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The Diagnostic Process for Gastrointestinal Diseases

Gastrointestinal signs (vomiting, diarrhea, regurgitation, weight loss, decreased appetite, abdominal distension & abdominal pain) are easily observed by clients and are often the reason for them bringing their pet lớn their veterinarian.

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Addison’s disease (hypoadrenocorticism) is more likely to occur in young animals.Infectious diseases such as parvovirut and/or GI parasitism are more comtháng in young animals.Look for evidence of possible congenital abnormalities such as megaesophagus (especially if regurgitation is present).

2. Older animals 

Gastrointestinal cancer (lymphoma) is a comtháng cause of vomiting in older animals (but it is possible at any age).Hyperthyroidism is a comtháng cause of vomiting in older cats.Renal failure is a comtháng cause of vomiting in older dogs or cats.Sex 

Female dogs are more likely khổng lồ have sầu Addison’s disease than male dogs.

Breed Predispositions

1. Large breed dogs

Standard poodles: Addison’s diseaseGerman Shepherd dogs

– Megaesophagus +/- persistent right aortic arch (PRAA)

– Exocrine pancreatic insufficiency +/- inflammatory bowel disease

– Gastric dilatation-volvulus (GDV)

Golden retrievers or Labrador retrievers

– Gastrointestinal or multicentric lymphoma

– Splenic or hepatic hemangiosarcoma

2. Small breed dogs

Yorkies or Maltese

– Protein-losing enteropathy (PLE) +/- inflammatory bowel disease

– Portosystemic shunt (PSS)

Miniature poodles: Addison’s diseaseMiniature schnauzers: Pancreatitis

Physical Examination Findings

Body Condition – in the Context of Appetite

1. Thin?

Thin despite a good appetite: Major differentials include esophageal diseases (such as megaesophagus), primary gastrointestinal disease (inflammatory bowel disease versus gastrointestinal lymphoma versus severe gastrointestinal infection), exocrine pancreatic insufficiency (EPI), hyperthyroidism (cats), or diabetes mellitus.Thin with a poor appetite: Major differentials include primary gastrointestinal disease & chronic kidney disease.

2. Normal weight (or overweight)?

Normal weight (or overweight) with a good appetite: Large intestinal diseasesNormal weight (or overweight) with a poor appetite: Diseases outside of the gastrointestinal tract such as pancreatitisAbdominal Palpation

1. Abdominal pain? 

PancreatitisGastrointestinal obstruction (obstructive mass; gastrointestinal FB, intussusception)

2. Abdominal distention?  

Enlarged stomach (gastric dilatation or gastric-dilatation volvulus)Enlarged abdominal organsAbdominal fluid (protein-losing enteropathy, pancreatitis)

3. Abdominal mass?

Gastrointestinal origin

– Enlarged stomach

– Gastrointestinal foreign material obstruction

– Intussusception

– Gastrointestinal tumor

Origin outside the gastrointestinal tract

– Enlarged pancreas

– Mass/tumor in an organ outside of the gastrointestinal tract

Extra-Abdominal Abnormalities

1. Oral exam – foreign material? Oral masses? Oral ulcers?

2. Throat exam – dilated esophagus? Thyroid slip?

3. Thoracic auscultation: Muffled lung sounds can be a sign of diaphragmatic hernia.

4. Peripheral lymphadenopathy? Dogs with gastrointestinal lymphoma can also have multicentric lymphoma. (However, normal peripheral lymph nodes vì chưng not rule out the possibility of gastrointestinal lymphoma.)


CBC/Chem/lytes, Urinalysis

1. Elevated kidney values along with unconcentrated urine can lead khổng lồ a diagnosis of chronic kidney disease as the cause of the gastrointestinal signs.

2. Elevated liver values can be present in dogs with portosystemic shunt, liver failure, pancreatitis, and/or gallbladder disease.

3. Low sodium & high potassium +/- glucose can be a sign of Addison’s disease. Patient may have sầu normal bloodwork & still have Addison’s disease. Dogs with atypical Addison’s disease can have sầu normal Na/K and laông chồng of a bức xúc leukogram. Dogs with Addison’s disease typically have sầu intermittent clinical signs.

4. Assess for concurrent problems that could affect treatment decisions

Fecal Flotation, Fecal Smear, Fecal PCR

1. Gastrointestinal parasites – can be a concurrent problem or can be the cause of the clinical signs; most of the gastrointestinal parasites are easy lớn diagnose

2. Giardia – can be hard to lớn diagnose


Abdominal Radiographs

1. Assess serosal detail

2. Assess the shape, position, and relationship of the abdominal organs

3. Look for gastrointestinal foreign material and/or gastrointestinal obstruction. Gastric foreign material may be easier lớn diagnose with radiographs.

Abdominal Ultrasound

1. Cheông xã for abdominal fluid (abdominal ultrasound is sensitive for this).

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2. Assess the thickness, motility, và layering of the gastrointestinal tract: Thickened intestines can be a sign of gastrointestinal inflammation (IBD), gastrointestinal neoplasia (lymphoma vs carcinoma vs other), or gastrointestinal infection (pythiosis) & location of the thickening can be helpful for planning follow-up diagnostics và plan (upper GI endoscopy vs. colonoscopy vs. both vs. exploratory laparotomy).

3. Look for gastrointestinal foreign material and/or gastrointestinal obstruction: Small intestinal foreign material and obstruction may be easier to lớn diagnose with ultrasound.

4. Assess the extra-gastrointestinal organs for structure, nodules, or masses.

5. Assess the pancreas for signs of pancreatitis (ultrasound is more sensitive).

Chest Radiographs

1. Assess the esophagus

2. Check for concurrent aspiration pneumonia

Special Labs

GI Panel (B12/folate/TLI/PLI)

1. Low B12 +/- low folate are screening tests for primary gastrointestinal disease.

2. Elevated PLI is diagnostic for pancreatitis (but a normal PLI does not rule it out).

3. Low TLI is diagnostic for exocrine pancreatic insufficiency.

Baseline Cortisol

Screening kiểm tra for Addison’s disease. If baseline cortisol > 2 ug/dL, this rules out Addison’s disease.

ACTH Stimulation Test

This is the definitive sầu means khổng lồ rule in or rule out Addison’s disease. If pre-ACTH & post-ACTH cortisol are 2 ug/dL, Addison’s disease is ruled out.

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Advanced Diagnostics

Upper Gastrointestinal Endoscopy +/- Colonscopy and Endoscopic GI Biopsies

1. Less invasive

2. The mucosal surface is visualized & assessed

3. Colonic tissue can be biopsied và colonic tissue samples can be submitted for tissue culture và fluorescence in situ hybridization (FISH) for diagnosis of granulomatous histiocytic colitis.

Exploratory Laparotomy và Gastrointestinal Biopsies

1. The gastrointestinal biopsies are full thickness and larger samples