Vomiting and Regurgitation Specific Diseases

Question 1

describe gastrointestinal obstructions

Answer 1

1. common in vet med!
2. occur due to foreign body ingestion most commonly
   -other causes: intestinal mass, intestinal stricture, intussusception
3. clinical presentation:
   -acute or chronic vomiting MOST COMMON
   +/- abdominal pain, hypo/anorexia, diarrhea

Question 2

describe diagnostics for GI obstructions

Answer 2

1. imaging:
   -radiographs!!!
   –two populations of bowel (unless at ICJ), plication (linear FB)

-abdominal ultrasound:
-second line for FB obstructions
-useful for intussusceptions and intestinal masses

2. bloodwork
   -metabolic alkalosis
   -often with hypochloremia (vomiting Cl out and not absorbing it)
   -seen in most pyloric outflow obstructions
   -seen in 50% of small intestinal obstrucitons

Question 3

describe gastric foreign bodies

Answer 3

1. foreign material within the stomach
   -typically not obstructive BUT
   -can cause pyloric outflow obstruction OR
   -move into the small intestines
2. clinical signs
   -vomiting
   -anorexia/hyporexia
   - +/- abd pain
3. tx:
   -endoscopic removal
   -gastrotomy

Question 4

describe small intestinal foreign bodies

Answer 4

1. foreign material in any segment of the small intestines
   -can cause partial or complete obstruction
2. can lead to necrosis or rupture of intestinal wall
   -pressure related necrosis
   -sharp edge on foreign body
3. can also occur in small mammals: ferrets, rabbts
4. clinical signs:
   -VOMITING
   -abdominal pain
   -anorexia, hyporexia
5. diagnosis:
   -rads or US
6. treatment:
   -enterotomy or intestinal resection and anastomosis

Question 5

how do you decide when to R&A/when intestine is no longer viable?

Answer 5

1. color of intestine:
   -white/gray/green/black= bad

-dark purple: may be okay; take the foreign body out let intestines sit for about 5 min and see if improve; if not, resect

-red: usually okay

2. if intestine is rupture or leaking, usually R&A
3. presence of blood supply to intestine:
   -feel for arterial pulses in mesentery to that segment
   -BUT won’t feel if BP is trash (common under anesthesia)
4. presence of peristalsis = still good
   -pinch and see if wiggles in response

Question 6

describe SI linear FBs

Answer 6

1. typically anchored either under the tongue or in the stomach
   -ALWAYS check under the tongue for anchor before sx!
2. moves through intestines by peristalsis
3. treatment:
   -gastrotomy +/- enterotomy +/- intestinal R&A depending on how far and how much damage
   -up to 40% of dogs with linear FBs have intestinal leakage

Question 7

describe intussusception

Answer 7

1. invagination of one portion of the GI tract into the lumen of an adjoining segment
2. typically at ICJ and usually less than 1 year of age
3. may be associated with enteritis
   -parasites, FBs, viruses
4. clinical signs similar to other obstructive GI diseases
   +/- more diarrhea bc underlying cause

Question 8

describe diagnosis and treatment of intussusception

Answer 8

1. diagnosis:
   -palpable cylindrical mass in abdomen
   -RADIOGRAPHS: mass effect, two populations of bowel
   -US: concentric rings!!!!
2. treatment:
   -explore entire bowel for abnormalities: could be more than one or a FB or mass

-manual reduction +/- resection: aided by gentle traction on intissusceptum and pressure on intussuscipiens
–only attempt if no evidence of bowel necrosis and if visible vasculature is patent
–may not be possible esp if more chronic

-manual reduction not possible in approx 81% of dogs due to serosal adhesions or intestinal leakage

-R&A: necessary if intestinal leakage and vascular compromise are present

Question 9

describe hiatal hernias

Answer 9

1. occur when abdominal contents herniate through esophageal hiatus into mediastinum
2. stomach is most commonly herniated
3. english bulldogs and shar peis overrepresented
4. 4 types:
   I: sliding hiatal hernia: most common in brachycephalic
   II: paraesophageal hernia
   III: combo of type I and type II
   IV: organs other than the stomach herniating through hiatus

Question 10

describe clinical signs of a hiatal hernia

Answer 10

1. regurg
2. hypersalivation
3. vomiting
4. dysphagia
5. resp distress
6. anorexia, weight loss

often occur between 2-4 months of age when introducing solid food

Question 11

describe diagnosis of hiatal hernias

Answer 11

1. thoracic radiographs
   -cranial displacement of the stomach
   -soft tissue mass effect in caudal thorax adjacent to diaphragm
   -gas-filled viscera in thorax
2. positive-contrast esophagram
   -fluoroscopy very beneficial for type I

Question 12

describe medical management of a hiatal hernia

Answer 12

1. very effective!
   -resolves clinical signs in over half
   -try a 30 day trial prior to surgery if possible
2. 4 goals:
   -reduce gastric acid secretion: H2 blockers (famotidine), proton pump inhibitors (omeprazle)

-provide esophageal mucosal protection: sucralfate

-increase rate of gastric emptying
-augment LES tone
-both above accomplished with: prokinetic agents (metoclopramide, cisapride), elevated feeding, and low-fat diet

Question 13

describe PRAA

Answer 13

persistent right aortic arch

1. congenital disease/vascular ring anomaly:
   -most common: PRAA with left ligamentum arteriosum
2. embryology:
   -aortic arch should develop from left 4th aortic arch but PRAA occurs when it develops from the right 4th aortic arch instead and creates a ring around the esophagus
3. mostly in large breed dogs: GSDs, irish setters
4. clinical signs:
   -regurgitation: typically starting with solid food ingestion (rule out hiatal hernia!)
   -failure to gain weight by 2-6 months of age
5. diagnosis:
   -radiographs: segmental megaesophagus, contrast may be helpful
   -fluoroscopy
   -esophagoscopy
   -CT