13. Diseases of the stomach in dogs and cats Flashcards
Acute gastritis?
Acute Gastritis
Inflammation of the stomach
The most common cause for vomiting
Dogs > Cats
Causes of acute gastritis?
CAUSES
§ Spoiled food § Contaminated food
§ High-fat food § Foreign bodies
§ Toxic plants § Chemicals
§ Irritating drugs § Allergy
§ Protein intolerance § Virus
§ Bacteria
Clinical signs of acute gastritis?
CLINICAL SIGNS
§ Acute onset of vomiting
§ Loss of appetite
§ Fever
§ Abdominal pain
Diagnosis of acute gastritis?
DIAGNOSIS
§ History; Physical exam
§ If condition worsens withing 1-3 days →
US
CBC
Serum biochemistry
Treatment of acute gastritis?
TREATMENT
§ NPO for 24 hrs
§ Antiemetics: Maropitant if persistent/excessive vomiting
§ IVFT; Small amounts of cool water
§ GI prescription diet
Haemorrhagic Gastroenteritis (HE)?
Haemorrhagic Gastroenteritis (HE)
C. perfringens hypersensitivity; Parvovirus; Parasites
Gastric Erosive Ulcerative Disease(GEU) Predisposing factors?
Gastric Erosive-Ulcerative Disease (GEU)
PREDISPOSING FACTORS
NSAIDS
§ Direct; All commonly used NSAIDs
§ Aspirin; Phenylbutazone; Ketoprofen; Flunixin; Ibuprofen
Glucocorticoids
§ ↓ Mucosal cell growth; ↓ Mucus; ↑ Gastric acid secretion
§ High doses for a long duration
§ Dexamethasone > Prednisolone
§ Glucocorticoids aren’t usually ulcerogenic on their own
Metabolic diseases
§ Liver failure § Addison’s
§ Renal failure § Acute pancreatitis
§ IBD § Neurological disease
Altered gastric blood flow; Stress-related factors
§ Hypotension § Spinal cord diseases
§ Shock § Surgery
§ Sepsis § GDV
↑ Gastric acid secretion
§ Pancreatic gastrin-secreting tumour
§ Mast cell tumour of the skin
§ Pyloric outflow obstruction → Chronic gastric distension
Toxic-traumatic agents
§ Bile salts
§ Pancreatic enzymes
§ Lead
§ Foreign body
§ Alcohol
Gastric neoplasia → Mast cell tumour
Diagnosis and treatment of Gastric erosive ulcerative disease?
DIAGNOSIS
History: Intermittent vomiting; Haematemesis; Melaena; Recent
NSAID/Glucocorticoid tx; Acute onset of weakness
Endoscopy: Benign ulcer; Superficial erosions; Malignant ulcer;
Biopsy needed
Physical exam: Often normal; Anaemia; Abdominal pain; Melaena
Laboratory tests
§ Anaemia: Regenerative; Non-regenerative; Hypochromic;
Microcytic
§ Renal failure; Liver disease; Addison’s
Radiography: Usually normal; Peritonitis or pneumoperitoneum
may indicate perforation
TREATMENT
§ Eliminate the cause
§ Symptomatic-supportive therapy: Diet; Fluid;
Antiemetics; Antacids; Protectants
§ Blood transfusion: Severe anaemia; GI bleeding
§ Surgery: Uncontrolled haemorrhage/perforation
Chronic gastritis?
Chronic Gastritis
AETIOLOGY
Lymphocytic-plasmocytic:
§ Helicobacter-associated (in dogs)
§ Physaloptera rara (in dogs)
Eosinophilic: Allergic reaction to food; Immune response to
parasites; Foreign body; Mast cell tumour; Idiopathic
Atrophic gastritis: Result of gastritis inflammatory disease
Hypertrophic gastritis: Idiopathic
CAUSES
See acute gastritis
§ Helicobacter spp. § Parasites
§ Dietary antigens § Foreign material
§ Fungal origin § Idiopathic
SYMPTOMS
§ Intermittent vomiting § Abdominal pain
§ Ø Response to treatment § Haematemesis
§ Weight loss § Melaena
§ Anorexia
DIAGNOSIS
Endoscopic/Full thickness biopsy + histopathology
Assessment for IBD & neoplasia
Radiology & Ultrasonography: Foreign body; Thickened gastric
wall; Mass lesion; Delayed gastric emptying
Lab. D: Ø diagnostic
TREATMENT
Exclusion of specific causes first
§ Low fat; Low fibre; Elimination diet for 2-4 weeks
§ Anti-parasitic trial
§ Helicobacter elimination therapy
If that isn’t effective…
§ Immunosuppressants: Prednisolone
§ Antacids – H2 blocker; Omeprazole
§ Protectants - Sucralfate
§ Prokinetics – Control reflux
§ Surgical resection of eosinophilic granulomatous masses
Helicobacter associated Gastritis?
