Management of polyethylene glycol solution aspiration using bronchoscopic lavage in a dog.

Polyethylene glycol lavage solutions are used for colonic preparation in dogs and are considered relatively safe. Aspiration is an uncommon but potentially devastating complication of polyethylene glycol administration. Full recovery is possible and often rapid in people treated with bronchoalveolar lavage. A healthy 2-year-old male Beagle used in an endoscopy teaching laboratory aspirated a small amount of polyethylene glycol lavage solution. Although initially appearing unaffected, the dog quickly became hypoxemic. Bronchoscopy was used to lavage the lungs and aspirate tracheal/pulmonary fluid 5 times over the course of 45 minutes. The dog completely recovered. This report presents the successful treatment of polyethylene glycol aspiration in a dog. Although the seriousness of aspiration might not be immediately evident, bronchoscopy and lavage should be pursued because of the rapidly progressive nature of polyethylene glycol-induced pulmonary edema.

ACVIM consensus statement: Support for rational administration of gastrointestinal protectants to dogs and cats.

The gastrointestinal (GI) mucosal barrier is continuously exposed to noxious toxins, reactive oxygen species, microbes, and drugs, leading to the development of inflammatory, erosive, and ultimately ulcerative lesions. This report offers a consensus opinion on the rational administration of GI protectants to dogs and cats, with an emphasis on proton pump inhibitors (PPIs), histamine type-2 receptor antagonists (H2 RAs), misoprostol, and sucralfate. These medications decrease gastric acidity or promote mucosal protective mechanisms, transforming the management of dyspepsia, peptic ulceration, and gastroesophageal reflux disease. In contrast to guidelines that have been established in people for the optimal treatment of gastroduodenal ulcers and gastroesophageal reflux disease, effective clinical dosages of antisecretory drugs have not been well established in the dog and cat to date. Similar to the situation in human medicine, practice of inappropriate prescription of acid suppressants is also commonplace in veterinary medicine. This report challenges the dogma and clinical practice of administering GI protectants for the routine management of gastritis, pancreatitis, hepatic disease, and renal disease in dogs and cats lacking additional risk factors for ulceration or concerns for GI bleeding. Judicious use of acid suppressants is warranted considering recent studies that have documented adverse effects of long-term supplementation of PPIs in people and animals.

Maximizing the diagnostic utility of endoscopic biopsy in dogs and cats with gastrointestinal disease.

Flexible endoscopy has become a valuable tool for the diagnosis of many small animal gastrointestinal (GI) diseases, but the techniques must be performed carefully so that the results are meaningful. This article reviews the current diagnostic utility of flexible endoscopy, including practical/technical considerations for endoscopic biopsy, optimal instrumentation for mucosal specimen collection, the correlation of endoscopic indices to clinical activity and to histopathologic findings, and new developments in the endoscopic diagnosis of GI disease. Recent studies have defined endoscopic biopsy guidelines for the optimal number and quality of diagnostic specimens from different regions of the gut. They also have shown the value of ileal biopsy in the diagnosis of canine and feline chronic enteropathies, and have demonstrated the utility of endoscopic biopsy specimens beyond routine hematoxylin and eosin histopathological analysis, including their use in immunohistochemical, microbiological, and molecular studies.

Feasibility of endoscopic retrograde cholangiopancreatography in healthy cats.

