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The digestive system probably has more separate parts or segments than any other system in the body. From mouth to anus, this system is responsible for breaking down foodstuffs, separating out the essential nutrients, absorbing the nutrients into the blood stream and preparing the waste products for excretion.
Diseases of the digestive system are probably the number one problem that veterinarians deal with in pet dogs. Diseases of other systems also commonly affect the digestive tract. After all, not eating is a common symptom in hundreds of different illnesses. This section will attempt to cover conditions one subsection at a time, i.e., mouth, stomach and so forth.
GLOSSITIS, STOMATITIS, and GINGIVITIS
Stomatitis is inflammation of the oral membranes; Glossitis is inflammation of the tongue; Gingivitis is inflammation of the gums. Notwithstanding the exact area affected, most oral lesions are due to some other specific problem which ultimately affects the mouth. Because the mouth is full of bacteria, yeast and other organisms, internal diseases can allow these to attack and cause infection. Most commonly, the above problems occur as resistance is altered for such reasons:
Drug reactions
The clinical signs will include decreased or poor appetite, reluctance to eat, foul oral odors, trouble swallowing, rubbing the face, pawing the mouth, unusual chewing-like motions, salivation and vomiting. Diagnosis is based on these clinical signs, physical examination of the mouth which may reveal redness, odor and ulceration; complete blood counts, serum chemical analysis, urinalysis, thyroid testing, cytology, cultures, and biopsy of the affected tissues. ((Gingivitis))
TREATMENT OF GLOSSITIS, STOMATITIS and GINGIVITIS
Specific conditions require their own treatment. Selected antibiotics, anti-fungal medications, oral antiseptic washes and anti-inflammatory medications will all be useful. Dental cleaning may be warranted and usually will improve oral health under all circumstances. Feeding soft or pureed foods or giving a liquid diet will help keep the dog's strength and resistance up while healing. Antibiotics should not be overused as they can lead to a worsening of certain infections.
PHARYNGITIS and TONSILLITIS
The pharynx is the back part of the mouth, after the teeth but before the esophagus. The tonsils lie on either side of the pharynx in small pockets called crypts. Inflammation of either of these structures (this would rarely occur one without the other) results in pharyngitis and tonsillitis. This problem can also be concurrent to other oral problems. (see stomatitis) Respiratory diseases, vomiting problems and nasal or sinus problems also can cause inflammation at the back of the throat. Young dogs may have tonsillitis only, but this usually needs little or no treatment as it resolves with age and maturity.
Clinical signs seem more common in young and smaller breeds of dog, often where there has been some recent trouble with coughing, vomiting, nasal discharge or so forth. Fever, loss of appetite, increased salivation, trouble swallowing, rubbing the throat, gagging and shaking the head may all be seen. Diagnosis is based on history, physical examination of the head and throat, X-rays, and cytology. A throat culture as is commonly performed in people is usually worthless.
TREATMENT OF PHARNGITIS and TONSILLITIS
Most dogs respond well to antibiotic and anti-inflammatory medications. Soft diets may help until soreness of the throat passes. Tonsillectomy is rarely performed and then only if there is a chronic failure of treatment or in an attempt to better diagnose the problem.
As a broad or more general classification, dental disease encompasses many problems of the teeth and gums. It is calculated that 95% of dogs will have dental disease in their lifetime making this the most common disease of pet dogs. To be more specific, it is periodontal disease, infection along the borders of teeth and gums (the periodontium) that is most commonly seen. One might also know this disease simply as "BAD TEETH"!
Dental disease begins as the dog eats and food particles accumulate along tooth surfaces. Bacteria in the mouth digest the food to form plaque, which is the yellow sticky film seen on the teeth. As this infection spreads, dental disease develops.
As enough plaque builds up, an infection of the gums known as gingivitis can occur. This is often seen as a red line along the teeth on the gums. As time passes, the plaque calcifies and hardens to form tartar which, in a way, holds the infection against the teeth and pushes it still further under the gums, leading to the formation of "pockets". Periodontal Disease is this deeper infection of the gums along the tooth margins and tooth roots, which will, if left unchecked, leads to tooth loss as the root decays.
All dogs seem to be affected, but smaller breeds have the most severe problems, probably because the teeth are closer together; because they are more often given soft foods and scraps and because they are not as good about chewing rawhide bones and so forth to help keep teeth clean. It has been observed that soft moist, canned, or table foods greatly increase the rate at which plaque and tartar build on the teeth so hard foods are highly advised.
While dental disease does cause teeth to look and smell bad, the damage that isn't seen is far worse. The gum tissues have an extensive blood supply and all the bacteria involved in periodontal infections easily enter the blood stream leading to valvular heart disease, kidney disease, hepatitis and joint disease, not to mention that constant pain from tooth loss is also present.
Clinical signs include bad breath, rubbing the face and mouth, increased salivation, bleeding gums, pus around the teeth and the obvious build up of plaque and tartar on the teeth. Many dogs will be less active, have poor appetite, and loose weight. Diagnosis is based on oral examination, X-rays and measuring the pockets around teeth with a special probe. ((Dental Disease)) ((Dental Disease 2))
As for humans, plaque and tartar must be removed from the teeth with scrapers and mechanical devices and then teeth need to be polished smooth again. As animals will not "hold still and open wide", anesthesia will be needed. Once cleaned, fluoride treatments and antibiotics can be used to cure existing infection.
While not 100% preventable, many things can be done to preserve oral health. Feeding only hard dry chow is the best place to start. Some special diets are also now available that clean the teeth more effectively than most regular dry diets. Brushing the teeth on a regular basis with disinfectant medications or enzymatic pastes is also possible depending upon how cooperative the patient is.
Your veterinarian can show you how to do this and recommend appropriate products. Allowing the dog to chew rawhide bones or special chew toys will also slow plaque deposition. We do not recommend bones, hooves or other very hard items as these often break the teeth. Lastly, remember that plaque will still form and some degree of professional care will be needed from time to time. Note: avoid human toothpaste; it is high in detergents that should not be consumed by your dog.
A cavity is erosion in the surface of the tooth surface (enamel). As plaque-forming bacteria produce acids which sometimes dissolve the calcium matrix and thusly the tooth surface. Cavities are uncommon in dogs. Clinical signs include mouth pain, trouble chewing, salivation and pawing at the mouth. Diagnosis is based on oral examination and X-rays.
In some cases teeth are so badly decayed as to require extraction. If caught early, a filling may be put into a tooth and its soundness restored. Many veterinarians are now capable of doing this type of restoration work
Dental fractures are common in dogs. Many dogs chew and bite objects with such a force as to fracture the crowns of the teeth. Canine teeth (fangs) and the large 4th upper premolar are most commonly damaged. Clinical signs include the obvious fracture, oral pain, difficulty chewing and bleeding from the mouth. Diagnosis is based on physical examination and X-rays.
Badly fractured teeth may need to be extracted. Vital pulpotomy, which is like a filling with a partial root canal, can be performed in many cases. Root canals will be needed if infection and decay have begun. Some dogs, often-valuable working dogs, will receive a metal crown to preserve the "bite" of the tooth. Antibiotics for infection are indicated.
Periodontal disease which becomes so bad as to extend to the deep root areas known as the "apex" is not uncommon. Bacteria causing infection form pockets between the tooth root and supporting bone structures and ultimately loosen the root hold. The canine teeth and the large upper molars are most commonly involved but this process easily affects any tooth in the mouth.
Clinical signs include foul oral odors, rubbing the face and mouth, open and draining sores on the face often just in front of the eye, nasal discharges, salivation, facial swellings, and open sores on the gums away from the dental crowns. Loose teeth most commonly have apical abscesses. Diagnosis is based on physical examination and X-rays.
Some teeth, particularly those that are loose, may only be treated by extraction. Sometimes the communication between root and face or nose must be opened and flushed. In other cases, a "reverse" root canal can be performed to preserve the tooth. Antibiotic therapy is always important. Once the infection is addressed, facial swelling and open sores will generally heal quickly.
Deciduous teeth are the "baby" or temporary teeth. These are generally pushed out as the permanent teeth cut in between 3 1/2 and 6 months of age. If the alignment needed to push the baby teeth out as the new tooth emerges is not perfect this may not occur, and two teeth are then present where one should be. The baby teeth are generally smaller, thinner and sharper than their adult counterparts.
