13. Diseases of the stomach in dogs and cats

Question 1

Acute gastritis?

Answer 1

Acute Gastritis

Inflammation of the stomach

The most common cause for vomiting

Dogs > Cats

Question 2

Causes of acute gastritis?

Answer 2

CAUSES

§ Spoiled food § Contaminated food

§ High-fat food § Foreign bodies

§ Toxic plants § Chemicals

§ Irritating drugs § Allergy

§ Protein intolerance § Virus

§ Bacteria

Question 3

Clinical signs of acute gastritis?

Answer 3

CLINICAL SIGNS

§ Acute onset of vomiting

§ Loss of appetite

§ Fever

§ Abdominal pain

Question 4

Diagnosis of acute gastritis?

Answer 4

DIAGNOSIS

§ History; Physical exam

§ If condition worsens withing 1-3 days →

US

CBC

Serum biochemistry

Question 5

Treatment of acute gastritis?

Answer 5

TREATMENT

§ NPO for 24 hrs

§ Antiemetics: Maropitant if persistent/excessive vomiting

§ IVFT; Small amounts of cool water

§ GI prescription diet

Question 6

Haemorrhagic Gastroenteritis (HE)?

Answer 6

Haemorrhagic Gastroenteritis (HE)

C. perfringens hypersensitivity; Parvovirus; Parasites

Question 7

Gastric Erosive Ulcerative Disease(GEU) Predisposing factors?

Answer 7

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

Question 8

Diagnosis and treatment of Gastric erosive ulcerative disease?

Answer 8

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

Question 9

Chronic gastritis?

Answer 9

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

Question 10

Helicobacter associated Gastritis?

Answer 10

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

Question 11

Parasitic Gastritis?

Answer 11

PARASITIC GASTRITIS

Dog: Physaloptera rara

Cat: Ollulanus tricuspis

Diagnosis: Floatation (difficult); Endoscopy; History of chronic

vomiting

Treatment

§ Dog: Pyrantel

§ Cat: Fenbendazole

§ Endoscopic removal

Question 12

Delayed Gastric Emptying and Gastric outlet obstruction?

Answer 12

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

Question 13

Gastric Motility disorders?

Answer 13

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

Question 14

Gastric Neoplasia?

Answer 14

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

Question 15

Gastric Dilation Volvulus?

Answer 15

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)

1. Stomach fills with gas → Simple gastric dilation (bloat)
2. Progression of the bloat → Volvulus (twisting)
3. Blockage of the stomach’s entrance & exit
4. Stomach may press on the diaphragm → Dyspnoea
5. Blood vessel compression → Systemic shock → Tissue

death

6. Animal collapses
7. Ø Digestion; Accumulation of toxins in the blood; Shock

worsens

8. 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