Small Animal Digestive Disorders

1- Mega esophagus
2- G.D.V
3- Intestinal obstruction
4- Mega colon
5- Rectal Prolapse

I. Mega Esophagus (esophageal dilatation):

Definition:
It is a disorder that commonly causes regurgitation in dogs (cats are rarely affected) it is
characterized by esophageal dilation, ineffective esophageal peristalsis and no reponse
to treatment.

Classification:
1. Congenital idiopathic Megaesophagus
‐ Involves generalized dilation of the esophagus
‐ Hypo-motility resulting in regurgitation
‐ Afflicted puppies may not survive after weaning
‐ Susceptible breeds include Irish Setter, Greyhound, Great Dane, German
Shepherd, Labrador Retriever, Pug, Chinese Shar-Pei and Newfoundland
breeds
‐ This disorder is hereditary in Wirehaired Fox Terrier and Miniature Schnauzer
2. Acquired idiopathic Megaesophagus
‐ Affects adult dogs 7-15 years old
‐ It may be associated with other conditions that cause neuromuscular
dysfunction (weakness of muscle, decreased Mg and selenium)

Symptoms:
· Regurgitation (may occur several minutes to several hours after eating or drinking)
· Fever, weight loss, poor physical condition
· Respiratory disorders (cough, nasal discharge, mucus) specially in puppies which
may lead to food passing to the airways
· Salivation, difficulty swallowing
· May experience malnutrition and aspiration pneumonia
· No response to treatment
Diagnosis:
· Thoracic x-rays (normally the esophagus is not seen)
· If it appears it may mean:
- Animal consumes air
- Food is lodged in esophagus
- By contrast: food normally goes to the stomach but if it appears in the x-ray
in the chest this indicates mega-esophagus

N.B. special case: pre-cardiac dilatation of esophagus

Prognosis
· Congenital idiopathic Megaesophagus
‐ Fair prognosis
‐ Attention must be directed to diet management and prevention of aspiration
pneumonia
‐ Over several months esophageal motility can improve
· Acquired idiopathic Megaesophagus
‐ Can result in a high morbidity and mortality
‐ Chronic malnutrition and recurring aspiration pneumonia can kill the dog

Treatment:
1. Soft high calorie diet may involve small feedings frequently per day
2. Use feeding table: dogs may be in an elevated or upright position to allow gravity
drainage (medium and large canines can place their front legs on a table for this
position)
3. Diet consistency is key; while some dogs adapt to a liquid diet, others improve
more with a solid diet.
4. A feeding tube can benefit the patient that cannot take in an adequate nutritional
balance orally (a gastrostomy tube may be temporary or permanent)
5. Pulmonary infections can receive antibiotic treatment

II. Gastric Dilation – Volvulus:

Definition:
Acute gastric dilatation-volvulus (GDV) is a life threatening condition with fatality 10-
60% within a time range not exceeding 12 hours.

Breed Predisposition:
Usually affects older, large, deep-chested dogs, including Great Danes, German
Shepherds, Standard Poodles, and large mixed breed dogs

Causes and Pathogenesis:

· It is a result of accumulation of gas, fluid, or a combination of the two in the
stomach
· Factors responsible for causing dilatation include:
‐ Aerophagia
‐ Exercise after ingesting a meal
‐ Overeating
‐ Eating spoiled food
· The stomach distends with gas or fluid, and rotation along the axis of the
esophagus and cardia follows
· The rotation is generally clockwise 360° (A less common fate is a counter-
clockwise rotation, to a maximum of 90°.)

Clinical Signs
‐ Abdominal distension (differential diagnosis = ascites) with frequent attempts to
vomit
‐ Hypersalivation (severe excessive salivation) which is very distinctive because
saliva accumulates in the esophagus and the mouth and does not fall out
‐ Rapid shallow respiration
‐ The animal may comatose and collapse depending on the degree of shock
‐ Signs related to hypovolemic shock are pale mucous membranes, prolonged
capillary refill time, rapid, weak, thready pulses, and tachypnea
‐ Restlessness, anxiousness, respiratory dysfunction
‐ The major life threatening abnormality associated with GDV is shock which is
due to compression of the caudal vena cava, blood vessels of the lower parts of
the body are engorged with blood, from distension of the stomach, and the
portal vein, from distension and rotation of the stomach, and ischemia of
abdominal organs can lead to necrosis/death of affected organs/tissues.

