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Angelou V, Fiska A, Tsingotjidou A, Patsikas M, Papazoglou LG. Surgical Anatomy of the Gastrointestinal Tract in Cats. Animals (Basel) 2023; 13:2670. [PMID: 37627461 PMCID: PMC10451872 DOI: 10.3390/ani13162670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
In cats, the gastrointestinal tract is one of the regions in which surgical procedures are most frequently performed by veterinary surgeons; therefore, knowledge of the surgical anatomy of the feline gastrointestinal tract is of high importance. The main surgical procedures performed include gastrotomy, gastrectomy, enterotomy, and enterectomy, as well as procedures in the liver and pancreas. There are also anatomical differences between dogs and cats, increasing the need for deep knowledge of the anatomy treated in the different surgical approaches. The aim of the present review is to describe in detail the anatomy of the gastrointestinal tract in cats highlighting the anatomical regions of significant importance in different surgical procedures.
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Affiliation(s)
- Vasileia Angelou
- Unit of Surgery and Obstetrics, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece; (V.A.); (L.G.P.)
| | - Aliki Fiska
- Department of Anatomy, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Anastasia Tsingotjidou
- Laboratory of Anatomy, Histology and Embryology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece;
| | - Michael Patsikas
- Laboratory of Diagnostic Imaging, Department of Clinical Studies, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Lysimachos G. Papazoglou
- Unit of Surgery and Obstetrics, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece; (V.A.); (L.G.P.)
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Phillips H, Corrie J, Engel DM, Duffy DJ, Holt DE, Kendall AR, Schmiedt CW, Vetter A, Meren IL, Follette C, Schaeffer DJ, Mayhew PD, Marks SL. Clinical findings, diagnostic test results, and treatment outcome in cats with hiatal hernia: 31 cases (1995-2018). J Vet Intern Med 2019; 33:1970-1976. [PMID: 31397500 PMCID: PMC6766504 DOI: 10.1111/jvim.15583] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/15/2019] [Indexed: 12/11/2022] Open
Abstract
Background Information regarding clinical signs, assessment, treatment, and outcome in cats with hiatal hernia (HH) is limited. Objectives To characterize the clinical presentation of HH and medical and surgical outcomes in a cohort of affected cats. Animals Thirty‐one client‐owned cats with HH. Methods Medical records of cats with HH were retrospectively reviewed for signalment, history, results of diagnostic tests, details of surgical and medical treatments, complications, and outcome. Long‐term follow‐up data were obtained by telephone communication. Relationships between clinical variables and outcome were evaluated by regression analysis. Results Type I HH was present in 85.7% (24/28) of cats, and 64.5% (20/31) were >3 years of age at diagnosis. Twenty‐one of 31 (67.7%) cats underwent surgical repair including phrenoplasty, esophagopexy, and left‐sided gastropexy, and 10 of 31 cats were treated medically without surgery. Concurrent illness was common, and 77.4% cats had comorbidities. All cats survived to discharge, and median time to death or follow‐up was 959 days (range, 3‐4015 days). Cats treated medically survived longer than cats treated surgically, with median time to death or follow‐up of 2559 and 771 days, respectively. Conclusions and Clinical Importance Type I HH is the most common type of HH in cats. A congenital etiology is possible, but many cats with HH were >3 years of age at diagnosis and suffered from comorbidities, including upper airway obstruction. Case selection and the presence of comorbidities likely influenced the outcome. Cats with HH may not be diagnosed until disease is advanced or concurrent illness draws attention to clinical signs.