Cats are predisposed to diseases of the biliary tract and the exocrine pancreas and these can be challenging to diagnose. In humans and dogs > 10 kg, endoscopic retrograde cholangiopancreatography (ERCP) has been successfully used to diagnose some of these disorders. The purpose of our study was to determine whether ERCP would also be feasible in cats using a pediatric duodenoscope. Four purpose-bred, clinically healthy, castrated domestic shorthair cats participated in two studies. Study 1 compared standard white light endoscopy with chromoendoscopy for localizing the major duodenal papilla. In Study 2 ERCP was performed. Repeated clinical examinations and measurements of serum feline pancreatic lipase immunoreactivity (fPLI) were performed before and up to 18 hours after interventions on all cats. Chromoendoscopy was subjectively judged to be superior for localizing the major papilla. Insertion of the ERCP catheter was best accomplished when cats were in dorsal recumbency. Complete ERCP was successful in two cats. In the other cats, either retrograde cholangiography or pancreatography was possible. Serum fPLI concentrations increased temporarily in two cats during Study 2 when measured immediately, 2, 4, and 18 h after ERCP. Peak fPLI concentrations were detected either immediately after ERCP or 2 h later. No clinical signs of complications were observed within 18 h after the procedures. Findings indicated that ERCP is technically demanding but feasible in healthy cats. Future studies need to determine whether the temporary increases in serum fPLI concentrations are clinically important and to investigate the utility of ERCP in feline patients.

Alimentary neoplasia in geriatric dogs and cats.

Lymphomas, carcinomas, leiomyomas, and stromal tumors are the most common tumors found in the canine and feline gastrointestinal tract. Endoscopic and surgical biopsies are often the mainstays of diagnosis, although ultrasound is playing an increasingly greater role. Small cell lymphocytic lymphoma of the feline intestines poses a special diagnostic dilemma and may require immunohistochemistry as well as polymerase chain reaction to distinguish it from lymphocytic-plasmacytic enteritis. This article will focus on the more common neoplastic problems of the esophagus and gastrointestinal tract (GIT) of geriatric dogs and cats.

Diagnosis of congenital portosystemic shunt in miniature schnauzers 7 years of age or older (1997-2006).

Dogs with congenital portosystemic shunt (PSS) are typically diagnosed before 2 years of age. The objective of this study was to determine if miniature schnauzers are more likely to be diagnosed with congenital PSS at an older age than are other breeds. This retrospective study examined the case records of 171 dogs diagnosed with congenital PSS; dogs were included if they were definitively diagnosed as having congenital PSS by nuclear scintigraphy, contrast portography, and/or exploratory surgery. Seven (23%) of 31 miniature schnauzers diagnosed with congenital PSS were 7 years of age or older at the time of diagnosis, compared to 3.4% for all other breeds. Miniature schnauzers had a relative prevalence ratio of 6.3 (95% confidence interval 2.2 to 18.6; P=0.001) for being diagnosed at or after 7 years of age when compared to all other breeds of dogs. Clinical signs of congenital PSS may not manifest sufficiently to cause an owner to seek veterinary care for some dogs until they are older. Congenital PSS should be considered in mature dogs, particularly miniature schnauzers, that are presented with signs potentially consistent with hepatic encephalopathy.

Stability of canine pancreatic lipase immunoreactivity concentration in serum samples and effects of long-term administration of prednisone to dogs on serum canine pancreatic lipase immunoreactivity concentrations.

OBJECTIVE: To evaluate stability of canine pancreatic lipase immunoreactivity (cPLI) in serum samples and to determine the effect of long-term administration of prednisone on serum cPLI concentrations. SAMPLE POPULATION: 8 canine serum samples for the stability evaluation and serum samples obtained from 6 healthy young adult heterozygous (carrier) dogs with X-linked hereditary nephritis for determining the effect of prednisone administration. PROCEDURES: To evaluate stability of serum cPLI concentration, an aliquot of each serum sample was stored at each of 4 temperatures between -80 degrees and 24 degrees C; samples were analyzed on days 0, 3, 7, 14, and 21. To determine the effect of long-term prednisone administration, pretreatment serum samples were obtained (days 0 and 14) and prednisone was administered (2.2 mg/kg, q 24 h, PO) on days 15 through 42, with serum samples obtained on days 28 and 42. Additional serum samples were obtained on days 56 and 70. RESULTS: Mean serum cPLI concentrations did not change significantly from day 0 to day 21 regardless of storage temperature. Serum cPLI concentrations in dogs after prednisone administration were within the reference range for all dogs at all time points, and results of repeated-measures ANOVA revealed that serum cPLI concentrations did not change significantly over time. CONCLUSIONS AND CLINICAL RELEVANCE: Serum cPLI concentrations measured in canine serum samples stored at room temperature, in a refrigerator, or in a freezer at -20 degrees or -80 degrees C were stable for at least 21 days. Also, long-term prednisone administration to dogs did not significantly affect serum cPLI concentrations.

