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380 Gastric Ulcers

neoplasia from other infiltrative diseases such • Rehydration with intravenous fluids, if • Monitor CBC for recovery from nonregen-
as pythiosis • Antibiotics for Helicobacter infection, if erative anemia or chemotherapy-induced
indicated
VetBooks.ir cytology (p. 1112): if a gastric wall abnor- • Blood transfusion and hematinic therapy for • Monitor for signs of dissemination of
• Ultrasound-guided fine-needle aspiration
myelosuppression.
indicated
mality or lymphadenomegaly is present.
alimentary lymphoma.
Lymphoma readily exfoliates; GIST or gastric
muscle tumors do not. nonregenerative iron-deficiency anemia, if PROGNOSIS & OUTCOME
indicated
• Analgesics as indicated by clinical signs
Advanced or Confirmatory Testing • Favorable for benign lesions (polyps,
• Endoscopic biopsy (p. 1098): for some Chronic Treatment adenomas, leiomyomas), although complete
patients, histopathologic diagnosis is essential • Gastric tumor resection often results in resection of mesenchymal tumors is unlikely
for treatment and prognosis. Endoscopy motility disorders. • Poor for adenocarcinoma, carcinoma, GIST,
effectively samples mucosal tissue but may ○ May require motility modifiers: metoclo- especially when metastatic
be inadequate for tumors in the muscular pramide 0.2-0.5 mg/kg IV, PO q 6-8h or ○ These dogs generally do not live beyond
or serosal layers, requiring surgical biopsy. cisapride 0.5 mg/kg q 8-12h PO 6 months, even with therapy.
• Surgical biopsy: exploratory surgery provides • Chronic antiemetic therapy may be required. • Guarded to fair for focal mass presentation
opportunity for diagnosis and treatment • Chemotherapy with doxorubicin, plati- of lymphoma
(surgical removal of the affected region). num agents, or antimetabolites may prove • Guarded for diffuse or multicentric alimen-
• Diagnosis is confirmed by cytology or biopsy helpful. tary lymphoma because lesions typically
with histopathology, and for some tumors, • Systemic chemotherapy for gastric lymphoma regress slowly and may have an indolent
immunohistochemical (IHC) markers to provides remission and prolonged survival course but are ultimately incurable
better define tumor type. Common IHC (p. 604).
assessment of gastric tumors includes: • Receptor tyrosine kinase inhibitor (toceranib PEARLS & CONSIDERATIONS
○ Immunohistochemical stains for expression 2.5-2.75 mg/kg PO q 48h or M, W, F) for
of KIT in GIST GIST with KIT gene mutation requires Comments
○ Cytokeratin, vimentin immunohistochem- gastric acid reduction with omeprazole • Gastric carcinoma is associated with early
istry for undifferentiated tumors (preferred) or famotidine. lymphatic spread. Lymph nodes detected on
○ Immunophenotyping for lymphoma ultrasound can be aspirated for diagnosis
Nutrition/Diet and prognosis.
TREATMENT • Diet modification to easily-digested, high- • Gastric carcinomas may overexpress
energy content food cyclooxygenase-2; nonsteroidal antiinflam-
Treatment Overview • Parenteral alimentation if the patient has not matory drugs (piroxicam 0.3 mg/kg PO q
Benign gastric lesions and early-diagnosed, eaten for > 3 days or is unable or unwilling 24h) may be palliative.
low-grade malignancy may be cured surgi- to eat after surgery • Scirrhous carcinoma is rapidly fatal.
cally. Other surgical goals are to relieve gastric
obstruction or remove tumors for clinical pal- Possible Complications Technician Tips
liation. Chemotherapy is potentially helpful in • Surgical wound dehiscence with secondary Monitor for signs of hypotension and abdominal
prolonging survival, although malignant gastric peritonitis, pneumoperitoneum effusion that may indicate gastric perforation.
tumors are typically incurable. • Chemotherapy-induced neutropenia can
predispose to infection; thrombocytopenia SUGGESTED READING
Acute General Treatment can increase gastric hemorrhage. Frost D, et al: Gastrointestinal stromal tumors
• Antiemetics: maropitant 1 mg/kg PO, • Chemotherapy may result in perforation of and leiomyomas in the dog: a histopathologic,
SQ or dolasetron 0.3 mg/kg q 12-24h IV, transmural lesions. immunohistochemical and molecular genetic study
SQ; metoclopramide should be avoided if of 50 cases. Vet Pathol 40:42, 2003.
obstruction is suspected. Recommended Monitoring AUTHOR: Barbara E. Kitchell, DVM, PhD, DACVIM
• Gastroprotectants: omeprazole 1 mg/kg PO • Postoperative thoracic radiographs and EDITOR: Rance K. Sellon DVM, PhD, DACVIM
q 12-24h favored over famotidine 0.5-1 mg/ abdominal ultrasound for recurrence or
kg IV, PO q 12h metastasis every 1-2 months for 1 year

Gastric Ulcers Client Education
Sheet

BASIC INFORMATION RISK FACTORS Clinical Presentation
• Iatrogenic: administration of cyclooxygenase
Definition (COX) inhibitors, other nonsteroidal antiin- HISTORY, CHIEF COMPLAINT
Disruption of the gastric mucosa as a result of flammatory drugs (NSAIDs), or corticosteroids • Vomiting, hematemesis, and melena are
coagulative necrosis that breaches the mucosal • Hypergastrinemia (e.g., gastrinoma, chronic common complaints.
layer and exposes the submucosa or deeper kidney disease) • Inappetence or anorexia and hypersalivation
layers of the stomach wall • Hyperhistaminemia (high-grade mast cell can be seen.
tumors) • Acute encephalopathic signs (e.g., stupor,
Epidemiology • Severe hypovolemia or ischemia (shock) seizures, or drooling in cats) may be observed
SPECIES, AGE, SEX • Extremes of exercise (e.g., racing sled dogs, in patients with concurrent severe liver
Dogs and cats of any age and either sex explosive detection) disease.

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