Diagnosis and Management of the Vomiting Patient. The Vomiting Patient: Four Important Questions. June 15 28, 2009
|
|
|
- Sherman Lawrence
- 6 years ago
- Views:
Transcription
1 The Vomiting Patient: Four Important Questions June 15-28, 2009 By David C. Twedt, DVM, Diplomate ACVIM AAHA gratefully acknowledges the following for their sponsorship of this Web Conference: Diagnosis and Management of the Vomiting Patient David C. Twedt, DVM, Diplomate ACVIM 1
2 Jake 10 yr C/M WWT Owner s complaint: 2 years duration of chronic vomiting Referred for a vomiting work-up The Patient Adopted 2 years ago Little history prior to adoption except a reported episode of pancreatitis On heartworm prevention Since owners obtained Jake he would vomit Jake has as been treated with a variety of medications The Four Important Questions 1. Is the animal really vomiting? 2. What is the vomiting history? 3. How should I direct my work-up? 4. When should I consider antiemetic therapy, and if so which one? 2
3 The Vomiting History The Vomiting History 1. Is the patient actually vomiting? Nausea Salivation Swallowing Retching Expulsion of gastric material The Vomiting History 1. Is the patient actually vomiting? 2. Detailed vomiting history Determine D FACTs: Duration Frequency Association with eating Character Treatments 3
4 The Vomiting History 1. Is the patient actually vomiting? 2. Detailed vomiting history 3. Diet and drug history The Vomiting History 1. Is the patient actually vomiting? 2. Detailed vomiting history 3. Diet and drug history 4. Other signs or symptoms associated with the vomiting Jake s History Vomiting: 2-3 X a week Contains predominately bile Occurs almost always during the night or early morning Occasionally has a gurgling stomach Sometimes vomits heartworm pills up to hours after given 4
5 Jake s History Additional history: Senior premium diet feed once a day Good appetite, no weight loss Past therapy: Several specialty GI diets Antibiotics Famotidine Physical Examination 9 kg bw, BCS - 5/9 Active and responsive T - 100º F, Pulse bpm GI - normal abdominal palpation Review of other systems - WNL Rectal exam - WNL and normal stool Would you consider prescribing an antiemetic as part of Jake s treatment plan? a. Yes b. No c. Need more information 5
6 Rational Use of Antiemetics First, always treat primary disease Indications would be. To prevent fluid and electrolyte loss Patient comfort from nausea and vomiting Fear of aspiration pneumonia Benefit.. Possibly an early return to nutrition Contraindications.. GI obstructions Rational Use of Antiemetics Common uses: Motion sickness Uremia Parvovirus Pancreatitis Acute gastroenteritis Cancer chemotherapy Undetermined causes and no etiology What Antiemetic? Serotonin antagonists Metoclopramide Butorphanol Phenothiazines NK 1 antagonists Antihistamines Anticholinergic drugs 6
7 Pathophysiology of Vomiting The Pathophysiology of Vomiting Remember all vomiting is a CNS initiated reflex CNS Vestibular Emetic Center CRTZ Vagal (X) Sympathetic CN IX Peripheral Sensory Receptors 2- NK1 adenergic 5-HT 1 Cat Emetic Center CRTZ Dog H 1 Histimergic Vestibular Vagal Afferents NK1 7
8 2- NK1 adenergic 5-HT 1A/3 Cat Phenothiazines Emetic Center Chlorpromazine 2 adenergic (dog?) D 2 dopaminergic H 1 histiminergic Vagal (weak) M 1 cholinergic (weak) Afferents Sedation / Hypotension Seizure threshold CRTZ Dog NK1 H 1 Histimergic Vestibular 2- NK1 adenergic 5-HT 1A/3 Emetic Antihistamines Center Diphenhydramine H 1 histiminergic M 1 cholinergic CRTZ Vagal Motion sickness Afferents Vestibular disease Sedation / dry mouth Effectiveness? NK1 H 1 Histimergic Vestibular 2- NK1 adenergic 5-HT 1A/3 Anticholinergics Emetic Isopropamide Center CRTZ M 1 cholinergic Peripheral afferent cholinergics Generally not indicated Vagal Dry mouth Afferents GI secretions GI motility NK1 H 1 Histimergic Vestibular 8
9 2- NK1 adenergic 5-HT 1A/3 Cat Dopamine Emetic Antagonist Metoclopramide Center CRTZ D 2 dopaminergic (cats?) 5HT 3 serotonergic ( dose) Rapid metabolism - CRI CNS excitement, Vagal with phenothiazines Afferents GI motility Dog NK1 H 1 Histimergic Vestibular 2- NK1 adenergic 5-HT 1A/3 Cat Serotonin Antagonist Ondansetron Dolasetron Emetic Center CRTZ 5HT 3 antagonists Uses: Chemotherapy Severe Vagal vomiting GI motility Afferents Dog NK1 H 1 Histimergic Vestibular 2- NK1 adenergic 5-HT 1A/3 Cat Maropitant NK 1 Antagonist Emetic Vomiting/nausea Center CRTZ Chemotherapy Motion sickness ( dose) Hepatic metabolism Vagal Dose accumulates > 5 Afferents days Dog NK1 H 1 Histimergic Vestibular 9