HELICOBACTER-ASSOCIATED GASTRITIS
Dog: H. bizzozeroni, salomonis, heilmannii et felis
Cat: H. heilmannii, bizzozeronii et felis
Diagnosis: C-13 urea breath test; Endoscopy-biopsy → Rapid urease
test; Histopathology; PCR; FISH
Treatment
§ Rule out other causes of chronic vomiting first!
§ Amoxiclav + Metronidazole for 14 days + Bizmuth powder
for 6 weeks
§ Proton pump inhibitors; + Azithromycin for cats
Parasitic Gastritis?
PARASITIC GASTRITIS
Dog: Physaloptera rara
Cat: Ollulanus tricuspis
Diagnosis: Floatation (difficult); Endoscopy; History of chronic
vomiting
Treatment
§ Dog: Pyrantel
§ Cat: Fenbendazole
§ Endoscopic removal
Delayed Gastric Emptying and Gastric outlet obstruction?
Delayed Gastric Emptying
GASTRIC OUTLET OBSTRUCTION
Causes
Antral pyloric hypertrophy syndrome/Pyloric stenosis
Congenital/acquired; Young-middle aged male
brachycephalic breeds
Diagnosis
CSx (projectile vomiting)
Radiography: Contrast study – “Beak-like” appearance of pyloric
lumen; Delayed gastric emptying
Endoscopy: Narrowed pyloric lumen; Thickened pyloric mucosa
Treatment: Pyloroplasty
Other causes
§ Chronic hypertrophic gastritis § Foreign body
§ Granulomatous gastritis § Antral polyps
§ Gastric ulcer § Neoplasia
§ External compression
Gastric Motility disorders?
GASTRIC MOTILITY DISORDERS
Causes
§ Gastroenteritis § Liver failure
§ Pancreatitis § DM
§ Abdo. pain § IBD
§ Ca2+↿⇂; K ↓ § Addison’s
§ Drugs § Constipation
§ Post-GDV § Trauma
§ Dysautonomia § Stress
§ Chronic gastritis § Peritonitis
Idiopathic disorder
Symptoms: Postprandial abdo. Discomfort; Bloating; Chronic
vomiting
Diagnosis: Documentation of gastric retention; Eliminating
obstruction & metabolic causes
Treatment: Diet; Prokinetics
Diagnosis
§ History: Vomiting (> 8 hours after eating)
§ Physical exam: Normal/abdominal tympany
§ Lab. D: Normal; Hypochloraemic metabolic alkalosis
§ Radiology: Fluid-distended stomach; Liquid barium
retention
§ Endoscopy: Confirmation of obstruction
Gastric Neoplasia?
GASTRIC NEOPLASIA
Low incidence in dogs & cats
Adenocarcinoma: Most common gastric tumour in dogs (male)
Lymphoma: Most common gastric tumour in cats
Symptoms
§ Weight loss
§ Worsening of vomiting
§ Anorexia
§ Melaena
§ Haematemesis
Diagnosis: Symptoms; US; Endoscopy; Biopsy
Treatment: Surgery; Chemotherapy
Gastric Dilation Volvulus?
GASTRIC DILATION VOLVULUS
Life-threatening disorder where by the stomach twists on its axis
Large, deep-chested breeds > Small breeds; Males > Females; Older
Pathogenesis (within minutes → hours)
- Stomach fills with gas → Simple gastric dilation (bloat)
- Progression of the bloat → Volvulus (twisting)
- Blockage of the stomach’s entrance & exit
- Stomach may press on the diaphragm → Dyspnoea
- Blood vessel compression → Systemic shock → Tissue
death
- Animal collapses
- Ø Digestion; Accumulation of toxins in the blood; Shock
worsens
- Possible rupture
Predisposing factors
§ Rapid drinking/eating → Vigorous exercise; Feeding SID
§ Family history of bloat; Underweight condition
§ Stressed/anxious temperament; Aggression
Treatment
§ Reduce the pressure immediately → Stomach tube; If
twisting is severe → Large bore needle inserted per
cutan into the stomach
§ Shock tx: IVFT; Emergency medications
§ Surgical correction: Gastropexy; Pyloroplasty