Small Ani. Med 2- Gastric Dzs

drraythe's version from 2016-04-29 15:16


Question Answer
what is the major clinical sign of gastric problems?VOMITING
what are the 3 factors you must differentiate with vomiting charateristics/causes?Acute vs. chronic, Self limiting vs. life threatening systemic illness, GI vs. Non-GI causes
clinical syndrome:Acute gastritis. what is the predominant features?Sudden onset of vomiting
clinical syndrome:Ulceration or erosion. what is the predominant features?Vomiting, hematemesis, melena, ± anemia
clinical syndrome:Gastric dilatation/volvulus what is the predominant features?Nonproductive retching, abdominal distension, tachycardia
clinical syndrome:Chronic gastritis what is the predominant features?Chronic vomiting of food or bile
clinical syndrome:Delayed gastric emptying. what is the predominant features?Acute to chronic vomiting more than 8-10 hours after feeding
clinical syndrome: neoplasia. what is the predominant features?Chronic vomiting, weight loss, ± anemia
what did she say about the age distribution of FIV vs FELVshe says felv is young cat dz and FIV is older cat dz
Self limiting vomiting--> how does the pt present? what should be in your minimum database?Pt presents as a Stable healthy patient with a few episodes of vomiting. MDB should include: PCV/TS, Gluc, Na/K, BUN/Creat (FeLV/FIV).... Fecal Flotation and smear.... Parvovirus SNAP if indicated
if you need to choose between a fecal float and tx, what shoud you do?go to tx...floats arent that reliable anyway.
she said always pick ___ for all possible GI parasitesfenbendazole
If you see vomiting and choose to do a therapeutic deworming, what should you do after you deworm?Monitor for worsening signs over next day - recheck (May have to proceed to further diagnostics)
what is her opinion on giving antiemetics to a vomiting dog?‘I do NOT give strong anti-emetics, max 1 single mcp injection’ ( “first line vet has to do something for money…” we might hide important clinical signs)

Acute gastritis, hemorrhagic gastroenteritis, GDV

Question Answer
acute gastritis-- what are the three general causes of this (and the main things in each category)(1) dietary: Indiscretion (eating garbage), Caustic substances, FBs (2) DRUGS: NSAIDs (3) Infectious
acute gastritis is Often a diagnosis of exclusion. you must Must rule out life threatening and systemic diseases such as...Ileus, Sepsis, Parvo, Pancreatitis, Addisonian crisis, DKA…
what will non-obstruction/low obstruction vomiting result in (metabolically)? how about if there is a high obstruction?LOW/NO obstuction: METABOLIC ACIDOSIS because of loss of bicarbonate (from duodeinum). HIGH OBSTRUCTION: HYPOchloremic metabolic ALKALOSIS
small dogs comes in with acute vomiting, which contains blood. They have a high PCV and normal protein. what are you thinking?Hemorrhagic Gastroenteritis
how does a patient present with hemorrhagic gastroenteritis?Often present critically ill. Profuse/severe/acute: Hematemesis, Hematochezia With an VERY HIGH PCV, normal TP. there will also be Severe dehydration
what will you need to differentiate hemorrhagic gastroenteritis from?parvo
which animals are particularly at risk for getting hemorrhagic gastroenteritis?Small breed/toy
what causes hemorrhagic gastroenteritis?UNKNOWN-- theory might be abnormal responses to bacteria/endotoxin/diet
how would you want to treat hemorrhagic gastroenteritis? what is prog like?Crystalloid +/-colloid therapy, GI protectants, Abx. Prog is good if caught early.
what are possible complications of hemorrhagic gastroenteritis?DIC, TBE, renal failure, shock
read case after hge gastroitisyes
what does the emergency ABC stand for?airway, breathing, circulation
*what is the shock dose for a dog?~90ml/kg
things you need to consider for IV fluid resusitation?Catheter size, Fluid type, Size infusion bag, Infusion rate, shock dose
so obv there is some variation with the size of the dog, but for ER IV fluid tx, what size caths and where?14–18 gauge, 1-2 cephalic or jugular
if you are ER iv fluid therapy, what kinda fluids should you be giving? (specifics too)CRYSTALLOIDS! Lactated ringer´s sol. , Plasmalyte A, Normosol R are the ones she highlighted
if you are going ER IV (shock dose) fluid therapy, how often should you reassess?every 15min!
*if you suspect GVD, which side do you wanna lay them on?THEIR RIGHT SIDE!!!
what do GDV rads look like?(remember to lay them on their R side!) (smurf hat)
*which type of animal/breed/whatever is prone to GDV?LARGE DOGS, DEEP CHESTED
what is the major hint hint buzzword clinical sign for GDV?non-productive retching
if you are taking a rad for suspect GDV, what else should you look for and why?met check-- tx of GDV is expensive and if it is an older dog it might be decision time
what is a preventative measure you can take for GDV?gastropexy
what is a very common complication post-sx for GDV?50% arrhythmia 24-72 hours (pic she attached looks like v-tach)
what causes GDV?Idiopathic-- theories of Abnormal motility or lax ligaments
GDV is the #1 cause of death in who?great danes
how do you dx GDV? Unproductive retching, PE, large cranial abdomen, typany. Right lateral abdominal radiography
what are predisposing factors for GDV?Large meals, Rapid eating, Low bodyweight, Elevated platform?, Male, Older age
is there a gender or age discrepancy for GVD?older and male!
does body condition affect GDV risk?low weight= higher risk
what are the factors which affect prog of GDV?TIME and LACATATE


