Duodenoscopic appraisal of duodenal ulcer in dogs

Aim: To assess the usefulness of duodenoscopy in the diagnosis of duodenal ulcers in dogs. Materials and Methods: Sick dogs with chronic gastrointestinal problems were physically examined and samples were collected for haematology, biochemistry and faecal examination. Duodenal biopsies, duodenal contents and brush cytology were obtained via duodenoscopy. Results: Seven duodenal ulcers cases were recorded, higher incidences was recorded in Labrador retriever, 2-4 years of aged male dogs. Significantly decreased Hb (9.10 ± 0.25 g/dl), RBCs (4.39 ± 0.19 mill/cu.mm) and albumin (2.343b ± 0.13 g/dl) level were noticed. Hyperaemia with ulceration of duodenal mucosa was observed. Conclusion: Duodenoscopy is very much useful for detection of duodenal ulceration and provided a sensitive technique for early diagnosis of mucosal lesions and ulceration.


Introduction
way of identifying the abnormalities of proximal small intestinal mucosa including mucosal irregularities, A chronic small intestinal disorder of dog is the distortion, ulceration, neoplasia, inflammation and major contributor to canine gastrointestinal disorders.other mucosal disorders of the duodenum [5].The majority of small intestinal disorders are occurring Duodensocopy is also useful for obtaining mucosal in the duodenum such as ulcer, inflammatory bowel biopsy and duodenal juice for routine histopathodisease (IBD) and small intestinal bacterial overgrowth logical and bacteriological studies [6].The aim of the (SIBO) [1].Factors like ulcerogenic drugs, stress study was to assess the usefulness of duodenoscopy in factors, neurological disease, entrogastric reflux, renal the diagnosis of duodenal ulcer in dogs.disease, hepatic disease, mucosal ischemia, primary gastroduodenal neoplasia, mastrocytoma and gastrinoma Materials and Methods were associated with development of gastroduodenal The study has been conducted in clinical cases ulceration and erosions [2].Duodenal ulcers are difficult and no such experimental model has been created / to identify clinically because of the non-specific symptoms.
used in this study.The endoscopic procedure and They may or may not be identifiable through routine collection of biopsy, cytology and duodenal contents radiographic, ultrasonographic or laboratory evaluation were done aseptically following standard procedure as methods, because many diseases of duodenum primarily per CPCSEA norms.involve the mucosal surface [3].
The study was conducted at the Department of Endoscopic examination of the upper gastro-Veterinary Clinical Medicine, Ethics and Jurisprudence, intestinal tract has been used increasingly as a Madras Veterinary College Teaching Hospital, Chennai.diagnostic tool in small animal practice.Use of this Apparently healthy dogs submitted for routine clinical procedure has led to an early diagnosis of chronic examinations were randomly selected to obtain gastrointestinal disease and better understanding of normal data for the parameters under study.Dogs with their pathophysiology [4].Duodenoscopy is an efficient clinical signs persistent/ chronic intermittent vomiting, analysed by using Independent sample test [14].diarrhoea, haematemesis and melena (for more than

Results and Discussion
three days) suggestive of gastrointestinal disease were physically examined and samples taken for Total number of dogs brought to Madras Veterinary hematology, biochemistory and fecal examination.College Teaching Hospital irrespective of nature of Duodenal biopsies, duodenal contents and brush diseases were 22,240 during the course of the study cytology were obtained via gastroduodenoscopy.
(two semesters).3610 (16.8 %) dogs had gastro Duodenoscopic study was conducted with Video intestinal disorders and 7 cases (0.19 %) had duodenal endoscope, Karl Storz type No. 60914 PKS ulcers.In the present study male dogs had more (Germany), with an outer diameter of 9.8 mm, incidence and most of the duodenal ulcers were found biopsies channel diameter of 2.8 mm and endoscopic in 2-4 years of age.There was no apparent sex images were captured digitally by using the software predilection in duodenal ulcer [15].Breed wise of IMIMO.Preparation and restraining of the patient Labrador Retrievers (57 %) followed by mongrels was done as suggested by Zoran [3] and Tams [7].Four (29%) and Boxer (14%).Breeds commonly affected to six representative biopsy samples were taken by with duodenal ulcer were mixed breeds [15], Labrador using pinch biopsy forceps [8] and samples were Retriever, Rottweiler and Dobermann [16].processed for histopathological examination as per All the seven dogs showed vomiting as a Sancho et al. [9] and interpretation as per Day et al. [10].
predominant clinical sign followed by anorexia Brush cytology smears were collected by cytology (57%), weight loss and abdominal pain (43% each), brushes enclosed in a plastic protective sheath and the lethargy and haematemesis (28 %each).Diarrhoea, smear stained with Giemsa.About 0.25 ml to1.0 ml of dehydration anaemia, melena, smell in faeces and duodenal contents was collected in a sterile test tube previous treatment of Non-steroid anti-inflammatory by a sterile plastic catheter inserted through an drugs (14 % each) were also recorded in duodenal endoscope operating channel [11].The collected ulcers.These findings were similar to the observations duodenal contents (0.1ml) were serially diluted up to of various authors who documented clinical signs such 6 10 for aerobic culture and 0.1ml of each dilution as vomiting, weight loss and abdominal pain15, transferred to nutrient agar plates and incubated at haematemesis, anaemia and abdominal pain [17].Leib o and Matz [18] stated that these signs were because of 35 C for 24 hrs and bacterial colonies were counted gastrointestinal haemorrhage due to ulceration.with colony counter [12].The collected duodenal The mean ± SE of haematology, serum contents were cultured for isolation and quantification biochemical and bacterial count values are given in of bacteria.Faecal samples were also collected and Table -1.Highly significant decrease in haemoglobin subjected to gross and microscopic examination as per and red blood cell count were noticed.Normocytic Broussard [13].The data obtained in this study were [15] stated that endoscopy was a useful and reliable adjunct to hypoalbuminia in duodenal ulcer might be due to histologic examination of biopsy specimen in gastro blood loss, ulceration and malabsorption of nutrients.intestinal tract disease.There were no significant The endoscopic appearance of duodenum in changes in bacterial counts.In faecal examination no healthy animals showed velvetty or slightly grainy, parasites were seen.
smooth and uniform pink color.Endoscopic findings Conclusion of duodenal ulcer showed hyperemic mucosa and duodenal ulceration in all the seven dogs (Fig. 1 & 1a), Duodenal ulcer can be successfully managed if followed by 29 % of the dogs had friable duodenal diagnosed and treated earlier.Duodenoscopy is very mucosa.Dowdle et al. [20] opined that duodenoscopy much useful for detecting duodenal ulceration and was more accurate for detecting sub clinical provided a sensitive technique for early diagnosis of gastroduodenal ulceration and provided a sensitive mucosal lesions and ulceration.technique for early diagnosis of mucosal lesions and

Table - 1. Mean ± SE of Haemato-biochemical and Bacterial colony counts in healthy and diseased animals normochromic
anaemia observed in dogs with animals and vacuolar degeneration of epithelial cells duodenal ulcer could be due to short term gastro with mononuclear cell (MNC) infiltration in duodenal intestinal blood loss[19].ulcer.Jergen et al.[23] reported that cytologic A significant decrease in the albumin value examination of exfoliative specimen obtained during (Table-1) was noticed.Jergens et al. b