Vomiting + stomach disease Flashcards
What is the difference between primary + secondary vomiting?
- Primary vomiting = underlying gastric disease
- Secondary vomiting = non-GI disease
What can cause secondary vomiting (systemic/metabolic disease)?
- infections = distemper, leptospirosis
- pyometra
- renal failure
- hepatic disease
- drugs = digoxin, erythromycin, morphine
- ketoacidotic D.M.
- hypoadrenocorticism
- CNS disease
- motion sickness
- vestibular disease
- neoplasia
What can cause chronic vomiting (2ary to intestinal / peritoneal disease)?
- inflammatory bowel disease
- intestinal neoplasia
- small intestinal obstruction
- pancreatitis
- peritonitis
What primary gastric disease can cause chronic vomiting?
- chronic gastritis
- gastric retention disorders
- gastric ulcers
- gastric neoplasia
What diffuse GI disease involving stomach can cause chronic vomiting?
- Inflammatory bowel disease
- Alimentary lymphoma
What is the pathophysiology of gastric disease?
- gastric outflow obstruction
- gastroparesis
- disruption of mucosal barrier
What are other signs of gastric disease?
- Haematemesis
- Nausea
- hypersalivation
- retching
- anorexia
- Melaena
- Miscellaneous
- belching
- bloating
- borborygmi
- weight loss
How can you diagnose chronic vomiting?
- Distinguish vomiting vs. regurgitation
- Eliminate secondary causes = Hx, PE, laboratory analysis, imaging
- Abdominal imaging = Plain radiography, Contrast radiography, Ultrasonography
- Gastroscopy / coeliotomy
- Symptomatic therapy
What would you do on Physical exam with chronic vomiting?
- Oral examination = ulcers, linear foreign body
- Abdominal palpation = pain, foreign body, intra-abdominal mass, distended stomach or bowel
- Rectal examination = diarrhoea, melaena
What would you do on clinical pathology of chronic vomiting?
- Electrolytes
- Haematology
- BAST - bile acid stim test
- ACTH Stim
- cPLI
- Urinalysis
What would you check of radiographs?
Abdominal radiographs =
* foreign body
* abdominal mass
* intestinal obstruction
* peritonitis
* GDV
What would you check of ultrasonography?
- foreign body
- ulcers
- thickening of gastric mucosa
- loss of layering (suggests infiltration)
What are causes of chronic gastritis?
- Generalised Inflammatory bowel disease
- chronic gastric parasitism (eg. Physaloptera)
- hairballs in cats
- spiral bacteria - Helicobacter
- Immune-mediated
What are clinical signs of chronic gastritis?
- intermittent chronic vomiting (vague)
- ± periodic early morning vomit with bile
- ± poor appetite
- ± gastric bleeding
How is chronic gastritis diagnosed?
- Gastroscopy
- Biopsy
What is Tx of chronic gastritis?
- Removal of aetiologic agent if known
- Diet = multiple small meals, low fat diet, ‘hypoallergenic’ diet
- Acid blocker
- Corticosteroids
What is bilious vomiting?
- Often occurs in dogs fed once daily (especially if fed in the morning)
- Vomiting occurs overnight or in the morning
- Vomitus often bile-stained fluid, not food
- Presumably reflects abnormal inter-meal motility allowing bile-reflux into stomach
How do you treat bilious vomiting?
- Feed more often
- Add prokinetics
What are gastric retention disorders?
- Retention of food for > 8 hours causing delayed vomiting of food
- Anatomical outflow obstruction
- Functional disorder = primary motility disorder / inflammatory disease =
- inflammatory bowel disease
- gastric ulcer
What can cause anatomical outflow obstruction of the stomach?
- Pyloric stenosis - congenital in brachycephalics
- Neoplasia, polyp
- CHPG (chronic hypertrophic pylorogastropathy) - toy breeds
- Foreign body = rubber ball, peach stone, conker, sock etc
How would you treat outflow obstruction of stomach?
- Stenosis = surgery
- CHGP = Surgery
- FB = removal
How would you treat gastric retention?
- Treat underlying inflammatory disease
- Prokinetics =
-metaclopramide (stim gastric peristalsis) - ranitidine (H2 antagonist + prokinetic)
- erythromycin (stim motilin receptors)
What are causes of haemtemesis?
- generalised bleeding
- swallowed blood = oropharyngeal, nasal, pulmonary
- severe gastritis
- gastric ulcer
- gastric neoplasia
- duodenal disease
What are signs of gastric ulcers?
- haematemesis
- melaena
- anaemia
- weight loss
- pain
- peritonitis etc. if perforated
- Prayer posture - abdominal pain
What can cause gastric ulcers?
- NSAIDs
- Corticosteroids
- Head + spinal injuries = w corticosteroids, colonic ulcers / perforation
- gastritis
- metabolic = liver disease, uraemia
- bile reflux
- mastocytosis
- gastrinoma (Zollinger-Ellison)
- spiral bacteria (Helicobacter)
How would you treat gastric ulcers?
- Tx identifiable primary cause
- Sucralfate
- Acid blockers =
- antacids
- H2 antagonists - ranitidine, cimetidine
- proton pump inhibitors - omeprazole
What can be used to prevent gastric ulcers?
Misoprostol - synthetic PGE
What is Tx of helicobacter?
- Triple therapy =
- 2 antibitoics + acid blocker =
1. Amoxicillin
2. Metronidazole
3. Omeprazole
What are gastric neoplasias in dogs / cats?
- Dogs =
- adenocarcinoma (75%) (belgian shepherds, collies, bull terriers)
- lymphoma
- polyps
- leiomyoma / leiomyosarcoma
- Cats =
- lymphoma
- adenocarcinoma
What are signs of gastric adenocarcinoma? Dx?
- suspect in older animal with =
- chronic vomiting
- anorexia and weight loss
- haematemesis and melaena
- anaemia
- drooling saliva
- Dx = contrast radiography, endoscopic biopsy / full thickness biopsy
What is Tx of gastric adenocarcinoma?
- Surgical resection - Hopleless prognosis = Euthanasia
What should be done with other tumours?
- Lymphoma = chemotherapy
- Leiomyoma = Surgery
- Polyp = surgical removal + histopath
