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Module 16 > Investigation & Management of Vomiting in Dogs and Cats > Flashcards

Investigation & Management of Vomiting in Dogs and Cats Flashcards

1
Q

what is the vomiting reflex

A
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2
Q

what acts on the vomiting centre (4)

A
  1. cerebral cortex
  2. chemoreceptor trigger zone
  3. vestibular apparatus
  4. gastro intestinal tract/peripheral stimuli
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3
Q

what acts on the chemoreceptor trigger zone (5)

A
  1. uremia
  2. DKA
  3. cardiac glycoside toxicity
  4. apomorphine
  5. chemotherapy
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4
Q

what acts of cerebral cortex to cause vomiting (4)

A
  1. anxiety
  2. raised intracranial pressure
  3. meningitis/encephalitis
  4. trauma
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5
Q

what acts on the vestibular apparatus to cause vomiting (2)

A
  1. motion sickness
  2. vestibular syndromes
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6
Q

what acts on the gastro intestinal tract/peripheral stimuli to cause vomiting (5)

A
  1. chemicals/irritants
  2. inflammation
  3. excessive stretch of the GI tract
  4. peritonitis
  5. bladder obstruction
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7
Q

how does the GI tract/peripheral stimuli send signals to the vomiting centre

A

via CN X, IX and sympathetic afferents

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8
Q

what are the receptors in the chemoreceptor trigger zone (6)

A
  1. D2 (dopamine)
  2. 5HT3 (serotonin)
  3. M1 (cholinergic)
  4. opioid receptors (μ, κ, δ)
  5. H1 (histamine(
  6. NK1
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9
Q

what are the receptors that are on the vestibular appartus (2)

A
  1. H1 (histamine)
  2. M1 (cholinergic)
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10
Q

what receptors are in the GI tract/peripheral stimuli

A
  1. 5HT3 (serotonin)
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11
Q

what are the receptors in the vomiting centre (3)

A
  1. 5HT1 (serotonin)
  2. alpha 2-adrenergic
  3. NK1
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12
Q

how does the vestibular apparatus send signals to the vomiting centre

A

via CN VIII

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13
Q

how emesis mediated by the vomiting centre (3)

A
  1. 5HT4
  2. Ach (muscarinic)
  3. motilin receptors
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14
Q

how does the vomiting centre send signal to mediate emesis

A

via CN X and IX efferents

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15
Q

how do you distinguish the difference between vomiting and regurgitation

A
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16
Q

which is active and forceful expulsion of gastric and/or duodenal contents, vomiting or regurgitation?

A

vomiting

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17
Q

which is passive retrograde expulsion of esophageal or gastric contents, vomiting or regurgitation

A

regurgitation

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18
Q

which is preceded by signs of nausea and retching

A

vomiting

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19
Q

which occur minutes to hours after eating, vomiting or regurgitation

A

regurgitation

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20
Q

which occurs minutes to hours after eating, vomiting or regurgitation

A

vomiting

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21
Q

which has typically undigested or partially digested food or liquid

A

regurgitation

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22
Q

which has undigested or partially digested food or liquid, often containing bile

vomiting or regurgitation

A

vomiting

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23
Q

which has forceful abdominal contraction, vomiting or regurgitation

A

vomiting

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24
Q

how is an episode of acute vomiting treated

A

often no specific

withholding food for up to 24 hours

bland low fat diets re introduced

small frequent meals

fluids if clinically indicated +/- anti-emetics

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25
Q

what are gastrointestinal disorders that cause acute vomiting (6)

A
  1. acute gastritis/enteritis
  2. dietary indiscretion
  3. foreign body (gastric or intestinal)
  4. gastric dilation and volvulus
  5. mesenteric torsion
  6. intussusception
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26
Q

what are non GI disorders that cause acute vomiting (7)

A
  1. acute pancreatitis
  2. acute hepatobiliary disease (acute stretch of the liver due to inflammation or increasing levels of bilirubin)
  3. acute renal failure (uremia, pain or stretch of kidney)
  4. peritonitis
  5. acute neurological insult
  6. endocrine dysfunction (Addison’s disease)
  7. toxin ingestion/exposure
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27
Q

what are some history questions to ask about vomiting (11)

