?

Answer 11

Gastric antral hypertrophy, hyperacidity, and ulceration

Question 12

Where is the most common location for a gastrinoma?

Answer 12

Right limb or body of the pancreas

Question 13

What percent of gastrinomas have metastasized at the time of diagnosis?

Answer 13

85% (LN, mesentery, spleen, liver)

Question 14

What prostaglandin is gastroprotective?

Answer 14

PGE2

Question 15

Where are NSAID induced ulcers typically located?

Answer 15

Antrum

Question 16

What is the main side effect of omeprazole?

Answer 16

Diarrhea

Question 17

What is octreotide?

Answer 17

Long acting somatostatin analog

Question 18

How does octreotide affect gastrin/gastric acid?

Answer 18

Directly decreases the secretion of gastrin and therefore gastric acid production - can be used in gastrinomas

Question 19

What is misoprostol and what is it used for?

Answer 19

PGE2 analog - protects against NSAID induced ulceration without altering gastric acidity

Question 20

How does sucralfate work?

Answer 20

Binds to areas of denuded epithelial mucosa

Question 21

Does prophylactic administration of misoprostol, cimetidine, and/or omeprazole prevent gastric erosions in dogs on steroids?

Answer 21

No, unlike with NSAIDs. Cause of ulceration due to steroid use is unknown

Question 22

How do mast cell tumors induce vomiting?

Answer 22

Histamine causes H1 activation of the chemoreceptor trigger zone; H2 activation of gastric acid secretion

Question 23

What is the mechanism of action for metoclopramide?

Answer 23

Antagonizes D2-dopamingeric and 5HT3-serotonergic receptors, agonist of 5HT4, cholinergic effects on smooth muscle

Question 24

What is the mechanism of action of ondansetron?

Answer 24

Antagonized peripheral 5HT3 receptors

Question 25

What is the mechanism of action of maropitant?

Answer 25

Antagonized NK1 (neurokinin 1) receptors

Question 26

Maropitant has been associated with bone marrow hypoplasia in what age of dogs and cats?

Answer 26

Dogs <8 weeks, Cats <16 weeks

Question 27

Gram negative or pathogenic bacteria induce the release of what cytokines from epithelial cells?

Answer 27

Proinflammatory - IL-8, IL-1 beta

Question 28

Commensal bacteria induce the release of what cytokines from epithelial cells?

Answer 28

Immunomodulatory - TGFbeta, IL-10

Question 29

What are two treatment protocols for Helicobacter in dogs/cats?

Answer 29

Metronidazole, amoxicillin and famotidine Metronidazole, amoxicillin, bismuth +/- famotidine

Question 30

Following treatment for Helicobacter, what percent of dogs had clearance of the bacteria at 6 months post treatment?

Answer 30

43% (high relapse rate)

Question 31

Where do Helicobacter species colonize in the dog/cat?

Answer 31

Superficial mucus and gastric glands, particularly in the fundus and cardia

Question 32

What histopathologic changes are more common in dogs/cats infected with Helicobacter?

Answer 32

Degeneration of the gastric glands, parietal cell necrosis, LP inflammation

Question 33

What clinical conditions have NOT been linked to Helicobacter infection in dogs/cats?

Answer 33

Gastric ulceration, neoplasia, changes in serum gastrin, acid secretion

Question 34

H. pylori induces much more severe proinflammatory cytokine and cellular responses in dogs/cats than natural infection with large Helicobacter species. What does this suggest?

Answer 34

Suggests large Helicobacter species are likely commensal. Loss of tolerance to commensal organisms, rather than pathogenicity of these organisms, may contribute to any disease condition

Question 35

Hypertrophy of the fundic mucosa is associated with severe enteropathy in what breed?

Answer 35

Basenjis

Question 36

Hypertrophy of the pyloric mucosa is found in what dog breeds and is associated with gastric outflow obstructions?

Answer 36

Brachycephalics, Lhasa Apso

Question 37

What worm is capable of causing parasitic gastritis in cats?

Answer 37

Ollulanus tricuspis

Question 38

How is Ollulanus tricuspis transmitted?

Answer 38

Cat to cat by eating vomit. Yes, eating vomit. Not found in feces

Question 39

What endoscopic and histologic changes are found with Ollulanus tricuspis infection?

Answer 39

Rugal fold hyperplasia, 2-3mm nodules LP infiltrates, lymphoid follicle hyperplasia, fibrosis

Question 40

How is Ollulanus tricuspis infection diagnosed? Treated?

Answer 40

- Examination of gastric juice, vomit, or histopath. Not found in feces. - Treatment = fenbendazole

Question 41

What worm is capable of causing parasitic gastritis in dogs AND cats?

