esophagus
true or false: corticosteroids are a go to treatment for moderate cases of esophagitis
FALSE! steroids are for extreme cases only. Go to treatments for moderate cases would be: gastric acid suppression, sucralfate, prokinetics, and low fat diets. Mild cases are minimal treatment, mainly low fat diets
What is the recommended treatment for acute gastritis?
Usually spontaneous resolution, can provide supportive care
List the 4 drug classes that work towards acid suppression
H2 receptor antagonist (block histamine, histamine normally will increase proton pump activity)
antacids (bind to stomach acid, decrease pepsin activity)
proton pump inhibitors (MORE EFFECTIVE AT RAISING GASTRIC PH THAN H2 BLOCKER, binds and blocks proton pump activity)
misoprostol (prostaglandin analog, inhibits histamine stimulated cAMP, lots of side effects so not used commonly)
True or false: cisapride is more potent prokinetic and is more effective at reducing GER in dogs than metoclopramide
TRUE, cisapride works in the whole GIT, metoclopramide only works in proximal GI (pylorus and duodenum)
A French bulldog comes in and has repeated episodes of reflux. What are treatment options?
Acid suppression (See section about that); close LES (metoclopramide, cisapride); promote gastric emptying (same drugs, pro kinetics); sucralfate
this esophageal condition is an emergency, should be treated immediately
Esophageal foreign body, need endoscopic removal or push into stomach asap to reduce risk for pressure necrosis and stricture
True or false: surgery is the go to treatment option for gastroduodenal ulcers?
FALSE! If the ulcers cause perforation then sure but for most, medical management is go to (eliminate predisposing factors like giving nsaid + steroid or other nsaid, maintain fluid, elyte, and acid-base status, rx gastroprotectants (PPI or H2 blocker, sucralfate)
Which drugs act on the vomiting center in cats and dogs? Cats only?
maropitant (nk1 antagonist) for cats and dogs
chlorpromazine (a2 antagonist) for cats and dogs
ondansetron (5ht3) for cats only
What does erythromycin do
Binds and stimulates motility receipts, so used in DOGS ONLY to increase GI motility
a cat comes in vomiting. Very azotemia and has been diagnosed with chronic kidney disease. What antiemetics can be used to help?
Target chemoreceptor trigger zone; can use maropitant and ondansetron (works at vomiting center so can help since it is central), can use chlorpromazine (works at CRTZ and vomiting center)
Following esophageal foreign body removal via endoscopy, which treatments should be given and for how long?
PPI and sucralfate +/- pro kinetic for 7-10 days to treat esophagitis
2 types of deflated gastric emptying and the different ways to treat them
Mechanical obstruction (most common type) - surgery/endoscopy (PROMOTILITY DRUGS ARE CONTRAINDICATED)
functional motility disorder - medical management (prokinetic agents - cisddapride>metoclopramide (30mins prior to meal)>erythromycin); switch diet to small low fat meals, soft food
True or false: giving a cat diphenhydramine will work on the vestibular apparatus to lower nausea/vomiting
FALSE, only dogs have a histamine receptor
What does metoclopramide do
=reglan
increase acetylcholine release, dopamine relic antagonist
GI effects: increase LES pressure, promote gastric emptying, increase proximal SI peristalsis
A cat has been diagnosed with chronic kidney disease and has been given maropitant, ondansetron, and chlorpromazine to help. What are side effects of each?
Maropitant: SQ is painful, +/- sedation
chlorpromazine: sedation, hypotension, hypothermia, seizures
ondansetron: well tolerated +/- sedation
List 3 treatments for cricopharyngeal disease and prognosis
different food consistencies (elevated feeding not helpful), gastrostomy tube, rule out acquired neuromuscular dz, cricopharyngeal myectomy/myotomy (pharynx and larynx must function properly), balloon dilation of cricopharynx, botulism toxin injections into cricopharyngeus
prognosis: guarded (sx failure common, aspiration pneumonia)
How long should you do a theraputic food trial for a dog with suspected food sensitivity?
2 weeks; hypoallergenic diets or hydrolyzed diets
always try deworming before putting on new diet, might have physaloptera rara (stomach worm)
What is the mechanism of action of sucralfate
Forms stable complexes in damaged mucosa (binds positive charged proteins)
interferes with action of pepsin
esophageal buffering
barrier ofr cytotoxic bile salts
stimulated prostaglandin production
What are the 5 sites of action of cisapride
GES/LES
stomach
intestine
colon
CRTZ
A young (4month) German shepherd comes in for regurgitation. Radiographs show a dilated esophagus that pinches off at the level of the great vessels. What is the anticipated disease, and recommended treatment and prognosis?
Surgical correction, good prognosis, worse if delayed surgery or if large diverticulum
List 3 ways to treat megaesopagus
Tx underlying dz (most commonly acquired myasthenia gravis - always do achr antibody titer test)
nutritional support (upright feeding, bailey chair, gastrotomy tube)
new evidence suggests that meds to relax LES might help in idiopathic cases (ex: sildenafil)
prognosis is guarded, might have repeat events of aspiration pneumonia
Helicobacter: when to treat it and what to treat it with?
Only to if biopsy is confirmed infection AND gastritis (need high degree of gastritis)
tx is very aggressive, only do for cases that are super confirmed for helicobacter infection: amoxicillin + metronidazole + clarithromycin + PPI
Name the areas that make pets vomit and state their receptors
Abdominal viscera: serotonin (5ht3) - D+C
chemoreceptor trigger zone: dopamine (D2) DOG ONLY; norepinephrine (a2) D+C
cerebral cortex: anxiety, fear
vestibular apparatus: acetylcholine (M1) cat; histamine (h1) dog
vomiting center: substance P (nk1) dog/cat; norepinephrine (a2) dog/cat; serotonin (5ht3) cat
What do histamine receptor antagonists do
Promotility: inhibit AChE, used when there is delayed gastric emptying and constipation
owner complains that dog vomits every morning. You have done diagnostics and ruled out infectious causes, and have also tried a therapeutic food trial and nothing is working. What is the next suggested treatment?
Likely dz: bilious vomiting syndrome
tx: give late night small meal/snack