USE OF A GASTROSTOMY AND JEJUNOSTOMY TUBE FOR MANAGEMENT OF GASTRIC DISTENTION FOLLOWING PYLORIC OUTFLOW OBSTRUCTION IN A FERRET (MUSTELA PUTORIUS FURO)

An 8-month-old spayed female ferret (Mustela putorius furo) was presented for evaluation of persistent, severe gastric distention following gastrotomy to retrieve several foreign bodies. A structural cause of gastric outflow obstruction was not identified ultrasonographically or surgically. A 14 Fr gastrostomy and an 8 Fr jejunostomy tube were used to facilitate medical management of severe gastric stasis and to allow enteral nutrition. The ferret tolerated the feeding tubes well and recovered completely following intensive medical therapy. This report describes successful management of idiopathic gastric distention using gastric and jejunal feeding tubes in a ferret. Feeding tubes and supplemental nutrition plans should be considered for management of ferrets with compatible disease processes.     

Hypertrophic gastropathy associated with gastric sarcoma in a dog

A 14-y-old spayed female Labrador Retriever was presented with an 8-mo history of chronic vomiting. Abdominal ultrasound and gastrointestinal endoscopy revealed a mass protruding into the gastric lumen, with cytologic features suggestive of sarcoma. A partial gastrectomy was performed; the gastric body and antrum were thickened, with a cerebriform appearance of the mucosal surface. Histologic examination revealed a submucosal neoplastic proliferation of fusiform cells variably arranged in irregular bundles and scattered whorls. Fusiform cells strongly reacted to antibodies against vimentin, S100, and neuron-specific enolase; glial fibrillary acidic protein was moderately and multifocally expressed. Pancytokeratin, KIT, α–smooth muscle actin, and desmin were nonreactive. Histologic and immunohistochemical findings suggested a diagnosis of gastric sarcoma with features referable to a non-GIST (gastrointestinal stromal tumor), non–smooth muscle NIMT (non-angiogenic, non-lymphogenic intestinal mesenchymal tumor). The overlying gastric mucosa was thickened by elongated and dilated gastric glands, predominantly lined by intensely periodic acid-Schiff–stained mucous cells. This altered mucosal architecture was suggestive of Ménétrier-like disease. Although this disease has been hypothesized to predispose to gastric adenocarcinoma in dogs, an association with gastric sarcoma has not been documented previously in the veterinary literature, to our knowledge.     

Botulinum toxin A as a treatment for delayed gastric emptying in a dog

A toy Australian shepherd dog was referred for bile peritonitis following excision of a biliary mucocele. Subsequent delayed gastric emptying was refractory to prokinetic therapy but responded to injection of botulinum toxin A into the muscularis layer of the pylorus; a novel therapy for delayed gastric emptying in dogs.     

Partial Invagination of the Canine Stomach for Treatment of Infarction of the Gastric Wall

A technique was evaluated for the management of infarction of a portion of the canine gastric fundus and body by invagination of the compromised gastric wall with a double layer of inverting sutures. Two methods of potentially producing vascular compromise of the gastic wall were developed and studied. In the first method (ten dogs plus three control dogs), the first three short gastric arteries and veins were ligated and divided; vascular compromise was not produced. In the second method (eight dogs), an area of the gastric fundus was isolated by a strangulating suture in addition to the division of the short gastric vessels; this method did produce vascular compromise. The invagination procedure caused melena for several days in four dogs. Complete healing of the gastric wall had not occurred at 2 weeks.     

Gastric emptying of liquids in the dog: serial test meal and modified emptying-time techniques

A serial test meal technique was used in the dog to evaluate the gastric emptying of a liquid test meal. On separate days, a phenol red test meal was placed in the stomach and completely aspirated at different times. A composite representation of the gastric emptying pattern was obtained for each dog, and a set of normative data was generated. Three emptying determinants (emptying time, half-life, and starting index) were calculated. The basic pattern of canine gastric emptying was linear and declined exponentially or as a function of the square root of the gastric volume. A modified emptying-time technique (METT) correlated well with the serial test meal and a set of normative values was determined. The METT was performed by aspirating test meal from the stomach 30 minutes after instillation. The METT was a simple and inexpensive technique that could be performed in 1 short testing period. With the METT, the half-life of gastric emptying was calculated, using the log of the percentage of retention of test meal; gastric emptying time was calculated, using the square root of the percentage of retention of test meal. Acetylpromazine was shown not to alter gastric emptying of a liquid test meal.     

