Pathology of the gi tract
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Pathology of the GI tract. Tim Morgan DVM, PhD. Alimentary Canal. Continuous tube “Tube within a tube” Mouth (oral end) Anus (aboral end) Function Acquire nutrients Digest nutrients Absorb nutrients Expel non-digestible portion. Prehension. Fairly complex series of events

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Pathology of the gi tract

Pathology of the GI tract

Tim Morgan DVM, PhD


Alimentary canal

Alimentary Canal

  • Continuous tube

    • “Tube within a tube”

    • Mouth (oral end)

    • Anus (aboral end)

  • Function

    • Acquire nutrients

    • Digest nutrients

    • Absorb nutrients

    • Expel non-digestible portion


Prehension

Prehension

  • Fairly complex series of events

  • Hunger centers in the brain

  • Higher senses to locate food

  • Lips – especially in herbivores

  • Tongue

  • Teeth

  • Esophagus


Digestion

Digestion

  • Mouth

    • Grinding

    • Salivary enzymes – starches

  • Stomach

    • Mixing vat

    • Acidification (monogastrics)

    • Fermentation (ruminates)


Digestion1

Digestion

  • Small intestine

    • Pancreas

      • Enzymes

      • Buffer

    • Bile

      • Emulsifies lipids


Digestion2

Digestion

  • Carbohydrates

    • Polysaccharides

    • Enzymatically broken down to monosaccharides

      • Hydrolysis


Digestion3

Digestion

  • Proteins

    • Polypeptides

    • Enzymatically broken down to amino acids

      • Hydrolysis


Digestion4

Digestion

  • Fats

    • Triglycerides – 3 fatty acids on a glyceride backbone

    • Enzymatically broken down to monoglycerides and fatty acids

      • Hydrolysis


Absorption

Absorption

Ingested fluid

1.5 liters

Secreted fluid

~7 liters

Total fluid

8-9 liters

Not having to pass 9 liters of fecal fluid a day

Priceless


Absorption1

Absorption

  • Mostly takes place in the small intestine

  • Dependant upon surface area

    • Mucosal folds  3x increase

    • Villi  10x increase

    • Microvilli (brush border)  20x increase

    • Total 600x increase in surface area

      • ~ area of a tennis court


Absorption2

Absorption

  • Carbs (monosaccharides)

    • Active transport

  • Proteins (amino acids)

    • Active transport

  • Fats (monoglycerides and fatty acids)

    • Micelles diffuse into cell membrane

    • Reconstituted to tryglycerides in SER

    • Dumped into lacteals as chylomicrons

      • Travel thru lymphatics and are dumped into the caudal vena cava


Dilemma

Dilemma

  • Nutrients are composed of same materials as the GI tract

    • Enzymes/mechanisms that breakdown nutrients can also affect GI tract

  • Selective absorption

    • Nutrients kept in

    • Toxic compounds kept out

  • Most contaminated environment

    • Up to 10 12 organisms per gram


Defense mechanisms

Defense mechanisms

  • Washing

    • Saliva, mucous, fluid secretion

      • Flushes bacteria etc. away before they get a chance to adhere

      • Keeps cells moist and happy

      • Prevents buildup of harmful materials

      • Buffers


Defense mechanisms1

Defense mechanisms

  • Enzyme control

    • Secreted in an inactive form

      • Protein cleavage

      • pH

      • Cofactors

    • Fuse or pin


Defense mechanisms2

Defense mechanisms

  • Cell turnover

    • Stratified squamous epithelial cells in upper GI

    • Mucosal epithelial cells in lower GI

      • Cells shed from villous tips

      • Crypts form proliferative pool

      • Cells become more mature as they move up the villi

      • Average turnover time ~ 3 days

    • Damage rapidly repaired by sliding of mucosal epithelial cells


Defense mechanisms3

Defense mechanisms

  • Nutrient sequestration

    • Fe sequestration

      • Fe required for bacterial growth

      • Fe binding proteins

      • Bacterial response: hemolytic toxins

  • Competition

    • Large numbers of normal intestinal flora/fauna

      • Limits niches available for invading organisms

      • Initial colonization very difficult to “unseat”


Defense mechanisms4

Defense mechanisms

  • Innate immunity

    • Paneth cells

      • Antimicrobial peptides

      • Defensins

      • Cathelicidins

      • Toll-like receptors

    • Neutrophils

    • Macrophages


Defense mechanisms5

Defense mechanisms

  • Acquired immunity

    • Separate (sort of) immune system

    • GALT

    • Secretory IgA

      • Resistant to degradation

      • Blocks uptake of toxic compounds

    • Very tight control

      • Always bacteria present

        • Pathogenicity may depend on number or organisms or other specific circumstances/conditions

      • Always protein antigens present

      • Under-responsive  infection

      • Over-responsive  chronic inflammation

        • IBD, Crohns, ulcerative colitis, PLE, amyloidosis


Summary

Summary

  • Contradictory function

    • Absorb nutrients/exclude toxins

    • Digest nutrients, don’t digest self

    • React to pathogens, don’t react too much

  • Effective defense mechanims

    • Constant washing

    • Rapid turnover

    • Competition

    • Environmental monitoring

    • Environmental control


Clinical signs

Clinical Signs

  • Ptyalism (drooling)

  • Regurgitation – undigested food

  • Vomiting – partially digested food

  • Diarrhea

  • Tenesmus

  • Dehydration – not specific for GI disease

  • Abdominal pain (colic)

  • Electrolyte abnormalities

  • Melena – digested blood

  • Hematochezia – bloody feces

  • Cholemesis/hematemesis


Oral cavity

Oral Cavity

  • Developmental

  • Traumatic

  • Toxic

  • Inflammatory

    • Infectious

      • Viral, bacterial, fungal

    • Autoimmune

  • Neoplastic


Developmental

Developmental

  • Cleft palate (palatoschesis)