Certain breeds including Yorkies, Toy Poodles and Chihuahuas seem quite prone to this disease, but small dogs in general more often have this condition. There are usually not obvious, immediate symptoms/diagnosis of the condition is readily obvious upon physical examination. Unfortunately, left untreated, the retained teeth alter position of the adult teeth resulting in abnormal tooth wear, dental fractures and faster decay processes. Sometimes, sores may be cut on the gums from tooth malposition. ((Retained Teeth))
All retained teeth should be extracted. This is all baby teeth not out by 6-6 1/2 months of age. We often advise this being done when dogs are spayed or neutered at about this age. If not, extraction should nevertheless be undertaken by itself. If it becomes evident during routine examination of young puppies that the deciduous teeth are or will cause misplacement of the adult teeth, extraction can and should be done earlier.
A salivary mucocele is an accumulation of saliva in a pocket under the skin but outside of the salivary gland(s) and ducts. While diseases of the salivary glands are uncommon, veterinarians see this particular problem with some regularity. While it is usually impossible to exactly determine what causes a leak in the system, trauma to the head, foreign objects penetrating the salivary glands or ducts, tumors or other swelling near the duct which causes obstruction may all lead to a mucocele.
The usual swelling occurs near or under the angle of the jaw. Some dogs will have a large swelling under the tongue that is called a Ranula. As saliva leaks under the skin, a pocket, which is an encapsulation of the saliva inside connective and inflammatory tissues, forms. This may cause the fluid mass to feel solid like some sort of tumor. ((Mucocele))
The clinical signs will vary with which salivary gland and/or duct has the leak. A ranula will cause trouble chewing, swallowing, and the tongue will often deviate out one side of the mouth. Large cervical mucoceles will rarely cause any noticeable problems. Trouble swallowing and obstruction to breathing will occur with pharyngeal mucoceles. Diagnosis is based on physical examination, X-rays, aspiration, cytology of the masses, culture and biopsy. ((Salivary Glands))
While drainage can be tried, it will rarely cure this condition. The best treatment will be the surgical removal of the affected glands along with surgical drainage of the mucocele. A ranula can be treated with surgery also. The surgery is delicate and using an experienced surgeon is highly advisable.
Salivary adenitis describes an uncommon inflammatory disease of the salivary glands, most often a bacterial infection secondary to foreign objects, oral infections or dental infections which spread to the salivary glands, salivary mucocele, trauma, and sometimes viral infections. One or more glands may be affected at any one time, but rarely would all glands be involved. ((Salivary Glands))
Clinical signs include salivation, including an abnormal thickening and color changes to the saliva, swelling of involved glands, which may also be warm and painful, trouble chewing or swallowing, and, in some cases, open, draining sores on the side of the face. Physical examination, aspiration and cytology of fluids and cultures will usually establish the diagnosis.
Any draining abscesses should be flushed and cleaned under anesthesia. Exploration for foreign objects should also be considered in these cases. Oral infections should be treated, and abscessed teeth may require removal. After these or any other initiating cause is dealt with, then antibiotics, prednisolone and oral rinses should help to resolve the condition.
A sialolith is a stone that forms in some part of the salivary system. They are quite rare and the cause for their formation is poorly understood. If present, they will more likely be secondary to salivary adenitis or salivary mucocele. Salivary stones, if present, can block the flow of saliva and result in failure of the associated gland. Clinical signs are similar to salivary gland inflammation and include localized swelling, heat, and pain. Diagnosis is based on physical examination, X-rays and ultrasound. Aspirates and cytology may be useful to differentiate this from similar problems. ((Salivary Glands))
When present, surgery is the treatment of choice and should be performed promptly. Once the stone is removed and assuming there are no complications, function of the gland and duct involved should quickly return to normal.
Traditionally, megaesophagus was used to describe an abnormal dilatation of the esophagus. More correctly, while dilatation will exist, there are generally problems with the motility of the esophagus that causes the abnormal dilation. Esophageal motility is very important; special contractions are what moves food from the mouth towards the stomach as food does not just "fall" in that direction. Without this normal motility, food and liquids do not move in the proper direction.
Two main types of megaesophagus are commonly seen, a primary form and a secondary form. The primary form is a congenital defect that affects young puppies and for which the cause is unknown. Otherwise, megaesophagus will arise secondary to cases of esophageal foreign body obstruction, persistent right aortic arch, SLE, polymyositis, polyneuritis, myasthenia gravis, hypothyroidism, hypoadrenocorticism, esophagitis, certain poisons, tumors which block the esophagus, and other neurologic diseases. Thusly, when megaesophagus is diagnosed, some primary condition should be sought.
Clinical signs include regurgitation, which most people will describe as vomiting when in reality, forceful vomiting is not occurring. Young dogs will often regurgitate milk through the nose and look poorly developed. Weight loss, salivation, gurgling sounds, weakness, paralysis, trouble swallowing, and bad oral odors may all be present. Because the regurgitation is uncontrolled, unlike vomiting, dogs may inhale fluids and food particles and severe aspiration pneumonia will then occur.
Diagnosis will be based on historical information, X-rays including dye studies, neurological examination, endoscopy, blood counts, serum chemistries, thyroid testing, urinalysis, and special neurological testing. It is important to understand that while the actual diagnosis of a megaesophagus may be relatively easy; the determination of the cause will be more involved. ((Megaesophagus))
Foreign objects should be removed and any other strictures should be approached and dealt with. Persistent right aortic arch will require surgical treatment. All dogs should be fed a gruel-like diet that the veterinarian determines as best for the patient. Some dogs may require feeding through a stomach tube for a time if the regurgitation has become too severe. Surgery is rarely useful to "reshape" the esophagus, and few drugs are available to help. Treatment of any primary disease as mentioned above will offer the best hope of control or reversal of this problem. Most dogs that die do so because of aspiration pneumonia or from poor home administration of dietary recommendations.
Esophagitis, which is inflammation of the esophagus, can include ulceration of the esophagus in more severe instances. The causes of this can include chronic vomiting problems, swallowing acid, alkali and other poisons, thermal burns and traumatic injury including swallowing some type of foreign objects such as a bone, stick or fishhook.
Clinical symptoms include poor appetite, salivation, trouble swallowing, regurgitation which may be confused as vomiting, blood may be present in any regurgitated materials; fever, shock and aspiration pneumonia can occur in some extreme cases. Oral inflammations may also be present. Diagnosis will be made with historical information, physical examination, endoscopy, X-rays including dye studies and blood counts.
If the dog has ingested a poison, then treatment for such should be undertaken first. Do not, in these cases, induce vomiting. General care for an inflamed esophagus will include antibiotics to control infection, the use of cimetidine to curb acid formation, feeding a diet that is watery and mushy like baby food, fluid therapy to prevent dehydration and in some cases using cortisone to relieve inflammation.
In some cases, as the esophagus heals, a scar that reduces the size of the esophagus will form. This is known as a stricture. Minor strictures may respond well to simple dietary changes. Major strictures may require manual stretching under anesthesia, or even surgical reconstruction by a specialist.
Every veterinarian will probably have their own story of items they have removed from a dog's esophagus. Bones, fishhooks, balls, pantyhose and so forth all become swallowed and stuck. Sometimes objects will only abrade the inside lining of the esophagus and pass on to other parts of the digestive tract. This may, however, predispose the patient to esophagitis. More often, the object will become lodged, and in a worse case scenario, will puncture the esophagus and allow leakage of fluids and food into the neck or chest cavity, possibly causing a pyothorax.
Symptoms may include trouble swallowing, pain, salivation, blood in regurgitated fluids, loss of appetite, depression and an inability to get into a comfortable position. Trouble breathing or swelling to the neck may be indicators of an actual perforation and subsequent infection. Diagnosis is based on history, although many owners may fail to be aware that the pet has swallowed anything, physical examination, X-rays including dye studies, endoscopy, ultrasound and analysis of fluids either from the mouth or aspirated from the chest cavity.
Because the esophagus is encased mostly within the chest cavity and surrounded by vital structures, removal of lodged objects can be extremely difficult. The best results can be obtained if an object can be removed with the aid of an endoscope. This will usually result in minimal trauma. In some cases, objects can be gently "pushed' into the stomach and removed from there.
Other times, surgery will be the only hope. This may, however, mean that the dog will have to have an open-chest procedure performed that can be quite expensive and moderately risky. Only a surgeon will all the proper equipment and training should routinely attempt such a surgery. Reconstruction of part of the esophagus may be required and possible complications include infection, failure of the surgery to hold and death.
