Postpartum endometritis in a cat. Clinical diagnostics veterinary medicine

VETERINARY PROPAEDEUTIICS

Educational and methodological manual

Stavropol

Compiled by:

Doctor of Veterinary Sciences, Associate Professor V.A. Orobets

Candidate of Veterinary Sciences, assistant N.E. Orlova

Reviewers:

Veterinary propaedeutics: educational manual / comp. V.A. Orobets, N.E. Orlova. – Stavropol: AGRUS, 2008. - p.

REGISTRATION OF AN ANIMAL.. 4

ANAMNESIS. 4

Anamnesis of life. 4

History of illness (Information about the animal since the moment of illness). 5

GENERAL RESEARCH.. 5

HABITUUS.. 5

SKIN EXAMINATION.. 6

Pathological changes in the skin. 7

STUDY OF MUCOUS MEMBRANES. 7

RESEARCH OF LYMPH NODES... 8

BODY TEMPERATURE.. 8

STUDY OF INDIVIDUAL SYSTEMS... 9

CARDIOVASCULAR SYSTEM.. 9

RESPIRATORY SYSTEM.. 21

THYROID GLAND.. 22

CHEST.. 24

DIGESTIVE SYSTEM.. 28

GINOROGENITAL SYSTEM.. 37

Female genitals. 43

Male genitals. 51

NERVOUS SYSTEM.. 57

Somatic department. 58

Motor sphere. 58

Sense organs. 58

MOTOR APPARATUS. 63

CONCLUSION... 64

References.. 66

ANIMAL REGISTRATION

Indicated:

1. serial number (according to the journal for registering sick animals);

2. individual characteristics of the animal;

3. type of animal (cattle or small cattle, horse, pig, dog).

4. nickname, number, brand;

5. Gender (cow, bull, ox, stallion, gelding, mare, sheep, ram, bull, pig, boar, boar, goat, goat, male, female).

6. suit, color and signs;

7. age (years, months, days);

8. date of birth;

9. breed;

10. fatness;

11. live weight;

12. owner of the animal (last name, first name, patronymic, household, institution);

13. detailed address of the owner and telephone number;

14. dates: admission of the animal to the clinic, departure from the clinic;

15. outcome of the disease. This section also includes the initial diagnosis and the final diagnosis at follow-up.

ANAMNESIS

Anamnesis of life.

This part of the history characterizes the animal until the moment of illness. It includes:

1. Where and when did this animal come to the farm or is it home-grown.

2. Characteristics of the premises in which the animal is kept (wooden or stone, reinforced concrete; dry or damp, light or dark; bedding, ventilation - sufficient or insufficient, presence of drafts, manure removal - regular or irregular, mechanized or manual), under a canopy, under open sky.

3. System and method of housing: tethered or loose (box). Care is impersonal or not. Exercise (active, passive or absent).

4. Feeding: quantitative and qualitative composition of the feed ration, good quality of feed, availability of mineral and vitamin supplements, feeding regimen. Type of feeding (general, group or individual).

5. Watering. Sources of water (pipeline, well, artesian well, river, lake, pond), quantity and quality of water (plentiful, insufficient; fresh, clean, poor quality, impurities), water temperature (cool, cold, warm), type of drinking (group or individual).

6. Purpose of the animal on the farm. The nature and duration of the work performed, load, productivity (daily and annual milk yield).

7. Use for reproduction. Pregnancy and childbirth (number of calvings, date of last calving and last fertile insemination, duration of start-up and dry period, course of labor (successful or unsuccessful) and the postpartum period.

8. Conducted veterinary treatments and diagnostic studies (for glanders, tuberculosis, brucellosis, etc.).

History of illness (Information about the animal since the moment of illness).

1. When and under what circumstances did the animal get sick (after feeding, during work, etc.).

2. What signs of disease were noted at the beginning of the disease and subsequently.

3. Has the animal been sick before (when, signs, diagnosis),

4. The presence of sick animals on the farm with similar or other signs. Have you had this type of disease before (when and for how long).

5. Was the animal treated (when, by whom and with what). The result of this treatment.

6. What diagnostic tests and preventive treatments has the animal undergone recently and their results?

It is quite clear that the above scheme for collecting anamnesis can be expanded, and sometimes a number of questions can be completely omitted.

To make a diagnosis, it is also important to know epizootological the state of the economy (favorable or unfavorable in terms of infectious and invasive diseases and which ones).

GENERAL RESEARCH

HABIT

Animal body position:

voluntary, natural forced, standing or lying down, unnatural postures (throwing back the head, sitting dog, observer, etc.), forced movements (uncontrollable movement forward, backward, in a circle, clockwise, etc.).

Body type:

strong (correct, good), medium and weak (incorrect, bad). Defects are indicated.

Fatness:

good, satisfactory, unsatisfactory, exhaustion, obesity.

Constitution:

rough, tender, dense (dry), loose (raw). The type of constitution (in horses) is light (asthenic), heavy (pyknic) and muscular.

Temperament

lively, phlegmatic (inert).

Temperament

good, evil (aggressive).

When recording the results of a study of a sick animal (Status praesens) in a medical history, students can use the following description of the body condition of a healthy cow as an example.

General research.

Temperature - 38.1°C, pulse - 62, respiration - 24.

Habit. The body position is natural - standing. Average build; individual parts of the body are proportionally developed. The nutrition is good. The constitution is dense. The temperament is phlegmatic, the disposition is kind.

The description of other organs and systems is carried out similarly.

SKIN EXAMINATION

Skin covering:

(hair, wool, bristles, feathers, fluff) - located correctly (in flows), evenly adjacent, tousled (in which areas), glued together. Shiny, matte (dirty), long, short, thick, sparse, held firmly (well) or weakly (take into account molting), elastic, brittle. Sectioned hair, graying, cutting, baldness (specify where).

Color of the skin:

(on non-pigmented areas) - pale pink, pink, gray, pale (anemic), red, cyanotic (cyanotic), icteric.

Elasticity:

preserved (elastic), reduced, lost (inelastic).

Temperature:

They are examined in symmetrical areas (the base of the ears, horns, limbs, the side surfaces of the chest, in pigs - the snout and ears, in dogs - the tip of the nose). The skin is moderately warm, equally expressed in symmetrical areas. General or local, increase or decrease (indicate where).

Humidity:

moderate, dry skin (hypohidrosis), increased (hyperhidrosis). General or local sweating (specify areas); sweat is cold, warm, sticky, watery.

Smell:

specific (moderately, sharply, weakly expressed), acetone, uremic, putrefactive.

Related information.

Gastrointestinal disorders are one of the most common reasons why small animal owners visit a veterinarian, and are also the area where most misdiagnoses or incomplete cures occur, leading to owner dissatisfaction and disappointment with veterinarians and unnecessary animal suffering. To properly conduct a clinical examination for diseases of the digestive system, it is necessary to begin by collecting a detailed medical history. A systematic approach to interviewing, carefully recording all information, and understanding the owner's responses will help the clinician lay the foundation for an accurate examination and diagnosis. Too often, haste during an op-sos, unsystematic or incomplete collection of anamnesis sends doctors along the wrong path, the consequences of which can be catastrophic. It is worth considering the most common mistakes at the stage of collecting an anamnesis in order to avoid them during the interview and obtain all the necessary information from the owner.

Ten common mistakes when taking anamnesis

The ten most common mistakes that veterinarians make when taking a history of an animal with a gastrointestinal disease:

1. They don’t understand the owner’s initial complaints.
2. Clinical signs are not taken into account.
3. Previous illnesses are not taken into account in the anamnesis.
4. General information is not collected in full.
5. Not paying enough attention to a comprehensive discussion of diet.
6. Allow the owner to direct himself down the wrong path.
7. They don’t ask the owner for the necessary details.
8. They do not remain objective when searching for the root cause.
9. They do not collect anamnesis correctly or spend less time on it than required.
10. They “miss” the diagnosis in atypical cases.

1. Misunderstanding of the owner's initial complaints

Often, veterinarians believe that they can understand the nature of owners' concerns from a short dialogue at the very beginning of the consultation; for example, an owner's complaint that the dog is “unwell and sometimes has diarrhea” leads the doctor to suspect enteritis, while diarrhea may be a secondary manifestation of a pathology unrelated to the intestines.
Therefore, it is necessary to establish what exactly the owner means when describing the main symptoms of his animal; a thorough interview will help to get an accurate picture of the subject of his concern. In addition, it must be borne in mind that upon examination the situation may turn out to be more serious than the owner believes, and the pathology will be completely different from that which would correspond to the symptoms described by the owner of the animal. However, it is prudent to find out what the owner himself considers the original problem to be, this will avoid misunderstandings in the future when treating his pet (Radford, 2002).

2. Insufficient attention to the animal’s symptoms

It is very easy to make an erroneous conclusion about a disease in a dog belonging to the breed to which it is characteristic. For example, diagnosing histiocytic ulcerative colitis in a boxer suffering from diarrhea. But not all Boxers with diarrhea suffer from histiocytic ulcerative colitis!

It is also important not to miss the obvious; for example, in a study of a male German Shepherd with diarrhea, it would be risky not to include microflora overgrowth as a differential diagnosis (Hall, 2005). Similarly, pyometra in an older female dog with weakness and vomiting can easily be missed unless the owner is asked to determine whether the dog has been spayed.

3. Neglect of medical history data about previous diseases

Overconfidence often narrows the view of the veterinarian, who believes that the animal has not had similar symptoms in the past because the owner did not mention them during the interview. A very common mistake made by doctors is to consider the disease acute, when in fact it is chronic, the owner simply did not report it or did not see the connection with the current disease of the clinical signs that the animal had several months or even years ago.

Determining the acute or chronic nature of the disease is the main stage of the diagnostic study of the animal. In addition, it is necessary to look at the exact vaccination and deworming records in the passport and not rely only on the owner's information, which can be very vague.

4. Incomplete amount of required general information

Although asking the owner for detailed general information about the animal may seem tedious, it is a necessary step in the investigation and may provide clues to the source of the problem. Thus, information about the conditions in which the animal is kept is of great importance, for example, where it lives, whether it is given treats or inedible toys, whether there are other animals in the house and whether they, as well as people in contact with the animal, show signs of diseases. Information that may be very valuable to the veterinarian is that the animal is allowed to roam freely around the house every day, has a habit of eating garden plants, has unhindered access to inedible materials, or that there is another animal in the house with new signs of gastrointestinal tract. intestinal disorder.

5. Insufficient discussion of diet

Diet and gastrointestinal disease often go hand in hand. Therefore, it is necessary to spend some time interviewing the owner and finding out all the details of feeding, and, if necessary, offering to fill out a “feeding diary”. Points to pay special attention to:

It is possible that the owner forgot to mention some component of the animal's diet, and it is this that may provide a clue to the problem. A classic example: a dog who was given milk intermittently, resulting in diarrhea due to lactose intolerance.
There may have been a recent change in the diet the animal has been fed for many months.
There is a certain risk in the theory that nutrition is the main cause of the problem - it may turn out that this has nothing to do with it.

6. The Owner Misdirecting the Doctor

The owner can easily misdirect the doctor, for example, if he is sure that “the dog was poisoned” or that the problem arose after returning from a walk, therefore, “the dog picked up something on the street.” On the other hand, the doctor is also not immune from an incorrect diagnosis, which he assumed immediately as soon as the animal appeared in the office, and the owner also becomes disoriented. Questions that provide only one answer (eg, “yes” or “no”) can exacerbate the error, and the owner may inadvertently mislead the physician.

7. Necessary survey details that remain unclear

It is very important to obtain detailed information from the owner about his dog's problem. For example, simply mentioning vomiting is not enough; a complete description must be obtained (DeNovo and Jenkins, 1998). The owner may have noticed that vomiting occurs shortly after eating, but a methodical approach to questioning reveals that in fact this is regurgitation, or the dog has dysphagia, or belching due to tracheal pathology. By clarifying the facts, for example, how long after eating does the animal vomit, its natural temperament, the color and consistency of the vomit, whether there is any blood (if there is any, it is necessary to clarify the data on the appearance and amount of blood), you can avoid erroneous judgments . Similarly, if an owner complains of diarrhea in an animal, details should be sought, such as the volume and consistency of stool, frequency of defecation, blood or mucus, and whether the animal has tenesmus or difficulty defecating (dyschezia) (Hall, 1998).

8. Lack of objectivity when identifying the root cause

It is all too easy to forget that not all illnesses that involve symptoms of vomiting or diarrhea are gastrointestinal in nature; A classic example is kidney or liver problems. Likewise, it is easy to miss a gastrointestinal illness in an animal without its main symptoms of vomiting and diarrhea; for example, anorexia and weight loss may be due to a primary gastric disorder that may not be accompanied by vomiting.

9. History is too short or incorrect

Trying to get all the necessary information from the owner during a short consultation can be a false economy of time. This is especially true for chronic cases or when there is already a conclusion from another doctor, since there is a very strong temptation to start research or even treatment without collecting a complete history. If necessary, it should be explained to the owner that it would be in his best interest to make another appointment for a consultation where sufficient time will be given so that the correct foundations for further investigation can be laid without unnecessary haste.
In addition, a busy or insufficiently experienced veterinarian does not always adhere to such an immutable rule as a methodical approach to collecting an anamnesis. In order not to miss questions important for diagnosis, written questionnaires can be distributed by the owner.

10. Missing a diagnosis in atypical cases

It is very tempting to believe that all diseases can be “sorted into shelves,” and sometimes doctors set traps for themselves, trying to bring all the data from the anamnesis (and even clinical examination) into line with the diagnosis to which they are inclined. In complex or recurrent cases, objectivity and a willingness to re-evaluate the history are necessary. Be prepared for the unexpected; for example, with the growing popularity of traveling with pets, diseases previously considered tropical or uncommon in your region may now be considered exotic simply by origin. For example, an animal returning from a country with a hot climate may develop a disease there that will only appear some time after returning home. Thus, a doctor who includes a question about possible travel with an animal in the questionnaire is acting wisely.

To successfully study animals with diseases of the stomach and intestines, the veterinarian needs a systematic approach to collecting anamnesis, in which ready-made questionnaires can be very helpful. It would be prudent to pay attention to the symptoms and take care to obtain all the necessary details about the diseases and the care of the animal. The owner must be carefully interviewed about various aspects of the problem and sufficient time must be taken to obtain a complete and accurate history before undertaking further diagnostic procedures or prescribing treatment.

Examination for pathology of the digestive organs

Having collected, if possible, all available information about the patient’s medical history, the veterinarian should proceed to conduct a clinical examination, which involves the use of appropriate additional non-instrumental tests. A thorough examination of the patient allows the veterinarian to obtain the maximum amount of information. This in turn facilitates the selection of appropriate additional studies and prevents unnecessary expenditure of time and money. This logical approach greatly increases the chances of making a correct diagnosis and, more importantly, helps avoid narrow-minded thinking.

1. Diagnostic measures

To standardize the clinical examination, the veterinarian must adhere to a methodological approach, which consists of 3 stages.

A) Assessment of the patient’s general condition
During a conversation with the animal owner during a thorough history taking, the veterinarian must assess the general condition before beginning direct contact with the patient or placing him on the examination table. This involves determining reactions to external stimuli, the nature of motor activity, posture, and interest in the environment.

Some of the most important signs that may indicate the presence of a disease include:

Drowsiness and lethargy may indicate the presence of metabolic diseases, which in some cases are accompanied by disturbances in the central nervous system (CNS) - for example, severe liver disease (portal systemic anastomoses, etc.). In this case, excessive activity of the animal may be associated with perverted appetite syndrome.

