Lecture 12: vomiting Flashcards
1
Q
Describe the pathway of vomiting caused by peripheral stimuli to the brain stem
A
- Stretch, injury or irritation receptors activated in gut
- Send serotonin on vagus nerve to vomiting center in brain stem
2
Q
describe the pathway of vomiting caused by central stimuli
A
receptors for histamine, serotonin, opioids, dopamine (dogs), substance P, ACh and NE that activated CRTZ and vomiting center and travel on vagus nerve to stomach
3
Q
what is the major priority for acute vomiting
A
rule out medical or surgical emergencies
4
Q
how do animals with FB obstruction present
A
vomiting, anorexic
5
Q
what lab work finding is consistent with FB obstruction in stomach or upper SI
A
hypochloremic metabolic alkalosis
6
Q
how do you dx FB obstruction
A
palpation, rads, ultrasound
7
Q
what view is this and what wrong
A
Right lateral- gas in fundus
FB in fundus
8
Q
What view is this and what wrong
A
left lateral- gas in pylorus
FB in pylorus
9
Q
what rad view allows better visualization of SI and can confirm that dilated loops are gas filled colon
A
VD
10
Q
what parameter can you use to measure dog SI loops to determine if distended
A
> 1.5x height of L5
11
Q
what parameter can you use to measure cat SI loops to determine if distended
A
> 2x size of L2
12
Q
what is a pneumocolonogram
A
pass RR or Foley catheter into rectum and inject 1-3ml/kg of air and do lateral and VD rad
13
Q
what is indicated by blue arrows, orange arrows and yellow circle
A
blue arrows: colon
Orange: cecum
Yellow circle: dilated SI
14
Q
what wrong and how do you know
A
linear foreign body- plication
15
Q
how do you remove FB in gastric vs elsewhere
A
gastric- endoscopy
Elsewhere: ex-lap
16
Q
mortality risk of FB obstruction is higher if __, __, or __
A
longer time from onset to presentation, linear FB, multiple enterotomies
17
Q
perforation from FB leads to ___ and __% mortality rate
A
septic peritonitis, 50% mortality
18
Q
what dogs are at greater risk for GDV
A
large, deep chested
19
Q
what are some signs of GDV
A
- Acute onset unproductive retching
- Shock, collapse- weak pulses, tachycardia, arrhythmias, prolonged CRT
- Distended abdomen
20
Q
what wrong
A
gastric dilation no volvulus
21
Q
what wrong
A
GDV
22
Q
What view do you take to dx GDV
A
right lateral
23
Q
what is pathogenesis of GDV
A
- Stomach dilates and twists
- Occlusion of LES and pylorus—> progressive gas dilation
- Enlarged stomach compress CdVC, splenic, portal veins
- Occlusion of gastric vasculature—> gastric necrosis, perforation
24
Q
most GDV patients are in __shock, poor __candidates
A
compensated, anesthetic
25
what presurgical management should you do to stabilize GDV patient
1. Improve tissue oxygen delivery—> correct hypotension, hypovolemia, hypoxia
2. Correct arrhythmias
3. Manage pain and provide sedation
4. Reduce gastric dilation
5. Identify and initiate tx for sepsis
26
GDV patients are hypotensive and hypovolemic lead to __, __, __, and __
tachycardia, low BP, high lactate, azotemia
27
how do you manage hypovolemia, hypotension in GDV
large catheter in forelimbs and give rapid bolus of balanced crystalloids solution
28
patient with GDV and following ECG- what wrong and what tx
VPC- no intervention
29
patient with GDV and following ECG- what wrong and what do
V-tach
1. Lidocaine
2. Procainamide
30
what pain meds can you give for GDV
1. Lidocaine CRI if concurrent ventricular arrhythmias
2. Full mu agonist opioid- hydromorphone, methadone
31
what is the main way to perform gastric decompression in GDV
trocharization
32
what are the sequela of perforation from GDV
septic abdomen, hypoglycemia, pneumoperitoneum, free fluid
33
what should you do if perforation from GDV
1. Bolus dextrose dilated with NaCl
2. Antibiotics- unasyn, enrofloxacin, metronidazole
34
what wrong and what concerned about
gas- concern for perforation
35
what are some poor prognostic indicators prior to ex-lap for GDV
1. Lactate doesn’t improve with fluids
2. Pre-op arrhythmias
3. Longer time between onset and admission
4. Peritonitis, sepsis
5. Hypotension
6. DIC
36
How do dogs get salmonid poisoning
1. Fluke with N. Helminthoeca infects snail
2. Fish eats snail
3. Dog eats fish
37
Salmonid poisoning is infection with __
neorickettsia helminthoeca
38
what is pathogenesis for salmonid poisoning
1. Dog ingests fluke infected with N. Helminthoeca
2. N. Helminthoeca travels to enterocytes—> lymphatic system—> macrophages
3. Granulomatous inflammation in stomach, LN, intestines, spleen
4. Signs: fever, hemorrhagic vomiting, lymphadenopathy
39
what lab work is consistent with salmonid poisoning
thrombocytopenia, neutrophilia, +/- left shift, marked lymophopenia
40
t or f: death from salmonid poisoning occurs in 10 days in 90% of untreated animals
true
41
how do you dx salmonid poisoning
1. Hx of raw fish ingestion or outdoor swimming
2. Fluke ova on fecal
3. N. Helminthoeca aggregates in macrophages on LN cytology
4. Blood tests (too slow)
42
how do you tx salmonid poisoning
1. Doxycycline
2. Praziquantel
43
what is acute nonspecific gastroenteritis
sudden onset vomiting +/0 diarrhea <7 days without gastric erosions, ulcerations or hematemesis
44
what are some causes of acute nonspecific gastroenteritis
