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Digestive System Exam 2 > Small Animal Gastric Disorders (Winston) > Flashcards

Small Animal Gastric Disorders (Winston) Flashcards

1
Q

List the general indications for using Anti-Emetic Drug Therapy:

A
  1. Symptomatic control of vomiting (short-term basis)
  2. Profuse vomiting which results in fluid, electrolyte, or acid-base imbalance
  3. Motion sickness** most common
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2
Q

Anti-Emetic Drug Therapy:
- Appetite stimulant in cats
- Non-selective serotonin antagonist (5-HT3, 5-HT2) alpha 2 adrenergic blocker

A

Mirtazapine (Remeron)

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3
Q

What are the “big categories” when thinking of gastric disease?

A
  • Inflammation
  • Ulceration
  • Neoplasia
  • Obstruction
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3
Q

What are the “big categories” when thinking of gastric disease?

A
  • Inflammation
  • Ulceration
  • Neoplasia
  • Obstruction
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4
Q

List the clinical manifestation of gastric disease:

A
  • Vomiting
  • Hematemesis
  • Melena
  • Retching
  • Burping
  • Hypersalivation
  • Abdominal distension
  • Abdominal pain
  • Weight loss
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5
Q

Predominant features: Sudden onset of vomiting; otherwise healthy
Clinical presentation:

A

Acute gastric

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6
Q

Predominant features: Chronic vomiting of food or bile; usually otherwise healthy
Clinical presentation:

A

Chronic gastric

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7
Q

Predominant features: Vomiting, hematemesis, melena, +/- anemia
Clinical presentation:

A

Ulceration or erosion

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8
Q

Predominant features: Nonproductive retching, abdominal distention, tachycardia
Clinical presentation:

A

Gastric-dilation volvulus

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9
Q

Predominant features: Acute to chronic vomiting of food > 10 hrs after eating
Clinical presentation:

A

Delayed gastric emptying

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10
Q

Predominant features: Chronic vomiting, weight loss, +/- hematemesis, +/- anemia
Clinical presentation:

A

Neoplasia

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11
Q

Definition:
Syndrome marked by vomiting presumed to be due to gastric mucosal insult or inflammation

A

Gastritis

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12
Q

What are some known causes of gastritis?

A
  • Diet-related factors
  • Foreign Bodies
  • Drugs, toxins, chemicals
  • Systematic disease
  • Infectious agents (bacterial, viral, fungal)
  • Bilious Vomiting Syndrome
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13
Q

What is the most common form of gastritis?

A

Idiopathic Gastritis

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14
Q

(T/F) A specific underlying cause of gastritis is often determined

A

False, underlying cause of gastritis is often NOT determined

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15
Q

What is the treatment for acute gastritis?

A

Symptomatic, supportive therapy and signs resolve

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16
Q

Clinical signs:
- Chronic intermittent vomiting of food or bile
- Weight Loss (common)
- +/- small or large bowel diarrhea
These clinical signs are from …

A

Chronic Gastritis

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17
Q

(T/F) In cats with really defused inflammatory bowel disease, their ONLY clinical sign can be vomiting

A

True

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18
Q

Chronic Gastritis: Food Sensitivity

  • Proven immunologic basis
  • Dietary proteins (carbohydrates too)
A

Food Allergy

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19
Q

Chronic Gastritis: Food Sensitivity

-Abnormal response to food or additive (not immunologic)
- Lactose, additives, histamine, toxins, others

A

Food Intolerance

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20
Q

Consider food sensitivity if the patient has concurrent ______________ disease

A

Dermatologic

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21
Q

Chronic Gastritis:
- Microaerophilic, spiral, Gram (-) Negative, urease activity
- Located within the stomach
- Present in many species
- Normal gut microbe vs pathogen?
- Infection does not equal disease

A

Helicobacter spp.

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22
Q

Helicobacter spp. in small animals:
- If clinical, what is more likely …
a. Gastritis
b. Gastritis Ulcers

A

a. Gastritis

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23
Q

Helicobacter spp. in small animals:
Treat or Ignore?

