Vomiting

Question 1

Acute Tx (4)

Answer 1

• with- hold food for 24 hours
• bland low-fat diets re-introduced
• small frequent meals
• fluids

Question 2

Physical exam

Answer 2

look for:

• weightloss
• abdominal masses/thickened intestines
• hydration
• signs of systemic disease (ascites, pyrexia/arrhthmia)

Question 3

Physiology of vomiting

Answer 3

• vomiting centre is in the medulla
• CTZ is just across the BBB
• starts with prodromal signs –> intestinal reflux –> relaxation of oesophageal sphincter
• inputs can come from abdominal viscera and vestibular apparatus

Question 4

Investigation (6)

Answer 4

Exclude systemic disease:

• bloods
• urinanalysis
• PLI
• T4
• Diet trail for 2-4 weeks: NOT is systemically ill patients
• with holding food is NOT appropriate

Question 5

Anti emetics (3)

Answer 5

Maropitant:

• central and peripheral effects
• give fro 5 days then 48 hour rest period
• useful for chemo

metacloprimide:

• blocks dopamine action on CTZ
• increase in gastric emptying and increase in oesophageal tone
• most effective as CRI

Ondansetran

• central effects in cats, peripheral in dogs
• serotonin antagonist
• expensive
• drug induced nausea

Question 6

Anti-ulcer therapy

Answer 6

H2 antagonists:

• cimetidine : may interfere with metabolism of other drugs
• ranitidine: pro kinetic effect
• famotidine
• omeprazole: PPI, use for a max of 8 weeks
• sucralfate: binds to gastric ulcers- useful in oesophageal reflux

Question 7

Investigations (3)

Answer 7

Radiographs:

• exclusion of obstruction
• shows delayed gastric emptying
• loss of serosal detail

US:

• gold standard
• look for free fluid and guid FNA
• look at pancreas and intestinal wall

Endoscopy:
- examination of oesophagous, sphincter, stomach and proximal duodenum

Question 8

Oesophagitis

Answer 8

Causes:

• gastric reflux
• recent anaesthesia
• doxycycline

Dx: endoscopy

Tx: self resolves, small frequent meals, sucralfate, metaclopramide, PPI, H2 antagonist, Broad spec ABs (due to trauma of oesophagous and stomach which is not sterile)

Prognosis: warn of stricture formation but good

Question 9

Chronic gastritis

Answer 9

Tx: diet trail, immuno suppressive, 4 types (lympocytic plasacytic is most common

Question 10

Helicobacter

• what (2)
• Dx (4)
• Tx (3)

Answer 10

• spiral-shaped gram negative bacteria
• often identified in chronic gastritis

Dx:

• biopsy
• inflammation
• intracellular location
• epithelial changes (necrosis)

Tx: metronidazole, amoxicillin, famotidine BUT is in healthy dogs so only treat is warranted