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Download DISEASES OF THE STOMACH
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Don’t be your own enemy “If there is no enemy within, the enemy outside can do us no harm.” -Les Brown DISEASES OF THE STOMACH Stomach Diseases: Acute Gastritis Acute Gastritis ◦ ◦ Commonly seen in dogs Spoiled food Change in diet Food allergy Infections (bacterial, viral, parasitic) Toxins (chemicals, plants, drugs, organ failure) Foreign objects Signs Anorexia Vomiting (maybe dehydration) Painful abdomen Hx of diet change, toxin ingestion, infection, parasites Acute Gastritis Dx ◦ Hx and PE ◦ CBC, Chem Panel to assess dehydration, metabolic imbalance, organ failure Rx ◦ ◦ NPO until vomiting stops 4-6 sips of water q1h Fluid therapy (SQ or IV) Gradually start feeding ◦ ◦ Bland food (Hill’s I/D, boiled chicken/rice) Antiemetics Maropitant (Cerenia) Metoclopramide (Reglan) Coating agents Sucralfate ◦ H2-blockers (famotidine, ranitidine, cimetidine) ◦ Antibiotics—often prescribed, rarely needed Acute Gastritis Client info Avoid abrupt changes in diet Gradually mix new food in with old (1 wk) If pet vomit 2-3 times, NPO x 24 h; if it continues see vet Dogs and cats do not need variety Immune-Mediated Inflammatory Bowel Disease (Chronic gastritis, Enteritis, Colitis) A decreased tolerance to the diet or to the normal flora results in accumulation of inflammatory cells in lining of stomach, Small Intestine, or Large Intestine Clinical Signs Chronic vomiting, wt loss Diarrhea, straining to defecate, mucus in stool Immune-Mediated Inflammatory Bowel Disease (Chronic gastritis, Enteritis, Colitis) Diagnosis Fecal to r/o parasites CBC, Chemistry panel, urinalysis to r/o metabolic disorder FeLV, FIV to r/o those diseases Endoscopy of stomach, SI, and colon, and biopsy for definitive diagnosis Immune-Mediated Inflammatory Bowel Disease (Chronic Gastritis, Enteritis, Colitis) Treatment Azathioprine—immunosupressant Cyclophosphamide—inhibits immune system response Sulfasalazine—a sulfa drug with anti-inflammatory/antibacterial effects Most effective against colitis Metronidazole Prednisone Hypoallergenic diet Free from preservative, additives Highly digestible protein (rabbit, lamb, duck, chicken) Homemade diets with rice base Some commercial diets are available Inflammatory Bowel Disease Client info Definitive Life-long diagnosis is through biopsy condition Immunosuppressive drugs have side-effects (PU/PD/PP, wt gain, skin/urinary infections) Use lowest dose that provides effect Stomach Diseases:Gastric Ulceration Usually a result of long-term NSAIDs (aspirin, ibuprofen, phenylbutazone) Signs Vary from asymptomatic to vomiting blood Anemia, edema Melena Anorexia Abdominal pain Septicemia if perforation occurs Gastric Ulceration Dx X-ray using contrast medium (Barium) to show ulceration in stomach lining (caution if perforation is suspected) Endoscopy Gastric Ulceration Rx ◦ Fluid therapy for dehydration ◦ NPO (as before) ◦ Coating agents/antacids ◦ Cimetidine—H2 antagonist (↓ HCl production) ◦ Omeprazole—↓ HCl production (proton-pump inhibitor) Client info ◦ Do not use NSAIDs without veterinary supervision ◦ Give NSAIDs with meal/antacids Stomach Diseases: Gastric Dilatation/Volvulus Primarily a disease of large, deep-chested dogs (2-10 yrs) Dilation—gas filled; Volvulus—twisted along longitudinal axis Cause: Food/exercise? Etiology unclear Signs ◦ Abdominal pain/distension ◦ Weakness, collapse, depression, nausea, salivation ◦ Increased HR, RR – may lead to arrhythmias Gastric Dilatation/Volvulus Gastric Dilatation/Volvulus Stomach Diseases: GDV Diagnosis ◦ PE shows depressed, weak animal with dpoor perfusion (↑CRT) ◦ X-rays show air filled stomach- “double-bubble” ◦ ECG may show vent arrhythmia or sinus tachycardia ◦ CBC and Chem panel necessary to assess electrolyte levels and pH imbalances Gastric Dilatation/Volvulus Treatment ◦ Goals Decompress stomach ◦ ◦ ◦ ◦ Pass stomach tube 18 gauge needle Stabilize patient (fluids, electrolytes, ECG) Rx for shock IV fluids Corticosteroids ◦ Antibiotics Prepare for Sx Surgery ASAP Gastric Dilatation/Volvulus Gastric Dilatation/Volvulus Post-Op ECG Blood Pain pressure management Monitor urine output Antibiotics Maintain fluids (oral, IV) Gastric Dilatation/Volvulus Client info Avoid large meals Limit exercise after meals Feed high-quality protein diet Tack-down procedure not 100% preventative Gastric Neoplasia Most common malignant neoplasia in dogs is adenocarcinoma; in cats lymphoma Signs Wt loss Vomiting w/ or w/o blood Obstruction Usually seen in older animals Dx Endoscopy and biopsy for diagnosis X-ray with Barium contrast Gastric Neoplasia Treatment Surgery is treatment of choice Many tumors are too far advanced (inoperable) Chemotherapy Radiation less successful for gastric tumors Client info Prognosis is poor; gastric neoplasia is a fatal disease Supportive care, control of vomiting, good nutrition are needed for these animals