Acute gastritis involves a sudden inflammation of the stomach with some damage to the lining of the stomach usually being present. Clinical signs of gastritis include a sudden onset of vomiting, and if the vomiting persists, abdominal pain, dehydration, and lethargy. Many cases of gastritis may be associated with cases of enteritis, colitis or the mixed forms called gastroenteritis or enterocolitis.
There are many causes of gastritis, but probably the most common cause is the dog eating either a different food than it is used to, including changing dog foods or new treats, giving some type of "human" or "table" food, or the pet getting into the garbage. Rancid or spoiled foods, non-food items including toys, wood, bones and weeds or grass, feces, chemicals, drugs, viruses, certain bacteria and internal parasites can all cause gastritis. If we remember that vomiting is the body's way of removing material that is causing an insult we then better understand this disease process.
There are, however, quite a few diseases that will ultimately cause vomiting, but in any case of sudden vomiting in an otherwise healthy dog, acute gastritis and its associated causes should be highly suspect. Diagnosis is based on history, including what the pet has eaten and when, fecal analysis, X-rays and blood counts in some cases.
In many cases, the offending substance will remain unknown or only supposed. Nevertheless, with proper historical and physical findings, good symptomatic treatment can and should be undertaken. Anti-vomiting medications and sometimes antibiotics are used to settle the stomach. Fluids are given if the pet has become dehydrated. Otherwise, symptomatic therapy of vomiting is done as follows:
No food or water is given for a period of time determined by the veterinarian. If no vomiting occurs during this time, the pet will be given relatively small amounts of water or mild electrolyte solutions every 30-60 minutes. If these small amounts are held down and no vomiting occurs, the amount of fluids given at each interval is gradually increased until the pet is drinking normally. Food is withheld until the dog is drinking and not vomiting, then as with the water, small quantities of a bland, low fat and easily digestible food is given every 3-4 hours and gradually increased until the pet is also eating normally. Some veterinarians will use mixtures of rice and boiled chicken, but we prefer special pre-made foods. Dogs, which continue to vomit and do not respond well to this simple treatment generally, have problems that are more serious and will often require IV fluids and further diagnostic tests to obtain a proper diagnosis and allow correct treatment.
Chronic gastritis occurs when a dog has repeat bouts of gastritis (vomiting) that is either nonresponsive to therapy or due to some type of chronic inflammatory process of the stomach. In many cases, a cause is never determined. Other times, a diagnosis may be obtained by gastric biopsy, a procedure easily performed with an endoscope. A biopsy will usually show some specific type of inflammatory process, an abnormal thickening of the stomach lining, ulcerative disease, an abnormal thinning of the stomach lining or evidence of an allergic-type reaction.
The clinical signs of chronic gastritis are vomiting that occurs relatively frequently or at a regular interval. Vomitus may be mucoid, thick and contain blood. Dogs may have poor appetite, dark stools, mild abdominal pain and drink more than usual. Diagnosis is based on history, physical examination, blood counts, serum chemical analysis, fecal analysis, X-rays, endoscopy and gastric biopsy.
There is not one exact treatment for all cases of chronic gastritis. If there is and exact cause or disease found, then that should be directly addressed. Various prescription diets are available including highly specific foods that would be unlikely to cause dietary allergies. Some foods may be used because they are low in fat and highly digestible. Feeding smaller but more frequent meals is also often employed.
Tagamet or Zantac are used in some cases to reduce gastric acidity. Cortisone- like drugs work well in cases of allergic or inflammatory disease. Drugs which control vomiting and improve gastric emptying, such as metoclopramide, have been used in some cases with good response. In other cases, simple protectants such as Pepto Bismol can be used to soothe the stomach. No matter which treatment ultimately does the best job, most dogs will require lifetime therapy, if at least being on a special diet.
The pylorus is the portion of the stomach leading into the small intestine that controls or regulates the emptying of the stomach. Hypertrophy denotes a thickening or enlargement. Thus, if the pylorus becomes thickened, the ability of material to flow from the stomach to the intestines is diminished. This condition may be seen in very young dogs and is therefore congenital. More often, but still uncommon, older dogs develop this hypertrophy secondary to cases of chronic gastritis or neoplastic thickening of the stomach and intestines. ((Pyloric Stenosis))
Most dogs with this condition are the smaller and short-nosed breeds. Clinical signs will include a chronic recurrent vomiting which is often related to feeding. Weight loss, general loss of condition and dehydration will also be noted. Diagnosis is based on history, physical examination, blood counts and serum chemistries, X-rays including dye studies, ultrasound and endoscopy. Doing an upper GI study often elucidates the failure of food to pass the pylorus.
If a chronic gastritis is involved, treatment of that may resolve the situation by decreasing the swelling at the pylorus. In other cases, surgical alteration of the pylorus will be the only option to (partially) restore a normal flow. Most dogs respond fairly well with this type of procedure and can live a normal life.
This is not simply one disease, but rather, a number of disease entities that alter the function of the stomach and then inhibit the flow of food from the stomach into the intestines. Normally, food in the stomach should enter the small intestine in 6-8 hours. If food is retained longer than 8 hours then impairment to motility is said to be occurring.
Causes can include trauma, pain, stress, surgery, chronic gastritis, diabetes, hypothyroidism, hepatic disease, chronic renal disease, other metabolic conditions, canine parvovirus, gastric dilatation-volvulus, gastrointestinal foreign objects and certain drugs; there may be no obvious cause.
Food retained in the stomach will cause bloating, and subsequent vomiting, usually 6-8 hours after the meal. Other symptoms include bloating of the abdomen, weight loss, loss of appetite and salivation due to nausea. Diagnosis is based on the history, physical examination, X-rays including dye studies such as an upper GI, blood counts, and serum chemistries.
Most dogs will need to be fed small, frequent meals of a bland, easily digestible food, and even then, the food may need to be blended with water. The use of metoclopramide, which can be used long term if needed, often improves gastric activity and outflow. Few other drugs benefit these dogs.
Dogs love to chew and swallow rocks, balls, toys, sticks, socks, pantyhose and a million other household items which have been found inside the stomach and intestines of dogs. This author has personally removed a salad bowl, a beach towel and a rope from one hungry canine! Unfortunately, these objects often become stuck and grossly interfere with the normal function of the digestive system. Puppies, in their exuberance, seem more prone to this condition but a few mature adults fail to learn the lessons of proper eating.
The symptoms of an obstruction will depend on where in the digestive tract the blockage is located and whether or not the bowel or stomach has been damaged in the process. Obstructions of the stomach and upper part of the intestines will cause repeated vomiting, dehydration, weakness and moderate abdominal pain. Obstruction farther down the intestine may not cause any vomiting but will lead to diarrhea that may become bloody, loss of appetite, abdominal pain and bloating, and abnormal posture as if the dog is unable to get comfortable.
Some dogs may have partial or "floating" obstructions where some material is still passing, and this will serve only to make the final diagnosis more difficult. One of the most dangerous types of foreign object is what is called a linear foreign body, where a string or pantyhose is inside a long portion of the intestine. This tends to pleat up a large portion of intestine and cut through the intestine wall leading to the very serious condition of peritonitis.
Diagnosis is based on history, especially if the pet was observed eating an item, physical examination, X-rays including dye studies, blood counts and serum chemical analysis, endoscopy, and ultrasound studies. Early diagnosis and rapid treatment will usually allow the veterinarian to save the dog. ((GI Foreign Objects))
Most dogs will need to be hospitalized and given IV fluids to correct dehydration and electrolyte disturbances. Once stable, surgical removal of the object(s) will be required. Direct removal of the object, removal of part of the intestine, or repair of any holes in the intestines will all be needed, again, depending upon the damage done by the foreign body. Only at surgery can the exact best course be determined. ((Gastrotomy))
Post operative hospital care including fluids, antibiotics, withholding of food and water for several days, followed by a slow and gradual return to a normal consumption will be needed. It may be best to feed dogs a bland and highly digestible food for up to 2 weeks post surgery. Once past the crisis, 100% recovery is possible for most dogs.
Fortunately, stomach ulcers are uncommon in the dog. Ulcers are described as erosions, superficial or deep, in the lining of the stomach. Ulcers are not a primary condition, but may be caused by acute gastritis, chronic gastritis, foreign objects, drugs, poisons and toxins, cancers or tumors, altered blood flow to the stomach, and infections by Heliobacter, a newly identified cause of ulceration. Kidney disease, liver disease and hypoadrenocorticism can also lead to irritation and ulceration of the stomach as well. ((Gastric Ulcer))
Dogs with gastric ulceration may have symptoms related to some primary condition, but symptoms of the ulcers can include vomiting, which may contain blood, dark black stools, abdominal pain, poor appetite, loss of weight, fever, pale gums, weakness and collapse. Any dog having some type of chronic gastritis would be suspect for ulceration.