    • Failure of maxillary bones to fuse

    • Variably sized defect in hard palate

    • May interfere with nursing, feeding, chronic nasal infections


Developmental1

Developmental

  • Cleft lip/hare lip

  • Brachygnathia

    • Superior – shortened maxillae

    • Inferior – shortened mandibles

  • Prognathism


Developmental2

Developmental

  • Dentition

    • Heterotopic polydontia

      • Common in horses

    • Anomalous dentition

    • Missing or retained deciduous teeth

    • Odontodystrophy

      • Enamal hypoplasia

        • Secondary to distemper virus infection in dogs

      • Fluorine toxicity, malnutrition, vitamin A deficiency


Traumatic

Traumatic

  • Fractures

  • Dislocations

  • Foreign bodies

    • Bones –dogs

    • Linear – cats


Inflammatory

Inflammatory

  • Stomatitis – general term

    • Glossitis, gingivitis, pulpitis

  • Infectious diseases of the oral cavity

    • Viral

    • Bacterial

    • Fungal


Viral stomatitis vesicular stomatitides

Viral Stomatitis: vesicular stomatitides

  • Vesicle = small circumscribed elevation of the epidermis/MM containing a serous liquid

  • Vesicular stomatitides – cannot be differentiated grossly – call state or federal vet immediately

    • Foot and mouth disease (Picornavirus) – ruminants, pigs – not in US

    • Vesicular stomatitis (Rhabdovirus) – ruminants, pigs, horses – in US

    • Vesicular exanthema (Calicivirus) – pigs – not in US

    • Swine vesicular disease (Enterovirus) – pigs – not in US


Pathology of the gi tract

Oral Cavity – Vesicular Stomatitides

Ruptured vesicle, sheep, FMD

Ruptured vesicles, snout, pig, FMD


Foot mouth bovine

Foot & Mouth, bovine


Pathology of the gi tract

Vesicular Stomatitides - VS

Ruptured vesicles, coronary band, horse, VS

Vesicle on teat of cow, VS


Viral stomatitis erosive ulcerative stomatitides

Viral Stomatitis: Erosive & Ulcerative Stomatitides

  • Erosion – loss of superficial layers of epidermis or mucosal membrane

  • Ulceration – loss of all layers of epidermis or mucosal membrane

    • Penetrates the basement membrane

  • Viral erosive & ulcerative stomatitides

    • BVD-MD

    • Malignant Catarrhal Fever

    • Rinderpest

    • Bluetongue

    • Equine Viral Rhinotracheitis

    • Felince Calicivirus


Bvd mucosal disease

BVD Mucosal Disease

  • Bovine viral diarrhea virus (BVDV)

    • Highly contageous

    • Rarely fatal

    • Fever, diarrhea, mucosal ulcerations, leukopenia

    • Multiple serotypes

      • Cytopathic

      • Non-cytopathic


Bvd mucosal disease1

BVD Mucosal Disease

  • “Normal” disease course

    • Immunocompetent animal

    • Subclinical or mild disease

  • Mucosal disease course

    • Infection during 4th month of gestation

      • Abortion, fetal mummification, develpmental anomalies (cerebellar hypoplasia)

      • Surviving animals

        • Persistent infection

        • Immunotolerant to virus


Bvd mucosal disease2

BVD Mucosal Disease

  • Persistently infected, immunotolerant animal

    • “Super-infected” with a cytopathic strain

    • Unable to mount effective immune response

    • Severe ongoing infection

      • Near 100% fatality rate

      • Anorexia, bloody diarrhea, fever, mucoid nasal discharge, ulcerative lesions throughout GI tract


Bvd mucosal disease3

BVD Mucosal Disease


Malignant catarrhal fever mcf

Malignant Catarrhal Fever (MCF)

  • Caused by several different gamma herpes viruses

  • Cattle, deer, most other ungulates

    • Ovine herpes virus 2

      • North America

    • Alcelaphine herpes virus 1

      • Endemic in African wildebeest

      • Causes disease in zoo ruminants and cattle in Africa


Malignant catarrhal fever mcf1

Malignant Catarrhal Fever (MCF)

  • Gross lesion is ulceration of mucosal surfaces, edema, mucopurulent nasal discharge, lymphadenopathy

  • Microscopic lesions

    • Lymphoid proliferation

    • Fibrinoid vascular necrosis


Malignant catarrhal fever mcf2

Malignant Catarrhal Fever (MCF)


Feline calicivirus

Feline Calicivirus

  • RNA virus

    • High rates of mutation

    • Variable virulence

  • Persistent infections

    • Minimal clinical signs

    • Virus shed in saliva, nasal secretions, feces

  • Clinical signs

    • Ulcers on tongue and foot pads

    • Conjunctival edema, edema of face & limbs

    • Pneumonia in kittens


Viral stomatitis papular stomatitides

Viral Stomatitis: Papular Stomatitides

  • Papule – small, circumscribed, superficial, solid elevation of skin or mucous membrane

  • Pustule – visible collection of pus within or beneath the epidermis or mucous membrane

  • Macule – discolored circular area on skin or mucous membrane that is not elevated above the surface. “Smoking remains of a papule or pustule”


Bovine papular stomatitis

Bovine Papular Stomatitis

  • Young cattle 1 month to 2 years old

    • Parapox virus

    • Epidermal proliferation

    • Papules, nodules, macules

      • Tongue, gingiva, palate, esophagus, rumen, omasum

      • Eosinophilic intracytoplasmic inclusions


Bovine papular stomatitis1

Bovine Papular Stomatitis


Contagious ecthyma orf

Contagious Ecthyma (Orf)

  • Sheep and lambs, goats, rarely man

  • Parapox virus

  • Epidermal proliferation

    • Lips, mouth, teats

  • Weight loss/poor growth due to pain

  • Self limiting


Contagious ecthyma orf1

Contagious Ecthyma (Orf)


Papillomatosis

Papillomatosis

  • Papovavirus

    • Bovine papilloma virus

    • Canine papilloma virus

  • Papillomas (warts) on mucosa of mouth, esophagus, rumen (cattle)

