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SA Sx - Gastric Sx Disorders 2

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drraythe's version from 2017-09-13 20:18

Neoplasms

Question Answer
What are the benign neoplasms common to the stomach?Adenoma, Adenomatous polyp
WHO usually gets benign neoplasms of the stomach & how do they look? How hard to excise?Rare, occur in old dogs. Often large, pedunculated. Easily excised
Where do you find Leiomyosarcoma & who usually gets them?In sm mm of stomach, usually Very old dogs (average age = 15 yrs in 1 study of 7 cases)
What are the 2 MAIN Malignant neoplasms of the stomach & who usually gets which?Adenocarcinoma for dogs, Lymphosarcoma for cats
Adenocarcinoma happens most commonly in who? Age? Is there a gender discrepancy?OLDER DOGS (60 - 70% of gastric cancer in dogs), avg age 8ys, 2.5:1 male to female ratio (more males get it)
Lymphosarcoma usually happens in who?Most common gastric tumor in cats (also occurs in older, usually male, dogs)
What might a gastric neoplasia look like? (Diff prob)Looks like a pyloric obstruction but not usually young dogs
How can you Dx an animal w/ gastric neoplasia?(1) Hx of hematemesis, anorexia, weight loss, abdominal pain
(2) Contrast radiography / ultrasonography - see mass lesion or ulcer
Would you expect bloody feces or vomit in an animal w/ gastric neoplasia?Yes! Neoplasia can cz ulcers or other problems
Where are malignant gastric neoplasias usually located?Often located on lesser curvature or pyloric antrum
How do benign gastric neoplasias usually look?Pedunculated / circumscribed
Would you want to use an endoscope to biopsy a gastric neoplasia?Usually NO (but can be useful) endo cant give full thickness biopsy - do exploratory celiotomy (esp if an older dog, want full thickness bc prolly neoplasia)
What are the CSs of an Adenocarcinoma?Hematemesis
Abdominal pain
Anemia
Melena
Signs of pyloric obstruction
Icterus
Why might you see icterus in a case of gastric neoplasia?Tumors in this area may obstruct biliary outflow causing icterus (duodenal blockage)
What is an apple core lesion/ when do you see it?Radiographic filling defect in pyloric antrum, "apple core" lesion
Differential Dx for gastric neoplasia?(1) Pyloric hypertrophy
(2) Pythiosis or phycomycosis
What should you know about Pythiosis or phycomycosis?P. insidiosum czs severe inflammatory & infiltrative lesions in alimentary tract. Most common in the Gulf states & in hunting dogs.
If you think the dog has pythiosis instead of neoplasia, how are you gonna treat/regard this mass?Highly invasive & looks like metastasis, has to be a very aggressive Sx from the beginning (In the gastrointestinal tract, Pythiosis clinically mimics an invasive carcinoma, so aggressive surgical extirpation must be attempted)
How deep into the stomach layers does Pythiosis usually go?Infnxn typically involves the full thickness of the stomach or intestine
Why might you be extra concerned if you find pythiosis in the pylorus or duodenum?Can extend to the pancreas, omentum, lymph nodes, or contiguous viscera
Adenocarcinoma → do these tend to metastasize? Where?Yes, to regional lymph nodes (70 - 80%), liver, lung (other sites incld omentum, peritoneal surface of diaphragm)
A 1° adenocarcinoma can present in what 2 kinds of ways?Scirrhous or Infiltrative
What is a scirrhous 1° neoplasm look like?Firm & white on serosal surface
What is an infiltrative 1° neoplasm like?Expansitile w/ central crater & ulceration on mucosal surface
Tx for gastric adenocarcinoma? Problems associated w/ Tx?Partial gastrectomy (this is more difficult on the lesser curvature though), Gastroduodenostomy or gastrojejunostomy (Billroth I or Billroth II) often required (remove tumor & close stomach & close other end of duodenum which is shortened & attach part of the jejunum). Cholecystoenterostomy may be required w/ pyloric tumors (jejunum mucosa is not prepared for acid of stomach so it gets ulcers)
