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Digestive Tract Disorders |
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Gastrointestinal Disorders in the GSD
and Several Other Breeds |
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Esophagus — Congenital
esophageal achalasia is
also known by many other names such as cardiospasm,
mega‑esophagus, dilated esophagus,
and ectasia. The disorder appears to be caused by a
simple autosomal recessive in German Shepherds,
although it is highly variable in expression. While reportedly only about one
percent of the dog population may be involved, mortality rate in pups is fairly
high. Even when PRAA has been ruled out as the cause, I believe the percentage
in German Shepherds is quite a bit higher than the reported one percent.
Correspondents in the late 1990s have given me testimonial comments that they
believe the incidence is on the rise, but this, too, may be more a matter of
greater awareness. This abnormally large and flaccid “food-pipe” between the mouth
and the stomach can be found in adults, but the most heartbreaking and serious
cases are in pups early in the weaning and solid-food stage.
GSDs, Goldens,
and Irish Setters seem most at risk, and if a pup survives to adulthood, the
condition often causes or is associated with other esophagus
problems, peripheral neuropathies, gastric dilation with or without torsion and
especially myasthenia gravis. Even in adults, many are euthanized
or asphyxiate due to progressive malnutrition, aspiration pneumonia, and owner
frustration over the regurgitation. Most adult cases that are presumed to be
acquired have no cause discovered, which leads me to believe it is simply a
milder form of the genetic problem that causes death by starvation in most pups
between 5 and 8 weeks of age. A loss of peristaltic action (that contraction
that squeezes the food downward like a cow being milked) is probably due to a
disorder of the afferent nerves. This is why there is no successful medical,
pharmaceutical, or surgical treatment. There may be a connection with other
nerve disorders, even giant axonal neuropathy, which mimics HD and GSD myelopathy.
Symptoms include
slow or halted growth, weight loss, dehydration, water in the lungs, and
persistent and progressively worse vomiting of food minutes after swallowing.
The disorder usually is detected at or slightly after the commencement of
weaning. As food slightly stretches the esophagus on
the way down, an affected pup's muscles apparently fail to contract enough to
prevent the food bolus from simply staying in a pouch just in front of the
entrance to the stomach. In time, the muscles become weaker and even less able
to squeeze the food ball, and even liquid food remains in a hanging “pelican
pouch” forward of the stomach entrance and below it. As with PRAA, the pup
becomes emaciated and listless, often dying of starvation. In fact, the two
conditions may be indistinguishable without autopsy. The accompanying pedigree
study gives food for thought.
Congenital pyloric
stenosis is a similar disorder but is mostly found in
Boxers and other short‑faced breeds; it is very rare in the German Shepherd. Spasm of the pyloric sphincter in excitable dogs,
especially toys and miniatures, is also uncommon in the Shepherd Dog. There may
be several other causes of esophageal dilation,
affecting various breeds to different extents. However, German Shepherds have
over thirteen times the incidence of esophageal
disorders of all other breeds combined, though PRAA may be part of this
statistic.
Vomiting and gastritis — Vomiting comes easily to dogs.
Grass eating and subsequent vomiting give rise to all sorts of explanations,
the most popular being that the dog was sick and ate the grass to help him
throw up. Actually, excess grass is more likely the reason for the reflex
action. Dogs eat grass because they like the taste of it, just as with the case
of garbage. Gastritis, an inflammation of the stomach lining, can be caused by
the ingestion of too much grass, garbage, or indigestible materials. It can also
be caused by viral or bacterial invasion, but much more common, especially in
pups, is the presence of endoparasites: tapeworms,
roundworms, hookworms, whipworms, and coccidia.
Actually, tapeworms or roundworms can fill up the belly to the extent that they
back up and cause vomiting from sheer bulk. The initial treatment for gastritis
or vomiting may be withholding food and administering Kaopectate
every four hours.
Torsion — Commonly
called bloat, sometimes described as gastric dilation/volvulus,
this is a terrifying and frequently fatal disorder that German Shepherds and
many other deep‑chested dogs experience. A
twisting of the entrance and exit to the stomach traps the food and gas, and as
the stomach swells, the twist is more unlikely to be relieved without
veterinary help. Great strides in surgical treatment have been made, but the
key to reducing the high mortality is still time. Recognize the symptoms and
get the dog to a veterinary surgeon, preferably an emergency or trauma‑oriented
hospital. Simple dilation (swelling due to gas) may not be serious as long as
the dog is able to pass food into the duodenum, but it has been estimated that
80 percent of all dogs that experience simple dilation will someday also have
torsion.
Symptoms of
torsion include a swollen, turgid abdomen; the sluggish action of the dog; his
white, frothy, unsuccessful attempts at vomiting; and perhaps his scratching in
the dirt to make a cool hole in which to lie down. Also, the spleen will feel
like a hard lump. The spleen is normally wrapped around some of the stomach and
therefore splenic torsion accompanies gastric
torsion. When this happens, the return of the blood that flows through the
spleen is shut off causing shock, the “immediate” killer.