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Affiliation(s)
- Heidi Phillips
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
| | - Jessica Corrie
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
| | - Danielle M Engel
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
| | - Daniel J Duffy
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
| | - David E Holt
- Section of Surgery, Matthew J. Ryan Veterinary Hospital, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Allison R Kendall
- Department of Internal Medicine, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - Chad W Schmiedt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Autumn Vetter
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Ilyssa L Meren
- Lloyd Veterinary Medical Center, Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa
| | - Christelle Follette
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - David J Schaeffer
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
| | - Philipp D Mayhew
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Stanley L Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, California
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Voutsinou A, Papazoglou LG, Antonopoulos I, Rallis TS. Clinical topographical anatomy of the gastro-oesophageal junction in the cat. J Feline Med Surg 2018; 20:308-311. [PMID: 28467284 PMCID: PMC11129226 DOI: 10.1177/1098612x17706799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The purpose of the present study was to describe histologically the gastro-oesophageal junction in the cat and interrelationships of this region. Our hypothesis was that cats are devoid of abdominal oesophagus. Methods Three centimetres of the terminal oesophagus, the phreno-oesophageal membrane with 1-2 cm margins of the diaphragmatic crural muscle and the proximal 3 cm of the gastric cardia were obtained from nine domestic shorthair cats and one domestic longhair cat that were euthanased for reasons other than digestive tract pathology. Longitudinal samples were examined histologically. Evaluated parameters included the location of the phreno-oesophageal membrane with reference to the transition between the oesophageal and gastric mucosa, the thickness of the circumferential smooth muscle of the muscular layer of the distal oesophagus at points 3 mm and 6 mm cranial to the mucosa transition, and the thickness of the circumferential smooth muscle layer at the mucosa transition level. Median differences in the thickness of the smooth muscle layer were compared by performing non-parametric statistical analysis using the Mann-Whitney U-test. Results The transition of the oesophageal to gastric mucosa was abrupt and corresponded to the point of insertion of the phreno-oesophageal membrane at the diaphragm level in all cats. The mean thickness of the circumferential smooth muscle layer at the point of oesophageal to gastric mucosa transition was significantly greater than the mean thickness of the oesophageal circumferential smooth muscle layer at 3 mm and 6 mm cranial to the mucosa transition ( P ⩽0.05). The increased muscle thickness at the gastro-oesophageal junction correlates with the accepted location of the high-pressure zone, reflecting the caudal oesophageal sphincter. It seems that the whole oesophagus was situated within the thoracic rather than the abdominal cavity. Conclusions and relevance No distinct abdominal oesophagus was observed in nine domestic shorthair cats and one domestic longhair cat. These findings might have implications for the pathophysiology of hiatal hernia in cats.
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Affiliation(s)
- Agni Voutsinou
- Department of Clinical Sciences, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lysimachos G Papazoglou
- Department of Clinical Sciences, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Antonopoulos
- Laboratory of Anatomy, Histology and Embryology School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Timoleon S Rallis
- Department of Clinical Sciences, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Gambino JM, Sivacolundhu R, DeLucia M, Hiebert E. Repair of a sliding (type I) hiatal hernia in a cat via herniorrhaphy, esophagoplasty and floppy Nissen fundoplication. JFMS Open Rep 2015; 1:2055116915602498. [PMID: 28491383 PMCID: PMC5361999 DOI: 10.1177/2055116915602498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2015] [Indexed: 11/24/2022] Open
Abstract
Case summary A 10-month-old domestic shorthair cat was evaluated for severe esophagitis and protracted vomiting and regurgitation secondary to a sliding (type I) hiatal hernia. The hernia and concurrent upper airway obstruction (nasopharyngeal polyp) were diagnosed with a multi-modality approach, including thoracic and abdominal radiographs, abdominal ultrasound, computed tomography and endoscopy. Following unsuccessful attempts at medical management, lower esophageal incompetence was successfully treated by employing a combination of surgical techniques, including herniorrhaphy, esophagopexy and modified (floppy) Nissen fundoplication. Relevance and novel information A multi-modality imaging approach was valuable in completely assessing the extent of this cat’s disease. Although an untraditional approach, the authors report herein the first clinical description of the use of combined surgical techniques with the floppy Nissen fundoplication technique (an antireflux procedure) in a cat. This procedure was used as a first-line surgical technique in this cat with severe lower esophageal incompetence, and may be a viable option for cases non-responsive to other therapeutic interventions. Further investigation of this surgical technique is warranted.
