Clinical findings and results of diagnostic imaging in 82 dogs with gastrointestinal ulceration.

E Fitzgerald,C R Lamb,D Barfield,K C L Lee

doi:10.1111/jsap.12631

E Fitzgerald, C R Lamb + Show 2 more

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https://doi.org/10.1111/jsap.12631

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Abstract

To describe clinical and imaging findings in dogs with confirmed gastrointestinal ulceration, to compare findings in dogs with perforated and non-perforated ulcers and to estimate the sensitivities of radiography, ultrasonography and computed tomography (CT) for gastrointestinal ulceration and perforation. Retrospective review of medical records of 82 dogs that had a macroscopic ulcer in the gastric or intestinal mucosa diagnosed directly at endoscopy, surgery or necropsy and had survey radiography, ultrasonography or a CT scan of the abdomen during the same period of hospitalisation. The most frequent clinical signs were vomiting in 88% dogs, haematemesis in 32%, melaena in 31% and weight loss in 7%. The most frequent imaging findings in dogs with non-perforated ulcers were gastrointestinal mural lesion in 56%, mucosal defect compatible with an ulcer in 44% and peritoneal fluid in 21%. In dogs with perforated ulcers the most frequent imaging findings were peritoneal fluid in 83%, gastrointestinal mural lesion in 48%, peritoneal gas in 31% and mucosal defect compatible with an ulcer in 29%. Sensitivities of radiography, ultrasonography and CT were 30, 65 and 67% in dogs with non-perforated ulcers and 79, 86 and 93% in dogs with perforated ulcers, respectively. In dogs with non-perforated ulcers, survey radiography was usually negative whereas ultrasonography and CT frequently enabled detection of the site of the ulcer; in dogs with perforated ulcers, radiography was frequently positive for peritoneal gas and CT was a sensitive modality for both the ulcer and signs of perforation.

Highlights

Perforation found regional hyperechoic mesenteric fat in 100%, peritoneal fluid in 84% and peritoneal air in 47% (Boysen and others 2003). These results suggest that ultrasonography could be a sensitive method for diagnosis of GI perforation; other studies have found problems with the ultrasonographic diagnosis of both GI ulceration and perforation
Radiographs were made with vertical x-ray beam in all dogs with additional radiographs in selected cases made with a horizontal x-ray beam and the dog in lateral recumbency to look for pneumoperitoneum (Day and Pechman 2012)
The frequency of prior administration of non-steroid anti-inflammatory drugs (NSAIDs) in dogs in the present study is compatible with previous reports that this is a major predisposing cause for GI ulceration in dogs

Summary

Introduction

Gastrointestinal (GI) ulceration in dogs is a well-recognised condition that may occur following administration of anti-inflammatory drugs (Cariou and others 2009, Dayer and others 2013, Enberg and others 2006, Lascelles and others 2005, Monteiro-Steagall and others 2013, Stanton and Bright1989) or corticosteroids (Rohrer and others 1999, Neiger and others 2000), ingestion of sharp foreign objects or magnets (Hickey and Magee 2011), strenuous exercise (Davis and others 2006, Ritchey and others 2011), primary gastrointestinal neoplasia (Gualtieri and others 1999, von Babo and others 2012), mastocytosis (Murray and others 1972, Stanton and Bright 1989), inflammatory bowel disease (Jergens and others 1992, Rallis and others 1998), hepatic disease (Murray and others1972, Stanton and Bright 1989), uraemia (Peters and others 2005) or without any apparent predisposing condition. Gastrointestinal (GI) ulceration in dogs is a well-recognised condition that may occur following administration of anti-inflammatory drugs Dogs with GI ulceration may present with acute abdominal signs, including pain, distension or vomiting, or with vague and non-specific signs including lethargy, inappetence, weakness and collapse (Murray and others 1972, Stanton and Bright 1989). When peritoneal fluid is identified, ultrasound-guided paracentesis enables prompt detection of signs of septic peritonitis, such as intracellular bacteria in white blood cells, and low glucose or high lactate concentration in peritoneal fluid compared to blood or plasma (Bonczynski et al 2003, Cortellini and others 2015, Koenig and Verlander 2015)

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