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==Introduction==

==Introduction==

This is an uncommon condition where there is '''thickening or hypertrophy of the pyloric circular smooth-muscle''' layer that results in delayed gastric emptying of solid foods.

This is an uncommon condition where there is '''thickening or hypertrophy of the pyloric circular smooth-muscle''' layer that results in delayed gastric emptying of solid foods.

It is primarily reported in '''young male dogs and brachycephalic breeds''' such as the Boxer and Boston terrier. It is rare in cats, but occurs almost excusively in '''young Siamese cats'''.

It is primarily reported in '''young male dogs and brachycephalic breeds''' such as the Boxer and Boston terrier. It is rare in cats, but occurs almost exclusively in '''young Siamese cats'''.

Concurrent '''megaoesophagus''' is often present in cats, suggesting an underlying autonomic disorder.

Concurrent '''[[megaoesophagus]]''' is often present in cats, suggesting an underlying autonomic disorder.

One proposed aetiology for the disease is that it is caused by the '''excessive secretion of gastrin''', which has a potent trophic effect on pyloric smooth muscle and on the mucosa.

One proposed aetiology for the disease is that it is caused by the '''excessive secretion of gastrin''', which has a potent trophic effect on pyloric smooth muscle and on the mucosa.

Clinical signs are seen in kittens and puppies which have '''just been weaned''', since outflow of solid foods is affected.

Clinical signs are seen in kittens and puppies which have '''just been weaned''', since outflow of solid foods is affected.

The main sign is '''vomiting''' partially digested food without bile, usually several hours after eating.

The main sign is '''[[vomiting]]''' partially digested food without bile, usually several hours after eating.

The animal may appear '''stunted''' and '''aspiration pneumonia''' may be present.

The animal may appear '''stunted''' and '''aspiration pneumonia''' may be present.

Delayed gastric emptying should be diagnosed on radiographic studies.

Delayed gastric emptying should be diagnosed on radiographic studies.

'''Radiographic signs''' may include gastric distention or delayed emptying of contrast material (swallowed barium or barium-impregnant polyethylene spheres, BIPS)

'''Radiographic signs''' may include gastric distention or delayed emptying of contrast material (swallowed barium or barium-impregnated polyethylene spheres, BIPS)

'''Ultrasonography''' may demonstrate thickening of the pyloric area.

'''Ultrasonography''' may demonstrate thickening of the pyloric area.

In cats, treatment is difficult and often unsuccessful.  

In cats, treatment is difficult and often unsuccessful.  

'''Medical therapy''' includes: prokinetic drugs such as metoclopramide, cisapride and erythromycin

'''Medical therapy''' includes: prokinetic drugs such as metoclopramide, cisapride and erythromycin. Dietary manipulation such as feeding a low-fat diet or liquid food to encourage gastric emptying.

 

Dietary manipulation such as feeding a low-fat diet or liquid food to encourage gastric emptying.

'''Surgical techniques''' can also be used:

'''Surgical techniques''' can also be used:

 

:''Fredet-Ramstedt pyloromyotomy'': longitudinal incision through the serosa, muscularis and submucosa to permit bulging of the mucosa, relieving constriction of the pylorus. The incision is left open.

''Fredet-Ramstedt pyloromyotomy'': longitudinal incision through the serosa, muscularis and submucosa to permit bulging of the mucosa, relieving constriction of the pylorus. The incision is left open.

:''Heineke-Mikulicz pyloroplasty'': similar incision but this one penetrates the mucosa and enters the pyloric lumen. The incision is closed transversely in a simple interrupted pattern penetrating all tissue layers.

 

''Heineke-Mikulicz pyloroplasty'': similar incision but this one penetrates the mucosa and enters the pyloric lumen. The incision is closed transversely in a simple interrupted pattern penetrating all tissue layers.

'''Post-operative care''' includes: providing fluids to maintain fluid balance, providing bland food within 24 hours.

'''Post-operative care''' includes: providing fluids to maintain fluid balance, providing bland food within 24 hours.

[[Category:To Do - Helen]]

[[Category:To Do - Review]]

 

 

[[Category:Gastric Diseases - Dog]][[Category:Gastric Diseases - Cat]]

[[Category:Expert Review - Small Animal]]