Blue-green endoscopy in a dog presenting chronic vomiting-regurgitation

A 2-year-old male Maremma sheepdog presenting with chronic vomiting-regurgitation was examined at the University Veterinary Teaching Hospital, Camerino University. An oesophagogastroscopy with a single blue + green (BG) filter restricting wavelengths from 400 to 550 nm was carried out. A conventional white light endoscopy showed a dilated oesophagus with mildly diffuse erythematous mucosa (more accentuated proximal to the cardia); some portions of the gastric mucosa were covered with fluids and appeared only slightly erythematous. A blue green endoscopy highlighted the oesophageal lesions in dark blue, which made them appear more clearly defined from the remaining mucosa. In the gastric antrum, a small, slightly darker blue roundish area was visible. This area did not show up under the white light endoscopy. A histopathological assessment of biopsy specimens from the distal oesophagus, antrum (including the area highlighted only by BG endoscopy) and gastric body showed chronic-active hyperplastic esophagitis and superficial squamous epithelial dysplasia, while gastric samples showed severe diffuse hyperaemic gastritis of the antrum and superficial diffuse atrophy of the gastric body. The authors believe that the use of a BG endoscopy could be useful in veterinary medicine to increase the diagnostic potential of endoscopic assessment in animals.     

Gastric ulcers in standardbred racehorses: prevalence,lesion description,and risk factors

This study was performed to estimate the prevalence of gastric ulcers in Standardbred racehorses, to describe the lesion score and location, and to identify potential risk factors. Two hundred seventy-five (275) Standardbred horses from 5 training centers and 2 racetracks in Quebec, Canada, were studied. Historical data for the 2 months before examination were recorded for each horse, and the presence of gastric ulcers was determined by gastroscopy. A previously reported scoring system that used grades 0-3 for gastric lesions was used. Overall, 121 horses (44.0%; 95% CI, 38.1-50.1%) had gastric ulcers. The prevalence of gastric ulcers was significantly higher (P < .0001) in actively racing horses (63.3%; 95% CI, 54.7-71.2%) than in horses at rest. Multivariate analysis defined that horses in racing (OR = 9.29; 95% CI, 3.55-24.3) were significantly more likely to have gastric ulcers than horses at rest and that trotters (OR = 2.23; 95% CI, 1.28-3.86) were more likely to have gastric ulcers than pacers. The number of lesion sites (P < .0001) and poor body condition (P < .0001) were significantly associated with lesion scores. Gastric ulcers are highly prevalent in Standardbred racehorses. Furthermore, actively racing horses and trotters are more likely to have gastric ulcers. Also, poor body condition in Standardbred racehorses may be an indication that gastric ulcers are present and that lesion scores are high. The cause-and-effect relationship between poor body condition and the presence of gastric ulcers is unclear.     

Influence of dietary composition on gastric emptying and motility in dogs: potential involvement in acute gastric dilatation

Gastric dilatation-volvulus is a dramatic and life-threatening disease of large-breed dogs. The cause is unknown, but ingestion of dry cereal-based food is frequently incriminated as a predisposing factor. The purpose of this study was to examine the effect of commercial diets on gastric motility and emptying in the dog. Four large-breed dogs were fed 3 different diets (diet A = canned meat-based; B = cereal-based with 77% added water; and C = dry cereal-based) in a randomized block design. Each experiment was done in triplicate. Motility was assessed, using 5 AgAgCl electrodes and 2 strain gauges sutured along the serosa of the stomach and proximal duodenum. Dogs were fed at the same time each day and the time to change from the fed to the fasted pattern of gastrointestinal motility (changeover) was measured. Gastric emptying was assessed by recording gastric radioactivity. After feeding a meal mixed with 99mTc-labeled resin, the log of activity was plotted against time, and the half-time of gastric emptying (t1/2 GE) was calculated. Mean (+/- SEM) times from feeding to changeover for the 3 diets were: diet A, 9.7 +/- 0.9; B, 10.5 +/- 0.4; and C, 11.0 +/- 0.8 hours. Diet had minimal influence on the half time of gastric emptying (diet A, 2.2 +/- 0.3; B, 2.6 +/- 0.4; and C, 2.9 +/- 0.3 hours; P greater than 0.05). The data indicate that gastric motility and emptying in healthy large-breed dogs were not affected by dietary composition. Because most large dogs are fed cereal-based food for reasons of cost and ease of use, these diets may have been wrongly incriminated as a predisposing factor in gastric dilatation-volvulus.     