A

Treat only if biopsy confirmed infection AND gastritis
- Combination tx: Amoxicillin + Metronidazole + Clarithromycin +PPI

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24
Q

What is a stomach worm (nematode) of dogs and cats?

A

Physaloptera rara

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25
Q

Is a fecal examination for Physalotera rara reliable or unreliable?

A

Unreliable
- because of intermittent shedding

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26
Q

Chronic Gastritis
Classic presentation: Morning vomiting of bile-stained fluid, otherwise healthy

A

Bilious Vomiting Syndrome

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27
Q

What is the best management for bilious vomiting syndrome?

A
  • Late-night meal
  • Others: Metoclopramide, acid suppression
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27
Q

What is the best management for bilious vomiting syndrome?

A
  • Late-night meal
  • Others: Metoclopramide, acid suppression
28
Q

(T/F) For chronic gastritis diagnostic approach, it is better to biopsy only after therapeutic trials

A

True

29
Q

What is the most likely read in a biopsy from a chronic gastritis case?

A

Lymphoplasmacytic inflammation

30
Q

If you see eosinophils in the biopsy, what might you consider?

A
  • Parasites
  • Really bad food allergies
31
Q

What is the prognosis for Chronic Gastritis?

A

Good
- Lifelong special diets or medications likely required

32
Q

Gastric Mucosal Barrier Defense Mechanisms:
- Mucus layer
- HCO3- secretion

A

Pre-epithelial defenses

33
Q

Gastric Mucosal Barrier Defense Mechanisms:
- Cell membranes and tight junctions
- Ion pumps (remove H+)
- Epithelial restitution

A

Epithelial defenses

34
Q

Gastric Mucosal Barrier Defense Mechanisms:
- Mucosal blood flow

A

Post-epithelial defenses

35
Q

Role of Prostaglandins
Arachidonic Acid can go into …

A
  • COX-1 (housekeeping)
  • COX-2 (Inflammation)
36
Q

Role of Prostaglandins
- Gastrointestiinal mucosal integrity
- Platelet aggregation
- Renal Function
- TXA2, PGI2, PGE2

A

COX-1 (housekeeping)

37
Q

Role of Prostaglandins
- Inflammation
- Mitogenesis
- Bone Formation
- Other functions?
- PGI2, PGE2

A

COX-2 (inflammation)

38
Q
  • High concentrations in mucosal cells
  • Stimulates mucus and HCO3 secretion
  • Promotes epithelial cell restitution
  • Inhibits acid secretion
A

Prostaglandins
- Mucosal Cytoprotection

39
Q

What things protect the mucosal integrity?

A
  • HCO3
  • Mucus
  • Blood Flow
40
Q

What things are damaging to mucosal integrity?

A
  • Acid
  • Hypoxia (low levels of oxygen in body tissues)
  • Bile/Enzymes
  • NSAIDS
41
Q

What are some of the clinical associations with gastroduodenal ulcers?

A
  • Drugs, Chemicals, Toxins
    • NSAIDS
    • Steroids
  • Increase gastric secretion
    • Kidney failure
    • Mast cell tumor
      • Releases more histamine
    • Liver disease
  • Local Disease
    • Gastric neoplasia
  • “Stress” Conditions
  • Other
    • Spinal cord disease
    • Hypoadrenocorticism
    • Lead toxicity
42
Q
  • Acute or chronic vomiting
  • Evidence of GI bleeding
    • Hematemesis
    • Melena
    • Pale MM
  • Anorexia and weight loss
  • Abdominal pain, fever, collapse, shock -> septic peritonitis
  • Other -> depending on the underlying cause
    These are clinical signs of …
A

Gastroduodenal Ulcers

43
Q

If there is evidence of bleeding elsewhere, what are we doing first?