A
  1. recent dietary changes?
  2. scavenging
  3. how freq is the vomiting
  4. is the vomiting unproductive
  5. undigested food/partially digested/fecal odour
  6. is there blood or coffee grounds in vomit
  7. has there been any recent weight loss
  8. concurrent GI signs
  9. is the patient on any meds
  10. is the patient systemically unwell
  11. appetite
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28
Q

what physical examination abnormalties could be seen with acute vomiting (6)

A
  1. are there signs of systemic disease: what’s the patient’s demeanour like, is he/she pyrexic
  2. is there any indication of liver disease (jaundice)
  3. is the abdomen painful
  4. can you palpate any abdominal masses? is there a suggestion of ascites
  5. assess hydration – CRT, skin tenting
  6. is your patient hypovolemic
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29
Q

what is the approach to investigation of acute vomiting

A
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30
Q

what is the initial evaluation of the patient

A
  1. CBC and serum biochemistry
  2. urinanalysis
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31
Q

what can CBC and serum biochemistry evaluate

A

identification of primary disease processes

32
Q

what are primary disease processes that can cause vomiting (4)

A
  1. acute pancreatitis (inflammatory leukogram, raised lipases, amylase, minor changes in liver profile)
  2. acute hepatobiliary disease
  3. acute renal failure
  4. endocrine dysfunction (DKA)
33
Q

how can CBC and serum biochem evaluate patient status

A
  1. is the patient severely dehydrated
  2. are there electrolyte disturbances that we need to address
  3. is there a metabolic acidosis
  4. do we have changes compatible with sepsis
34
Q

what can diagnostic imaging evaluate

A

is it surgical?

  1. evidence of GDV
  2. GI foreign body
  3. obstructive pattern
  4. GI perforation
  5. peritonitis
35
Q

what can abdominal US evaluate

A

GI tract

  1. assessment of biliary system
  2. evaluation of pancreas
  3. evaluation of repro tract
  4. US guided aspiration of peritoneal fluid
36
Q

what are the aims supportive and symptomatic management (4)

A
  1. address fluid and electrolyte disturbances caused by vomiting –> IVFT
  2. reduce frequency/stop vomiting –> anti emetics
  3. to reduce acid production if there are concerns gastro-duodenal ulceration –> anti ulcer
  4. improve gastric emptying –> prokinetic drugs
37
Q

what are the anti emetic drugs (4)

A
  1. NK1 pathway inhibitors: maropitant
  2. anti-dopaminergics: metoclopramide
  3. serotonin antagonists: ondansetron
  4. phenothiazines: chlorpromazine
38
Q

what are the anti ulcer drugs (4)

A
  1. histamine (H2) blockers: cimetidine, ranitidine, famotidine
  2. proton pump inhibitors: omeprazole
  3. sucralfate
  4. synthetic prostaglandins: misoprostol
39
Q

what are the pro kinetic drugs (3)

A
  1. metoclopramide (CRI)
  2. ranitidine
  3. cisapride
40
Q

what receptor does maropitant act on

A

NK1 antagonist

acts on both chemoreceptor trigger zone and vomiting centre

41
Q

what receptors does metoclopramide act on

A

D2 antagonist

5HT3 antagonist

42
Q

where does metoclopramide act on

A
  1. chemoreceptor trigger zone
  2. GI tract/peripheral stimuli
43
Q

what receptor does odansetron act on

A
  1. 5HT3 antagonist
44
Q

where does odansetron act on

A

chemoreceptor trigger zone

GI tract/peripheral stimuli

45
Q

where does misoprotstol act on

A

PGE1 analog

direct action on parietal cells

inhibits gastric acid secretion

46
Q

where does rantitidine act on

A

H2 receptor antagonist prokinetic

at H2 receptors of parietal cells, completely inhibits histamine and reducing gastric acid secretion

47
Q

where does omeprazole

A

proton pump inhibitor

binds irreversibly to the secretory surface of parietal cells to the enzyme H+/K+ ATPase where it inhibits the transport H+ ions into the stomach

48
Q

where does sucralfate act on

A

local effect in the stomach

may react with HCl to form a paste like complex that preferentially binds to the proteinaceous exudates that are found at ulcer sites

49
Q

order from least to most potent between ranitidine, famotidine, cimetidine

A

cimetidine < ranitidine < famotidine

50
Q

which H2 blocker is licensed in UK

A

only cimetidine

51
Q

which has prokinetic acitivity

cimetidine, ranitidine, famotidine

A

ranitidine

52
Q

what are systemic causes of chronic vomiting (7)

