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RUSVM SAM 2 > GI System - Upper and stomach > Flashcards

GI System - Upper and stomach Flashcards

1
Q

What is the purpose of the circular and longitudinal muscles of the pharynx?

A

Circular - constrict to push food into esophagus (bolus formation)

Longitudinal - lifts the walls of the pharynx during swallowing

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2
Q

What are the phases of swallowing and what nerves are involved?

A

Oral: pre-hend food and form bolus which moves to end of tongue (CN trigeminal V, facial VII, hypoglossal 12)

Pharyngeal: propel bolus along pharynx, closure of larynx by epiglottis and inhibition of breathing, opening of UES by cricopharyngeal m. (CN glossopharyngeal IX and accessory XI)

Esophageal: bolus moves along esophagus into stomach (CN glossopharyngeal IX and vagus X)

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3
Q

Your patient presents for dysphagia..

What are your top DDX?

A

Congenital - cricopharygnealachalasia or esophageal dysmotility

Neuromuscular - myasthenia gravis or brainstem lesions

Myopathy/myositis

Neoplastic or paraneoplasic

Infectious (uncommon)

  • viral distemper or rabies
  • bacterial abscess
  • spirocera lupi
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4
Q

The main presenting complaint in your patient is dysphagia… what diagnostics would you do to find the cause?

A

Physical exam - watch patient eat and drink

Neurologic assessment — assess GAG or pharyngeal reflex (CN 9 and 10)

Assess pulmonary — aspiration pneumonia

Thin muscling of head — MMM (titers)

Nutrition status

MDB +/- thyroid 
Radiographs 
Fluoroscopy 
Acetylcholineseerase receptor antibody titer — MG 
Upper GI endoscopy 
MRI for brain stem lesions
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5
Q

What is the general management for dogs with pharyngeal disease?

A

Food and water consistency —> variable amongst patients (slurry vs meatballs vs solid food)

Elevate food and water dishes

Some need feeding tubes
Monitor for pneumonia

No neck leads —> use harness

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6
Q

What type of muscle makes up the esophagus in dogs and cats?

A

Dog - entire length is striated

Cat - distal aspect is smooth muscle

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7
Q

What are the layers of the esophagus

A 
Epithelium 
Basement membrane 
Laminate propria 
Muscularis mucous 
Submucosa 
Muscularis propria 
Adventitia
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8
Q

What diagnostics can determine the presence of foreign body or compressive lesions?

A

Barium mixed with water or food (careful of aspiration)

Lohexol - injectable contrast agent

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9
Q

What diagnostic method can you use to evaluate swallowing phases and peristalsis?

A

Fluoroscopy

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10
Q

What is esophagitis?

A

Inflammation of the esophageal mucosa (can affect motility)

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11
Q

What are causes of esophagitis?

A

Secondary to meds (eg doxycycline)

Foreign bodies

Caustic toxins

Gastrointestinal reflux (GERD)

General anesthesia

Primary GI disease

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12
Q

What could you see with rads and endoscopy that indicates esophagitis?

A

Rads : unremarkable or a mild transient dilation

Endoscopy: erythema +/- edematous mucosa +/- ulcer or erosions

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13
Q

What is the treatment for esophagitis?

A

Pain management

  • buprenorphine, codeine, fentanyl
  • magic mouthwash = lidocaine, diphenhydramine, maalox

Mucosal protection

  • sucralfate/carapace
  • antacid (omeprazole PPI)

Monitor for strictures
Look for underlying dz

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14
Q

What are causes of esophageal stricture?

A 
Trauma 
Neoplasia
Post-foreign body 
Post-anesthesia 
Severe esophagitis
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15
Q

Treatment fo esophageal stricture?

A

Balloon catheterization — breakdown stricture

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16
Q

Esophageal diverticulae are secondary to??

A

Trauma

Congenital abnormalities (PRAA)

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17
Q

What is the treatment for esophageal diverticulae?

A

Clear impaction

Surgery

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18
Q

What is myasthenia gravis?

A

Antibody production against acetylcholine receptions at NM junction

Congenital or acquired megaesophagus

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19
Q

T/F: it is possible for congenital megaeosphagus to improve over time

A

True

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20
Q

What breeds do we see congenital megaesophagus in?

A

SharPei, fox terrier, German shepherd, lab, Great Dane, Irish setters, mini schnauzer, Newfie, and Siamese cats

<6months

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21
Q

What are causes of acquired megaesophagus?

A

Idiopathic
Primary CNS - brainstem lesion

Primary neuromuscular disease

Neoplastic syndrome ( thymoma)

Endocrine association

  • hypothyroidism
  • Addison’s disease
Lead toxicity (hunting or fishing dogs- evidence on blood work) 
LES stricture / dysfunction
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22
Q

What is the treatment of MG?

A

Underlying disease and symptoms

Nutritional support +/- feeding tubes
Decrease risk of aspiration pneumonia and treat PRN

Variable food consistency

  • smaller more frequent meals
  • elevated food dishes
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23
Q

What is the prognosis for megaesophagus ?

