Gastric Drainage Procedures: Effects in Normal Dogs III. Postmortem Evaluation

Postmortem macroscopic examination of the gastrointestinal tract and plastic moldings of the gastrointestinal communication were done in 29 dogs which had been subjected 3 to 4 weeks previously to one of the following gastric drainage procedure: (1) Fredet-Ramstedt pyloromyotomy (FRP) (6 dogs); (2) Heineke-Mikulicz pyloroplasty (HMP) (6 dogs); (3) Finney pyloroplasty (FP) (6 dogs); (4) Jaboulay's gastroduodenostomy (JG) (6 dogs); and (5) antral gastrojejunostomy (AG) (5 dogs). Plastic moldings were also done in nine normal dogs of similar size for comparative measurements. Postmortem examinations and plastic casts of the antropyloroduodenal segment and antrojejunal communication showed significantly widened pyloric canal or large gastrointestinal communication compared to control dogs in all groups except for the FRP group. Almost complete healing had occurred at the myotomy site in FRP dogs, and the pyloric lumen was not significantly larger (less than 0.05) than the pyloric lumen of the control dogs. The lumen of the gastrointestinal junction was increased approximately 4.5 times in the HMP group, 12.0 times in the FP group, 7.2 times in the JG group, and 10.0 times in the AG group.     

Gastric Drainage Procedures: Effects in Normal Dogs II. Clinical Observations and Gastric Emptying

Complete gastric emptying time using barium sulfate mixed with commercial canned dog food was measured radiographically in 29 mature mixed breed dogs before and 3 to 4 weeks after Fredet-Ramstedt pyloromyotomy (FRP) (6 dogs), Heineke-Mikulicz pyloroplasty (HMP) (6 dogs), Finney pyloroplasty (FP) (6 dogs), Jaboulay's gastroduodenostomy (JG) (6 dogs), and antral gastrojejunostomy (AG) (5 dogs). The dogs were observed for clinical evidence of side effects. Postoperative endoscopic examination and double contrast gastrography were performed to subjectively evaluate the diameter of the gastrointestinal communication and the amount of enterogastric reflux. Although none of the procedures significantly (p < 0.05) altered gastric emptying time, the overall tendency was toward slowing down gastric emptying time. The severity of gastrointestinal side effects and enterogastric reflux appeared to be related to the size and/or location of the gastrointestinal opening.     

COMPARISON OF THE EFFECT OF LAPAROSCOPIC AND CONVENTIONAL PYLORIC SURGERY ON GASTRIC EMPTYING IN DOGS

The effect of a laparoscopic approach and pyloric surgery on canine gastrointestinal activity, particularly gastric emptying time, is not well understood. The purpose of this study was to compare the effect of laparoscopic and conventional pyloric surgery, in Ramstedt pyloromyotomy and Heineke-Mikulicz pyloroplasty, on complete gastric emptying time in 20 clinically normal dogs. Dogs were divided into four groups of five animals: dogs with laparoscopic Ramstedt pyloromyotomy, conventional Ramstedt pyloromyotomy, or laparoscopic Heineke-Mikulicz pyloroplasty, and the conventional Heineke-Mikulicz pyloroplasty group. Gastric emptying time using barium sulfate mixed with dry kibble dog food was measured fluoroscopically before and 1 month after surgery. Gastric emptying of solids was significantly enhanced in the pyloroplasty groups in the postoperative period compared with preoperative emptying. Just as after conventional pyloromyotomy, gastric emptying time after laparoscopic pyloromyotomy was not statistically different as compared with preoperative values. This study indicates that the fluoroscopic test meal is a valuable tool for defining complete gastric emptying time in normal dogs. We conclude that pyloromyotomy was less effective in decreasing complete gastric emptying time than Heineke-Mikulicz pyloroplasty in normal dogs. The possibility of decreasing complete gastric emptying time by laparoscopic surgery suggests a potential clinical application for this technique in small animals.     