Severe gastric impaction secondary to a gastric polyp in a horse

A 13-year-old Percheron gelding was presented for refractory gastric impaction. At necropsy a pedunculated 10 cm × 11 cm × 14 cm mass, histologically identified as an inflammatory polyp, was suspected to have been partly obstructing the pylorus. This is the first report of a polyp resulting in gastric outflow obstruction in a horse.     

Gastric inflammatory pseudotumour secondary to <Emphasis Type="Italic">Actinomyces hordeovulneris</Emphasis> infection in a cat

Background

The authors report the first case of feline gastric actinomycosis associated with infection by Actinomyces hordeovulneris.

Case presentation

A 4-year-old, neutered male, semi-feral European cat, with a 1 year history of chronic vomiting, was referred to the clinic. Abdominal ultrasound examination identified a hypoechoic focal transmural thickening with loss of normal wall layering and hyperechoic speckles at the gastric body. Initial gastroscopic examination showed a tumour-like gastric mass with an ulcerated depression at the level of the greater curvature. Histologic examination of endoscopic biopsy specimens was consistent with a severe lymphoplasmacytic gastritis. After 2 months, due to persistence of abdominal discomfort, surgical exploration and intraoperative sampling of gross abnormalities was recommended. Full thickness gastric wall biopsies, and fine needle aspiration of the gastric thickening and gastric lymph node, were performed. Histopathological examination identified a transmural pyogranulomatous gastritis. Aspirate samples of the gastric wall cultured positive, with colony morphology, biochemical testing and PCR of the 16 s rRNA gene compatible with Actinomyces hordeovulneris. After 4 months of treatment with cefovecin (8 mg/kg subcutaneously every 14 days), the vomiting completely resolved, as well as the ultrasonographic gastric alteration.

Conclusion

This case report of feline gastric actinomycosis, caused by Actinomyces hordeovulneris, suggests that gastric bacterial infection should be considered in cases of focal gastric wall thickening associated with chronic vomiting in the cat, which may otherwise closely resemble neoplastic disease. Once a diagnosis of actinomycosis was obtained, a correct treatment with antibiotic therapy can resolve it.

     

GASTRIC LYMPHOSARCOMA IN A DOG: A CASE REPORT

A 9-year-old female spayed mixed-breed dog was presented with a ten-week history of vomiting. A survey abdominal radiograph showed a soft tissue mass on the lesser curvature of the stomach and an adjacent thickened greater curvature. A barium contrast study confirmed the presence of this mass. The radiographic diagnosis was gastric tumor. Radiographic signs of gastric neoplasia include soft tissue masses or thickening of the stomach wall, delayed gastric emptying, immobility of portions of the stomach wall, and residual stomach-wall staining by barium. Necropsy revealed a gastric lymphosarcoma that had infiltrated the entire circumference of the pyloric antrum. The most common gastric malignancy in the dog is adenocarcinoma. Gastric lymphosarcoma is considered rare.     

Breed predisposition to canine gastric carcinoma - a study based on the Norwegian canine cancer register

Background

Previous research has indicated a breed predisposition to gastric carcinoma in dogs. However, results to date are inconsistent since several studies have failed to prove such a predisposition. Better knowledge of breeds at risk could facilitate early detection of gastric carcinoma in dogs. The aim of the study was to retrospectively investigate the proportion and possible breed predisposition to canine gastric carcinoma using the Norwegian Canine Cancer Register for calculations of proportional morbidity ratios (PMRs) for the period 1998–2009.

Results

Histologically verified tumours recorded in the Norwegian Canine Cancer Register were studied (n = 19,715). A total of 31 (0.16%) cases of canine gastric carcinomas were identified. The median age of affected dogs was 10 years. The most commonly reported clinical signs were vomiting, anorexia, and weight loss. Males had significantly higher odds of gastric carcinoma than females (P = 0.02). The PMR with 95% confidence interval (CI) was calculated for each breed, and a breed predisposition was identified. Individuals of the breeds Tervuren (PMR 56.1), Bouvier des Flandres (PMR 36.5), Groenendael (PMR 34.5), Collie (PMR 26.1), Standard poodle (PMR 7.6), and Norwegian elkhound (PMR 6.1) had a significantly increased risk of developing gastric carcinoma.

