Pyloric Obstruction/Stenosis in Dogs - Page 4

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Pyloric Obstruction/Stenosis in Dogs

By: Dr. Nicholas Trout

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The effects of chronic vomiting or regurgitation must be addressed in treatment. This will include placement of an intravenous catheter to initiate fluid therapy, not only to correct dehydration but also to correct for electrolyte imbalance.

  • Anti-emetic drugs. Chronic vomiting can lead to the acidic content of the stomach irritating and inflaming the esophagus. Your dog may also receive antacids such as Tagamet® (cimetidine).

  • Antibiotics. Concerns about gastric or esophageal ulceration and the possibility of having aspiration pneumonia, may prompt your vet to place your dog on antibiotics. If chest radiographs confirm the presence of pneumonia, then the selection of antibiotic may be based on a tracheal wash.

  • Surgery. All of the above treatments will be beneficial and supportive, but they do not address the pyloric disorder itself. To correct the problem surgery is indicated. Medical treatment also helps to insure that your animal is in the best possible shape for anesthesia and corrective stomach surgery.

    The pyloric obstruction or stenosis can involve the muscular portion of the stomach, the lining layer or mucosa of the stomach, or both. Different surgical procedures were originally developed to address these different conditions.

    The simplest procedure involves cutting the thickened muscular layer of the pylorus and leaving the mucosa intact. This does not allow inspection or biopsy of the mucosa and is probably only a temporary solution. For these reasons it is no longer recommended.
    Other techniques cut through all the layers and then widen the lumen of the pylorus. These procedures can be performed using suture material or surgical stapling equipment.

  • Surgical resection. In some cases, the thickening may be such that altering the size of the outflow from the pylorus is not enough. In this instance a corrective surgery that either entirely removes the region of obstruction or stenosis, or by-passes that area of the stomach, may be more appropriate. In both examples the stomach would be joined to the small intestine so that food and liquids could resume their normal passage through the digestive system. Again, these procedures can be performed using suture material or surgical stapling equipment.

    During any gastrointestinal surgery, care is taken not to contaminate the abdomen with any stomach or intestinal contents and the abdomen would be thoroughly irrigated during and after completion of the procedure.

    Removed tissue is submitted to a pathologists for histopathological evaluation to ensure that the disease is benign.

  • Analgesics. Your dog will have received analgesics (pain-killers) in injectable form before and after the procedure. Oral analgesics may be prescribed for a short time, when your dog goes home.

  • Intravenous fluids. Fluids will continue after surgery to maintain normal hydration. The day after surgery small amounts of water will be offered. If no vomiting occurs, small amounts of moist food will be offered about 24 hours after the surgery. If this is kept down, intravenous fluid support will be removed and your dog will usually be able to go home.

  • Motility drugs. Because the surgical procedures involve the outflow portion of the stomach, sometimes the coordination and rhythm of the stomach's contractions need some medical assistance. If your dog does vomit after surgery, medications e.g. Reglan® (metaclopromide), may be given to enhance and assist in the flow of food and liquid through the stomach. This may be continued for a short time at home.

  • Blood tests. Blood samples may be obtained in the early postoperative period, before eating and drinking has resumed, to make sure that electrolytes remain in balance.

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