Term
| What are the 3 muscle layers of the stomach? |
|
Definition
-circular
-longitudinal
-oblique |
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Term
| How is the gastric mucosa protected? |
|
Definition
-bicard + mucus: secreted by epi cells
-epi cells contain hydrophobic phospholipids: repels HCL
-rapid cell division rate: replaced damaged cells w/ new cells
-damaged cells secrete mucus
-prostaglandins stim mucus, bicarb secretion, mucosal blood flow, promote cell regen |
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Term
| Describe the motility of the stomach. |
|
Definition
-controlled by neuronal and hormonal stimuli
-liquids expelled more rapidly than solids
-small partiles expelled more rapidly than large particles
-carbs expelled mroe quickly than proteins, followed by fats
-large, indigestile particles, are expelled from the stomach during times of fasting |
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Term
|
Definition
-in peolpe, link to gastric ulceration and neoplasia
-can be found in dogs as young as 6w
-pdc urease enzyme that converts ureat to ammonia to protect themselves from gastric acid |
|
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Term
| What are the categories of acute vomiting? |
|
Definition
-self-limiting
-life-thretening |
|
|
Term
| What are the characteristics of acute self-limiting vomiting? |
|
Definition
-infrequent
-hx of dietary indiscretion
-normal PE |
|
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Term
| What are the characteristics of acute life-threatening? |
|
Definition
-profuse/persistent
-inc frequency
-contains blood
-fever-severe diarrhea
-abdominal pain |
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|
Term
| What PE parts do we add for vomiting? |
|
Definition
-look under tongue
-abdominal pain
-palpate
-hydration status |
|
|
Term
| What are the typical couses of vomiting? |
|
Definition
-Acute gastritis: dietary indiscretion, drugs or toxins, foreign material
-parasites: roundworms, hookworms, physaloptera
-coronavirus |
|
|
Term
| What diagnostics do we run on acute, mild vomiting? |
|
Definition
-PCV and total solds
-Zn sulfate fecal flotation
-rectal exam |
|
|
Term
| How do we manage acute, self-limiting vomiting? |
|
Definition
-withold food/water for 24h
-small amount of water, frequently
-small amount of highly idgestible food (high carb, low fat) |
|
|
Term
| How do we manage acute, life-threatening vomiting? |
|
Definition
-treat underlying dz
-treat hydration
-if vomiting recurs or persists, reasses
-H2 blockers & gastroprotectants |
|
|
Term
| What are systemic causes of chronic vomiting? |
|
Definition
-CKD
-liver dz
-systemic mastocytosis
-DM/DKA
-hyperthyroidism
-hypercalcemia
-feline HW |
|
|
Term
| What diagnostics do we use for chronic vomiting? |
|
Definition
-normal + Zn sulfate fecal float, HW in cats, T4 in cats
-rads
-abdominal U/S |
|
|
Term
| What does delayed gastric emptying look like? |
|
Definition
-vomiting undigested food >8-12h after ingestion
-postprandial abdominal distension and pain |
|
|
Term
| What are some cuases of delayed gastric emptying? |
|
Definition
-mechanical obstruction
-abnormal motility |
|
|
Term
|
Definition
-anit-emetic
-blocks CRTZ and raises threshold of vomiting center = prokinetic and inc LES tone |
|
|
Term
| What are the contraindications of Metoclopramide? |
|
Definition
|
|
Term
| What is Maropitant (Cerenia)? |
|
Definition
-NK1 rc antagnist = blocks substance P in CNS
-given SID SC or PO |
|
|
Term
| What are Ondansetron and Dolasetron? |
|
Definition
| -5-H3T: serotonergic Rc antagonists = block CRTZ and vomiting center |
|
|
Term
| What are chlorpromazine and Prochlorperazine? |
|
Definition
-block CRTZ and vomiting center
-bad adverse effects (hypotension and sedation) so don't use |
|
|
Term
| What are FAmotidine, Ranitidine, and Cimetidine? |
|
Definition
| -block H2 rc on gastric parietal cell |
|
|
Term
|
Definition
-gastroprotectant and binds to ulcerated mucosa to protect it