It is caused by metabolites similar to neurotransmitters that are formed during liver failure (Cauzinille, Bouvy, 2003). With severe hypoproteinemia, animals often react poorly to external stimuli. Slow movements and a hunched back may indicate pain in the animal, which is caused by such reasons as foreign bodies in the stomach and intestines, pancreatitis, peritonitis, pyelonephritis, viral enteritis, esophagitis, duodenitis, or severe inflammation of the cecum (typhlitis). Muscle weakness may be associated with hypoadrenocorticism, pseudoparalytic myasthenia gravis, cachexia, hypokalemia (developing secondary to vomiting or severe intestinal obstruction) or diffuse neuromuscular disease. Ataxia, proprioceptive deficits and limb weakness seen in central nervous system disease or diffuse motor neuron disease.
Muscle pain with polymyositis, which can manifest as megaesophagus. Joint pain or lameness that occurs with systemic lupus erythematosus or other pathologies leading to the development of arthritis; note that these diseases may also cause enterocolitis or chronic active hepatitis (Jergens, 1999; Magne, 2000). Animal discomfort associated with damage to the oral cavity in cases of impaired secretion of the digestive glands or perverted appetite, gastroesophageal reflux or gastroduodenal pain. Aggression or irritability in cases of excessive appetite (caused by indigestion or malabsorption) or abdominal discomfort.

B) General clinical examination
The veterinarian must then assess the animal's physical condition. At the same time, the hair coat, the quality (including keratinized areas) and elasticity of the skin, the color of the mucous membranes, humidity, the time of filling the capillaries with blood, as well as the appearance of the anal area are examined. During the study, the following deviations from the norm may be identified:

Poor quality of coat or skin, which happens in cases of developed malabsorption and digestive disorders; dryness and cracks of the nasal planum. In infectious/invasive diseases (for example, leishmaniasis), it is possible to detect other disorders of the normal condition of the skin, including exfoliative dermatosis or granulomas.
Poor skin elasticity in cases of dehydration.
Disturbances in the condition of the mucous membranes, which may manifest themselves as: stagnation of blood with slow filling of capillaries in case of dehydration or poor tissue perfusion; grayish discoloration and poor oxygenation due to pain, shock or enterotoxemia; pallor in acute or chronic diseases accompanied by blood loss; septum in diseases of the liver, pancreas or gall bladder.

An abnormal appearance of the anal area, which may be due to pathologies such as perianal fistula (Figure 1) or anorectal carcinoma (Figure 3). These problems are associated with defecation problems, diarrhea or constipation depending on the stage of the disease.

Figure 1. Perianal fistula in a 5-year-old German Shepherd.

Figure 2. Clinical examination of the same German Shepherd revealed micronodules in the external anal sphincter.

Figure 3. Palpation revealed the presence of numerous polyps (anorectal carcinoma) in the West Highland White Terrier.

C) Study of individual systems
The veterinarian should then auscultate the heart and lungs and palpate the neck area. This may reveal:
Functional systolic murmurs (eg, in cases of severe anemia).
Bradycardia and weak femoral pulse (eg, hypoadrenocorticism), tachycardia and weak pulse (infectious enteritis with septic shock), or tachycardia with pulse deficiency (gastric dilatation).
Breath sounds in cases of dysphagia caused by aspiration of feed.
Noise (caused by the presence of fluid or air) that occurs when the esophagus is palpated in the neck or at the entrance to the chest cavity (for example, with dilatation of the esophagus), as well as increased or rapid swallowing (for example, with a persistent right aortic arch, megaesophagus, or the presence of esophagus foreign body). It is important to determine what is bothering the patient and, if the dog is very anxious, is this related to the upcoming treatment? Such a nervous state can be misinterpreted as a sign of illness!
Shortness of breath may also indicate problems with the esophagus (such as a foreign body or a hiatus lesion)
(Gualtieri, 2004).

Then the oral cavity is examined. This may reveal:
Excessive salivation caused by pain when swallowing (odynophagia), caused by a foreign body (eg needle or bone) or esophagitis (Lecoindre, 2004).
Oral ulceration associated with uremia or secondary stomatitis in immunocompromised animals (eg thrush). In these cases, excessive salivation is also observed (Lecoindre, 2004).
Bad breath (halitosis) caused by fermented food or bones lodged in the esophagus, chronic gastrointestinal disease, tumors, or periodontal disease.

After this, you can proceed to auscultation, percussion and palpation of the abdominal cavity in order to detect intestinal flatulence, ascites or acute abdominal syndrome in the animal. This examination may reveal one or more of the following disorders:
Rumbling or bowel sounds caused by the movement of fluid or gas in the intestines. They occur in situations in which bacterial fermentation is increased with poor absorption of carbohydrates and proteins (Tarns, 2003) (chronic enteritis, increased bacterial proliferation). Bowel sounds may be normal in cases of aerophagia associated with the animal quickly ingesting food or consuming a diet (legumes, cabbage, etc.) that produces large amounts of gas. In such a situation, also cancel
They expect flatulence, in which the animal releases foul-smelling gases. Consider that 99% of the gases emitted by animals consist of oxygen, nitrogen, carbon dioxide, hydrogen and methane, which are odorless (Tarns, 2003). Bowel sounds may also accompany functional digestive disorders (eg, irritable bowel syndrome (Guilford, 2002)).
Overflow of intestinal gases due to decreased peristalsis (for example, with severe damage to the intestinal wall, in old animals suffering from spondyloarthrosis, which may be accompanied by impaired innervation of the digestive organs, with intestinal obstruction (Guilford, 2002)).
Sagging of the abdomen due to ascites caused by severe hypoproteinemia (secondary to chronic disease of the small intestine or severe liver damage).
Acute abdomen, i.e. abdominal pain on palpation (it occurs, for example, with viral enteritis, pancreatitis, peritonitis, pyelonephritis, portal hypertension and congestion in the liver, foreign bodies in the lumen of the digestive canal or intussusception). Sometimes careful palpation makes it possible to establish the localization of pain (left hypochondrium with liver disease, right hypochondrium with pancreatitis, renal (lumbar) region with inflammation of the cecum, left iliac with intussusception). The intestinal loops located in the mesogastric region can be easily felt by placing the animal on its hind limbs, while the owner lifts it by the front limbs.
Keep in mind that the use of tranquilizers and subsequent relaxation of the abdominal wall makes palpation of the abdominal organs easier; this can be especially useful when testing for a stomach tumor or determining the cause of swollen lymph nodes.

After this, the anus and rectum are palpated along the entire perimeter (360°), which makes it possible to identify:
Pain and sensitivity of the rectal mucosa (for example, caused by perianal fistula, paranal sinus disease, proctitis, inguinal hernia, anorectal carcinoma).
Disturbance of the structure of the rectal mucosa (for example, its compaction associated with the formation of granulomatous tissue in the early stage of perianal fistula) and anorectal polyps (Figure 2).
Anorectal or colorectal stenosis (for example, due to the development of a perianal fistula, infiltrative diseases such as rectal carcinoma, scarring resulting from cervical surgery (Tarns, 2003) or after obstructed labor).
When conducting a clinical examination, fecal samples should be taken from the animal for erganoleptic evaluation (appearance, color, smell and consistency), which can provide valuable diagnostic information (Figures 5-8):

Figure 5. Feces from a dog suffering from exocrine pancreatic insufficiency. Note their shiny yellowish color due to the presence of fat.

Figure 6. Feces from a dog suffering from mild chronic erosive lymphoplasmacytic colitis. Note the presence of reddish streaks and mucus in the feces.

Figure 7. Feces from a dog suffering from eosinophilic gastroenteritis. The feces are dark due to the presence of undigested blood.

Figure 8. Feces of a dog suffering from moderate lymphoplasmacytic gastroenterocolitis. They contain an admixture of mucus and pieces of wood (signs of perverted appetite).

Change in color of feces; lemon yellow in exocrine pancreatic insufficiency (EPI), light brown to orange in chronic enteritis, dark green in most cases of intense bacterial growth in the intestines, in places black in intermittent bleeding in the proximal part of the alimentary canal or almost black in melena, caused by heavy gastrointestinal bleeding. Smell of feces; for example, putrefactive in cases of intense bacterial fermentation, sour in cases of malabsorption, or almost completely absent in cases of poor digestion of feed. The presence of mucus or fresh blood, which may be mixed with the feces (if their source is in the cecum or proximal colon) or coating them (if proctitis or rectal polyps). Abnormal consistency; for example, feces are greasy (in some cases EPI), sticky in melena, runny in acute secretory diarrhea, and some cases of chronic intractable diarrhea. The presence of inedible materials in the feces such as plastic, wood, etc., which may indicate a perverted appetite.

2. Difficulties most often encountered during clinical examination

A) Unsystematic clinical examination
Examining only organs associated with clinical symptoms described by the pet owner may result in misdiagnosis. For example, if the veterinarian neglected to examine the esophageal area because the owner told him the dog was vomiting, he may very well fail to recognize megaesophagus. It is not at all difficult to skip part of the examination even if the doctor is distracted by a conversation with the owner or for another reason. It is tempting to proceed with additional tests before the clinical examination is fully completed. But then there will certainly be a need to conduct more tests than necessary, or an increased likelihood that the necessary tests will not be performed.

For example, in the case of a patient who has been vomiting intermittently for 10 days, the veterinarian may focus on radiography to rule out the presence of a foreign body in the esophagus without first performing a clinical examination of the animal. However, if he has enough time to examine the feces using appropriate tests, such as enzyme-linked immunosorbent assay for the presence of trypsin-like factor, and endoscopy, then his efforts will not be in vain in the case of pancreatic insufficiency or lymphoplasmacytic gastroenteritis.

B) Abstract interpretation of clinical signs
Vomiting, diarrhea and weight loss are not independent clinical signs. In most cases, they are accompanied by other disorders, which makes it necessary to interpret the clinical picture of the disease as a whole. It is important not to focus on just one of the identified clinical signs; The importance of a holistic approach when interpreting symptoms cannot be underestimated.

C) Suggestion of serious problems in animals that are weak and inactive
In severe esophagitis, dogs usually exhibit obvious signs of pain and dysphagia, which are associated with increased activity. Yorkshire Terriers often have portocaval anastomoses and progressive liver disease.

D) False belief that clinical examination of the animal during consultation is sufficient to make a diagnosis.
If the symptoms of the disease described by the owner are not clear, or if the animal lives outside the home, which makes it impossible to accurately identify signs of the disease (for example, the nature of vomiting and defecation), then there is a need for its hospitalization.

E) Careless palpation of the abdominal cavity
Palpation of the abdominal cavity must be carried out carefully so as not to cause damage, especially if the veterinarian does not suspect the true cause of the disease or is trying to find confirmation of a previously made diagnosis. For example:
1) Without suspecting the presence of a spleen tumor, it can be damaged during palpation, which is fraught with internal bleeding.
2) If, based on the results of palpation, it is suspected that there is a tumor in the abdominal cavity, it is necessary to exclude the alternative possibility that the detected lump is a foreign body; if it has sharp edges or is surrounded by a loop of intestine, careless palpation may result in perforation of the latter.

F) Lack of scrupulous monitoring of a sick patient
If the history suggests recurrent vomiting that resolves with symptomatic treatment, take time to check for dark-colored stools, which may indicate gastrointestinal bleeding.

If you do not pay attention to this sign, then you can make an incorrect diagnosis in cases of such serious diseases as, for example, gastric lymphoma or pro-testing lymphoplasmacytic gastroenteritis (Figure 8).
Do not confuse feces with the contents of the anal and paranal glands, which can sometimes be black or remain on the inside of the anus, making it look like feces containing digested blood. If laboratory tests are necessary, manual removal of feces from the rectum is preferable.
If the owner mentions "red blood in the feces", it must be determined whether it is mixed with the feces or simply covering them. In cases of recurrent bleeding, serial stool examinations are necessary.

G) Place the patient immediately on the examination table
First, you should observe the animal on the floor. Very often, owners of small dogs immediately place their pets on the examination table; this may cause important signs of disease to go undetected due to the animal's posture, position and behavior during examination.

H) An approach that assumes that a significant deterioration in general condition is a sign of cancer, and maintaining good condition excludes this possibility
Gastric neoplasms are recorded in animals that, despite a slight decrease in body weight, maintain a normal coat and skin condition, while animals with lymphoplasmacytic gastroenteritis can be in very poor condition, be emaciated and depressed, and have an altered coat. Similarly, patients with intestinal tumors may remain in significantly better condition compared to animals suffering from chronic enteritis, in which severe hypoproteinemia and decreased intestinal motility have a marked impact on the patients' appearance.

As stated at the beginning of this chapter, the clinical study should provide enough information to enable the veterinarian to:
Correctly determine what additional studies are needed to make a final diagnosis.
Act as promptly as the specific circumstances of the situation require.
Avoid unnecessary additional research, which will not provide the necessary information to solve the problem, but will entail additional waste of time and money.

Non-instrumental additional studies for diseases of the digestive system

With the exception of cases of quickly passing uncomplicated gastrointestinal diseases, veterinarians usually resort to additional studies that help make a diagnosis and prescribe treatment for a sick animal. There are a large number of studies used for this, and their choice largely depends on the information obtained from the analysis of the medical history and the results of the clinical examination (we have already mentioned this in previous chapters).

These studies can be divided into a number of large groups: laboratory, neurological, clinical, carried out after the use of sedatives to the animal, and therapeutic.

1. Laboratory tests

Figure 1. Giardia.

Figure 2. Coccidia (Isospora canis).

Immunological methods aimed at identifying pathogen antigens are also useful for diagnosing parvovirus infection (which has an acute course and manifests itself in young animals with reduced immunity by attacks of vomiting and profuse diarrhea).

Electrolyte analysis:
Blood electrolyte analysis can reveal: hypokalemia (eg, acute secretory gastroenteritis, chronic kidney disease) or hyperkalemia and hyponatremia (vomiting and/or diarrhea due to hypoadrenocorticism).
Blood chemistry:
It is important to remember what changes in the biochemical parameters of the blood occur in animals with pathology of the digestive organs:
A decrease in total protein with a simultaneous moderate decrease in albumin concentration (inflammatory enteropathy accompanied by digestive disorders or malabsorption) or a very significant decrease in albumin concentration (enteropathy accompanied by protein loss, intestinal lymphoma); normal protein content with low albumin concentration (kidney or liver dysfunction in chronic disease); absolute hypoproteinemia (bleeding). High levels of urea and creatinine in the blood (vomiting with/or without diarrhea in kidney disease) or high concentrations of only urea in the blood (digestion of blood that has entered the digestive canal as a result of bleeding in severe gastroenteritis). Moderately increased activity of liver enzymes in the blood (sometimes chronic bowel disease (Bush, 1997), liver failure, developing, for example, with portocaval anastomosis, or pancreatitis) or very high activity (primary liver disease). Animals with liver disease may also have normal or slightly decreased enzyme levels. Hyperglycemia (diabetes mellitus) or hypoglycemia (eg, diarrhea due to septicemia; multiple blood samples may need to be tested to detect hyperglycemia).

