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167 Cards in this Set
- Front
- Back
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What are the 4 regions of the stomach
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cardiac
fundus body antrum |
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esophagus
cardia fundus body antrum pylorus duodenum |
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G cells of the stomach secrete what?
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gastrin
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These cells release histamine in the stomach
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enterochroffamin cells
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This helps to increase pH
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somatostatin
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The H/K ATPase pump is found in these cells
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parietal cells
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How is the stomach protected from gastric acid?
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gastric mucosal barrier
(bicarb rich mucosus and local prostaglandins) |
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What actin dose pepsin perform in the stomach?
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digests protein
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Lipase dose what in the stomach?
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digests fat
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How is the alkaline tide produced?
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H20->H+ (in stomach) and -OH and HCO3 -> with the HCO3 going into the blood
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What are the 4 main categories of stomach disease
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inflammation
ulceration neoplasia obstruction |
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General clinical signs of stomach disease:
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vomiting
hematemesis melena retching burphing hypersalivation ABD distention ABD pain weight loss |
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This is a common cause of acute onset of vomiting
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acute gastritis
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This is a common cause of vomiting, hematemesis, melena, +/- anemia
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gastric ulceration/or erosions
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This is a common cause of non-productive retching, ABD distention, tachycardia
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GDV
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This is a cause of acute/chronic cause of vomiting 8-10 hours after feeding
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delayed gastric emptying
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This is a cause of chronic vomiting of food or bile
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chronic gastritis
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This is a cause of chronic weight loss, chronic vomiting, +/- anemia
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gastric neoplasia
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What are some common causes of acute vomiting (acute gastritis) (8)
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mudosal insult/inflammation
dietary indescretion FB RX/toxins systemic disease parasites bacteria viruses |
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With what clinical signs should a work up for acute gastritis be done?
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FB
RX/toxins systemic disease hematemesis melena vomiting that fails to respond to therapy |
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Most animals with simple gastritis respond to...
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symptomatic treatment.
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TX for acute gastritis:
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SQ fluids (<5% dehydrated)
dietary restriction pepto 1 ml/5kg TID kaolinpectain 1 ml/kg TID sulcralfate |
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What are some diseases that cause Gi erosion and ulcerations (6):
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-Metobolic/endocrine: Cushings, uremia, liver disease, DIC, hypergastrinemia
- Inflammation: gastritis - Neoplasia - RX induced: NSIAD/Pred - Hypotension: shock/sepsis - Ideopathic: stress, exercise induced (sled dogs) |
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Clinical signs of gastric erosions/ulceration
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vomiting
hematemesis melena weakness inappetance |
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Clinical pathology changes with gastric ulcers
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Anemia - initally regeneraive, but can b/c microcytic (MCV) and hypochromic (MCHC) and thrombocytosis
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Diagnosing gastric ulcers
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Rads- R/O other causes
Endoscopy - best Ultrasound |
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Where in the stomach do NSAID ulcers tend to be found
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antrum and are not associated with mucosal thickening or irregular ulcerated edges
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How do gastric tumor look endoscopically
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Irregular and ulcerated edges that are frequently thicked edges of mucosa
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Where should ulcers be endoscopically biopsied?
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Periphery to avoid perforation
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This combination of signs on endoscopy should be suggestive of a gastric hypersecretory state
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mucosalulceration
antral mucosal hypertrophy copious gastric juice esophagitis |
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When should gastric pH & serum gastrin be measured?
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gastric erosions not associated with RX or gastric tumors
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Why do dogs with MCT have low gastrin levels
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Histamine is causing the gastric acid release and not gastrin
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If gastric pH <3 and increased gastrin levels suggestive of
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gastrinoma
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TX of gastric ulcers
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TX underlying cause
ensure hydration and blood Q Watch K due to vomiting H2 blockers proglumide (blocks gastrin) PGE analogues H/K AtPase inhibitors |
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These two medication swill directly decrease gastric acid secretion and have been used to TX gastrinomas
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octereotide (somatostatin analoge)
omeprazole (K/H ATPase inhibitor) |
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For dogs with stomach ulcers, what medication is generally started and what is added on if first isn't working
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H2 blockers
omeprazole |
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Where should ulcers be endoscopically biopsied?