Question Answer
remember DDx DAMNIT-V[But also remember her CENTRAL/inside GI/Outside GI thing] degenerative, anomalous/ allergy, metabolic, neoplasia/nutritional, infectious, immune, toxic/trauma, vascular
what are some central reasons for vomiting?toxins, inflammation, neoplasia, pain/pressure, stress, anatomic
what are the toxins most likely to cause vomiting (and which is #1?)NSAIDS!!!!, Doxycyclin/Tetracyclin, Erythromycin, Penicillamine / Zinc, Cardiac glycosides, Lead, Ethylen glycol, strychnine, medetomidine, chemotherapy agents, xylazine, apomorphine
is it HYPER or HYPOadrenocorticism which can cause vomiting?HYPO (Addisons) (bc buildup of toxins)
possible Outside Gastrointestinal tract locations/reasons for vomiting?liver, kidney, adrenals (addisons), uterus (pyometra), prostate (prostatitis), pancreas (itis), peritoneum (itis), spleen (torsion), lymphnodes (lymphoma (bc hypercalcemia and cytokines) ), endocrine (DM, DKA)
If you see vomiting, and you are thinking "inside GI" causes....what thing should come to your mind immedaitely?PARASITES, PARASITES, PARASITES
vomiting workup flow chart (pic)
* what are the 3 major reasons for hematemesis?(1) coagulopathy (2) swallowing of blood (3) GI ulceration/erosion
If you suspect coagulopathy as a cause for the hematemesis, what are your main reasons this could happen and what plan (tests) should you do?Thrombocytopenia / - pathia, Intoxication (rodenticides) / DIC / liver ..... to figure it out, do a platelet count, a coag panel (aPT, aPTT, fibrinogen, ACT,...) and a buccal mucosal bleeding time (BMBT)
what is considered a low platelet count which might lead to coagulopathy-->hematemesis? < 30-50 x 10^9 /L (1 platelet / 100 x oil field ~ 10 -15 x 10^9 /L)
if you think the dog that vomited blood just swallowed the blood, where are the places this blood can be coming from? and why might it be coming from there?(1) lung--> do thoracic rads!/ bronchoscopy. NOSE: Fb, aspergillosis, hemophilia, neoplasia
#1 reason ulceration / erosion?NSAIDs!!!!
what might cause hyperacidity of the GI?Gastrinoma/Mast cell tumor (pylorus / begin duodenum)
8 possible reasons for GI ulceration/erosion?(1) NSAIDs!!!! (2) "Stress“ / hypovolemia=> decreased visceral perfusion (3) Systemic disease: liver > pancreas > kidney (4) hypoadrenocorticism (decreased cellular stability) (5) Foreign body (6) Hyperacidity-->Gastrinoma/Mast cell tumor (pylorus / begin duodenum) (7) Recent surgery ? (muscular layer) (8) Infiltrations: Pythium, IBD, Polyps,Leiomyosarcoma, Lymphoma, Carcinoma
cause study: not a clotting problem. ACTH stim normal, diffuse thickening of change and anti-nausea/acid meds helped a little bit. You will now want to endoscopy because your two major DDx are...? suspect IBD / exclude lymphoma
Lymphoplasmacellular gastritis & enteritis--> how do you tx this? for how long?Sucralfate, ranitidine, omeprazole, prednisolone 1-1.5mg/kg/dag, 2 weeks beyond clinical cure, than tapering over weeks
major clinical sign of Lymphoplasmacellular gastritis & enteritis?VOMTING!! remember, need to differentiate acute vs chronic, Self limiting vs. life threatening systemic illness, GI vs. Non-GI causes
Chronic Gastritis-- what are the 5 types, which two are most common?Lymphoplasmacellular, eosinophlic, granulomatous, atrophic, hypertrophic
what bacteria might be suspect in chronic gastritis? How would you treat/when would you consider tx for this? Helicobacter like organisms. Triple therapy if no other reason found
what is the parasite most likely to cause vomiting in dogs? drug to tx?Physaloptera, (pyrantel)
what is the parasite most likely to cause vomiting in cats? drug to tx? Ollulanus (fenbendazole)
a definitive dx of chronic gastritis requires you to do what? Definitive Dx requires biopsy AFTER trial-therapies-- Endoscopy often better than surgery, because you can do Visualization and biopsies at site of concern
how do you tx chronic gastritis?tx Primary cause, +/- hypo/low allergenic diet, +/- corticosteroids, GI protectants, +/- prokinetics
in a chronic vomiting case, what will be your first choice of workup, and why?in chronic cases, usually do diet change first- you have some time. if just a GI prob, win first 2weeks should see good chance, if not, stop and try sthing else
what is the general work-up plan for chronic vomiting?(1) Exclude extra GI causes ... (2) Testing for parasites (direct smear, Giardia,Flotation,SNAP) (3) Treatment for parasites (4) Abdominal ultrasound (5/6) Diet change (new carb, new protein) for >2-4 weeks (6/5) Endoscopy
she said chronic vomiting is most often what problem?lymphoplasmacytic gastritis
what is the TX plan for chronic vomiting, and what should you always do first with tx??(1) *** ALWAYS treat for parasites first-- Fenbendazole for 3-5 days (2) Diet change: new protein / new carbohydrate (3) Biopsy outcome determines further specific treatment: ---- (4) Prednisolone 1mg/kg SID in lymphoplasmacytic gastritis (5) Triple therapy if helicobacter like organisms and no other reason: Amoxicillin, metronidazole, famotidine (High recurrence rate)
chronic vomiting--> what is "triple therapy" and when do you do this therapy?Do this if you have elim other reasons for chronic vomiting, because then the suspect is helicobacter like organisms. The Trip therapy is: Amoxicillin, metronidazole, famotidine
what are you gonna treat suspected GI parasites with? Fenbendazole ((she listed some study and the conclusion was that If you want more certainty of if it is parasites: combine the tests!
***how do you detect giardia with confidence?Giardia-oocyst shedding occurs intermittently, but three fecal analyses are 90 - 95% sensitive
***if you want more certainty of your possible parasite diagnosis, what should you do?If you want more certainty: combine the tests! (such as fecal zinc sulfate flotation + fecal SNAP, + possibly PCR) (note, 10% of healthy dogs=positive)
If you choose to attempt a diet change....what is the biggest problem you face?OWNER COMPLIANCE!!! no snacks from anyone and such- these little snacks mess up dietary trials
*what is the diet she recommends for a diet trial?Diet change: new protein / new carbohydrate--- so, she recommends 2/3 rice and 1/3 TURKEY (not chicken- chicken has high allergic potential). A commercial sensitivity diet like from royal cannin might work too.
what is something you can reccomend your owners should do if their dog is on a diet trial and they want to take them out out walks?dogs can eat things in the environment!! put a muzzle on them so they cant