Diagnosis is based on history, physical examination, blood counts, serum chemistries, X-rays including dye studies, and endoscopy including gastric biopsy.
Besides treating any primary condition, some dogs will respond well to feeding bland, easy to digest foods, and giving antacids or Tagamet. The drug sucrafate has been used with good results to coat and seal ulcerated tissues. Debilitated dogs may need fluid therapy and even liquid nutritional support. Extreme cases may call for removal of damaged portions of the stomach, but this is rarely performed. Dogs with Heliobacter infection may heal quickly and completely with simple antibiotic therapy.
Bile and pancreatic juices enter the digestive tract in the small intestine. They are kept out of the stomach by the pylorus. Some dogs, for reasons that may include motility disorders, chronic gastritis or loss of pyloric tone, have bile and digestive juices flowing backwards into the stomach. As these juices were not meant to be in the stomach, they cause gastritis and in some cases ulceration, resulting in the clinical signs of vomiting, often early in the morning, with the dog being normal the remainder of the time.
The symptom of vomiting bile, primarily in the morning, is highly suggestive of this disorder. Diagnosis otherwise is based on history, physical examination, X-rays including dye studies and endoscopy including gastric biopsy.
Many dogs will respond well to simply being fed later at night, and giving at least two meals a day. Otherwise, feeding of high fiber foods, the use of metoclopramide, antacids and further feeding schedule manipulation will often produce good results but will need to be maintained for life. These dogs may also benefit for the feeding of a highly digestible diet.
GDV is a severe and life threatening problem common in large dogs with deep chests, such as the Great Dane, German Shepherd Dog, Saint Bernard and Irish Wolfhound. The condition is a medical emergency and must be treated quickly if the dog is to have any chance of survival. Nevertheless, many dogs will not survive even with the very best of care.
Firstly, the stomach of the dog becomes grossly dilated and gas, fluid and food becomes trapped. Then, rotation of the stomach occurs within the abdomen that totally blocks the esophageal and intestinal openings to the stomach. Furthermore, the twisting sets in play a series of VERY SEVERE heart and metabolic changes that quickly threaten the life of the patient. Collapse and death can occur in hours or even minutes in some cases.
The exact cause of this condition is unknown, but vets think the causes include eating or drinking large quantities of food and water followed by exercise which serves to loosen the attachments of the stomach; simply eating or drinking too much at one time, trauma, dysfunctions of the sphincter (valve) between the stomach and the esophagus, previous vomiting episodes and other genetic factors not yet understood.
Clinical signs often come on very quickly and totally unexpectedly. It is not uncommon at all to find a dog that was eating and playful down or dead a few hours later. These symptoms include an enlarged or frankly bloated abdomen, unusual posture, collapse, retching or trying to vomit without results, salivation, pale gums, difficulty breathing, blue gums or very red gums and extreme restlessness. Dogs, which start out with a simple bloating due to overeating or excess gas, can quickly be in danger if they are not belching up the gas. Diagnosis is based on the history, physical examination and X-rays. We cannot overemphasize the need to seek rapid attention for any dog with even mild symptoms of GDV.
Rapid administration of IV fluids and electrolytes, oxygen and high levels of cortisone to stabilize the dog is needed. Some dogs may benefit from either passing a stomach tube, which sometimes may be impossible, or trocharizing the distended stomach to relieve the pressure. If a tube can be passed, pumping and flushing the stomach with cool water while under mild sedation may be all that is needed to allow the dog to recover.
In other cases, either the dog will defy decompression or the bloating will recur shortly after treatment. More aggressive therapy is then indicated. This may include some semi-permanent placement of a tube to maintain decompression, or performing surgery to return the stomach to its usual position and hold it there. Continued supportive care with fluids, antibiotics, sedation and steroids will all be needed. In some cases, the stomach will be found to have almost completely rotted and euthanasia may be the only option. In other cases, part of the stomach can be removed and the patient saved.
Of dogs that die, shock, electrolyte disturbances, cardiac arrhythmia and severe infection all contribute to the cause. Survival is based on quick responsive treatment and a little luck. While there is not sure way to prevent GDV, it is advisable to feed more but smaller meals, feed high quality and highly digestible foods, avoid excess water intake at any one time and avoid exercise after meals.
GASTROENTERITIS and ENTEROCOLITIS (GARBAGE-CAN TOXICOSIS)
Gastroenteritis and enterocolitis are mentioned here, not because they are different diseases, but because they are commonly diagnosed mixtures of other basic conditions. Because the digestive tract is connected from mouth to rectum, it is common for inflammation to be occurring in more than one area at a time. Hence, gastritis often occurs along with enteritis, and enteritis often occurs along with colitis. Because these conditions are most commonly associated with eating "people", "table" foods or garbage veterinarians often use the name garbage-can toxicosis.
The common clinical signs of gastroenteritis include vomiting and diarrhea. These symptoms may be strong and frequent. If they continue, dehydration and abdominal tenderness will occur. Besides the ingestion of foodstuffs not intended for the dog, bones, toys, sticks, grass, internal parasites, and poisons and toxins can all produce this condition. Nevertheless, the most common cause is the owner giving the dog "just a little bit of..." or the dog helping his or herself to something left within reach.
The cause of gastroenteritis or enterocolitis may never be exactly determined unless the owner admits to the offending feeding or knows of garbage ingestion. Otherwise, diagnosis is based on history available, physical examination, fecal analysis, X-rays and blood counts.
In many cases, the offending substance will remain unknown or only supposed. Nevertheless, with proper historical and physical findings, good symptomatic treatment can and should be undertaken. Anti-vomiting medications and sometimes antibiotics are used to settle the stomach. Other medications are used to control diarrhea. Fluids are given if the pet has become dehydrated. Otherwise, symptomatic therapy is done as follows:
No food or water is given for a period of time determined by the veterinarian. If no vomiting occurs during this time, the pet will be given relatively small amounts of water or mild electrolyte solutions every 30-60 minutes. If these small amounts are held down and no vomiting occurs, the amount of fluids given at each interval is gradually increased until the pet is drinking normally.
Food is withheld until the dog is drinking and not vomiting, then as with the water, small quantities of a bland, low fat and easily digestible food is given every 3-4 hours and gradually increased until the pet is also eating normally. Some veterinarians will use mixtures of rice and boiled chicken, but we prefer special pre-made foods. Dogs that continue to vomit and do not respond well to this simple treatment generally have problems that are more serious and will often require IV fluids and further diagnostic tests to obtain a proper diagnosis and allow correct treatment.
Enteritis is inflammation of the small intestines. While foods or foreign objects can cause enteritis, more commonly an infection will lead to this condition. This includes many different types of bacterial infections including salmonella and camphylobacter, parvovirus, canine distemper, coronavirus, poisons and toxins, intestinal parasites of all kinds, histoplasmosis, stress and drugs. The severity of the disease and thusly the clinical signs produced varies greatly, depending on the agent causing the primary insult; thusly, specific individual diseases should be studied.
Clinical signs in general include vomiting, diarrhea which can include blood in some cases, weight loss, loss of appetite, fever, increased amounts of stool volume, very watery stools, weakness, and collapse. Diagnosis is based on history, physical examination, stool analysis, blood counts and serum chemistries, specific tests for specific agents, i.e. parvo test, X-rays including dye studies and endoscopy including biopsy.
Methods of treatment will vary depending on which primary cause is present. In general, fluid and electrolyte therapy will be used to combat dehydration. Antibiotics will be used to control infection and sepsis. Anti-vomiting and anti-diarrhea medications will be used depending on the nature and severity of the symptoms. Medications to kill parasites may also be needed. If the illness is severe, as in cases of parvovirus enteritis, then the dog will require hospitalization. Less severe cases may respond to outpatient therapy as follows:
No food or water is given for a period of time determined by the veterinarian. If no vomiting occurs during this time, the pet will be given relatively small amounts of water or mild electrolyte solutions every 30-60 minutes. If these small amounts are held down and no vomiting occurs, the amount of fluids given at each interval is gradually increased until the pet is drinking normally.