A

Running a COAGs

44
Q

Gastroduodenal Ulcers
If you have:
- Normal Albumin
- Low Globulin
this may indicate …

A

young age

45
Q

Gastroduodenal Ulcers
If you have:
- Low Albumin
- Normal Globulin
this may indicate …

A
  • Liver Failure
  • Protein-losing nephropathy (PLN)
  • Increased vascular permeability
46
Q

Gastroduodenal Ulcers
If you have:
- Low Albumin
- Low Globulin
this may indicate …

A
  • Protein-losing enteropathy (PLE)
  • Blood Loss
47
Q

Gastroduodenal Ulcers
- Microcytic, hypochromic, minimally regenerative anemia
- Thrombocytosis
- Decreased Iron saturation, low serum ferritin –> Chronic Bleeding
This is describing …

A

Iron deficiency anemia

48
Q

(T/F) You must avoid the concurrent use of NSAIDs and steroids or NSAIDs together

A

True

49
Q

What causes intermittent pyloric outflow obstruction?

A

Gastric foreign body

50
Q

List some things that can lead to Hair Balls (trichobezoars):

A
  • Excess hair ingestion
    - Long haired cats
    - Excess grooming
    - Fleas
    - Other pruritic skin disease
  • Altered upper GI motility
    - 2 to IBD
    - Dietary intolerance
    - Other
51
Q

What is a common cause of hairball vomiting (shorthaired cat)?

A

Diet-responsive GI disease

52
Q

(T/F) Cats relatively lack “housekeeper contractions” sweeping from the stomach and distal intestines

A

False, cats have inter-digestive migrating motor complexes only in distal SI

53
Q

What is the most common cause of delayed gastric emptying?

A

Mechanical gastric outflow obstructions

54
Q

Delayed Gastric Emptying
- Weak or ineffective gastric contractions

A

Functional gastric motility disorders

55
Q

Delayed Gastric Emptying:
Barium in the stomach after _______ hrs confirms delayed gastric emptying

A

12-24

56
Q

Definition:
- Gastric distention with air + volvulus (twisting) of the stomach on its axis
- Caudal vena cava compression impaired venous return to heart Hypovolemic shock

A

Gastric Dilation-Volvulus

57
Q
  • Non-productive retching and salivation
  • Abdominal distension and tympany
  • Tachycardia
  • Pallor
  • Shock -> Hypothermia, depression, etc …
    These are clinical signs of …
A

Gastric Dilation-Volvulus (GDV)

58
Q

What are the clinical presentations of gastrointestinal bleeding?

A
  • Vomiting
  • Hematemesis
  • Melena
  • +/- anemia (iron deficiency) –> microcytic, hypochromic anemia
59
Q

Why does hypochloremic metabolic alkalosis occur with pyloric obstruction?

A

Pyloric obstruction leads to “gastric vomiting” (No bicarbonate from duodenal content) –> Net loss of HCL

60
Q

Net loss of H+ –> Metabolic alkalosis
_____ pH & ____ HCO3

A

Increases, Increases

61
Q

Fluids:
- Lots of chloride for hypochloremia
- Acidifying fluid for alkalemia

A

0.9% Saline supplement with KCL

62
Q

(T/F) NSAIDs inhibit the production of prostaglandins, which are essential for maintaining the gastric mucosal barrier integrity

A

True

63
Q

List potential complications of administering NSAIDs:

A

Ulcers and erosions

64
Q

What should you be suspicious of if a patient’s serum biochemistry profile reveals a metabolic alkalosis?

A

Pyloric outflow obstruction

65
Q

After stabilization of the patient for GDV, a ______________ abdominal radiograph should be performed to confirm the diagnosis

A

right lateral

66
Q

(T/F) GDV is a surgical emergency

A

True

67
Q

What must be differentiated from GDV (right lateral abdominal radiograph)?

A

Food Bloat
- most cases will resolve in 24-48 hrs with supportive care

68
Q

(T/F) Malignant tumors are more common than benign

A

True
- Gastric neoplasia tends to affect older dogs and cats

Digestive System Exam 2 (11 decks)

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