Posts Tagged ‘endoscopy’

Is It Vomiting or Is It Regurgitation?

Sunday, July 22nd, 2012

Boomer, an adorable and effervescent young Cairn Terrier, was recently referred to me for vomiting of three days duration. This mischievous little boy raided the kitchen garbage the day before the vomiting began. Neither blood work nor abdominal X-rays performed by the referring veterinarian provided a diagnosis. When I questioned Boomer’s family, I learned that their dog was bringing up clear fluid after drinking and undigested food after eating. Additionally, none of the retching that dogs typically do right before vomiting had been observed. This history provided some big clues that redirected my thinking. Boomer was likely regurgitating rather than vomiting.

Vomiting occurs when food or liquid is expelled from the stomach or upper small intestine, and is preceded by some audible retching (no different than when you or I are nauseated and hovering over the toilet). The vomited material may consist of clear liquid if it originates from the stomach, yellow or green liquid if it originates from the small intestine, or food that appears undigested or partially digested.

Regurgitation differs from vomiting in that the expelled material almost always originates from within the esophagus- the muscular tube that propels food, water, and saliva from the mouth down into the stomach. The regurgitated material consists of water, saliva, or undigested food that comes spewing forth without any audible retching or warning. Regurgitation typically takes the dog and anyone in close proximity completely by surprise. Because the event is so sudden, the larynx (the opening to the windpipe) doesn’t have time to close, and some of the regurgitated material can be inhaled into the lungs resulting in aspiration pneumonia.

So, why is it important to differentiate whether my patient is regurgitating or vomiting? Here’s the reason. The tests for determining the cause of regurgitation are different than those used to determine the cause of vomiting. And the more wisely diagnostic tests are selected, the more expediently a diagnosis is established (better for my patient as well as my client’s pocket book). Diagnostic testing for regurgitation involves evaluation of the esophagus. Diagnostics for the vomiting patient evaluate the stomach and small intestine and screen for other diseases such as kidney failure, liver disease, and pancreatitis all of which can cause vomiting.

So, what ever happened with Boomer? Given his history, I recommended X-rays of his chest cavity (where the esophagus lives). Low and behold, the images revealed a piece of bone lodged within his esophagus. Using an endoscope (a long telescope device) and some fancy foreign body retrievers I was able to nonsurgically remove Boomer’s foreign body. We treated the resulting esophageal inflammation with medications and counseled his family on preventing their little darling from tampering with the garbage! Thankfully, Boomer experienced a complete recovery.

If ever you have a “vomiting” dog on your hands, carefully think about whether what you are observing is vomiting or regurgitation. Distinguishing the two will help point your veterinarian in the appropriate diagnostic direction.

Has your dog ever been evaluated for vomiting or regurgitation? If so, what was the outcome?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

Never a Dull Moment!

Sunday, January 29th, 2012

Having graduated from veterinary school in 1982, this year marks my 30th year practicing veterinary medicine! Wow, that’s a lot of years! What feels most remarkable is that I’ve been able to work at the same profession for so long without becoming bored or complacent. I’m certain the reason is that not a single week goes by without my seeing or experiencing something new and exciting.

Take Dottie, for example. This exuberant 5-year-old spayed female Jack Russell Terrier mix was referred to me because of persistent vomiting despite treatment with a variety of medications. Little Miss Dot continued to eat well and she remained normally active, but her daily vomiting continued. Blood and urine testing were normal as were x-rays of her belly.

Physaloptera worms. Photo Credit vet.ohio-state.edu.

When I examined Dottie, had I not known better I would have thought she was a completely healthy little girl. I performed abdominal ultrasound, the results of which were normal. The next step was endoscopy in which a long telescope device was passed down her esophagus and into her stomach and upper small intestine. Lo and behold, when I entered Dot’s stomach I was greeted by a herd of little white worms! They were crawling every which way and many dove into their burrows within the lining of Dot’s stomach in response to the bright light of the endoscope. No wonder the poor girl was vomiting!

Never before thirty years of practice have I seen stomach worms, aka Physaloptera! I’ve just moved cross-country, so I assumed that I’d just encountered my first case of a disease that must be common in the Carolinas. Not so! Other than as photos in a textbooks, none of my coworkers had ever before seen Physaloptera. There was a crowd of twenty or so people crowded into the endoscopy suite in order to have a look. (I should have charged admission!)

Intestinal worms in dogs and cats are commonplace. Worms living (and burrowing) in the stomach are a rarity and I may have encountered my first and only career case of Physaloptera. These worms are transmitted via insects such as beetles, cockroaches, and crickets. Dogs who eat such critters are subject to developing stomach worms. The eggs of the worm may show up via fecal flotation (the stool sample is examined under the microscope). Veterinarians don’t commonly think of running fecals on patients with vomiting as the only symptom. I certainly won’t be skipping this test in the future! Running a simple fecal flotation is far less expensive and a whole lot easier on the patient than an endoscopic procedure.

