Small Animal Gastric Disorders (Winston) Flashcards
List the general indications for using Anti-Emetic Drug Therapy:
- Symptomatic control of vomiting (short-term basis)
- Profuse vomiting which results in fluid, electrolyte, or acid-base imbalance
- Motion sickness** most common
Anti-Emetic Drug Therapy:
- Appetite stimulant in cats
- Non-selective serotonin antagonist (5-HT3, 5-HT2) alpha 2 adrenergic blocker
Mirtazapine (Remeron)
What are the “big categories” when thinking of gastric disease?
- Inflammation
- Ulceration
- Neoplasia
- Obstruction
What are the “big categories” when thinking of gastric disease?
- Inflammation
- Ulceration
- Neoplasia
- Obstruction
List the clinical manifestation of gastric disease:
- Vomiting
- Hematemesis
- Melena
- Retching
- Burping
- Hypersalivation
- Abdominal distension
- Abdominal pain
- Weight loss
Predominant features: Sudden onset of vomiting; otherwise healthy
Clinical presentation:
Acute gastric
Predominant features: Chronic vomiting of food or bile; usually otherwise healthy
Clinical presentation:
Chronic gastric
Predominant features: Vomiting, hematemesis, melena, +/- anemia
Clinical presentation:
Ulceration or erosion
Predominant features: Nonproductive retching, abdominal distention, tachycardia
Clinical presentation:
Gastric-dilation volvulus
Predominant features: Acute to chronic vomiting of food > 10 hrs after eating
Clinical presentation:
Delayed gastric emptying
Predominant features: Chronic vomiting, weight loss, +/- hematemesis, +/- anemia
Clinical presentation:
Neoplasia
Definition:
Syndrome marked by vomiting presumed to be due to gastric mucosal insult or inflammation
Gastritis
What are some known causes of gastritis?
- Diet-related factors
- Foreign Bodies
- Drugs, toxins, chemicals
- Systematic disease
- Infectious agents (bacterial, viral, fungal)
- Bilious Vomiting Syndrome
What is the most common form of gastritis?
Idiopathic Gastritis
(T/F) A specific underlying cause of gastritis is often determined
False, underlying cause of gastritis is often NOT determined
What is the treatment for acute gastritis?
Symptomatic, supportive therapy and signs resolve
Clinical signs:
- Chronic intermittent vomiting of food or bile
- Weight Loss (common)
- +/- small or large bowel diarrhea
These clinical signs are from …
Chronic Gastritis
(T/F) In cats with really defused inflammatory bowel disease, their ONLY clinical sign can be vomiting
True
Chronic Gastritis: Food Sensitivity
- Proven immunologic basis
- Dietary proteins (carbohydrates too)
Food Allergy
Chronic Gastritis: Food Sensitivity
-Abnormal response to food or additive (not immunologic)
- Lactose, additives, histamine, toxins, others
Food Intolerance
Consider food sensitivity if the patient has concurrent ______________ disease
Dermatologic
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
Helicobacter spp.
Helicobacter spp. in small animals:
- If clinical, what is more likely …
a. Gastritis
b. Gastritis Ulcers
a. Gastritis
Helicobacter spp. in small animals:
Treat or Ignore?
Treat only if biopsy confirmed infection AND gastritis
- Combination tx: Amoxicillin + Metronidazole + Clarithromycin +PPI
What is a stomach worm (nematode) of dogs and cats?
Physaloptera rara
Is a fecal examination for Physalotera rara reliable or unreliable?
Unreliable
- because of intermittent shedding
Chronic Gastritis
Classic presentation: Morning vomiting of bile-stained fluid, otherwise healthy
Bilious Vomiting Syndrome
What is the best management for bilious vomiting syndrome?
- Late-night meal
- Others: Metoclopramide, acid suppression
What is the best management for bilious vomiting syndrome?
- Late-night meal
- Others: Metoclopramide, acid suppression
(T/F) For chronic gastritis diagnostic approach, it is better to biopsy only after therapeutic trials
True
What is the most likely read in a biopsy from a chronic gastritis case?
Lymphoplasmacytic inflammation
If you see eosinophils in the biopsy, what might you consider?
- Parasites
- Really bad food allergies
What is the prognosis for Chronic Gastritis?
