Stomach Flashcards
Which stomach of Ru is most closely related to the simple-stomached animals in terms of structure & function?
abomasum
(third compartment of new world camelids)
What is the structure of the fundic part of the stomach?
- fundic mucosa is lined by numerous folds & produces HCl acid (parietal cells) & pepsinogen (chief cells)
What is the structure of the pyloric part of the stomach?
- lined by epithelium w/ mucous-secreting glands.
What is the structure of the esophageal part of the stomach in some species?
in Eq, Sw, & Rat, the esophageal part (pars esophagea) is nonglandular & lined by stratified squamous epithelium
What is the dividing line btwn the nonglandular and the glandular epithelium in the horse?
margo plicatus
What are the steps of a postmortem examination of the stomach/abomasum?
- open along the greater curvature & gently scrape away ingesta to examine mucosa, do not wash w/ water
- examine the quality & quantity of the gastric contents & remove them
- examine the gastric mucosa, in particular the colour, thickness, & integrity of the mucosal surfaces
- examine the content for presence of blood (if needed to perform occult blood test)
- always take fundic mucosa for histo, plus obviously pathologic changes
- If Haemonchosis is suspected, first tie off pylorus & cardia to collect content for worm count, & then open the abomasum in a bucket/tray
Who does simple gastric dilation occur in?
- a variety of animals including primates
Explain gastric dilation & volvulus in Dogs?
- in large, deep-chested breeds of dogs, distended stomach w/ food & gas can rotate on mesenteric axis counter clockwise (180, 270, or 360 degrees when the abdomen is viewed from the dorsal aspect), resulting in a gastric volvulus w/ an obstructed esophagus that prevents eructation & thus further contributes to gastric dilation
- the spleen, attached to the stomach by the gastrosplenic ligament, rotates w/ the stomach & is thus folded back upon itself & located in the R cranial abdomen against the diaphragm
- both gastric & splenic vein are compressed, resulting in a congested & edematous gastric wall (venous infarction in later stages) & congested spleen, b/c the arterial blood supply remains patent longer than venous drainage
What are predisposing factors to gastric dilation & volvulus in dogs?
- hereditary predisposition (large breeds)
- obstruction of the cardia that prevents eructation & emesis
- obstruction of the pylorus that prevents passage of gastric contents
- repeated episodes of gastric dilation, overfeeding, &/or postprandial exercise, that contribute to stretching & relaxation of the gastrohepatic ligament
What is the cause of death w/ gastric dilation & volvulus in dogs?
- acid-base imbalance
- increased intragastric pressure interferes w/ venous return from portal circulation
- myocardial depressant factors released from pancreas
- decreased cardiac output & shock
What does gastric dilation & volvulus look like in Sw?
- torsion of the stomach or the small intestine is one of the main causes of sudden death in adult breeding stock
- the twist can involve the stomach, the spleen, part of the liver, &/or the intestine
What does gastric dilation & rupture look like in Eq?
- acute gastric dilation & rupture in equids occurs most frequently as a terminal event in small intestinal obstruction, ileus, & displacement
- it can also be the result of rapid ingestion of fermentable feeds or grains, a situation analogous to grain overload w/ lactic acidosis in cattle
What does gastric dilation & rupture look like in non-human primates?
- in research facilities occasionally develop acute gastric dilation associated w/ food restriction & accidental overfeeding
- this cause is unknown, but two principal factors seem to be the intragastric fermentation associated w/ Clostridium perfringens, & abnormal gastric function
In other animals what is gastric/abomasal dilation usually secondary to?
- ulcers, pyloric stenosis, overeating, gastritis/abomesitis, vagal indigestion, etc.
What are the clinical consequences of gastric dilation?
- severe distention compromises respiration & cardiovascular function & electrolyte balance
- gastric rupture (usually along the major curvature) is often the ultimate cause of death
How do you distinguish btwn ante-mortem & post-mortem gastric rupture?
- the only reliable indicator of ante-mortem rupture of the stomach is the presence of hemorrhage along the margins & evidence of acute inflammation (ex: fibrin strands)
- if these changes are not present on gross exam, histo exam of the margins is recommended to rule out postmortem distention & rupture of the stomach/abomasum
Who does abomasal displacement and volvulus usually occur in in cows?
- high-producing dairy cattle during the first 6 weeks after parturition
What are the causes of abomasal displacement & volvulus in cattle?
- abomasal atony due to heavy grain feeding (volatile fatty acids decrease motility)
- impaired movement of ingesta & gas formation
- hypocalcemia at the onset of lactation -> decreased strength of muscle contractions
What are the clinical features of a displaced abomasum (right or left sided)?
- anorexia, dehydration, decreased amount of feces, ketouria, characteristic high-pitched ping subsequent to percussion over displaced abomasum
What is important about a left-sided abomasal displacement?
- most common
- generally nonfatal
What is important about a right-sided abomasal displacement?
- occurs only in 10-15%
- it is considered more significant b/c it may progress to abomasal volvulus resulting in an abomasal venous infarction & death
What is important about Clostridium septicum in abomasitis?
- it is a cause of hemorrhagic abomasitis w/ submucosal emphysema of lambs & occasionally calves (a disease known as BRAXY)
- this disease is most common in Europe, but it occasionally also occurs in North America
- generally, the disease follows ingestion of frozen feeds contaminated w/ the causative Clostridium spp.
- the lesions are produced by the exotoxin of the bacteria, & death therefore is due to an exotoxemia (similar to Clostridial myositis)
What is fundic mucosal infarction in pigs?