Significance of the Heineke-Mikulicz Pyloroplasty in the Treatment of Gastric Dilatation-Volvulus A Prospective Clinical Study

Twenty-six dogs with gastric dilatation-volvulus (GDV) were stabilized medically, followed by tube gastrostomy and gastropexy. In 13 dogs, a Heineke-Mikulicz pyloroplasty was also performed. Complications and recurrences were monitored during the immediate postoperative period and for 5 to 31 months thereafter. Barium gastrograms and contrast radiographs of the stomach were evaluated at week 1 and months 5 to 31. Significantly fewer dogs without pyloroplasty had complications during the immediate postoperative period. There were no differences in the long-term complication rates. Radiographic evaluations of the width of the pylorus, the size of the stomach, and the rate of gastric emptying showed no differences between dogs with and without pyloroplasty at any evaluation period. The Heineke-Mikulicz pyloroplasty increased the immediate postoperative complication rate after surgical fixation of the stomach for the treatment of GDV. It did not appear to influence the long-term outcome of the surgical treatment of this disease. The Heineke-Mikulicz pyloroplasty is not recommended in the treatment of GDV unless pyloric outflow obstruction can be demonstrated.     

Chronic hypertrophic pyloric gastropathy in 14 dogs

SUMMARY Ten mate and 4 female dogs with chronic hypertrophic pyloric gastropathy were seen at the Sydney University Veterinary Teaching Hospital in the period 1982–88. The most commonly affected breeds were the Shihtzu and Maltese. The mean age was 8.2 yr and the mean body weight 6.5 kg. The most common clinical signs were vomiting, weight loss, polydipsia and depression. Hypokalaemia was present in 11 of 12 dogs examined and hypochloraemia in 10 of 11 dogs examined. Five of the six dogs that had blood gases measured were found to have a metabolic alkalosis. Surgery was performed on 13 dogs; pyloromyotomy 7, pyloroplasty 4, gastroduodenostomy 2. There was a recurrence of symptoms in one pyloromyotomy dog, and fatal ulceration and perforation of the cardia occurred in one pyloroplasty case. The remaining 11 dogs had a mean known symptom-free survival time of 20 mo. This study confirms the preponderance of affected males, identifies electrolyte and blood gas disturbances as significant complications of chronic hypertrophic pyloric gastropathy, and suggests that relatively minor surgery (pyloromyotomy) may have a place in the treatment of a selected subgroup of cases.     

Effects of the Y-U Pyloroplasty on Gastric Emptying and Duodenogastric Reflux in the Dog

A Y-U pyloroplasty was performed on five healthy adult dogs. Gastric emptying half times (t1/2 GE) of a canned food meal were measured by scintigraphy three times before surgery and three times from 6 to 8 weeks after surgery. Fluoroscopic studies of gastric and duodenal motility were made before surgery and 3, 7, and 35 days after surgery. Clinical observations were made daily throughout the study. Gross and histologic evaluations of the gastroesophageal and pyloric regions were performed at the termination of the study. The t1/2 GE was significantly decreased after surgery. By positive contrast fluoroscopy, the vigor of antral contractions was seen to be decreased in three of the five dogs. On days 7 and 35, fluoroscopic findings were comparable to preoperative studies. Duodenogastric reflux was recognized fluoroscopically in three dogs on four different occasions. This may reflect normal reflux patterns in the dog. No gastrointestinal problems were evident after surgery in four dogs. Reflux esophagitis developed in one dog after surgery, which resolved with therapy. Studies of the Y-U pyloroplasty after 2 months indicated that it decreased gastric emptying time of solid food. Results of postmortem examination showed no abnormal gross or histopathologic changes of esophageal, gastric, or proximal duodenal tissues.     

Recurring gastric volvulus in a dog

A successful prophylactic permanent gastropexy was performed on a dog that had previously experienced four gastric volvulus procedures, one prophylactic pyloroplasty, and two subsequent gastric volvulus repairs. Radiographic evaluation of the previous pyloroplasty and the final permanent gastropexy are illustrated.     