-alteres absorption of other drugs |
|
|
Term
| What are Omeprazole, Pantoprazole, Esomepraozle, and Lansoprazole? |
|
Definition
| -inh proton pump on parietal cell and prevents acid secretion |
|
|
Term
|
Definition
-synthetic prostaglandin analog
-used to prevent/treat ulcers assoc w/ NSAID and steroid therapy |
|
|
Term
|
Definition
| -inflammation of the gastric mucosa |
|
|
Term
| How do we diagnose the etiology behind chronic gastritis? |
|
Definition
|
|
Term
| What are the possible etiologies behind ulcerative gastritis?- |
|
Definition
-NSAIDs & steroids
-primary gastric, gastrinoma (Zollinger-Ellison syndrome), MCT
-kidney or liver dz
-parasites
-infiltrative dz |
|
|
Term
| How do we dx ulcerative gastritis? |
|
Definition
| -hx + blood in vomitus + melena +/- abdominal pain |
|
|
Term
| How do we treat mild ulceration? |
|
Definition
-acid reducers
-gastric protectans
-supportive care
-antibiotics |
|
|
Term
| How do we treat severe ulceration? |
|
Definition
-transfusion
-IV antibiotics
-cid reducers
-gastric protectants
-supportive care
-surgical resection |
|
|
Term
| HOw do we treat perforated ulcers? |
|
Definition
-IV abx
-aggressive supportive care
-prompt surgical repair |
|
|
Term
| What is pyloric hypertrophy? |
|
Definition
-hypertrophy of mucosa or muscularis
-causes gastirc outflow obstruction |
|
|
Term
| What are the clinical signs of pyloric hypertrophy? |
|
Definition
-delayed gastric emptying
-chronic, progressive vomiting
-wt loss
-enlarged stomach may be palpable |
|
|
Term
| How do we manage pyloric hypertrophy? |
|
Definition
-surgery
-metoclopramide post-op to promote motility if severe gastric distension has occured
-good prognosis if motility is preserved |
|
|
Term
| What are the clinical signs of gastric neoplasia? |
|
Definition
-interference w/ gastric motility
-inflammation
-ulceraiton and/or hemorrhage
-obstruction
-metastasis ot other organs
-GI signs
-hematemesis and/or melena |
|
|
Term
| HOw do we manage gastric neoplasia? |
|
Definition
-surgical resection
-chemo |
|
|
Term
| What is the prognosis of gastric neoplasia? |
|
Definition
|
|
Term
| What is cuased by gastric FB? |
|
Definition
-gastritis
-perforation
-obstruction
-toxicity |
|
|
Term
| How do we manage gastric FB? |
|
Definition
-induction of vomiting
-endoscopic removal
-surgical removal
-manage gastriits and any complications |
|
|
Term
|
Definition
-spirochete bacteria
-causes ulcerative dz in humans
-assoc w/ lymphocytic inflammation
-also in dogs and cats
-may or may not cause primary GI dz |
|
|
Term
| When do bacterial counts inc in the stomach? |
|
Definition
-meal time
-after coprophagis |
|
|
Term
| What effect does inc bacterial counts have in the stomach? |
|
Definition
| -acid hyposecretion results in inc bacterial counts: glandular atrophy (Chronic gastritis) & pharma (acid reducers) |
|
|
Term
| What are the 4 major mechanisms of vomiting? |
|
Definition
-Efferent rc stim by distension, irritation, hyperosmolarity, and chems
-substances trigger the CRTZ in 4th ventricle activating vmit center
-input from semicircular canals (motion sickness)
-vomit center stim by input from the cerebral cortex or limbic system |
|
|
Term
| What are the major consequences of vomiting? |
|
Definition
-dehydration
-loss of electrolytes: Na, K, Cl
-acid/vase derangements
-aspiration pneumonia |
|
|
Term
| How does an animal get metabolic acidosis due to vomiting? |
|
Definition
| -loss of duodenal bicarb and contraction of extracellular fluid space |
|
|
Term
| How does an animal get metabolic alkalosis due to vomiting? |
|
Definition
| -occurs with an obstructed pylorus due to losss of gastric acid |
|
|
Term
| What are some of the GI causes of vomtiing? |
|
Definition
-obstruction
-inflammation
-infiltration
-ulceration
-toxicant/toxin
-parasite
-motility disorder |
|
|
Term
| What are some fo the non-GI causes of vomiting? |
|
Definition
-metabolic
-endocrine
-neuro
-toxicant/toxin
-pain
-stress/excitement
-cardiac |
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