C) Urine should also be examined to determine its density and protein content. It is preferable to take urine samples from the animal at the same time as blood. A urine test reveals:
Its normal (renal azotemia) or reduced density (kidney disease).
High proteinuria in combination with hypoproteinemia (nephrotic syndrome), moderate proteinuria (systemic disease) or absence of proteinuria (chronic inflammatory enteropathy, lymphangiectasia, intestinal lymphoma).
Typically, the need to determine a hemogram and conduct a biochemical blood test, as well as a urine test, arises in the presence of signs of a systemic disease such as polyuria/polydipsia, anorexia, weight loss, vomiting and/or profuse diarrhea. Even when the mentioned clinical signs are not severe or disappear periodically, these screening tests always provide an opportunity to obtain more complete information about the patient's health.

D) Gastrointestinal functional tests:
The trypsin-like immunoreactivity (TLI) test is useful for assessing the condition of the pancreas. In some cases of pancreatitis, the concentration of trypsin-like factor can be very high, but with EPI it constantly remains below the normal level.
A test for pancreatic lipase immunoreactivity has been recently developed. It allows a more accurate diagnosis of pancreatitis, although it should be borne in mind that it is currently only performed in laboratories in the United States (www.cvm.tamu.edu/gilab).
Canine serum cobalamin and folate tests can be useful but are often misinterpreted. A reduced cobalamin content is detected in cases of EPI, intensive proliferation of bacteria in the proximal part of the small intestine, as well as in diseases of its distal section. High levels of folate in the blood serum occur in cases of intensive bacterial growth in the proximal part of the small intestine, and their reduced concentration occurs in diseases of the small intestine.
The content of bile acids in the blood serum is determined before and after feeding the animal. This indicator is useful for assessing the functional state of the liver in cases of suspected liver failure.
More specific biochemical tests can be performed if preliminary clinical examination or additional diagnostic measures give reason to suspect organic or systemic disorders in the animal, and it is necessary to exclude or confirm such assumptions.

For this purpose, the following tests are carried out:
The adrenocorticotropic hormone stimulation test is performed in dogs with diarrhea and vomiting thought to be caused by hypoadrenocorticism.
The Tensilone test is performed in dogs with severe regurgitation or dysphagia, as well as muscle weakness, when pseudoparalytic myasthenia gravis is suspected. Detection of anti-acetylcholine antibodies (currently this study is carried out only by American laboratories). Note that regurgitation caused by esophageal dilatation and swallowing difficulty associated with epiglottis dysfunction may be the only symptoms of the initial stage of pseudoparalytic myasthenia gravis (Shelton, 2002). Detection of antinuclear antibodies is carried out in dogs suffering from joint pain or when autoimmune polyarthritis is suspected (which may be accompanied by dysphagia or regurgitation).

2. Neurological tests

The need for a neurological examination arises in the following cases:
If focal lesions of the medulla oblongata are suspected, which may manifest as dysphagia, ataxia, limb weakness and proprioceptive deficits.
If there is a suspicion of damage to the cranial nerves; It may be necessary to assess the state of the cranial nerves in cases of swallowing disorders, dysphagia/regurgitation and problems associated with the tongue - first of all, the functional state of the IX (glossopharyngeal), X (vagus) and XII (hypoglossal) nerves is tested. For motor activity disorders; it may be associated with muscle weakness, one of the manifestations of which is dysphagia.

3. Clinical examination of animals after administration of sedatives

The use of these funds may be necessary during examinations:
Oral cavity, pharynx, larynx or tonsils (in case of dysphagia).
Abdomen, as this allows for more effective palpation of the abdominal cavity in nervous or overweight animals.
Anorectal region, when palpation is painful (in this case, clinical manifestations of the disease such as dyschezia and hematochezia are often observed).

4. Therapeutic testing

5. Difficulties that most often arise during additional research

A) Delaying the start of additional tests
The veterinarian will determine how quickly such tests should be performed based on the information obtained from the analysis of the medical history and the results of the clinical examination. The earlier the diagnosis is made, the higher the likelihood that a positive treatment result will be obtained. If the patient is in serious condition, has persistent vomiting and diarrhea for 1-2 weeks, or shows clinical signs of abdominal pain, anemia or shock, then there is every reason not to delay testing. However, these time frames may also depend on the consent of the animal owner.

D) Assessment of the biochemical profile of the blood of animals as “normal” without testing the protein content
Normal serum total protein levels should not cause reassurance. Hypoalbuminemia can occur in animals with gastrointestinal diseases without hypoglobulinemia. In all cases of nutritional diseases, when assessing the biochemical profile of animals, it is necessary to determine the content of total protein, albumin and globulins. Based on knowledge of these parameters, the clinician can differentiate between compensatory hypoalbuminemia (for example, in cases of leishmaniasis and ehrlichiosis) and absolute hypoproteinemia, in which the concentration of both albumins and globulins in the blood decreases.
On the contrary, if hypoalbuminemia is established, it is necessary to compare it with the results of urinalysis to differentiate nephrotic syndrome or liver failure from protein-losing enteropathy. The severity of the latter disease increases rapidly if the diagnosis is delayed and treatment is started when the serum albumin concentration has decreased below 20 g/L (2 g/dL).

E) Neglecting the determination of TPI in cases where the animal is suspected of having EPI and chronic disease of the small intestine
Neglecting this simple test can lead to incorrect diagnosis, unsuccessful treatment and, as happens in severe cases, significant deterioration of the intestinal mucosa. It is very easy to confuse EPI with enteritis. Refusal to determine TPI may result in unsuccessful repeated therapeutic testing for the intensity of pancreatic enzyme formation, which in turn gives grounds to the animal owner to refuse further treatment, and causes the doctor to fall into despair.

F) Determination of TPI in animals when diagnosing EPI without a sufficiently long starvation diet
Performing this test within 6 hours of depriving the animal of food often produces results that are difficult to interpret; It is recommended to keep animals without food for at least 10 hours before taking their blood for analysis.

G) Exclusion of EPI based on obtaining “normal” TPI results
A decrease in the trypsin-like factor titer in dogs below the level of 2 mg/l is considered diagnostic for EPI. A value of this indicator ranging from 3.5 to 5 mg/l may indicate a subclinical course of pancreatic disease, for example, chronic pancreatitis. Later, when the trypsin-like factor titer in these patients decreases to 2-3.5 mg/l, EPI may progress. It is important to keep in mind that if a questionable test result is obtained, it will need to be repeated after 1 month.

H) Determination of TPI in cases of suspected pancreatitis several days after treatment
TPI should be determined in blood samples taken from animals at the onset of the disease, since this indicator quickly decreases after the first intravenous administration of drugs. In cases where there is reason to suspect that an animal has pancreatitis, appropriate treatment should be started as early as possible rather than waiting for pancreatic lipase immunoreactivity results. This test, which is the most sensitive method for diagnosing pancreatitis, is performed at the University of Texas.

I) Overestimation of the results of determining the concentration in blood serum of cobalamin and folates in the diagnosis of intestinal diseases
It is quite easy to misinterpret serum cobalamin and/or folate results in animals. For example, the concentration of cobalamin decreases below normal more often with EPI than with intensive proliferation of bacteria in the intestine. Not all dogs with intestinal diseases have levels of cobalamin and folate in the blood serum that deviate from normal parameters. Not in all intestinal diseases, the absorption of vitamins from the digestive canal is so significantly and for such a long time reduced as to cause a decrease in their reserves in the body (Melgarejo, 2002).

J) The choice of treatment regimen is based only on the results of bacteriological examination of feces and duodenal contents
The technique for taking samples of pathological material is quite complex, especially when they are obtained directly from the small intestine, since in this case endoscopy or surgical manipulations are necessary. If direct sterile sampling is not possible, the results of bacteriological examination may be of little value in guiding treatment decisions.

J) Exclusion of hepatopathy in the case of hemorrhagic vomiting or melena, when the activity of liver enzymes in the blood is within normal limits or only slightly increased
Determination of the concentration of bile acids in the blood may be necessary to exclude or confirm the presence of liver failure, which is responsible for gastric bleeding and loss of protective layers of the gastric mucosa; but determining only biochemical blood parameters may not be sufficient to exclude liver involvement in the pathological process.

L) Selection of laboratory tests taking into account the breed characteristics of the animal
Narrow thinking may lead the clinician to select laboratory methods based on the patient's breed. For example, there is a tendency to determine TPI only in German shepherds, the concentration of bile acids in the blood only in Yorkshire terriers or miniature schnauzers, and the albumin level in the blood only in Shar-Pei dogs.

M) Lack of planning for the next stage of work with the patient after the therapeutic test
When conducting a therapeutic test (whether drug or dietary therapy is used), the clinician needs to prepare for the next step in diagnosing the disease in case the therapeutic test does not produce the expected result. If you do not plan your actions for the future, after the first failure, you can fail again when changing your medication or diet. This entails additional loss of time to make a diagnosis and may cause the owner to lose confidence in the veterinarian, and will also necessitate additional laboratory or instrumental tests in the future.

N) Ignorance of the differences between dogs and cats in the normal values ​​of indicators determined by laboratory diagnostic methods
When interpreting blood test results, it is important to consider that normal values ​​are not the same in dogs and cats; for example, low serum total protein levels have been reported in enterocolitis in dogs, but not in cats. The clinician must also be well versed in what parameters and in what cases should be determined in their patients.

The astute veterinarian will be careful in selecting the necessary additional tests so as not to unduly increase the time to obtain an accurate diagnosis for gastrointestinal diseases. To use test results correctly, you should be careful when interpreting them.

Visual diagnostic methods and endoscopy of the digestive system: instructions for use

Vomiting and diarrhea are nonspecific symptoms commonly observed in animals. They are not always caused by primary diseases of the digestive system and, in addition, the same sachet symptoms can be associated with diseases that are accompanied by damage to various parts of the gastrointestinal tract. After a general clinical examination of the patient has been carried out and hematological, biochemical and serological parameters have been determined, there is often a need to use instrumental diagnostic methods to obtain a final understanding of the nature of the disease.

Numerous imaging modalities are now available that are acceptable for the diagnosis of various diseases of the digestive system, including radiography, ultrasound scanning, endoscopy and computed tomography (CT). The use of each of them has its own indications.

1. X-ray examination

Abdominal radiography is indicated in cases where clinical signs and laboratory results indicate the presence of a disease that has caused damage to organs or structures located in the abdominal cavity. Signs by which animals are judged to have gastrointestinal diseases before the first laboratory results are obtained include regurgitation, vomiting, diarrhea, tenesmus, anorexia and weight loss. In addition, it should be remembered that primary diseases of the gastrointestinal tract may be accompanied by other nonspecific clinical signs, such as detection of neoplasms during palpation of the abdominal cavity, enlargement of organs, pain, stretching of the abdominal wall, as well as anemia, fever of unknown etiology, polyuria/polydipsia .
Since all organs of the abdominal cavity produce dark shadows typical of soft tissues and fluids, the interpretation of the results of abdominal radiography is often difficult and ambiguous due to the lack of reliable differences between one organ and another.

Pathological changes are revealed by radiography only in situations where the disease is accompanied by a sufficient change in the density, size, shape and position of certain organs, which makes them unlike the surrounding structures.

Some organs, meanwhile, are characterized by a certain density of contents, and therefore they are easy to distinguish from surrounding structures. In typical cases, gas accumulations are found in the stomach and intestinal loops, and feces are found in the colon and rectum.

To identify pathological changes not recognized by conventional radiography, it is often performed after the animal has been given contrast agents orally or rectally. However, keep in mind that contrast radiography should be used only after conventional radiography. Examination of the proximal digestive canal by this method is carried out using contrast agents such as liquid barium. The main indications for the study are the desire of the veterinarian to see the anatomical changes in the organs, checking for the presence of foreign bodies (Figure 1), partial blockage (Figure 2) or establishing deviations from the norm in the time of passage of the contrast agent through them. Studies of the distal digestive canal (colon and rectum) using contrast radiography are carried out much less frequently, partly because such a need does not arise often, but mainly due to the easier and more effective solution of the same problem using endoscopy.

Figure 1. X-ray picture of a foreign body in the stomach (fish hook).

Figure 2a. Contrast radiography: barium accumulation caused dilation of the ileum in front of the site of obstruction.
Figure 2b. Same case as in Figure 2a; during surgery to excise a chronic inguinal hernia, with a strangulated loop of the ileum.

The possibility of high-quality contrast radiography and accurate interpretation of its results mainly depends on how correctly it is possible to prepare the patient for this procedure, inject him with the required volume of contrast agent, and obtain a sufficient number of images after the administration of the latter. Consideration should also be given to significant differences between dogs in the rate of gastric emptying and passage of contrast material through the alimentary canal (Konde, 2003).
Properly performing contrast radiography is not easy and often requires sedation (especially in nervous dogs). Please note that if it is not possible to conduct the study correctly, then the interpretation of its results may not bring any benefit for making a diagnosis, and even, on the contrary, may cause a diagnostic error. In addition, sedatives (if used) significantly slow down the transit time of the contrast agent through the digestive canal. Therefore, contrast radiography is gradually being replaced from veterinary practice by other research methods, especially ultrasound.

To determine the peristaltic activity of the stomach and intestines, it has recently been proposed to conduct contrast radiography not with liquid barium, but with barium-impregnated polyethylene balls (Robertson, 2000). These small balls have different diameters and are located in gelatin capsules that are mixed with food. Using this method, it is possible to detect partial stenosis of the digestive canal, estimate the rate of gastric emptying and the time it takes the balls to travel the distance from the oral cavity to the colon (Robertson, 2000). However, not all veterinarians began to use them - the author of these lines also cannot be considered an adherent of this method. When examining the abdominal cavity, radiography should always be used in at least two projections: direct (ventro-dorsal) and lateral (usually performed with the animal lying on its right side). Pictures are taken at the end of exhalation. It is essential to be aware of normal radiographic anatomy and the (often mentioned but ignored) morphological variations associated with the position of the animal during examination.

Before deciphering X-ray images, which may have recorded changes and disturbances in the structure of organs, it is necessary to evaluate how correctly the exposure and positioning of the X-ray machine were chosen. In special situations, the correct positioning during radiography in the lateral projection is checked by whether the silhouettes of the transverse costal processes of the lumbar vertebrae are superimposed on the image of the wings of the ilium. Correct positioning in the ventro-dorsal projection is determined by whether the images of the spinous processes of the vertebral bodies divide into 2 symmetrical parts.

Finally, it should be remembered that not all digestive organs are located in the abdominal cavity - this means the pharynx and esophagus.

Therefore, a complete assessment of the condition of the digestive canal should also be based on the results of radiography of the neck and chest cavity (Figure 3).

Figure 3. Large foreign body (bone) in the esophagus.

In conclusion, X-ray examination is a fast and cost-effective method for screening the condition of the gastrointestinal tract. However, due to numerous limitations in the capabilities of simple radiography, it is not always possible to make a final diagnosis, which dictates the need to use additional, more complex diagnostic methods.

2. Ultrasound examination

Until recently, ultrasound was considered a poor method for studying the gastrointestinal tract: the prolonged presence of gases, food and feces in the latter, as well as the low clarity of displayed objects inherent in early ultrasound equipment, served as an obstacle to an accurate and complete sonographic assessment of the state of the digestive organs. However, technological advances, combined with improved training of ultrasound laboratory personnel, have produced higher quality images, significantly increasing the diagnostic value of ultrasound scanning and making it one of the most common methods for diagnosing diseases of the gastrointestinal tract. A large body of evidence in the veterinary literature suggests that ultrasound can serve its purpose well (Penninck, 1990 and 1995; Hudson, 1995). With its help, it is very often possible to clearly diagnose neoplasms, ileal intussusception, inflammatory diseases and congenital malformations, as well as detect foreign bodies in the digestive organs. Ultrasound has many advantages over other visual diagnostic methods:

Does not create a biological risk for the operator and the patient performing it;
allows you to examine the patient without the use of anesthesia and sedatives;
makes it possible to conduct serial patient studies with minimal cost;
allows you to evaluate the peristaltic activity of the stomach and intestines, examine the layers of the walls of the stomach and intestines, and assess the condition of other structures located in the abdominal cavity (Figure 4);
facilitates obtaining samples of pathological material for cytological examination, minimizing the invasiveness of biopsy.

