Page 454 - Small Animal Internal Medicine, 6th Edition

426 PART III Digestive System Disorders

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FIG 27.14
Endoscopic view of a gastric ulcer on the greater curvature
in a Chow. Note that it is obvious that the mucosa is
eroded to the level of the submucosa.

FIG 27.13
View of the lower esophageal sphincter (as seen from the
stomach) of a dog with a leiomyoma (mass covered with
normal-appearing mucosa). This tumor was causing vomiting
and regurgitation.

to extract a foreign object. Finally, care must be taken to
avoid creating gastric distention in patients with esophageal
strictures or tension pneumothorax in animals with an
esophageal perforation.
Rigid endoscopy is often more useful than flexible endos-
copy in removing esophageal foreign objects. Rigid endo-
scopes can protect the esophagus during extraction of the
object and allow use of rigid forceps that permit the endos-
copist greater control. Care must be taken to maintain the
animal’s esophagus as straight as possible when using a rigid
endoscope. If a flexible endoscope is used to remove a foreign FIG 27.15
body, it is sometimes helpful to pass it through a rigid scope Endoscopic view of the gastric mucosa of a dog’s stomach
or tube that has been passed through the cricopharyngeal that has obvious bleeding. This dog had received
nonsteroidal drugs, and the bleeding represented erosions
sphincter; this may facilitate retrieval of the foreign object that could not be detected with radiographs or
through the sphincter. ultrasonography. (From Fossum T, ed.: Small animal
Gastroduodenoscopy and biopsy are indicated in selected surgery, St Louis, 1997, Mosby.)
animals with vomiting, apparent upper GI blood loss, sus-
pected gastroduodenal reflux, or small intestinal disease. It
is more sensitive and specific than radiography for detecting tissue specimens and allow the use of better foreign object
mucosal ulcers (Fig. 27.14), erosions (Fig. 27.15), tumors retrieval devices.
(Fig. 27.16), and inflammatory lesions (Figs. 27.17 to 27.19). The stomach must be as empty as possible when gastro-
Endoscopy is also quicker and less stressful to the animal duodenoscopy is performed, which usually necessitates at
than exploratory laparotomy. Many foreign objects in the least a 24-hour fast; many animals undergoing gastroscopy
upper GI tract (Fig. 27.20) can be removed endoscopically, may not empty their stomachs as rapidly as would a dog
and multiple biopsy specimens can be obtained. Occasion- without abdominal disease. During the procedure the
ally, unexpected diagnoses (e.g., Physaloptera infection; Fig. stomach must be adequately inflated with air to allow thor-
27.21) may be found. It may be necessary to use endoscopes ough evaluation of its mucosa. Suction must be available to
with outer diameters of 9 mm or less in dogs and cats weigh- remove secretions or air. The endoscopist must inspect the
ing less than 4 to 5 kg. Whenever possible, a scope with a mucosa methodically. It is particularly easy to miss lesions
2.8-mm biopsy channel should be used to obtain larger (e.g., ulcers or Physaloptera) just inside the pylorus. Biopsy