10 No Emetic Events Peripheral Central Maropitant Mechanism of Action Blocks Substance P (a neuropeptide) at NK1 receptor P P MAROPITANT Maropitant Oral (16, 24, 60, 160 mg tabs) 2 mg/kg PO q 24 hr - vomiting 8 mg/kg PO q 24 hr - motion sickness Injectable (10 mg/ml) 1 mg/kg SQ q 24 hr Efficacy - Prevention of Vomiting Central vs. Peripherial Least Squares Mean Number of Emetic Events Ipecac Apomorphine Pfizer Study 10
11 Review of Experience At CSU May 14 to July 26, 2007 We used 19 bottles in 2 months >85 cases have been treated with Maropitant A review of first 50 clinical cases 46 dogs 3 cats 1 ferret First 50 Cases 7 Parvovirus 11 Gastroenteritis 4 Pancreatitis 2 Renal disease 2 Liver disease 17 Oncology 15 chemotherapy 2 tumor related 7 Other conditions: 2 peritonitis 2 neurological disease 1 vestibular disease 1 rattlesnake bite 1 unknown First 50 Cases Treatment response: 30/50 had treatment response recorded in record 29/30 cases showed a positive response to therapy 1 case (abdominal cancer) failed to respond with continued vomiting 11
12 First 50 Cases Adverse effects - first 50 cases 4 clinicians reported stinging at injection site Cases subsequent to first 50 Bassett hound getting chemotherapy developed gastric dilatation Pancreatitis case developed gastric atony and required gastric suction Parvovirus: 7 Cases Vomiting & nausea are a major complication Ability to begin early oral nutrition improves recovery Maropitant appears to decrease hospital time by almost one day Motion Sickness Acepromazine Maropitant Maropitant had a 84% to 93% efficacy in dogs with a history of motion sickness Give 2 hours before the trip Conder GA: Efficacy and safety of maropitant for prevention of vomiting due to motion sickness. J. Vet. Pharmacol Dec
13 QuickTime and a decompressor are needed to see this picture. Does Maropitant Effect GI Motility? SmartPill evaluation of GI motility in dogs given placebo vs Maropitant Does Maropitant Effect GI Motility? Maropitant appears to have no effect on GI motility (ACVIM Forum 2009) Antiemetics in Cats Antihistamines - poor for motion sickness Metoclopramide - a poor choice Maropitant Not yet approved for cats mg/kg q 24 h SQ or PO Motion sickness 1 mg/kg PO Hickman: Safety, pharmacokinetics of maropitant for prevention of vomiting and motion sickness in cats. J Vet Pharmacol Therap 31;220, 2008 Milton 13
14 QuickTime and a decompressor are needed to see this picture. Maropitant Off label use: IV in several cases Dogs under 16 weeks Dogs for longer than 5 days SQ Cautions: Liver disease Prolonged use When are Antiemetics Contraindicated? Not first performing diagnostics GI obstructions Antiemetic adverse side effects Chronic disease - always pursue a diagnosis Back To Jake No fluid or electrolyte loss No nausea causing anorexia No debilitation due to vomiting 14
15 Jake s First Wave Diagnostics CBC - WNL Biochemical profile - WNL Urinalysis - WNL Fecal flotation - negative Giardia fecal ELISA - negative GI Disorders: Initial Evaluation Normal Laboratory Evaluation Classify the Case Mild Disease Significant Disease GI Disorders: Initial Evaluation Mild Disease Symptomatic Therapy Anthelmintic Therapy Dietary Trials 15
16 Parasites and Vomiting Ascarids Tricuris Giardia Physaloptera World wide prevalence Intermediate host - insects Fecal flotation - poor Treatment - febendazole Insert video physaloptera Adverse Food Reactions Food allergies Immune reaction to dietary protein Food intolerance pharmacologic to a dietary substance Chronic nonspecific GI disease ~50% responded to diet change Dogs: Gaschen; JVIM 2006 Cats: Guilford; JVIM 2001 Dietary Trials Novel protein diets Gluten free diets Hydrolyzed diets Gastrointestinal diets Other commercial diets * Diets should be fed for ~ 2 weeks to determine response 16
17 Cortisol µg/dl Jake: First Wave Treatment Trial therapies: Febendazole 50 mg/kg X 3 da Hydrolyzed protein diet X 3 weeks Day 10 days later: Vomited 3 X Owner started famotidine and bland diet Jake: Second Wave Jake was re-admitted for further diagnostics Now possible causes of chronic vomiting? Chronic pancreatitis? Atypical Addison s disease? Primary GI disease Jake s Results Spec cpl: 36 µg/l (normal < 200 µg/ L) Abdominal ultrasound : normal ACTH 18 Stimulation test : normal 15 Zero = 3.1 µg/dl 1 hr. = 13.2 µg/dl Zero A baseline cortisol > 2 µg/dl is unlikely hypoadrenocorticism 1 Hour 17
