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- Author or Editor: Michael S. Leib x
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Abstract
Objective—To evaluate the signalment, clinical signs, diagnosis, treatment, and outcome associated with esophageal obstruction caused by a dental chew treat in dogs.
Design—Retrospective case series.
Animals—31 dogs.
Procedures—Medical records were contributed from 19 hospitals via responses to a questionnaire that was developed for veterinarians who managed the cases.
Results—Esophageal obstructions with the dental chew treat occurred primarily in small dogs (26/31 [83.9%]). The most common clinical signs were gagging, regurgitation, vomiting, anorexia, and lethargy. Diagnosis was usually made via survey thoracic radiography. Obstructions were most commonly located in the distal portion of the esophagus (23/31; 74.2%). Esophageal lesions were moderate or severe in 86.7% (26/30) of the dogs. Orad endoscopic removal of the foreign bodies was uncommon (8/31 [25.8%]); most were pushed into the stomach. Thoracotomy was necessary in 6 dogs. Esophageal strictures developed in 6 of 25 (24%) dogs that survived initial hospitalization. Overall mortality rate was 25.8%.
Conclusions and Clinical Relevance—Esophageal obstructions with a dental chew treat were difficult to remove orally via endoscopy, resulted in moderate or severe esophageal damage, frequently were associated with stricture formation, and were associated with a high mortality rate.
Summary
The effects of preanesthetic medication on ease of duodenal endoscopic intubation in dogs was evaluated. One of 12 combinations of preanesthetic medications (using atropine, glycopyrrolate, morphine, meperidine, acepromazine, and 0.9% NaCl solution) was administered im to each of 12 dogs in a trial. Twelve endoscopic trials were performed so that each dog received each treatment combination once. Anesthesia was induced with thiamylal administered iv and maintained with halothane vaporized in oxygen. Electrocardiographic recordings, indirect blood pressure measurements, end-tidal carbon dioxide partial pressures, and halothane concentrations were monitored during the anesthetic period. The ease with which the fiberoptic endoscope was passed into the proximal portion of the duodenum was qualitatively scored on the basis of time and maneuvering effort. None of the preanesthetic combinations made intubation of the duodenum significantly easier than that with 0.9% NaCl solution (control). Only the combmation of morphine and atropine induced gastropyloric conditions that resulted in significantly higher (more difficult) endoscopic scores than those after preanesthetic medication with 0.9% NaCl solution.
Summary
Observations made during endoscopic evaluation of the stomach, duodenum, and colon of 58 dogs and 17 cats with a history of regurgitation, vomiting, and/or diarrhea were compared with results of histologic examination of tissues obtained during the procedures. Endoscopic observations included normal mucosa, alternations in mucosal color and texture, and luminal masses. Although endoscopy alone is a useful technique for detecting alterations of the gastrointestinal mucosa, histologic assessment of tissues obtained is necessary to confirm either an inflammatory or a neoplastic process.
Summary
The purposes of this study were to evaluate the efficacy of metoclopramide to aid passage of a flexible endoscope into the duodenum of dogs, and to determine whether the effect of metoclopramide is dependent on dose. In a randomized, blinded, complete-block design, 6 healthy dogs were anesthetized, then each was given saline solution or 1 of 4 doses of metoclopramide on different days. The - ease of passage of a flexible, fiberoptic gastroscope through the pylorus was assessed independently by 3 endoscopists.
Administration of metoclopramide hydrochloride at a dosage of 0.4 mg/kg of body weight, iv, made passage of a flexible endoscope into the duodenum significantly (P= 0.009) more difficult than when, saline solution was administered; however, dosages of 0.1, 0.2 and 0.8 mg of metoclopramide/kg did not (P = 0.489, 0.842, and 0.092 respectively). It was concluded that metoclopramide did not facilitate, and at one dosage hindered, successful passage of a flexible endoscope into the duodenum of healthy dogs under the conditions of the study. Metoclopramide, therefore, cannot be recommended as an aid for passage of a flexible endoscope into the duodenum of dogs.