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Affiliation(s)
- Jennifer M Gambino
- Department of Diagnostic Imaging, Mississippi State University, College of Veterinary Medicine, Mississippi State, MS, USA
| | - Ramesh Sivacolundhu
- Balcatta Veterinary Hospital, Perth, Western Australia, University of Western Australia, Honorary Research Associate, Murdoch University
| | - Meghan DeLucia
- Department of Internal Medicine, VCA Katonah Bedford Veterinary Center, Bedford Hills, NY, USA
| | - Elizabeth Hiebert
- Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
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Abstract
A 3 mo old male domestic shorthair weighing 2 kg was presented for acute onset of anorexia, lethargy, paradoxical breathing, and a palpable mass effect in the cranial abdomen. Initial diagnostics and imaging suggested a pleuroperitoneal or hiatal hernia. Emergency abdominal exploration was performed, and a complex type II paraesophageal hiatal hernia was identified. The entire stomach, greater and lesser omenta, spleen, left limb of the pancreas, and the proximal segment of the descending duodenum were herniated through a discrete defect in the phrenicoesophageal ligament. After reduction of the herniated organs back into the abdomen, a phrenicoplasty, esophagopexy, and left-sided fundic gastropexy were performed. The cat recovered uneventfully from the procedure and was free of any signs of disease for at least 30 mo postoperatively. This is the first detailed report of the findings and successful surgical treatment of a complex congenital, type II paraesophageal hiatal hernia with complete herniation of the stomach, omenta, and spleen in a cat.
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Affiliation(s)
- Kim Tong
- From the Dallas Veterinary Surgical Center, Dallas, TX (K.T.); and Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Veterinary Medical Center, Michigan State University, East Lansing, MI (R.G.)
| | - Reunan Guillou
- From the Dallas Veterinary Surgical Center, Dallas, TX (K.T.); and Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Veterinary Medical Center, Michigan State University, East Lansing, MI (R.G.)
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Batchelor DJ, Devauchelle P, Elliott J, Elwood CM, Freiche V, Gualtieri M, Hall EJ, Den Hertog E, Neiger R, Peeters D, Roura X, Savary-Bataille K, German AJ. Mechanisms, causes, investigation and management of vomiting disorders in cats: a literature review. J Feline Med Surg 2013; 15:237-65. [PMID: 23403690 PMCID: PMC10816764 DOI: 10.1177/1098612x12473466] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Vomiting is a common presenting complaint in feline practice. This article differs from previous reviews in that it is an evidence-based review of the mechanisms, causes, investigation and management of vomiting in the domestic cat. Published evidence was reviewed, and then used to make recommendations for clinical assessment, diagnosis, antiemetic drug treatment, dietary management and monitoring of cats presenting with vomiting. The strength of the evidence on which recommendations are made (and areas where evidence is lacking for cats) has been highlighted throughout.
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Digestive System, Liver, and Abdominal Cavity. THE CAT 2012. [PMCID: PMC7158306 DOI: 10.1016/b978-1-4377-0660-4.00023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sivacolundhu RK, Read RA, Marchevsky AM. Hiatal hernia controversies--a review of pathophysiology and treatment options. Aust Vet J 2002; 80:48-53. [PMID: 12180879 DOI: 10.1111/j.1751-0813.2002.tb12046.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To provide a detailed discussion of the aetiology and pathophysiology of hiatal hernia in both humans and small animals, and review current medical and surgical treatments. DESIGN Review article. SUMMARY Hiatal hernia is not completely understood in humans or animals. It has a complex multifactorial aetiology and pathophysiology. A primary disturbance of the lower oesophageal sphincter has not been shown in humans or animals. Knowledge of pathophysiology is necessary to institute appropriate treatment. Medical and/or surgical therapy is not indicated in asymptomatic cases. Medical treatment should be used for up to 1 month in stable cases of sliding hiatal hernia. Paraoesophageal hiatal hernias and any large sliding hiatal hernia should be considered for prompt surgical treatment. Surgical techniques used depend on the type of hiatal hernia present. Surgical treatment of hiatal hernia cases should be performed by experienced surgeons, and must include hiatal closure and gastropexy. The Nissen fundoplication procedure has been discontinued in the veterinary field due to poor success rates, coupled with the published view that there is a marked difference in pathophysiology between humans and dogs. Reported complications associated with the original Nissen fundoplication technique are identical in the human and veterinary literature. There have been no complications reported with use of the modified or 'floppy' Nissen fundoplication in dogs. Both oesophagopexy and Nissen fundoplication require further evaluation in small animals.