  • Usually self-limiting lesions


Papillomatosis1

Papillomatosis


Papillomatosis2

Papillomatosis


Papillomatosis3

Papillomatosis


Bacterial stomatitides

Bacterial Stomatitides

  • Associated with trauma

    • Feeding, iatragenic, foreign body

  • Opportunistic normal bacterial inhabitant

    • Actinobacillus, actinomyces, fusobacterium


Necrotizing stomatitides

Necrotizing stomatitides

  • Oral necrobacillosis

    • Calf diphtheria

    • Necrotic membrane

    • Foul breath, anorexia, fever


Wooden tongue

Wooden tongue

  • Actinobacillus lignieresii

  • Often associated w/lingual groove

  • Chronic infection

    • Severe fibrosis

    • “Wooden tongue”


Wooden tongue1

Wooden tongue

  • Pyogranulomas

  • Club-shaped bacterial colonies

    • “Splendora-Hepli”

    • “sulfur granules”


Periodontal disease

Periodontal Disease

  • Periodontal tissues

    • Gingiva, cementum, periodontal ligament, alveolar supporting bone

  • >85% of dogs and cats 4 years and older are affected

  • Pathogenesis

    • Placque formation

      • Mucin, slouphed epithelial cells, aerobic gram + bacteria

    • Mineral salts deposite on plaque

      • Tartar/calculus

    • Tartar  gingival irritation

      • pH change

        • Pathogenic gram – aerobic & anaerobic bacteria proliferate beneath gingiva


Periodontal disease1

Periodontal Disease

  • Destructive inflammation forms gingival crevice

  • Sub-gingival bacteria continue to proliferate

    • Deeper pockets of destruction

      • Gingival stroma

      • Periodontal ligament

      • Alveolar bone

  • Tooth loss, bacteremia, osteomyelitis, bacterial endocarditis


Pathology of the gi tract

Stages of Periodontal Disease

Stage I – gingivitis, gingival edema

Stage III – stroma loss, deep pockets

Stage II – gingivitis, pockets

Stage IV – bone loss, loose teeth


Inflammatory non infectious

Inflammatory, non-infectious

  • Inappropriate immune/inflammatory response

    • “Self” antigen – autoimmune

    • Unknown antigen – immune mediated

  • Generally a problem of small animals (Dogs and Cats)


Auto immune

Auto-immune

  • Considered dermatologic diseases

  • Frequently affect muco-cutaneous junctions

  • Pemphigus vulgaris

    • Severe, acute or chronic vesicular/bullous disease of humans, dogs, cats

    • Flaccid bullae & erosions of muco-cutaneous junctions, oral mucosa, skin to lesser extent

    • Clinical signs

      • Salivation, halitosis, mucosal erosion/ulceration

      • Severity varies greatly

    • Histology

      • Basal cells remain attached to basement membrane

        • “tomb stone” appearance

      • Destruction of acanthocytes (acantholysis)

      • Lichenoid infiltration of lymphocytes and plasma cells

      • Scattered neutrophils and eosinophils


Auto immune1

Auto-immune

  • Bullous pemphigoid

    • Grossly impossible to tell from pemphigus vulgaris

    • Histology

      • Subepidermal blister formation

      • No acantholysis

    • Reported in humans, dogs, horses, possible cases in cats


Immune mediated

Immune Mediated

  • Feline plasma cell gingivitis

    • Raised, erythematous, proliferative lesion

    • Glossopalatine arch

    • Periodontal gingiva


Immune mediated1

Immune Mediated

  • Feline plasma cell gingivitis

    • Histologic appearance

      • Gingival hyperplasia

      • Gingival ulceration

      • Large numbers of plasma cells

        • Russell bodies

      • Secondary suppurative inflammation over areas of ulceration

    • Increased serum gamma globulin


Immune mediated2

Immune Mediated

  • Eosinophilic ulcer (Rodent ulcer, Eosinophilic granuloma complex)

    • Chronic superficial ulcerative disease of mucosa and mucocutaneous junction

      • Frequently affects upper lip of cats

      • Siberian huskies

    • Affected area is thickened, red, ulcerated


Immune mediated3

Immune Mediated

  • Eosinophilic ulcer

    • Histologic appearance

      • Ulcerated surface

      • Moderate to large numbers of eosinophils with macrophages, lymphocytes, and plasma cells

      • Collagenolysis


Uremic glossitis

Uremic glossitis

  • Relatively common lesion associated with renal failure in dogs and less commonly in cats

  • Clinical signs

    • Cyanotic buccal mucosa

    • Fetid ulceration of tongue

      • Margins of ulcer swollen


Uremic glossitis1

Uremic glossitis

  • Histologic appearance

    • Necrosis of mucosal epithelium with ulceration

    • Vascular necrosis of small arterioles of tongue

  • Ischemic vascular lesion

  • Pathogenesis poorly understood

  • Poor correlation between blood ammonia levels and lesion development


Proliferative and neoplastic oral lesions

Proliferative and neoplastic oral lesions

  • Gingival hyperplasia

    • Non-neoplastic proliferation of gingival tissue

    • Caused by chronic inflammation

      • May be associated with periodontal disease

    • Generalized or localized

    • Brachycephalic breeds


Gingival hyperplasia

Gingival hyperplasia

  • Histologic appearance

    • Mature fibrous connective tissue

    • Hypocellular

    • May have focal areas of ulceration and inflammation


Epuloides

Epuloides

  • Fibromatous epulis

    • Fibrous mass arising from the periodontal ligament

    • Firm, hard, gray to pink

      • Similar in appearance to focal gingival hyperplasia

    • Between teeth or on hard palate near teeth

      • Carnasal teeth in brachycephalic breeds

      • May mechanically displace the teeth

    • Attached to the periosteum

    • Do not invade bone


Epuloides1

Epuloides

  • Fibromatous epulis

    • Histologic appearance

      • Interwoven bundles of fibroblastic tissue

      • More cellular than gingival hyperplasia

      • May have areas of bone production

        • “Ossifying epulis”


Epuloides2

Epuloides

  • Acanthomatous epulis (acanthomatous ameloblastoma)

