SA Med, MT, II
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what is the term applied to vomiting of sudden onset *presumed* to be caused by gastric mucosal insult or inflammation?
what are some causes of acute gastritis?
- dietary indiscretion/intolerance
- foreign body
- NSAIDs, drugs/toxins
- infectious, viral/bacterial (poorly characterized)
what are some causes of secondary gastritis?
- injury occurs indirectly due to systemic disease
- (mediated by incr. gastric acid, reduced blood flow to mucosa, altered mucosal barrier)
is acute gastritis more common in dogs or cats? what are presenting signs?
- acute onset vomiting, anorexia
- (fever and abdominal pain NOT common)
How do you make the diagnosis of acute gastritis?
- "happy" vomiter so work-up unnecessary in most cases
- common presentation, cause rarely identified
- *presumptive diagnosis w/rapid response to treatment*
when does the acute vomiting patient warrant a full diagnostic work up?
- systemic illness or fever
- abdominal pain or FB suspected
- or attempted therapy for acute gastritis is not resolving w/in1-2 days
what is treatment for acute gastritis?
- NPO for 24 hours
- fluids SQ sufficient (or IV)
- modify diet (restrict fat/protein), small amt of water
- +/-H2 blockers, proton pump inhibitors, antiemetics
what is etiology for hemorrhagic gastroenteritis? is this a small or large dog problem usually?
With HGE, does patient present with melena or hematochesia? fever? how sick is the patient?
- hematochesia ("raspberry jam")
- no fever
- rapid progression/rapid debilitation - can present in shock
what is expected PCV/TS for HGE patient?
- PCV: >55-60%
- TS: *normal*
- (TS appears normal bc elevation from dehydration is countered by PLE)
After ruling out other possible causes, you diagnose the patient presumptively with HGE. What is your treatment plan? (home care or hospitalize?)
- hospitalize - aggressive IV fluid therapy
- IV Abs (ampicillin)
- NPO - antiemetics/H2 blockers/proton pump inhibitors
what is prognosis for HGE patient? recurrence? what are poor prognostic indicators?
- good prognosis for most patients if treated early/aggressively
- recurrence is possible
- poor indicator if hypoproteinemic or septic
what is the most common etiology for chronic gastritis? second most common?
- 1: lymphocytic/plasmocytic
- 2: eosinophilic
- (both defined as immune mediated, although specific cause rarely determined-occult parasite, food allergy, immune rx to unknown pathogen)
How do you diagnose chronic gastritis?
when other causes of chronic vomiting ruled out AND *biopsy confirms inflammation*
what may be the ONLY clinical sign with chronic gastritis patient? what percent are asymptomatic?
- 26-48% asymptomatic
In addition to MDB, what other routine tests should be run when trying to rule out other causes of chronic gastritis (esp. in cats)?
what do you expect to see when scoping a chronic gastritis patient?
hemorrhages on mucosa
Before definitive diagnosis, you can try to treat suspected chronic gastritis with dewormers and dietary therapy. Once histopath results confirm your suspicion, what is your treatment plan? what is your goal?
- steroids or other immunosuppressants
- goal to manage, not cure (good prognosis w/lymphocytic/plasmocytic and eosinophilic in dogs)
What percentage of clinically healthy cats/dogs test positive for Helicobacter organisms? Why is this significant?
- ~40-100% of healthy dogs/cats are positive
- ~60-100% of vomiting dogs/cats are positive
- *presence of organism does not equate with disease*
- cause and effect uncertain
what is the most common clinical feature associated with Helicobacter disease?
- most are asymptomatic
- (can see nausea, vomiting, anorexia)
what is treatment suggested for helicobacter associated disease?
- *multiple combinations suggested*
- cats: metro-amox-clarithromycin
Physaloptera rara, nematode that attaches to stomach wall, causes vomiting in dogs. What is worm burden required to see these signs? is this a happy or sad vomiter?
- only *one worm* can cause clinical signs so even if don't see the worm, *treat* with fenbendazole (emperical deworming)
- -pt is otherwise BAR/happy
Is Chronic hypertrophic pyloric gastropathy (aka pyloric stenosis) more commonly a congenital or acquired problem? more common in dogs or cats?
- acquired (cause unknown)
what are the three types of acquired chronic hypertrophic pyloric gastropathies?