Figure 4. Ultrasound visualizes structures located in the abdominal cavity: an enlarged lymph node is visible in this photo.

The main disadvantages of ultrasound that limit its use for studying the digestive organs are:
difficulty in examining all areas of the stomach and intestines;
absence of pathognomonic ultrasound signs in many diseases
the difficulty of accurately determining the localization of lesions in the intestine, due to the lack of reference (marker) points in it;
the presence of gases in the digestive organs, which limits the possibility of visualizing internal organs and causes artifacts that do not allow an accurate assessment of the condition of the intestinal walls located distal to the emitter;
difficulties associated with detecting and assessing the condition of the pancreas.

Ultrasound of the digestive organs must be performed using equipment that has high resolution and produces high-frequency radiation (5-7.5 MHz), which ensures optimal visualization of the walls of the digestive canal and identification of even small structural changes and damage. It is recommended not to feed animals 24 hours before the start of the study to reduce the amount of gases, digestive matter and feces in the digestive organs. As noted above, the presence of gases in the gastrointestinal tract is the main factor limiting the use of ultrasound, due to artifacts and the inability to visualize the digestive canal along its entire length. One of the ways to increase the clarity of the image of the digestive organs obtained during ultrasound scanning is to change the position of the animal being examined during the scan and move the emitter of the apparatus from one side of the body to the other; The easiest way to achieve this is by using a special ultrasonic table with a hole. These manipulations ensure the movement of gases in a dorsal direction, which reduces the amount of artifacts, while the alimentary canal tends to descend onto the adjacent abdominal wall. Another way to shift gases in intestinal loops is to apply light but gradually increasing pressure on the area being examined, which ensures gas displacement while the intestinal loops under study are in a stable position. However, such manipulations can cause a painful reaction in animals, which makes them difficult to carry out, and in case of an acute abdomen, their implementation is completely impossible. More complex methods are used when examining the stomach. For this purpose, for example, a small oro-gastric tube is used to remove air from the organ and then fill it with water (Penninck, 1995). The introduction of a barium contrast medium into the stomach before ultrasound will significantly improve the quality of the resulting image (Hudson, 1995). However, such methods are rarely used in clinical practice, partly because they usually require the use of sedatives.

A methodological standard approach to ultrasound scanning of the abdominal cavity is the most important condition for an adequate assessment of the condition of the digestive canal: all its quadrants must be examined by scanning in the longitudinal, transverse and oblique directions. This method usually makes it possible to assess the condition of the patient’s digestive canal from the stomach to the anus, determining whether its anatomical structure corresponds to the norm and identifying pathological changes. Ultrasound of the digestive system always involves determining the folding and thickness of the mucous membrane, the contents of the digestive organs, the intensity of peristalsis and the condition of regional lymph nodes. The layering of the walls of the digestive canal detected by ultrasound has constant characteristics and corresponds to the histological structure of its organs: moving from the lumen to the outer wall, the first hypoechoic line is sequentially identified, forming the boundary between the lumen and the intestinal mucosa, then the second hypoechoic line corresponding to the mucous membrane, the third the hyperechoic line of the submucosal layer, the fourth hypoechoic line of the muscular layer and the fifth (last) line of the serous and subserous layers. However, it should be noted that the correct recognition of all the above layers depends on various factors, including the presence of gases and other contents in the intestines. The inability to identify all layers of the intestinal wall does not necessarily mean its pathological condition. The thickness of the mucous membrane in different parts of the digestive canal is not the same. In the stomach it ranges from 3 to 5 mm, in the small intestine - from 2 to 3 mm, and in the colon it is 2-3 mm.

Using ultrasound, you can clearly trace the peristaltic movements of the digestive organs. Normally, in a calm animal, the stomach and duodenum perform them with a frequency of 4-5 waves per minute, the rest of the small intestine contracts with a frequency of 1-3 times per minute, and, finally, the large intestine usually does not show peristaltic movements at all. movements. In the intestine, ultrasound reveals 3 typical substrates: gas, mucus and liquid. While the presence of fluid and mucus makes it easier to decipher the ultrasound image of the walls and structures of the abdominal cavity, the accumulation of gases leads to the appearance of hyperechoic surfaces at the border with the mucous membrane, which serve as a source of so-called “sounding” artifacts.

As mentioned above, ultrasound is a diagnostic method that provides early identification of a large number of changes in the alimentary canal, many of the images it produces are non-specific, and biopsies are often required to make a definitive diagnosis. Under ultrasound control, it is convenient to perform both aspiration and tissue biopsies with minimal risk of damage to organs and tissues. The advantage of this approach is that manipulations carried out under ultrasound guidance are minimally invasive and make it possible to obtain good quality material even from deep-lying areas of organs that could only be achieved through more complex and risky surgical procedures. In conclusion, we note that ultrasound is an effective method for examining the gastrointestinal tract. However, it cannot completely replace other visual diagnostic methods. Therefore, ultrasound should be performed in combination with high-quality radiography and endoscopy; in this case, ultrasound provides unique information that complements the indications of the other diagnostic methods mentioned.

3. Endoscopic examination

Endoscopy was originally used as a complement to other established diagnostic methods, but has now become the most important way to identify diseases of the stomach and intestines (especially their subacute and chronic forms).

The advantage of endoscopy, without a doubt, is that it not only allows visual examination of the mucosal surface (Figure 7), but also the collection of tissue samples for cytological and histological examination using appropriate instruments. Endoscopy can examine most of the alimentary canal, with the exception of the jejunum and part of the ileum. Tissue samples are taken even in cases where it is not possible to detect changes in the mucous membrane, since the absence of macroscopic lesions does not exclude the presence of structural changes and infiltration processes that can only be detected through histological examination. Endoscopy allows for precise identification and location of lesions such as polyps, small ulcers and superficial erosions, which is not possible with radiography and ultrasound. It also allows you to detect changes and lesions that are also difficult to detect with other tests, such as diverticula, inguinal hernia, prolapse of the stomach, esophagus and duodenum (Figure 8). Endoscopy can be used for many therapeutic procedures that are difficult to perform by other means. These include expansion of narrowed areas of the esophagus (Figure 9) and colon, removal of foreign bodies from the stomach and esophagus (Figure 10), insertion of probes intended for feeding animals with special mixtures, removal of polyps and other neoplasms.

Figure 7. Diffuse unevenness of the surface of the mucous membrane of the duodenum: lymphangiectasia was diagnosed upon histological examination.
Figure 8. Duodenal-gastric prolapse in a dog suffering from chronic vomiting.
Figure 9. Balloon dilatation of the esophagus due to stricture.
Figure 10. Large foreign body (bone) in the esophagus.

The main disadvantage of this method is the need for general anesthesia, and therefore contraindications to endoscopy are associated with the risk of complications of anesthesia. It should also be remembered that endoscopy cannot be performed in case of perforation of the digestive canal.

Numerous models of endoscopes have now become available. They differ in their suitability for examining the proximal and distal alimentary canal. The most suitable for this purpose are long flexible endoscopes, the head of which can be moved in different directions - this is necessary for examinations of the gastrointestinal tract and obtaining biopsy samples from different parts of the examined organs. The endoscope must also be equipped for air injection, water rinsing and aspiration of gases and liquids, which allows you to expand the lumen of the digestive organs and clean the instrument head during the examination.
Endoscopes with an outer diameter of 8.0 to 9.5 mm can be used to examine most patients, although instruments with a smaller outer diameter (7.8 mm) are much easier to maneuver in the digestive organs of dogs weighing less than 5 kg.

It is necessary that the frontal examination angle be at least 100°, and the endoscope head must move up by 210°, down by 90 and to the sides by 100°. One of the most important characteristics of endoscopes is the diameter of their working channel, since it determines the size of the forceps that can be used for biopsy and, accordingly, the quality of the biopsy specimens. A working channel with a diameter of 2.0 to 2.8 mm allows one to obtain tissue samples of satisfactory quality; however, only the largest endoscopes have such a channel.

Finally, the length of the instrument is an important parameter that limits the ability to examine deep parts of the intestine.

Endoscopes less than 100 cm in length are unsuitable because they cannot examine the duodenum in medium- and large-sized animals. Although this is not necessary, you should consider the possibility of attaching a video camera to the instrument, with which you can monitor all stages of the study and study in detail the appearance of the mucous membrane on a high-resolution monitor.

In addition, the video camera facilitates the operator’s work, allows him to choose the most comfortable position, discuss findings with assistants and colleagues, collect and record images and video recordings. Patients are specially prepared for endoscopy of the proximal and distal digestive canal. Without such preparation, it is impossible to examine many areas of the alimentary canal that contain food, gastric juice, feces, and (possibly) barium-containing contrast medium. As mentioned above, one of the main advantages of endoscopy is the ability to take biopsies. To obtain quality tissue samples in sufficient quantities, good instruments are necessary. The biopsy forceps used should be as large as possible, but comparable in size to the diameter of the endoscope's working channel. The most effective are biopsy forceps with oval jaws with holes - they can obtain tissue samples from a greater depth than forceps with round jaws; in addition, the presence of holes in them prevents damage to biopsy samples from compression and deformation. Tongs with cups that have serrated edges also work well.

A tissue biopsy should be performed every time during endoscopy, regardless of whether or not changes are detected in the examined area of ​​the mucous membrane. It was reported that the intestinal mucosa can have a normal appearance in many inflammatory and oncological processes, and, conversely, that when examining tissue that has a different appearance from the norm, histological changes could not be detected in almost 30% of cases. When taking samples, the biopsy forceps should be directed perpendicular to the surface of the mucous membrane, which is first grasped and then pulled with the instrument until the sample is separated from the mucous membrane. If the forceps are not directed exactly perpendicularly, they may slip through the tissue, which will not allow obtaining a biopsy suitable for analysis. Carrying out a biopsy is easier if gases are previously removed from the organ, as this reduces the pressure in their lumen, which facilitates tissue capture. At least 10 samples should be taken from each organ examined (stomach, duodenum, colon and ileum).

4. Computed tomography (CT)

CT is an excellent method for diagnosing abdominal diseases of all types in humans. Although it is rarely used in veterinary medicine, there is no reason why it should not become as routine a diagnostic tool as ultrasound and endoscopy. The capabilities of CT go beyond the limitations of radiographic examination:
It has excellent low-contrast resolution (Figure 12) thanks to the highly collimated (limited) X-ray beam, which allows it to obtain cross-sectional images of the patient's organs and tissues. Using special detectors, the radiation intensity required to pass through such sections is determined.
It is possible to expand and lengthen the window in order to change the size of the image and thereby select the contrast required by the operator.
New fast CT options, such as helical CT, allow for exceptionally rapid examination of animals and acquisition of images taken within a short period of time at the end of expiration. The result is high-quality three-dimensional images that can be converted into multi-dimensional images. New CT options are also used - continuous viewing, CT angiography, virtual-real images and CT endoscopy.
Digital images obtained in this way can be processed to extract as much information as possible to better understand the nature (shape and structure) of the lesions.

Figure 12a. Sagittal contrast-enhanced CT scan revealed smooth focal thickening of the jejunal wall.
b. Appearance of the lesion shown in Figure 12a. Based on histological examination, well-differentiated adenocarcinoma was diagnosed.

Oral administration of a contrast medium to animals (for example, meglumine diatrizoate, diluted with water in a ratio of 1:25) makes the entire digestive canal opaque. This makes it easier to differentiate intestinal loops filled with homogeneous fluid from abscesses and neoplasms. The simultaneous expansion of the stomach and intestines with forced air further improves the quality of the resulting images.

As described above, there are a large number of visual methods that allow you to study and diagnose diseases of the digestive system in detail. Each of these methods has its own specific indications and disadvantages (Table 1). Accurate knowledge of the capabilities of a particular visual diagnostic method, used with the appropriate equipment, is necessary for the informed and optimal use of diagnostic resources currently available to veterinary professionals. Finally, the inclusion of such technologies in a specific standard diagnostic procedure ensures that the maximum amount of information is obtained and eliminates their use in situations where it is not necessary.

The main mistakes in the treatment of digestive diseases in dogs

A good clinician must approach each case with maximum objectivity in order to find the optimal solution to the problem at hand.
If necessary, conduct additional research immediately.
Avoid prescribing several consecutive courses of symptomatic treatment; if clinical signs do not disappear, it is advisable to find out the etiology of the disease as soon as possible.
When prescribing a long course, clearly explain to the owner the need for treatment and its limitations. Inform him of any possible side effects of treatment and the prognosis of his animal's illness.
If dietary adjustments are necessary, remember that food itself is not medicine and therefore cannot replace drug treatment in cases where it is indicated.

Introduction

Drug treatment of digestive diseases in dogs can be difficult. The owner of a sick animal expects rapid improvement and eventual recovery upon completion of treatment, especially if symptoms have developed over a period of time and/or the general condition of the animal is deteriorating.

Basic provisions

The main mistakes in the treatment of diseases of the digestive system are due to the fact that the doctor:

1. Did not notice important clinical signs.
2. Did not order additional studies or made a mistake when interpreting the results.
3. Did not follow certain rules when prescribing treatment.
4. Did not interact with the owner in cases requiring long-term treatment.

1. Important clinical signs and reminders

The presence of certain clinical signs should immediately prompt the doctor to think about appropriate additional studies, which are prescribed in order of importance. They are necessary in order to find out the cause and act on it, and not just try to eliminate the symptoms. This should always be the primary goal of a competent physician.

A) With vomiting or diarrhea
There are two possible scenarios:
If vomiting and diarrhea are "acute", the presence of one or more of the following signs is an indication for hospitalization or immediate investigation to determine the source of the problem.
If the animal is very small.
If the general condition of the animal worsens.
If the animal has dehydration, fever, bloody vomiting, or melena.
If the animal experiences abdominal pain, it may have uncontrollable vomiting or diarrhea.
If there is a risk of deterioration of the condition or the likelihood of concomitant pathology.

If vomiting or diarrhea is “chronic”, for example, clinical signs are present for more than a week or recur intermittently, further investigations should be carried out before any treatment is started.

Clinical examination is a necessary part of diagnosis. It must be accurate and scrupulous, since the number of different differential diagnoses can be very large. A detailed history should be recorded: weight loss, changes in behavior and/or appetite are all clinical signs that need to be taken into account.

After you have ruled out metabolic and digestive disorders, you need to conduct a number of additional studies: general and biochemical blood tests, x-rays, ultrasound of the abdominal cavity, endoscopy, etc. The sequence of studies largely depends on the medical history, information received from the owner, age , breed and lifestyle of the animal. Clinical examination and additional studies must be selected on a case-by-case basis. For example, various epidemiological studies have shown a predisposition of certain breeds to gastric carcinoma (Estrada, 1997): this is especially true for Belgian Shepherds, Collies and Chow Chows. If a dog of one of these breeds does not stop vomiting for several days, despite antiemetic medications, early gastroscopy is indicated.

