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

2. DISEASES OF THE STOMACH

3. Stomach Diseases: Acute Gastritis Acute Gastritis ◦ Commonly seen in dogs  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

4. Acute Gastritis Dx ◦ Hx and PE ◦ CBC, Chem Panel to assess dehydration, metabolic imbalance, organ failure Rx ◦ NPO until vomiting stops  4-6 sips of water q1h  Fluid therapy (SQ or IV) ◦ Gradually start feeding  Bland food (Hill’s I/D, boiled chicken/rice) ◦ Antiemetics  Maropitant (Cerenia)  Metoclopramide (Reglan) ◦ Coating agents  Sucralfate ◦ H2-blockers (famotidine, ranitidine, cimetidine) ◦ Antibiotics—often prescribed, rarely needed

5. Acute Gastritis  Client info  Avoid abrupt changes in diet  Gradually mix new food in with old (1 wk)  If pet vomit 2-3 times, NPO x 24 h; if it continues see vet  Dogs and cats do not need variety

6. Immune-Mediated Inflammatory Bowel Disease (Chronic gastritis, Enteritis, Colitis)  A decreased tolerance to the diet or to the normal flora results in accumulation of inflammatory cells in lining of stomach, Small Intestine, or Large Intestine  Clinical Signs  Chronic vomiting, wt loss  Diarrhea, straining to defecate, mucus in stool

7. Immune-Mediated Inflammatory Bowel Disease (Chronic gastritis, Enteritis, Colitis)  Diagnosis  Fecal to r/o parasites  CBC, Chemistry panel, urinalysis to r/o metabolic disorder  FeLV, FIV to r/o those diseases  Endoscopy of stomach, SI, and colon, and biopsy for definitive diagnosis

8.  Treatment  Azathioprine—immunosupressant  Cyclophosphamide—inhibits immune system response  Sulfasalazine—a sulfa drug with anti-inflammatory/antibacterial effects  Most effective against colitis  Metronidazole  Prednisone  Hypoallergenic diet  Free from preservative, additives  Highly digestible protein (rabbit, lamb, duck, chicken)  Homemade diets with rice base  Some commercial diets are available Immune-Mediated Inflammatory Bowel Disease (Chronic Gastritis, Enteritis, Colitis)

9. Inflammatory Bowel Disease  Client info  Definitive diagnosis is through biopsy  Life-long condition  Immunosuppressive drugs have side-effects (PU/PD/PP, wt gain, skin/urinary infections)  Use lowest dose that provides effect

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

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

12. Gastric Ulceration Rx ◦ Fluid therapy for dehydration ◦ NPO (as before) ◦ Coating agents/antacids ◦ Cimetidine—H 2 antagonist ( ↓ HCl production) ◦ Omeprazole— ↓ HCl production (proton-pump inhibitor) Client info ◦ Do not use NSAIDs without veterinary supervision ◦ Give NSAIDs with meal/antacids

13. Stomach Diseases: Gastric Dilatation/Volvulus  Primarily a disease of large, deep-chested dogs (2-10 yrs) 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

14. Gastric Dilatation/Volvulus

16. Stomach Diseases: GDV  Diagnosis ◦ PE shows depressed, weak animal with dpoor perfusion ( ↑ CRT) ◦ X-rays show air filled stomach- “double-bubble” ◦ ECG may show vent arrhythmia or sinus tachycardia ◦ CBC and Chem panel necessary to assess electrolyte levels and pH imbalances

17. Gastric Dilatation/Volvulus Treatment ◦ Goals  Decompress stomach ◦ Pass stomach tube ◦ 18 gauge needle  Stabilize patient (fluids, electrolytes, ECG) ◦ Rx for shock  IV fluids  Corticosteroids ◦ Antibiotics  Prepare for Sx ◦ Surgery ASAP

19. Gastric Dilatation/Volvulus

20.  Post-Op  ECG  Blood pressure  Pain management  Monitor urine output  Antibiotics  Maintain fluids (oral, IV)

21.  Client info  Avoid large meals  Limit exercise after meals  Feed high-quality protein diet  Tack-down procedure not 100% preventative Gastric Dilatation/Volvulus

22. 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  Dx  Endoscopy and biopsy for diagnosis  X-ray with Barium contrast

23.  Treatment  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 Gastric Neoplasia