Endoscopic diagnosis of diseases causing vomiting.

Animals that are chronically throwing up can be diagnostic challenges. Endoscopy can be a useful adjunct in the diagnostic and therapeutic approach to many of these patients; however, it is critical that endoscopic examinations be done properly and carefully. Poorly performed endoscopic examinations can miss important lesions, especially when poor biopsy technique results in inadequate tissue samples for the pathologist. Likewise, rough technique (especially when trying to remove foreign objects) can harm the patient.

Assessment of clinical reasoning skills in veterinary students prior to and after the clinical year of training.

OBJECTIVE: To examine the effect of various clinical tracks within the veterinary medical clinical curriculum at Texas A&M University on clinical diagnostic proficiency as determined by pre- and post-training assessment. We expected that the clinical track chosen by the student would impact their measured outcome with bias toward higher scores in their chosen field. DESIGN: Prospective cohort study. STUDY POPULATION: 32 students from the College of Veterinary Medicine and Biomedical Sciences at Texas A&M University. PROCEDURES: By use of standardized, written case scenarios, clinical reasoning was assessed twice: once prior to the clinical (fourth) year of the curriculum and again at completion of the clinical year. Students demonstrated their abilities to collect and organize appropriate clinical data (history, physical examination, and laboratory findings), determine clinical diagnoses, and formulate and implement acceptable treatment modalities. Data from clinical assessments were compared for a given cohort and correlated with other measures (eg, grades, standardized test scores, and species-specific curricular track). RESULTS: Differences were detected in clinical diagnostic proficiency among students in different clinical tracks and for different species groups in the case scenarios. Tracking by species group in the clinical veterinary curriculum appeared to affect development of clinical reasoning and resulted in differential proficiency among cases for differing species groups. CONCLUSIONS AND CLINICAL RELEVANCE: Differences in clinical experiences between small animal tracks and all other track opportunities (large animal, mixed animal, and alternative) influenced the development of clinical proficiency in fourth-year veterinary students during their clinical training period.

Efficacy of famotidine for the prevention of exercise-induced gastritis in racing Alaskan sled dogs.

BACKGROUND: Omeprazole reduces the severity of exercise-induced gastritis but not the prevalence of gastric lesions in sled dogs. The frequent feeding of sled dogs during competition likely results in decreased absorption of omeprazole and, thereby, decreased efficacy. HYPOTHESIS: Famotidine, a histamine-2 blocker with good bioavailability in the presence of food, would reduce the incidence and severity of exercise-induced gastric disease in sled dogs. ANIMALS: Sixteen fit Alaskan sled dogs (4 female, 12 male, all intact, age 2-6 years). METHODS: Dogs were randomly assigned to treatment (22 mg famotidine PO q24h) or control groups (n = 8 per group). Famotidine was administered with a meal to the treatment group once daily for 7 days before a challenge and once during exercise. Control dogs were fed an identical diet as the principal group. The 16 dog team completed a 100-mile exercise challenge in 18 hours. A gastroscopy was performed 24 hours after the challenge. The appearance of the mucosa was scored by an individual by using a scoring system. RESULTS: Treatment with famotidine significantly reduced the severity score compared with control (P = .0004). No adverse effects of treatment were reported. CONCLUSIONS AND CLINICAL RELEVANCE: Famotidine is effective in reducing the severity of exercise-induced gastric disease in racing Alaskan sled dogs, with minimal to no adverse effects, and may be recommended for prophylactic use in short distance races.

Serum chemistry alterations in Alaskan sled dogs during five successive days of prolonged endurance exercise.