Comparison of ultrasonographic characteristics of the gastroduodenal junction during pyloroplasty performed laparoscopically or via conventional abdominal surgery in dogs

OBJECTIVE: To evaluate the use of ultrasonography to detect morphologic changes in the pylorus during pyloroplasty performed laparoscopically or via conventional abdominal surgery in dogs. ANIMALS: 10 healthy mixed-breed dogs. PROCEDURE: Laparoscopic ultrasonography of the pylorus was performed in 5 dogs during laparoscopic pyloroplasty (LP), and ultrasonography of the pylorus was performed in 5 dogs during pyloroplasty via conventional abdominal surgery (CAP group). Appearance and dimensions of the pyloric sphincter were evaluated by use of a 7.5-MHz flexible laparoscopic linear-transducer probe. RESULTS: Mean +/- SD duration of the ultrasonographic procedure was 11 +/- 3.04 minutes (range, 6 to 18 minutes). In the CAP group, cross-sectional views of the pylorus revealed significant differences between the overall transverse external diameter, overall craniocaudal external diameter, and transverse diameter of the pyloric lumen. After surgery, the pyloric area was significantly increased. Longitudinal views of the pylorus revealed that width of the pyloric ring was significantly less after surgery. Transverse views of the pylorus for the LP group revealed a significant increase in the transverse diameter and craniocaudal diameter of the pyloric lumen after LP. The pyloric area was also significantly increased after surgery. Longitudinal views of the pylorus revealed that width of the pyloric ring was significantly less after surgery. Transverse diameter of the pyloric lumen was significantly increased after LP. CONCLUSIONS AND CLINICAL RELEVANCE: Analysis of results of this study suggests that ultrasonography is useful for detecting relevant morphologic changes in the pyloric sphincter after pyloroplasty.     

Gastric and intestinal surgery.

Gastric surgery is commonly performed to remove foreign bodies and correct gastric dilatation-volvulus and is less commonly performed to treat gastric ulceration or erosion, neoplasia, and benign gastric outflow obstruction. Intestinal surgery, although commonly performed by veterinarians, should never be considered routine. The most common procedures of the small intestinal tract performed in dogs and cats include enterotomy and resection/anastomosis. Surgery of the large intestine is indicated for lesions causing obstruction, perforations, colonic inertia, or chronic inflammation.     

Ultrasound-guided percutaneous drainage as the primary treatment for prostatic abscesses and cysts in dogs

Thirteen dogs with prostatic abscesses and cysts were treated using percutaneous ultrasound-guided drainage. Eight dogs were diagnosed with prostatic abscesses and five with cysts on the basis of cytopathological examination and bacterial culture of the prostatic fluid. Antibiotic therapy, based on culture and sensitivity results, was administered for a minimum of 4 weeks. Intact dogs were castrated after initial drainage. Repeat ultrasonography of the prostate was performed every 1 to 6 weeks, and any residual cavitary lesions were drained and fluid analysis repeated. The median number of drainage procedures required to completely resolve the lesions was two (range, one to four). No complications were observed after drainage, and clinical signs resolved in all dogs. None of the dogs developed clinical signs of recurrent abscesses or cysts in the follow-up period (median, 36 months; range, 10 to 50 months). Ultrasound-guided, percutaneous drainage of prostatic abscesses and cysts appears to be a useful alternative to surgical treatment in select dogs.     

Heineke–Mikulicz pyloroplasty for the treatment of pyloric stenosis secondary to gastro-duodenal ulcer disease in three foals

The objective of the study was to describe a modified Heineke–Mikulicz pyloroplasty for the treatment of pyloric stenosis in foals due to gastric ulceration and assess the short- and long-term outcome of foals receiving the pyloroplasty. Medical records of foals undergoing a modified Heineke–Mikulicz pyloroplasty due to gastric outflow obstruction secondary to a pyloric stenosis were included in this retrospective case series. The pyloroplasty consisted of an oral to aboral full thickness longitudinal incision on the ventral aspect of the pylorus and proximal duodenum, which was sutured closed with 0 polydioxanone in a transverse orientation, thereby, enlarging the pyloric lumen diameter. Long-term outcome was obtained from medical and race records. The pyloroplasty was successfully performed in three foals with a surgical time of 95–121 min, with immediate return to nursing and hospital stay of 4–14 days. Complications included a small intestinal volvulus and intra-abdominal adhesions in a foal that did not survive. Another foal had an incisional infection. Two of the three foals went on to race. It was concluded that the pyloroplasty procedure is an acceptable option for the treatment of pyloric stenosis and secondary gastric outflow obstruction due to gastric ulceration. The limited amount of bowel manipulation with no change in intestinal flow, along with the successful outcomes achieved, make this another surgical option available for the correction of pyloric stenosis in foals.     

