31. Diseases of stomach, differential diagnosis of vomiting

What are examples of diseases of the stomach?

1. Gastritis

2. Gastric ulcers

What is gastritis?

Inflammation of the gastric mucosa, associated with secondary acute or chronic vomiting

What are some causes of acute gastritis?

1. Infectious agents (bacteria like Helicobacter, parasites, viruses like parvo, panleukopenia, distemper)

2. Eating garbage or spoiled food, foreign bodies (mechanical irritation), toxins, chemicals, drugs (aspirin, NSAIDs, glucocorticoids)

3. Systemic disorders (uraemia, liver diseases, shock)

What are some causes of haemorrhagic gastroenteritis?

Clostridium perfringens, parvovirus, and parasites

What are some causes of chronic gastritis?

Persistent cases of acute gastritis, ulcers, nematodes, inflammatory bowel disease, reflux gastritis, and food allergy

What are some clinical signs of acute gastritis?

Severe vomiting post-feeding and abdominal pain

What are some clinical signs of chronic gastritis?

Occasional vomiting and weight loss

How is gastritis diagnosed?

History (acute/chronic vomiting), abdominal palpation, and imaging (endoscopy, X-ray with contrast, ultrasound showing thicker wall)

How is gastritis treated (causal)?

1. Causal: discontinue drugs that upset stomach (NSAIDS, ATB), Remove FB. Antiparasitics, prednisolone. Activated charcoal. ATB (Amoxicillin, Metronidazole)

2. Diet: No oral food for 24 hours after last vomiting (stomach must calm down unless it will continue vomiting).

   1. Give bland, low-fat diet- boiled rice & chicken, fluids, Hills I/D.

3. Symptomatic: antiemetics (maropitant), H2 blockers, omeprazole, GIT-protectants (Sucralfate)

What are gastric ulcers (peptic ulcers)?

Open sores that develop on the stomach lining and upper portion of the small intestine. More common in dogs than cats.

What are some exogenous causes of gastric ulcers?

NSAIDs (ibuprofen inhibiting COX), glucocorticoids (dexamethasone), other drugs, stress, and lead

What are some endogenous causes of gastric ulcers?

1. Renal failure (increased uraemic toxins)

2. Liver failure (stimulating gastrin release and increasing HCl)

3. Gastritis

4. Neoplasia (mast cell tumour)

5. Metabolic diseases

What is the pathogenesis of gastric ulcers?

Cell death or decreased mucus production. Gastric juice acting on a damaged gastric wall results in ulcers that can be superficial (inflamed mucosa) or deep (bleeding, penetration of all mucosal layers)

What are some clinical signs of gastric ulcers?

Sporadic/chronic vomiting, vomiting blood (haematemesis), melaena, abdominal pain, anaemia, and hypoproteinaemia

How are gastric ulcers diagnosed?

1. Gastroscopy

2. History of drug use/toxins

3. Signs of blood loss (haematemesis, melaena, anaemia)

4. Haematology (anaemia, iron deficiency, hypoproteinaemia, neutrophilia)

5. Biochemistry (liver and renal values)

6. X-ray with contrast

7. Ultrasound (wall thickening)

How are gastric ulcers treated?

Surgery for perforated ulcers, stopping ulcer-producing drugs, sucralfate, gastric protection drugs (omeprazole, ranitidine/cimetidine/Zoolack/Canicur), and fluids to correct dehydration

What are some differential diagnoses for vomiting?

1. Motion sickness

2. Ingestion of emetogenic substances (drugs, rotten food)

3. GIT obstruction

4. Abdominal inflammation or irritation

5. Extra-gastrointestinal tract diseases stimulating the emetic centre of the brain

What information should be gathered in the history and anamnesis for vomiting?

1. When the vomiting occurs, frequency, duration (acute/chronic)

2. Content of vomit

3. Water intake (normal/altered)

4. Presence of diarrhoea

5. Current medications

6. Current diet

7. Access to toxins

8. Access to foreign bodies

What should be included in the physical examination for vomiting?

Abdominal palpation and rectal examination

What laboratory examinations are used for vomiting?

Biochemistry, haematology, urinalysis, and electrolytes

What imaging methods are used for vomiting?

Endoscopy, X-ray (to rule out surgical causes), and abdominal ultrasound

What other tests can be performed for vomiting?

1. Faecal analysis (Giardia snap test)

2. Viral testing (parvovirus, coronavirus, FeLV)

3. Endocrine tests (total T4, ACTH stimulation test)

What are some gastrointestinal causes of vomiting?

1. Gastritis (acute, chronic, haemorrhagic)

2. Gastrointestinal foreign body/obstruction (foreign bodies, intraluminal masses, intussusception, neoplasia, gastric dilation-volvulus (GDV))

3. Gastric motility disorders (muscular dystrophies, weak/ineffective gastric contractions)

What are some extra-gastrointestinal causes of vomiting?

1. Systemic diseases

   1. endocrine: hyperadrenocorticism, hyper/hypothyroidism, diabetes mellitus, hypercalcaemia

   2. metabolic: hepatic/renal disease

   3. electrolyte abnormalities; pancreatitis, neoplasia

2. Vestibular disease (head tilt, nystagmus)

3. Central nervous system disease causing nausea and vomiting

4. Motion sickness

5. Chemicals or toxins (uraemia, diabetic ketoacidosis)

What is the difference between regurgitation and vomiting?

• Vomiting: central nervous system reflex integrated in the vomiting centre of the brain

• Regurgitation: passive expulsion of undigested food indicating a pharyngeal, oesophageal or pyloric disorder

What are the stages of vomiting?

1. Nausea

2. Hypersalivation

3. Abdominal contractions

What are medical treatments for vomiting?

1. Antiemetics (phenothiazines, metoclopramide, maropitant, ondansetron, butorphanol)

2. H2 blockers (famotidine, cimetidine, ranitidine)

3. Proton pump inhibitors (omeprazole)

4. Mucosal protection (sucralfate, misoprostol)

What is the difference between cats and dogs vomiting?

None

Do dogs or cats vomit more often?

Dogs