OBJECTIVE: To determine the impact of successive days of endurance exercise on select serum chemistry values in conditioned Alaskan sled dogs. DESIGN: Prospective cohort study. ANIMALS: 10 conditioned Alaskan sled dogs. PROCEDURES: All dogs ran 160 km/d for 5 consecutive days. Serum was obtained prior to exercise and immediately after each exercise run; all samples were obtained before dogs were fed. Serum electrolyte, mineral, protein, total bilirubin, urea nitrogen, creatinine, and cardiac troponin-I concentrations and serum alkaline phosphatase, alanine aminotransferase, creatine kinase, and aspartate aminotransferase activities were measured. Data were analyzed by means of analysis of covariance for a randomized complete block design with dog as a blocking variable, time as a covariate, and distance run as the treatment of interest. Least square mean values were compared with values obtained prior to exercise, and linear and quadratic contrasts were examined. RESULTS: Serum globulin concentration was low prior to exercise (mean +/- SD, 2.2 +/- 0.3g/dL) and progressively decreased as exercise continued. Exercise was associated with increases in serum chloride, urea nitrogen, and cardiac troponin-I concentrations and serum alanine aminotransferase, creatine kinase, and aspartate aminotransferase activities and with progressive decreases in serum potassium, total protein, and albumin concentrations. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that multiple successive days of endurance exercise resulted in mild aberrations in serum chemistry variables in conditioned sled dogs. Changes likely reflected the metabolic stresses of prolonged endurance exercise as well as dietary composition. Hypoglobulinemia in resting, conditioned sled dogs may reflect the immunosuppressive or catabolic effects of intense endurance training.

Sustained strenuous exercise increases intestinal permeability in racing Alaskan sled dogs.

We assessed gastric and intestinal permeability and performed gastroscopy to evaluate the effects of sustained strenuous exercise on the gastrointestinal tract in racing sled dogs. Three teams of racing Alaskan sled dogs were examined approximately 1 week before and 24 hours after the 2003 Iditarod sled dog race (1,100 miles in 10 days). Each examination consisted of the administration of a solution of sucrose, lactulose, and rhamnose to evaluate gastric and intestinal permeability, as well as gastroscopy to visually inspect the gastric mucosa. Of the 54 dogs examined before the race, 16 completed the course and contributed data to the analysis. Sustained strenuous exercise was associated with an increased frequency of gastric erosions or ulcerations seen endoscopically (0% prerace versus 61% postrace). A significant postrace increase occurred in the median lactulose to rhamnose ratio in both serum and urine (0.11 versus 0.165, P = .0363; 0.11 versus 0.165, P = .0090, respectively). No significant differences were found in median serum or urinary sucrose concentrations when pre- and postrace values were compared. No correlation was found between visible gastric lesions and the concentration of sucrose in serum or urine samples obtained 4-5 hours after administration of the sugar solutions. We conclude that sustained strenuous exercise is associated with increased intestinal permeability, but the sucrose permeability test as we performed it did not correlate with visible gastric lesions.

Clinicopathological abnormalities and treatment response in 24 dogs seroreactive to Bartonella vinsonii (berkhoffii) antigens.

Bartonella vinsonii (B. vinsonii) subspecies berkhoffii is a recently recognized cause of endocarditis, myocarditis, and granulomatous disease in dogs. In an effort to elucidate other potential disease manifestations, the case records of 24 dogs that were seroreactive to B. vinsonii (berkhoffii) antigens were studied retrospectively. Diagnoses included immune-mediated hemolytic anemia, neutrophilic or granulomatous meningoencephalitis, neutrophilic polyarthritis, cutaneous vasculitis, and uveitis. Repeated B. vinsonii (berkhoffii) antibody titers became negative after treatment. This study indicates that a diverse spectrum of disease manifestations and clinicopathological abnormalities can be detected in dogs that are seroreactive to B. vinsonii (berkhoffii) antigens.

Esophagitis and esophageal strictures.

