Screen Shot 2020-12-02 at 12.41.01 PM.png — Severe Gastric Ulceration in a Mixed Breed

Dr. Kara Woody

Patient Information:

Age: 8 years

Gender: Neutered Male

Breed: Mixed Breed

Species: Canine

History:

Patient presented with a history of vomiting and anorexia. “Coffee ground” vomitus and melena was noted by the owner. The patient had a fever and abdominal pain upon exam. No history of NSAID usage or other systemic illness.

Initial Diagnostics:

Prior to ultrasound, the patient had undergone a barium series in which barium transit was greatly prolonged. Foreign body was not suspected by the radiologist. Ultrasound was recommended for further evaluation.

Ultrasonographic Findings:

The stomach contains a small amount of fluid and gas/barium with moderately thickened walls up to 8.4mm and loss of normal layering distinction. There is multi-focal gas "capping" noted in the gastric mucosa. The tissue surrounding the caudal border of the stomach is moderately hyperechoic. The pylorus is free of obstruction.

Abdominal Ultrasound Interpretation:

Stomach - the findings are moderate - DDx: active gastritis vs. gastric ulceration with secondary granulation and thickening/edema vs. primary neoplasia vs. infiltrative neoplasia (lymphosarcoma, mast cell tumor, etc)

Recheck Exam:

Gastric ulceration was highly suspected based on history and ultrasound findings. The patient continued to decline despite aggressive treatment for ulceration. Additionally, extensive investigation was performed to identify an underlying cause of ulceration. A recheck ultrasound was recommended.

Ultrasonographic Findings:

The stomach contains a small amount of gas with a focally thickened wall in the fundus (up to 11.0mm; previously up to 8.4mm) and loss of normal layering distinction. There is multi-focal gas "capping" noted in the gastric mucosa (2.3mm width). The tissue surrounding the stomach is moderately hyperechoic. The rest of the stomach wall is normal thickness and layering. The pylorus is visualized and free from obstructions.

Abdominal Ultrasound Interpretation:

Stomach - the findings are moderate and PROGRESSED - DDx: active gastritis vs. gastric ulceration with secondary granulation and thickening/edema vs. primary neoplasia vs. infiltrative neoplasia (lymphosarcoma, mast cell tumor, etc)

Case Conclusion:

Unfortunately, no underlying cause for ulceration was identified. Patient condition continued to decline so humane euthanasia was elected. A necropsy was performed which revealed extensive mucosal ulceration of the gastric wall. The rest of the gastrointestinal tract and abdomen was within normal limits. Histopathology was not performed.

Discussion:

Gastric ulceration occurs when gastric acid production is increased or if the mucosal surface is compromised. Common causes include: liver disease, renal disease, Addison’s Disease, inflammatory bowel disease, and non-steroid inflammatory administration. Neoplastic causes include gastrinomas or mast cell tumors. Typically patients present with a history of vomiting, anorexia +/-hematemesis and/or melena. Fever, abdominal pain, diarrhea and lethargy also commonly occur. Treatments include H2 receptor antagonists, proton pump inhibitors, and prostaglandin E analogs and sucralfate. It is important to identify and treat the underlying cause if possible.