Diseases of the Canine and Feline Stomach

Question 1

What is the diagnostic approach to gastric disease?

Answer 1

Acute gastritis

• either self-resolving or life-threatening
  
  • symptomatic tx
• chronic gastric disease
  
  • CBC, chem, UA
  • Imaging (Rads, US)
  • Therapeutic trials (e.g. diet)
  • Biopsy (sx, endoscopy)
  • Specific therapy

Question 2

What are the causes of acute gastritis?

Answer 2

• mucosal damage results in incr permeability
• acid diffuses back into mucosa to cause gastritis
• epithelial cells may necrose and cause erosions (hematemesis)

Question 3

What is the clinical presentation of acute gastritis?

Answer 3

• vomiting
• lethargy
• depression
• polydipsia
• hematemesis
• cranial abdominal pain

Question 4

How do you diagnose and treat acute gastritis?

Answer 4

Ddx: gastrix FB (obstruction), acute pancreatitis, infx dz, systemic dz

• Dx: Hx and PE, abd rads and biochem tests, response to therapy
• Tx: rest the GI tract, supportive care, feed a “bland” diet
  
  • FBs = often endoscopically removed
  • GDV = sx correction

Question 5

What are the causes of chronic gastritis?

Answer 5

• Inflammatory (idiopathic)
  
  • lymphoplasmacytic (maybe assoc. w/ FRD)
  • eosinophilic
• Food Responsive Disease
• Reflux (Bilious Vomiting Syndrome)
• Helicobacter?

Question 6

How do you medically manage lymphoplasmacytic chronic gastritis?

Answer 6

• Mild dz:
  
  • diet trials –> hypoallergenic
  • acid reducers - omeprazole
  • Cisapride/metoclopramide
• Moderate to severe dz:
  
  • pred, azathioprine, chlorambucil

Question 7

What are the causes of gastric ulcers?

Answer 7

• ulcerogenic drugs
• liver dz
• tumors (mast cell, gastrinoma)
• protein-calorie malnutrition
• uremia?
• stress?

Question 8

How do you diagnose and treat gastric ulcers?

Answer 8

Dx: contrast rads or endoscopy and biopsy

Tx:

• eliminate underlying cause
• PPIs
• Sucralfate
• blood transfusion
• endoscopy
• sx

Question 9

What is the clinical presentation of a gastric outflow disorder?

Answer 9

• Congenital stenosis (pyloric mm hypertrophy)
  
  • Boxers, bulldogs, Bostons; cats
  • signs often start at weaning
• Acquired stenosis (antral pyloric mucosal hypertophy)
  
  • older, mostly male smaller breeds
  • Lhaso apso, pekingese, shih tzu
• Intermittent vomiting (maybe projectile)
  
  • months to years
  • incr freq
  • often contains food hours after eating
• HypoCL, hypoK, metabolic alkalosis

Question 10

How do you diagnose and treat gastric outflow disorders?

Answer 10

Dx: Rads (contrast), US, endoscopy, sx

Tx: surgery

• Y-U pyloroplasty
• Pyloromyotomy

Question 11

What are the clinical signs of chronic lymphoplasmacytic gastritis?

Answer 11

• vomiting = most consistent
• hematemesis
• appetite changes
• weight loss

Question 12

What are the clinical signs of helicobater gastritis and how is it diagnosed? How is it treated?

Answer 12

• lymphoid hyperplasia (some cats/dogs)
  
  • NOT assoc. w/ ulceration
• may be assoc. w/ chronic vomiting
• Dx w/ Warthin-Starry stain on biopsy
• Tx: amoxicillin, clarithromycin, metronidazole

*dx of exclusion

Question 13

Describe reflux gastritis

Answer 13

• defect in pyloric function or gastric motility defect that allows prolonged contact of bile w/ the mucosa
  
  • bile is a detergent –> damages cells
• C/S: chronic vomiting of bile-stained material after a prolonged fast, most often in early morning
• Tx: incr feeding frequency, cisapride or metoclopramide, H2 receptor antagonists (ranitidine), PPIs