Answer 41

Physaloptera spp. 2-6cm long worms

Question 42

What are the intermediate and paratenic hosts of Physaloptera?

Answer 42

Cockroaches, beetles Lizards, hedgehogs

Question 43

Atrophic gastritis characterized by reduction in parietal cells and hyperplasia of neuroendocrine cells has been associated with gastric adenocarcinoma in what dog breed?

Answer 43

Lundehunds

Question 44

What is the suspected cause of bilious vomiting syndrome?

Answer 44

Motility disorder characterized by duodenogastric reflux

Question 45

What is the mechanism by which erythromycin promotes gastric motility?

Answer 45

Releases motilin to act on motilin receptors and mimic phase III of the inter digestive migrating motility complex to empty the stomach of solids

Question 46

What is the most common gastric neoplasm in dogs? In cats?

Answer 46

Dogs: Adenocarcinoma (47-72%) Cats: Lymphoma

Question 47

Where do gastric carcinomas most commonly occur in the dog?

Answer 47

Lesser curvature and pylorus

Question 48

In a retrospective analysis of dogs and cats with gastric neoplasia, what percent of neoplasms were identified on ultrasound? On endoscopy?

Answer 48

50% on ultrasound, 95% on endoscopy

Question 49

In a retrospective analysis of dogs and cats with gastric neoplasia, what neoplasm was the most commonly missed by ultrasound?

Answer 49

Lymphoma

Question 50

In a prospective clinical trial, did laparoscopic assisted gastropexy affect GI transit time in healthy dogs?

Answer 50

Nope!

Question 51

Does the cat esophagus enter the abdomen?

Answer 51

No - transitions directly into the stomach at the diaphragm level

Question 52

How small must particles be to enter the duodenum?

Answer 52

2mm

Question 53

How often do motilin plasma levels increase and what do they trigger?

Answer 53

Every 90-120 minutes, trigger migrating motor complexes

Question 54

What cat breed can develop pyloric stenosis at a young age?

Answer 54

Siamese

Question 55

Where are 5HT4 receptors located? Activation of these receptors results in what changes?

Answer 55

Located on enteric cholinergic neurons that innervate intestinal smooth muscle. Activation results in release of acetylcholine in the synaptic cleft and excitation of the cell membrane to increase motility

Question 56

How does gastroesophageal intussusception differ from a hiatal hernia?

Answer 56

The gastroesophageal junction remains in the normal anatomic position with an intussusception

Question 57

What is the average age of dogs with gastroesophageal intussusception?

Answer 57

Young - 13 months

Question 58

What was the survival to discharge and MST for dogs with gastroesophageal intussusception?

Answer 58

88% survival to discharge, MST 995 days

Question 59

What is common following surgical correction of gastroesophageal intussusception?

Answer 59

Persistent regurgitation, although some dogs had prior megaesophagus so ??

Question 60

What two drugs have been shown to increase gastric transit time in healthy cats?

Answer 60

Metoclopramide, erythromycin (equally effective)

Question 61

Chronic gastritis with lymphofollicular hyperplasia is associated with what other disease condition?

Answer 61

Chronic upper airway obstruction - brachycephalics, inspiratory dyspnea

Question 62

Compared to dogs with chronic gastritis, dogs with gastric carcinoma displayed what changes?

Answer 62

Older (10 vs 6.5 yrs), lower BCS (3 vs 4.5), higher CRP (>25), low folate

Question 63

Describe feline gastrointestinal eosinophilic sclerosing fibroplasia

Answer 63

Presence of eosinophilic masses confined to the GI tract and local LNs - cause unknown

Question 64

What breed of cat is over-represented in cases of feline gastrointestinal eosinophilic sclerosing fibroplasia?

Answer 64

Ragdolls

Question 65

What is a common physical exam finding in cats with feline gastrointestinal eosinophilic sclerosing fibroplasia?

Answer 65

Firm, irregular fixed abdominal mass in the cranial or mid-abdomen

Question 66

In cats with feline gastrointestinal eosinophilic sclerosing fibroplasia, what are common clinicopathologic changes?

Answer 66

Peripheral eosinophilia (50%), hyperglobulinemia (70%)

Question 67

When IV apomorphine is administered, what percent of dogs successfully vomit up foreign material?

Answer 67

76% in one study (495 dogs), 78% in another (61 dogs)

Question 68

What factors were associated with successful emesis of foreign material after apomorphine? With unsuccessful emesis?

Answer 68

Success: young dogs, dogs ingesting fabric, leather, or bathroom waste Unsuccessful: longer time between consumption and administration of apo, dogs that received opioids, sedatives, or antiemetics first