- 1-circular muscle hypertrophy
- 2-muscle hypertrophy + mucosal hyperplasia
- 3-primarily mucosal hyperplasia
which breeds are more commonly associated with acquired pyloric stenosis? what age?
- lhasa apsa, pekingese, shihtzu, poodle
Is patient with chronic hypertrophic pyloric gastropathy a "happy" or "sick" vomiter? Will patient have metabolic acidosis or alkalosis?
- happy- vomit shortly after eating but otherwise BAR
- metabolic alkalosis (vomiting HCl- and kidney retains bicarb)
how is pyloric stenosis definitively diagnosed? what is treatment when its confirmed?
- histopath to confirm - complex surgery
- (can see stenosis on scope/ultrasound but need biopsy to confirm there is no inflammation/infiltrates associated)
what are findings with MDB if patient has high/pyloric obstruction?
- hypOkalemic, hypOchloremic
- metabolic alkalosis
Will most foreign bodies pass on their own or need to be removed?
most need to be removed
When the stomach dilates excessively and rotates, what is usually the direction of rotation?
pylorus rotates from right, passes underneath the stomach and ends up dorsal to gastric cardia on left side
Does being offspring of parents who had GDV put the dog at higher risk? does being older or younger increase risk?
- yes, offspring incr. risk
- older incr. risk
what will be MDB findings on GDV patient? What about coagulation tests?
- hemoconcentration (dehydration/hypovolemic shock)
- variable acid/base distrubance (more commonly met. acidosis)
- variable electrolyte abnormalities (hyokalemia)
- -DIC possible so you would see thrombocytopenia/prolonged APTT
What lab value can be used as prognostic indicator for GDV patient?
lactate (indicative of anaerobic metabolism)
what is tx for GDV?
- aggressive fluid therapy/resuscitation
- decompression(left side)/pass stomach tube if possible
what are some post op concerns after GDV corrective surgery?
- cardiac arrhythmias (VPCs)
- viability of spleen, stomach
- gastric motility or ulceration
- reperfusion injury
- bacterial translocation
- sepsis, SIRS
- DIC, coagulopathy
- MODS (pancreatitis, ARF)
what electrolytes should be you make sure are normalized when considering treatment for arrhythimias?
normalize K and Mg then tx with lidocaine
what is etiology for bilious vomiting syndrome? how often does vomiting occur? happy or sick vomiter?
- empty stomach for prolonged period (overnight)
- gastroduodenal reflux
- (diagnosis of exclusion)
- usu. once a day of bile-stained fluid; late night
what is the difference between gastric erosion and ulcer?
- erosion is superficial lesion involving mucosa
- ulcer extends through mucosa into submucosa
what is a major cause of gastric ulceration erosion (GUE)?
- (esp. if multiple NSAIDs, no wash out period, combined w/steroids)
what are some other etiology of GUE?
- MCT, gastrinoma
- renal disease, liver disease/PSS
- chronic gastritis, IBD
- stress (hypovolemia, sepsis)
is GUE more prevalent in cats or dogs? what is principle clinical sign?
are most animals with GUE painful upon abdominal palpation? How is CBC affected w/GUE?
- not painful unless perforates
- anemia + hypoproteinemia
How is GUE diagnosed?
- *presumptive* (evidence of GI bleeding w/o coagulopathy; ruled out other causes)
- *Endoscopy* is most sensitive and specific diagnostic tool - get a *BIOPSY* (ulcer/carcinoma resemble each other)
what is treatment for GUE? when is it time for surgery?
- fluids + proton pump/H2 inhibitors + sucralfate
- sx if life threatening bleeding or no response to tx w/in3-6 days
- (endoscopy first to locate ulcer for sx resection)
which breed of dog is associated with gastric carcinoma? what gastric neoplasia is common in cats?
- cat: lymphoma (diffuse)
what is most common sign associated with gastric neoplasia? what type of anemia is seen with neoplasia?
- anorexia (asymptomatic until advanced disease)
- iron deficiency anemia (slow GI bleeding over time)
what blood value is altered w/leiomyoma?
what is a fungal infection encounted in aquatic environments in Gulf coast? what is treatment?
- surgical excision is best chance; antifungals (poor prognosis)
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