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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 GastritisAcute 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 dietGradually 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
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
Immune-Mediated Inflammatory Bowel Disease (Chronic Gastritis, Enteritis, Colitis)
Inflammatory Bowel Disease
Client infoDefinitive diagnosis is through biopsyLife-long conditionImmunosuppressive drugs have side-
effects (PU/PD/PP, wt gain, skin/urinary infections)
Use lowest dose that provides effect
Stomach Diseases:Gastric UlcerationUsually 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-OpECGBlood pressurePain managementMonitor urine outputAntibioticsMaintain fluids (oral, IV)
Client info
Avoid large mealsLimit exercise after mealsFeed high-quality protein dietTack-down procedure not 100%
preventative
Gastric Dilatation/Volvulus
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
Treatment
Surgery is treatment of choiceMany 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
Gastric Neoplasia