B) For constipation or blood in the stool
Constipation is much less common in dogs than in cats. By definition, it is manifested by more infrequent bowel movements with the release of dry feces or a very small volume of it. In case of constipation, you should find out whether the animal has difficulty passing feces and whether it receives a balanced diet (a rectal examination will help rule out prostatic hyperplasia in males). Defecation may be painful (dyschezia), which is an “alarm signal” for the doctor.
Hematochezia is the presence of blood in formed stool, which may have a reduced or normal diameter. Traces of blood are usually visible as streaks or red spots, and when found, a veterinarian should always examine the animal to determine if any intestinal injury is causing the bleeding before prescribing treatment. Colonoscopy is performed after appropriate preparation of the animal; The colonic mucosa and, if possible, also the ileocecal valve should be examined (Tarns, 1996). If any lesions are detected, a biopsy can be taken for histological diagnosis.

It should be noted that in some cases, malignant neoplasms are difficult to distinguish from benign ones based on their macroscopic appearance (De Novo, 2000).

Tumors of the rectum and colon can have a variety of appearances. The following points are worth noting:
Pedunculated polyps are found in the distal colon, especially in the area up to 10 cm from the anus and in the folds at the border of the anal canal (Figure 1). Sometimes multiple polyps can be seen. They are often benign, but histological examination can reveal the cancerous nature of the apex of the formation, which requires radiation therapy. Neoplasms in the intestinal lumen vary greatly in appearance; they may have different diameters, protrude into the lumen to a greater or lesser extent, be fragile, bleeding or ulcerated. The prognosis is worse than with polyps, since these formations are ring-shaped, non-proliferative and make the intestinal wall much stiffer.

2. Careful selection of additional research methods and accurate interpretation of results

If treatment does not provide improvement, one of the reasons may be refusal of additional studies or incorrect interpretation of the results. In this situation, the diagnosis should always be reconsidered. Below are some examples.

Do not rule out metabolic causes of digestive disorders. With some congenital anomalies, signs are sometimes observed that are mistakenly attributed to gastroenteritis:
Kidney dysplasia in German Shepherds causes early development of kidney failure, but symptoms are not always specific.
Portocaval anastomoses in puppies may present with symptoms of gastrointestinal disease; if they are suspected, it is recommended to determine the concentration of bile acids in the serum before and after feeding.

If pancreatitis is suspected, it is recommended to perform a blood test for amylase and lipase daily for several days. If possible, send blood samples to a reputable veterinary laboratory.
When conducting a clinical and biochemical analysis of the blood of a dog with vomiting, do not forget to determine electrolytes: this will exclude tpoadrenocorticism (if necessary, you can also do an ACTH test) and is necessary for adequate infusion therapy while the animal is in the hospital.

The use of antibiotics can worsen the situation, and giving them during the period of diarrhea without identifying the cause is even contraindicated.

Antibiotics must be prescribed according to strict, systematic rules (Marks, 2000).
The most commonly isolated bacteria from the intestines are Clostridium perfringens or difficile, Escherichia coli, Campylobacter spp, Salmonella and Yersinia enterolitica. Thus, the growth of E. coli colonies on microbiological stool culture may be normal and does not require treatment if the colonies do not have known characteristics of pathogenic strains; Determining the serotype of E. coli is not always easy. In the same way, CI. perfringens is isolated from more than 80% of stool samples from both sick and clinically healthy dogs.
3. Clinical salmonellosis is very rare in domestic carnivores and causes diarrhea in less than 2% of cases (Marks, 2000).
Therefore, an accurate diagnosis of bacterial diarrhea is made on the basis of clinical signs and epidemiological data, microbiological culture, and in doubtful cases, even polymerase chain reaction (PCR). Indications for the prescription of antimicrobial drugs for diseases of the digestive system can be reduced to the following cases:
The growth of colonies of pathogenic microorganisms during microbiological culture in the appropriate epizootic environment (it is worth finding out if there are other animals in the house with similar symptoms that arose at the same time).
Bacterial overgrowth syndrome. It is not yet clear whether this syndrome is primary or secondary in nature. In fact, bacterial overgrowth can accompany many chronic digestive diseases and recur periodically if the cause is not identified and eliminated. This especially applies to exocrine pancreatic insufficiency and chronic inflammatory bowel diseases.
Gastritis, which also leads to ulceration of the walls of the gastrointestinal tract, when the general condition of the animal worsens (for example, with an increase in temperature or bloody diarrhea). Gastritis caused by Helicobacter; in this case, triple therapy can be prescribed, consisting of two antibiotics and an antacid (if justified based on the clinical picture of the disease). However, a small percentage of dogs are healthy carriers of this microorganism without any symptoms of damage to the alimentary canal. It is known that in dogs Helicobacter does not have the same pathogenic potential as in humans.

If an x-ray examination is carried out, it is necessary to be guided by x-ray constants and position the animal correctly. It is advisable to take all photographs in two projections, frontal and lateral. X-rays with contrast are required in a limited number of cases, and the indications for them are continuously decreasing due to the development of ultrasound and endoscopy. But if you propose to take a barium image, a logical, systematic approach and optimal conditions are necessary: ​​images should be taken in appropriate projections at regular intervals and the resulting images should be compared by viewing them simultaneously (especially if there is any uncertainty in the interpretation of the results).

Ultrasound examination of the digestive canal under inappropriate technical conditions may not provide all the information within the capabilities of this method. Quality research requires trained personnel and good equipment. However, you should know the indications and limitations of this additional research method, which has become a necessary working tool for a gastroenterologist. Before the study, the animal is kept on a fasting diet for 24 hours, if possible. If endoscopy is planned, it is performed after the ultrasound, otherwise air trapped inside will interfere with the penetration of the ultrasound signal.

Visualization of some parts of the intestine, especially the pancreas and duodenum area, as well as the colon (due to gases), requires extensive experience.
When a biopsy is taken under ultrasound guidance, it must be taken into account that its results may not provide information about the affected area, since ultrasound does not always accurately determine its location.

During endoscopy, as noted earlier, the final diagnosis should not be given until the results of histological examination are available, even if the problem seems obvious. The macroscopic picture of some lesions can be misleading, since in some cases the inflamed area looks like a neoplasm. Similarly, diffuse tumor infiltration, such as lymphoma, may be missed. In addition, the effectiveness of endoscopy depends on topographic features determined by the size of the animal or the length of the digestive canal. When taking a biopsy, you may inadvertently sample material from outside the affected area or the sample taken may not be representative. Three examples deserve mention in this regard:
In case of a stomach ulcer, the possibility of its tumor nature should always be taken into account (gastric ulcers themselves are quite rare in domestic carnivores). The biopsy may contain only necrotic or inflammatory material without any malignant cells. Therefore, if gastric carcinoma is suspected, a large number of biopsies must be taken by endoscopy. In ulcerative and infiltrative forms of carcinoma, thickening of most of the wall is noted. It is likely that tumor cells will be found in only one or two out of ten samples taken.
If you suspect lymphoma of the gastrointestinal tract, remember that in many cases the neoplasm is accompanied by diffuse inflammatory lesions.

With neoplasms of the colon or rectum, malignant tumors may occur sporadically along the entire length of the intestine, but not be detected even when a large number of biopsies are taken. In cases of functional impairment or abdominal pain, a detailed ultrasound examination or exploratory laparotomy may be indicated - with the owner's consent.

It is recommended to carefully examine biopsies and tissues at the border of the affected areas and, if necessary, prescribe additional treatment, for example, chemotherapy or radiation therapy.
For all these reasons, it is advisable to be able to “read between the lines” and not rely solely on histological analysis. Additionally, if there is no clinical improvement within a few days, the veterinarian should not hesitate to reconsider the diagnosis.

3. Basic principles of drug treatment and new dietary approaches

Symptomatic or etiotropic treatment must meet certain criteria, for example:
If successive courses of treatment do not produce results, it is recommended to check the dosage of medications; This especially applies to cases where the animal was referred by another doctor, who prescribed treatment. Do not use dosages of medications designed for humans in animals; Some drugs are given to animals at a lower dose, while others are given at a higher dose.

If you are prescribing several courses of symptomatic treatment with a similar mechanism of action of the active components, they cannot be prescribed simultaneously. For example, if an animal's condition does not improve or even worsens after administration of metoclopramide as an antiemetic, it is unlikely that another antiemetic with a similar mechanism of action will be effective. In addition, in such a situation, it is undesirable to prescribe new generation antiemetics with a different mechanism of action (for example, serotonin antagonists, in particular, odansetron), since, most likely, they will not be more effective than the first drug: at this stage, a final diagnosis is necessary.

Please note that a number of drugs have well-known side effects that should be pointed out to the owner; for example, metoclopramide has extrapyramidal effects and may lead to unwanted behavioral changes such as agitation or aggression. From time to time, idiosyncrasy occurs due to individual intolerance in a particular animal.

Do not continue treatment if it has not worked after a few days; for example, if diarrhea does not stop after using loperamide for three or four days, there is no use in prescribing this medicine for a long time and expecting any improvement in the future. When choosing medications for humans (some essential drugs do not have a veterinary equivalent), it is advisable to remind the owner that the side effects listed on the packaging are based on studies in humans, not dogs; for example, salazosulfapyridine, indicated for colitis, causes numerous side effects in humans that are unlikely to occur in dogs.

Once treatment is started, the doctor should have an idea of ​​how long it will take to expect improvement or when to undertake further investigations if symptoms do not disappear. The choice of diet has a huge impact on the course of diseases of the digestive system: during the consultation, it is recommended to find out how the animal is fed and check to what extent the owner adheres to the chosen diet; It often turns out that the named diet is considered only as a “base” to which other components are added. It is advisable to explain to the owner that any new food prescribed is in addition to drug treatment.

It is a good idea to define a reasonable time frame within which to expect improvement, usually a few days (rather than a few weeks, unlike, for example, elimination diets in dermatology). The owner's belief that a therapeutic diet can completely replace drug treatment should never be reinforced.

4. When prescribing long-term or medium-duration treatment, you must discuss everything with the owner

A) Quality of follow-up and therapeutic treatment
For a chronic or disabling disease that requires treatment over several weeks or months (such as stomach tumors or severe chronic inflammatory diseases), owners often expect or demand a lot from the doctor; It is recommended to provide a way to quickly communicate with your doctor, allowing them to obtain advice or consultation if necessary. Monitoring the animal's condition by telephone, periodic clinical examinations, laboratory tests and repeated additional studies may be required. This fully reveals the concept of a family veterinarian.

B) Treatment of chronic diseases: the importance of consent in the treatment regimen
It is absolutely necessary that the prescribed treatment suits the owner: he must be prepared for some effort and be able to carry out the prescriptions daily for as long as required. To do this, it is necessary to take into account a number of parameters, especially the lifestyle and temperament of the animal, as well as the interest of the owner and his capabilities. The owner's intransigence can create difficulties when it is necessary to prepare the dog for additional tests (starvation diet before a colonoscopy, liquid food before an ultrasound or blood test, etc.).

From a pharmacological point of view, it is not always easy to control the effects of too many drugs when used at the same time: if possible, it is better to prescribe no more than four or five drugs at a time.

If chemotherapy is necessary, the owner should be fully aware of the treatment options. The most important thing here is to consider the animal's likely "survival time" and clearly explain the therapeutic limitations and possible side effects of the drugs you are about to administer.

A number of chronic diseases of the digestive system require long-term treatment with corticosteroids or immunomodulators. Their use should be rational and limited, but the possibility of leaving them as a reserve should still be discussed with the owner in order to reach agreement in the future.
The same applies to the appointment of lifelong treatment for exocrine pancreatic insufficiency in dogs. Because complete cure cannot be achieved, improvement in response to therapy may be variable; Periodic bouts of diarrhea due to bacterial overgrowth are likely. Sometimes the prohibitive cost of long-term treatment, especially if the dog is large, forces owners to choose euthanasia.

The possibility of early diagnosis of the disease depends on a methodological approach, a thorough clinical examination and careful selection of additional diagnostic methods. Correct interpretation of research results determines the choice of appropriate drug treatment. Treatment must be prescribed with the consent of the owner, who must be notified of its duration, cost and possible side effects of the selected medications. The personal qualities and abilities of the doctor are of particular importance in the treatment of chronic diseases of the gastrointestinal tract: very common in domestic carnivores.

The most common questions and misconceptions

1. Questions that owners ask most often

Q) Will my dog ​​be sick for the rest of his life? How long will she remain in this state as she is now?
Unfortunately, many chronic diseases of the gastrointestinal tract last a long time, but this does not necessarily mean that the animal is constantly feeling unwell or has clinical manifestations, such as diarrhea; this only means that the dog may get sick again in the future. This is especially likely in cases where the owner does not adhere to the prescribed regimen, or (more likely) stops treatment when the dog feels better. However, many diseases can be successfully treated, allowing the animal to live a full life with minimal inconvenience and discomfort, which must be convincingly proven to the owner!

C) What will be the cost of treatment/diagnosis?
The cost of treatment varies greatly depending on the diagnosis. As veterinary medicine develops, following progress in humane medicine, it becomes possible to successfully treat many animal diseases that were considered incurable just a few years ago. However, the issue may come down to money, especially since many diseases of the digestive system are chronic and can recur after stopping treatment or reducing the dose. It is best to give the owner an accurate cost estimate (both for the initial examination and possible subsequent procedures) as early as possible so that he can plan his budget for the animal's treatment or find out about the possibility of cheaper treatment before an expensive regimen is prescribed.

D) Is long-term medication use dangerous for my dog?
Owners often wonder if their animals need lifelong treatment. All drugs licensed for veterinary use have been approved only after extensive testing for safety and effectiveness. Even drugs not licensed for veterinary use, such as many medications, have been shown to be safe for animals. However, it is very important to notify the owner of the possible side effects of any drug offered by the veterinarian (especially long-term use), and to reassure him that regular examinations of the animal (if necessary in combination with laboratory tests) will help to recognize any problems associated with taking medication, and keep them to a minimum. This will help to achieve agreement with the owner - an animal admitted to the clinic with a relapse of the disease due to the owner stopping treatment due to his belief in side effects can be very disappointing. It is necessary to draw the owner's attention to the fact that for chronic gastrointestinal disorders, treatment is unlikely to be more harmful than the disease itself!

E) How serious are the measures that I, as the owner, will have to take to treat the dog?
Usually, treatment of diseases of the digestive system does not require significant changes in the lifestyle of both the dog and the owner, so it is necessary to explain to the latter that the likelihood of problems in the future will be less if he is ready to take an active part in the treatment. Long-term treatment for gastrointestinal disorders is often limited to medicated foods, eliminating treats, or giving the correct dose of medication at the same time. In some cases, where the owner's commitment to compliance seems questionable to the extent that it may interfere with the success of treatment, it is necessary to take some time to discuss the treatment regimen with him and explain possible obstacles and ways to solve them before starting the chosen course.

F) Can I give my dog ​​with inflammatory bowel disease other foods in addition to the recommended diet?
This is a complex pathology. Treatment options can vary greatly depending on the exact diagnosis and cause, but generally, if a food is helping your dog cope with the problem, it's best to play it safe and not change it. The varied diet that humans enjoy is not as important to animals; For many of them, the fact that they are fed is important, and not what they are fed. Thus, the owner must resist the temptation to give the animal something new “just for variety.” This is especially important for animals with enterocolitis; it is necessary to explain that new food can provoke a relapse of the disease in clinical form and before giving it, the owner should consult a veterinarian. But it would still be better to strictly adhere to the recommended diet for the animal and not give any treats or other foods.