18 QuickTime and a Sorenson Video 3 decompressor are needed to see this picture. Clinical Assessment of GI Disorders Possibly Causing Vomiting Diagnostic Evaluation Radiology Endoscopy Surgical biopsy Obstructive Inflammatory Motility disorder Likely Differentials for Jake Inflammatory disease: Gastritis/IBD Helicobacter Insert video Obstructive disorders N Duodenum Mucosal hypertrophy Motility disorders Bilious vomiting disorder Jake: Second Wave Results Gastric biopsy Normal Helicobacter culture Negative Intestinal biopsy Insert video Normal Gastric reflux 18
19 Enterogastric Reflux Syndrome Bilious Vomiting Syndrome Etiology: Idiopathic Gastric motility disorder? Secondary IBD Giardia Enterogastric Reflux Syndrome Clinical syndrome Older dogs Chronic bilious vomiting Early morning Empty stomach Endoscopy Antral inflammation Enterogastric Reflux Treatment Dietary management Late evening meals Gastric protectants Antiacids Sucralfate Prokinetic agents Metoclopramide - poor Cisapride - better Erythromycin - good? Dose: mg/kg BW 19
20 Jake: Follow Up Treatment Diet 3 meals/day Last meal late in the evening Cisapride 0.25 mg/kg 30 min before last meal Outcome Resolved > 1 year Vomiting: Final Thoughts First rule out: Common conditions Non-GI disease Treat primary disease Use antiemetics with acute or severe signs or when nausea and vomiting effect nutrition or clinical status of patient 20
21 1. To complete the evaluation, please go to the following website: 1. After completing the evaluation, you will automatically be linked to the Continuing Education Certificate. The CE certificate can only be accessed after the evaluation is completed. 2. Download the CE Certificate (in pdf format) to your computer and print enough copies for those persons viewing the webcast with you. Your input is very important! We take feedback seriously in order to provide you with the highest quality experience possible. If you have any questions about completing the evaluation or accessing your CE certificate, please us at or call 800/ Questions to the Speaker Please your questions to by Sunday, July 5, Dr. Twedt will provide written responses to all of the questions and they will be posted on AAHA s website by Wednesday, July 15, AAHA gratefully acknowledges the following for their sponsorship of this Web Conference. 21
GI Pharmacology -4 Irritable Bowel Syndrome and Antiemetics. Dr. Alia Shatanawi
GI Pharmacology -4 Irritable Bowel Syndrome and Antiemetics Dr. Alia Shatanawi 11-04-2018 Drugs used in Irritable Bowel Syndrome Idiopathic, chronic, relapsing disorder characterized by abdominal discomfort
Nausea and Vomiting in Palliative Care
Nausea and Vomiting in Palliative Care Definitions Nausea - an unpleasant feeling of the need to vomit Vomiting - the expulsion of gastric contents through the mouth, caused by forceful and sustained contraction
DIAGNOSTIC AND THERAPEUTIC APPROACH TO THE CHRONICALLY VOMITING DOG AND CAT
DIAGNOSTIC AND THERAPEUTIC APPROACH TO THE CHRONICALLY VOMITING DOG AND CAT Stanley L. Marks, University of California, Davis, School of Veterinary Medicine Davis, California, USA The primary clinical
Vomiting Approach to diagnosis
Vomiting Approach to diagnosis By Dr. Sahar El-Gharabawy Associate professor of internal medicine Hepato-gastroenterology Unit )SMH ) Mansoura University Definitions: Nausea: Feeling "sick to the stomach",
Diagnostic approach to vomiting and regurgitation. Deborah S. Greco DVM, PhD, Diplomate ACVIM Senior Research Scientist, Nestle Purina Petcare
Diagnostic approach to vomiting and regurgitation Deborah S. Greco DVM, PhD, Diplomate ACVIM Senior Research Scientist, Nestle Purina Petcare Differentiate Vomiting from Regurgitation Vomiting Regurgitation
International Congress of the Italian Association of Companion Animal Veterinarians
www.ivis.org International Congress of the Italian Association of Companion Animal Veterinarians 2 - May, 201 Rimini, Italy Next Congress : SCIVAC International Congress Ma -, 201 -, Italy Reprinted in
Symptom Management. Thomas McKain, MD, ABFM, ABHPM Medical Director
Symptom Management Nausea & Vomiting Thomas McKain, MD, ABFM, ABHPM Medical Director Mr. Jones has nausea and vomiting. May I initiate Compazine from the Comfort Pak? Objectives 1. Delineate the Differential
VOMITING. Tan Lay Zye
VOMITING Tan Lay Zye Vomiting is a common symptom. It is a complex reflex behavioural response involving forceful expulsion of the stomach contents through oral cavity. Contents Emetic reflex Causes of
Sponsored by an educational grant from Pfizer Animal Health
Sponsored by an educational grant from Pfizer Animal Health clinician s forum Expert Views from a Roundtable GI Roundtable: Current Approaches to Vomiting in Cats & Puppies PARTICIPANTS Frédéric P. Gaschen,
Introduction & Expectations Learning Objectives Etiology & Pathophysiology of Nausea & Vomiting Pharmacology of Dimenhydrinate...