Dot received the appropriate deworming medication and her vomiting has completely resolved. Her doting family members are thrilled with the outcome and they are going to do their best to prevent their little girl from snacking on insects in the future.

Do you encounter new and exciting things in your chosen profession? Please do tell!

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

 

I Can’t Believe He Ate That!

Sunday, December 11th, 2011
Needle lodged within the intestinal tract © Cuyahoga Falls Veterinary Clinic
Dogs and cats eat some pretty darned crazy things! Sure, I can understand nabbing a loaf of bread from the kitchen counter or sneaking some “kitty roca” out of the litter box. But why on earth eat a sewing needle, panty hose, Lego pieces, or mama’s favorite diamond earrings? Just when I think I’ve seen it all, something new surprises me.

Dogs, more so than cats, tend to be “repeat offenders.” I recall one Labrador in particular who had six surgeries over the course of his lifetime to remove socks lodged within his intestinal tract (in spite of counseling his humans repeatedly on picking up their socks). As many surgeries as this dog had, we should have installed an abdominal zipper!

Not all cases of foreign body ingestion have such happy endings, particularly if the foreign object has perforated through the wall of the stomach or intestinal loop. This allows leakage of nonsterile gastrointestinal contents into the normally sterile abdominal cavity resulting in widespread inflammation known as peritonitis. With emergency surgery and post-operative intensive care, many of these patients survive, but it is certainly becomes a big deal, both for the patient and the pocketbook.

Esophageal foreign bodies are notoriously difficult to remove, particularly if they’ve been lodged for more than a day or two. (The esophagus is the muscular tube that transports food and liquids from the mouth down into the stomach.) Even if the foreign object is successfully removed, the resulting inflammation within the esophagus can result in the formation of a stricture (narrowing of the esophageal lumen) and chronic, severe swallowing difficulties.

Some dogs and cats are lucky. The foreign objects they eat pass freely without any ill effects. I see the not so lucky ones with objects that have become lodged within their gastrointestinal tracts. There are two means to retrieve a gastrointestinal foreign body, surgery and endoscopy. An endoscope is a long telescope device that can be passed through the oral cavity, down the esophagus and into the stomach and upper portion of the small intestine. The endoscope allows visualization of the inside lining of the bowel and its contents. A grabber type instrument can be deployed through a channel in the endoscope to grab the object and then pull it out through the mouth. Endoscopy requires general anesthesia, but it is often preferred over surgery because of its less invasive nature.

In order for endoscopy to be of benefit, the foreign body must be located within the esophagus, stomach, or the very upper part of the small intestine (this is as far as the endoscope can reach). Some objects (coins, needles, tennis ball fragments, cloth) are well suited to being removed endoscopically because they are more “grabbable.” Objects that have traveled further down the gastrointestinal tract (beyond reach of the endoscope) or are without “grabbable” surfaces (large rounded bones, balls) are better retrieved surgically.

What can you do to prevent your dog or cat from eating inappropriate things? First and foremost, “baby proof” your home and yard for your pet. Anything unsafe that your little snookums might want to “mouth” should be put away and out of reach. This is particularly important when caring for a puppy or kitten. Secondly, it pays to know your pet- some cats and dogs never grow out of the habit of putting strange things in their mouths. Some adult cats continue to graze on dental floss found in the bathroom garbage pail, and some adult dogs continue to scarf down panty hose and underwear. If you provide chew toys or bones to your dog, supervise carefully to be sure that he’s a nibbler rather than a “swallow it whole” kind of guy. The best defense against gastrointestinal foreign bodies is avoidance of the things your pet might be willing to swallow. In some extreme cases, I’ve encouraged folks to muzzle their dogs when outdoors unsupervised or on walks, so they can relax knowing that their dog cannot gobble something down in the blink of an eye.

Perhaps my most memorable foreign body retrieval was performed on an adult Saint Bernard. X-rays suggested something was lodged in her stomach, but I couldn’t be clear exactly what the foreign material was. I passed my endoscope down into the stomach and saw an intact hand. I thought, “Oh my goodness!” I looked around a bit more and spotted a foot, and then what looked like some human hair. My heart was racing until I finally removed what I could identify as the chewed up remains of a troll doll! Afterwards I chuckled remembering that the view I get through the endoscope is magnified significantly!

What crazy thing has your dog or cat eaten in the past? Did it pass on its own or was it necessary for your vet to come to the rescue?

Happy holidays to you and your loved ones,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.