    • Odontogenic epithelial origin

    • Rough, cauliflower-like lesion

    • Dental arcade of dogs

    • Locally invasive

      • Invades and destroys bone

      • Do NOT metastasize


Epuloides3

Epuloides

  • Acanthomatous epulis

    • Histologic appearance

      • Highly cellular

      • Interconnecting odontogenic epithelial sheets bordered by columnary to cuboidal cells

      • Contain numerous, usually empty, blood vessels


Other tumors of dental origin

Other tumors of dental origin

  • Less common than epuli

  • Ameloblastoma

    • Dental lamina

    • Outer enamel epithelium

    • Odontogenic epithelium

    • May produce dentin or enamel matrix

    • Rare in all species, but less rare in cattle

      • Young cattle


Other tumors of dental origin1

Other tumors of dental origin

  • Complex odontoma

    • Fully differentiated dental components

    • Disorganized, no tooth like structures

    • Young horses

  • Compound odontoma

    • Mass containing numerous tooth-like structures

      • “denticles”

    • Young dogs, cattle, and horses

    • Mandibular or maxillary arch


Oral tumors of non dental origin

Oral tumors of non-dental origin

  • Squamous cell carcinoma

    • Most common oral neoplasm is cats

      • Ventral surface of the tongue, along the frenulum

      • Nodular, red-grey mass

        • Friable

        • Often ulcerated

      • Locally invasive

      • Metastasize to regional lymph nodes

      • Rarely metastasize to lung


Squamous cell carcimona

Squamous cell carcimona

  • 2nd most common oral neoplasm in dogs

    • Usually involves tonsil

    • Small granular plaque  2-3x size of the tonsil

    • Nodular, firm, white, frequently ulcerated

    • Locally invasive

    • Metastasize to regional lymph nodes

    • Frequently met to distant sites, especially lung

      • SCC arising from the gingiva is less likely to met than tonsillar SCC in dogs

  • Horses & cattle

    • Rare, slow growing, very destructive, met to regional lymph nodes


Melanoma

Melanoma

  • Most common oral tumor in dogs

    • Rare in cats and large animals

  • Almost always malignant

    • Most have metastasized by the time of dx

  • More common in males than females

  • More common in pigmented animals

  • No correlation between degree of pigmentation and biologic behaviour

  • Met to lymph nodes, distant organs, especially lungs

  • Median survival time ~ 65 days in untreated animals


Melanoma1

Melanoma

  • Gross appearance

    • Nodular, variably pigmented masses

    • Anywhere in the oral mucosa

    • Invasive and destructive

    • May or may not be ulcerated


Melanoma2

Melanoma


Melanoma3

Melanoma

  • Microscopic appearance

    • Variable

    • Heavily pigmented to amelanotic

    • Cytologically appear as round cells


Melanoma4

Melanoma


Fibrosarcoma

Fibrosarcoma

  • Can occur in all animals, but usually seen in dogs

    • 3rd most common oral tumor of dogs

    • ~ 25% occur in dogs < 5 yrs of age

    • Occur in gums around upper molars and in the cranial ½ of the mandible


Fibrosarcoma1

Fibrosarcoma

  • Gross appearance

    • Nodular to multi-nodulare

    • +/- ulceration

    • Firm

  • Local invasion

  • ~ 35% metastasize to lymph nodes

  • Early pulmonary metastasis


Fibrosarcoma2

Fibrosarcoma

  • Histologic appearance

    • Moderately cellular

      • Streams of fibroblastic cells

    • High mitotic rate

    • Collagenous extra-cellular matrix


Osteosarcoma

Osteosarcoma

  • Bones of the skull or jaw

  • Similar in appearance to fibrosarcoma

  • Bone lysis and proliferation on radiographs


Round cell tumors

Round cell tumors

  • Mast cell tumors

    • Discreet mass

  • Lymphosarcoma

    • Tonsillar

    • Epitheliotrophic

  • Plasma cell tumors

    • Discreet mass

    • Pleomorphic plasma cells


Pathology of the gi tract

Salivary Glands

  • Sialoadenitis = inflammation of salivary gland – uncommon in vet medicine

    • Sialodacryoadenitis (SDA) coronavirus of lab rats

    • Rabies and canine distemper

  • Ranula = cystic distention of duct of sublingual or mandibular glands

    • Occurs on floor of mouth alongside the tongue

    • Cause is unknown

  • Salivary mucocoele (sialocoele) = pseudocyst filled with saliva that causes inflammation with formation of granulation tissue

    • Possible causes include trauma, foreign body or sialolith

  • Sialolith = stone in gland or duct

    • Formed from sloughed gland epithelium that becomes surrounded by mineral

  • Tumors usually derived from glandular/duct epithelium (adenoma, adenocarcinoma)

    • May also see mesenchymal or mixed tumors including osteosarcoma


Salivary ranula

Salivary Ranula


Pathology of the gi tract

Diagnosis of Sialocoele

  • Aspirate mass with large bore needle

    • Thick fluid that resembles mucus

    • Macrophages filled with vacuoles (ingested mucin)

    • May also see hematoidin crystals (from RBC degradation)

  • Rx = surgical drainage and removal of affected salivary gland


Pathology of the gi tract

Salivary gland

Chronic inflammation of mandibular salivary gland secondary to sialocoele in dog

Sialocoele wall composed of granulation tissue


Esophagus

Esophagus

  • Tube

    • Smooth and striated muscle

    • Glands

    • Mucosal epithelium


Esophagus developmental anomalies

Esophagus: developmental anomalies

  • Developmental anomalies of the esophagus are rare

    • Segmental aplasia

    • Esophago-respiratory fistula

    • Esophageal diverticulae

    • Hyperkeratosis/squamous metaplasia


Esophagus traumatic lesions

Esophagus: traumatic lesions

  • Obstruction

    • “choke”