Food is withheld until the dog is drinking and not vomiting, then as with the water, small quantities of a bland, low fat and easily digestible food is given every 3-4 hours and gradually increased until the pet is also eating normally. Some veterinarians will use mixtures of rice and boiled chicken, but we prefer special pre-made foods. Dogs that continue to vomit or have severe diarrhea and do not respond well to this simple treatment generally have more serious problems and will often require IV fluids and further diagnostic tests to obtain a proper diagnosis and allow correct treatment. This will, again, generally require hospital care.
HGE is a relatively common problem seen in pet dogs. It is characterized by a very sudden onset of vomiting and diarrhea that is quite bloody. Severe dehydration also often accompanies this syndrome. While an exact cause is not understood, this author has noted that most dogs were otherwise healthy, but were given some "table" food within 12-24 hours of the onset of symptoms; thusly, this may be a severe form of gastroeneritis.
Besides the obvious symptoms of vomiting and bloody diarrhea, abdominal pain, loss of appetite, fever and shock may all be present. Oftentimes blood may not be readily apparent until examination. Diagnosis is made by history, physical examination, fecal analysis, blood counts and serum chemistries, X-rays including dye studies, and ultrasound. Poodles and Schnauzers seem most at risk for this illness although small breed dogs in general will get HGE.
Although the disease presents swiftly and severely, most dogs will recover well when given IV fluids and electrolytes, antibiotics, cortisone if needed for shock and by allowing the intestines to rest by giving no food or water for a period of time. After the initial treatment, feeding a bland and easy to digest food for a few weeks is generally helpful. Avoiding dietary changes is felt to prevent recurrence. If this does recur, inflammatory bowel disease needs to be considered.
Lymphocytic/plasmacytic enteritis occurs when millions of lymphocytes and plasmacytes (types of white blood cells) infiltrate and line the small intestines. This is considered one type of inflammatory bowel disease. The exact cause is not known, but it is thought to be an abnormal immune response. Next IBD
Symptoms of LPE include chronic, watery diarrhea, which may contain blood, and does not seem to respond to any treatment. Loss of appetite, vomiting, weight loss and enlarged lymph nodes may also be seen. Diagnosis is based on history, physical examination, fecal analysis, blood counts, serum chemistries, X-rays including dye studies, and endoscopy including biopsy. The only way, however, to actually get a diagnosis is by obtaining an intestinal biopsy.
While it is difficult to cure this condition, control is possible if the proper treatment is provided. Feeding of high-quality diets that are either highly digestible, high in fiber or non-allergenic can be tried until the best results are obtained. Special types of antibiotics and cortisone type drugs in various doses are often employed; some level of lifetime therapy may be required. Vitamin therapy is also indicated.
Eosinophilic enteritis occurs when millions of eosinophils, a type of white blood cell, infiltrate and line the small intestine. While the cause is not understood, this may be a form of allergic reaction, including a response to food allergens or internal parasites. Eosinophilic enteritis is also considered a type of inflammatory bowel disease.
Clinical signs include occasional vomiting, diarrhea that is chronic and may be dark or bloody. Weight loss and poor appetite may also occur. Diagnosis is based on history, physical examination, stool analysis, X-rays including dye studies, blood counts, serum chemistry and endoscopy including biopsy. Biopsy is the only way to obtain this exact diagnosis.
First, all dogs will need to be on some type of hypoallergenic diet, probably for life. Parasites should be killed. Cortisone and cyclophosphamide are often effective in controlling the inflammatory process. Long-term success is usually good with this basic treatment, which may be needed for life.
Blockage of the small intestine can occur for many reasons. These causes, other than gastrointestinal foreign objects, are covered here. Notwithstanding the cause, anything that blocks flow of material through the intestines will create a severe problem. Obstruction can occur from either inside or outside of the bowels. Causes include tumors and polyps, including those on other organs which press against the bowels, obstruction caused by bowel thickening as in lymphocytic/plasmacytic enteritis, abscesses, intussusception, which is when one piece of intestine slips inside another piece and starts to decay, torsion where the intestine becomes twisted and strangulation when a piece of intestine gets stuck inside of a hernia.
The symptoms of blockage will depend upon the severity of the blockage and the location. Some blockages may not be complete and thusly will produce symptoms that may not perfectly indicate a blockage. Sometimes, the symptoms may come on in a slow and progressive fashion. Obstructions of the stomach and upper part of the intestines will cause repeated vomiting, dehydration, weakness and moderate abdominal pain. Obstruction farther down the intestine may not cause any vomiting but will lead to diarrhea that may become bloody, loss of appetite, abdominal pain, bloating and abnormal posture as if the dog is unable to be comfortable.
Diagnosis is based on history, physical examination which may reveal an abdominal mass, blood counts and serum chemistries, X-rays including dye studies, and ultrasound. As some cases come on slowly, the dog may be treated at first for other problems that cause vomiting and diarrhea. The best rule-of-thumb is that if a problem is being treated symptomatically and the response is not good, there usually is a problems which has not been properly diagnosed, and further tests should certainly be performed.
Most dogs will need to be hospitalized and given IV fluids to correct dehydration and electrolyte disturbances. Once stable, surgical correction of the blockage will be required. Direct removal of a mass or growth, removal of part of the intestine, repair of any holes in the intestines, drugs and chemotherapy of cancers and so forth may all be needed, again, depending upon the specific type of obstruction. Only at surgery can the exact best course be determined.
Post operative hospital care including fluids, antibiotics, withholding of food and water for several days, followed by a slow and gradual return to normal consumption will be needed. It may be best to feed dogs a bland and highly digestible food for up to 2 weeks post surgery. Once past the crisis, 100% recovery is possible for most patients.
MALABSORPTION and MALDIGESTION
When nutrients are not properly absorbed from the intestine, it is called malabsorption.
Any dysfunction that alters the actual digestive process is called maldigestion.
Causes of maldigestion include pancreatic exocrine insufficiency, poor bile flow from the liver, increased stomach acidity, and bacterial infections.
Causes of malabsorption are usually diseases that thicken, block or destroy the intestinal lining tissues:
Lymphocytic/plasmacytic enteritis
Bacterial infections that directly disrupt bowel function.
Idiopathic villous atrophy where the intestine lining withers away for no reason.
Loss of intestine from a prior surgery.
Lymphosarcoma of the intestinal tract.
Symptoms include weight loss or failure to gain weight, chronic diarrhea that is often quite voluminous and rancid, undigested food in the stool, frequent, large bowel movements and an increased appetite. Diagnosis can be more challenging. Besides history and clinical signs, blood counts and serum chemistries, fecal analysis including digestive enzyme function, special stains during the fecal analysis, and fecal fat analysis are all needed. In many cases, special tests involving the feeding of certain (safe) chemicals and measuring the rate at which they enter the blood will be needed. Biopsy of the intestines may also be required for an exact diagnosis.
TREATMENT OF MALABSORPTION and MALDIGESTION
As with many other conditions, if an underlying disease can be identified and removed, the best results will be obtained. In most instances, feeding small, frequent meals of a low fat, highly digestible food is advised. Supplementation with certain vitamins, especially the B vitamin group is very important. In some cases, the use of a digestive enzyme like viokase or pancreazyme will help. Drugs that slow intestinal flow such as imodium, paragoric and other medications to reduce straining may also be needed. Long term and consistent treatment will be critical, but most dogs can live a relatively long and healthy life.
PLE is an uncommon disorder characterized by loss of blood proteins into the intestinal tract. Many of the causes of malabsorption/maldigestion can lead to PLE. Certain uncommon defects may also produce this condition. Clinical signs include chronic watery diarrhea, weight loss, poor general condition, occasional vomiting, pale gums and possibly swelling of the feet, legs, and abdomen. Diagnosis is based on history, physical examination, blood counts and serum chemistries including protein levels, intestinal biopsy, fecal analysis and special tests to determine how food is absorbed in the intestine.
If a primary or underlying cause can be diagnosed and treated, then the chance for recovery is good. Primary intestinal defects, however, may be very difficult to control and cure is unlikely. Feeding low fat diets, vitamin supplementation, adding special fat supplements to the diet may all be helpful. The use of diuretics to control fluid retention and plasma transfusions to bolster blood protein levels may also be needed.
Colitis is inflammation of the large bowel or colon. It is quite common, most often brought about by some other offending substance that irritates the bowel. These include the ingestion of table foods or garbage, whipworms, giardia, foreign objects that do not block but that irritate the bowel allowing a bacterial infection to begin, food allergies and systemic fungi. As the bowel becomes inflamed, mucus and blood may be produced and become present in the stool.
