Small animal GI Learning objectives (4: regurge and dysphagia; 5: dz of canine and feline stomach)

Question 1

Dysphagia and dz location

Answer 1

• seen in proximal esophagus dz
  
  • oral dz
  • pharyngeal dz
  • cricopharyngeal dz
    
    • achalasia: smooth muscle fibers don’t relax, opening stays closed
  • neuromuscular dz

Question 2

Regurge and dz location

Answer 2

• dz of esophageal body
  
  • will be coupled with ptyalism
• distal esophagus could also be cause
  
  • regurge
  • ptylism
  • inappetence
    ​

Question 3

four basic causes of regurge

Answer 3

1. inflammatory dz
2. extraluminal compression
3. intraluminal obstruction
4. neuromuscular dz

Question 4

Examples of regurge in inflamm dz

Answer 4

• esophagitis
  
  • can lead to stricture
• myositis
• granuloma

Question 5

examples of regurge in extraluminal compression

Answer 5

• vascular ring anomaly
• thymoma
• intrathoriacic tumors
• hilar lymphadenopathy

Question 6

examples of regurge in intraluminal obstruction

Answer 6

• stricture
• foreign body
• tumor
• diverticulum
• intussusception

Question 7

examples of regurge in neuromuscular dz

Answer 7

• dysmotility
• megaesophagus
  
  • congenital or acquired

Question 8

Primary peristaltic waves

Answer 8

• wave of relaxation in front of bolus and contraction behind it to propel it to stomach
• initiated by a food bolus

Question 9

Secondary peristaltic waves

Answer 9

• clears residual material in esophagus after bolus gets to stomach
• initiated by residual food particles (I think)

Question 10

Tertiary peristaltic contractions

Answer 10

• seen in esophageal dz
• disorganized contractions associated with chest pain

Question 11

Esophagitis (inflamm dz)

Diagnosis

Answer 11

• survey radiographs (difficult to see)
• contract radiographs (stricture)
• endoscopy
  
  • ​don’t bx unless you suspect neoplasia

Question 12

Management of Esophagitis

Answer 12

• Rest esophagus: feeding tube in severe cases
• sulcralfate
• cisapride/metaclopramide: inc LES tone
• omeprazole: reduce acid output
• pain meds

*abx only if there’s aspiration pneumonia

Question 13

Extraluminal esophageal compression

Diagnosis

Answer 13

• radiographs (survey or contract)
• contrast CT
• endoscopy

Question 14

Extraluminal esophageal compression

Management

Answer 14

• surgical ligation of PRAA or mass removal
• gaurded prognosis

Question 15

Intraluminal/mural esophageal obstruction

Diagnosis

Answer 15

• contrast esophagram
• endoscopy
• rads (foreign body)
• superficial biopsy on peri-esophageal tumor

Question 16

Intraluminal/mural esophageal obstruction

Management

Answer 16

• Balloon dilation then antacid
  
  • possibly prokinetic after
• Gougienage: stretches => then antacid
  
  • possibly prokinetic after
• stinting
• intralesional steroids (oral steroids NOT recommended)
• Mitomycin C

Question 17

Megaesophagus/neuromuscular dysfunction

Diagnosis

Answer 17

• Congenital: poor prognosis
• survey rads
• aspiration pneumonia
• bloodwork
• acetylcholine receptor antibody test for neuromuscular check
• thyroid testing

Question 18

Megaesophagus / neuromuscular dysfunction

Management

Answer 18

• symptomatic and supportive care
• fluids
• antibiotics for pneumonia (culture if possible)
• nutrition

*prognosis is always guarded

Question 19

breeds predisposed to congenital megaesophagus

Answer 19

• german shepherd
• great dane
• irish setter
• mini schnauzer
• wire-haired terrier

Question 20

Causes of acute gastritis

Answer 20

• gastric foreign body
• obstruction
• acute pancreatitis
• infectious disease
• systemic disease

Question 21

Clinical presentation of acute gastritis

Answer 21

• vomiting
• lethargy
• depression
• polydipsia
• hematemesis
• cranial abdominal pain

Question 22

Diagnosis of acute gastritis

Answer 22

• history
• PE
• abdominal rads
• biochemical tests to exclue other dz and resp to therapy

Question 23

Management of acute gastritis

Answer 23

• rest GI
  
  • 12-24 hours without food, restrict water if vomiting
• supportive care
• feed bland diet
  
  • digestible
  • low in fat

Question 24

Causes of chronic gastritis

Answer 24

• inflammatory
• food responsive dz
• reflux
• helicobacter
• idiopathic

Question 25

Clinical Signs of chronic gastritis

Answer 25

• vomiting
• hematemesis
• appetite changes

Question 26

Diagnostics in chronic gastritis

Answer 26

• PE can be unremarkable, possible weight loss
• parasite test
• bx tumors

Question 27

TX for chronic gastritis

Answer 27

• diet trials
• acid reducers
• cisapride/metachlopramide

Question 28

Causes of gastric ulcers

Answer 28

• circumscribed breaks in mucosis with acid pepsin
  
  • NSAIDS and steroids
  • liver dz
  • tumors
  • protein-calorie malnutrition
  • uremia
  • stress (more so humans…?)

Question 29

Signs of gastric ulcers

Answer 29

• vomiting
• depression
• inappetance/anorexia
• melena
• anemia

Question 30

DDX for gastric ulcers

Answer 30

• addisons
• parasites
• tumors

Question 31

TX of gastric ulcers

Answer 31

• eliminate underlying cause
• PPI
• sulcralfate
• H2 blockers
• MCT (medium chain triglycerides)
• blood transfusion
• endoscopy
• sx

Question 32

Clinical pres gastric outflow disorder

Answer 32

• intermittent vomition (projection) long periods
• hypochloremia
• hypokalemia
• metabolic alkalosis

Question 33

DX gastric outflow disorder

Answer 33

• rads (+/- contrast)
• ultrasound
• endoscopy
• sx

Question 34

TX for gastric outflow disorder

Answer 34

• Surgery
  
  • pyloroplasty
  • pyloromyotomy