What are non-surgical Txs of gastric neoplasia like?No effective chemotherapy for adenocarcinoma. Gastric lymphosarcoma does not respond well to chemotherapy. Radiation therapy rarely used due to sensitivity of surrounding tissues (so...they suck)
Prognosis of gastric adenoma?Complete excision is curative
Prognosis of gastric leiomyoma/leiomyosarcoma?Mean survival is 1 yr
Prognosis of gastric adenocarcinoma?Sx is palliative, mean survival is 6mo
If you want a full thickness biopsy, do what? If you want partial thickness, do what?Full = Exploratory celiotomy
Partial = endoscopy
Which gastric tumor can look "whitish"?Adenocarcinoma in dogs
Is it normal to be able to separate mucosa from muscularis?YES - so you know if it's thickened & hard & doesnt separate that there might be neoplasia
What mimics an invasive carcinoma?Pythiosis
***6-8 week old Siamese cat comes into your office w/ a Hx of vomiting following ingestion of solid food which presented at weaning. The cat seems to have a ravenous appetite but vomits up to 24 hours after eating. Radiograph shows barium in stomach beyond 8-12 hours. Which is more likely w/ these presenting signs? (Acquired pyloric hypertrophy / stenosis OR Congenital Pyloric Hypertrophy / stenosis)Congenital (more common in brachycephalic breeds of dog & Siamese cats) **Also, Acquired is Rare in Cats**
***Which breeds more commonly get the Acquired form of pyloric hypertrophy/stenosis?Lhasa Apso & Shih-tzu
***Which surgical procedure for Pyloric Hypertrophy / stenosis does NOT enter the lumen?Fredet-Ramstedt pyloromyotomy
***Which procedure is ONLY indicated in the congenital form of pyloric hypertrophy / stenosis?Fredet-Ramstedt pyloromyotomy (Y-U IS JUST FOR ACQUIRED)
***Which procedure has more successful results than the others? (a) Fredet-Ramstedt pyloromyotomy
(b) Helneke-Mikulicz pyloroplasty
(c) Y-U antral advancement flap pyloroplasty
Y-U antral advancement flap pyloroplasty
***Which is used for Acquired pyloric hypertrophy / stenosis? (a) Fredet-Ramstedt pyloromyotomy
(b) Helneke-Mikulicz pyloroplasty
(c) Y-U antral advancement flap pyloroplasty
Y-U antral advancement flap pyloroplasty
***Which is used for either Acquired or Congenital pyloric hypertrophy / stenosis? (a) Fredet-Ramstedt pyloromyotomy
(b) Helneke-Mikulicz pyloroplasty
(c) Y-U antral advancement flap pyloroplasty
Helneke-Mikulicz pyloroplasty **However... it’s not usually effective w/ Acquired pyloric hypertrophy**
***Which is the most common gastric cancer in dogs?Adenocarcinoma
***Which is most common gastric tumor in cats?Lymphosarcoma
***True or False - Radiographic filling defect in the pyloric antrum is also called / looks like - an “Apple Core” lesiontrue
***P. insidiosum (phycomycosis) mimics what sort of cancer?Adenocarcinoma - Mimics Invasive Carcinoma
***What states & what dogs are more commonly infected by P. insidiosum (phycomycosis)?Gulf states & hunting dogs
***True or False - Complete excision of Adenoma is curativeTrue
***True or False - Gastropexy for Hiatal Hernia is right-sided fundus to body wallFalse **Hiatal Hernia Gastropexy → LEFT-sided FUNDUS to Body Wall
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Hernia

Question Answer
DEFINE hiatal herniaProtrusion of abdominal esophagus, gastroesophageal jnxn & sometimes a portion of gastric fundus through the esophageal hiatus of the diaphragm into the caudal mediastinum
Etiology of hiatal hernia?Usually congenital, associated w/ abnormalities of hiatus, especially of the phrenicoesophageal ligament. Possibly traumatic.
