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Y4 SA - Endocrine > The approach to vomiting > Flashcards

The approach to vomiting Flashcards

1
Q

Primary vomiting is due to?

A

Underlying gastric disease

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2
Q

Secondary vomiting is due to?

A

Non-GI disease

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3
Q

List the causes of focal primary gastric disease

A
  • Chronic gastritis
  • Gastric ulcers
  • Gastric retention disorders
  • Gastric neoplasia
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4
Q

List the causes of diffuse primary gastric disease

A
  • Inflammatory bowel disease
  • Diffuse alimentary lymphoma
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5
Q

What clinical sign usually predominates in secondary gastric disease?

A

Diarrhoea

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6
Q

List some causes of secondary vomiting

A
  • Infections: distemper, lepto
  • Pyometra
  • Renal failure
  • Hepatic disease
  • Drugs
  • Hypoadrenocorticism
  • CNS disease
  • Motion sickness
  • Vestibular disease
  • Neoplasia
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7
Q

Chronic vomiting can occur secondary to which intestinal diseases?

A

Inflammatory bowel disease
Intestinal neoplasia
Small intestinal obstruction
Pancreatitis
Peritonitis

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8
Q

Other than vomiting, list some other clinical signs of gastric disease

A

Haematemesis
Nausea/retching
Hypersalivation
Anorexia
Melaena
Bloating
Borborygmi
Weight loss

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9
Q

Describe the pathophysiology of gastric disease

A

Gastric outflow obstruction
Gastroparesis
Disruption of mucosal barrier

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10
Q

How can the cause of chronic vomiting diagnosed?

A
  • Distinguish vomiting vs. regurgitation
  • Eliminate secondary causes: history, physical exam, laboratory analysis, imaging
  • Abdominal imaging
  • Gastroscopy / coeliotomy
  • Symptomatic therapy e.g. anti-emetic
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11
Q

Describe the clinical exam for chronic vomiting cases

A
  • Oral examination: Ulcers
  • Abdominal palpation: Pain, Foreign body, intra-abdominal mass, distended stomach or bowel
  • Rectal exam, Diarrhoea, Melaena
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12
Q

On clinical pathology in chronic vomiting cases, what can electrolyte levels tell you?

A

Can tell you information regarding Addison’s

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13
Q

On clinical pathology in chronic vomiting cases, what can haematology tell you?

A

Inflammatory or not

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14
Q

On clinical pathology in chronic vomiting cases, what can the ACTH stimulation test tell you?

A

Basal cortisol – if low then do this test. If normal Addison’s can be ruled out

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15
Q

On clinical pathology in chronic vomiting cases, what can the bile acid stimulation test tell you?

A

Is the liver working as it should?

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16
Q

How is radiography used in chronic vomiting cases? What can be diagnosed?

A

Survey abdominal radiograph
- Foreign body
- Abdominal mass
- Intestinal obstruction
- Peritonitis
- GDV

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17
Q

How is ultrasound used in chronic vomiting cases? What can be diagnosed?

A

Foreign body
Ulcers
Thickening of gastric mucosa
Loss of layering (suggests infiltration)

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18
Q

When is endoscopy/gastroscopy indicated in chronic vomiting cases?

A

If clinical or radiographic signs of gastric disease

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19
Q

What are the causes of chronic gastritis?

A

Aetiology usually unknown
Sometimes generalised IBD
Various possible reasons
- Chronic gastric parasitism (eg. Physaloptera)
- Hairballs in cats?
- Spiral bacteria - Helicobacter
- Immune-mediated?

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20
Q

What are the most common clinical signs of chronic gastritis?

A

intermittent chronic vomiting (vague)
± periodic early morning vomit with bile
± poor appetite

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21
Q

How is chronic gastritis diagnosed?

A

Laboratory changes often non-specific
Imaging findings non specific
Gastroscopy and biopsy

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22
Q

How is chronic gastritis treated?

A

Removal of aetiologic agent if known
Diet
- Multiple small meals
- Low fat diet
- ‘hypoallergenic’ diet
Acid blocker
Corticosteroids ?

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23
Q

When does bilious vomiting occur?

A
  • Often occurs in dogs fed once daily (especially if fed in the morning)
  • Vomiting occurs overnight or in the morning
24
Q

How is bilious vomiting characterised?

A
  • Vomitus often bile-stained fluid, not food
  • Presumably reflects abnormal inter-meal motility allowing bile-reflux into stomach
25
Q

How is bilious vomiting diagnosed?

A

Rule out other causes of vomiting
Treatment trial - When patient is not severely ill do this earlier on

26
Q

How is bilious vomiting treated?

A

Feed more often, focussing on late meal
You might add prokinetics (ranitidine or metocloperamide) - Sometimes only needed in the evening

27
Q

Define gastric retention disorders

A

Retention of food for > 8 hours causing delayed vomiting of food

28
Q

Why do gastric retention disorders occur?