Diagnosis:
· Clinical signs
· X-ray
· Percussion: drum-like sound
· Contra-indicated to use ultrasonography (because stomach is filled with gases)
Treatment:
First aid management is trocarization to reduce the stomach distension (needle gastro-
centesis)
1. The first priority is cardiovascular stabilization including administration of NaCl
(0.9) + dextrose (5%)
2. Introduction of oro-gastric tube (after anesthesia)
Helps decompress stomach and its distension
Acts as a guide during surgery (to detect where the gas is coming from)
3. Laparotomy and rotation of the stomach to its normal position (we can use
trocar and cannula in the stomach wall after incising the abdominal wall)
4. Gastropexy (fixation of the stomach at its greater curvature)

Complications:
 Left untreated, GDV can lead to multiple organ failure, circulatory shock and
death
 Factors which contribute to a higher mortality rate include:
‐ Gastric necrosis
‐ Gastric resection
‐ Splenectomy
‐ Pre-operative cardiac arrhythmias
 Post-operative percussion to avoid recurrence:
‐ Provide several meals with small quantities and avoid large meals
‐ Contra-indicated to feed animal before or right after exercise
‐ Provide healthy food
‐ Avoid drinking large amounts of water with meals

III. 3-Intestinal Intussusception:

Definition:
 Intussusception is an uncommon but potentially life-threatening condition that
can occur in dogs and cats of all ages
 Intussusception is the sliding or telescoping of the intestine within itself. It occurs
primarily in the small intestine but may occasionally occur in the large intestine
 When the intestine slides within itself the blood supply to that section is greatly
reduced and the tissue begins to swell then occurs necrosis and gangrene

N.B.
 ‐ Puppies and kittens are the most likely ones to be affected without breed
predisposition
‐ Intestinal obstruction is more common in cats (foreign body, trangulation,
intussusceptions)
‐ Mostly occurs at the lowest part of small intestine (small intestine has stricture
at cecum and due to high peristaltic movement it will slide inside small intestine
at ileo-ceco-colic junction)

Causes:
‐ Parasites: specially in puppies carrying large numbers of intestinal parasites such
as roundworms, hookworms, or whipworms(soft and weak tissue)
‐ Viral: such as parvovirus in puppies (or viruses that cause severe diarrhea which
causes high peristaltic movement)
‐ Bacterial gastroenteritis from spoiled food that cause diarrhea such as
salmonella
‐ Pieces of plastic, bone or wood in the intestine of a dog can lead to the
development of intussusception
‐ Some surgical interventions (post operational) mostly if tumors are removed
(surgery causes abnormal movement of intestine)

Clinical Signs:
‐ Late vomiting due to stop of peristalsis
‐ Stools are scant to none
‐ Fecal material that is passed is jelly-like, may be bloody or containing mucus, and
not well formed (no solid particles)
‐ Severe abdominal pain, and eventually shock and death

Diagnosis:
 Clinical signs and animal age (susceptibility)
 Palpation:
- Pencil-like texture, very characteristic; we find a soft part then a hard part
followed by another soft part
 Radiography
- Ileus phenomenon: due to accumulation of fluids and gases, the diameter
of the intestine is 2 times more than the thickness of the second lumbar
vertebra (we measure thickness of lumbar vertebra and we find that the
intestine is twice the thickness to differentiate ileus phenomenon)
- Mass (because the small intestine is inside the large intestine)
  Ultrasonography (easier than x-ray)
- Multilayered appearance in horizontal scan
- Bull’s eye appearance in vertical scan (in the affected part only but the
areas before and after it are normal)