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Periphery to avoid perforation
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Misoprostal can cause this side effect
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diarrhea
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When should ABs be added in for gastric ulcerations
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shock
GI barrier dysfunction |
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This combination of signs on endoscopy should be suggestive of a gastric hypersecretory state
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mucosalulceration
antral mucosal hypertrophy copious gastric juice esophagitis |
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When should gastric pH & serum gastrin be measured?
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gastric erosions not associated with RX or gastric tumors
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Why do dogs with MCT have low gastrin levels
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Histamine is causing the gastric acid release and not gastrin
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If gastric pH <3 and increased gastrin levels suggestive of
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gastrinoma
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TX of gastric ulcers
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TX underlying cause
ensure hydration and blood Q Watch K due to vomiting H2 blockers proglumide (blocks gastrin) PGE analogues H/K AtPase inhibitors |
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These two medication swill directly decrease gastric acid secretion and have been used to TX gastrinomas
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octereotide (somatostatin analoge)
omeprazole (K/H ATPase inhibitor) |
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Where should ulcers be endoscopically biopsied?
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Periphery to avoid perforation
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For dogs with stomach ulcers, what medication is generally started and what is added on if first isn't working
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H2 blockers
omeprazole |
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This combination of signs on endoscopy should be suggestive of a gastric hypersecretory state
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mucosalulceration
antral mucosal hypertrophy copious gastric juice esophagitis |
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Misoprostal can cause this side effect
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diarrhea
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When should gastric pH & serum gastrin be measured?
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gastric erosions not associated with RX or gastric tumors
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When should ABs be added in for gastric ulcerations
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shock
GI barrier dysfunction |
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Why do dogs with MCT have low gastrin levels
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Histamine is causing the gastric acid release and not gastrin
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If gastric pH <3 and increased gastrin levels suggestive of
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gastrinoma
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TX of gastric ulcers
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TX underlying cause
ensure hydration and blood Q Watch K due to vomiting H2 blockers proglumide (blocks gastrin) PGE analogues H/K AtPase inhibitors |
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|
These two medication swill directly decrease gastric acid secretion and have been used to TX gastrinomas
|
octereotide (somatostatin analoge)
omeprazole (K/H ATPase inhibitor) |
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For dogs with stomach ulcers, what medication is generally started and what is added on if first isn't working
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H2 blockers
omeprazole |
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Misoprostal can cause this side effect
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diarrhea
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When should ABs be added in for gastric ulcerations
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shock
GI barrier dysfunction |
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Misoprostal and H2 blockers can help prevent against formation of ulcers from these medications, but not these
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NSAID
Corticosteriods |
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What mediations should be used to help prevent ulcers from Prednisone
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Sucralfate
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How dose histamine from MCT cause vomiting and gastric acid secreation?
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chemoreceptor trigger zone (CRTZ)
histamine causes direct incresase in gastric acid secretion |
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How should histamine from MCT be TX
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corticosteriods for the tumor
H2 blockers to decrease central and peripheral histamine effects |
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When is SX implemented for gastric ulcers
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Non-healing
Large ulcers perforated |
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What physiological changes occur with GDV
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caval obstructin
decreases blood Q to heart results in hypovolemic shock |
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Cause of GDV
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No singe cause
Lg breed with deep chest Possible Abn electrical activing and gastric emptying Possibly length of hepatosplenic ligament |
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C/S of GDV
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Non-productive retching
salivation Abd distention wealkness collapse |
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With radiographs difference between gastric dillitation vs volvulus
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dillation- gas distention with gas in fundus
volvulus - band of soft tissue with pylorus located dorsally |
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Labratory changes with GDV
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increased Hct
metabolic acidosis hypokalemia coagulation px - DIC |
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gastric dillitation - no volvulus
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GDV
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PE findings for possible GDV
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ABD distention
tympany tachycardic pale mm |
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TX in general for GDV
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Fluid support
gastric decompression AB Cardiac arrhythmias |
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Fluid support for GDV
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shock therapy 60-90 mls/kg/hr crystaloids
colloids |
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How is gastric decompression performed for GDV?