A
  1. chronic pancreatitis
  2. chronic kidney disease (PUPD?)
  3. chronic hepatobiliary disease
  4. hyperthyroidism
  5. hypoadrenocorticism
  6. chronic drug/toxin exposure
  7. neurological disease
53
Q

what are GI - stomach causes of chronic diseases (7)

A
  1. chronic gastritis
  2. bilious vomiting syndrome
  3. foreign body
  4. gastric ulceration
  5. gastric neoplasia
  6. pyloric outflow obstruction/stenosis
  7. motility disorder
54
Q

what are GI intestinal causes of chronic diseases (7)

A
  1. inflammatory bowel disease
  2. neoplasia
  3. foreign body
  4. intussusception
  5. extra intestinal obstruction
  6. ulceration
  7. parasitic
55
Q

what is the approach to chronic vomiting

A
56
Q

what are the primary disease processes that can cause chronic vomiting (3)

A
  1. liver dysfunction
  2. chronic kidney disease
  3. endocrine dysfunction
57
Q

what can be seen on rads that may cause chronic vomiting (4)

A
  1. chronic FB
  2. GI neoplasia
  3. pyloric outflow obstruction
  4. chronic pancreatopathy
58
Q

when is endoscopic evaluation used in chronic vomiting patient

A

when primary disease is suspected

investigation of hematemesis

59
Q

what causes of chronic vomiting may be seen on endoscopic evaluation (4)

A
  1. gastric ulceration
  2. gastric neoplasia
  3. chronic gastritis
  4. duodenal disease (IBD)
60
Q

what is the etiology of gastric/gastro-duodenal ulceration (6)

A
  1. gastritis
  2. gastric neoplasia (adenocarcinoma, lymphoma, leiomyoma/leiomyosarcoma)
  3. NSAID-associated ulceration
  4. metabolic/endocrine disease (renal failure, liver disease, hypoadrenocorticism)
  5. mast cell disease
  6. gastrinoma (rare)
61
Q

what is the most common canine gastric tumour

A

gastric adenocarcinoma

62
Q

what breeds are predisposed to gastric adenocarcinoma

A

belgian shepherds

collies

staffies

63
Q

how do dogs present with with gastric adenocarcinoma (5)

A
  1. anorexia
  2. vomiting
  3. weight loss
  4. hypersalivation
  5. +/- hematemesis and melena
64
Q

how do gastric lymphomas present

A

similar to gastric adenocarcinoma

ulcerative disease

65
Q

how do you manage gastroduodenal ulcers (3)

A
  1. treat underlying disease process
  2. anti ulcer drugs (4-8 week treatment)
  3. symptomatic treatment (anti emetic)
66
Q

how is chronic gastritis diagnosed

A

according to cellular infiltrate

lympho plasmacytic is most common

mucosal biopsy or gastric biopsy

67
Q

how is chronic gastritis managed

A
  1. diet modification (hypoallergenic diet)
  2. immunosuppressant medication (prenisolone)
  3. symptomatic management
68
Q

when would helicobacter associated gastritis be relevant (3)

A

if there is

  1. associated inflammation
  2. intracellular location
  3. epithelial changes (necrosis)
69
Q

how is helicobacter associated gastritis treated

A

antibiotics and acid lowering drugs

  1. amoxicillin + metronidazole plus bismuth +/- famotidine
  2. amoxicillin + metronidazole + omeprazole
  3. clarithromycin + metronidazole + ranitidine
70
Q

what is delayed gastric emptying

A

food in stomach for > 8 hours post ingestion

71
Q

wjat are potential causes for delayed gastric emptying (7)

A
  1. electrolyte disorders
  2. post anesthetic complication
  3. local peritonitis
  4. intramural disease (gastritis, pyloric stenosis)
  5. extramural compression
  6. GI foreign body
  7. dysautonomia (rare)
72
Q

what can pyloric stenosis cause

A

can cause delayed gastric emptying

73
Q

what is shown here

A

dilation of stomach

accummulation of gas

74
Q

what are the two types of pyloric stenosis

A
  1. congenital
  2. acquired
75
Q

what breeds are predisposed to congenital pyloric stenosis

A

boxers and boston terriers

76
Q

what does congenital pyloric stensosis involve (muscle, mucosa?)

A

muscle only

mucosal folds seen in FBD

77
Q

what does acquired pyloric stensosis involve (muscle, mucosa?)

A

muscle and mucosa

Module 16 (26 decks)

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