The clinical signs of colitis include diarrhea that will often consist of frequent but smaller stools that may be watery, mucoid and/or bloody. The dog may strain to defecate, which is often confused with constipation, and may show obvious discomfort. Fever, dehydration, abdominal pain, foreign objects in the stool and an increased need to defecate are also common symptoms. Diagnosis is based on history, physical examination, fecal analysis, colonic cytology, fecal culture, X-rays and colonoscopy. Many cases of colitis occur concurrently with cases of enteritis. ((Colitis))
Most cases of acute colitis will respond quickly when properly treated. Treatment of intestinal parasites should be performed if needed. Giving only liquids for 24-48 hour so the bowel can rest is very important. Then, gradual introductions of a bland, low fat and easily digestible food for a week or two works well. Antibiotics, anti-inflammatory medications, motility modifiers to slow diarrhea and fluids for dehydration also helps these patients.
If a dog has recurrent or continuous bouts of colitis, changes in bowel function, alteration of the health of the bowel lining and ulceration are all likely to occur. While many possible causes for this condition have been proposed, the exact cause of this inflammatory syndrome has not been determined. Dietary intolerance including food allergy, whipworms, histoplasmosis and other more specific causes of colonic disease have all been implicated. Tumors and polyps may also mimic chronic colitis.
The symptoms of chronic colitis include chronic diarrhea which includes frequent defecation but passing only small stools, mucus and liquid consistency to the stools, blood in the stool, urgency to defecate, straining to defecate, and pain upon defecation. Many dogs will otherwise appear normal; a few may loose weigh, have a fever and be sensitive to touch. Diagnosis is based on physical examination, stool analysis, blood counts and serum chemistries, X-rays including dye studies, colonoscopy, and colonic biopsy.
Many cases of chronic colitis respond well to the feeding of either a high fiber food or a highly digestible food low in fat. Dogs should be on an extremely strict diet, as often any other food will stimulate the colitis. In some cases, special, non-allergenic foods work well. The use of antibiotics or sulfasalazine can be effective, as has metronidazole and tylosin in some cases. While it is generally not advised, cortisone like drugs seems to help in a small percentage of dogs.
Eosinophilic colitis is an inflammatory disease similar to eosinophilic enteritis. Eosinophils, a type of white blood cell, migrate and infiltrate the lining of the colon and interfere with normal colonic function. While the cause is not understood, this may be a form of allergic reaction, including a response to food allergens or internal parasites. It is generally considered and abnormal immune reaction. Next IBD
Clinical signs include diarrhea which may be regular or come and go, blood in the stools, straining to defecate, frequent defecation, mucoid stools and small stool volume. Other symptoms will be present if this is indeed only an extension of eosinophilic enteritis. Diagnosis is based on history, physical findings, blood counts, fecal analysis, X-rays, colonoscopy and colonic biopsy.
First, all dogs will need to be on some type of hypoallergenic diet, probably for life. Parasites should be killed. Cortisone and cyclophosphamide are often effective in controlling the inflammatory process. Long term success is usually good with this basic treatment. Treatment may indeed need to continue for life.
Histiocytic colitis is another type of inflammatory colon disorder, this disease characterized by a special type of macrophage, a type of white blood cell, infiltrating and lining to colon. The cause is unknown but may have initiating factors similar to that of chronic colitis. Boxers under 2 years of age are most commonly affected and have symptoms of a chronic bloody, mucoid diarrhea similar to other types of chronic colitis. Other physical and diagnostic findings are also similar. Definitive diagnosis is by colonic biopsy. (see.. treatment of chronic colitis for treatment of this condition.)
PROTOTHECOSIS: A disease caused by an organism related to green algae; may also attack skin and other internal organs.
HISTOPLASMA COLITIS: Colitis cause by histoplasmosis.
PSEUDOMEMBRANOUS COLITIS: Colitis caused by antibiotic damage to the colon.
TYPHILITIS: Colitis and irritation caused to the cecum by whipworms.
AMEBIASIS: Colitis caused by the ameba, Entamoeba histocytica.
BALANTIDIASIS: Colitis caused by the protozoan Balantidium coli. Comes from pigs.
This is a non-inflammatory dysfunction of the colon that is usually associated with stress or stressful events. The symptoms include a sudden onset of diarrhea that may be mucoid, and in some cases, only mucus may be passed. Straining to defecate, frequent defecation and blood in the stool are also possible. Usually there are no other physical findings. Diagnosis is based on history, physical examination, fecal analysis, fecal cytology, colonoscopy, biopsy, and X-rays.
Most dogs will do well with a combination of drugs. Mild tranquilizers or sedatives will help to reduce stress levels. Medications that alter bowel motility are also employed. Adding coarse wheat fiber to the diet has also proven highly beneficial in healing to colon although long term use of such may be required.
Pseudocoprostasis literally means "false constipation". In some dogs, especially breeds with fine coats like the Poodle, hair and fecal material may become matted and impacted onto the area around the anus, actually blocking the flow of feces from the body. Clinical signs will include straining to defecate and some decree of pain. Diagnosis is simple upon physical examination.
Dogs may or may not need to be sedated because of the pain involved, and then clipping and cleansing the anal area, giving an enema if needed, and using antibiotics and cortisone orally and/or topically to heal the associated irritation. Keeping the area clipped a little shorter should also prevent recurrence.
In some dogs, the colon may become grossly dilated and stop functioning normally, with large quantities of feces being retained in the colon. This is called megacolon. While megacolon can occur at birth in rare cases, most of the time, intestinal foreign objects, tumors or some other blockage of the colon will lead to this condition.
Clinical signs include repeated constipation, failure to defecate for several days, straining and repeated attempts to defecate, loss of appetite, vomiting, depression, weakness, abdominal pain, and even possibly passing soft, mucoid and bloody stools on occasion. Diagnosis is based on history, physical examination, X-rays, fecal analysis and colonoscopy.
Upon initial presentation, most dogs will need enemas and lubrication of the colon so that they can pass impacted feces. Some dogs may require manual removal of the feces! If the dog is weak and depressed, fluids and electrolytes will also be required. If an underlying problem can be identified and corrected, the megacolon may resolve itself. In most cases, long term use of bran or Metamucil in the diet, oral laxatives or lactulose can keep the pet running smoothly. Many dogs, however, will need lifetime therapy. In rare instances, all or part of the colon may need to be removed.
Fecal incontinence is a rare problem whereby a dog is unable to partially or completely control the passage of bowel movements. This often results in feces being passed while the dog is resting, or even while it is walking from place to place. Most dogs suffering from this condition will have had anal/rectal surgery, or have advancing, degenerative neuological or muskuloskeletal conditions including cauda equina syndrome, degenerative myelopathy, and degenerative joint disease. The clinical signs are obvious, and diagnosis is based on this history, physical and neurological examination, X-rays and colonoscopy.
Most cases will not be well treated. Loperamide may work to enhance anal tone in some cases. Diets that produce fewer stools, a firm feeding schedule and frequent trips to the backyard may be all that can be done. Some dogs have responded to spinal manipulation, acupuncture and surgery.
DISEASES OF THE RECTUM and ANUS
A rectal prolapse occurs when the inside of the rectum comes outside the body. This usually occurs after heavy straining during bouts of diarrhea although constipation can also be the cause. Many cases occur in puppies with heavy internal parasite loads or enteric bacterial infections. Clinical signs include a raw puffy swelling of variable length at the anus, straining to defecate and pain upon defecation. Diagnosis is based on physical examination. ((Rectal Prolapse))
Assuming any parasites or infection can be dealt with, many times the prolapsed tissues can be pushed back into the body, and special sutures can be used to hold everything in place for a few days until healing occurs. Medicated ointment may also be needed along with a very soft or mushy food for a week or so.
In some more severe cases, the rectal tissues may be badly damaged or fail to stay in place after reduction. In these cases, surgical removal of the damaged tissues and suturing the healthy tissues back together may also solve the problem. After that, a week or so on a very soft diet and the use of stool softeners will be required so that healing can occur.
A stricture is a restriction upon the rectum. Many times this will involve scar tissue that forms after some other disease or injury has occurred to the rectum or colonic areas. Strictures can also occur if fractures of the pelvic bones impinge upon the rectum/colon or after some type of rectal surgery. In all these situations, the flow of feces throughout the colon may be hindered. Clinical signs include difficulty in passing feces, straining and pain upon defecation, and even failure to defecate. Diagnosis is based on history, physical and rectal examination, X-rays, and colonoscopy.