Wound Drainage from Under Full-thickness Skin Grafts in Dogs Part I. Quantitative Evaluation of Four Techniques

The formation of hematomas or seromas under skin grafts is reported to be the most common cause of graft failure. Several techniques have been developed to prevent fluid accumulation by increasing drainage, but their effectiveness has not been evaluated. In this study, four full-thickness skin grafting procedures were performed on both sides of the chests of 12 dogs, and the amount of wound drainage was quantitated for the first 10 postoperative days. The techniques evaluated were a sheet graft (control), continuous low level suction, piecrust incisions, and nonexpanded mesh graft. Significantly more drainage fluid was removed by continuous low level suction than the other techniques evaluated. Meshing allowed significantly more drainage than the piecrust or sheet grafts but was not as effective as continuous low level suction. Piecrust incisions had no significant effect on wound drainage.     

Histopathologic features of canine uremic gastropathy: a retrospective study

Uremic gastritis is a term commonly used to describe the gastrointestinal signs and histopathologic changes associated with renal failure in the dog. This retrospective study reviews the clinical, serum biochemical, and postmortem histopathologic data from 28 dogs with renal failure to determine the prevalence of gastric histopathology, characterize the gastric histopathology, and identify associations between gastric histopathology and serum concentrations of blood urea nitrogen (BUN), creatinine (Cr), calcium-phosphorus product (Ca x Phos), and hematocrit. Affected and control dogs with available renal and gastric tissue, serum biochemistry data, and urinalysis data were identified over a 10-year period (1992-2002) in the pathology department postmortem examination database at the Cornell University College of Veterinary Medicine. The serum biochemistry data and histopathologic findings were scored as normal, mild, moderate, and severe. All affected dogs had derangements of BUN, Cr, or Ca x Phos with gastric histopathology in 22 of 28 dogs (79%). Dogs with renal failure had a higher prevalence of gastric histopathologic changes compared with the control group. Associated histopathologic changes in the stomach were edema (P = .008), mineralization (P = .03), and vasculopathy (P = .03). Only 1 dog had evidence of gastric ulceration. Gastric necrosis was an uncommon finding (4/28, 14%). Gastric histopathology appears to be common in dogs with renal failure and is associated with increasing severity in the serum biochemistry data. Unlike humans with renal failure, in whom gastric ulceration predominates, gastric necrosis and ulceration appear to be uncommon in dogs with renal failure.     

Outcomes of Heimlich valve drainage in dogs

Objective and design   Retrospective study of the outcomes of Heimlich valve drainage in dogs.
Procedure   Medical records of the past 3 years were retrospectively reviewed. Heimlich valve drainage was used in 34 dogs (median body weight 30 ± 5 kg): lobectomy (n = 15), pneumonectomy (n = 9), intrathoracic oesophageal surgery (n = 2), diaphragmatic hernia repair (n = 1), traumatic open pneumothorax (n = 2), bilobectomy (n = 2), ligation of the thoracic duct (n = 1), and chylothorax and pneumothorax (n = 1 each). Evacuation of air and/or fluid from the pleural cavity was performed with the Heimlich valve following thoracostomy tube insertion. During drainage, the dogs were closely monitored for possible respiratory failure. Termination of Heimlich valve drainage was controlled with underwater seal drainage and assessed with thoracic radiography.
Results   Negative intrathoracic pressure was provided in 29 dogs without any complications. Post pneumonectomy respiratory syncope and post lobectomy massive hemothorax, which did not originate from the Heimlich valve, were the only postoperative complications. Dysfunction of the valve diaphragm, open pneumothorax and intrathoracic localisation of an acute gastric dilatation–volvulus syndrome caused by a left-sided diaphragmatic hernia following pneumonectomy were the Heimlich valve drainage complications.
Conclusions   The Heimlich valve can be used as a continuous drainage device in dogs, but the complications reported here should be considered by veterinary practitioners.     

