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Maciej Grzegory, Krzysztof Kubiak, Jolanta Spuzak, Marcin Jankowski, Jozef Nicpon, Katarzyna Michlik, Igor Maksymowych* ©
Department of Internal Diseases with Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, University of Environmental and Life Sciences, pl. Grunwaldzki
47, 50-366 Wroclaw, Poland *Lviv National University of Veterinary Medicine and Biotechnologies named after
S.Z. Gzhytskyj, Lviv, Ukraine
HYPERTROPHIC PYLORIC STENOSIS IN DOGS: CASE PRESENTATION.
Abstract. Hypertrophic pyloric stenosis is the constriction of the pyloric lumen caused by the smooth muscles hypertrophy of the pyloric circular layer and/or hyperplasia of the pyloric mucosa, consequently leading to disorders in the chyme passage. The disease etiology has not yet been revealed and its most frequent clinical symptom is chronic vomiting. The diagnosis of hypertrophic pyloric stenosis chiefly involves anamnesis, clinical examination and stomach imaging examination. The final diagnosis of the disease should always depend on the histopathological examination of the collected stomach tissue.
Key words: hypertrophic pyloric stenosis, dog
Introduction
Hypertrophic pyloric stenosis is the constriction of the pyloric lumen caused by the smooth muscles hypertrophy of the pyloric circular layer and/or hyperplasia of the pyloric mucosa, consequently leading to disorders in the chyme passage. Chronic vomiting as a result of the pyloric or antral region of the stomach is a relatively common occurrence in the dog. Antral mucosal hypertrophy (acquired antral pyloric hypertrophy or chronic hypertrophic pylorogastropathy), a condition that is being diagnosed with increasing frequency in small (particularly oriental) breeds is an additional and important cause of gastric outlet obstruction (1). Congenital and acquired pyloric stenosis both have a similar clinical presentation, but the congenital form occurs in young dogs, usually at the time of changing to solid food, while the much more common acquired form occurs in older animals. Congenital pyloric stenosis occurs most frequently in brachycephalic breeds (especially the Boxers and Boston Terrier) (1). Acquired pyloric stenosis occurs most frequently in Lhasa Apso , Shih Tzu, Mini Poodle, Maltese Dog, Pekinese Dog, in German Shepherd Dog and Doberman .The disease etiology has not yet been revealed and its most frequent clinical symptom is chronic vomiting. Both congenital and acquired pyloric stenosis result from hypertrophy of the circular muscle of the pylorus and must always be differentiated from " pylorospasm".
© Maciej Grzegory, Krzysztof Kubiak, Jolanta Spuzak, Marcin Jankowski, Jozef Nicpon, Katarzyna Michlik, Igor Maksymowych, 2010
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The aim of the article
The aim of the article is to present own experiences connected with diagnosed hypertrophic pyloric stenosis in dog based on case presentation.
Material and methods
The study presents 1 clinical case of a dog with hypertrophic pyloric stenosis referred to the endoscopic laboratory of Department of Internal Disesases with Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine , University of Environmental and Life Sciences, for endoscopy of the anterior part of the digestive tract.
The dog, male, German Shepherd Dog, 11 years old, for about 2 months, especially few hours after feeding suffered vomiting, which had foamy character or contained alimental substances. The therapy using omeprazole, metoclopramide, and sucralfate didn't did not satisfactory effects. The blood laboratory examination revealed only an increased number of leucocytes and a slightly proportional increased number of neutrophilic granulocytes and decreased proportional number of lymphocytes. The odd hematological and biochemical parameters were normal. (tab. 1)
Tab.1.
Results of laboratory examinations._
Parameter Value Unit Physiological norm
RBC 6,35 T/l 5,5-8,9
HGB 13,4 mmol/l 7,4-11,8
HCT 0,395 l/l 0,37-0,55
MCV 77,0 f/l 60-77
MCH 1,79 fmol 1,18-1,49
MCHC 22,1 mmol/l 19,8-22,4
PLT 157 G/l 150,0-500,0
WBC 28,8 G/l 6,0-15,0
bacilliform neutrophilic granulocytes 2 % 0-3
segment neutrophilic granulocytes 92 % 60-90
monocytes 4 % 3-10
lymphocytes 4 % 12-37
ALT 50,0 U/I < 100,0
AST 54,0 U/I < 90,0
diastase 1950,0 U/I 388,0-1800,0
urea 7,96 mmol/l 3,3-8,9
creatinine 102,0 ^mol/l 88,0-159,0
total protein 67,7 g/l 48,0-78,0
glucose 4,37 mmol/l 3,7-6,7
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The endoscopic examination showed: normal esophageal tunica mucosa, closed lower esophageal sphincter , swollen, red and brittle tunica mucosa of the stomach corpus and part of pylorus with visible erosions and ulcerations, difficulty in the endoscope introduction into a part of the stomach pylorus and lack of possibility of the pyloric sphincter observation. It was a consequence of intensive narrowing of a part of the pyloric sphincter. Segments of tunica mucosa were collected from a part of the pyloric sphincter, for a histopathological examination. The histopathological examination showed chronic giant hypertrophic gastropathy inclusive hypertrophy and hyperplasia of tunica mucosa with associate active and chronic inflammation (gastritis chronica magni gradus sine neoplasmate)- in Sydney classification: activity (+++), intensity (+++), glandular atrophy (-), intestinal metaplasia (-) . Treatment of inflammation of the stomach tunica mucosa comprised: omeprazole in dose- 1mg/kg b.w., p.o SID, metoclopramide in dose- 0,4mg/kg b.w., p.o TID and sucralfate in dose- 0,5g/dog; p.o; TID. Easily digestive, liquid or semiliquid, moist feed, served frequently in small doses was recommended.