G) Are natural foods better than prepared foods?
Dietetics is a complex science. Pet food manufacturers invest huge amounts of money in research to create optimal diets for dogs and cats; The answer to this question will also depend on the animal. For a working breed, the best diet is different than for a small lap dog. In addition, the prescription depends on whether the disease is amenable to diet therapy; in this case, a ready-made balanced diet will most likely be more effective, since homemade food is probably not balanced in all vitamins, minerals and nutrients. If the reaction to home-prepared food was better than to ready-made medicinal food, pathology of the digestive system would be much less common.

I) Can you remove lymphoma from my dog?
Lymphoma is a malignant tumor of lymphoid tissue that is part of the organs of the lymphatic system. This is the main system of the body, which consists of communicating lymphatic vessels and lymph nodes that pass through the entire body of the animal and, therefore, can serve as pathways for the spread of malignant cells throughout the body. Thus, even if the affected lymph node on a dog's paw is removed, the tumor cells have most likely already spread throughout the body, although this may not be apparent. In such situations, drug treatment is much better, such as chemotherapy, which can often successfully treat such tumors.

J) Why didn't my previous vet diagnose this?
This question is often asked by owners referred to the clinic by another veterinarian or wanting a second opinion. It is important to understand that diagnosing the disease at an early stage and finding out what the problem is is often difficult or even impossible. The tumor may not have been large enough to be seen on X-rays, or the initial blood tests did not reveal any abnormalities. It is also possible that the second doctor has better diagnostic equipment or is a specialist in a particular field, so it was easier for him to make a diagnosis, while general practitioners may not be familiar enough with any of the rare diseases. Of course, special knowledge and/or good diagnostic equipment are the two main reasons when, in difficult cases, animals are redirected to specialized specialists, for example, gastroenterologists.

K) I'm afraid of chemotherapy
Many owners are afraid of the word "chemotherapy" because they know - or think they know - about chemotherapy in human medicine and its severe side effects. Generally, anticancer drugs have fewer side effects in dogs, partly because they are used medically in maximum doses to kill tumors. The situation with animals is a little different. Veterinarians primarily strive to achieve remission while maintaining a good quality of life for the animal and minimal harmful effects. In most cases, chemotherapy drugs can significantly improve the quality of life of animals and prolong their life without problems such as hair loss or bone marrow suppression; this must be explained to the owner when discussing possible treatment regimens for neoplasms. However, it is necessary to be aware of the effectiveness and possible complications of these drugs and use them with caution, both for the welfare of the animal and the person; It is important to regularly monitor the animal's condition and never take chemotherapy lightly.

L) Will my dog ​​survive?
It can sometimes be difficult to give an accurate prognosis in the early stages of the disease or in cases where the diagnosis is tentative and not definitive. The outcome of the disease depends on a number of factors. It is better to explain to the owner that with some diseases of the digestive system, it can be difficult or even impossible to predict how the animal will feel in 6 weeks, months or years. However, most owners would appreciate it if the veterinarian provided an estimate, even as an approximate percentage of likely outcomes, or alerted them to possible mishaps or problems.

M) My dog ​​is constipated - what should I do?
Constipation, by definition, is a condition in which intestinal motility slows down so much that stool becomes dry and hard. This does not apply if the dog does not defecate every day from time to time. However, if constipation becomes chronic in the absence of other clinical signs, it is recommended to enrich the animal's diet with dietary fiber, ensure the required level of daily physical activity and reduce body weight if it is excess. However, in certain cases treatment may be required:
For painful bowel movements
When there is blood in the stool or blood discharge after bowel movements
For sudden constipation without any reason
For tenesmus (the urge to defecate)
In such cases, diagnostic studies to determine the etiology of the disease, especially colonoscopy, are warranted.

N) Is it possible to give bones to a dog?
Some owners believe that the bones do not pose any danger to the dog and give them for several years without any serious problems. Even if the dog has digested them normally over a long period, there is always the possibility of unpredictable complications: for example, fragments of bone or cartilage may become lodged in the esophagus, leading to dysphagia, requiring immediate and complex endoscopic or surgical removal.
Excess bones in the diet should be avoided as this can lead to problems with bowel movements due to partially digested fragments. Sometimes the stool becomes so hard that it cannot pass naturally and must be removed from the rectum under general anesthesia. It is safe to give only very large bones that the dog cannot chew and swallow.

2. The most common questions from veterinarians

A) Is surgery the last resort when studying animals with diseases of the digestive system? / Is laparotomy performed too often?
For many general practitioners who do not have access to sophisticated diagnostic equipment, such as endoscopy or ultrasound, the method of diagnostic laparotomy seems attractive. Although invasive in nature, it provides an excellent opportunity to examine the abdominal organs and possibly make a definitive diagnosis and treatment, as well as take samples for histological examination of the organs. However, it is important to note that this method is not useful for diagnosing many diseases, such as motility or absorption disorders, and if not used wisely, is a poor substitute for more elegant and less invasive methods. Ideally, before performing an operation, the doctor should have a good idea of ​​what he expects to find, and always perform it methodically competently and accurately. In addition, it should be noted that even with a normal macroscopic picture of the organ, a biopsy should always be taken, for example:
For diarrhea, you need to take 3 small tissue samples (duodenum, jejunum and ileum), plus a lymph node (if enlarged), plus the liver.
In case of vomiting, along with the above, it is necessary to take a biopsy from the stomach and pancreas. Full-thickness samples of colon tissue should be taken only if there are severe signs of damage.

Q) How common is irritable bowel syndrome and inflammatory bowel disease in dogs? What is the most effective way to treat the latter?
Veterinarians and owners alike often confuse irritable bowel syndrome and inflammatory bowel disease. The term “irritable bowel syndrome” comes from humanistic medicine and is believed to be caused by various types of stress; it may present with periodic bouts of diarrhea without any signs of intestinal damage. Inflammatory bowel disease is a collective term for various infiltrative diseases of the small intestine. It is important to emphasize: this is just a description and not a definitive diagnosis. If inflammatory bowel disease is suspected, it is advisable to try to find out what is causing the chronic bowel inflammation by taking a biopsy. Inflammatory bowel disease is generally believed to be much more common in dogs than initially thought; however, one should not label every case as “inflammatory bowel disease” without further investigation. There is no right or wrong treatment for this condition; it depends on various factors, such as the dog's response to initial treatment (particularly diet or corticosteroids), the owner's ability to comply with treatment, the severity of the disease, and the presence of complications.

C) How informative is a cytological examination of the rectum?
Cytological examination of the rectum is a simple, but not widely used method for studying animals with diseases of the digestive system; During a rectal examination, the doctor may scrape off some cells from the epithelial lining of the intestines with a finger, make a smear, and stain it with an appropriate dye for microscopic examination. Although in many cases no abnormalities are detected, large numbers of neutrophils or lymphocytes can provide valuable information and help suggest a diagnosis; however, a more thorough biopsy may be required for a definitive diagnosis.

E) What blood tests are the most informative?
Biochemical and general blood tests can provide valuable information when examining an animal with pathology of the digestive organs; in particular, it helps to exclude or confirm a general disease. Determination of serum electrolytes is invaluable in acute cases, especially when fluid resuscitation is necessary (Figure 3). Indications for more specific studies are determined by medical history, results of clinical examination and other diagnostic studies. It is clear that tests for diseases such as exocrine pancreatic insufficiency and bacterial overgrowth are specific and are not a necessary part of the initial examination in every case. In addition, it should be emphasized that the results of blood tests should be interpreted taking into account each specific case and a good knowledge of normal values.

F) How informative is x-ray for diseases of the gastrointestinal tract? Has barium x-ray retained its value to this day?
Conventional x-rays are very informative for diagnosing certain diseases of the digestive system. This non-invasive method is useful for diagnosing foreign bodies in the gastrointestinal tract, although a normal x-ray does not exclude the presence of a radiolucent foreign body. Traditionally, X-rays with contrast in combination with plain films have been used to solve this problem. X-ray with contrast has retained its importance, since other methods, such as endoscopy, do not guarantee the detection of a foreign body or pathology outside the lumen of the gastrointestinal tract. Barium is still very widely used for the study of motility disorders in combination with fluorography. The main disadvantage of this method is that doctors are often not familiar with it and use it incorrectly (inappropriate amount/type of contrast agent), which can prevent the correct diagnosis.

G) How common are exocrine pancreatic insufficiency and bacterial overgrowth in dogs?
Both exocrine pancreatic insufficiency and bacterial overgrowth should be considered as differential diagnoses for chronic diarrhea in dogs, and methods for identifying them should therefore be included in the study. It should be noted that in many cases, excessive growth of microflora manifests itself secondary to other intestinal pathologies, and is not a primary disease; for example, it is believed that exocrine pancreatic insufficiency may be a predisposing factor in some cases. Study results such as folate/cobalamin testing should be interpreted with caution because many cases of chronic diarrhea are multifactorial in nature.

H) How to interpret the results of microbiological culture and sensitivity testing?
It is very tempting to treat any microbiological test result as a diagnosis, consider the isolated bacteria to be the cause of gastrointestinal disease, and prescribe medications according to susceptibility testing. However, this approach may be erroneous, since many of the bacteria isolated during microbiological examination of feces belong to the normal intestinal microflora, so the use of antibiotics can upset its balance and aggravate the animal’s condition (see below). Treatment with appropriate drugs is only justified if an infection is detected, for example, salmonellosis, campylobacteriosis or giardia. If in doubt, contact the laboratory that performed the test; Perhaps the information obtained will help determine whether the isolated microorganisms are of clinical significance.

I) Should the use of antibiotics be limited to cases in which bacteria of clinical significance are cultured?
Many veterinarians tend to overuse antibiotics in the treatment of gastrointestinal diseases, for example, in the mistaken belief that diarrhea in many dogs means a bacterial infection, or because the owner believes that these are the drugs the dog needs. Antibiotics should be avoided as symptomatic treatment; inappropriate antibiotics will not only allow the disease to progress further without the necessary research/treatment, but can also aggravate its course, for example, by causing vomiting or changing the normal composition of the microflora. As a general rule, antibiotics should only be used when there is strong evidence of a beneficial effect on the animal (this, in turn, requires the doctor to make a definitive diagnosis before starting treatment). Exceptions include cases of leukopenia, neutrophilia, or shock, where antibiotics may be used as the drug of choice before a definitive diagnosis is made.

J) After what time should the diagnosis be reconsidered if treatment does not help?
This depends mainly on the presumptive diagnosis; It is very important that the doctor understands the period during which improvement can be expected and, if necessary, consults reference literature or textbooks. The reluctance of the doctor to reconsider the diagnosis after the animal's condition has not improved as expected can aggravate the course of the disease. As a general rule, if the disease is thought to be acute, improvement should occur quickly (and, accordingly, if there is no improvement, the case should be quickly reconsidered), but improvement in the treatment of a chronic disease may take several weeks to occur. With overgrowth of microflora, improvement may occur only after 4 weeks of treatment with antibiotics, and with diseases associated with feeding, it may take up to six weeks to judge the effectiveness of treatment. In all cases where the response to treatment is less than expected, the physician must ensure that the owner has followed the instructions correctly.

Misconceptions of Veterinarians

A) When is a disease considered chronic?
Veterinarians often divide diseases of the digestive system into acute and chronic, since the investigation, diagnoses and treatments can vary significantly depending on this. Any illness lasting more than two to three weeks is considered chronic; however, it is important to remember that diseases often occur in a recurrent form, so the doctor should always check with the owner whether these or similar signs of the disease appeared for the first time or were observed previously. Owners do not always understand that episodes of illness separated by a period of several months, and possibly accompanied by other symptoms, may be associated with ongoing pathology.

Q) Are corticosteroids dangerous for animals?
The widespread and sometimes injudicious use of glucocorticoids in animals and humans over the years has contributed to the generally accepted belief that these drugs are extremely dangerous. There is no doubt that long-term use of corticosteroids can cause serious side effects, but the effectiveness of these drugs justifies their use when necessary. Ideally, the use of corticosteroids should be limited to cases where the diagnosis is certain and should not be used symptomatically. For diseases of the digestive system, if corticosteroids are the drugs of choice, the doctor should use the one most suitable for the given animal, calculate the optimal dose that will have a beneficial effect with the least likelihood of unwanted side effects. By accurately calculating the dosage, administering the drug every other day, and periodically monitoring the animal's condition (combined with appropriate assessment of any side effects of corticosteroids), successful treatment without adverse effects can be ensured.

C) Is it normal for an animal to eat plants? / What is the significance of unusual animal postures?
Regardless of age and breed, dogs are often indiscriminate eaters and swallow a variety of objects: bones, plastic products, stones, rags, etc. Owners even tend to consider it normal for the animal to “clean its stomach” on the street; Therefore, when collecting anamnesis, it should be taken into account that the owner may not mention vomiting, considering it not related to the disease. Eating vegetation (grass or other plants) and even soil too frequently (licking bricks, swallowing stones, etc.) should always be considered pathological, especially if it happens several times a week. In most cases, this behavior indicates pain in the gastrointestinal tract. The same applies to forced postures of animals, which are sometimes the only symptoms of gastrointestinal damage, for example:
The animal begins to sleep in an unusual place or changes the position in which it usually sleeps (for example, lying on its back or, conversely, on its chest, trying to lie on its stomach on a cold surface).
The animal takes atypical poses, for example, “begging” (bent forelimbs, throwing the head back, while the hind limbs remain straight), shows excitement, bites its sides, etc.

In conclusion, it is important to evaluate these clinical signs during the consultation and decide what their diagnostic value is, without jumping to the conclusion that their cause is related to behavior problems.

D) Diagnostic value of vomiting: can the appearance of vomit help in determining the cause of the disease?
Contrary to what can often be found in the literature, the appearance of vomit or the timing of vomiting in relation to feeding does not always allow one to judge the nature of the pathology. There are reliable criteria:
Uncontrollable or sudden vomiting occurring at any time during the day suggests a metabolic disorder, pancreatitis, severe viral illness, obstruction/obstruction, or peritonitis.
The presence of undigested food during vomiting long after feeding indicates a syndrome of delayed evacuation of gastric contents of a functional (gastric paresis) or anatomical (dysfunction of the pylorus, hypertrophic gastropathy, tumor of the proximal part of the pylorus or duodenum, foreign body, etc.) nature, as well as pancreatitis.
Vomiting in the morning on an empty stomach can be caused by the reflux of bile from the duodenum into the stomach, especially in small breeds (Bichon Frize, miniature poodle, Yorkshire terrier, Chihuahua, etc.).
A large volume of vomit is often observed with obstruction/blockage of the gastrointestinal tract or delayed evacuation of gastric contents.

However, there are also many “diagnostic pitfalls”:
Owners may not be able to distinguish between vomiting soon after feeding and late regurgitation (that is, regurgitation some time after feeding), so the doctor takes an incorrect history and orders the wrong diagnostic tests.
Blood in the vomit may indicate a primary disease with a very poor prognosis (usually this occurs with tumor infiltration leading to gastric ulceration). But this symptom is also observed in inflammatory diseases that are completely benign, for example, with chronic lymphoplasmacytic infiltration of the stomach and duodenum.

