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Pyloric Obstruction/Stenosis

By: Dr. Nicholas Trout

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The pylorus is the lower portion of the stomach that leads into the small intestine. Pyloric obstruction or stenosis usually refers to a thickening of the various layers of muscle and mucosa (stomach lining tissue) that make up this region, leading to obstruction of flow of food or water through the stomach. This thickening is a benign, non-cancerous process.

Pyloric obstruction or stenosis is most commonly seen in brachycephalic (short-faced) breeds of dog such as boxers, Boston terriers and bulldogs. These dogs tend to be young and predominantly male. It can also occur as a more chronic condition in small breeds of dog such as Lhasa apso, shih tzu and Maltese terrier. These dogs tend to be middle-aged to older.

If food and water cannot move through the stomach, the dog will regurgitate or vomit and become sick, dehydrated, and depressed. Untreated, the chronic vomiting can lead to significant metabolic problems, weight loss and the risk of aspiration pneumonia. This combination of problems could easily become fatal.

What to Watch For

  • Young brachycephalic breed of dog
  • Older small breed dog
  • Chronic vomiting
  • Regurgitation

    In young animals, vomiting often occurs at the time of weaning onto solid foods.

    Diagnosis

    A detailed history and physical examination can initially lead your veterinarian to suspect pyloric obstruction. Additional tests are necessary to make a definitive diagnosis. Tests may include:

  • Radiographs (X-rays) may be taken of the abdomen, but neither plain radiographs, contrast radiographs using liquid barium or ultrasound are as good as gastroscopy for diagnosing the type of pyloric disease present.

  • Gastroscopy involves placing an endoscope down through the stomach in order to visualize and biopsy the pylorus.

  • Many changes may be present in the blood work of an animal that has been vomiting for some time. The loss of acid from the stomach will cause a loss of chloride and a relative increase in the amount of alkali present (metabolic alkalosis). Elevations in kidney parameters can occur, reflecting dehydration.

  • There is no specific blood test to determine pyloric obstruction or stenosis.

    Treatment

  • Medical management is important to correct the metabolic abnormalities of chronic pyloric obstruction, but definitive treatment requires surgery.

  • Your pet may be given intravenous fluids, antacids and antibiotics prior to anesthesia, in order to be in as stable a condition as possible going into the surgical procedure.

  • There are multiple different types of corrective surgery for the thickened pylorus and the type selected can depend on the surgeon's experience and which layers of the pylorus are affected by the disorder.

  • Whichever type of surgery is performed, the aim of the procedure is to restore the normal size of the opening from the pylorus to the duodenum, the first part of the small intestine.

    Home Care and Prevention

    Your dog's abdominal skin incision will need to be monitored for swelling, redness or discharge. Staples or stitches can be removed in 10 to 14 days.

    Your pet will have received pain-killers (analgesics) during the period of hospitalization and these may continue in oral form when he goes home.

    Follow your veterinarian's recommendations regarding feeding and contact your veterinarian if your dog begins vomiting or does not eat.

    The cause of this disease is not known. For this reason there is nothing an owner can do to prevent the problem from occurring. Prompt veterinary care for your vomiting pet is the best course of action.

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