Primary Care Paramedic Dimenhydrinate (Gravol) Certification Learner Package www.lhsc.on.ca/bhp 1 Table of Contents Introduction & Expectations... 4 Learning Objectives... 4 Etiology & Pathophysiology
Inflammation of the Esophagus (Esophagitis) Basics
Inflammation of the Esophagus (Esophagitis) Basics OVERVIEW Inflammation of the esophagus typically involves the tubular area of the esophagus itself (known as the esophageal body ) and the muscular area
INFLAMMATORY BOWEL DISEASE
INFLAMMATORY BOWEL DISEASE What is inflammatory bowel disease? Inflammatory Bowel Disease (IBD) is a syndrome rather than a specific disease, with a number of possible causes. Occasionally, the stomach
Prevention of Antineoplastic Medication induced Nausea and Vomiting in Pediatric Cancer Patients
Prevention of Antineoplastic Medication induced Nausea and Vomiting in Pediatric Cancer Patients Done by :Meznah Zaid Al-Mutairi Pharm.D Candidate PNU University College of Pharmacy Introduction Nausea
DECONTAMINATION AGENTS and ANTIEMETICS *** This material won t be covered in lecture, but you are responsible for it***
Decontamination and Antiemetics Med 5724 Page 1 of 8 DECONTAMINATION AGENTS and ANTIEMETICS *** This material won t be covered in lecture, but you are responsible for it*** REFERENCES: Katzung (9th ed.)
David C. Twedt, DVM, DACVIM
IS IT VOMITING OR REGURGITATION? David C. Twedt, DVM, DACVIM GASTROENTEROLOGY There are many gastrointestinal disorders that either frequently go unrecognized or are often misdiagnosed. Appropriate recognition
Chronic Vomiting in Cats. Jinelle Webb DVM, DVSc, Dipl ACVIM
Chronic Vomiting in Cats Jinelle Webb DVM, DVSc, Dipl ACVIM Is a vomiting cat normal? l At my house maybe? Or maybe I should attend my own lecture. l Cats do tend to vomit more readily than dogs l Hairballs
Gastroparesis and other upper GI problems DR ANDREW DAVIES
Gastroparesis and other upper GI problems DR ANDREW DAVIES Outline Gastroparesis Hiccoughs Gastroparesis Gastroparesis Definition: A syndrome of objectively delayed gastric emptying in the absence of mechanical
Updates in Chemotherapy-Induced Nausea and Vomiting (CINV) 2017
Updates in Chemotherapy-Induced Nausea and Vomiting (CINV) 2017 MELISSA C. MACKEY, PHARMD, BCPS, BCOP ONCOLOGY CLINICAL PHARMACIST DUKE UNIVERSITY HOSPITAL AUGUST 5, 2017 Objectives Review risk factors
AUTACOIDS. Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine, The University of Jordan April, 2014
AUTACOIDS Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine, The University of Jordan April, 2014 AUTACOIDS Endogenous substances with complex physiologic and pathphysiologic functions; commonly understood
A SLP s Guide to Medication Therapy and Management. Sarah Luby, PharmD, BCPS KSHA 2017
A SLP s Guide to Medication Therapy and Management Sarah Luby, PharmD, BCPS KSHA 2017 Objectives Identify the appropriate route of administration for medications and proper formulations for use Understand
Fundamentals of Pharmacology for Veterinary Technicians Chapter 11
Dog Cecum Pylorus Esophagus Rectum Stomach Fundus A Colon Body Horse Colon Esophagus Rectum Stomach Apex Haustra B Ileum Cecum Ruminant Small colon Rumen Cecum Esophagus Reticulum Ileum Omasum C Spiral
Emesis, or vomiting, is one of the
3 CREDITS Article 1 Héctor J. Encarnación, DVM Gulf Coast Veterinary Specialists Houston, Texas Joshua Parra, DVM Florida Veterinary Referral Center and 24-Hour Emergency and Critical Care Hospital Estero,
Active ingredients: Metoclopramide Hydrochloride mg Equivalent to metoclopramide hydrochloride anhydrous mg
Name Primperan 10 mg / 2 ml Metoclopramide hydrochloride anhydrous Solution for I.M. or I.V. injection (Ampoules) Composition Each 2 ml ampoule contains: Active ingredients: Metoclopramide Hydrochloride.
Managing Adverse Events in the Cancer Patient. Learning Objectives. Chemotherapy-Induced Nausea/Vomiting
Managing Adverse Events in the Cancer Patient Lisa A Thompson, PharmD, BCOP Assistant Professor University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Learning Objectives Describe
Gastrointestinal Obstruction
Customer Name, Street Address, City, State, Zip code Phone number, Alt. phone number, Fax number, e-mail address, web site Gastrointestinal Obstruction (Blockage of the Gastrointestinal Tract) Basics OVERVIEW
Nausea & Vomiting. Dr Eve Lyn TAN Liverpool Hospital NSW, AUSTRALIA
Nausea & Vomiting Dr Eve Lyn TAN Liverpool Hospital NSW, AUSTRALIA Prevalence prevalence varies *, systemic review 2007 : overall prevalence : nausea 30%, vomiting 20% in last 1-2 weeks of life : nausea
Chronic GI PROBLEMS in Cats & dogs
Chronic GI PROBLEMS in Cats & dogs Chronic vomiting, diarrhea or both are fairly common problems in dogs and cats. They may be related to relatively minor causes, such as chronic swallowing of hair, or
DOMPERIDONE BNF 4.6. Domperidone is a dopamine type 2-receptor antagonist. It is structurally related to the
DOMPERIDONE BNF 4.6 Class: Prokinetic anti-emetic. Indications: Nausea and vomiting, dysmotility dyspepsia, gastro-oesophageal reflux. Pharmacology Domperidone is a dopamine type 2-receptor antagonist.