Gastric hemorrhage in dogs given high doses of methylprednisolone sodium succinate.

OBJECTIVE: To determine whether healthy dogs given high doses of methylprednisolone sodium succinate (MPSS) develop gastrointestinal tract ulcers and hemorrhage. ANIMALS: 19 healthy male hound-type dogs. PROCEDURE: Dogs were assigned randomly to intravenously receive high doses of MPSS (30 mg/kg of body weight, initially, then 15 mg/kg 2 and 6 hours later, and, subsequently, every 6 hours for a total of 48 hours; n = 10) or an equal volume of saline (0.9% NaCl) solution (9). Gastroduodenoscopy was performed before and after treatment. Endoscopic evidence of gross hemorrhage in the cardia, fundus, antrum, and duodenum of each dog was graded from none (0) to severe (3), and a total stomach score was calculated as the sum of the regional gastric scores. Number of ulcers were recorded. The pH of gastric fluid and evidence of occult gastric and fecal blood were measured. Food retention was recorded. RESULTS: Gastric hemorrhage was evident in all dogs after MPSS administration and was severe in 9 of 10 dogs but not visible in any dog after saline treatment. Occult gastric blood was detected more commonly (9/10 vs 2/9), median gastric acidity was greater (pH 1 vs pH 3), and food was retained more commonly (7/10 vs 1/9) in the stomach of MPSS-treated dogs. CONCLUSIONS AND CLINICAL RELEVANCE: High doses of MPSS cause gastric hemorrhage in dogs. All dogs treated with high doses of MPSS should be treated with mucosal protectants or antacids to prevent gastric hemorrhage.     

Effect of repeated oral administration of hypertonic electrolyte solution on equine gastric mucosa

REASONS FOR PERFORMING STUDY: Electrolyte supplementation is common in horses during endurance competitions, but the effect on the gastric mucosa is unknown. HYPOTHESIS: Repeated oral administration of hypertonic electrolyte solution is associated with exacerbation of gastric ulcers in mature horses. METHODS: The study design was a randomised, blinded, crossover trial. Fourteen horses were divided randomly into equal groups and administered either 60 ml water (placebo) or 56.7 g commercial electrolyte supplement mixed with 60 ml water by dose syringe orally once an hour for 8 h. The minimum concentration of individual constituent electrolytes/28.35 g dry commercial product used was: sodium (5528 mg); chloride (11,886 mg); potassium (3657 mg); calcium (754 mg); and magnesium (153 mg). Gastric lesions were scored prior to and after oral treatments, and analysis of variance procedures were then performed. RESULTS: Administration of hypertonic electrolytes resulted in a significant increase in mean ulcer number (P = 0.0174) and severity (P = 0.0006) scores in the nonglandular stomach. Mean ulcer number score was 3.6 and mean ulcer severity score 2.7 after hypertonic electrolyte treatment. CONCLUSIONS: Oral hypertonic electrolyte administration to horses in this model was associated with exacerbation of gastric ulcers. POTENTIAL RELEVANCE: Our findings suggest that one schedule of electrolyte supplementation used commonly in endurance horses may be harmful to the gastric mucosa.     

Canine gastric adenocarcinoma and leiomyosarcoma: a retrospective study of 21 cases (1986-1999) and literature review

