Surgical affection of stomach and cardia in dogs
Affection of stomach and cardia in dogs are Gastric emptying disorder, Gastritis, Gastric dilatation and Volvulus (GDV), Pyloric stenosis etc.
Surgical affection of stomach and cardia in dogs are-
Gastric emptying disorder
Gastric emptying disorder is the three types-
- Accelerated gastric emptying (seen in hyper thyroidism)
- Retrograde or gastroesophageal reflux, Affected animals vomit usually after an overnight fasting
- Delayed gastric emptying due to functional obstruction or mechanical obstruction
Gastritis
The causes of Gastritis are bacterial viral or toxins. gastric ulcers also occur due to neoplasms, corticosteroids, systemic diseases.
Many acute gastric lesions are self limiting.
Gastrotomy
Gastrotomy is the Incision through stomach wall into lumen.
Indication
- Foreign body in stomach
- Gastric Dilatation and volvulus
- Benign gastric outflow obstruction
- Gastric ulceration and erosion
- Gastric neoplasia and infiltrative disease
- Stricture of cardia
- Foreign body in the caudal thoracic oesophagus
Surgical anatomy
Oesophagus entry at cardiac ostium of stomach.
Fundus is relatively smaller in canine and dorsal to cardiac ostium. On radiography gas present.
- Body of stomach: lies against left lobe of liver
- Pyloric antrum: funnel shaped, open into pyloric canal.
- Pyloric ostium: end of pyloric canal and empties into duodenum.
- Blood supply: Aorta, Celiac artery, Gastric artery on lesser curvature & gastroepiploic artery on greater curvature of stomach.
Precaution
Avoid nitrous oxide in Gastric dilatation or torsion or intestinal obstruction, it rapidly diffuse in distended organ and cause additional distension.
Surgical Procedure
- Incision is taken on ventral midline from xiphoid backwards
- Abdominal content is packed;
- Stay sutures are placed on the stomach
- Incision on stomach is made on ventral aspect between greater and lesser curvature at hypo vascular area
- Precaution is taken not to incise near pylorus (closure of incision may cause in infolding of tissue and the outflow may be obstructed
- Stab incision on stomach wall to lumen by scalpel and enlarged with metzenbaum scissors
- Suction is used to aspirate gastric content and to reduce spillage
- After correction of condition based on indication, closure of incision by 2-0 or 3-0 absorbable suture material. Suturing pattern; two layers;
- I layer – Connell suture including all the layers followed by a Lembert/Cushing suture
- Before closing abdomen incision- instrument is substituted with sterile set and gloves are changed
Post operative care
- Monitor fluid status, maintain hydration until animal is drinking. Correct electrolyte abnormalities
- Start feeding 12-24 hrs after surgery if patient is not vomiting.
- Broad spectrum antibiotic
Gastric dilatation and Volvulus (GDV)
Gastric dilatation and Volvulus (GDV) is the enlargement of stomach associated with rotation on its mesenteric axis. It is an emergency condition which warrants immediate surgical intervention
Even in treated animals about 45% mortality is recorded since it is an acute condition. Hence this is considered as an emergency condition.
Clinical signs
- Enlarged abdomen
- Animal recumbent and depressed
- Non productive retching
- Hyper salivation
Physical examination
- General appearance- Dull
- Behavior- Depressed
- Feeding habit- Not satisfactory
- Excretory habit- Normally voided
- Lymph nodes- NAD
- Pulse- Weak
- Respiration- Thoracic
- Skin and coat- Smooth and shiny
- Conjunctival mucous membrane- Pale
Radiography
X-ray radiograph (Right lateral view) of a dog showing gas filled structure (Gastric dilatation)
Pylorus is placed cranial to the body in radiographs of GDV.
Pyloric stenosis
Pyloric stenosis refers to benign muscular hypertrophy of the pylorus.
Pyloric stenosis also known as Benign antral muscular hypertrophy or Congenital hypertrophic stenosis or Congenital pyloric muscle hypertrophy.
Chronic antral mucosal hypertrophy refers to benign hypertrophy of the pyloric mucosa causing outflow obstruction.
Chronic hypertrophic pyloric gastropathy (CHPG) Denotes pyloric hypertrophy without specifying whether the mucosa or the muscularis is involved.
Etiology
The cause of pyloric stenosis is unknown, but it may be due to-
- Hypergastrinemia– major regulator of gastric acid secretion and is trophic for gastric smooth muscle and mucosa
- Gastrin administration to pregnant bitches
- Neurogenic dysfunction– spinal cord disorders
- Acute stress
- Inflammatory disease
- Trauma
- Prolonged gastric distention
- Foreign body
- Neoplasm
Diagnosis
Physical examination and history (Generally nonspecific findings – Weight loss, Anorexia, Depression, Dehydration or Abdominal pain)
Survey radiograph of abdomen may reveal gastric distention (usually filled with fluid) and Contrast Radiographic findings reveals delayed emptying or filling defect in the pylorus (Normal elimination of liquid barium does not rule out gastric outflow obstruction).
Diffrential diagnosis
Any condition that causes vomiting is a differential diagnosis-
- Gastrointestinal foreign body
- Gastritis
- Neoplasia
- Ulceration
- Uremia
- Hypoadrenocorticism
- Diabetic ketoacidosis
- Hepatic insufficiency
- Peritonitis, pancreatitis
- Inflammatory bowl disease
Medical management
- Dehydration, electrolyte & acid – base abnormalities should be corrected
- H-2 blockers.
- Antibiotics is indicated for esophagitis due to ulceration aspiration.
Gastric prokinetics (metoclopramide and cisapride) should not be used if outflow obstruction is suspected.
Surgical management
These surgical procedures are used for pyloric stenosis in dogs-
- Ventral midline celiotomy
- Fredet-Ramstedt pyloromyotomy
- Heineke-Mikulicz pyloroplasty (transverse pyloroplasty)
- Y-U Advancement Pyloroplasty