Treatment:
1. Surgically 'sliding' the telescoping portion of the intestine apart or complete
removal of the intussusceptions depending on:
- Size of the intussusception
- Amount of tissue damage
- Length of time the animal has been sick
2. If gangrene occurs: removal and anastomosis of the intestine by:
- End to end
- End to side
- Side to side (if a side is wider we make end to side or we narrow a part of
it to become the same size as the other side)

N.B.
‐ The animal will have to go through a normal recovery period
‐ If the intussusception is caught soon enough and the animal undergoes a
successful surgery, most will recover completely
‐ 25% of dogs that develop an intussusception would have a recurrence in the
future
‐ There is a surgical procedure called 'enteroplication' in which the loops of
intestine are attached to one another and thus reduces the incidence of
recurrence in some pets

Prevention:
‐ Good deworming and vaccinating programs
‐ Preventing access to foreign bodies
‐ Early recognition and treatment of other intestinal diseases
‐ Providing clean healthy food

IV. Megacolon:

Definition:
 It is a functional disorder that is defined as dilatation of the colon or large
intestine; this leads to infrequent and difficult passage of feces and constipation
  It may be congenital or acquired (which is more common)
 Megacolon is found primarily in cats, but also can occur in dogs
 The owner complains that the cat has not defecated in 20 days (large intestine
movement has stopped and the feces is accumulated and enlarged in size –larger
than the pelvic outlet- so the feces cannot pass out)

Causes:
 Dietary and environmental factors such as:
- Foreign bodies in the colon
- Lack of exercise
- Lack of litter box or dirty litter box
- Eating dry food for a long time (we must increase water, fibers and milk)
 Painful defecation due to:
- Anal sac abscess
- Stricture of the anus
- Narrowed pelvic canal due to:
o Previous fracture of the pelvis
o Current fracture (pain)
o Intra-pelvic tumors
 Neurologic disease which results is the inability to posture for bowel movements
and fecal expulsion, or nerves controlling the signal to defecate are not working
properly
 Idiopathic (most common)

N.B. Normally cats can retain feces in the colon for a period of several days without
harm; if the passage of feces is prevented the colon becomes distended; the duration
and degree of constipation necessary to cause megaconlon is unknown

Clinical Signs:
 Passage of smaller stools than normal
 Less frequent defecation
 Straining to defecate
 Frequent trips to the litter box which are nonproductive
 Systemic signs:
‐ Lack of appetite
‐ Depressed attitude
‐ Thin
‐ Dehydration
 ‐ Vomiting
 Anemia

Diagnosis:
1. Clinical sign
2. X-ray: stone-like structure filling the large intestine (and sometimes the small
intestine)

Treatment:
 Conservative
‐ Stool softeners and lubricating agents
‐ Cleansing enemas
‐ Manual removal of stool
‐ Dietary modification (increased fiber diet)
‐ Drugs to increase motility of the colon (cisapride)
‐ When conservative therapy is not effective surgery is recommended
 Surgery
‐ First treat the actual cause: anal saculitis, pelvic fracture or any painful
condition
‐ Removal of the colon:
o Choose the widest area of the colon
o Open the smallest possible incision
o Inject paraffin oil
o Suture (Lambert)
o The end of the small intestine is connected to the rectum
o Sometimes sub-total colonectomy is required (if it recurs we
remove the widened part completely)

V. Rectal Prolapse

Definition:
A part of the rectum or colon is protruded out of the anus

Causes:
- Parasite
- Recurrent prolonged diarrhea
- Straining during severe constipation
- Straining during parturition
Treatment:
1. Hot fomentation on the protruded part
- Epidural anesthesia (to make relaxation of anal sphincter and aid in
repositioning)
- Removal of any necrosis
- Using lubricant oil (e.g. Inosol – ointment for prolapse)
- Gentle pushing
- Suture
2. If it recurs: we perform colopexy (surgical fixation of colon)
- Epidural anesthesia I very easy in dogs and cats in lumbo-sacral space
3. Sub-total or total excision may be required in case of necrosis or gangrene