A

Fair to good when patients tolerated interventions or feeding tubes

Guarded to poor

  • fulminant MG crisis
  • severe aspiration pneumonia
  • intractable regurg
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24
Q

What is the connection between the stomach and esophagus and prevents food from passing back?

A

Cardiac/esophageal sphincter

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25
Q

What is the connection between the stomach and duodenum?

A

Pyloric sphincter

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26
Q

What do you call food in the area of the duodenum that is a semi-solid, soapy mixture?

A

Chyme

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27
Q

What gastric juices are secreted into the stomach?

A 
HCl 
Salts
Enzymes
Water
Mucous
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28
Q

What are the layers of the stomach?

A

Gastric mucosa made of gastric glands and muscularis mucosae

Submucosa

Meissners plexus

Muscularis (3layers)

Auerbach (myenteric) plexus

Serosa

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29
Q

What are signals innervate the enteric nervous system?

A

Can function autonomously (sensory receptors, primary afferent, internurons, and motor neurons)

Also receives PSNS and SNS innervation from the central nervous system

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30
Q

Where is gastrin produced?

A

Gastric antrum, duodenum, and pancrease

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31
Q

What are the main physiologic actions of gastrin?

A

Simulate secretion of gastric acid and intrinsic factor from parietal cells

Simulate secretion of pepsinogen from chief cells

Promote gastric and intestinal motility, mucosal growth

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32
Q

Where is somatostatin produced?

A

Stomach, intestine, and pancreas (D cells)

33
Q

What is the main physiologic action of somatostatin?

A 
Inhibit the secretion and action of many hormones, including 
Gastrin 
Cholecystokinin 
Secretin 
Vasoactive intestinal peptide 
Gastric inhibitory polypeptide 
Motilin
34
Q

What are the components of the mucosa of the stomach?

A

Superficial epithelium
Laminate propria -> loose CT, immune system cells, and nutritional support

Gastric glands -> mucous neck cells, parietal cells (HCl), and chief cells (digestion)

Neuroendocrine cells

  • enterocromafin -> serotonin, histamine
  • somatostatin
  • gastrin

Muscularis mucosa - thin muscle layer

35
Q

Most intrinsic factor in dogs comes from the ____________ and is essential for absorption of what nutrient?

A

Pancreas

B12 (cobalmin) absorption

36
Q

What enzymes in the stomach contribute to protein and fat digestion

A

Pepsin - protein

Gastric lipase - fat

37
Q

How does fatty food affect the motility of the stomach?

A

Slows movement

38
Q

What clinical sign can help differentiate between esophageal disease and stomach disease?

A

Vomiting —> stomach disease

Regurgitation —> esophageal disease

39
Q

What is acute gastritis?

A

Inflammation of the stomach

  • sudden onset
40
Q

What are causes of acute gastritis?

A 
Drug, toxins 
Dietary indiscretion or intolerance 
Parasites 
Bacterial 
Viral 
Systemic illness
41
Q

How can you diagnose acute gastritis?

A

Based on history and clinical findings —> trial response to symptomatic care if not systemically ill

If clinical signs persist or systemically ill —> biopsy

42
Q

Treatment for acute gastritis?

A

Fluids
Antacids

Anti-emetics — once foreign body rule out or vomiting is protracted/severe enough to cause dehydration or electrolyte imbalances

Pain meds
Water and bland diet

43
Q

What is the diagnosis and treatment for gastric foreign body?

A

Based on history and clinical signs —> obstructive lesion has intermittent or persistent clinical signs
RADS

More common in young animals

Surgery or endoscopy

44
Q

How can you diagnose food bloat?

A

Acute vomiting or fetching along with abdominal distention or discomfort

Rads— gas distended stomach

45
Q

Treatment for food bloat?

A

Time - 24 to 36hours

Fluids 
Withhold food 
Walk frequently 
Pain managment 
\+/- lavage 
\+/- surgery
46
Q

Gastric ulcers arise from mucosal barrier injury.. what are the types of these injuries?

A

Disruption of normal gastroprotection

Decreased blood flow

Hyper-secretion of acid

Decreased mucous or bicarb

47
Q

Mucosal barrier injury leading to gastric erosion and ulcers can be secondary to what causes?

A

Neoplasia: gastrinoma, MCT, other hypovolemic shock, hypotension

Trauma, foreign bodies

Medications: NSAID or steroid

Uremic gastritis

48
Q

Clinical signs associated with gastic erosion and ulcers?

A 
\+/- vomiting 
Hematemesis 
Melena 
Retch 
Inappetence 
Weak
49
Q

What diagnostics would you do if you suspected gastric uclers and what would you expect to find?

A

CBC/biochem : anemia, elevated BUN

Rads- defects may be seen with contrast

UA- protein loss? R/O renal disease causing a gastric uremia

Ultrasound +/- thickened wall or focal looks of layers/free fluid

** endoscopy - visual confirmation and biopsy

50
Q

What is the treatment for gastric erosion/ulceration?

A

Treat primary dz

Mucosal protection —> sucralfate, proton pump inhibitor (omeprazole)

Pain management

Blood transfusion

Nutrition

51
Q

What treatment options can you use for helicobacer gastritis?