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may need sedation - butorphanol:
OG tube 16G catheter - trocharize (followed by OG tube) |
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PE findings for possible GDV
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ABD distention
tympany tachycardic pale mm |
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What about AB and steriods for GDV?
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Cephalsporin and fluoroquinolone
Prednisone sodium succinate Dex SP 10 mg/kg IV |
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TX in general for GDV
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Fluid support
gastric decompression AB Cardiac arrhythmias |
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What has lipid peroxidation and chelate iron medications helped with for GDV
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decrease mortality(experimentally)
best given before untwisting torsion |
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Fluid support for GDV
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shock therapy 60-90 mls/kg/hr crystaloids
colloids |
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What arrythmias are common for GDV
Occur in 40% of patients |
VPCs and ventricular tachycardia
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How is gastric decompression performed for GDV?
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may need sedation - butorphanol:
OG tube 16G catheter - trocharize (followed by OG tube) |
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When should arrhythmias be treated?
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associated with weakness or syncope
HR>150 bpm |
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What about AB and steriods for GDV?
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Cephalsporin and fluoroquinolone
Prednisone sodium succinate Dex SP 10 mg/kg IV |
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TX of cardiac arrythmias
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TX underlying acid/base, lyte, and hemostatic dz
Lidocaine 1-2 ml/kg IV bolus or as CRI |
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What has lipid peroxidation and chelate iron medications helped with for GDV
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decrease mortality(experimentally)
best given before untwisting torsion |
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Mortality rate of GDV
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15%
>30 if resection or spleenectomy |
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What arrythmias are common for GDV
Occur in 40% of patients |
VPCs and ventricular tachycardia
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When should arrhythmias be treated?
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associated with weakness or syncope
HR>150 bpm |
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TX of cardiac arrythmias
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TX underlying acid/base, lyte, and hemostatic dz
Lidocaine 1-2 ml/kg IV bolus or as CRI |
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Mortality rate of GDV
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15%
>30 if resection or spleenectomy |
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ventricular tachycardia
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ventricular tachycardia
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ventricular tachycardia
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ventricular tachycardia
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ventricular premature contractions (VPCs)
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VPC
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VPCs
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This disease is classified according to the cellular infiltrat &, architecture abnormalities.
Very common in dogs |
chronic gastritis
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This is the most common mild form of chronic gastritis (K9 and Fel)
Etiology? |
superficial lymphoplasmacytic gastritic with lymphoid hyperplasia.
Etiology rarely found |
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What are diseases that should be R/O that can cause chronic gastritis
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systemic disease
RX induced FB parasties (Physalloptera) Fungal - rare |
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Once systemic, fungal, RX etc are R/O for chronic gastritis - what are you generally left with for DDx
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dietary intollerance
dietary allergy occult parasitism |
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This disease is classified according to the cellular infiltrat &, architecture abnormalities.
Very common in dogs |
chronic gastritis
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Clinical signs of chronic gastritis
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chronic vomiting of food or bile
+/- weight loss, anorexia, melena hematemesis |
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This is the most common mild form of chronic gastritis (K9 and Fel)
Etiology? |
superficial lymphoplasmacytic gastritic with lymphoid hyperplasia.