    • Occurs at areas of esophageal narrowing

      • Larynx

      • Thoracic inlet

      • Base of heart

      • Diaphragmatic hiatus

    • Clinical signs

      • Salivation, wretching, regurgitation, dehydration


Esophagus1

Esophagus

  • Complications of choke

    • Esophageal rupture  cellulitis, death

    • Esophageal dilation – mega-esophagus

    • Ulceration with subsequent stricture

      • Common in cattle

      • Hedge apples

    • Aspiration pneumonia


Esophagus2

Esophagus


Pathology of the gi tract

Esophagitis

  • Esophageal biopsy from horse with 2 month history of regurgitation

  • Mucosal ulceration

  • Marked submucosal inflammation

  • Disruption of submucosal glands

  • Outcome could be stricture or aspiration pneumonia


Pathology of the gi tract

Megaesophagus

  • Dilation of esophagus due to insufficient or uncoordinated peristalsis in the mid and cervical esophagus

  • Observed in humans, cattle, horses, cats, dogs and llamas

  • Primary clinical sign is regurgitation after ingestion of solid food

  • May be congenital with onset clinical signs at weaning

    • Persistent right aortic arch (dilation cranial to heart)

    • Idiopathic denervation in several dog breeds and Siamese cats

  • May be acquired later in life secondary to: (dilation cranial to stomach)

    • Myasthenia gravis (autoimmune disease against ach receptors at nm jxn)

    • Autoimmune myositis (inflammation of esophageal wall muscles)

    • Polyneuritis

    • Hypoadrenocorticism

    • Hypothyroidism

    • Polyradiculoneuropathy

    • Toxins such as botulism, lead, OP’s

    • Parasites such as Toxoplasma gondii and Trypanosoma cruzi

    • Idiopathic


Pathology of the gi tract

Megaesophagus

  • Persistent right aortic arch

    • Upper right – normal development of aortic arch (inset shows normal embryonic development of great vessels)

    • Lower right – when embryonic right fourth aortic arch becomes adult aorta, esophageal constriction occurs (inset shows vascular malformation

      • Constricting ring formed by right aortic arch, pulmonary artery, and ductus arteriosus

      • Dilation of esophagus occurs cranial to heart


Megaesophagus

Megaesophagus


Pathology of the gi tract

Megaesophagus

  • Diagnosis

    • Survey and contrast radiography

    • Esophagoscopy

    • T3 and T4 before and after TSH stimulation (R/O hypothyroidism)

    • Cortisol concentrations with dexamethazone suppression (R/O hypoadrenalcorticism)

    • Plasma cholinesterase levels (R/O OP tox)

    • Antiacetylcholine receptor antibody assay (R/O MG)

    • Toxoplasma titer


Pathology of the gi tract

Megaesophagus

Dilated esophagus anterior to stomach


Pathology of the gi tract

Megaesophagus


Pathology of the gi tract

Esophageal Parasitic Disease

  • Spirocerca Lupi of canids

    • Nematodes reach esophageal submucosa after they migrate through the wall of aorta

    • Form granulomas in wall of intrathoracic esophagus, and granuloma opens to esophageal lumen allowing eggs to pass out through feces

    • Associated clinical problems include dysphagia, aortic aneurysms, spondylitis, HPO, and esophageal fibrosarcoma/osteosarcoma

    • Intermediate host is dung beetle

    • Dx = thoracic radiography, fecal exam

    • Rx = ivermectin


Spirocerca lupi

Spirocerca lupi


Pathology of the gi tract

Aortic Nodules and Aneurysms

During the time that parasites are normally in the aorta, or if parasites are arrested in the aorta during migration, they may cause the formation of small nodules or larger, more diffuse granulomas and aneurysms which can rupture leading to fatal extravasation into the abdominal cavity.


Pathology of the gi tract

Epidemiology

The slide illustrates the general distribution of reported Spirocerca sarcoma in the Southeast. Incidence of simple Spirocerca infection would follow a similar distribution. Bailey at Auburn recorded an 8% infection rate in Alabama in a survey between 1951 and 1963, but only 2% from 1963-1970. Georgia surveys show less than 1% of the dogs infected. Bailey considered the feeding of uncooked intestinal tracts of chickens to be a primary source of infection for dogs . Incidence of Spirocerca has decreased in recent years due to better care of dogs, the shift to confinement poultry operations, and reduction of dung beetle numbers by large scale use of agricultural insecticides.


Pathology of the gi tract

Egg of Spirocerca lupi

Note the small size, thick wall and larvae. A whipworm egg is also present. Recovery of eggs is dependent on a patent opening to the lumen of the digestive tract and therefore ova are not consistently found. Spirocerca worms do not live more than a few years and lesions do not always contain worms at necropsy.


Esophagus miscellaneous conditions

Esophagus: Miscellaneous Conditions

  • Idiopathic muscular hypertrophy of distal esophagus

    • Seen in horses, no clinical significance

  • Esophagitis

    • Often result of trauma

    • Secondary bacterial infection

  • Esophageal erosions/ulcers

    • Reflux, trauma, viral disease

      • BVD MD in cattle

  • Papillomas


Ruminant forestomach

Ruminant Forestomach

Normal Anatomy

Rumen papillae

Reticulum epithelial folds

Omasum epithelial folds


Ruminant forestomach1

Ruminant Forestomach

  • Bloat (ruminal tympany)- Overdistention of rumen and reticulum by gases produced during fermentation

    • Primary tympany (legume bloat, frothy bloat)

      • Following diet change, rumen pH decreases to 5-6, foam forms which blocks cardia and causes rumen to distend (seen clinically as distended left paralumbar fossa)

    • Secondary tympany

      • Physical or functional obstruction/stenosis of esophagus leads to eructation failure and gases accumulate in rumen

        • Esophageal foreign body, vagal nerve dysfunction, lymphosarcoma, etc.

