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Gastric Ulceration - Dog (view source)
Revision as of 13:21, 6 September 2015
, 13:21, 6 September 2015no edit summary
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Also known as: '''''Gastrointestinal ulceration
==Introduction==
See also:'''[[Gastric Ulceration - all species]]'''
[[Image:Gastric ulceration.jpg|thumb|right|250px|Gastric Ulceration - Copyright David Walker RVC]]
Gastric ulcer is a round or oval punched out lesion of the gastric mucosa ranging from 1-4 cm in diameter.
There are many disease associations including:
There are many disease associations including:
|-
|-
|'''Hypotension'''
|'''Hypotension'''
|[[Shock - Pathology|Shock]], Sepsis
|[[Shock|Shock]], Sepsis
|-
|-
|'''Drug - induced'''
|'''Drug - induced'''
|-
|-
|'''Inflammatory'''
|'''Inflammatory'''
|[[Gastritis, Acute|Gastritis]], [[Pancreatitis - Dog and Cat|Pancreatitis]]
|[[Gastritis, Acute|Gastritis]], [[Pancreatitis - Dog|Pancreatitis]]
|-
|-
|'''Neoplastic'''
|'''Neoplastic'''
|Adenocarcinoma, lymphosarcoma, leiomyoma, [[Gastrinoma|gastrinoma]] (Zollinger-Ellison syndrome),
|Adenocarcinoma, lymphosarcoma, leiomyoma, [[Gastrinoma|gastrinoma]], (Zollinger-Ellison syndrome), Mast cell Tumours.
|-
|-
|'''Metabolic/endocrine'''
|'''Metabolic/endocrine'''
|}
|}
Gastric ulceration is caused by damage to the gastric mucosa through the above mechanisms. [[NSAIDs|NSAIDs]] directly damage the mucosa and interfere with the prostaglandin synthesis. Gastric ulceration is worsened by the use of NSAIDs in combination with [[Steroids|corticosteroids]]. This risk can be minimised by using cyclooxygenase-1 (COX-1) sparing NSAIDs.
Gastric ulceration is caused by damage to the gastric mucosa through the above mechanisms. [[NSAIDs|NSAIDs]] directly damage the mucosa and interfere with prostaglandin synthesis. Gastric ulceration is worsened by the use of NSAIDs in combination with [[Steroids|corticosteroids]]. This risk can be minimised by using cyclooxygenase-1 (COX-1) sparing NSAIDs.
Gastric acid hypersecretion following mast cell degranulation of histamine and gastrin secretion from gastrinomas is a major cause of gastric ulceration.
Gastric acid hypersecretion following mast cell degranulation of histamine and gastrin secretion from [[Gastrinoma|gastrinomas]] is a major cause of gastric ulceration.
==Signalment==
==Signalment==
[[Image:Gastric ulceration.jpg|thumb|right|250px|Gastric Ulceration - by David Walker RVC]]
Sled dogs are prone to gastric ulceration.
Sled dogs are prone to gastric ulceration.
==Clinical Signs==
==Clinical Signs==
History may involve access to toxins and drugs such as [[NSAIDs|NSAIDs]].
History may involve access to toxins and drugs such as [[NSAIDs|NSAIDs]].
Clinical Signs can include vomiting, haematemesis, malaena, pale mucous membranes, abdominal pain, weakness, inappetance and hypersalivation which can progress to circulatory compromise.
Clinical Signs can include vomiting, haematemesis, malaena, pale mucous membranes, abdominal pain, weakness, inappetance and hypersalivation which can progress to circulatory compromise.
==Laboratory Tests==
==Laboratory Tests==
===Haematology===
===Haematology===
[[Anaemia|Anaemia]] which may be regenerative initially, and can progress to microcytic, hypochromic and minutely regenerative anaemia.
[[Regenerative and Non-Regenerative Anaemias|Anaemia]] which may be regenerative initially, and can progress to microcytic, hypochromic and minutely regenerative anaemia.
A thrombocytosis may also be present. If a stress leucogram (lymphopenia and neutrophilia) is not present this is supportive of [[Hypoadrenocorticism - Addison's Disease|hypoadrenocorticism]].
A thrombocytosis may also be present. If a [[Stress Leucogram|stress leucogram]] (lymphopenia and neutrophilia) is not present this is supportive of hypoadrenocorticism.
Examination of the buffy coat may detect mastocytosis.
Examination of the buffy coat may detect mastocytosis.
A [[Changes in Inflammatory Cells Circulating in Blood - Pathology#Neutrophilia|Neutrophilia]] and a left shift are indicative of inflammation or gastric perforation.
A [[Neutrophilia|Neutrophilia]] and a left shift are indicative of inflammation or gastric perforation.