Discussion and conclusion

The proportion of cases of gastric carcinoma recorded in the Norwegian Canine Cancer Register was found to be 0.16%, and a breed predisposition was identified. The breed predisposition observed in the current study indicates a genetic susceptibility to gastric carcinoma.     

Squamous gastric ulceration complicated by gastric stenosis in a foal

A 2-month-old Warmblood colt presented with recurrent colic and regurgitation. Gastroscopy, performed on several occasions, and barium-contrast radiography revealed severe squamous gastric ulceration and stenosis at the level of the margo plicatus. Treatment with omeprazole reduced the extent and severity of the gastric ulcers but did not affect the stenosis. The foal was euthanised because of a poor prognosis, and post-mortem examination confirmed the clinical diagnosis. Severe squamous gastric ulceration, granulation tissue formation and cicatrisation of deep gastric lesions were considered to have caused the stenosis. Gastroduodenal outflow obstruction is a recognised disorder in foals, but stenosis at the level of the margo plicatus has not been reported in foals or adult horses. To the authors' knowledge, this is the first case of severe squamous gastric ulceration, complicated by stenosis at the level of the margo plicatus, in a foal. Although rare, gastric stenosis should be considered in foals suffering recurrent colic and regurgitation.     

Angiostrongylus vasorum infection in a Scottish terrier associated with gastric dilation

A case of Angiostrongylus vasorum infection in an eight-month-old Scottish terrier associated with gastric dilation is reported,     

Validation of a transendoscopic glandular and nonglandular gastric biopsy technique in horses

Reasons for performing study: In order to study the evolution of histopathological and immunohistochemical changes in the gastric mucosa of horses with EGUS (equine gastric ulcer syndrome), a feasible, useful, valid and safe in vivo gastric biopsy technique is required. Objectives: To determine the average gastric mucosal healing time following endoscopic gastric biopsy sampling, and evaluate the feasibility, safety and usefulness of samples obtained by this method for histopathological analysis. Methods: Six mature mares from the Faculté de Médecine Vétérinaire research herd were used. Transendoscopic gastric biopsy was performed on Days 0 and 9 using a flexible forceps with oval and fenestrated jaws to obtain gastric mucosal samples from 4 different sites: cardia (C), fundus (F), margo plicatus (MP) and glandular mucosa (GL). A maximum of 4 samples per site was taken and processed routinely for histopathology, evaluated by a pathologist. On Days 1–4 and 9–11 the lesions created by the biopsies were evaluated by gastroscopy. Lesions were evaluated over time based on a score from 0–4, where 4 was the most severe. Results: Biopsy samples could be obtained from all targeted sites except C. No abnormal clinical signs were observed up to 7 days post biopsy. The average biopsy lesion scores decreased significantly with time for all sites. The average lesion score was significantly higher for the MP compared to the other sites at Days 1 and 2. Samples taken from the nonglandular portion of the stomach were considered inadequate for histopathology, while those taken from the glandular mucosa were adequate. Conclusion: The transendoscopic gastric biopsy technique described here is a feasible, safe and useful technique for obtaining samples from the equine gastric glandular mucosa. Although biopsy samples could be obtained from several areas in the nonglandular mucosa, these were very small, took longer to heal and were not considered adequate for histopathological evaluation, and another technique should therefore be validated.     

GASTRIC EMPTYING IN THE NORMAL DOG A Contrast Radiographic Technique

A total of 22 radiographic studies was made to determine comparative gastric emptying times of two different solid test meals (intact kibble food and ground kibble food mixed with barium sulfate suspension) in four mature (15-26 months) normal Beagle dogs under controlled conditions. Complete gastric emptying times of the intact kibble and ground kibble meals of a given dose (8 g/kg of dog food plus 5-7 ml/kg of the contrast agent) ranged from five to ten hours (7.6 ± 1.98 hours with intact kibble meal and 7.0 ± 1.86 hours with ground kibble meal). Feeding a halfdose of ground kibble meal (4 g/kg of dog food plus 3.5 ml/kg of the contrast agent) resulted in complete gastric emptying times of four to six hours (4.7 ± 0.67 hours). Individual dogs had repeatable gastric emptying times although the times varied among different dogs.     