In most cases, some type of surgery to open the stricture will be required. Soft, low-residue diets and stool softeners may provide symptomatic relief for some dogs. Unfortunately, fecal incontinence can be a side effect of any anal/rectal surgery.
While obesity can hardly be considered a disease of the digestive system, other than that of the system working all too well, it is one of the major health concerns for dogs in our country. It is estimated that over 40% of all dogs qualify as obese. This means that their body weight is at least 15% above normal. The art of nutrition has progressed so well that even dogs eating average quality foods get at least an ample supply of calories. Pets on premium foods are often overfed. Many owners choose to show their love for their pets in the form of tidbits and treats that tend to be fatty. Some dogs may feel they need to compete with other dogs in the house and consume more food if not fed separately.
Obesity does become more common with age, after neutering or spaying, in certain breeds like the Labrador, Collie, Dachshund, Beagle and the Cocker Spaniel, and in female dogs. Nevertheless, unless there is a metabolic disorder, most cases result from too many groceries consumed, and too few calories burned (sounds familiar). How do we know it our dog is overweight? This is a common question asked of every veterinarian.
Since dogs come in so many shapes and sizes, it is very difficult to give a one-size-fits-all weight. The best method is to use what is known as body score. Body score is a method of relating size and structure to proper weight. On a one-to-five scale, a body score of 3 is perfect, 2 is thin, 1 is dangerously thin, 4 is overweight, and 5 is obese. To be ideal weight, you should not be able to see your pet's ribs, but you should be able to feel the ribs with very light pressure on the skin over the chest. The abdomen should not hang down but rather, should be tight and slope up towards the hindlegs nicely. The spine should be slightly visible and there should be no fatty bulges along the back, hips and rump. (sounds familiar again)
As mentioned before, there are a few metabolic disorders commonly associated with obesity. These include hypothyroidism, hyperadrenocorticism and diabetes mellitus. More often, simply being overweight carries with it significant health risks. Obese dogs live a life about 30% shorter than lean animals. The risk of heart disease, degenerative joint disease, diabetes mellitus, liver disease, anesthetic risks, infertility, and cancer are all increased by obesity.
If metabolic disease is present, it should be treated. Hypothyroid dogs still require assistance loosing weight. Starting the dog on a high-fiber, low-calorie diet, fed twice a day in exact amounts as advised by your veterinarian, is a first step. Complete cessation of any table treats or "doggie" treats should also be done. "Just a little..." goes a long way with small dogs. Giving carrots, celery or cucumbers can be used to provide filler for the dog that thinks it is starving. Then, slowly and gradually starting on an exercise program, usually just walking will produce good results over time. Just like with people, it seems to go on easy, but it doesn't want to budge when it is time to leave.
The peritoneal cavity is literally the inside of the abdominal cavity, but outside the organs contained therein. In other words, it is the area between the abdominal wall and the outside lining of the intestines and other abdominal organs. Peritonitis is inflammation and most commonly an infection in this area. This type of inflammation/infection is very serious as the process can quickly multiply spreading to the blood and other organs, leading to shock, organ failure and death.
The causes of peritonitis are diverse and numerous. Infections can be caused by wounds, penetration by foreign objects, uterine rupture as in pyometritis, intestinal damage followed by leakage of intestinal contents following surgery or after damage by intestinal foreign objects, bowel rupture after an intussusception occurs, or if a prostatic abscess ruptures. Other causes include rupture of the urinary bladder, uterine rupture during pregnancy, rupture of the gall bladder, or inflammation caused during bouts of pancreatitis. ((Fluid from Infected Abdomen))
Peritonitis will cause symptoms of severe abdominal pain, fever, loss of appetite, weakness, collapse and death. Diagnosis is based on history that may lead to an assumption of peritonitis, physical examination, X-rays, blood counts, culture and cytology of abdominal fluids and surgical investigation.
If peritonitis is suspected, rapid action is necessary to save most dogs. IV fluids, general hospital care and large antibiotic doses are needed. Exploratory abdominal surgery to some degree will be indicated to 1. determine the cause of the peritonitis if unknown, 2. repair damage or specific problems as then indicated, and 3. clean the abdomen. The inside of the abdomen needs to be cleared of exudates and debris, usually accomplished by putting warm fluids and antibiotics into the abdomen, suctioning them out and repeating the process several times. Sometimes a drain or drain tubes are left in the abdomen and further flushing is performed over several days. If the damage causing the peritonitis is repaired and the pet recovers from the infection and shock the long-term prognosis is good.


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I will keep Steve in my thoughts and pray he comes out ok. I dont know Steve personally, has he raced at Byron Union Grove is my home track and hate to hear news like this coming from there.
To all the guys we race with whomay nothave heard.....Stevetook a bad spill at Union Grove Dragaway over the weekend as he went through the traps on his second time run. He is in the hospital still as of today and doctors are running tests. If anyone would like any more information on his condition, feel free to call me at 847-366-9860. Please keep your fingers crossed and keep Steve in your prayers for a quick recovery. Thanks, Mike
I will keep Steve in my thoughts and pray he comes out ok. I dont know Steve personally, has he raced at Byron Union Grove is my home track and hate to hear news like this coming from there.
Thank you.Yes, Steve races at Byron in Shootout class.
I heard from his engine builder that he escaped with no broken bones but one hell of a bell ringer! Get back on that horse Steve, you've worked too hard to walk away now. You know what happened and it wasn't your riding skill. Keep your head up bud, we look forward to seeing you out at Byron soon.
The only place you will find success before work is in the dictionary........
I hope that Steve recovers with no complications
Hey mike: I talked to Steve about 2 hrs ago and he said that they were going to release him tonite or tomorrow.I would like to see maybe a collection of donations taken up to help Steve out.(I am sure being out of work is not lucrative).I am willing to donate.Let me know.& nbsp; Jason
Thanks guys. Steve came home late last night and we looked over the bike and his leathers and gear. It still hasn't really set in that this happened and he doesn't recall the accident. I told him to relax, think things over and decide what he wants to do. At this point I know he is just happy to be here.
Originally Posted by switchedhp2
Like I said last night maybe someone could take a collection this weekend or if him or Mike have paypal. We could get some money together doesn't have to be alot just a couple of bucks from each person goes a long way.
I do have a PayPal account and I also would be willing to give some cash to see Steveget his bike back together and buy some new gear.I will talk to Steve about it and see what his feelings are.[img]smileys/smiley20.gif[/img]Thanks again.
We will be at the event this weekend to watch for sure on saturday, weather permitting.

subset: commoncrawl


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By Emma Batha
LONDON (TrustLaw) - War-torn countries trying to break repeated cycles of violence should closely involve women in building a more resilient, wealthy and secure society.
That's one of the lessons that can be learnt from nations making successful transitions from conflict to peace, according to this year's World Bank development report.
Providing examples from Nepal to Nicaragua, the report says involving women in security and justice reforms as well as economic empowerment programmes can deliver quick results and support longer term institutional change.
For example, including women in the security forces can help rebuild confidence between citizens and the state.
Employing women police officers not only makes it easier for women to report crimes like rape, it increases the trust of the civilian population in the security sector, the World Bank says. Studies on policing have also found that female officers are better at defusing potentially violent situations.
Haiti, Liberia, Namibia, Nicaragua and Sierra Leone have all seen the benefits of introducing women into the force or increasing their participation. Some have also set up special units to handle cases of rape and domestic abuse.
Nicaragua's police force has been described as the most women-friendly in the region and has been praised for its success in addressing sexual violence. Reforms initiated in the 1990s include providing police training on sexual and physical violence against women and introducing women's police stations staffed by female police officers.
The report says widespread rape and violence against women is a characteristic of many contemporary civil wars which are often waged by small, poorly trained groups who can unleash great brutality on civilian populations.
Women are also far more likely than men to be uprooted by war; women and children make up close to 80 percent of the world's refugees and internally displaced people.
The World Bank says helping women to recover socially and economically from violence not only benefits the women themselves, but also their families and communities. And targeting women's economic empowerment can have more lasting effects on women's status than national gender action plans.
The report cites a women's programme in the southern Nepal which has produced a small but significant social shift within just a few years. The project provided training for 130,000 women from 1999 to 2001. Almost half gained a level of literacy, and two-thirds started a business, giving them an independent source of income for the first time.
However, women in fragile and post-conflict countries often face many challenges in setting up businesses, the World Bank says. Hurdles include limited mobility and access to markets, restricted access to credit, restrictive social attitudes and discriminatory legislation.