Etiology rarely found |
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Diagnosing Chronic gastritis
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MDB- normal
- increased Eos for parasites/dietary issues or MCT ABD rads - normal Endoscopy **** |
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What are diseases that should be R/O that can cause chronic gastritis
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systemic disease
RX induced FB parasties (Physalloptera) Fungal - rare |
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On endoscopy for chronic gastritis, if seeing large amts of bile stained fluid is suggestive of
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duodenalgastric reflex
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Once systemic, fungal, RX etc are R/O for chronic gastritis - what are you generally left with for DDx
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dietary intollerance
dietary allergy occult parasitism |
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On endoscopy for chronic gastritis, if seeing large amounts of clear fluid is suggestive of
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xs. secreation of gastric acid
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Clinical signs of chronic gastritis
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chronic vomiting of food or bile
+/- weight loss, anorexia, melena hematemesis |
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On endoscopy for chronic gastritis, if seeing irregular masses in pyloric outflow tract is suggestive of
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Pythiosis (southern states)
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Diagnosing Chronic gastritis
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MDB- normal
- increased Eos for parasites/dietary issues or MCT ABD rads - normal Endoscopy **** |
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With endoscopy, how many biopsies are taken and from where?
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3 from each region:
pylorus fundus cardia |
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On endoscopy for chronic gastritis, if seeing large amts of bile stained fluid is suggestive of
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duodenalgastric reflex
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On endoscopy for chronic gastritis, if seeing large amounts of clear fluid is suggestive of
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xs. secreation of gastric acid
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On endoscopy for chronic gastritis, if seeing irregular masses in pyloric outflow tract is suggestive of
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Pythiosis (southern states)
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With endoscopy, how many biopsies are taken and from where?
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3 from each region:
pylorus fundus cardia |
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Parasitic chronic gastritis:
Ollulanus tricuspis is a.. |
microscopic worm (<1 mm)
Feline stomach cat to cat transmission via vomit |
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How is Ollulanus tricuspis DX?
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evaulation of gastric juice, vomitus, or histology
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TX of Ollulanus tricuspis?
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fenbendazole 2 d maybe effective
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How do animals acquire Physalloptera?
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ingestionof beetles, cockroaches, lizards
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TX of Physalloptera
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pyrantel pamoate (Nemex)
dogs - single dose Cats - two doses |
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This parasitic disease causes transmural thickening of gastric outflow tract
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Pythium insidiosum
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DX for Phythium insidiosum
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special staining
culture serology PCR |
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TX for Pythium insidiosum
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Aggressive SX resection
itraconazole terbinafine TX for 2-3 months post op medically |
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Prognosis for Pythium insidiosum?
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Poor
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When is Helicobacter associated gastritis TX?
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The author (A. Jergens) recommends to TX only symptomatic animals with biopsy with confirmed Helicobacter and gastritis
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Uncontrolled study showed 90% of dogs/cats responded to TX for Helicobacter associated gastritis with
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Metronidazole
amoxicillin famotidine 70% of animals re-scoped had no evidence of Helicobactor |
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With medical TX of Helicobacter - instead of cure, what might be a better way to describe what ABs do?
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Causes a transietn suppression rather than eradication due to when TX stops, it returns.
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What drugs maybe better long term solution to eradicate Helicobacter associated gastritis?
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>21 day of antibiotics:
clarithromycin |
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How common is lymphcytic plasamacytic gastritis of unknown cause?
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common in K9/Fe
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For unknown causes of lymphocytic/plasmacytic gastritis - how is he mild form TX?
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TX with diet
hydrolized diet novel proteins |
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How is food intollerance suggested for lympoplasmacitic gastritis?
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If hydrolized diet works and re-challange with original diet
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If hydrolized diet isn't enought for lymphocytic plasmacytic gastritis of unknown cause, what can be added
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prednisone 1-2 mg/kg/day
taper to EOD at lowest dose |
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How is moderate/severe lymphocytic plasmacytic gastritis of unknown cause TX?