1. Dietary indiscretion or intolerance
2. Drugs/toxins (NSAIDS, antibiotics, chemo, methimazole)
3. Bacterial enterotoxins- salmonella, campylobacter
4. Viral- rotavirus, coronavirus, FeLV, FIV
5. Parasites
6. Fungal (not commonly acute)
45
how will patient appear with acute nonspecific gastroenteritis
systemically well, good appetite, able to hold down food and water, normal energy, no pain just vomiting
46
What is symptomatic tx for acute nonspecific gastroenteritis
1. Highly digestible diet- low fat, low fiber
2. Anti-emetics
3. SC fluids
4. Empirical anthellminthic therapy
47
T or f: fats are highly digestible in diets
false
48
what is a parasitic cause in dogs for chronic gastritis/vomiting and what is tx
physaloptera
Tx: pyrantel
49
what is a parasitic cause in cats for chronic gastritis/vomiting and what is tx
ollulanus, physaloptera
Tx: fenbendazole, pyrantel respectively
50
what is common fungal cause of chronic gastritis/vomiting
histoplasmosis
51
how do you dx histoplasmosis
urine antigen testing, organisms ID on cytology
52
what is tx for histoplasmosis
Intraconazole, amphotericin B
53
What fungal adjacent organism can cause chronic gastritis/vomiting
oomycetes- pythiosis
54
oomyecetes are fungal adjacent because they have no __
ergosterol
55
what are common sites for pythiosis infection
skin and GI involvement—> pylorus, duodenum, ICJ
56
how do you dx pythiosis
1. Culture
2. Anti-Pythian AB’s ELISA
57
what is tx for pythiosis
1. Aggressive surgical resection
2. Medical: itraconazole, amphoterin B, terbinafine
58
what is tx for Helicobacter infection
amoxicillin, metronidazole, bismuth (no bismuth in cats)
59
what are some sterile causes of chronic gastritis
1. Chronic inflammatory enteropathies
2. Chronic pancreatic or biliary disease
3. Gastric hyperacidity
4. Constipation
60
what are mechanisms of gastric ulceration and erosion
1. Direct injury
2. NSAIDS, glucocorticoids (interfere with PGE2 synthesis)
3. Interference with mucus or bicarbonate production
4. Inflammation
5. Hyperacidity
6. Decreased gastric BF
61
what are some extra-GI causes for gastric ulceration and erosions
1. Liver disease
2. Kidney disease
3. Addison
4. Cushing
5. Hypotension
6. Gastrinoma
7. Severe stress of exercise
8. MCT and histamine
9. Shock, sepsis
62
gastric ulcers/erosions should be suspected with ___ or ___
hematemesis, melena
63
what lab work findings are consistent with gastric ulceration/erosions
1. Unexplained high BUN
2. Regenerative anemia
3. Thrombocytosis
64
how do you dx gastric ulcerations and erosions
1. Traditional endoscopy- camera on long tube
2. Capsule endoscopy- dog swallows camera pill
65
when are some sequela to gastric ulcerations and erosions
1. Vomiting (hematemesis)
2. Nausea
3. Pain
4. Anemia
5. GI perforation
66
what is tx for gastric ulceration and erosions
1. Tx underlying cause
2. Anti-emetics
3. Analgesics- not NSAIDS (opioids or gaba)
4. PPI: omeprazole, esomeprazole
5. Sucralfate
6. Somatostatin analogs: octreocide
67
what is functional delayed gastric emptying
gastroparesis
68
what is structural/mechanical delay of gastric emptying and some causes
obstruction
1. Neoplasia
2. Other masses
3. Pyloric stenosis
4. Chronic FB
69
what can cause functional gastroparesis
1. Gastritis
2. Ulcers
3. Dysautonomia
4. Anticholinergic or opioid drugs
5. Visceral pain or anxiety
70
what is bilious vomiting syndrome
chronic, early morning vomiting or bile in otherwise healthy dog
71
what is hypothesis behind bilious vomiting syndrome
1. Abnormal gastric motility
2. Duodenal pressure—> gastric pressure—> reflux bile into pylorus
3. Bile causes irritation and gastritis
4. Vomiting
72
how do you tx bilious vomiting syndrome
small, frequent meals, late evening meal, acid suppression, metoclopramide
73
manage functional gastroparesis with __
prokinetics
74
what are some examples of benign gastric neoplasia
leiomyoma- smooth muscle
Adenomatous polyp
75
polyps may be removed via __, but leiomyoma requires __
endoscopic snare, surgical resection
76
what is the most common malignant gastric neoplasm in dogs
adenocarcinoma
77
where does gastric adenocarcinoma like to metastasize to
lungs, liver, LN
78
what is prognosis for gastric adenocarcinoma
poor, <6 months
79
what is the most common malignant gastric neoplasm of cats
lymphoma
80
what is indolent small T cell lymphoma
infiltrative, slowly progressive, diffuse (not tumor like) disease in cats only
81
what is intermediate/large cell lymphoma
more likely to form tumor, more aggressive, dogs and cats
82
which has better prognosis: indolent small T cell or intermediate large cell lymphoma
indolent small T cell
83
what malignant gastric neoplasia occurs in older dogs, slow growing, causes paraneoplastic hypoglycemia and PU/PD
leiomyosarcoma
84
what is prognosis for leiomyosarcoma
good to excellent if surgically resectable
85
how do you dx gastric neoplasia
1. AUS- gas may make difficult
2. Gastroscopy and biopsy
86
what is tx for gastric neoplasia
ex-lap and resection
Except lymphoma- chemo
87
with pyloric stenosis are dogs vomiting or regurgitating
vomiting
88
what breeds are prone to pyloric stenosis
brachycephalics
89
What is dx and tx for pyloric stenosis
dx: endoscopy
Tx: surgery
