Page 603 - Clinical Small Animal Internal Medicine

53 Motility Disorders of the Alimentary Tract 571

dysmotility of the remaining parts of the GI tract, with a solitary foreign body obstruction (plastic balls, stones,
VetBooks.ir reduction of slow waves and disappearance of interdiges- textiles) was the most common cause (69 cats and 338
dogs) followed by a linear foreign body (35 cats, 43 dogs)
tive motility. Clinical signs usually consist of watery diar-
rhea, steatorrhea, polyphagia, and weight loss. Total
were intussusception, ileal obstipation, intraabdominal
parenteral nutrition and aggressive medical manage- and neoplasia (24 cats, 195 dogs). Less common causes
ment are often necessary in the early postoperative inflammatory or neoplastic adhesions, volvulus, incar-
period, until oral feeding can counterbalance the nutri- cerations of intestinal loops, idiopathic intestinal paraly-
tional needs. Stabilization of intestinal function should sis, intestinal diverticula, and parasitic infections.
start within 1–3 months after surgery. Complete recov- Diagnosis (history of foreign body ingestion, physical
ery occurs within 3–12 months, but depends on the examination revealing abnormal intestinal palpation,
extent of surgical removal of intestinal segments, with diagnostic imaging confirming the suspicion of obstruc-
early reports demonstrating a poor prognosis in some tion/ileus) is usually straightforward and the optimum
cases with massive resections (74–88%). treatment depends on the localization, size, material or
underlying cause (i.e., neoplastic) of the obstruction. In
Intestinal Pseudoobstruction most cases (>90%), surgical intervention is necessary.
Intestinal pseudoobstruction or functional paralytic Long‐term‐survival can be achieved in >80% of patients.
ileus is characterized by the presence of chronic intesti- A longer duration of clinical signs, presence of a linear
nal dilation and dys‐ or amotility in the absence of foreign body (as opposed to a discrete one), multiple
mechanical obstruction. Only 12 cases of chronic intesti- surgical procedures/incisions of the intestine and intesti-
nal pseudoobstruction have been reported in small ani- nal perforation have been associated with increased
mals (10 dogs and two cats) that showed clinical signs of mortality, whereas neither the degree of obstruction
chronic intestinal disease (anorexia, intermittent vomit- (partial or complete) nor the location of the foreign body
ing, diarrhea). Diagnosis was based on abdominal imag- had an effect on survival.
ing with radiographs showing generalized intestinal Obstruction due to neoplasia carries a much graver
dilation but no evidence of mechanical obstruction. prognosis, with median survival times of six months for
Histopathology showed some recurrent common fea- dogs and seven days for cats.
tures in dogs such as atrophy or complete loss of smooth Intussusception is frequently found in young animals
muscle fibers (n = 10), moderate to severe lymphoplas- and often associated with parvoviral enteritis or other
macytic or mixed inflammation of the muscular layers (n forms of acute gastroenteritis. There is some evidence
= 7) with predominantly T cells being present (n = 4), for a breed predisposition in the German shepherd dog
and varying degrees of fibrosis/sclerosis (n = 6). In one and pure‐breed/pedigree cats. Prognosis is good if surgi-
dog, severely hyperplastic smooth muscle of the lamina cal reposition or resection is successful.
propria and thickening of the muscularis mucosae were Functional SI dysmotility can be secondary to any type
reported. In cats, the histologic picture was somewhat of infection or inflammation of the GI tract or within the
different: even though muscle atrophy was present, this abdominal cavity. Both hypo‐ and hyperperistalsis can
was true only for the longitudinal muscle layers in cer- occur, but reports of hyperperistalsis are scarce.
tain segments of the jejunum in one cat. Seven out of the Parvoviral enteritis is the classic example of functional
10 dogs were euthanized due to progressive disease ileus secondary to infection. Generalized atony of the
within days to five weeks after diagnosis. intestinal tract with distended and fluid‐filled intestinal
loops is a frequent finding on ultrasonography (75%) and
Secondary Small Intestinal Hypomotility weak peristaltic contractions indicative of functional
Dogs and cats frequently suffer from obstructive intesti- ileus were observed in most of the remaining cases.
nal diseases (foreign bodies, bezoars, neoplasia, volvu- Sepsis or other serious medical illnesses requiring
lus), hence these conditions – together with neoplasia hospitalization in the intensive care unit (ICU) are
and intussusceptions – should always be considered as known to be associated with gastrointestinal dysfunction
potential cause of dysmotility. in people. Both gastric and small intestinal motility is
Few large‐scale reports examining clinical abnormali- delayed in human ICU patients, which may lead to intol-
ties, causes, prognostic factors, and outcome in small erance of enteral nutrition and increased risk of aspira-
animals with mechanical ileus are available. Of 704 tion. Additionally, acute stress‐induced gastropathy and
examined cases, the average age was 4 years for dogs and ischemic colitis (both associated with risk of hemor-
3 years for cats, with 60% being male. Mean duration of rhage) is a common finding in human ICU patients. In
illness before presentation was four days and most com- the authors’ experience, similar syndromes and compli-
mon symptoms included inappetence, vomiting, lack of cations also exist in small animals admitted to the ICU.
defecation, and abdominal pain. Mechanical ileus due to We routinely and regularly assess the grade of gastric