SUMMARY
Modification of gastroduodenal motility has been proposed to aid endoscopic examination of the duodenum in dogs. The objective of this study was to evaluate the use of the following pharmacologic agents for facilitation of endoscopic intubation of the duodenum in 6 clinically normal dogs: metoclopramide HCl (0.2 mg/kg of body weight), atropine sulfate (0.045 mg/kg), glucagon (0.06 mg/kg), and isotonic saline solution.
In a randomized, blinded, crossover design, the ease of endoscopic duodenal intubation was qualitatively scored by 3 endoscopists (in random order), using the following scale: immediate entry; rapid entry—moderate manipulation; difficult entry—multiple attempts; and no entry after 2 minutes. Anesthesia was induced with thiopental and maintained with halothane. The 4 agents were diluted to a fixed volume and randomly administered. Duodenal intubation was attempted 2 minutes after iv injection of 1 of the agents. Four endoscopic procedures (1 for each agent) were performed on each dog with a minimum of 5 days between each procedure.
In this study, no agent facilitated endoscopic duodenal intubation at the dose used. Instead, atropine and metoclopramide made duodenal intubation significantly more difficult, compared with use of saline solution. Difference between intubation after administration of glucagon and saline solution was not seen. On the basis of our findings, the use of these agents for facilitating endoscopic duodenal intubation is not recommended.
In addition, in this study, we found that experience in endoscopic intubation is an important factor in determining the ease of duodenal intubation.
Abstract
Case Description—An 8-year-old male Golden Retriever was evaluated because of an 8-week history of intermittent diarrhea with melena and hematochezia that were not responsive to medical treatment and resulted in severe anemia.
Clinical Findings—Exploratory celiotomy with intestinal and colonic biopsy revealed mild enterocolitis but did not result in diagnosis of the cause of melena and hematochezia. Endoscopy of the upper portion of the gastrointestinal tract and colonoscopy were performed. Multifocal areas of coalescing, tortuous mucosal blood vessels were observed in the cecum and all regions of the colon. A diagnosis of vascular ectasia (VE) was made on the basis of the endoscopic and histologic appearance of the lesions.
Treatment and Outcome—An ileorectal anastamosis was performed. Melena and hematochezia resolved within 3 days after surgery, and the anemia resolved within 6 weeks after surgery. Surgical resection of the cecum and colon and feeding of a highly digestible diet resulted in long-term (22 months) resolution of clinical signs.
Clinical Relevance—Initial exploratory celiotomy with intestinal and colonic biopsy failed to reveal the VE lesions responsible for the melena, hematochezia, and anemia. Endoscopic evaluation was necessary for detection of the colonic VE lesions. Surgical resection of the cecum and colon and feeding of a highly digestible diet may result in a favorable outcome in affected dogs.
Abstract
Objective—To determine whether substantial interobserver variation exists among diagnostic pathologists for descriptions of intestinal mucosal cell populations and whether histopathologic descriptions accurately predict when a patient does not have clinically evident intestinal disease.
Design—Comparative survey.
Sample Population—14 histologic slides of duodenal, ileal, or colonic tissue from 10 dogs and 3 cats.
Procedure—Each histologic slide was evaluated independently by 5 pathologists at 4 institutions. Pathologists, who had no knowledge of the tissues' origin, indicated whether slides were adequate for histologic evaluation and whether the tissue was normal or abnormal. They also identified the main infiltrating cell type in specimens that were considered abnormal, and whether infiltrates were mild, moderate, severe, or neoplastic.
Results—Quality of all slides was considered adequate or superior by at least 4 of the 5 pathologists. For intensity of mucosal cellular infiltrates, there was uniformity of opinion for 1 slide, near-uniformity for 6 slides, and nonuniformity for 7 slides. Five dogs did not have clinical evidence of intestinal disease, yet the pathologists' descriptions indicated that their intestinal tissue specimens were abnormal.
Conclusions and Clinical Relevance—Substantial interobserver variation was detected. Standardization of pathologic descriptions of intestinal tissue is necessary for meaningful comparisons with published articles. Clinicians must be cautious about correlating clinical signs and histopathologic descriptions of intestinal biopsy specimens. (J Am Vet Med Assoc 2002;220:1177–1182)