Esophagitis and esophageal strictures are important causes of esophageal disease in dogs and cats. Clinical suspicion is created when the clinician recognizes the clinical signs suggestive of esophageal disease and accounts for historical information and physical examination findings. Once suspected, the diagnosis of esophagitis and esophageal strictures is a fairly simple one in most cases. Although the benefit of diminishing secretion of gastric acid in patients with esophagitis is unquestioned, other questions regarding adjunctive medical treatments, such as sucralfate and glucocorticoids for dogs and cats with esophagitis, have not been answered through appropriate clinical studies. Esophageal strictures are readily treated with balloon dilation or esophageal bougienage, and clients can expect most patients to become functional, although dietary change may be necessary.

Protein-losing enteropathies.

GI protein loss can result from a heterogeneous group of diseases, including lymphangiectasia, IBD, neoplasia, ulceration, intussusception, and histoplasmosis. PLE should be suspected in any hypoalbuminemic patient with no evidence of exudative protein loss, proteinuria, or HI. A minimum laboratory database for the suspected PLE patient should include a complete blood cell count, a biochemical and electrolyte profile, urinalysis (+/- urine protein:cretinine ratio), and pre- and postprandial bile acid determinations. Fecal alpha 1-PI concentrations may be used to confirm the presence of GI protein loss in cases with concurrent renal or hepatic disease. Because PLE is a syndrome and not a specific disease, the most effective therapy must be directed at the underlying cause. Multiple high-quality endoscopic biopsies are sufficient to diagnose most patients with PLE, although full-thickness biopsies are required in some cases. Patients with PLE are often clinically "fragile," and careful symptomatic therapy must be integrated with dietary and medical management strategies in most cases.

Biopsy of the gastrointestinal tract.

Gastrointestinal biopsy is a potentially powerful tool, but it is easy to do it incorrectly. If clinicians are careless in performing or submitting biopsies, or if they blindly believe whatever the histopathology report says, they are abdicating their responsibility to the client and patient. Two comments seem most appropriate. First, the goal of endoscopy is not to be able to place the tip of an endoscope in a particular location; rather, the goal of endoscopy is to be able to access a particular location and then take a diagnostic specimen well enough that surgery can be avoided. Second, attention to detail is worth at least as much if not more than technology.

Protein-losing enteropathy associated with cystic mucoid changes in the intestinal crypts of two dogs.

Two dogs were emaciated and hypoalbuminemic due to protein-losing enteropathy associated with a severe, focal, mucoid, cryptal ectasia of the duodenum and marked villus atrophy. In one case, diseased portions of the duodenum were obvious endoscopically and were limited to discrete, focal areas in the small intestine, with apparently more undiseased tissue than diseased tissue being present. The signs and lesions in one dog resolved after initiating combination dietary and pharmacological therapy.

Interobserver variation among histopathologic evaluations of intestinal tissues from dogs and cats.

OBJECTIVE: To determine whether substantial interobserver variation exists among diagnostic pathologists for descriptions of intestinal mucosal cell populations and whether histopathologic descriptions accurately predict when a patient does not have clinically evident intestinal disease. DESIGN: Comparative survey. Sample Population-14 histologic slides of duodenal, ileal, or colonic tissue from 10 dogs and 3 cats. PROCEDURE: Each histologic slide was evaluated independently by 5 pathologists at 4 institutions. Pathologists, who had no knowledge of the tissues' origin, indicated whether slides were adequate for histologic evaluation and whether the tissue was normal or abnormal. They also identified the main infiltrating cell type in specimens that were considered abnormal, and whether infiltrates were mild, moderate, severe, or neoplastic. RESULTS: Quality of all slides was considered adequate or superior by at least 4 of the 5 pathologists. For intensity of mucosal cellular infiltrates, there was uniformity of opinion for 1 slide, near-uniformity for 6 slides, and nonuniformity for 7 slides. Five dogs did not have clinical evidence of intestinal disease, yet the pathologists' descriptions indicated that their intestinal tissue specimens were abnormal. CONCLUSIONS AND CLINICAL RELEVANCE: Substantial interobserver variation was detected. Standardization of pathologic descriptions of intestinal tissue is necessary for meaningful comparisons with published articles. Clinicians must be cautious about correlating clinical signs and histopathologic descriptions of intestinal biopsy specimens.