3 month history of vomiting at least several times daily, usually associated with food, but timing not consistent. Bowel movements small, but formed. Multiple diets have been tried. Blood work is WNL including an ACTH stim. In last several days, has stopped eating and drinking. Maropitant was started last week and that did subside the vomiting.
Initial ultrasound showed a large amount of partially shadowing, spherical, hyperechoic ingesta (up to 1.5 cm diameter) in the stomach fundus along with a large amount of fluid and gas. Pyolorus WNL. Suspected kibble and delayed gastric emptying. Mild enteritis and mild increase in echogenicity surrounding the pancreas. Otherwise unremakable.
Plan was to repeat abdominal ultrasound 6 days from the original ultrasound with a 24 hour fast. Patient has fasted herself beyond the 24 hours with anorexia. I’m concerned about potential for something like a wrapper floating around in the fundus with all the gas shadowing and the VD radiograph, but may be overinterpretting. Also wondering what you think about the dorsal stomach wall in the video I could provide. Treating for delayed motility and mild pancreatitis and potential next steps endoscopy with biopsies, TX A&M panel, Helicobacter trial treatment.
Would greatly appreciate any input!
Comments
Pretty wicked gastric wall thickenign and loss of mrual detail especially in the caudal aspect of the pyloric antrum. Meets neoplastic criteria like sclerosing carcinoma but sever gastritis can do this as well. Scope or full thicknes bx warranted. If there are portal or regional rounded LNs you can fna those to start but sampling needed here. If the owner won’t do anything then try a helicobacter protocol and canned small tid feedings for 3 weeks and rescan at that point if makign positive progress but i highly encourage sampling. USG fna of the gastric wall here i dont think will give the answer needs bx…. scope may not get it totally either so surgical shopping spree of bx would be my choice if possible.
Thank you so much, Eric. Did you appreciate anything on the radiographs? I’m assuming all the gas shadowing in the stomach is just from poor motility, but if you have other thoughts, please share.
just gas related to GI upset on rads. Not obstructive
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Jumping in a bit late but consider pythiosis if it is a player in your part of the country.