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Diseases of the stomach
/content/chapter/10.22233/9781910443361.chap19
Diseases of the stomach
- Author: Kenneth W. Simpson
- From: BSAVA Manual of Canine and Feline Gastroenterology
- Item: Chapter 19, pp 151 - 175
- DOI: 10.22233/9781910443361.19
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Copyright:
- Publication Date: January 2005
Abstract
PLEASE NOTE THAT A MORE RECENT EDITION OF THIS TITLE IS AVAILABLE IN THE LIBRARY
The stomach functions as a reservoir that controls the size and rate of passage of ingesta into the small intestine, and initiates the digestion of protein and fat, and the absorption of vitamins and minerals. The stomach is made up of four functional regions: the cardia, fundus, body and antrum. The fundus and body expand to accommodate ingesta. The antrum is thick and muscular and grinds food into small particles that are triturated into the duodenum. The pyloric sphincter controls efflux into the duodenum, and the lower oesophageal sphincter prevents reflux of ingesta into the oesophagus. This chapter looks into Structure and function; Diagnostic approach; Evaluating gastric function; and Diseases of the stomach.
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Figures
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19.1
Functional anatomy of the stomach. Inset A = fundic mucosa; Inset B = pyloric mucosa showing gastrin-positive cells stained brown. © 2005 British Small Animal Veterinary Association
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19.1
Functional anatomy of the stomach. Inset A = fundic mucosa; Inset B = pyloric mucosa showing gastrin-positive cells stained brown.
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19.2
Regulation of acid secretion. ACh = acetylcholine receptor; ATPase = adenosine triphosphatase; ECL = enterochromaffin-like cell; GRP = gastrin-releasing peptide; H2 = histamine H2 receptor and PGE = prostaglandin E2 receptor. (Reproduced from
Simpson et al. (2000a)
; © Kenneth Simpson. With permission from the publishers) © 2005 British Small Animal Veterinary Association
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19.2
Regulation of acid secretion. ACh = acetylcholine receptor; ATPase = adenosine triphosphatase; ECL = enterochromaffin-like cell; GRP = gastrin-releasing peptide; H2 = histamine H2 receptor and PGE = prostaglandin E2 receptor. (Reproduced from
Simpson et al. (2000a)
; © Kenneth Simpson. With permission from the publishers)
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19.3
Helicobacter-associated gastritis. Helicobacter infection is best diagnosed from impression smears or biopsy samples. (a) Numerous spiral organisms are visible in this Diff-Quik-stained impression smear of gastric juice. (b) Modified Steiner-stained, formalin-fixed, paraffin-embedded biopsy sample showing Helicobacter organisms stained dark blue. (c) Lymphoid follicle hyperplasia and lymphocytic gastritis in a cat with H. felis-associated gastritis (H&E stain). The significance of Helicobacter infection is based on the presence of histopathological changes on biopsy. © 2005 British Small Animal Veterinary Association
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19.3
Helicobacter-associated gastritis. Helicobacter infection is best diagnosed from impression smears or biopsy samples. (a) Numerous spiral organisms are visible in this Diff-Quik-stained impression smear of gastric juice. (b) Modified Steiner-stained, formalin-fixed, paraffin-embedded biopsy sample showing Helicobacter organisms stained dark blue. (c) Lymphoid follicle hyperplasia and lymphocytic gastritis in a cat with H. felis-associated gastritis (H&E stain). The significance of Helicobacter infection is based on the presence of histopathological changes on biopsy.
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19.7
Contrast radiographic evaluation of a dog presented for investigation of chronic vomiting. (a) Survey radiographs show a soft tissue density in the antrum (arrowed). (b and c). Left lateral and ventrodorsal radiographs show retention of liquid barium contrast, revealing the presence of a mass in the pyloric outflow tract (arrowed). © 2005 British Small Animal Veterinary Association
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19.7
Contrast radiographic evaluation of a dog presented for investigation of chronic vomiting. (a) Survey radiographs show a soft tissue density in the antrum (arrowed). (b and c). Left lateral and ventrodorsal radiographs show retention of liquid barium contrast, revealing the presence of a mass in the pyloric outflow tract (arrowed).
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19.8
Imaging of the stomach with ultrasonography and endoscopy provides complementary information. The ultrasonogram shows a mass projecting into the lumen of the stomach of a dog presented for the investigation of vomiting and hyperglobulinaemia (IgA). Endoscopy confirmed the presence of a mass and enabled a biopsy diagnosis of gastric plasmacytoma. © 2005 British Small Animal Veterinary Association
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19.8
Imaging of the stomach with ultrasonography and endoscopy provides complementary information. The ultrasonogram shows a mass projecting into the lumen of the stomach of a dog presented for the investigation of vomiting and hyperglobulinaemia (IgA). Endoscopy confirmed the presence of a mass and enabled a biopsy diagnosis of gastric plasmacytoma.