Some diseases of a tumor nature are accompanied by nonspecific symptoms that manifest themselves late. Consequently, the picture of gastric carcinoma in dogs is rarely pathognomonic: symptoms may include perversion of appetite, profuse salivation (which may be unrelated to the disease) and vomiting not associated with food intake, often containing fresh blood in the early stages of the disease. This lack of specificity complicates diagnosis; Often the final diagnosis is made at a late stage of the disease, when treatment options are very limited and the likely survival time is very short.

Chronic conditions with incomplete obstruction are difficult to identify and may pose a significant diagnostic challenge for the clinician. For example, in some animals, symptoms are observed sporadically, which usually does not raise suspicion of the presence of a foreign body; symptoms may include perverted appetite, vomiting not associated with feeding, intermittent diarrhea of ​​the small intestinal type, and periodic changes in general condition from depressed to normal and vice versa.
It must be emphasized in conclusion that the veterinarian must make every effort to improve the diagnostic approach by defining reliable criteria and proposing the most appropriate sequence of diagnostic methods for each case.

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Postpartum endometritis in a cat

1. Registration(registration)

1. Type of animal (Species) - cat

2. Sex (Sexsus) - cat

3. Age (Aetas) - 5 years

4. Breed (Jenus) - outbred

5. Color - tortoiseshell

6. Body weight (Massa) - 3 kg

8. Owner and his address - Travnikova E.Yu., st. Mashinostroiteley 21, apt. 65

9. Nickname - Dasha

Initial diagnosis(Diagnosisprimaria)

Postpartum endometritis

Final diagnosis(Diagnosisfinalis)

Postpartum endometritis

Outcome of the disease(Exitusmorbid) and date

Partial recovery

2. Anamnesis(ANAMNESIS)

cat endometritis postpartum disease

1. History of the life of a sick animal (ANAMNESIS VITAE):

According to the owner, the animal came into the family as a kitten, lives in an apartment, and in the summer lives in the country. The cat had previously given birth 3 times, no complications were observed and no veterinarian was contacted. Vaccinated and dewormed annually according to plan.

2. History of the present disease (ANAMNESIS MORBI):

According to the owner, the cat's labor lasted about 3 hours, the kittens all survived. (4 kittens were born) after which the cat became inactive, the owners noted her poor health, after the birth brown discharge appeared, this lasted 3 days, the cat was lethargic, ate without appetite. On the 3rd day, the owners turned to the Efa veterinary clinic for help.

3. Examination of the animal upon admission(statuspraesens)

Temperature: 39.3C

Pulse: 127 beats/min

Breathing: 27 bpm

1. General condition:

Average build; nutrition is good; body position in space is natural, sitting; lively temperament, good disposition.

2. Leather and its derivatives. In non-pigmented areas, the skin is pale pink. Humidity is normal. The hair is uniform, smooth and shiny. The hair is short, elastic, and holds well in the skin. Subcutaneous tissue is moderately expressed and evenly distributed. The skin is elastic.

3. The visible mucous membranes of the eyes are pale pink, intact, moderately moist. The nasal and oral cavities are pale pink, intact, moderately moist. The vaginal mucosa is bright pink, intact, and moist.

4. Muscles and bones. The muscles and bones of the skeleton are well developed, symmetrical, and consistent with the appearance. Muscle tone is moderate.

5. Joints are symmetrical and mobile.

6. Cardiovascular system.

Inspection of the cardiac area and palpation of the heart area:

When examining the chest, hair vibrations are visible in the area of ​​the heartbeat. The cardiac impulse is apical, localized, and well palpated. Warm, pain, and tactile sensations are preserved.

Auscultation of the heart: the sounds are clear, rhythmic, loud.

7. Respiratory system. The mucous membrane of the nasal cavity is pigmented, intact, and moderately moist. The paranasal sinuses are painless upon percussion and palpation. Examination of the larynx: the local temperature to the touch above the larynx is moderately warm, painless on palpation. Examination of the trachea: local temperature is moderately warm to the touch, painless on palpation, integrity is preserved. When auscultating the trachea, tracheal breathing is heard. The chest is anatomically correct in shape, breathing through the nose is free, 27 respiratory movements per minute. On palpation and percussion, the chest is painless. When auscultating the lungs, a vesicular noise is heard.

8. Digestive system. Oral cavity: the mucous membrane of the oral cavity in non-pigmented areas is pale pink, intact, moderately moist. The tongue is pink, moist, whole. Teeth with a yellowish coating. The bite is correct. Complete closure of the mouth and lips. Saliva is clear and liquid in moderate quantities. The pharynx and esophagus are painless on palpation. The abdomen is symmetrical, pain and tactile sensitivity are preserved, soft and painless on palpation. During auscultation, gurgling, iridescent periodic noises are heard in the area of ​​the small and large intestines.

9. Urinary system. On palpation, the kidneys are painless and bean-shaped.

10. Female genitals. The visible mucous membrane of the vagina is hyperemic, moist, and purulent-hemorrhagic mucus is released from the vagina. The mammary glands are developed evenly, in accordance with the species. The nipples are pale pink, cone-shaped, about 3 mm long. The skin around the nipples is clean and painless.

11. Nervous system. General condition is satisfactory. The bones of the skull are symmetrical, the spine is straight, the local temperature in the area of ​​the skull and spinal column is moderately warm, pain and tactile sensitivity are preserved. Motor ability is preserved. Movements are coordinated. Sense organs without visible disturbances. The placement of the limbs is anatomically correct.

4 . Study of local process (Status praesens localis)

1. Vaginal examination - no instrumental examination was performed

2. Rectal examination - not performed

5 . Special and labORAThorical research(EXPLORATIONESSPECIALSETLABORATORIALS)

Not carried out.

6. Diagnosis(Diagnosis)

Based on clinical studies and medical history, the diagnosis was: postpartum endometritis.

7 . Treatment plan(PLANUMCURATIONIS)

Theoretical part

Anatomical and pathological certificate. The female genital organs are usually divided into internal and external.

Internal genital organs. These include the ovaries, fallopian tubes, uterus and vagina.

The ovaries (Ovaria, Oophoron) are the primary paired sex gland that performs reproductive and hormonal functions. The ovaries are ovoid in shape, somewhat flattened laterally, reaching a diameter of approximately 1 cm. During heat, the luteal phase of the sexual cycle and during pregnancy, their shape can be grape-shaped.

The ovaries are located in the abdominal cavity behind and below the kidneys in the open ovarian bursa. The wall of the latter is formed by the mesentery of the fallopian tubes and is translucent (does not contain fatty deposits). Its lower edge does not form adhesions with surrounding tissues and is therefore easily removed from the surface of the ovary. Using its own ligament, the ovary is connected to the apex of the corresponding uterine horn, and is attached to the lumbar vertebrae by means of an accessory (suspensory) ligament. The accessory ovarian ligaments in cats are quite long and elastic, contain blood vessels, are practically devoid of fat and generally provide good operational access to the ovaries.

Externally, the ovary is covered with a single-layer cubic epithelium, under which there is a well-developed fibrous (albuginine) membrane. The ovarian parenchyma is represented by the medulla and cortex. The medulla consists of connective tissue, blood vessels and nerves and is localized inside the cortex. The connective tissue base of the cortex contains the follicular apparatus of the ovary (primary, secondary and tertiary follicles) and the corpus luteum.

Primary follicles, or primordial, resting, are a 1st order oocyte surrounded by a single layer of follicular cells. Secondary follicles, or growing ones, are 1st order oocytes surrounded by two or more layers of follicular cells. At this stage of folliculogenesis, the egg actively grows and becomes covered with a transparent membrane. Tertiary follicles, or vesicular, cavity, graafian, contain a micro- or macroscopic cavity filled with follicular fluid. Their wall is lined from the inside with multilayered follicular epithelium, and on the outside - by the inner and outer layers of the connective tissue membrane (teca interna et externa). The cells of the follicular epithelium form an egg-bearing tubercle, in the center of which the 1st order oocyte is located. Tertiary follicles produce estrogenic hormones. The hormonal activity of graafian follicles depends on the degree of their maturity. The most endocrine-active ones are preovulatory follicles that have entered the final stage of their development. Their number can range from 1 to 8 or more. Shortly before ovulation they reach 2-3.5 mm in diameter. The fate of mature follicles can be different and depends on the presence or absence of sexual intercourse. When mating with a cat, the follicles ovulate (open and release an egg along with the flow of follicular fluid) and transform into the corpus luteum. In the absence of sexual intercourse, preovulatory follicles do not ovulate and after the end of sexual heat they become atretic (dissolve).

The corpus luteum is an endocrine gland of temporary secretion. Cells of the corpus luteum (luteocytes) produce progesterone, a hormone necessary to maintain pregnancy. There are corpora lutea of ​​the reproductive cycle and pregnancy. In cats, the corpus luteum of the reproductive cycle is formed after sterile intercourse or after injection of drugs with LH (lutropin) or LH-releasing activity into females during the period of estrus.

In structure and hormonal activity, the corpus luteum of the reproductive cycle corresponds to the corpus luteum of pregnancy and differs from the latter only in that it functions for a shorter period of time: on average 42 days, while the corpus luteum of pregnancy is 63-65 days.

The fallopian tubes (Tuba uterina, Salpinx), or oviducts, fallopian tubes, are a paired organ in the form of a convoluted tube extending from the apical part of each horn of the uterus. The fallopian tubes are located in their own mesentery, formed by the internal layer of the broad uterine ligament. Their opposite end opens into the cavity of the ovarian bursa; the wall consists of mucous, muscular and serous membranes. The mucous membrane is folded, its epithelium is single-layer cylindrical and is represented by secretory and ciliated cells. Sperm mature in the fallopian tubes (capacitation), the egg is fertilized and the embryo develops to the stage of a 16-cell blastomere. Germ cells and embryos are transported to the uterus due to vibrations of the cilia of epithelial cells and contraction of smooth muscle fibers of the organ wall. The contractile activity of the muscular lining of the fallopian tubes is stimulated by estrogens and suppressed by progesterone.

The uterus (Uterus, Histera, Metra) in cats consists of a cervix, body and two horns. The cervix and body of the uterus are short, the horns are long and serve as a receptacle for the fruit, diverging at an acute angle, giving the uterus the shape of a slingshot. The size of the uterine horns in cats depends on the age and physiological state of the body (stage of puberty, stage of pregnancy). For example, during the period of anestrus, the uterine horns are straight, reaching a length of 7-8 cm, a diameter of 0.3-0.4 cm; during the period of sexual heat they become longer, more convoluted and increase in diameter to 0.5-0.7 cm.

The wall of the uterus is built from three membranes: the outer - serous (perimetry), the middle - muscular (myometrium) and the inner - mucous (endometrium). The muscular layer is represented by longitudinal and circular layers, between which there is a layer rich in blood vessels and nerves. The contractile activity of the body myometrium and uterine horns is stimulated by estrogens and suppressed by progesterone. The structure of the mucous membrane of the body and the horns of the uterus is quite complex. It is covered with a single-layer columnar epithelium; in its thickness there are numerous tubular glands, the ducts of which open into the uterine cavity. These glands produce the so-called royal jelly, which is necessary to nourish the embryo. The endometrium, like the myometrium, serves as a target tissue for sex hormones. Estrogens enhance the vascularization of the endometrium and stimulate the growth of endometrial glands. Progesterone causes branching of the tubular glands and stimulates the production of royal jelly.

During pregnancy in cats, as well as in other placental animals, a placenta is formed from the mucous membrane of the uterus and the choroid of the fetus, which in its macroscopic structure belongs to the zonal (zonal) type, and in its microscopic structure - to the endotheliochorionic type. During childbirth, only the baby part of the placenta falls off.

The cervix (Cervix uteri) is short, without clear boundaries with the body of the uterus and vagina; has a narrow channel, a thick wall with a well-developed muscle layer. The cervix acts as a sphincter of the uterus. Full opening of her canal is noted during childbirth, partial opening - during periods of estrus, sexual heat and postpartum. The opening of the cervix during childbirth is stimulated by estrogens and relaxin; during estrus - only estrogenic hormones. The epithelium of the mucous membrane of the cervix is ​​single-layered, cylindrical and is represented mainly by secretory cells that produce a mucous secretion with bactericidal and bacteriostatic properties. Unlike many other animals, the mucous membrane of the cervix in cats contains tubular glands.

The uterus is located in the abdominal cavity and is supported by wide and round uterine ligaments. The broad ligaments of the uterus are double sheets of peritoneum extending from the lesser curvature of the horns, the lateral surface of the body, the cervix and the cranial part of the vagina to the lateral walls of the pelvis. The round ligaments of the uterus in the form of cords extend from the top of the uterine horns and are directed to the internal opening of the inguinal canal.

The vagina, or vagina, is a thin-walled elastic tube that extends from the cervix to the opening of the urethra (urethra). It is located in the pelvic cavity and serves as an organ of copulation and the birth canal. The inside of the vaginal wall is lined with a mucous membrane, devoid of glands and covered with stratified squamous epithelium. Under the influence of estrogens during the period of proestrus and especially estrus (sexual heat), the number of layers of epithelial cells increases, the surface cells become keratinized, lose their nucleus, and keratin accumulates in their cytoplasm. The second membrane of the vagina is represented by two layers of muscles: longitudinal and circular (transverse). The cranial part of the vaginal tube is externally covered with a serous (peritoneal) membrane, the rest is covered with loose connective tissue, which, together with pararectal tissue, ensures fixation of the vagina and rectum in the pelvic cavity.

External genitalia. These include the vestibule of the vagina, labia and clitoris.

The vestibule of the vagina (Vestibulum vaginae) serves as the urogenital canal. Its mucous membrane is covered with stratified squamous epithelium and accordingly performs a protective function. In the thickness of the mucous membrane there are paired vestibular glands that produce a mucin-like secretion during the period of sexual heat. The muscular layer is well developed. The border between the vagina and its vestibule is the opening of the urethra.

The hymen (Hymen) in cats is poorly developed or absent. The vestibule of the vagina passes caudally into the genital fissure (Rima pudendi), bounded by the labia vulvae, or vulva, genital loop. The upper corner of the vulva is rounded, the lower is pointed. In the lower corner of the genital slit there is the clitoris (Clitoris), a homologue of the penis. The clitoris consists of fibrous, adipose and erectile tissues, is rich in sensory nerve endings, and does not contain the genital bone.

Treatment for vaginal inflammation depends on the cause of its occurrence and the severity of the process. In mild cases, you can limit yourself to washing the vagina with herbal decoctions. If there is excessive purulent or bloody discharge, systemic treatment with antibiotics, immune drugs, and local disinfectant solutions is required. If the endocrine cause of vaginitis is determined, hormonal levels are corrected. Pyometra is treated surgically.

In this animal, the cat's owners refused surgical intervention; the following scheme was used for its treatment:

Gamavit is a complex preparation that contains B vitamins, as well as amino acids, which are necessary to maintain immunity. The drug increases the body's resistance.

Mastomethrin - contains homeopathic components indicated for inflammatory diseases and functional disorders of the reproductive organs and mammary gland of females.