Proceedings of the World Small Animal Veterinary Association Sydney, Australia 2007
Proceedings of the World Small Animal Veterinary Association Sydney, Australia 2007 Hosted by: Australian Small Animal Veterinary Association (ASAVA) Australian Small Animal Veterinary Association (ASAVA)
Chronic Diarrhea in Dogs
Chronic Diarrhea in Dogs Basics OVERVIEW A change in the frequency, consistency, and volume of bowel movement (feces) for more than 3 weeks Can be either small bowel (small intestine) diarrhea, large bowel
AAHA National Staff Meeting Web Conference - Taking Action With the AAHA Nutritional Assessment Guidelines 9/23/2010
Taking Action With the AAHA September 23, 2010 By Katherine Knutson, DVM & Susan Thorson, DVM The AAHA for Dogs and Cats were sponsored by a generous educational grant from Hill s Pet Nutrition. Educational
Second term/
Second term/ 2015-2016 L. 1 Dr Mohammed AL-Zobaidy Learning objectives GIT pharmacology After completing this chapter the student will be able to: Recognise pathophysiological factors implicated in acid-peptic
Chapter 29 - Nausea and Vomiting
Chapter 29 - Nausea and Vomiting Episode Overview: 1) Describe the mechanism of development of a Hypochloremic Metabolic Alkalosis in vomiting 2) List commonly used anti-emetics including their dose and
Clinical Policy: Gastric Electrical Stimulation Reference Number: CP.MP.40
Clinical Policy: Reference Number: CP.MP.40 Effective Date: 09/09 Last Review Date: 10/16 Coding Implications Revision Log See Important Reminder at the end of this policy for important regulatory and
First a caution. Processes we might NOT try to treat with medications. Processes we might try to treat. Main drug categories.
Pharmacological Interventions for dizziness Timothy C. Hain, MD Northwestern University Medical School Chicago, Illinois, USA First a caution Torok N. Old and new in Meniere's disease. Laryngoscope 87:1870-1877,
CHRONIC VOMITING IN DOGS AND CATS: A PRACTICAL DIAGNOSTIC APPROACH
CHRONIC VOMITING IN DOGS AND CATS: A PRACTICAL DIAGNOSTIC APPROACH Michael S. Leib DVM, MS, Diplomate ACVIM Virginia Maryland Regional College of Veterinary Medicine, Blacksburg, VA Chronic vomiting (intermittently
P R E S E N T S Dr. Mufa T. Ghadiali is skilled in all aspects of General Surgery. His General Surgery Services include: General Surgery Advanced Laparoscopic Surgery Surgical Oncology Gastrointestinal
Is one of the most common chronic disorders. causing patients to seek medical treatment.
ILOs After this lecture you should be able to : Define IBS Identify causes and risk factors of IBS Determine the appropriate therapeutic options for IBS Is one of the most common chronic disorders causing
2011 AAHA Canine Vaccination Guidelines: Practical Application in Practice
2011 AAHA Canine Vaccination Guidelines: Practical Application in Practice November 7 20, 2011 By Link V. Welborn, DVM, DABVP AAHA gratefully acknowledges Boehringer Ingelheim Vetmedica, Merck Animal Health,
Canine Megaesophagus Barbara Davis, DVM, DACVIM DoveLewis Annual Conference Speaker Notes
Canine Megaesophagus Barbara Davis, DVM, DACVIM DoveLewis Annual Conference Speaker Notes Megaesophagus is a condition characterized by decreased or absent esophageal tone and motility usually resulting
GASTROPARESIS. C. Prakash Gyawali, MD Professor of Medicine Washington University in St. Louis
GASTROPARESIS C. Prakash Gyawali, MD Professor of Medicine Washington University in St. Louis Symptom Definitions Nausea: a subjective feeling of wanting to vomit Vomiting: forceful expulsion of gastroduodenal
CYCLIC VOMITING SYNDROME. C. Prakash Gyawali, MD Professor of Medicine Washington University in St. Louis
CYCLIC VOMITING SYNDROME C. Prakash Gyawali, MD Professor of Medicine Washington University in St. Louis Case 26 year old male Symptoms began at age 19 yr 5-6 day episodes of recurrent, severe vomiting
My dog or cat has problems with the stomach, intestines or liver... what do I do now?
Dietary food for the targeted tackling of gastrointestinal and/or liver problems in dogs and cats My dog or cat has problems with the stomach, intestines or liver... what do I do now? reliable and and
What can you expect after your ERCP?
ERCP Explained and respond to bed rest, pain relief and fasting to rest the gut with the patient needing to stay in hospital for only a few days. Some patients develop severe pancreatitis and may require
First a caution. Processes we might NOT try to treat with medications. Processes we might try to treat. Main drug categories.