There may also be abnormalities in [[Haemostasis - Pathology|haemostasis]].
There may also be abnormalities in [[:Category:Haemostasis and Bleeding Disorders|haemostasis]].
===Biochemistry===
===Biochemistry===
Increased liver enzymes and bilirubin, decreased urea, albumin and cholesterol will indicate hepatic disease as an underlying problem.
Increased liver enzymes and bilirubin, decreased urea, albumin and cholesterol will indicate hepatic disease as an underlying problem.
If renal disease is present, an azotaemia will be present on biochemistry.
If renal disease is present, an azotaemia will be present on biochemistry.
If [[Hypoadrenocorticism - Addison's Disease|Hypoadrenocorticism]] is the cause of the ulceration, it is likely biochemistry will show a Sodium:Potassium ratio of less than 27:1.
If Hypoadrenocorticism is the cause of the ulceration, it is likely biochemistry will show a Sodium:Potassium ratio of less than 27:1.
If the animal is vomiting this will lead to electrolyte and acid-base abnormalities, a metabolic alkalosis, hypokalaemia and hypochloraemia.
If the animal is vomiting this will lead to electrolyte and acid-base abnormalities, a metabolic alkalosis, hypokalaemia and hypochloraemia.
===Urinalysis===
===Urinalysis===
Animals will be dehydrated resulting in Hypersthenuria. If renal disease is the underlying cause, urine may be isosthenuric.
Animals will be dehydrated resulting in hypersthenuria. If renal disease is the underlying cause, urine may be isosthenuric.
===Plain radiography===
===Plain radiography===
[[Image:Gastric ulceration.png|thumb|right|250px|Gastric Ulceration - Copyright David Walker RVC]]
[[Image:Gastric ulceration.png|thumb|right|250px|Gastric Ulceration - by David Walker RVC]]
Not usually diagnostic but can rule out differentials such as foreign bodies and peritonitis.
Not usually diagnostic but can rule out differentials such as [[Gastric Foreign Objects|foreign bodies]] and [[Peritonitis|peritonitis]].
===Positive contrast radiography===
===Positive contrast radiography===
===Ultrasonography===
===Ultrasonography===
Shows gastric thickening and rules out differentials.
Shows gastric thickening and rules out other differential diagnoses.
===Endoscopy and Biopsy===
===Endoscopy and Biopsy===
Diagnostic test of choice and allows biopsies to be taken. [[NSAIDs|NSAID]] related ulcers are reguarly located in the antrum and there is limited mucosal thickening or irregularity whereas ulcerated [[Gastric Neoplasia|gastric tumours]] will have thickened mucosa and edges. Any biopsies should be taken at the edge of normal and diseased to avoid further deepening or perforation.
Diagnostic test of choice and allows biopsies to be taken. NSAID related ulcers are regularly located in the antrum and there is limited mucosal thickening or irregularity whereas ulcerated [[Gastric Neoplasia - Dog and Cat|gastric tumours]] will have thickened mucosa and edges. Any biopsies should be taken at the edge of normal and diseased tissue to avoid further deepening or perforation.
==Treatment==
==Treatment==
The main aim is to treat any primary underlying cause whilst giving general support. This may be hydrating, restoring electrolytes and acid-base and also helping the gastric lining to recover. Anti-ulcerative therapy should be continued for up to 6-8 weeks.
The main aim is to treat any primary underlying cause whilst giving general support. This may be hydrating, restoring electrolytes and acid-base and also helping the gastric lining to recover. [[Gastroprotective Drugs|Anti-ulcerative]] therapy should be continued for up to 6-8 weeks.
===[[Fluid Therapy]]===
===[[Principles of Fluid Therapy|Fluid Therapy]]===
Depends upon degree of dehydration, prescence of shock and any other diseases that are affected by volume. Prolonged vomiting or anorexia may lead to hypokalaemia so KCl may need adding to any fluids given. Normal rates for treatment of shock apply with dehydration being overcome by a fluid rate over 24 hours to replace the defecits along with a maintenance rate.
Depends upon the degree of dehydration, presence of shock and any other diseases that are affected by volume. Prolonged vomiting or anorexia may lead to hypokalaemia so KCl may need adding to any fluids given. Normal rates for treatment of shock apply with dehydration being overcome by a fluid rate over 24 hours to replace the deficits along with a maintenance rate.
===Acid-base correction===
===Reducing acid secretion===
[[Gastroprotective Drugs#Histamine (H2) Receptor Antagonists|Histamine receptor antagonists]] inhibit acid secretion and include cimetidine, ranitidine and famotidine.
