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Also known as: '''''Gastrointestinal ulceration
==Description==
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:
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 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 - Copyright 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.
[[Anaemia - Introduction|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.
A thrombocytosis may also be present. If a 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.
===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 - Copyright David Walker RVC]]
Not usually diagnostic but can rule out differentials such as foreign bodies and [[Peritonitis|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===
===Endoscopy and Biopsy===
===Endoscopy and Biopsy===
Diagnostic test of choice and allows biopsies to be taken. NSAID related ulcers are reguarly 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.
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.
===[[Principles of Fluid Therapy|Fluid Therapy]]===
===[[Principles of Fluid Therapy|Fluid Therapy]]===
Depends upon the 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.
===Reducing acid secretion===
===Reducing acid secretion===
[[Gastroprotective Drugs#Histamine (H2) Receptor Antagonists|Histamine receptor antagonists]] inhibit acid secretion and include cimetidine, ranitidine and famotidine.
[[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 prouction by the parietal cells.
[[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===
==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.
==Literature Search==
[[File:CABI logo.jpg|left|90px]]
Use these links to find recent scientific publications via CAB Abstracts (log in required unless accessing from a subscribing organisation).
<br><br><br>
[http://www.cabdirect.org/search.html?rowId=1&options1=AND&q1=gastr*&occuring1=title&rowId=2&options2=OR&q2=stomach&occuring2=title&rowId=3&options3=AND&q3=ulcer*&occuring3=title&rowId=4&options4=AND&q4=dogs&occuring4=od&x=36&y=7&publishedstart=yyyy&publishedend=yyyy&calendarInput=yyyy-mm-dd&la=any&it=any&show=all Gastric Ulceration in Dogs publications]
==References==
==References==
Ettinger, S.J, Feldman, E.C. (2005)'''Textbook of Veterinary Internal Medicine''' (6th edition, volume 2)W.B. Saunders Company
Ettinger, S.J, Feldman, E.C. (2005)'''Textbook of Veterinary Internal Medicine''' (6th edition, volume 2)W.B. Saunders Company
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