This retrospective study describes the clinical course, treatment, and outcome of 21 dogs with gastric adenocarcinomas (n=19) and leiomyosarcomas (n=2). Medical records from 1986 to 1999 were reviewed for signalment, weight, diagnosis, tumor location, clinical signs, radiographic imaging procedures, surgical procedures, chemotherapy, duration of follow-up monitoring, outcome, cause of death, metastatic rate, metastatic sites, and method of detection of metastasis. Fourteen of 19 (74%) dogs with gastric adenocarcinomas had metastasis. Metastatic sites included gastric lymph nodes, omentum, liver, duodenum, pancreas, spleen, esophagus, adrenal glands, and lungs. Both cases of a gastric leiomyosarcoma had metastatic disease involving the liver (n=2) and duodenum (n=1). Surgery, consisting of either a Billroth I or a gastrojejunostomy, provided immediate relief of the gastric outflow obstruction and clinical improvement in the early postoperative period. The beneficial effects of chemotherapy alone or adjuvant chemotherapy are still unknown. Recurrence of clinical signs 3 days to 10 months after surgery caused all owners to elect euthanasia. The long-term prognosis for most cases of gastric adenocarcinomas and leiomyosarcomas is poor because of the presence of advanced disease. Surgical resection, however, does alleviate gastric outflow obstruction in the immediate postoperative period.     

The mixed acid-base disturbances of severe canine babesiosis

Thirty-four dogs suffering from severe babesiosis caused by Babesia canis rossi were included in this study to evaluate acid-base imbalances with the quantitative clinical approach proposed by Stewart. All but 3 dogs were severely anemic (hematocrit <12%). Arterial pH varied from severe acidemia to alkalemia. Most animals (31 of 34; 91%) had inappropriate hypocapnia with the partial pressure of CO2 < 10 mm Hg in 12 of 34 dogs (35%). All dogs had a negative base excess (BE; mean of - 16.5 mEq/L) and it was below the lower normal limit in 25. Hypoxemia was present in 3 dogs. Most dogs (28 of 34; 82%) were hyperlactatemic. Seventy percent of dogs (23 of 33) were hypoalbuminemic. Anion gap (AG) was widely distributed, being high in 15, low in 12, and normal in 6 of the 33 dogs. The strong ion difference (SID; difference between the sodium and chloride concentrations) was low in 20 of 33 dogs, chiefly because of hyperchloremia. Dilutional acidosis was present in 23 of 34 dogs. Hypoalbuminemic alkalosis was present in all dogs. Increase in unmeasured strong anions resulted in a negative BE in all dogs. Concurrent metabolic acidosis and respiratory alkalosis was identified in 31 of 34 dogs. A high AG metabolic acidosis was present in 15 of 33 dogs. The lack of an AG increase in the remaining dogs was attributed to concurrent hypoalbuminemia, which is common in this disease. Significant contributors to BE were the SID, free water abnormalities, and AG (all with P < .01). Mixed metabolic and respiratory acid-base imbalances are common in severe canine babesiosis, and resemble imbalances described in canine endotoxemia and human malaria.     

Endoscopy (fibreoptic) of the oesophagus and stomach in the dog with persistent regurgitation or vomiting

A flexible gastrointestinal panendoscope was used to examine 90 dogs; 29 for oesophageal and 61 for gastric investigation. Twenty-two of the oesophageal cases had changes associated with foreign body obstruction. The commonest feature was simple mucosal damage. Small numbers of strictures (5), diverticula (1) and perforations (4) were identified. The remainder of the cases were vascular rings (5) and leiomyomata (1). The 61 gastroscopies could be subdivided into the following groups: 1, no abnormalities (14); 2, chronic gastritis (16); 3, neoplasia (26); 4, others (5). Further, gastric carcinoma accounted for 36 per cent of all gastroscopic examinations. Oesophageal abnormalities were found in 13 per cent of those cases investigated for, and found to have, gastric lesions, where reflux oesophagitis (5) was the commonest lesion.     

犬猫剖腹产手术的操作程序及体会

犬、猫难产是动物门诊较为常见的犬猫疾病之一,随着社会发展,看厂(场)护院的大型犬、家庭饲养的宠物犬猫不断增多,因缺乏科学的饲养管理,犬猫因难产施行剖腹产手术的越来越多。笔者就近几年来西北农林科技大学动物医院犬猫剖腹产手术共98例,其中犬66例,猫32例,成功93例(其中犬63例,猫30例,成功率94.90%)。现就犬猫剖腹产手术的适应症、操作程序(手术术式和术后护理)及手术体会进行分述,供同行参考。