[[Gastroprotective Drugs#Proton Pump Inhibitors|Omeprazole]] is the drug of choice to treat ulceration associated with mass cell tumours and gastrinomas. It inhibits the hydrogen-potassium ATPase which prevents hydrogen ion production by the parietal cells.
===Mucosal protectants===
===Mucosal protectants===
Such as misoprostol can be given alongside [[NSAIDs|NSAIDs]] to decrease the risk of ulceration. '''[[Gastroprotective Drugs#Binding Agents|Sucralfate]]''' which is polyaluminium sucrose sulphate, binds to damaged mucosa and assists in the treatment of gastric ulceration. It is best given 2 hours after acid inhibitors to prevent interference.
Such as misoprostol can be given alongside NSAIDs to decrease the risk of ulceration. [[Gastroprotective Drugs#Binding Agents|Sucralfate]] which is polyaluminium sucrose sulphate, binds to damaged mucosa and assists in the treatment of gastric ulceration. It is best given 2 hours after acid inhibitors to prevent interference.
===Prophylaxis===
===Prophylaxis===
Prophylactic treatment has been shown not to prevent gastric ulceration. [[Gastroprotective Drugs#Binding Agents|Sucralfate]] is reported to be the best drug in patients receiving high doses of glucocorticoids.
Prophylactic treatment has been shown not to prevent gastric ulceration. Sucralfate is reported to be the best drug in patients receiving high doses of glucocorticoids.
===[[Emetics and Anti-Emetic Drugs#Anti-Emetics|Anti-emetics]]===
===Anti-emetics===
[[Emetics and Anti-Emetic Drugs#Anti-Emetics|Anti-emetics]] are indicated if vomiting is severe causing fluid and electrolyte imbalances and discomfort.
===Analgesia===
===Analgesia===
Is best provided by [[Opioids|opiods]] such as buprenorphine, pethidine and fentanyl.
Is best provided by [[Opioids|opiods]] such as buprenorphine, pethidine and fentanyl.
===[[Antibiotics]]===
===Antibiotics===
Animals suffering from shock and gastric barrier dysfunction may require prophylactic antibiotic cover. First line drugs include [[Penicillins|ampicillin]] or a [[Cephalosporins|cephalosporin]] which are effective against Gram-positive, some Gram-negative and some anaerobes. These can be combined with an [[Aminoglycosides|aminoglycoside]] which are effective against Gram-negative aerobes if sepsis is present. [[Fluoroquinolones|Enrofloxacin]] can also be used instead of an [[Aminoglycosides|aminoglycoside]] in skeletally mature animals
Animals suffering from shock and gastric barrier dysfunction may require prophylactic [[Antibiotics|antibiotic]] cover. First line drugs include [[Penicillins|ampicillin]] or a [[Cephalosporins|cephalosporin]] which are effective against Gram-positive, some Gram-negative and some anaerobic bacteria. These can be combined with an [[Aminoglycosides|aminoglycoside]] which are effective against Gram-negative aerobes if sepsis is present. [[Fluoroquinolones|Enrofloxacin]] can also be used instead of an aminoglycoside in skeletally mature animals.
===Surgery===
===Surgery===
May be required to investigate or to resect peforating ulcers which may lead to [[Peritonitis - Cats and Dogs|peritonitis]].
May be required to investigate or to resect perforating ulcers which may lead to [[Peritonitis - Cats and Dogs|peritonitis]].
==Prognosis==
==Prognosis==
For animals with peptic ulcers is good. Prognosis is poorer for patients with renal or hepatic failure related ulcers. It is also poor for animals with gastric carcinoma and gastrinoma.
For animals with peptic ulcers is good. Prognosis is poorer for patients with renal or hepatic failure related ulcers. It is also poor for animals with gastric carcinoma and gastrinoma.
{{Learning
|Vetstream = [https://www.vetstream.com/canis/Content/Disease/dis01152.asp, Gastric ulceration]
|literatures search = [http://www.cabdirect.org/search.html?q=%28title%3A%28gastr*%29+OR+title%3A%28stomach%29%29+AND+title%3A%28ulcer*%29+AND+od%3A%28dogs%29 Gastric Ulceration in Dogs publications]
}}
==References==
==References==
Hall, J.E., Simpson, J.W. and Williams, D.A., (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
Hall, J.E., Simpson, J.W. and Williams, D.A., (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
Ettinger, S.J, Feldman, E.C. (2005) '''Textbook of Veterinary Internal Medicine''' (6th edition, volume 2) ''W.B. Saunders Company''
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[[Category:Gastric_Ulceration]][[Category:Gastric Diseases - Dog]]
[[Category:Gastric_Ulceration]][[Category:Dog]]
[[Category:Expert_Review - Small Animal]]
[[Category:To_Do_-_Caz]]