Pharmacological Interventions for dizziness Timothy C. Hain, MD Northwestern University Medical School Chicago, Illinois, USA First a caution Torok N. Old and new in Meniere's disease. Laryngoscope 87:1870-1877,
CHAPTER 11 Functional Gastrointestinal Disorders (FGID) Mr. Ashok Kumar Dept of Pharmacy Practice SRM College of Pharmacy SRM University
CHAPTER 11 Functional Gastrointestinal Disorders (FGID) Mr. Ashok Kumar Dept of Pharmacy Practice SRM College of Pharmacy SRM University 1 Definition of FGID Chronic and recurrent symptoms of the gastrointestinal
STRATEGIES TO IMPROVE ENTERAL FEEDING TOLERANCE. IS IT WORTH IT? ENGELA FRANCIS RD(SA)
STRATEGIES TO IMPROVE ENTERAL FEEDING TOLERANCE. IS IT WORTH IT? ENGELA FRANCIS RD(SA) DEFINITION OF ENTERAL FEEDING INTOLERANCE Gastrointestinal feeding intolerance are usually defined as: High gastric
SAEMS. Ondansetron HCL Self-Learning Module
SAEMS Ondansetron HCL Self-Learning Module Dawn Daniels Tucson Medical Center November, 2008 1 DATE: November 2008 PURPOSE TRAINING MODULE FOR ONDANSETRON This Training Module has been developed to serve
Fecal incontinence causes 196 epidemiology 8 treatment 196
Subject Index Achalasia course 93 differential diagnosis 93 esophageal dysphagia 92 95 etiology 92, 93 treatment 93 95 work-up 93 Aminosalicylates, pharmacokinetics and aging effects 36 Antibiotics diarrhea
Gastroenterology Fellowship Program
Gastroenterology Fellowship Program Outpatient Clinical Rotations I. Overview A. Three Year Continuity Clinic Experience All gastroenterology fellows will be required to have a ½ day continuity clinic
Issues in Enteral Feeding: Aspiration
Issues in Enteral Feeding: Aspiration A webinar for HealthTrust Members February 11, 2019 Co-sponsored by HealthTrust and V NOS Continuing Education Provider Presented by: Kathleen Stoessel, RN, BSN, MS
Gastroduodenal Ulcer Disease
Gastroduodenal Ulcer Disease (Ulcers in the Stomach and Upper Small Intestine [Duodenum]) Basics OVERVIEW Gastro- refers to the stomach; duodenal refers to the upper small intestine or duodenum Ulcers
Gastrointestinal Tract Imaging. Objectives. Reference. VMB 960 April 6, Stomach Small Intestine Colon. Radiography & Ultrasound
Gastrointestinal Tract Imaging VMB 960 April 6, 2009 Stomach Small Intestine Colon Objectives Radiography & Ultrasound Contrast Examination of the Small Intestine Reference Chapters 45 47 Pages 750 805
Management of Gastroparesis
Management of Gastroparesis Bible Class Jan Hendrik Niess As published in Am J Gastroenterol. 2013 Jan;108(1):18-37 What is the definition of gastroparesis? What are cardinal symptoms of gastroparesis?
Dsuvia (sufentanil) NEW PRODUCT SLIDESHOW
Dsuvia (sufentanil) NEW PRODUCT SLIDESHOW Introduction Brand name: Dsuvia Generic name: Sufentanil Pharmacological class: Opioid agonist Strength and Formulation: 30mcg; sublingual tabs (housed in a disposable,
GASTROENTEROLOGY ESSENTIALS
GASTROENTEROLOGY ESSENTIALS Practical Gastroenterology 8/25/2018 Jahnavi Koppala, MBBS Abdullah Abdussalam, MD A 48-year-old male was evaluated for noncardiac chest pain. Treatment with PPI twice daily
What Is an Endoscopic Ultrasound (EUS)?
