Gastric ulceration subsequent to partial invagination of the stomach in a dog with gastric dilatation-volvulus

Diagnostic utility of abdominal ultrasound for detecting non-perforated gastroduodenal ulcers in dogs

BACKGROUND

Abdominal ultrasound is frequently used to detect non-perforated gastroduodenal ulcers in dogs. Studies assessing the diagnostic utility of abdominal ultrasound for the detection of non-perforated gastroduodenal ulcers have yielded mixed results. No studies to date have investigated the effects of patient bodyweight, breed, sex, age, ulcer aetiology (neoplastic or inflammatory) or location on the diagnostic accuracy of abdominal ultrasound.

METHODS

Retrospective, multicentre study to evaluate the diagnostic utility of abdominal ultrasonography for the diagnosis of non-perforated gastroduodenal ulceration in dogs.

RESULTS

Sixty-one dogs met the inclusion criteria. Ulcers were detected during ultrasound examination in 18 of 61 dogs, yielding a sensitivity of 29.5% (95% confidence interval 18.8%-42.7%). Ulcers in the pyloric region were detected more frequently than those in the duodenum; however, location was not significantly associated with the ability of ultrasound to detect lesions (p = 0.41). No associations were identified between the ability of ultrasound to detect an ulcer and patient bodyweight (p = 0.45), breed (p = 0.98), sex (p = 0.90), age (p = 0.94), and neoplastic versus inflammatory nature of ulcerative lesions (p = 0.93).

CONCLUSION

The diagnostic utility of ultrasound as the sole modality for the detection of non-perforated gastroduodenal mucosal ulceration is poor. The authors therefore recommend the use of additional modalities when ulcerative lesions are suspected.

Sudden death associated with bleeding into digestive system of finishing pigs – a review

Sudden deaths of finishing pigs in modern pig herds cause economic losses and therefore draw constant attention worldwide. In the case of peracute mortality associated with gastrointestinal bleeding, pigs usually die during a short period without clinical manifestations. Necropsy can detect bleeding into various parts of the digestive system. Determining the exact aetiology of the sudden death can be difficult in many cases. Diseases and conditions such as gastric ulcers, abdominal torsion, haemorrhagic bowel syndrome and infectious diseases should be taken into account in the differential diagnosis. Because some of these diseases still have an unclear aetiology and pathogenesis, the aim of our work was to provide a summary of existing knowledge as well as to describe related pathognomonic pathological changes.

Postoperative management of dogs with gastric dilatation and volvulus

The objective of the study was to review the veterinary literature for evidence-based and common clinical practice supporting the postoperative management of dogs with gastric dilatation and volvulus (GDV). GDV involves rapid accumulation of gas in the stomach, gastric volvulus, increased intragastric pressure, and decreased venous return. GDV is characterized by relative hypovolemic-distributive and cardiogenic shock, during which the whole body may be subjected to inadequate tissue perfusion and ischemia. Intensive postoperative management of the patients with GDV is essential for survival. Therapy in the postoperative period is focused on maintaining tissue perfusion along with intensive monitoring for prevention and early identification of ischemia-reperfusion injury (IRI) and consequent potential complications such as hypotension, cardiac arrhythmias, acute kidney injury (AKI), gastric ulceration, electrolyte imbalances, and pain. In addition, early identification of patients in need for re-exploration owing to gastric necrosis, abdominal sepsis, or splenic thrombosis is crucial. Therapy with intravenous lidocaine may play a central role in combating IRI and cardiac arrhythmias. The most serious complications of GDV are associated with IRI and consequent systemic inflammatory response syndrome and multiple organ dysfunction syndrome. Other reported complications include hypotension, AKI, disseminated intravascular coagulation, gastric ulceration, and cardiac arrhythmias. Despite appropriate medical and surgical treatment, the reported mortality rate in dogs with GDV is high (10%-28%). Dogs with GDV that are affected with gastric necrosis or develop AKI have higher mortality rates.

Evaluation of initial plasma lactate values as a predictor of gastric necrosis and initial and subsequent plasma lactate values as a predictor of survival in dogs with gastric dilatation-volvulus: 84 dogs (2003-2007)

OBJECTIVE

To test whether an initial plasma lactate ≥ 6.0 mmol/L is associated with the presence of macroscopic gastric wall necrosis and overall survival in dogs presenting with gastric dilatation-volvulus (GDV). Additionally, if no association was identified we sought to identify a different predictive initial plasma lactate concentration and to examine whether serial plasma lactate concentrations provide better prediction of survival.

DESIGN

Retrospective study over a 5-year period (2003-2007).

SETTING

Urban private referral small animal teaching hospital.

ANIMALS

Eighty-four client-owned dogs with a diagnosis of GDV and plasma lactate measurements.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

There was no statistically significant relationship found between survival and the presence of macroscopic gastric wall necrosis with the initial plasma lactate ≥ 6 mmol/L. There was a significant relationship between the initial plasma lactate >2.9 mmol/L for predicting necrosis and <4.1 mmol/L for predicting survival to discharge. Forty dogs that had an increased initial plasma lactate (>2.5 mmol/L) also had a subsequent plasma lactate measured within 12 hours of presentation, with 37/40 dogs surviving and 70% of these surviving dogs having the subsequent lactate decrease by ≥ 50% within 12 hours. The 3/40 that died failed to decrease their plasma lactate by ≥ 50% from the initial blood lactate.

CONCLUSION

The results of this study indicate that an initial presenting plasma lactate concentration ≥ 6.0 mmol/L is not predictive of macroscopic gastric wall necrosis or survival in dogs presenting with GDV. A decrease in plasma lactate concentrations ≥ 50% within 12 hours may be a good indicator for survival. Limitations to the study include its retrospective nature, the small number of patients, and the number of dogs that were euthanized rather than allowed to progress to a natural outcome.

Emesis in dogs: a review

Emesis is a common presenting sign in small animal practice. It requires a rational approach to management that is based upon a sound understanding of pathophysiology combined with logical decision making. This review, which assesses the weight of available evidence, outlines the physiology of the vomiting reflex, causes of emesis, the consequences of emesis and the approach to clinical management of the vomiting dog. The applicability of diagnostic testing modalities and the merit of traditional approaches to management, such as dietary changes, are discussed. The role and usefulness of both traditional and novel anti-emetic drugs is examined, including in specific circumstances such as following cytotoxic drug treatment. The review also examines areas in which common clinical practice is not necessarily supported by objective evidence and, as such, highlights questions worthy of further clinical research.