EVALUATION OF SOLID PHASE RADIOLABELS OF DOG FOOD FOR GASTRIC EMPTYING

99mTc-Pertechnetate, 99mTc-mebrofenin, 99mTc-disofenin, 99mTc-sulfur colloid, and 99mTc-Dowex resin beads were evaluated for in vitro stability as a label for both dry extruded, and canned dog food for gastric emptying scintigraphy. A sample of each radiolabeled diet was added to water, gastric juice, intestinal juice, or gastric juice followed by intestinal juice for in vitro digestion. After a 3-hour digestion period, tubes were centrifuged and percentage solid phase retention (%SPR) was calculated. The experiment was repeated three times over a 14-day period to minimize day-to-day variation. For dry dog food, 99mTc-mebrofenin and 99mTc-disofenin had similar %SPR in water (96 and 93%, respectively) and gastric juice (>95% each) and were significantly higher than other labels. For canned dog food, mebrofenin had a 91% SPR for the water or gastric juice digestions, and 99mTc-Dowex had a %SPR of >99%. 99mTc-mebrofenin and 99mTc-Dowex were also tested in vivo, where 99mTc-Dowex had poor stability, and 99mTc-Mebrofenin had excellent stability. 99mTc-Mebrofenin is a suitable label for dog food for gastric emptying scintigraphy.     

Effect of the somatostatin analogue octreotide on gastric fluid pH in ponies.

The effect of the somatostatin analogue, octreotide, on gastric fluid pH was investigated in 4 ponies. Gastric fluid pH was determined after SC administration of octreotide or physiologic saline solution (control). A baseline sample of fluid was obtained, the agent was given, and 8 additional samples were collected hourly. Administration of octreotide at all dosages tested (0.1, 0.5, 1.0, and 5.0 micrograms/kg of body weight) increased gastric pH to > 5.0. Baseline values were consistently < 2.7. Administration of octreotide at these same dosages induced gastric pH values > 4.0 for 2.4 +/- 1.2, 4.8 +/- 0.8, 5.7 +/- 1.3, and 5.4 +/- 2.6 (mean +/- SD) continuous hours, respectively. Treatment at all dosages increased the pH of gastric fluid, compared with control values. The duration of the increase in pH was significantly (P < 0.05) different than that of the control treatment, even for the lowest dosage, 0.1 microgram/kg.     

Diagnosis and treatment of gastric motility disorders.

A disorder of gastric motility should be suspected in patients with chronic vomiting. Imaging studies are used to confirm delayed gastric emptying, the most common form of a gastric motility disorder. Other causes of chronic vomiting, for example, metabolic or endocrine disorders, other abdominal disorders, mechanical causes of gastric obstruction, and lower gastrointestinal tract disease, are then ruled out. If no underlying cause is determined, a functional disorder of gastric emptying is presumptively diagnosed. Treatment consists of dietary management and gastric prokinetic agents. Cisapride is the drug of choice for treating delayed gastric emptying followed by erythromycin and ranitidine or nizatidine.     

Gastrointestinal transit of solid radiopaque markers in large and giant breed growing dogs

Observations on food tolerance in dogs have shown that some breeds, especially the giant breeds, have a greater digestive sensitivity. One of the consequences common in these breeds is a higher faecal water content and a poor faecal quality. This could be explained, at least in part, by limited digestive capacity and function in giant breed dogs. In this report, the gastric emptying that represents one parameter of the digestive function was studied in large and giant breed dogs during their growth. Six Great Danes (GD) and six Giant Schnauzers (GS) were fed small radiopaque markers mixed with a test diet at 12, 22 and 36 weeks of age. Abdominal radiographs were made every 30 min for a period of 4 h and then hourly until 12 h. At 12 weeks of age, the gastric emptying pattern was similar in both breeds. However, from 22 weeks of age, the gastric emptying of the GD was significantly more rapid than that of GS. The gastric emptying of small markers tended to slow down in growing dogs, especially in GS. A significant positive correlation between the gastric emptying time of 50% of markers and the body weight was found. These results show that GD have a lower gastric retention time of foods, which could lead to a poor digestion and an altered absorption of nutrients. These could explained why digestive function and sensitivity could be different in dogs from different sizes and breeds.