Canine, mixed breed, 11 years old, female spayed, 76 pounds.
The dog presents with a recent history of vomiting and anorexia for the last two weeks. There has been a weight loss of about
5 lbs. When the dog eats for the owner, she will vomit the food soon after. At home, the dog is lethargic and quiet, but in
the examination room today the dog is active and alert.
The findings include rectal temperature 101.0° F, heart rate 144/min., respiratory rate 25/min., pink mucous membranes, capillary
refill time less than 2 seconds, and normal heart and lung sounds. The dog is alert and responsive. The cranial abdomen is
slightly tense on palpation. Several subcutaneous lipomas are palpated along the ventrum.
Table 1: Results of laboratory tests
A complete blood count, serum chemistry profile and urinalysis are performed and outlined in Table 1.
Survey thoracic and abdominal radiographs are done. The thoracic radiographs are normal for this dog's age. The abdominal
radiographs show a prominent spleen. The liver shadow is of normal size for this dog's age. The upper GI contrast study shows
that the contrast media moved through the GI tract quickly and no obvious masses were seen. The stomach wall looks to be of
normal thickness and uniform in thickness. The duodenum and proximal jejunum appear to have the contrast media irregularly
distributed. Otherwise, there are no other abnormal findings in the abdomen.
L to R: Photo 2, 3, 4, 5, &6
Thorough abdominal ultrasonography is performed with the dog positioned in dorsal recumbency. The ultrasonographic image provided
hereafter is of the duodenum and pancreatic region.
The liver shows uniform, slightly increased echogenicity in all liver lobes. There is some periportal infiltrate or fibrosis
that makes some of the portal vessels appear slightly more prominent then normal. The gallbladder is mildly distended, and
its walls are not thickened or hyperechoic. The spleen has uniform, slightly increased echogenicity - no masses noted. The
left and right kidneys are similar in size, shape and echotexture. No masses or calculi were noted in either kidney. The urinary
bladder is distended with urine and contains some urine sediment material - no masses or calculi noted. The stomach wall may
be slightly thickened. The pancreas is seen but has uniform echogenicity. I did not visualize the walls of the duodenum and
remaining intestinal loops well.
In this case, chronic inflammatory bowel disease is the clinical diagnosis. This is the type of case in which it is always
good to pass an endoscope into the stomach and duodenum for direct visualization and collection of appropriate surface biopsies,
especially if supportive care does not resolve the vomiting and anorexia.
I do not believe that lymphoma or chronic pancreatitis is a concern in this case.
Two days following the initial diagnostic evaluation, the dog returned with acute cranial abdominal pain, generalized weakness
to almost the point of collapse, and more vomiting. An exploratory laparotomy was performed and multiple duodenal ulcers and
one perforated duodenal ulcer were found. The following is state-of-the-art information on duodenal ulceration and its clinical
management in older dogs.
Review on duodenal ulceration
Duodenal erosions are superficial mucosal defects that do not penetrate the lamina muscularis mucosae. Duodenal ulcers penetrate
deeper into the muscular mucosae layer.
Duodenal ulcers are less commonly observed than duodenal erosions and diagnosed more commonly in adult dogs than in adult
Duodenal ulceration or erosions may result from any of the agents that cause acute or chronic gastritis and acute or chronic
duodenitis. The most important causes include drugs (NSAIDs, corticosteroids), primary gastric or duodenal diseases (inflammatory
bowel disease, gastric dilatation-volvulus, neoplasia, chemical toxins), stress factors (hypotension, severe illness, environmental
stress), neurologic disease, metabolic disorders (renal disease, liver disease, hypoadrenocorticism), gastric hyperacidity
conditions (systemic mastocytosis, neoplasia), and miscellaneous disorders (pancreatitis, shock, foreign objects).
The most common causes of duodenal ulceration in older dogs include drugs, liver disease, renal disease, pancreatic disease,
neoplasia and shock. Drugs (especially NSAIDs), chronic inflammatory bowel disease and neoplasia are more commonly ulcerative,
whereas other causes more commonly result in erosions.