A

Anatomical outflow obstruction
Functional disorder

29
Q

What are the causes of an anatomical outflow obstruction (…which causes gastric retention disorders)?

A

Pyloric stenosis
Neoplasia, polyp
CHPG = Chronic hypertrophic pylorogastropathy
Foreign body - rubber ball, peach stone, conker, sock

30
Q

Describe the main features of pyloric stenosis

A

Congenital in brachycephalic breeds
Association with megaoesophagus in cats
Treatment - pyloromyotomy / pyloroplasty

31
Q

Describe the main features of Chronic hypertrophic pylorogastropathy

A

Idiopathic mucosal hypertrophy
May cause outflow obstruction
Most common in toy breeds
May result from hypergastrinaemia ?
Treatment - surgery

32
Q

What are the causes of a functional outflow obstruction (…which causes gastric retention disorders)?

A

Primary motility disorder
Inflammatory disease
- Inflammatory bowel disease
- Gastric ulcer

33
Q

How can you treat the functional causes of gastric retention disorders?

A

Treat underlying inflammatory disease
Prokinetics

34
Q

Describe some prokinetic drugs used in function gastric retention disorders

A
  1. Metoclopramide - Licensed products exist - Stimulate normal gastric peristalsis
  2. Ranitidine - H2 antagonist plus prokinetic action
  3. Erythromycin - Low dose stimulates motilin receptors
35
Q

List the causes of haematemesis

A
  • Generalised bleeding
  • Swallowed blood: Oropharyngeal, Nasal, Pulmonary
  • Severe gastritis
  • Gastric ulcer
  • Gastric neoplasia
  • Duodenal disease
36
Q

List the clinical signs of gastric ulcers

A

Haematemesis
Melaena
Anaemia
Weight loss
Pain
Peritonitis etc. if perforated

37
Q

Which posture indicated abdominal pain?

A

The prayer posture

38
Q

What is a peptic ulcer?

A

An ulcer in the stomach or duodenum

39
Q

Which drugs can cause peptic ulcers?

A

NSAIDs
Corticosteroids

40
Q

List some other causes of peptic ulcers

A
  • Head and spinal injuries, in combo with corticosteroids
  • Gastritis
  • Liver disease
  • Uraemia
  • Mastocytosis (excess number of mast cells gathering in the body’s tissues)
  • Gastrinoma
41
Q

Name the bacteria that can cause peptic ulcers

A

Spiral bacteria (Helicobacter)

42
Q

Name the drugs used to treat gastric ulcers

A

Sucralfate
Acid blockers – antacids, H2 antagonists, proton pump inhibitors

43
Q

What is the action of H2 receptor antagonists, name some drug examples used in practice

A

Block stimulation of HCl secretion
- Cimetidine
- Ranitidine

44
Q

What is the action of proton pump inhibitors, name some drug examples used in practice

A

Proton pump inhibitors completely block HCl secretion
Omeprazole (Losec)
Others (pantoprazole, esomeprazole, lansoprazole)

45
Q

How can you prevent ulcers?

A

synthetic PGE
misoprostol - antidote to overdose

46
Q

Describe the triple therpay options for treating Helicobacter

A

Two antibiotics plus an acid blocker e.g. amoxicillin, metronidazole and omeprazole
OR
3 antibiotics e.g. amoxicillin, metronidazole, clarithromycin

47
Q

Which animals more common present with gastric neoplasia?

A

Middle-age/older male dogs > cats

48
Q

Which gastric neoplasia are most commonly seen in dogs?

A

Adenocarcinoma (75%)
Lymphoma
Polyps
Leiomyoma / leiomyosarcoma

49
Q

Which gastric neoplasia are most commonly seen in cats?

A

Lymphoma
Adenocarcinoma

50
Q

Describe the effects of gastric adenocarcinomas

A

Infiltrate gastric wall -> Fibrosis / thickening and ulceration
- Often lesser curvature / distal stomach
- Metastasis to local LN and liver

51
Q

Gastric adenocarcinomas have a predisposition to which breeds?

A

Belgian shepherds, Collies, Bull terriers

52
Q

What clinical signs may lead you to suspect gastric adenocarcinoma?

A

Suspect in older animal with:
- Chronic vomiting
- Anorexia and weight loss
- Haematemesis and melaena
- Anaemia
- Drooling saliva

53
Q

How are gastric adenocarcinomas diagnosed?

A

Contrast radiography
Endoscopic biopsy - often
Full thickness biopsy

54
Q

How are gastric adenocarcinomas treated?

A

Surgical resection

55
Q

Describe the prognosis of gastric adenocarcinomas

A

grave/hopeless - Probably painful
‘leather-bottle’ stomach

Y4 SA - Endocrine (6 decks)

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