– 5 month old male Labrador Ret. who had a one day history of vomiting with some frank blood in it 3 days prior to ultrasound
– rDVM started the dog on sulcrate and rice/ground beef diet and gave cernia injection on that day
– clinically dog is doing well, maybe a little quieter – no v/d since episode and eating well but owner concerned as two weeks prior she thought the dog ate a small flashlight that clipped onto the leash as it had gone missing – she did not see the dog eat it though.
– scan revealed no evidence of a FB or obstuctive pattern
– 5 month old male Labrador Ret. who had a one day history of vomiting with some frank blood in it 3 days prior to ultrasound
– rDVM started the dog on sulcrate and rice/ground beef diet and gave cernia injection on that day
– clinically dog is doing well, maybe a little quieter – no v/d since episode and eating well but owner concerned as two weeks prior she thought the dog ate a small flashlight that clipped onto the leash as it had gone missing – she did not see the dog eat it though.
– scan revealed no evidence of a FB or obstuctive pattern
– pyloric-duodenal junction normal (what do you think?)
– thickened pyloric wall with wall layering maintained and moderately thickened/hypertrophic muscularis layer with a diffuse pattern of hyperechoic speckles and striations
So what has caused this lesion? Severe gastritis caused by dietary indiscretion, FB that has passed, food allergey, giardia or other internal parasites?
Could this be some sort of congenital hypertrophy and fibrosis? Anything that looks like pyloric stenosis? Would like to get this patient back and rescan in a week or two. Any thoughts?
– the fundus and the body of the stomach was much less drastically thickened however some hypechoic speckles noted in the muscularis layer there as well
Comments
Chronic gastritis for sure
Chronic gastritis for sure with the thickened echogenic submucosal layer and hypertrophied muscularis. Subjectively the pylorus looks stenotic but would need scope or manual assessment to confirm. Try slurry feeding hydrolyzed diet TID and helicobacter protocol on the meantime and see if it settles down in a few weeks. Then the stenosis might be clearer.
Jacquie , you got nice images
Jacquie , you got nice images of the pylorus. In my experience with confirmed cases of helicobacter one of the things that I see is scarring or fibrosis within both the mucosa and sub mucosa layering. It is often regional and seen in the pyloric antrum. It can be seen as parallel striations in the mucosa as well. I do not observe any of these changes in these attachements. I do not have images of this on this laptop, sorry. I assume that the hypertrophied muscularis is limited to the pyloric area secondary to the restrictive outflow. This is not a true blockage but simply swelling that is impeeding the exit of gastric contents. This equates in greater resistance and as a consequence increased contractile force needed to be exerted by the muscle layering to empty the stomach. This results in hypertrophy.
It takes time to develop these changes so this may be more chronic then once thought.If I were a betting man some degree of food sensitivity would be highest on my list. I think that Eric’s suggestion of adding a hydrolised diet fits well for this patient. A trial of venisson may be another option. You may want to add benadryl or claritin for 10 days then rescan as suggested.
Thanks Eric and Bob
This is a
Thanks Eric and Bob
This is a bit of a strange one as the patient is young and ultrasound suggests a chronic condition and the history only has the dog a single day of vomting – but it is a lab and they can have guts of steal.
I have recommended a low residue or hypoallergenic diet (I am really liking the Rayne Kangaroo formula lately) and to rescan. I am up for a scope if need be.
Jacquie
I agree its a young dog maybe
I agree its a young dog maybe PS underneath or parasitism or something underlying but it only takes a few weeks for scar formation to occur like we have here in the submucosal layer… if you have ever followed an acute to chronic hepatitis you will see subtle changes progress with increased portal markings and such. I think the same is possible here. Bob possibly has followed something like this in house from normal to chronic Gi changes over time. Being mobile its tough to do so much less get histopoath. Bob do you have anything like this with Gi cases?
Regarding scope you may miss the boat on the histopath here with scope acquired mucosa and maybe submucosa because you want muscularis and submucosa with the mucosa in your sample so I would encourage full thickness and palpate the pylorus for stenosis as well. Maybe be ready to do a pyloroplasty if need be.
Eric,I do. I’m first going to
Eric,I do. I’m first going to attach a video of the striping so often seen in these cases within the muscularis layering. I’m going into appointments right now and will add other comments in a few hours time. Have a good day.
Eric I was trying to attach a
Eric I was trying to attach a video but I guess when you are this deep in a discussion that it cannot be added. So if you are both OK with it, I will start a new discussion along this topic line. I am sorry if I am messing this thread up continuity wise. I am still learning.
Hi Dr. Hylands if you would
Hi Dr. Hylands if you would like you can send your video to me at kelly.vazquez@sonopath.com and I can insert it into the post. 🙂 -Kelly
Bob you can start a new
Bob you can start a new thread and just paste the URL on the thread. Im hoping an eventual Soite overhaul would add this feature but trying to find a solid anmd effective Drupal webmaster can be very challenging. If you have one out there please email info@sonopath.com🙂
Heres a new thread I started
Heres a new thread I started on the worm burden subject
https://sonopath.com/forum/gi-worm-burden-ultrasound#comment-5570