Democratic Republic of Congo, for example, has a host of laws which make it difficult for women to work. Married women need marital authorisation to start a business and banks generally require the husband's approval if his wife wants a loan.
Women run only 18 percent of small businesses in Congo. But women in neighbouring Rwanda, which has no such regulations, run more than 41 percent of small businesses.
However, these legal, financial and social obstacles are not insurmountable, the report says. It cites efforts in Afghanistan to promote women's access to finance, moves in Liberia to improve women's participation in the national reconstruction effort and business mentoring opportunities for women entrepreneurs in Iraq.
The World Bank highlights women's inclusion as one of five key areas of importance for states wanting to link rapid confidence-building measures to longer term institutional transformation. But its dense 325-page report contains relatively little discussion of women's roles in state-building - which is perhaps a fairly accurate reflection of just how marginalised women are in many conflict-affected countries.
However, it is not just national governments which sideline women. In the last decade, less than 7 percent of negotiators on official delegations in peace processes have been women, according to the United Nations Development Fund for Women.


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You can get on the PTR and learn to love patch 2.4 by heading over to the Account Management page on the main World of Warcraft site. When there, click on the "Test Realm Character Copy" button, and then on "Copy a Character". After you've asked Blizzard to copy your character over, come back and check about every hour to see if they've done it yet. Even though the wait time says four days, in my experience it has been substantially less.
One last tip: if the button comes up gray, just hit refresh a few times.
Good luck!
Updated 1:15 p.m. EST: Screams of frustration can be heard around Azeroth as Blizzard plays dirty tricks with their character copy process. People are now having mixed results in getting their characters copied across. It might be that the queue is full again.


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JP Sotille: Everyone is a potential target in the War on Terror's lingering "With Us or Against Us" protection racket, and drones are the crooked-nosed enforcers that kill without remorse, without hesitation and without accountability.
Why Do Political Elites All Hate Democracy?
Heather Gautney: We need to start pressing for things that our politicians did NOT discuss at the conventions. Real solutions–like universal education, debt forgiveness, wealth redistribution, and participatory political structures—that would empower us to decide together what's best. Not who's best.


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MEMPHIS, Tenn. — We were whipping up some excitement on Live at 9 Thursday morning with the Rhinestone Roper!
He's an award-winning performer known for his Wild West Stunts.
The Rhinestone Roper is one of the featured acts at the Delta Fair, which starts Friday.
The Delta Fair and Music Festival is August 29 through September 7 at Agricenter International.


text: Nikolay Sturm <Nikolay_(_dot_)_Sturm_(_at_)_desy_(_dot_)_de> wrote: > If I want to update a port of mine and have the choice of using the old > distfile plus a diff and using a new distfile, what is preferred? (let's > assume the patch is much smaller than the new distfile) We usually go with the new distfile. > We have a port of teTeX, which is rather old (teTeX, not the port). I'd > like to update some of the stuff comming with teTeX, mainly pdftex. Is > it in any way possible to get this committed or is it inacceptable for > one port to update another one? How is this supposed to work? A port must not overwrite files that belong to a different port; if there is such a conflict the packages must be marked as conflicting and only one can be installed at any time. Regarding teTeX, you could modify the port such that it replaces the included old pdftex with the new one. > math/fftw needs a working f77 > - Get a list of architectures without a working f77 (where?) and define > NOT_FOR_ARCHS accordingly? I guess so. math/fftw may well be the only port so far that requires f77. I have no idea on which of our platforms f77 doesn't work. Add them to NOT_FOR_ARCHS as you run into them. > net/gnut needs threads > - Get a list of architectures without native threads (where?) and > define a dependency on pthreads (if possible) or define NOT_FOR_ARCHS > accordingly? Yes. Where's the question? :-) If a port requires threads, try it with our native threads. Tends to work for i386, tends not to work for sparc. If it doesn't on a platform, try with devel/pth there. If it still doesn't, use NOT_FOR_ARCHS. Don't worry too much about platforms you don't have access to. -- Christian "naddy" Weisgerber naddy_(_at_)_mips_(_dot_)_inka_(_dot_)_de


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When children are sick they tend to vomit more readily than adults. It's often a single event and your child will be back to normal again soon afterwards.
There are many causes of vomiting, but the most common cause is an infection (either bacterial or viral) – for example, gastroenteritis, a urinary tract infection or even the common cold. Other causes of vomiting include motion sickness and more serious illnesses, such as appendicitis or meningitis.
Young babies tend to vomit up small amounts of milk after feeds (posseting). This is normal, and can usually be reduced by burping your baby a little more during feeds. Gastro-oesophageal reflux also causes babies to regurgitate feeds. This occurs more frequently than posseting (before, during and after meals).
Vomiting is often accompanied by abdominal pain and diarrhoea.
Dehydration is one of the serious risks of vomiting, especially in young babies. Signs of dehydration include decreased urination (with fewer wet nappies), sunken eyes, dry tongue and mouth, loss of weight, tiredness and lethargy.
You should go to the doctor if:
Medications that stop vomiting shouldn't be used in children. The side effects can be very serious.
The most important thing to do when treating vomiting is to make sure your child gets adequate fluid replacement. This helps prevent dehydration. Read our article on dehydration to learn more about this.
If your baby suffers from gastro-oesophageal reflux, there are various treatment strategies to help the problem, including propping her up after a feed. Find more treatment details in our article on gastro-oesophageal reflux.
Hutson, J., & Clarnette, T. (2009). Surgical conditions. In K. Thomson, D. Tey & M. Marks (Eds), Paediatric handbook (8th edn, pp. 532-542). Melbourne: Wiley-Blackwell.
McDougall, P., & Hunt, R. (2009). Neonatal conditions. In K. Thomson, D. Tey & M. Marks (Eds), Paediatric handbook (8th edn, pp. 431-451). Melbourne: Wiley-Blackwell.
Sundaram, S., Hoffenberg, E., Kramer, R., Sondheimer, J.M., & Furuta, G.T. (2009). Gastrointestinal tract. In W. Hay, M. Levin, J. Sondheimer & R. Deterding (Eds), Current diagnosis and treatment: Pediatrics. (19th edn, pp. 595-630). New York: McGraw-Hill.
Wyllie, R. (2007). Major symptoms and signs of digestive tract disorders. In R. Kliegman, R. Behrman, H. Jenson & B. Stanton (Eds), Nelson textbook of pediatrics (18th edn, pp. 1522).
Allen, K. (2007). The vomiting child--what to do and when to consult. Australian Family Physician, 36(9), 684-7.


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H2K was the first of our conferences to have more than one track and to run three full days. Originally, we had planned on using the 18th floor for the main stage and a much smaller room downstairs on the 6th floor for the second track. Within a day, this idea proved to be infeasible, as the second track was becoming far too crowded. On Saturday, we moved the second track up to the 18th floor, which also allowed us to record some of it with the equipment we had there. (For the really big talks like Jello Biafra and social engineering, the second track stage became the origination for a simulcast to both rooms.) A third unscheduled and unrecorded track continued on the 6th floor which also attracted some great speakers like Richard Stallman. While we don't have every talk that was given in the two scheduled tracks, this collection does include a much bigger selection than had ever been gathered before at a single conference.
H2K was also held at a very contentious time in history. Not only was there a bitter presidential campaign underway (keynote speaker Jello Biafra had even been a former candidate who had been running on the Green Party platform earlier that year), but 2600 Magazine had just been sued by the Motion Picture Association of America for posting the DeCSS code on our website. The trial was even scheduled for the very day after H2K! DeCSS author Jon Johansen was in attendance at both the conference and trial, along with members of the Electronic Frontier Foundation, and civil libertarians of all sorts. Kevin Mitnick even made his first appearance at a hacker convention - however, federal authorities made sure it was confined to the telephone.
To order, just click the button(s) near the H2K symbol. Click on the titles for descriptions of the talks and panels or to see the video in non-DVD quality.


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Before you slate the Aprilia CRT bike as being destined for tailgunner positions on the grid consider this.
The Aprilia RSV4 started life as a full prototype MotoGP bike and spent most of its existance that way.
It only changed to become a road bike when MotoGP switched to 800s and Aprilia changed it to a road going production bike to recoup the expense of its development.
In other words the Aprilia is a full on "prototype" factory MotoGP bike its just taken a roundabout way to get there. When fully race ready I would bet this bike will surprise many and soon be towards the sharp end of the grid.