L20: Chronic Vomiting In Dogs And Cats (Hill) Flashcards
Causes of dysphagia/regurge/vomiting
Intestinal vs. non-intestinal
- inflammation/infection
- extraluminal compression
- intraluminal obstruction
- toxin
- neuromuscular dysfx
2 main categories of dysphagia
Oral (more common)
Pharyngeal (less common)
Causes of oral dysphagia
Congenital: cleft lip/palate (brachycephalics)
Acquired:
- dental/gingivitis/periodontal dz
- eosinophilic and other ulcers ex. Colici (cats)
- stomatitis in cats
- benign mucosal hyperplasia (collies, boxers, drugs like cyclosporine, amlodipine)
- ranula
- vesicular dz
- FB
- retrobulbar abscess
- sialocele/sialodenitis
- craniomandibular osteopathy
- masticatory muscle myositis
- trigeminal neuritis (dropped jaw)
- neoplasia
Chronic Ulcerative Paradental Stomatitis (CUPS)
- gingiva reacting to tooth tartar, or sometimes assoc. with outflow of salivary duct
- Tx: immunosuppression therapy or removing teeth
Sialoadenitis
- causes inflammation behind the eye
- opening mouth can put pressure on salivary ducts and back of eyes
- can cause a form of seizures which –> chronic vomiting
Benign neoplasia or the oral cavity
- epulides
- papillomas
Malignant neoplasia of the oral cavity
- SCC
- Melanoma
- Fibrosarcoma
Pharyngeal dz differentials
- inflammation
- compression
- luminal mass
- MOST common: neuromuscular dz: cricopharyngeal achalasia or dyssynchrony, rabies
*pharyngeal dz can look like other things ie. Trigeminal palsy
Cricopharyngeal achalasia more common in younger or older dogs?
Younger
Eval for oral dz or dysphagia
-Hx/PE
-watch try to eat or drink
-exam of mouth and pharynx under general anesthesia!
-look for odynophagia (painful swallowing) and when it occurs
+/- blood tests/rads/fluoro/EMG/Ab test
Swallowing disorders and tx
Cricopharyngeal achalasia (failure of UES to open): sx or botox injections Cricopharyngeal dyssnchrony (bad timing of UES opening): tx as megaesophagus
4 causes of regurgitation
1) Neuromuscular dysfx
2) Intraluminal obstruction
3) Inflammatory dz
4) Extraluminal compression
Causes of neuromuscular dysfx –> regurgitation
- megaesophagus (acquired or idiopathic)*
- esophageal dysmotility (+/- LarPar) due to myasthenia*, polymyositis/neuritis, SLE hypoadrenocorticism, hypothyroidism, organophosphate or lead toxicity, distemper
Causes of intraluminal obstruction –> regurgitation
- FB/hairball*
- stricture*
- hiatal hernia*
- granuloma spirocerca lupi*
- tumor
- esophageal diverticulum
- gastroesophageal intussussception (stomach herniates into esophagus)
Inflammatory diseases that –> regurgitation
- Esophagitis (thermal, chemical, or reflux ie. Post-anesthesia)
- Myositis
- Granuloma (fungal, bacterial, parasitic*)
Causes of extraluminal compression that –> regurgitation
Vascular ring anomaly
Intrathoracic tumors (thymoma, lymphoma)
Hilar lymphadenopathy
Dx tests for megaesophagus
-Chest rads
-fluoroscopy
-CBC, Chem, UA + CPK
-T4, TSH to look for hyperthyroid
+/- resting cortisol to look for Addison’s
-Cholinesterase activity if looking for organophosphate toxicity
-lead concentrations
-EMG + biopsy +/- tensilon test
When does vomiting become chronic?
> 7-14 day duration
NON-GI causes of vomiting
1) Metabolic:
2) Toxins
3) Drugs
4) Neurologic
5) Other (heartworm in cats)
Metabolic causes of vomiting
Uremia Addison's DM Hyperthyroid Liver dz Electrolyte and acid/base disorders Septicemia
Common toxins that cause vomiting
Lead Zinc Strychnine Antifreeze Mycotoxins
Common drugs that cause vomiting
Digitalis
Abx
Chemo drugs
Neurologic causes of vomiting
Brain tumors Encephalitis Meningitis Limbic epilepsy Encephalitis Meningitis Limbic epilepsy Vestibular dz (Salivary gland infarction)
GI causes/categories of vomiting
Diet: indiscretion, intolerance, allergy/hypersensitivity
Gastric: see other slide
Small Intestine: see other slide
LI: colitis, parasites, neoplasia
Abdominal: pancreatitis, peritonitis, neoplasia
Gastric causes of vomiting
- gastritis (helicobacter?)
- ulceration
- FB
- chronic GDV
- neoplasia
- hypertrophy
- parasites (Physaloptera, Ollulanus stomach worms)
- motility disorders
SI causes of vomiting
- FB
- IBD
- Infections (pythium/histo)
- neoplasia
- intussusception
Causes of gastric/duodenal ulceration +/- melena
Drugs: NSAIDs, steroids Metabolic: uremia, LIV failure Excess acid: mastocytosis (excess mast cells), gastrinoma Neurologic: spinal or brain injury Neoplasia: Lymphoma Other: peritonitis, pancreatitis, stress
Gastrinoma
tumor in the pancreas or duodenum that secretes excess of gastrin leading to ulceration in the duodenum, stomach and the small intestine. There is hypersecretion of the HCl acid into the duodenum, which causes the ulcers
Benign and malignant gastric neoplasms
Benign:
- polyps
- hypertrophy (young small breeds)
- leiomyomas
Malignant:
- Adenocarcinoma
- Lymphoma
Tx: sx except for lymphoma
Common cause of intussusception in older cats
Neoplasia
Properties of Helicobacter infection
- very common in cats
- usually have asymptomatic infection
- causes lymphoid hyperplasia
- Dx with Warthin-Starry stain on biopsy, urease test or PCR
- may be cause OR result of disease, so must rule out other causes of vomiting if you see them
Tx of helicobacter infection
"Triple therapy": -Proton pump inhibitor -Amoxicillin -Clarithromycin \+/- metronidazole, bismuth
Almost all causes of vomiting effect motility and most changes in motility are secondary to the underlying cause ie. Low protein
:)
Signs of gastric motility disorders
Vomiting on empty stomach Vomiting bile (bilious vomiting) Bloating Inappetence Ptyalism Hairballs
Dx of gastric motility disorders
- Dx of exclusion; rule out other causes with CBC, Chem, Rads
- radio-labeled food/liquid with gamma camera
- Food + 5% Barium delayed emptying
- Barium impregnated plastic spheres (BIPS)
- Endoscopy of stomach after fasting to look for delayed emptying
BIPS
Barium impregnated plastic spheres
-radiopaque markers fod dx of GI obstructions and motility problems
Tx of gastric motility disorders
- Tx gastritis, underlying dz
- metoclopramide
- Cisapride
- Feed q8-12hr including late at night
- Octreotide/Lidocaine for ileus
FISH test
Fluorescence In Situ Hybridization
-maps the genetic material in cells to visualize specific genes or portions of genes; can look for neoplasia
PARR test
PCR for Antigen Receptor Rearrangements
- amplifies DNA and can tell if majority of cells are derived from the same original clone (consistent with neoplasia) or multiple clones (consistent with reactive process)
- used to look for lymphoma
Do phenobarb trial if suspect salivary adenomatosis
:)
History of chronic vomiting patient
- distinguish dysphagia vs. regurge v. Vomiting
- characterize abnormalities and secondary effects
- duration
- progression, response to therapy