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19.10
Hypersecretion of gastric acid can be caused by decreased elimination of gastrin in patients with renal failure, or the excessive production of histamine from mast cell tumours or gastrin from gastrinomas. Renal failure should be detected by measuring the serum creatinine concentration and urine specific gravity. Cutaneous masses and an enlarged spleen should be aspirated for evidence of mast cells. (a) Fine needle aspirate of a cutaneous mass on a dog with vomiting associated with mastocytosis showing round cells containing cytoplasmic pink-stained granules. (b) Ultrasonographic detection of splenomegaly in a cat with chronic vomiting enabled fine needle aspiration and cytological diagnosis of mastocytosis. (c and d) Endoscopic appearance of (c) the oesophagus and (d) the pyloric antrum of a dog with a gastrinoma. Note the small multifocal haemorrhages and erythema in the oesophagus consistent with oesophagitis and mucosal erosion, and antral hypertrophy in the stomach. (e) Duodenal perforation in a dog with a pancreatic gastrinoma. (f) Gastrin-secreting mass (gastrinoma) found in the pancreas of a dog. © 2005 British Small Animal Veterinary Association
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19.10
Hypersecretion of gastric acid can be caused by decreased elimination of gastrin in patients with renal failure, or the excessive production of histamine from mast cell tumours or gastrin from gastrinomas. Renal failure should be detected by measuring the serum creatinine concentration and urine specific gravity. Cutaneous masses and an enlarged spleen should be aspirated for evidence of mast cells. (a) Fine needle aspirate of a cutaneous mass on a dog with vomiting associated with mastocytosis showing round cells containing cytoplasmic pink-stained granules. (b) Ultrasonographic detection of splenomegaly in a cat with chronic vomiting enabled fine needle aspiration and cytological diagnosis of mastocytosis. (c and d) Endoscopic appearance of (c) the oesophagus and (d) the pyloric antrum of a dog with a gastrinoma. Note the small multifocal haemorrhages and erythema in the oesophagus consistent with oesophagitis and mucosal erosion, and antral hypertrophy in the stomach. (e) Duodenal perforation in a dog with a pancreatic gastrinoma. (f) Gastrin-secreting mass (gastrinoma) found in the pancreas of a dog.
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19.13
Gastric ulceration caused by ibuprofen before and after 1 week’s treatment with cimetidine and sucralfate. © 2005 British Small Animal Veterinary Association
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19.13
Gastric ulceration caused by ibuprofen before and after 1 week’s treatment with cimetidine and sucralfate.
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19.14
Gastric ulceration associated with a gastric carcinoma. Note the mucosal thickening surrounding the ulcer compared with the NSAID-induced ulcer in
Figure 19.13
. © 2005 British Small Animal Veterinary Association
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19.14
Gastric ulceration associated with a gastric carcinoma. Note the mucosal thickening surrounding the ulcer compared with the NSAID-induced ulcer in
Figure 19.13
.
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19.15
Radiographic diagnosis of gastric dilatation (top row), and dilatation and volvulus (bottom row). Right and left lateral, and dorsoventral radiographs showing gastric compartmentalization with the pylorus (*) separated from the fundus by a soft tissue density in the lower row. © 2005 British Small Animal Veterinary Association
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19.15
Radiographic diagnosis of gastric dilatation (top row), and dilatation and volvulus (bottom row). Right and left lateral, and dorsoventral radiographs showing gastric compartmentalization with the pylorus (*) separated from the fundus by a soft tissue density in the lower row.
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19.16
A standardized photographic scale for atrophy, fibrosis and cellular infiltrate. 0 = normal; 1 = mild; 2 = moderate; 3 = severe. (Reproduced from Wiinberg et al. (in press) with permission from the American College of Veterinary Internal Medicine) © 2005 British Small Animal Veterinary Association
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19.16
A standardized photographic scale for atrophy, fibrosis and cellular infiltrate. 0 = normal; 1 = mild; 2 = moderate; 3 = severe. (Reproduced from Wiinberg et al. (in press) with permission from the American College of Veterinary Internal Medicine)
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19.17
Hypertrophic gastropathy. (a) Diffuse fundic hypertrophy. (b) Multifocal fundic hypertrophy. (c) Endoscopic view of antral mucosal hypertrophy. (d) Appearance of antral mucosal hypertrophy caused by Pythium spp. infection, resected at surgery. © 2005 British Small Animal Veterinary Association
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19.17
Hypertrophic gastropathy. (a) Diffuse fundic hypertrophy. (b) Multifocal fundic hypertrophy. (c) Endoscopic view of antral mucosal hypertrophy. (d) Appearance of antral mucosal hypertrophy caused by Pythium spp. infection, resected at surgery.
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19.19
Marked retention of barium in a cat with delayed gastric emptying associated with submucosal infiltration with neutrophils. © 2005 British Small Animal Veterinary Association
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19.19
Marked retention of barium in a cat with delayed gastric emptying associated with submucosal infiltration with neutrophils.
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19.20
The use of barium impregnated polyethylene spheres (BIPS) to evaluate gastric emptying. This radiograph shows the accumulation of BIPS in the gastric body. © 2005 British Small Animal Veterinary Association
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19.20
The use of barium impregnated polyethylene spheres (BIPS) to evaluate gastric emptying. This radiograph shows the accumulation of BIPS in the gastric body.
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19.22
Benign gastric tumours. (a) An ulcerated gastric leiomyoma (arrowed) in the cardia of a dog. (b) Adenomatous polyp (arrowed) in the pyloric outflow tract of a dog. © 2005 British Small Animal Veterinary Association
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19.22
Benign gastric tumours. (a) An ulcerated gastric leiomyoma (arrowed) in the cardia of a dog. (b) Adenomatous polyp (arrowed) in the pyloric outflow tract of a dog.
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19.23
Malignant gastric tumours. Endoscopic appearance of (a) diffuse gastric adenocarcinoma (arrowed), (b) focal gastric adenocarcinoma (arrowed) and (c) gastric lymphoma with infiltration of all rugae in the visual field. © 2005 British Small Animal Veterinary Association
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19.23
Malignant gastric tumours. Endoscopic appearance of (a) diffuse gastric adenocarcinoma (arrowed), (b) focal gastric adenocarcinoma (arrowed) and (c) gastric lymphoma with infiltration of all rugae in the visual field.