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SIVACOLUNDHU RK, READ RA, MARCHEVSKY AM. Hiatal hernia controversies - a review of pathophysiology and treatment options. Aust Vet J 2002. [DOI: 10.1111/j.1751-0813.2002.tb12833.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pratschke KM, Bellenger CR, McAllister H, Campion D. Barrier pressure at the gastroesophageal junction in anesthetized dogs. Am J Vet Res 2001; 62:1068-72. [PMID: 11453482 DOI: 10.2460/ajvr.2001.62.1068] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effect of body position on barrier pressure at the gastroesophageal junction in anesthetized Greyhounds and to assess alterations in barrier pressure following gastropexy. ANIMALS 8 adult Greyhounds. PROCEDURE Barrier pressure at the gastroesophageal junction was measured by fast (1 cm/s) and slow (1 cm/10 s) withdrawal of a subminiature strain gauge transducer through the gastroesophageal junction in 8 anesthetized dogs. The effect of body position was measured. Each dog then was placed in right-lateral recumbency, and gastropexy was performed in the left flank. Additional measurements were obtained 1, 5, 10, 20, and 30 minutes after gastropexy. RESULTS Barrier pressure for dogs positioned in sternal recumbency (mean +/- SEM, 1.1 +/- 0.53 mm Hg) was significantly less than for dogs positioned in right lateral or left lateral recumbency. Following gastropexy, there was a steady increase in barrier pressure. Thirty minutes after gastropexy, barrier pressure was significantly higher (13.36 +/- 3.46 mm Hg), compared with the value before surgery. CONCLUSIONS AND CLINICAL RELEVANCE Barrier pressure in anesthetized dogs is highly variable and influenced by body position. This is most likely the result of anatomic interrelationships between the diaphragm, stomach, and terminal portion of the esophagus. Gastropexy also increases barrier pressure in the immediate postoperative period, which may be clinically relevant in terms of understanding how resolution of gastroesophageal reflux disease associated with hiatal hernia may be affected by gastropexy combined with hernia reduction.
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Affiliation(s)
- K M Pratschke
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, University College Dublin, Ballsbridge, Ireland
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Callan MB, Washabau RJ, Saunders HM, Kerr L, Prymak C, Holt D. Congenital esophageal hiatal hernia in the Chinese shar-pei dog. Vet Med (Auckl) 1993; 7:210-5. [PMID: 8246209 DOI: 10.1111/j.1939-1676.1993.tb01009.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Esophageal hiatal hernia was diagnosed in 11 young Chinese Shar-Pei dogs between October 1985 and July 1991. The dogs ranged in age from 2 to 11 months and included 3 females and 8 males. The most common clinical signs were regurgitation, vomiting, and hypersalivation. Physical examination was normal in 6 dogs; abnormal physical examination findings in the other 5 dogs included fever, dehydration, hypersalivation, and pulmonary wheezes and crackles. Laboratory evaluation was significant only for neutrophilia in 5 dogs. A diagnosis of hiatal hernia was made on the basis of survey thoracic radiographic and/or barium esophagram findings of displacement of the esophagogastric junction and stomach into the thoracic cavity; the diagnosis was confirmed by surgery in 9 dogs and at necropsy in 2 dogs. Megaesophagus (n = 7), gastroesophageal reflux (n = 4), and esophageal hypomotility (n = 1) were additional findings in some dogs. Aspiration pneumonia was diagnosed in 7 of the dogs. Medical therapies formulated for the therapy of presumed reflux esophagitis generally failed to resolve the clinical signs associated with the hiatal hernia. Hiatal herniae were surgically repaired in 9 of the Shar-Peis by various combinations of diaphragmatic crural apposition, fixation of the esophagus to the diaphragmatic crus (esophagopexy), and left fundic tube gastropexy. Eight of the animals survived surgery, six of which have been asymptomatic since surgery (19 to 36 months). The megaesophagus, esophageal hypomotility, and bronchopneumonia resolved in all of these dogs.
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Affiliation(s)
- M B Callan
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia 19104-6010
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Ham LV, Bree H. Conservative treatment of tetanus associated with hiatus hernia and gastroesophageal reflux. J Small Anim Pract 1992. [DOI: 10.1111/j.1748-5827.1992.tb01146.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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