Section: Veterinary Care In-depth
Diagnosis In-depth
Certain diagnostic tests must be performed to diagnose a gastric motility disorder, and to exclude other disease processes that may cause similar symptoms. A thorough work-up begins with a broad general baseline of tests, and in many cases, more specialized or advanced testing may be indicated as well. It is important to note that an accurate diagnosis is necessary for an appropriate treatment regime.
Obtaining a complete medical history and performing a thorough physical examination are necessary in order to create an appropriate diagnostic plan for the patient with a gastric motility disorder.
A complete blood count (CBC) will evaluate for the presence of infection, inflammation, and anemia, associated with some diseases that cause gastric motility disorders.
A biochemical profile evaluates kidney, liver, electrolytes, total protein, and blood sugar status. All of these parameters are important to establish on these patients. A low potassium level is not uncommonly seen as a cause of motility disorders.
A urinalysis helps evaluate the kidneys and hydration status of the patient.
A fecal flotation must be performed to rule out parasites as an associated cause.
Abdominal X-rays evaluate the abdominal organs, presence of fluid, and the presence of a foreign body or tumor.
Your veterinarian may recommend additional tests to insure optimal medical care. These are selected on a case-by-case basis.
An ACTH stimulation test may be recommended to rule out hypoadrenocorticism (Addison's disease). It is a safe, simple, timed blood test that measures adrenal function and can usually be performed at your veterinary hospital.
Bile acids are a simple timed blood test that evaluates liver function. The test is very safe and can be performed at your veterinary hospital.
A blood lead level may be indicated in these patients where there has been known or possible lead exposure.
Chest X-rays are an important part of the work up for the chronically vomiting patient, as tumors and other types of cancer can metastasize (spread) to the lungs.
Abdominal ultrasound evaluates the abdominal organs and helps assess for the presence of tumors. Organs, lymph nodes, and masses can be sampled with a needle or biopsy instrument with the guidance of ultrasound. This procedure is relatively safe, but may necessitate a mild sedative. It is often recommended that a specialist perform the procedure.
An upper gastrointestinal (GI) barium (dye) series may be considered in those patients with chronic vomiting associated with gastric motility disorders. It may help diagnose foreign objects or tumors that are not apparent on X-rays, or confirm a diagnosis of GI ulceration. A safe dye is given to the patient by mouth, and is then watched as it travels through the GI tract. It is a non-invasive test that can often be performed by your regular veterinarian, although in some cases may necessitate transfer to a specialty hospital.
Gastroscopy may be of benefit in the vomiting patient. Although it is usually within normal limits in patients with idiopathic or primary gastric motility disorders, it may facilitate the removal of foreign bodies, help evaluate for ulcer disease, and sample tissue for the presence of inflammation or cancer. Hospitalization is brief, and healing is generally quick and uneventful. It does, however, necessitate general anesthesia, and therefore is associated with minor risks. It is often necessary to refer the patient to a specialist, and is performed when other diagnostics are either inconclusive or support the diagnosis of a gastric foreign body.
Lastly, an exploratory laparotomy should be performed as a diagnostic tool in any individual that has had an extensive diagnostic and treatment course, with little to no response. It is an invasive test, but it is necessary in a handful of cases for a definitive diagnosis and possible therapy or cure.
Therapy In-depth
In patients with gastric motility disorders, little is as important as finding the underlying cause to insure appropriate therapy. Most patients are treated as outpatients, although in critically ill animals with severe vomiting and dehydration, hospitalization and intensive therapy is necessary. Therapy for gastric motility disorders include:
Dietary manipulation is important in the management of primary gastric motility disorders. Dietary modification should include small frequent feedings of an easily digestible product. Diets should be formulated that are liquid or semi-liquid consistency and low in fat and fiber content. The specific disease should be addressed with the appropriate feeding regime.
On severe cases intravenous fluid and electrolyte therapy may be necessary to correct dehydration, acid-base, and electrolyte abnormalities.
Antiemetic drugs to stop vomiting should be used with caution. It is best to identify and treat the underlying cause of vomiting; however, in selected cases they may be recommended.
Antacids to decrease acid production by the stomach, such as Tagamet (cimetidine), Pepcid (famotidine) or Zantac (ranitidine), may be of benefit in some cases, especially where ulceration is associated.
Gastrointestinal protectants and adsorbents to protect or sooth are felt to coat an "irritated" intestinal lining and bind "noxious" (harmful) agents. Sucralfate (Carafate) liquid helps smooth and coat an inflamed or ulcerated stomach.
Promotility drugs to increase movement such as metoclopramide (Reglan) may be of benefit in some cases.
Surgery is indicated for those patients with gastric outflow blockages, including tumors and foreign bodies.
