Internal Medicine: Gastroenterology: Approach to Vomiting Flashcards
What is the difference between primary and secondary vomiting?
Primary vomiting
* Underlying gastric disease
Secondary vomiting
* non GI-diease
What causes vomiting?
- Chemoreceptor trigger zone
- Pharynx
- Stomach
- Duodenum
Causes the vomiting centre to:
- Contract pylorus
- Relax stomach
- Contract abdominal M
- etc
What could cause vomiting secondary to systemic/metabolic diease
- Infections- distemper, lepto
- Pyo
- Renal failure
- Hepatic diease
- Drugs- digoxin, erythromycin
- Hypoadrenocorticism
- CNS disease
- Motion sickness
- Vestiublar disease
- Neoplasia
Etc
What can cause chronic vomiting?
- Inflammatory bowel disease
- Intestinal neoplasia
- Small intestinal obstruction
- Pancreatitis
- Peritonitis
Primary gastric disease- chronic gastritis, retention disorders, ulcers, neoplasia
What is the pathophysiology of gastric disease?
- Gastric outflo obstruction
- Gastroparesis
- Disruption of mucosal barrier
How is chronic vomiting diagnosed?
- Distinguish vomiting vs regurgitatoin
- Eliminate secondary causes
- Abdominal imaging- radiograph, US
- Gastroscopy
- Symptomatic therapy
How is chronic vomiting diagnosed?
- Distinguish vomiting vs regurgitatoin
- Eliminate secondary causes
- Abdominal imaging- radiograph, US
- Gastroscopy
- Symptomatic therapy
What may be found on physical examination woth chronic vomiting?
Oral examination
* Ulcers
* Linear foreign body
Abdominal palpation
* Pain
* Foreign body, intra-abdominal mass
* Distended stomach or bowel
Rectal examination
* Diarrhoea
* Melaena
What are possible causes of chronic gastritis?
- Aetiology usually unknown
- Sometimes generalised IBD
- Chronic gastric paratism
- Hairballs in cats
- Spiral bacteria
- Immune-mediated
- What are the signs of chronic gastritis?
- How is it diagnosed?
- Intermittent chronic vomiting, periodic early morning vomit with bile, poor appetite, gastric bleeding
- Lab changes non-specific, imaging findings non-specific, gastroscopy and biopsy
How is chronic gastritis treated?
- Removal of aetiological agent if known
- Diet- multiple small meals, low fat diet, hypoallergenic
- Acid blocker
- Corticosteroids?
What may cause bilious vomiting?
How is it treated?
- Often occurs in dogs fed once daily
- Vomiting occurs overnight or in the morning
- Bile-stained fluid
Diagnosis- rule out other causes
Tx
* Feed more often, late meal
* Prokinetics
What can cause gastric retention disorders?
Retention of food for > 8h causing delayed vomiting of food
- Anatomical outflow obstruction
- Functional disorder- primary motility disorder, inflammatory disease
What can cause anatomical outflow obstructions?
- Pyloric stenosis
- Neoplasia, polyp
- CHPG
- Foreign body
Chronic hypertrophic pyloric gastropathy
How are the following disease treated?
1. Pyloric stenosis
2. CHPG
- Pyloromyotomy/pyloroplast
- Surgery
How are functional causes of gastric retention treated??
- Treat underlying inflammatory disease
- Prokinetics- metoclopramide
What can cause haematemesis?
- Generalised bleeding
- Swallowed blood- oropharyngeal, nasal, pulmonary
- Severe gastritis
- Gastric ulcer
- Gastric neoplasia
- Duoedenal disease
What is a peptic ulcer?
What are the aetiologies?
Peptic ulcer- ulcer in stomach or duodenum
Aetiology
* Drugs
* Head and spinal injuries
* Gastritis
* Metabolic- liver disease, uraemia
* Mastocytosis
* Gastrinoma
* Spiral bacteria- heliobacter
How are gastric ulcers treated?
- Treat identifiable primary cause
- Sucralfate
- Acid blockers
- ABs?
- H2 receptor antagonists- block stimulation of HCL secretion
- Proton pump inhibitors- omeprazole
Triple therapy
How can ulcers be prevented?
Limited protective effect
* H2 atagonists
* PPIs
* Sucralfate
Protective
* Synthetic PGE
What treatment can be for helicobacter causing gastric ulcers?
Triple therapy
* Two antibiotics plus an acid blocker
* 3 antibiotics- amoxicillin, metronidazole, clarithromycin
What gastric neoplasia can affect dogs and cats?
Dogs
* Adenocarcinoma
* Lympgoma
* Polyps
* Leiomyoma
Cats
* lymphoma
* Adenocarcinoma
What are the characterisitcs of gastric adenocarcinoma?
When should it be suspected?
- Infiltrate gastric wall
- Often lesser curvature of stomach
- Metastasis to LN and liver
Older animal with
* Chronic vomiting
* Anorexia and weight loss
* Haematemesis and melaena
* Anaemia
* Drooling saliva