A

Antibiotics — amoxicillin / tetracycline / erythromycin / flagyl

Antacids — omeprazole / Pepcid AC

Pepto-bismol - accumulates in cell wall and destroys helicobacter

52
Q

Common roundworms found in dog stomach?

A

Toxocara canis

53
Q

What is the treatment for toxocara ?

A

Fenbendazole or paraneoplasic palmate

54
Q

Stomach worm of canines and felines? How can each be diagnosed?

A

Round worms (toxocara canis/cati) - visualize or fecal

Physalloptera - difficult to float but 2-6cm worms can be seen on endoscopy

Feline — ollulanus tricuspsi - biopsy, gastric juice evaluation, vomitus evaluation

55
Q

How can physalloptera be treated?

A

Pyrantel pamoate

56
Q

How do you treate ollulanus tricuspsi?

A

Fenbendazole

57
Q

You have chronic vomiting in your dog.. you do endoscopy and see a thickened gastric outflow tract and masses which biopsy shows to be pyogranulomatous inflammation What would be on your Dx?

A

Pythiosis

Oomycete - P. Insidiosum

58
Q

What is the treatment and prognosis for pythiosis?

A

Pythiosis vaccine (preventative)

Terbinafine and itraconazole antifungals

surgery — wide margins required

High fatality ate

59
Q

Clinical signs associated with gastroesophageal reflux?

A

Chronic vomiting or regurgitation

Lip licking, hard swallow, ptyalism, esophagitis

60
Q

How do you treat gastroesophageal reflux?

A

Sucralfate and proton pump inhibitor

Treat primary disease

61
Q

How can you diagnose inflammatory gastritis?

A

Endoscopy / surgical biopsy — infiltrate of inflammatory cells (lymphoplasmacytic, also eosinophilic and mast cells) in mucosa and lamina propria

62
Q

You suspect an inflammatory gastritis but are waiting for your biopsy to confirm… how do you treat in the meantime?

A

Symptomatic therapy
Antacid/gastorprotectant
Antiemetics
Empirical deworming — fenbendazole and pyrantel pamoate

Diet trial with hypoallergenic or novel protein diet

63
Q

Biopsy confirms inflammatory gastritis… how do you treat?

A

Immune modulation

Prednisone (dog)/ Prednisolone (cat)

Cyclosporine or atopica
Mycophenolate
Azathioprine
Chlorambucil

64
Q

Your patient has atrophic gastritis… what happens if the inflammation is not treated?

A

Chronic vomiting
Marked mononuclear (lymphocytes, macrophages)
Thinning of gastric mucosa
Atrophy of gastric glands

65
Q

How is atrophic gastritis treated??

A

Same also other inflammatory dz..

Immune modulation

Prednisone (dog)/ Prednisolone (cat)

Cyclosporine or atopica
Mycophenolate
Azathioprine
Chlorambucil

66
Q

Clinical signs associated with hypertrophic gastropathy?

A

Chronic vomiting — hours after earring

67
Q

What are causes of of hypertrophic gastropathy?

A

Inflammatory infiltrates

Hypergastrinemic conditions

  • decreased clearance from renal or liver dz
  • gastrin secreting tumor
68
Q

Breeds associated with hypertrophic gastropathy?

A

Older, small breeds

69
Q

Therapy for hypertrophic gastropathy?

A

Treat underlying dz

Surgical resection of thickened tissue

70
Q

Congenital pyloric stenosis/hypertrophy is see in what breeds?

A

Boxer, Boston terrier, English bulldog, and Siamese cats

71
Q

Clinical signs of pyloric stenosis/hypertrophy?

A 
Vomiting several hours after meal — delayed gastric emptying (rads) 
Weight gain 
Aspiration pneumonia 
Depression 
Dehydration
72
Q

Acquired causes of pyloric stenosis?

A

Inflammation

Neoplasia (gastrinoma)

73
Q

What is Zollinger-Ellison syndrome?

A

Gastrinoma— gastrin secreting tumor

Chronic vomiting
Thickened gastric wall, hypertrophy of pyloris, gastric ulceration

Reflux esophagitis
+/- diarrhea

74
Q

Where are gastrinoma tumors usually located?

A

Pancreas

75
Q

How can you diagnose a gastrinoma?

A

Gastrin level assessment

Low pH of gastric juice + high level of gastrin

US/CT scan
Scintigraphy
Biopsy

76
Q

Treatment of a gastrinoma?

A

Surgical removal of tumor (often has mets)

PPI- high dose
Octreotide — inhibits gastrin

77
Q

DDX for stomach neoplasia?

A

Leiomyoma/leiomyosarcoma
Adenomatous polyps

  • *Adenocarcinoma (DOG)
  • *LSA (CAT)
78
Q

How do you diagnose bilious vomiting syndrome ?

A

Early morning bile vomiting
Usually young dogs

Caused by reflux of duodenal fluid into stomach and irritation of GI mucosa

79
Q

Treatment of Bilioius vomiting syndrome?

A

Frequent small feedings
Prokinetic
Gastroprotectants
Novel protein diet

RUSVM SAM 2 (44 decks)

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