Discussion
Hypertrophic pyloric stenosis is a rare disorder diagnosed in dogs. In own experiences, this disease, constitued 3,7% cases referred to the endoscopic laboratory of Department of Internal Disease of Horses, Dogs and Cats.
In medicine pyloric hypertrophy is known to affect adults and children. AC. Dick, J. Ardill, SR. Potts and JA. Dodge obtained results that abnormality in somatostatin homoeostasis is associated with infantile hypertrophic pyloric stenosis in human (2, 3).
The condition has been also described in Siamese cats, domestic rabbits, horses and dogs. The brachycephalic breeds of dogs, e.g. Pugs and Boxers are primarly affected by this condition, with a higher incidence reported amongst male animals. In surgical treatment pyloromyotomy is the procedure of choice and is attended with an excellent prognosis. The condition is clinically similar in each of the species (2).
In diagnostics of hypertrophic pyloric stenosis useful methods are graphic techniques, e.g.: contrast X-ray examination, USG examination, and/or endoscopic examination and histopathological evaluation of tissue materials received from the stomach. In this case, should be base on changes confirmed in endoscope examination, suspected hypertrophic pyloric stenosis or neoplastic modification. Definitive recognition based on histopathological evaluation. The above observations were confirmed by: Walter and co-operators (4), Leiba and co-operators (5), Happe and co-operators (6), Kuan and co-operators (7).
Conclusion/Summary
In case of chronic vomiting in dogs, its cause is always suspected to be hypertrophic pyloric stenosis, apart from the fact, that it is a very rare disease. In diagnostics of hypertrophic pyloric stenosis very useful are graphic techniques, e.g.: endoscopic examination, because they make an accessory evaluation of stomach tunica mucosa possible. Definitive recognition of this disease will always be based on the histopathological examination result.
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Reference
1.Colin F. Burrows: " Gastric Disease" in : Thomas D.A., Simpson J.W., Hall E.J.: "Manual of Canine & Feline Gastroenterology." 1996, BSAVA, p. 111-113.
2.R.M. Abel, C.J. Dore, A.E. Bishop, P. Facer, J.M. Polak, L. Spitz- " A Quantitative Study of the Neural Changes Underlying Pyloric Stenosis in Dogs" , "Anat. Histol. Embryol." 31, 193-143 (2002), Blackwell Verlag, Berlin
3.AC. Dick, J. Ardill, SR. Protts, JA. Dodge- " Gastrin, somatostatin and infantile hypertrophic pyloric stenosis", "Acta Paediatr." 90: 879-882. 2001
4.Walter M.C., Mattiehsen D.T.: "Aquired Antral Pyloric Hypertrophy in the Dog", J. Vet. Clin. North Am., 1993, 23, p. 547-554.
5.Leib. M.S., Saunders G.K., Moon M.L., Mann M.A., Martin R.A., Matz M.E., Nix B., Smith M.M, Waldron D.R.: "Endoscopic Diagnosis of Chronic Hypertrophic Pyloric Gastropathy in Dogs. "J. Vet. Intern. Med.", 2008, 7, p. 335341
6.Happe R.P., van der Gaag I., Wolvekamp W. Th. C.: "Pyloric Stenosis by Hypertrophic Gastritis in Three Dogs." "J. Small. Anim. Pract.", 2008, p. 7-17
7.Kuan S., Hoffmann K., Tisdall P.: "Ultrasonographic and Surgical Findings of a Gastric Hyperplastic Polyp Resulting in Pyloric Obstruction in a 11-Week-Old French Bulldog.", "Aust. Vet. J.", 2009, 87, p. 253-255
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