Enroxil - Enrofloxacin, which is part of Enroxil, belongs to the group of fluoroquinolones and has a wide spectrum of antibacterial action, is active against gram-positive and gram-negative microorganisms, including Escherichia, Protea, Salmonella, Pasteurella, Staphylococcus, Klebsiella, Pseudomonas, Bordetella, Campylobacter, Corynebacterium , clostridium and mycoplasma. Enrofloxacin is quickly absorbed from the gastrointestinal tract and penetrates all organs and tissues of the body. The maximum concentration of the drug in the blood is achieved 1.0-1.5 hours after its administration and is maintained at a therapeutic level for 24 hours. Enrofloxacin is excreted from the body mainly unchanged in urine and bile. The drug has low toxicity for warm-blooded animals. Treatment of animals with infections of the respiratory system, gastrointestinal tract and genitourinary system, septicemia, colibacillosis, salmonellosis, streptococcosis, bacterial and enzootic pneumonia, atrophic rhinitis, MMA syndrome and other diseases whose pathogens are sensitive to enrofloxacin.

Calcium borgluconate - has a desensitizing, antitoxic and anti-inflammatory effect; increases the level of ionized calcium in the blood, stimulates metabolism, and enhances the contraction of the heart muscle.

Ovariovit - prescribed for hormonal disorders in the area of ​​the female reproductive organs. It is effective for ovarian diseases, eliminates hormonal dysfunction (caused by insufficiency of ovarian and pituitary gland function) and restores hormonal balance in the body. Has the following effect:

1. Quickly restores ovarian function, triggers follicle growth and development mechanisms,

2. Restores and regulates the function of the hypothalamic-pituitary system,

3. Eliminates mental disorders due to hormonal imbalances (for example, false pregnancy)

8 . Analysis of medical history materials

1. Determination of the essence of the disease and its economic significance.

Endometritis is a disease that is caused by an inflammatory process in the surface layer of the endometrium, the inner mucous membrane of the uterine body.

Traditionally, acute and chronic types of endometriosis are distinguished.

Endomyometritis is an inflammatory process localized in deeper tissues (basal layer of the endometrium, myometrium).

Endometritis is inflammation of the uterine mucosa. It occurs after childbirth, abortion, and can also develop when intrauterine diagnostic techniques are violated. 80 out of 100 cases of endometritis are associated with cesarean section.

Endometritis is a polymicrobial disease that is caused by opportunistic bacteria, mycoplasmas, chlamydia and viruses. The main causative agents of endometritis are opportunistic aerobic and anaerobic bacteria that make up the normal microflora of a woman’s lower genital tract. Currently, the leading place in the etiology of the disease is occupied by a mixed viral-bacterial infection.

This is a sluggish inflammation of the mucous membrane of the body and the horns of the uterus. Mostly dogs that have reached the age of 7-8 years are affected, cats - starting from the age of 5.

Gonorrheal endometritis is damage to the uterine mucosa (endometrium) by the causative agent of gonorrhea. The infection enters the uterine cavity from the vagina through the cervix. The peculiarity of gonorrheal endometritis is that in severe cases, inflammation from the mucous membrane passes to the muscular layer of the uterus, which contributes to the occurrence of uterine ruptures during pregnancy.

The main ways of spreading infection in endometritis are:

ascending, which is associated with the presence of opportunistic microorganisms living in the vagina;

hematogenous;

lymphogenous;

intraamnial, associated with the introduction of instrumental research methods into obstetric practice (amnioscopy, amniocentesis, cordocentesis).

A significant role in the occurrence and course of the infectious process in the postpartum period belongs to a decrease in immunological reactivity. It has been established that even healthy people experience a partial weakening of immunity in the early stages of the postpartum period.

Symptoms The disease occurs 15-45 days after the next emptying. The most characteristic sign is the flow of watery, cloudy (with catarrhal endometritis) or mucopurulent, gray-brown (with purulent-catarrhal endometritis) exudate through the genital slit. The animal is slightly depressed, less mobile, appetite is impaired; loss of fatness is noted. A vaginal examination reveals hyperemia and swelling of the mucous membranes of the anterior part of the vagina and the vaginal part of the cervix, the application of exudate on them, and a slightly open cervical canal. Through the abdominal wall, you can feel the slightly enlarged, unevenly tuberous (or sausage-shaped) horns of the uterus.

For the purpose of differential diagnosis, smears-imprints of the contents of the uterine cavity are examined. The cytological picture is characterized by a large number of acidophilic-stained epithelial cells, dead leukocytes of the neutrophil group and microorganisms.

Pathological picture. The uterine vessels are injected, the wall of the horns is unevenly thickened, the mucous membrane is congestively hyperemic, edematous, dull (due to the death and rejection of the integumentary epithelium), part of the uterine glands has turned into retention cysts ranging in size from millet to wheat grains.

2. Etiology

Chronic endometritis is often a continuation of acute postpartum endometritis. However, the inflammatory process often occurs after the end of the postpartum period due to the entry of pathogenic microorganisms into the uterus through the cervical canal or by way. transition of the inflammatory process from other organs.

The occurrence and development of the disease is facilitated by an imbalance of sex steroids (estrogens, progesterone) with various lesions of the ovaries; this, in turn, disrupts the mechanism of local protective reactions. This is confirmed by the fact that endometritis is usually preceded by a discharge with certain abnormalities or the use of sex steroids to normalize it.

3. Pathogenesis

Fever, general malaise, pain in the lower abdomen, liquid pus-like leucorrhoea. The chronic course is accompanied by hardening of the uterus, menstrual cycle disorders, and miscarriage.

Complications: Without timely treatment for endometritis, the infection can spread to the fallopian tubes or deeper layers of the uterus, which can subsequently cause infertility, sepsis, or even death. Endometritis often leads to pyometra, so affected cats have to be excluded from breeding. If endometritis is suspected or this diagnosis is confirmed by biopsy and bacterial culture of valuable cats, you can try to urgently mate them simultaneously with the use of broad-spectrum antibiotics.

4. Clinical picture and diagnosis.

The main symptoms of the disease are manifested by depression of the general condition, decreased food excitability, stiffness of movements, vomiting, the animal lies more, loses weight, has difficulty getting up, and polyuria (polydipsia) is noted.

5. Treatment

Endometritis is an inflammation of the uterus, which primarily affects its mucous membrane. The primary cause of endometritis in cats is infection of the organ cavity under the influence of various microflora (staphylococci, streptococci, Proteus, Escherichia coli, Clepsiella, Pseudomonas aeruginosa, pathogenic fungi) during childbirth.

According to our observations, this disease in cats manifested itself 3-5 days after birth. The clinical picture of the disease was characterized by general weakness, lethargy, decreased appetite, thirst, increased body temperature to the upper limit of normal (39.5 °C) and 0.5-1 °C above normal. Sick cats refused to feed kittens.

9 . Epicrisis (Epicrisis)

The date of admission of the animal was April 14, 2013, the diagnosis was made based on a clinical examination and anamnesis of postpartum endometritis.

The treatment was successful, the animal’s health improved, and clinical signs of postpartum endometritis were not observed. The prognosis at the time of discharge of the animal is favorable. The animal must be kept in a dry and warm room, fed with high-quality feed according to the instructions on the package.

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In most cats, vomiting occurs as a result of gastrointestinal pathology. The main causes of vomiting are listed in Table 1.

Vomiting in cats can be acute or chronic.. Diagnostic and therapeutic approaches for the two forms of vomiting differ.
At acute vomiting in a cat Most often, simple symptomatic supportive treatment is required, whereas for chronic vomiting- carrying out specific diagnostic methods before prescribing appropriate therapy. Some healthy cats have a tendency to vomit, in which it is physiological in nature.

Initial approach
A general outline of the examination of a patient with chronic vomiting is shown in Figure 1. It includes the collection of medical history and a thorough general physical examination of the patient.

Figure 1. Logical approach to diagnosing the causes of chronic vomiting in cats.

Anamnesis
When collecting medical history data, you need to pay attention to the following:

• How long does vomiting last?
• How often is it observed;
• What are the characteristics of vomit: color, consistency, presence of mucus, blood, bile, hair, grass;
• Is the occurrence of vomiting related to food intake?
• How fast does the animal eat?
• Other symptoms of the disorder: restlessness, pacing, watery eyes, salivation;
• What is the animal's appetite?
• Have similar episodes been observed before, as well as exacerbations and remissions.

Table 1. Causes of vomiting in cats:

Diseases of the abdominal organs

Systemic and metabolic diseases

• Uremia
• Drug or drug poisoning (eg, acetaminophen, tetracyclines, digoxin)
• Ketosis
• Dirofilariasis
• Hyperthyroidism

General physical examination for vomiting in a cat:

• General impression and appearance of the animal
• Condition (body weight, coat condition)
• Vital signs (body temperature, pulse, respiratory rate)
• Condition of the mucous membrane (pale, swollen, icteric)
• Condition of the oral cavity (pay attention to the sublingual space and frenulum)
• Careful palpation of the abdominal cavity (presence of stagnant masses, thickness of the small intestine, liver boundaries, presence of lymphadenopathy, tenderness, effusions into the abdominal cavity).

Anamnesis data and the results of a general physical examination allow us to identify the causes of the disease (Table 1).

With pancreatitis, vomiting in cats is observed in approximately 15% of cases. This pathology is usually characterized by anorexia. With inflammatory liver diseases or lipidosis, vomiting is observed in 50% of sick cats.

Optimal examination of the animal:

• Clinical and biochemical blood tests.
• Study of liver function (determination of bile acids) in case of impaired activity of liver enzymes in the blood.
• Diagnostic tests for the presence of FeLV and FIV.
• Determination of T4-thyroxine in cases of suspected hyperthyroidism.
• X-ray examination of the abdominal and thoracic cavities (in case of breathing problems).
• Ultrasound examination of the abdominal cavity. Particular attention should be paid to local deviations and the thickness of the walls of the small intestine should be determined. Thorough examination of the liver and pancreas.
• Endoscopic examination and biopsy of the mucous membrane of the stomach and intestines.
• Testing bowel function for diarrhea or malnutrition.
• If blood test results indicate liver disease, a biopsy of the organ should be done.
• If stagnant masses or other injuries are detected in the abdominal cavity, an exploratory laparotomy is performed. Be sure to obtain biopsies at the same time.

Therapeutic approaches
The nature of treatment depends on the cause of vomiting. Pyloric obstruction is rare in cats, but requires surgical intervention. After the necessary supportive therapy, foreign bodies are surgically removed from the stomach and intestines. Some of them can be removed by endoscopy (Figures 2 and 3).

Figure 2. Removal of hairballs from a cat using endoscopy. Hairballs of this size often form in the stomach when its motility is impaired. The animal suffered from severe inflammation of the stomach and small intestine.

Figure 3. Removing a foreign body from a cat's stomach using an endoscope.

The nature of treatment for tumors in the gastrointestinal tract depends on their type. Adenocarcinomas of the stomach or intestines should be removed surgically.
These tumors grow relatively slowly in cats, and after surgery the animals usually live quite a long time.

Intestinal lymphoma is treatable with chemotherapy. The accumulation of hairballs in the stomach is usually associated with impaired motility of this organ and inflammation of the large intestine. After removing hairballs (surgically or endoscopically), a course of treatment for intestinal inflammation should be carried out.

Inflammation of the colon is the most common cause of chronic vomiting in cats. Prednisone is used for treatment (1-2 mg/kg body weight 2 times a day for 2-3 weeks). Over the next 2 weeks, the dose of the drug can be gradually reduced by 50%. then administer prednisone every other day.

For severe forms of inflammation of the large intestine, azathioprine is used (0.3 mg/kg body weight every day or every other day).
When using this drug daily, it is necessary to monitor the number of white blood cells in the cat's blood. Sometimes animals require long-term immunosuppressive therapy. In particularly severe cases of the disease, aggressive therapy using cyclosporine or chlorambucil is used. Some cats with severe intestinal inflammation respond well to parenteral corticosteroids. To feed sick animals, it is recommended to use dietary rations that do not contain proteins previously consumed by the animal.

Dietary therapy is especially effective if vomiting is accompanied by diarrhea.

Vomiting is a common manifestation of liver disease in cats.. For liver lipidosis, enteral nutrition is usually used through gastrostomy or nasoesophageal tubes. Cholangiohepatitis is treated with prednisone and antibiotics such as enrofloxacin and metronidazole. A synthetic analogue of bile acids, ursodeoxycholic acid, has a good choleretic and anti-inflammatory effect.

To treat liver disease, cats also benefit from supplementing with antioxidants (vitamin E and S-adenosyl-methionine).

Conclusion
In severe forms of inflammatory bowel disease, cats require long-term immunosuppressive therapy.
If the results of the endoscopic examination do not coincide with the existing symptoms, it is recommended to perform an exploratory laparotomy while simultaneously obtaining biopsies of the examined organs.

Professor S. F. Burrows BVetMed, PhD, MRCVS
Department of Clinical Small Animal Veterinary Medicine, Florida State University, USA

(according to the book of inpatients).

1. Type of animal: cat: color and characteristics: red.

age: 4 years, nickname Barsik.

breed: outbred.

fatness: average.

2. Who owns: Severin A.A., living at the address: Minsk district, Smolevichi, st. Mayskaya, 45.

3. Date of admission to the clinic 08.08.2008.

4. Diagnosis (initial): limited acute eczema.

5. The final diagnosis: limited acute eczema.

6. Complications: none.

7. Outcome: the animal in a state of clinical recovery was transferred to the owner for further treatment.

Anamnesisvitae:

The number of animals in the apartment on the day of the examination is one; the animal is kept in the premises of a 3-room wooden house located in Smolevichi, st. Mayskaya, 45.

The animal's feeding diet is similar to the owner's feeding diet - it includes meat, milk, sour cream, vegetables, and root vegetables.

Special food for cats is not included in the animal’s diet; mineral and vitamin supplements are not used.

The animal is kept for catching mice.

Drinking - plenty.

Cat food does not come into contact with pesticides and fertilizers.

The cat is not purebred, a gift from relatives.

There is no disinfection of the premises where the cat is located.

The room is maintained at normal room temperature.

The animal goes for walks at will, and the cat leaves the house periodically.

There are no other pets on the premises.

According to the owner, there are quite a large number of mouse-like rodents in the room.

Vitamins, macro- and microelements were not administered to the animal.

The animal was not subjected to any vaccinations, therapeutic and prophylactic treatments, or dewormings.

Anamnesis morbi:

The disease in the cat was first noticed by the owner on August 6, 2008.

According to the owner, at that time he noticed the following signs:

The animal's appetite is not very good, red, hot, painless itchy spots appeared on the skin in the area of ​​the shoulder blade on both sides, disappearing under finger pressure, the hair in the area of ​​the shoulder blade is poorly held. After 2 days, red, hot, itchy nodules and blisters appeared on the skin.

The supposed source of the disease is insufficiently balanced and high-quality feeding of the cat, which caused the occurrence of eczema.

At the time the animal was admitted to the clinic, the clinical signs were as follows:

The animal's appetite is not very good, the animal is slightly depressed.

On the skin in the area of ​​the shoulder blade on both sides there are red, hot, painless itchy spots about 3 by 4 cm, which disappear under finger pressure, hair in the area of ​​the shoulder blade is poorly held, and there are red, hot, itchy nodules and blisters on the skin.

The animal actively combs spots and knots.

The cat responds to scratching the spots with calmness. Itching and pain in the area of ​​nodules and blisters is somewhat greater than in the area of ​​spots.

The lesions and the skin near them are covered with cloudy exudate.

Before admission to the clinic, no medical care was provided to the animal.

Epizootological and sanitary condition:

The city of Smolevichi is free from major infectious and invasive diseases of cats.

G.p. Smolevichi is unfavorable for trichophytosis and microsporia.

The sanitary condition of the animal's living conditions is satisfactory, the state of feeding is not sufficiently satisfactory.