  • Foreign bodies

    • Hair balls, plant balls

    • Hardware disease

    • Lead poisoning

  • Rumenitis

    • Lactic acidosis (Grain overload)

    • Bacterial – secondary to acidosis or mechanical injury

    • Mycotic – secondary to acidosis or antibiotic administration

      • Lesions due to infarcts caused by fungal vasculitis

      • Primary fungi are Aspergillus, Mucor, Absidia, etc

  • Miscellaneous

    • Parakeratosis

    • Vagus indigestion


Ruminant forestomach bloat

Ruminant Forestomach - Bloat

  • Post mortem diagnosis often based on observing bloat line which is a line of demarcation between the bloodless distal esophagus and the congested proximal esophagus at thoracic inlet


Ruminant forestomach foreign bodies

Ruminant Forestomach – Foreign Bodies

  • Trichobezoars = hairballs

    • Hair forms nidus

  • Phytobezoars = plant balls


Ruminant forestomach foreign bodies1

Ruminant Forestomach – Foreign Bodies

  • Hardware disease

    • Ingestion of baling wire, nails perforates through wall of reticulum (reticulitis) and enters peritoneal cavity (peritonitis) or pericardial sac (pericarditis)

Hardware disease – fibrinous pericarditis


Rumenitis lactic acidosis

Rumenitis (Lactic Acidosis)

  • Common disease of cattle that consume excessive readily digestible carbohydrates, especially grain (grain overload)

  • Within 2-6 hours, microbial population of rumen changes to gram positive bacteria (Strep bovis) which results in production of lactic acid

  • Rumen pH falls below 5 which destroys protozoa, lactate-using organisms and rumen motility ceases

  • Lactic acid causes chemical rumenitis.

  • Absorption of lactic acid into bloodstream causes lactic acidosis resulting in cardiovascular collapse (shock), renal failure and death

  • If survive, may develop bacterial or mycotic rumenitis in several days, or liver abscesses (necrobacillosis) or laminitis in several weeks

  • Dx = check pH of rumen fluid obtained by stomach tube, examine rumen fluid with microscope ( no protozoa, few gram negative, mostly gram positive bacteria on gram stain)


Grain overload

Grain Overload


Reticulitis rumenitis

Reticulitis/Rumenitis


Rumenitis

Rumenitis


Mycotic rumenitis

Mycotic Rumenitis


Miscellaneous rumen conditions

Miscellaneous Rumen Conditions

  • Ruminal parakeratosis – seen in cattle and sheep fed diets with less than 10% roughage

    • Papillae are enlarged, adhered together and firm

    • Affected papillae contain excessive layers of keratinized epithelial cells, bacteria and food material

    • May alter nutrient absorption, decrease feed efficiency


Miscellaneous rumen conditions1

Miscellaneous Rumen Conditions

  • Vagus Indigestion (chronic indigestion)

    • Seen in cattle and sheep

    • Gradual development of rumenoreticular and abdominal distention

    • Four types recognized based on site of functional obstruction

      • Type I – failure of eructation resulting in free-gas bloat, usually due to inflammatory lesions that involve vagus nerve (hardware disease, pneumonia, etc)

      • Type II – failure of transport from omasum to abomasum via omasal canal, usually due to abscess in wall of reticulum near vagus (hardware disease), or lymphoma or papilloma blockage

      • Type III – abomasal impaction due to feeding of dry coarse roughage with restricted access to water, especially in winter

      • Type IV – poorly characterized partial forestomach obstruction that usually occurs during gestation, may be due to enlarging uterus shifting abomasum to more cranial position

    • Dx – definitive may require exploratory left paralumbar fossa laparotomy and rumenotomy


Stomach and abomasum

Stomach and Abomasum

  • Similar function and response to injury among ruminant abomasum and simple-stomached animals

Normal horse stomach

Histologic appearance


Abomasal disorders

Abomasal Disorders

  • Abomasal displacement (LDA, RDA)

  • Abomasal volvulus

  • Abomasal ulcers

  • Abomasal Impaction

  • Abomasal inflammation (abomasitis)

  • Bovine viral diarrhea and mucosal disease

  • Abomasal parasites

  • Lymphosarcoma


Abomasal displacements

Abomasal Displacements

  • Usually to left side in high producing dairy cattle within one month of parturition

    • Result of abomasal atony with gas distention and displacement upward along left abdominal wall

    • Fundus and greater curvature displaced creating partial obstruction

    • No interference with blood supply but passage of ingesta slowed leading to chronic partial anorexia

    • Also see metabolic alkalosis – related to sequestration of chloride in abomasum (HCL production continues)

    • RDA – occurs infrequently but atony, gas production and displacement occur as in LDA

      • Then have rotation (volvulus) of abomasum on its mesentery resulting in ischemia

      • Rotation is usually in counterclockwise when viewed from rear

      • Leads to complete anorexia, necrosis of abomasal wall, shock


Right displaced abomasum with rotation

Right Displaced Abomasum with Rotation


Abomasal ulcers

Abomasal Ulcers

  • Seen in adult cattle and calves

  • Many etiologic possibilities such as viral disease (BVD, rinderpest, MCF)

  • Nonviral – in dairy cows 6 weeks after parturition (stress, heavy grain feeding?)

  • Nonviral – feedlot cattle on high grain rations

  • Nonviral – hand fed dairy calves on milk replacer that start to eat roughage

  • Nonviral – suckling beef calves on good summer pasture

  • Fungal – secondary to rumen acidosis. Caused by infarcts due to fungal invasion and destruction of small arterioles

  • Ulcers most common along greater curvature

    • Type 1 = erosion/ulcer, no hem

    • Type II = hemorrhagic

    • Type III = perforation/local peritonitis

    • Type IV = perforation with acute diffuse peritonitis


Perforating abomasal ulcer

Perforating Abomasal Ulcer


Dietary abomasal impaction

Seen in cattle and sheep fed poor quality, indigestible roughage during cold weather, can also be sand if on poor quality pasture with sandy soil

See abomasal atony and chronic dilation

Dehydration, anorexia, alkalosis, and progressive starvation

Abomasal emptying defect is an idiopathic condition in Suffolk sheep

Dietary Abomasal Impaction


Abomasal inflammation

Abomasal Inflammation

  • Braxy in sheep and cattle

    • Caused by Clostridium septicum

    • Hemorrhagic abomasitis with submucosal emphysema

    • Bacteria produces exotoxin that leads to toxemia and shock


Bvd md

BVD-MD

  • Pestivirus that has cattle as primary host but most even-toed ungulates are susceptible

