“If there is no enemy within, the enemy outside can do us no harm.” Don’t be your own enemy “If there is no enemy within, the enemy outside can do us no harm.” -Les Brown

DISEASES OF THE STOMACH

Stomach Diseases: Acute Gastritis Spoiled food Change in diet Food allergy Infections (bacterial, viral, parasitic) Toxins (chemicals, plants, drugs, organ failure) Foreign objects Signs Anorexia Vomiting (maybe dehydration) Painful abdomen Hx of diet change, toxin ingestion, infection, parasites

Acute Gastritis Diagnosis History and Physical Exam CBC, Chem Panel H2 blockers decrease the amount of gastric juice produced. Decrease amount of pepsin secreted.

Acute Gastritis Treatment NPO until vomiting stops small sips of water every hour Fluid therapy (SQ or IV) Gradually start feeding Bland food (Hill’s I/D, boiled chicken/rice) Antiemetics Cerenia (maropitant) Regaln (metoclopramide) Coating agents – sucralfate H2 blockers Antibiotics – rarely needed

Acute Gastritis Client info Avoid abrupt changes in diet Gradually mix new food in with old If pet vomit 2-3 times, NPO x 24 h; if it continues see vet Dogs and cats do not need variety in the diet as some clients believe

Stomach Diseases: Gastric Ulceration Cause: Usually a result of long- term NSAIDs (aspirin, ibuprofen, phenylbutazone) Signs Vary from asymptomatic to vomiting blood Anemia Melena Anorexia Abdominal pain Septicemia if perforation occurs

Gastric Ulceration Diagnosis X-ray using contrast medium (Barium) to show ulceration in stomach lining (caution if perforation is suspected) Endoscopy

Gastric Ulceration Treatment Client info Fluid therapy for dehydration NPO Coating agents/ H2 blockers Sucralfate Cimetidine - H2 blocker (↓ HCl production) Omeprazole –proton pump inhibitor (↓ HCl production) Client info Do not use NSAIDs without veterinary supervision Give NSAIDs with meal/antacids Antacids: Aluminium OH or Magnesium OH

Stomach Diseases: Gastric Dilatation/Volvulus Primarily a disease of large, deep-chested dogs Dilation - gas filled, Volvulus - twisted along longitudinal axis Cause: Food/exercise? Etiology unclear Signs Abdominal pain/distension Weakness, collapse, depression, nausea, salivation Increased HR, RR – may lead to arrhythmias

Gastric Dilatation/Volvulus

Gastric Dilatation/Volvulus Air filled stomach that twists along longitudinal axis. Pylorus passes under stomach and comes to rest above the cardia on the L side. Simple dilation: air filled stomach, volvulus is twist.

Stomach Diseases: GDV Diagnosis PE shows depressed, weak animal with poor perfusion (↑CRT) X-rays show air filled stomach- “double-bubble” Or “popeye arm”, or “smurf hat” ECG may show ventricular arrhythmia or sinus tachycardia CBC and Chem panel electrolyte levels pH imbalances Lactate levels

Gastric Dilatation/Volvulus Treatment goals Decompress stomach Pass stomach tube 18 gauge needle Stabilize patient (fluids, electrolytes, ECG) Antibiotics Prepare for Surgery ASAP Best view: R lateral view.

Gastric Dilatation/Volvulus

Gastric Dilatation/Volvulus Post-Op ECG Blood pressure Pain management Monitor urine output Antibiotics Maintain fluids (oral, IV)

Gastric Dilatation/Volvulus Client info Avoid large meals Limit exercise after meals Feed high-quality diets Tack-down procedure not 100% preventative 15 – 18% mortality rate

Stomach Diseases: Gastric Neoplasia Most common malignant neoplasia in dogs is adenocarcinoma; in cats lymphoma Signs Wt. loss Vomiting w/ or w/o blood Obstruction Usually seen in older animals Diagnosis Endoscopy and biopsy for diagnosis X-ray with Barium contrast Benign: polyps, gastric leiomyomas

Gastric Neoplasia Treatment Client info Surgery is treatment of choice Many tumors are too far advanced (inoperable) Chemotherapy Radiation less successful for gastric tumors Client info Prognosis is poor; gastric neoplasia is a fatal disease Supportive care, control of vomiting, good nutrition are needed for these animals