- in many cases of septicemia in pigs (ex: salmonellosis, swine dysentery, Glasser’s disease, & colibacillosis), venular thromboses occur in the fundic mucosa/submucosa resulting in congestion, hemorrhage, venous infarction, & ulceration
What is gastritis often associated w/ clinically?
vomiting, dehydration, & metabolic acidosis
what are the different types of gastritis?
- acute mild gastritis
- canine hemorrhagic gastroenteritis (acute hemorrhagic diarrhea syndrome)
- chronic gastritis
Who is acute mild gastritis most common in and why?
- dogs rather than cats due to less discriminating eating habits
What are the clinical signs of acute mild gastritis?
vomiting & inappetence w/o systemic signs
What are the causes of acute mild gastritis?
- ingestion of spoiled or contaminated food, foreign objects, toxic plants, chemicals, NSAIDs
What is the prognosis of acute mild gastritis?
- not fatal & transient
- it is successfully diagnosed & treated clinically (feed withdrawal & antiemetics)
Who does canine hemorrhagic gastroenteritis (acute hemorrhagic diarrhea syndrome) most often occur in?
most often occurs in smaller breeds
What is the cause of canine hemorrhagic gastroenteritis (acute hemorrhagic diarrhea syndrome)?
not clear but infection w/ Clostridium perfringens of unknown type is suspected
What are the clinical signs of canine hemorrhagic gastroenteritis (acute hemorrhagic diarrhea syndrome)?
- hematemesis & hematochezia (often w/ hemoconcentration > PCV .60%)
- on presentation, animal may be moribund & may die due to cardiovascular collapse, renal failure, &/or DIC
What would you see on endoscopy/necroscopy for canine hemorrhagic gastroenteritis (acute hemorrhagic diarrhea syndrome)?
- diffuse hemorrhagic necrosis of gastrointestinal superficial mucosa (most severe in colon)(w/ Clostridial bacteria identified by histo)
Parvo vs canine hemorrhagic gastroenteritis (acute hemorrhagic diarrhea syndrome)?
- parvoviral enteritis may have similar gross appearance, but histologically there is cryptal necrosis in the small intestines & it DOES NOT AFFECT THE STOMACH
What are the clinical signs of chronic gastritis?
- emesis & if intestines are also affected than diarrhea & occasionally hematochezia
- dehydration
What are the different types of chronic gastritis?
- eosinophilic gastritis as part of gastroenteritis or gastroenterocolitis
- lymphoplasmacytic gastritis
- hyperplastic (also called hypertrophic) gastritis in dogs
- uremic gastritis
Who is eosinophilic gastritis as part of gastroenteritis or gastroenterocolitis seen in?
in dogs & less commonly in cats
What is the etiology of eosinophilic gastritis as part of gastroenteritis or gastroenterocolitis?
etiology is poorly understood: 2 conditions should be considered when the diagnosis of eosinophilic gastroenteritis is made on an endoscopic biopsy of the stomach, duodenum , & colon (REMEMBER TO ALWAYS SAMPLE ALL 3 SITES WHEN DOING ENDOSCOPIC GIT BIOPSY TO INCREASE THE CHANCE OF YOUR DIAGNOSIS!!!):
1. Parasites
2. hypersensitivity reaction to unknown allergen or food intolerance
why should you consider parasites w/ eosinophilic gastritis as part of gastroenteritis or gastroenterocolitis?
- gastrointestinal parasites (ex: Toxocara canis, Physaloptera canis, Ollulanus tricuspis, Trichuris vulpis, Ancylostoma spp - last two can cause blood & protein loss) & their products induce variable degrees of eosinophilic inflammation occasionally w/ mild to moderate hyperplasia
why should you consider a hypersensitivity reaction to an unknown allergen or food intolerance w/ eosinophilic gastritis as part of gastroenteritis or gastroenterocolitis?
- most likely due to feed ingredients or preservatives or medications (allergens)
- sometimes this is accompanied by a peripheral eosinophilia & skin disease
- more severe aspect of this condition can present as hemorrhagic enteritis
What will you see with endoscopy w/ eosinophilic gastritis as part of gastroenteritis or gastroenterocolitis?
- the gross lesions of eosinophilic gastroenteritis are rather nonspecific (mild hyperemia & thickening of the mucosa, increased amounts of mucus)
How do we diagnose eosinophilic gastritis as part of gastroenteritis or gastroenterocolitis?
Histo
What is the cause of lymphoplasmacytic gastritis?
not determined - chronic irritative/antigenic stimulus by gastric bacteria (including Helicobacter spp.) suspected
What is characteristic of hyperplastic (hypertrophic) gastritis in dogs?
thickened rugae secondary to hyperplasia of gastric glands
What are the causes of hyperplastic (hypertrophic) gastritis in dogs?
- chronic retention of gastric fluid & reflux of intestinal bile
- immune-mediated process resulting in hyperplastic lymphoplasmacyctic gastritis
- idiopathic
What is FOCAL hyperplastic (hypertrophic) gastritis in dogs?
Antral (pyloric) hyperplastic (hypertrophic) gastritis:
- in older small breed dogs
- clinical signs of upper GI obstruction (post-prandial vomiting)
- diagnosis by endoscopy & radiography (endoscopic biopsy may not be useful diagnostic test b/c samples are taken only from the superficial mucosa)
- must be differentiated from pyloric obstruction due to pyloric muscular hypertrophy which presents w/ similar clinical signs (may need imaging or laparoscopy to differentiate from pyloric hyperplastic gastritis)
What is DIFFUSE hyperplastic (hypertrophic) gastritis in dogs?
- chronic giant hypertrophic gastropathy is a rare disease in Ca which are affected by weight loss, D+, V+, & hypoproteinemia
- cause is unknown
- ante-mortem diagnosis is made by endoscopy