  • Two biotypes – noncytopathic and cytopathic (effect in cultured cells)

  • All age cattle are susceptible

  • Persistently infected cattle are natural reservoir – noncytopathic virus transmitted in utero, therefore infected at birth and infection lasts for life

  • Clinical disease and reproductive failure in cattle in contact with persistently infected cattle

  • Acute and chronic MD are highly fatal forms of BVD seen in persistently infected cattle that become infected with cytopathic biotype (from non-CPE mutation, other cattle or MLV vaccine)

  • Acutely, see erosions/ulcers throughout GI tract especially over Peyer’s patches, necrosis of lymphoid tissue, interdigital skin lesions

  • Chronically, see intermittent diarrhea and gradual wasting with lesions similar to acute but less severe

  • Dx = require diagnostic lab support – paired serum samples with 4 fold rise in titer, PCR, virus isolation (submit lymph node, spleen, gut lesions)


Abomasal parasites

Abomasal Parasites

  • Haemonchus contortus – common parasite of sheep and other ruminants

  • Third stage larvae eaten on grass – enter gastric glands – onto surface as adults

  • Feed on blood – serious anemia and hypoproteinemia (seen as submandibular and mesenteric edema)


Haemonchus

Residual damage in abomasal mucosa caused by third stage larvae

There is focal destruction of deep glands and lymphocytic inflammation

Haemonchus


Abomasal parasites1

Ostertagiosis

Sheep and goats = O. circumcincta

Cattle = O. ostertagia

Live as larval stages in gastric glands giving mucosa a rough and thick appearance

Chronic inflammation, mucous cell hyperplasia and lymphoid nodules

Poor weight gain, diarrhea, and hypoproteinemia

Abomasal Parasites


Abomasal lymphosarcoma

Abomasal Lymphosarcoma

  • Lymphosarcoma can be primary, metastatic or multicentric in origin

  • In cattle, often caused by bovine leukemia virus


Horse stomach

Horse Stomach

  • Stomach capacity is only about 2.5 gallons

  • Located on left side of abdomen beneath rib cage

  • Junction of distal esophagus and cardia is one-way valve (in but not out)

    • therefore, horses cannot vomit gastric contents

  • Celiac artery supplies blood to stomach


Stomach colic conditions

Stomach Colic Conditions

  • Gastric dilatation

  • Gastric rupture

  • Gastric impaction

  • Gastric Ulcer Syndrome (adults/foals)

  • Gastric parasites

  • Gastric neoplasia


Gastric dilatation

Gastric Dilatation

  • Caused by overeating fermentable foodstuff producing excessive gas or intestinal obstruction

    • Overeating leads to increase in volatile fatty acids which inhibit gastric emptying

  • Obstruction usually in small intestine and fluid accumulates in stomach

  • Right dorsal displacement of colon around cecum – obstructs duodenal outflow

  • Proximal enteritis-jejunitis leads to gastric fluid buildup


Gastric rupture

Gastric Rupture

  • Stomach rupture is fatal outcome of uncorrected gastric dilatation

  • Tear usually occurs along greater curvature

  • Most (approximately 2/3) occur secondary to mechanical obstruction, ileus or trauma

    • Remaining due to overload or idiopathic causes


Gastric impaction

Gastric Impaction

  • Uncommon cause of colic

  • May be associated with pelleted feeds, persimmon seeds, straw, barley, etc

  • Also associated may be poor dentition, lack or water, rapid eating


Equine gastric ulcer syndrome

Equine Gastric Ulcer Syndrome

  • Currently recognized EGUS in adults >1 year of age, in order of decreasing frequency

    • Primary erosion/ulceration of nonglandular (squamous) mucosa

    • Primary glandular ulcer disease

    • Secondary squamous ulceration

  • Currently recognized syndromes in foals <1 year of age, in order of decreasing frequency

    • Gastroduodenal ulcer disease (GDUD)

    • Primary erosion/ulceration of squamous mucosa

    • NSAID-induced ulcer disease (primary glandular ulcer disease as for adults)


Normal equine stomach fill

Normal Equine Stomach Fill

  • Gastric fill and contents composition in horse allowed free access to forage

  • Fill line is not much above lower esophageal sphincter

  • Coarser contents layer at top and fine particulates filter to bottom

  • Upper, coarser mat is furthest away from acid secreting mucosa and more accessible to swallowed saliva – has higher pH than more liquid contents at bottom

  • Bottom contents adjacent to HCL-producing parietal cells


Normal gastric acid secretion

Normal Gastric Acid Secretion


Equine gastric ulcer syndrome1

Equine Gastric Ulcer Syndrome

  • Erosion and/or ulceration of nonglandular (squamous) mucosa

  • Seen as a primary or secondary condition

  • Seen in adult horses under intensive training, any breed

  • Pathogenesis is poorly understood


Egus proposed pathogenesis

EGUS (proposed pathogenesis)*

  • Exercise in horses causes pH change in proximal part of stomach

  • The more liquid, highly acidic contents in the lower glandular stomach are squeezed up around the more solid contents by increased intra-abdominal pressure (red arrows) due to tensing of abdominal muscles as part of the movement at faster gaits

*Merritt, AAEP, 2003


Primary glandular ulcer disease

Primary Glandular Ulcer Disease

  • Ulceration of glandular mucosa, especially in pyloric region

  • Causes include NSAID toxicity (leads to down regulation of PGE2 production within glandular mucosa)

  • Changes in mucosal blood flow and Helicobacter infection have not been demonstrated


Primary glandular ulcer disease1

Primary Glandular Ulcer Disease

  • Multiple sites of glandular mucosal ulceration (yellow arrows) induced by NSAID toxicity

  • Squamous mucosa (upper right) is free of lesions


Secondary squamous ulceration

Secondary Squamous Ulceration

  • Primary lesion commonly occurs in duodenum (GDUD) of foals – never seen in horses >1 year old

  • In adults may see gastric outflow obstruction caused by duodenal stricture – reflux?