Good
- Lifelong special diets or medications likely required
Gastric Mucosal Barrier Defense Mechanisms:
- Mucus layer
- HCO3- secretion
Pre-epithelial defenses
Gastric Mucosal Barrier Defense Mechanisms:
- Cell membranes and tight junctions
- Ion pumps (remove H+)
- Epithelial restitution
Epithelial defenses
Gastric Mucosal Barrier Defense Mechanisms:
- Mucosal blood flow
Post-epithelial defenses
Role of Prostaglandins
Arachidonic Acid can go into …
- COX-1 (housekeeping)
- COX-2 (Inflammation)
Role of Prostaglandins
- Gastrointestiinal mucosal integrity
- Platelet aggregation
- Renal Function
- TXA2, PGI2, PGE2
COX-1 (housekeeping)
Role of Prostaglandins
- Inflammation
- Mitogenesis
- Bone Formation
- Other functions?
- PGI2, PGE2
COX-2 (inflammation)
- High concentrations in mucosal cells
- Stimulates mucus and HCO3 secretion
- Promotes epithelial cell restitution
- Inhibits acid secretion
Prostaglandins
- Mucosal Cytoprotection
What things protect the mucosal integrity?
- HCO3
- Mucus
- Blood Flow
What things are damaging to mucosal integrity?
- Acid
- Hypoxia (low levels of oxygen in body tissues)
- Bile/Enzymes
- NSAIDS
What are some of the clinical associations with gastroduodenal ulcers?
- 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
- 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 …
Gastroduodenal Ulcers
If there is evidence of bleeding elsewhere, what are we doing first?
Running a COAGs
Gastroduodenal Ulcers
If you have:
- Normal Albumin
- Low Globulin
this may indicate …
young age
Gastroduodenal Ulcers
If you have:
- Low Albumin
- Normal Globulin
this may indicate …
- Liver Failure
- Protein-losing nephropathy (PLN)
- Increased vascular permeability
Gastroduodenal Ulcers
If you have:
- Low Albumin
- Low Globulin
this may indicate …
- Protein-losing enteropathy (PLE)
- Blood Loss
Gastroduodenal Ulcers
- Microcytic, hypochromic, minimally regenerative anemia
- Thrombocytosis
- Decreased Iron saturation, low serum ferritin –> Chronic Bleeding
This is describing …
Iron deficiency anemia
(T/F) You must avoid the concurrent use of NSAIDs and steroids or NSAIDs together
True
What causes intermittent pyloric outflow obstruction?
Gastric foreign body
List some things that can lead to Hair Balls (trichobezoars):
- Excess hair ingestion
- Long haired cats
- Excess grooming
- Fleas
- Other pruritic skin disease - Altered upper GI motility
- 2 to IBD
- Dietary intolerance
- Other
What is a common cause of hairball vomiting (shorthaired cat)?
Diet-responsive GI disease
(T/F) Cats relatively lack “housekeeper contractions” sweeping from the stomach and distal intestines
False, cats have inter-digestive migrating motor complexes only in distal SI
What is the most common cause of delayed gastric emptying?
Mechanical gastric outflow obstructions
Delayed Gastric Emptying
- Weak or ineffective gastric contractions
Functional gastric motility disorders
Delayed Gastric Emptying:
Barium in the stomach after _______ hrs confirms delayed gastric emptying
12-24
Definition:
- Gastric distention with air + volvulus (twisting) of the stomach on its axis
- Caudal vena cava compression impaired venous return to heart Hypovolemic shock
Gastric Dilation-Volvulus
- Non-productive retching and salivation
- Abdominal distension and tympany
- Tachycardia
- Pallor
- Shock -> Hypothermia, depression, etc …
These are clinical signs of …
Gastric Dilation-Volvulus (GDV)
What are the clinical presentations of gastrointestinal bleeding?
- Vomiting
- Hematemesis
- Melena
- +/- anemia (iron deficiency) –> microcytic, hypochromic anemia
Why does hypochloremic metabolic alkalosis occur with pyloric obstruction?
Pyloric obstruction leads to “gastric vomiting” (No bicarbonate from duodenal content) –> Net loss of HCL
Net loss of H+ –> Metabolic alkalosis
_____ pH & ____ HCO3
Increases, Increases
Fluids:
- Lots of chloride for hypochloremia
- Acidifying fluid for alkalemia
0.9% Saline supplement with KCL
(T/F) NSAIDs inhibit the production of prostaglandins, which are essential for maintaining the gastric mucosal barrier integrity
True
List potential complications of administering NSAIDs:
Ulcers and erosions
What should you be suspicious of if a patient’s serum biochemistry profile reveals a metabolic alkalosis?
Pyloric outflow obstruction
After stabilization of the patient for GDV, a ______________ abdominal radiograph should be performed to confirm the diagnosis
right lateral
(T/F) GDV is a surgical emergency
True
What must be differentiated from GDV (right lateral abdominal radiograph)?
Food Bloat
- most cases will resolve in 24-48 hrs with supportive care
(T/F) Malignant tumors are more common than benign
True
- Gastric neoplasia tends to affect older dogs and cats