What other body system/problem is associated w/ hiatal hernias?May be associated w/ upper airway obstruction
Which ligament is usually the troublemaker w/ hiatal hernias?Phrenicoesophageal ligament
What is the usual signalment of an animal suffering from hiatal hernias?Dogs & cats (rare in cats), Male Shar-pei & Bulldogs predisposed
What is the usual Hx of an animal suffering from a hiatal hernia?Could be NO Hx - often asymptomatic & hernia is an incidental finding. However, can also present as Regurgitation, or vomiting, or dysphagia, Hematemesis, Anorexia, weight loss (very vague GI signs so have good DDx rule outs & listen very carefully)
(Said in class) what is the most common hiatal hernia & why might it be hard to Dx?Sliding esophageal is the most common hernia, cant Dx w/ endoscopy
How can you Dx a hiatal hernia?Radiography
Fluoroscopy
Endoscopy (can see w/ endoscope if there is esophagitis ← happens w/ any harm to the esophagus)
Why is fluoroscopy so useful in Dx a hiatal hernia?Can see DYNAMIC MVT w/ it
If you suspect a perforation but you want to do a contrast study when trying to Dx a hiatal hernia, what should you use?Use IODINE instead of barium (super bad if it gets into body cavities)
When do you Tx hiatal hernia?Only intervene w/ Sx if symptomatic! With asymptomatic, monitor
Why would you want to be very careful of the dorsal esophageal hiatus?VAGUS N LIVES THERE
4 options for surgical Tx of hiatal hernia?(1) Gastropexy
(2) Hiatal reduction & esophagopexy (phrenoplasty)
(3) Gastrostomy tube
(4) Nissen fundoplication
How would you gastropexy for a hiatal hernia?Left-sided fundus to body wall
A hiatal reduction & esophagopexy (phrenoplasty) essentially does what?Reduce the size of the esophageal hiatus
Nissen fundoplication is indicated when?Indicated only if reflux and esophagitis are present
Explain a little about the Nissen fundoplication procedure & why esophagitis being present is necessary to justify the procedureReflux damages the esophagus >>esophagitis >> scar formation >> stricture >> not let bolus into stomach >> regurg. perform by putting umbilical tape around the abdominal esophagus, dont disturb vagus n, elevate the stomach, ID fundus, wrap fundus around esophagus & suture it to itself >> makes a cuff of stomach around the esophagus
What procedure is this? When is it used? Nissen fundoplication
Indicated only if reflux and esophagitis are present w/ a hiatal hernia (basically make a cuff around the esophagus w/ the fundus so that its wider & less likely to slip through the hiatus)
What procedure is this? What is going on? Gastropexy - hiatal hernia incision on fundus & other on left abd wall. 3.5-4 cm incision to create strong adhesions.
Explain the hiatal reduction & esophagopexy (phrenoplasty)(1) Reduce the size of the hiatus w/ simple stitches
(2) Esophagopexy = Attach esophagus to the other side of the opening
What is a tube gastropexy?Tube gastropexy - place a tube on the fundus... gastropexy is you're fusing the sera muscularis to the ab. wall aka tube gastrostomy
Explain how a gastropexy differs btwn a GDV & a hiatal hernia Tx?GDV has the pexy on the pyloric antrum on the RIGHT side. The hiatal hernia has the pexy on the fundus on the LEFT side. (GDV doesnt have a L in it but Hiatal does)
How long should the incisional gastropexy be in order for it to properly adhere?3.5-4 cm long else it'll not adhere permanently
*Dx hiatal hernia with??Fluoroscopy
Worst bones you could give to cz lots of problems?Pork bones
What is a paired hiatal hernia?Eso & part of fundus get through hiatus
A hiatal hernia might lead to gastro-esophageal dilation...why is this problematic?Pressure on thorax → impair breathing
Whats a phrenoplasty?Reduce size of opening & suture esophagus to edges of diaphragm hiatus, prevents abd esophagus from migrating into thorax
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