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prednisone & diet
+/- sucralfate/H2 blockers if ulcers or melena present |
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If prednisone and diet are not working for lymphoplasmacytic gastritis of unknown cause, what other disease should be re-evaluated?
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re-evaluate biopsies for
LSA |
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If need to increase immunosuppression for unknown cause of lymphoplasmacytic gastritis, what medications can be used?
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K9 - azithroprim
Fe - chlorambucil |
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With eosinophillic gastritis, TX?
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similar to lymphoplasmicitic gastritis.
diet & prednisone |
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With eosinophillic gastritis, what must be R/O with cats?
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hyperesoinophillic syndrome
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This gastritis is associated with marked cellular infiltrate
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atrophic gastritis
infrequent in animals, but some simalarities to people |
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Atrophic gastritis results in decrease of _____ and hyperplasia of ____ which has been associated with gastric adenocarcinoma in Lundehunds
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parietal cells
neuroendocrine cells |
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How do you TX atropic gastritis?
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TX just like Helicobacter and immunosuppressive therapy
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This condition is ideopathic in brachycephalic dogs
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hypertropic gastritis
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Delayed gastric emptying and motility disorder is caused by one of these two things
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outflow obstruction
defective propulsion |
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What clinical sign should be suspicious of delayed gastric emptying & motility disorder
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vomiting food less than 8-10 hours after ingestion
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If puppies develope vomiting after weaning, what motility disorder should be considered?
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pyloric stenosis
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What are differentials for outflow obstruction (7)
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congenital stenosis
FB hypertrophic stenosis granuloma polyps neoplasia extragastric masses |
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DDX for defective Propulsion (14)
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gastric disorder
gastritis ulcers neoplasia gastroenteritis peritonitis pancreatitis metabolic nervous inhibition dysautonomia GDV SX RX ideopathic |
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Diagnosing outflow obstruction/defective propulsion?
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MDB- fecal/triple to R/O systemic dz
Radiographs U/S Endoscopy (prior to barium) |
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TX for delayed gastric emptying and motility disorder?
|
TX underlying cause
GI ulcers - medical TX pyloric stenosis/polyps/hypertrphic disorders - SX Prokinetic agents - metoclopramide, cisapride, erythomycin, or ranitidine |
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This RX may only facilitate the emptying of liquids and less effective in promoting organized gastroduodenal intestinal motility than this RX.
|
metoclopramide
cisapride |
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This RX is better promotion of solids
|
cisapride
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How long should prokinetics be given to see if effective for motility dissorders
|
5-10 days
|
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Which is more common benign or malignant gastric neoplasia?
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malignant
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This gastric neoplasia occurs at the pyloric antrum and/or lesser curvature
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adenocarcinoma
|
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These two gastric neoplasias are common at the cardia
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leiomyoma
leiomyosarcoma |
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This gastric neoplasia is diffuse
|
LSA
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This gastric neoplasia is common in dogs
|
adenocarcinoma
|
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Where do adenocarcinomas metastasize to?
|
liver and LN
|
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What are the three types of presentations of adenocarcinoma
|
diffuse
rasied central ulcer polyploid |
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What is the most common gastric neoplasia
|
LSA
involvment of liver, LN, SI, BM |
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What is the MST for leiomyosarcoma?
|
10 months
|
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What type of C/S or syndromes are seen with Leiomyosarcoma
|
paraneoplastic hypoglycemia
seizure due to insulin like growth factors |
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DX gastric neoplasia
|
survey rads - WNL
US endoscopy |
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How do you TX for gastric SX
|
surgery for everything but LSA
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What gastric neoplasia have excellent prognosis
|
leiomyosarcoma
unless not localized and not able to SX removed. |
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Prognosis for GI LSA
|
poor in dogs
Feline - dependent on Lg cell/Sm cell small cell - substantial remission with pred & chlorambucil Lg cell - TX with chemo & carries much poorer prognosis |