  • In adults may also see secondary to any condition causing glandular ulcerative gastritis (NSAID)


Secondary squamous ulceration1

Endoscopic view of normal pyloric sphincter region (yellow arrow, upper right) in its commonly open state- this allows for reflux of duodenal contents

Endoscopic view of severe inflammation around pyloric canal – yellow arrow indicates mucosal erosion – such lesions can scar and result in stricture that reduces gastric emptying

Secondary Squamous Ulceration


Gastric ulcer

Gastric Ulcer

  • Stomach from adult thoroughbred mare that was unthrifty and partially anorectic

  • There are erosions/ulcers in both the glandular and nonglandular portions of the mucosa


Current syndromes in foals 1 yr of age

Current Syndromes in Foals (< 1 yr of age)

  • Gastroduodenal ulcer disease (GDUD) - sucklings and early weanlings

  • Cause is unknown

  • In early stage of GDUD see roughened duodenal mucosa covered with fibrinous plaque – causes some disruption of gastric emptying with some secondary squamous erosion and ulceration

  • May recover after supportive Rx or develop advanced disease


Advanced gdud in foals

Clinical signs include drooling, teeth grinding, periodic bouts of colic especially after suckling, and weight loss

If signs persist for a week, may indicate stricture of duodenum by inflammation and mechanical obstruction to gastric emptying

Barium meal will be retained longer than 1 hour

Endoscopy will show erosion/ulceration of squamous mucosa of stomach and lower esophagus

Advanced GDUD in foals


Advanced gdud in foals1

Advanced GDUD in Foals

Endoscopic views of reflux esophagitis and squamous gastritis that are commonly seen in foals with chronic GDUD. Lighter islands of tissue in esophagus are remnants of normal mucosa. Broken yellow line in stomach is site of margo plicatus. Severe ulceration has occurred

Post-mortem finding of 2 distinct strictures of duodenum (arrows) which is a serious consequence of GDUD


Primary erosion ulceration of squamous mucosa in foals

Primary Erosion/Ulceration of Squamous Mucosa in Foals

  • May cause unthriftiness and/or mild colic

  • Etiology and pathogenesis are unknown

  • Must always rule out partial obstruction of gastric outflow as after a previously unrecognized GDUD


Stress related gastric ulcers in foals

Stress-Related Gastric Ulcers in Foals

  • Primarily seen in foals suffering from a severe illness or trauma

  • May involve down-regulation of PGE2 due to reduced mucosal blood flow

  • Lesions usually confined to glandular mucosa just adjacent to margo plicatus – may be severe enough to perforate


Gastric parasites

Gastric parasites

  • Gastrophilus spp (horse bots)

    • Larvae of bot flies, adult flies are not parasitic and cannot feed, lay eggs and die

    • Three species (G. intestinalis – lays yellow eggs on hairs of forelimbs; G. haemorrhoidalis – black eggs on hairs of lips; G. nasalis – white eggs on hairs of submaxillary area)

    • Larvae of all three embed in mucosa of mouth before passing to stomach, attach to stomach lining by oral hooks, cause mild gastritis, pass out in feces in 8-10 months


Horse bots

Horse Bots

Large numbers of larvae attached to gastric mucosa

Adult bot fly


Gastric parasites1

Gastric Parasites

  • Habronema (H. muscae, H. microstoma, Draschia megastoma

    • H. microstoma and D. megastoma deposit larvae, but H. muscae lays eggs containing larvae.

    • Larvae ingested by housefly or stablefly maggots which develop in manure

    • Larval forms develop inside the maggot, becoming infective third stage larvae at about time adult fly emerges from pupa

    • Larvae deposited on lips, nostrils and wounds of horses as flies feed – if licked and swallowed, larvae mature in stomach

    • If larvae in wounds not licked and swallowed, they stay in or around wound causing cutaneous habronemiasis

    • Infected flies can also be eaten by horse

    • In stomach, H. muscae and H. microstoma are on mucosal surface under layer of mucus – cause mild catarrhal gastritis

    • In stomach, D. megastoma causes granulomas up to 10 cm in diameter

      • Filled with necrotic debris and worms

      • Covered by epithelium except for small opening for egg passage


Habronema

Habronema

Posterior end of adult Habronema spp worm showing spicule

Cutaneous habronemiasis

Nodule in stomach caused by D. megastoma


Stomach conditions of pigs

Stomach Conditions of Pigs

  • Gastric ulcers

  • Edema disease

  • Parasites


Pig gastric ulcers

Pig Gastric Ulcers

  • Seen in pigs of all ages but most common in confined growing pigs (45-90 kg)

  • Cause unknown but finely ground feed and stress are risk factors

  • Lesions occur at pars esophagea and begin as areas of hyperkeratosis, this erodes and later have ulcer.

  • Pigs can bleed out and produce tarry stool, or be chronically unthrifty


Edema disease

Edema Disease

  • Acute to peracute toxemia caused by several serotypes of E. coli that are able to produce a verotoxin (related to Shigella) now called SLT-IIv (Shiga-like toxin type II variant)

  • Toxin affects capillaries and small arteries leading to edema and ischemia in many organs

  • Usually occurs in young pigs 1-2 weeks after weaning and affects healthiest animals in a group

  • We will talk more about this disease later


Edema disease1

Edema disease

Periocular edema

Submucosal edema in glandular region

Edema in stomach wall


Stomach parasites of pigs

Stomach Parasites of Pigs

  • Hyostrongylus rubidus (red stomach worm)

    • Direct life cycle

    • Seen in grazing pigs

    • Adults are on mucosal surface in film of mucus

    • Larvae are in mucosa and may cause severe hypertrophic gastritis with proliferation of gastric glands


Stomach neoplasia

Stomach Neoplasia

  • Cattle – lymphosarcoma – anywhere in forestomach

    • Usually associated with BLV

    • Squamous cell carcinoma of rumen also seen rarely

  • Horse – squamous cell carcinoma of nonglandular region of stomach

  • Pig – tumors of stomach very rare


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