Question Answer
what is pyloric stenosis?Benign muscular pyloric hypertrophy, with Antral hypertrophy.
what are the presenting clinical signs of an animal with pyloric stenosis?Persistent vomiting, Right after eating
is there a age/breed predilection for pyloric stenosis?more in YOUNG animals, ESP brachycephalic dogs and siamese cats
what are common complications of pyloric stenosis?Esophagitis, megaesophagus, regurgitation, +/- Hypochloremic met. alkalosis
how do you dx pyloric stenosis?Ultrasonography, Endoscopic or surgical biopsies to Rule out infiltrative disease like malignancy, Contrast radiography (Inadequate gastric emptying)
what will contrast study look like with pyloric stenosis?inadequate gastric emptying.
how do you treat pyloric stenosis? prog? Pyloroplasty, tissue resection. excellent prog
what are the three most common gastric neoplasias?(1) Gastric adenocarcinoma (2) Leiomyosarcoma (3) lymphoma
where do gastric adenocarcinomas like to live? Pyloris / Incisura angularis
where do Leiomyosarcomas like to live?cardia
**Incisura angularis (kink in lesser curvature) has what two problems happen there most often?ulcers and adenocarcinoma
**the duodenum/pylorus has what 3 main problems happen to them?BECAUSE OF A RISE IN GASTRIN, you will suspect gastrinoma / MCT (mast cell tumor) / renal failure
label it
**what lab parameter would be raised and would make you think duodenum/pylorus problem?inc in gastrin
*which two dzs have a DIFFUSE distribution all through the stomach?lymphoma and IBD
*what dz likes to be at the cardia of the stomach?leiomyosarcoma
Pythium insidiosum--> what are the presenting clinical signs?Vomiting and Diarrhea, GI stasis
what is pythium? where is it found?Fungal infection. Found on the gulf coast.
how does pythium affect the stomach mucosa?Purulent, eosinophilic, granulomatous submucosal inflammation with GI stasis
How do you dx and tx pythium?DX: Cytology, histology, serology + PCR. TX: (ONLY IF CAUGHT EARLY ENOUGH) Surgery: resection, and itraconazole ( +/- terbinafine, +/- liposomal amphotericin B)