ENDOSCOPIC ULTRASOUND (EUS) What Is an Endoscopic Ultrasound (EUS)? An endoscopic ultrasound (EUS) is a specialized procedure that blends: Endoscopy use of a scope to look at the inside lining of the gastrointestinal
Pancreatitis. Acute Pancreatitis
Pancreatitis Pancreatitis is an inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum. The duodenum is the upper part of the small intestine. The pancreas
June By: Reza Gholami
ACG/CAG guideline on Management of Dyspepsia June 2017 By: Reza Gholami DEFINITION OF DYSPEPSIA AND SCOPE OF THE GUIDELINE Dyspepsia was originally defined as any symptoms referable to the upper gastrointestinal
National Digestive Diseases Information Clearinghouse
Upper GI Endoscopy National Digestive Diseases Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is upper gastrointestinal (GI) endoscopy? Upper
Gastrointestinal Involvement in Adult Mitochondrial Disease
Newcastle Mitochondrial Disease Guidelines At a glance guidelines: Gastrointestinal Involvement in Adult Mitochondrial Disease For full guideline visit: http://www.newcastle-mitochondria.com/service/patient-care-guidelines/
Upper Gastrointestinal (GI) Tract X-ray (Radiography)
Upper Gastrointestinal (GI) Tract X-ray (Radiography) What is Upper Gastrointestinal (GI) Tract Radiography? What are some common uses of the procedure? How should I prepare? What does the equipment look
An Approach to Vomiting Block 10
An Approach to Vomiting Block 10 Dr A Meyer Department of Pediatrics and Child Health Children vomit! Common Anxiety Need to find serious life-threatening disorders 1 The magnitude of the problem. To illustrate
Gastroenterology and Feeding Issues in Fanconi Anemia
Gastroenterology and Feeding Issues in Fanconi Anemia Sarah Jane Schwarzenberg, MD Pediatric Gastroenterology, Hepatology and Nutrition August 12, 2012 GI problems in FA 5% have gastrointestinal tract
A Trip Through the GI Tract: Common GI Diseases and Complaints. Jennifer Curtis, MD
A Trip Through the GI Tract: Common GI Diseases and Complaints Jennifer Curtis, MD Colon Cancer How does it develop? Most cancers arise from polyps Over time these can turn into cancer Combination of genetic
Clinical Policy: Gastric Electrical Stimulation
Clinical Policy: Reference Number: CP.MP.40 Last Review Date: 08/18 Coding Implications Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description
Urine a Mess: Micturition Disorders Joe Bartges, DVM, PhD, DACVIM, DACVN Cornell University Veterinary Specialists Stamford, CT
Urine a Mess: Micturition Disorders Joe Bartges, DVM, PhD, DACVIM, DACVN Cornell University Veterinary Specialists Stamford, CT 1. Micturition refers to the process of storing and periodically voiding
Propulsion and mixing of food in the alimentary tract Chapter 63
Propulsion and mixing of food in the alimentary tract Chapter 63 Types of GI movements: Propulsive movement-peristalsis Propulsion: controlled movement of ingested foods, liquids, GI secretions, and sloughed
Chapter 41. Media Directory. Lower Digestive Tract. Constipation (continued) Constipation
Chapter 41 Drugs for Bowel Disorders and Other Gastrointestinal Conditions Slide 43 Media Directory Tegaserod Animation Upper Saddle River, New Jersey 07458 All rights reserved. Lower Digestive Tract Figure
Eosinophilic Disease. E.g.i.d. group. An Introduction written by parents
www.egid.org.uk Our facebook group link: http://www.facebook.com/home.php?#!/group.php? gid=28072826009 Eosinophilic Disease E.G.I.D. Group E.g.i.d. group An Introduction written by parents 0 Table of
2 QUALITATIVE AND QUANTITATIVE COMPOSITION
1 PRODUCT NAME TROPISETRON-AFT tropisetron hydrochloride (equivalent to 2 mg or 5 mg tropisetron) per ampoule. 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Each ml contains 1 mg of tropisetron 1 2 ml ampoule
PEDIATRIC EMERGENCY DEPARTMENT CLINICAL GUIDELINE: GI SURGICAL EMERGENCIES: VOMITING
GI SURGICAL EMERGENCIES: VOMITING PYLORIC STENOSIS Population: Infants: onset between 2-5 weeks of age 1 in 250 births Male: female ratio 4:1 Familial incidence History: No vomiting in the first few weeks
Outline. Definition (s) Epidemiology Pathophysiology Management With an emphasis on recent developments
Chronic Dyspepsia Eamonn M M Quigley MD FRCP FACP MACG FRCPI Lynda K and David M Underwood Center for Digestive Disorders Houston Methodist Hospital Houston, Texas Outline Definition (s) Epidemiology Pathophysiology
Patient Gastroscopy Package
2014 Patient Gastroscopy Package BARRIE ENDOSCOPY 5 Quarry Ridge Road, Barrie, Ontario- L4M 7G1 General Patient Information THE FOLLOWING INFORMATION PERTAINS TO ALL PATIENTS HAVING PROCEDURES AT BARRIE
P R E S E N T S Dr. Mufa T. Ghadiali is skilled in all aspects of General Surgery. His General Surgery Services include: General Surgery Advanced Laparoscopic Surgery Surgical Oncology Gastrointestinal
INVESTIGATIONS OF GASTROINTESTINAL DISEAS
INVESTIGATIONS OF GASTROINTESTINAL DISEAS Lecture 1 and 2 دز اسماعيل داود فرع الطب كلية طب الموصل Radiological tests of structure (imaging) Plain X-ray: May shows soft tissue outlines like liver, spleen,
Pediatric Gastroenterology Referral Guidelines
Suggested Pre-Referral Workup This is a general suggestion of possible testing to confirm a suspected diagnosis. Although referrals will be accepted without the suggested work up being complete, to ensure
Pexact gastrostomy. GI Unit. Patient Information Leaflet
Pexact gastrostomy GI Unit Patient Information Leaflet Introduction This leaflet is for people who are considering having a Pexact gastrostomy. It gives information about what this is, what the procedure
My dog or cat has pancreas problems what do I do now?
