-11 year old female spayed Shih-Tzu
– ADR, refused treats
– initially reported no vomiting but then said there was a very large puddle of vomitus that they thought must have been from the laborador
– bloodwork slight elev WBC all else normal
– to me it looks like the stomach walll in the pylorus area is abnormal. The stomach was very full. On radiographs there is a circular mass effect at location of pylorus on lateral.
-11 year old female spayed Shih-Tzu
– ADR, refused treats
– initially reported no vomiting but then said there was a very large puddle of vomitus that they thought must have been from the laborador
– bloodwork slight elev WBC all else normal
– to me it looks like the stomach walll in the pylorus area is abnormal. The stomach was very full. On radiographs there is a circular mass effect at location of pylorus on lateral.
Comments
Discliamer scope and bx
Discliamer scope and bx or full thickness always best here but here is my assessment based on tendencies:
Not likely neoplasia here because curvilinear patterns are maintained just a bit lumpy form chronic inflammation and peristalsis is solid. Neoplasia loses detail and lacks peristalsis typically. The submucosa is in tact which is a key element here (small arrows). The muscularis is hypertrophied (long arrow) and some echogenic hypertrophy of the mucosae (middle arrow). This doesn’s have all the criteria of hypertrophic pyloric gastropathy (wall 0.8 cm muscularis 0.6 cm) but same difference. I see delayed outflow with these guys a lot. Scope for mucosal bx but my empirical trial is this to cover for helicbacter for 3-4 weeks and resassess the clinical signs and US. Anything dry will just sit there on these guys so slurry first then move to canned bid feedings long term. Won’t likely resolve completely but getting him manageable on bid canned usually works without sx:
Helicobacter/Gastritis protocol
A clinical trial of Zithromax (Dogs: 5-10 mg/kg p.o. q24h. May increase dosing interval to q48h after 3-5 days of treatment), Metronidazole (10-20 mg/kg po bid) , Pepcid ( 0.5-1 mg/kg sid) and Sucralfate (0.5-2 g/dog PO) or Omeprazole (1 mg/kg po sid) over the next 3 weeks along with a novel-protein or hydrolyzed diet with slurry feeding bid/tid. over the next 2-4 days and then increase to canned diet bid. Dry food should be avoided over the next 4 weeks. A recheck sonogram to assess GI improvement or progression would be ideal in 4 weeks.
If you do this please upload 3 week follow-up image sets:)
Discliamer scope and bx
Discliamer scope and bx or full thickness always best here but here is my assessment based on tendencies:
Not likely neoplasia here because curvilinear patterns are maintained just a bit lumpy form chronic inflammation and peristalsis is solid. Neoplasia loses detail and lacks peristalsis typically. The submucosa is in tact which is a key element here (small arrows). The muscularis is hypertrophied (long arrow) and some echogenic hypertrophy of the mucosae (middle arrow). This doesn’s have all the criteria of hypertrophic pyloric gastropathy (wall 0.8 cm muscularis 0.6 cm) but same difference. I see delayed outflow with these guys a lot. Scope for mucosal bx but my empirical trial is this to cover for helicbacter for 3-4 weeks and resassess the clinical signs and US. Anything dry will just sit there on these guys so slurry first then move to canned bid feedings long term. Won’t likely resolve completely but getting him manageable on bid canned usually works without sx:
Helicobacter/Gastritis protocol
A clinical trial of Zithromax (Dogs: 5-10 mg/kg p.o. q24h. May increase dosing interval to q48h after 3-5 days of treatment), Metronidazole (10-20 mg/kg po bid) , Pepcid ( 0.5-1 mg/kg sid) and Sucralfate (0.5-2 g/dog PO) or Omeprazole (1 mg/kg po sid) over the next 3 weeks along with a novel-protein or hydrolyzed diet with slurry feeding bid/tid. over the next 2-4 days and then increase to canned diet bid. Dry food should be avoided over the next 4 weeks. A recheck sonogram to assess GI improvement or progression would be ideal in 4 weeks.
If you do this please upload 3 week follow-up image sets:)
Thank you. This dog belongs
Thank you. This dog belongs to one of our receptionists so we should be able to get follow-up images.
Thank you. This dog belongs
Thank you. This dog belongs to one of our receptionists so we should be able to get follow-up images.