TROVET Digestion Support, dietary supplement for the targeted tackling of pancreas problems in dogs and cats My dog or cat has pancreas problems what do I do now? reliable and affordable dietary pet food
Constipation An Overview. Definition Physiology of GI tract Etiology Assessment Treatment
CONSTIPATION Constipation An Overview Definition Physiology of GI tract Etiology Assessment Treatment Definition Constipation = the infrequent passage of hard feces Definition of Infrequent The meaning
European Medicines Agency recommends changes to the use of metoclopramide
20 December 2013 EMA/13239/2014 Corr. 1 European Medicines Agency recommends changes to the use of metoclopramide Changes aim mainly to reduce the risk of neurological side effects On 24 October the European
Dr. Patsy Smyth, FNP-BC
Dr. Patsy Smyth, FNP-BC Gastroparesis literally translated means stomach paralysis. Gastroparesis is a syndrome characterized by delayed gastric emptying in absence of mechanical obstruction of the stomach.
Barrett s Esophagus. lining of the lower esophagus that bears his name (i.e., Barrett's esophagus). We now
Shamika Johnson Anatomy & Physiology 206 April 20, 2010 Barrett s Esophagus What is Barrett s Esophagus? Norman Barrett was a pathologist. In 1950, he described an abnormality in the lining of the lower
80th Western Veterinary Conference
80th Western Veterinary Conference SIS12 Changing our Ideas in the Diagnosis and Treatment of Pancreatitis David C. Twedt, DVM, DACVIM Colorado State University Fort Collins, CO, USA OBJECTIVES OF THE
Advanced Medical Care: Improving Veterinary Anesthesia. Advanced Medical Care: Improving Veterinary Anesthesia
Advanced Medical Care: Improving Thursday, April 23, 2009 By Tamara Grubb, DVM, MS, DACVA AAHA gratefully acknowledges the following for their sponsorship of this Web Conference: Advanced Medical Care:
CASE-BASED SMALL GROUP DISCUSSION
MHD I, Session 11, Student Copy Page 1 CASE-BASED SMALL GROUP DISCUSSION MHD I SESSION 11 Renal Block Acid- Base Disorders November 7, 2016 MHD I, Session 11, Student Copy Page 2 Case #1 Cc: I have had
Kidney Failure Sudden (Acute) Uremia
Customer Name, Street Address, City, State, Zip code Phone number, Alt. phone number, Fax number, e-mail address, web site Kidney Failure Sudden (Acute) Uremia Basics OVERVIEW Uremia is the medical term
Proceedings of the 34th World Small Animal Veterinary Congress WSAVA 2009
www.ivis.org Proceedings of the 34th World Small Animal Veterinary Congress WSAVA 2009 São Paulo, Brazil - 2009 Next WSAVA Congress : Reprinted in IVIS with the permission of the Congress Organizers STAGED
What is a Small Bowel Capsule Endoscopy?
What is a Small Bowel Capsule Endoscopy? Capsule endoscopy is a way for your doctor to see inside part of your digestive system. A small bowel capsule endoscopy looks at the lining of the small intestine.
Disclosures. Objectives. Gastroparesis: Are We Moving On? Gastroparesis: Clinical Overview
Gastroparesis: Are We Moving On? Anthony Lembo, M.D. Associate Professor of Medicine Harvard Medical School Beth Israel Deaconess Medical Center Boston, MA Disclosures Consultant Alkermes, Allergan, Forest,
Delirium and Nausea. Delirium - definition. Delirium Incidence. Predisposing Risk Factors for Delirium. Impact. Delirium Types 10/14/2016
Delirium - definition Delirium and Nausea Etiologically non-specific global cerebral dysfunction associated with changes in LOC, attention, thinking, perception, memory, psychomotor behavior, emotion and
Amyloidosis & the GI Tract
Amyloidosis & the GI Tract John O. Clarke, M.D. Director, Esophageal Program Clinical Associate Professor of Medicine Stanford University john.clarke@stanford.edu 2017 Topics to cover 1) Patterns of GI
Upper Gastrointestinal Endoscopy -Open Access
Upper Gastrointestinal Endoscopy - Open Access Facility:... A. INTERPRETER / CULTURAL NEEDS An Interpreter Service is required? Yes No If Yes, is a qualified Interpreter present? Yes No A Cultural Support
Regurgitation (Return of Food or Other Contents from the Esophagus, Back Up through the Mouth) Basics
Regurgitation (Return of Food or Other Contents from the Esophagus, Back Up through the Mouth) Basics OVERVIEW Passive, backward movement or return of food or other contents from the esophagus (part of
Gastrointestinal, Hepatic, and Nutritional Challenges in FA
Gastrointestinal, Hepatic, and Nutritional Challenges in FA Sarah Jane Schwarzenberg, MD Pediatric Gastroenterology, Hepatology and Nutrition June 29, 2014 GI problems in FA 5% have gastrointestinal tract
Nausea and Vomiting. Principles and Practice in End of Life Care November 2018
Nausea and Vomiting Principles and Practice in End of Life Care November 2018 Overview Aims and Objectives Why is managing nausea and vomiting important? Definitions Causes Interventions pharmacological
Peptic ulcer disease Disorders of the esophagus
Peptic ulcer disease Disorders of the esophagus Peptic ulcer disease Burning epigastric pain Exacerbated by fasting Improved with meals Ulcer: disruption of mucosal integrity >5 mm in size, with depth