The first thing
your vet is likely to do is attempt to push a tube down the throat into the
stomach so the gas pressure can be relieved. If he cannot get past the twisted
part of the alimentary canal, he may opt for immediate surgery so he can untwist
the organs. One emergency veterinary service in the
Follow‑up
surgical techniques are numerous, but the one with the most success in
preventing future torsion is a tube gastrostomy. In
this procedure, a rubber or vinyl tube is put into the stomach through the
abdominal wall, and in a week the stomach wall at that point becomes attached
with scar tissue to the peritoneum and abdominal wall. The tube is then pulled
out. The surgical opening seals off in a few days, and since the stomach is
fused to the abdominal wall, it is prevented from again twisting out of
position. Regular gastroplexy, which is suturing the
stomach to the abdominal cavity, is also widely performed. Because of these and
other techniques, especially the rise of emergency clinics, the mortality rate
among those that make it to the clinic while still alive has plummeted to about
15 percent. Another 15 percent or so die without being seen by the vet first.
Groups of
scientists at many locations have been studying bloat for a long time, partly
with help from such as Morris Animal Foundation, the GSDCA, and many others. So
far, they have identified a number of likely causative factors, including behavioral traits.
Breed susceptibility is pretty obvious, with 25 percent or more of Great
Danes, Saint Bernards, Weimaraners,
and Irish Setters expected to suffer from bloat sometime during their lives.
German Shepherd Dogs, Standard Poodles, Collies, and Gordon Setters are fairly
high on the incidence lists, also. Some of the characteristics seen most often
in dogs that had bloated include some stressful event, even minor, in approximately
the eight hours prior to the incident, a fearful temperament, and consumption
of fairly large quantities of non-food material. The only dogs I’ve had direct
contact with that bloated were of impeccable character, but those may have been
in the minority. Purdue researchers found no pattern in presoaking dry food or not, but a slight correlation
between several smaller meals and less bloat. Others found no relation
to soybean meal in the food, an early target of breeders looking for a primary
cause. Adding vegetables and canned or meat scraps appears to help lower
incidence. Most dogs (60%) bloated not immediately after vigorous exercise soon
after a meal, but in mid- to late evening when resting or sleeping.
There is a
familial element in torsion/volvulus in many, similar
to the way cancer “runs in families”, but most cases don’t give a clue to
hereditary factors. As in “toxic gut syndrome” which is also seen a lot in some
GSD lines, it is almost impossible to tell which came first, the presence of abnormal
bacterial populations and irritated intestinal or stomach linings, or the bloat
itself. Which is cause and which is
effect is not going to be easy or even possible to determine. Some
investigators suspect that breeders may be stuffing their small, young puppies’
stomachs too much, with results that show up only later in life. Work goes on.
Less likely are other types of torsion, but they can
be as life-threatening. Splenic torsion can occur without gastric twisting, and an
even more rare disorder is mesenteric root torsion. The mesentery is the white,
fibrous, web-like or film-like tissue that connects the various sections of
intestines to each other and to the abdominal wall. Blood vessels travel through the mesentery,
and if there is a twisting there, regardless of whether the intestine itself is
closed off, the blood supply can be halted and the intestinal tissue can become
necrotic. Bloody diarrhea, vomiting, abdominal
swelling and/or pain, and shock or general collapse can be symptomatic. It may
be the same as what some call “twisted intestines”. So few dogs survive that it
is impossible to prevent recurrence or conclusively predict whether those are
at greater risk for another attack than any other dog is.
Intussusception — In young pups (and other animals
including humans) the intestine can invaginate (one
part slips inside another). The condition, also
referred to as "telescoping intestines," occurs in adults, too, but
not as frequently. Most common immediate causes include worms, obstruction by
indigestible materials, garbage, or toxic substances. The German Shepherd seems to experience a high incidence of this
disorder and I believe there is a genetic propensity, a familial trait, in
certain bloodlines.
Diarrhea and soft stool — Diarrhea can be a symptom of any
number of disorders from cancer to overeating, but is most often associated
with disease or parasitism of the small intestine. Diarrhea
or loose stool is quite common in the German Shepherd
Dog, even when no physiological disease has been identified. However, since
this is not a normal condition, the owner should make a sincere attempt to find
and attack the cause. Some of the causative factors in true diarrhea
are: pancreatic insufficiency, chemical or mechanical irritation of intestinal
linings, parasites, microorganisms, and a
psychosomatic condition related to the "high‑strung," emotional
make‑up of the German Shepherd Dog. Foods that can cause loose stool
include milk (if suddenly introduced into the diet), liver, fats, and those
with a high‑fiber
content. However, simple overeating is perhaps the most frequent culprit in
adults.
Soft to runny
stools may be an indication of a general inflammation of the stomach and
intestines known as eosinophilic gastroenteritis. It
is treated symptomatically with something to coat the lining, plus perhaps a
steroid and Kaopectate, until the dog "heals
itself." Many veterinarians administer Pepto-Bismol, also. In the case of
young puppies with watery stool or repeated diarrhea,
rush to your veterinary clinic with the pup and the stool samples. Most of the time the cause of diarrhea in
a young puppy is serious, such as parvo or coccidiosis, perhaps with hookworm as well. The
Campylobacter bacteria cause some cases of acute or chronic diarrhea,
and most labs would have no trouble identifying this infection. Generally
watery diarrhea is not an indicator of “campy”.
Erythromycin antibiotic is 90% effective, although resistant strains may be
evolving.
Toxic gut syndrome (TGS) — This disorder has been identified as a
specific syndrome, with some similarities to other disorders such as intestinal
volvulus, which may have been blamed for death when
TGS was the real villain. The German Shepherd Dog has
a higher number of blood cells per unit of blood than do most other breeds,
with 50 to 60 percent compared with 40 to 45 percent. When such a dog becomes
dehydrated, thickened and/or lessened blood supply to the small intestine
increases growth of bacteria that are always present there. These Clostridium
and E. cold bacteria produce such quantities of toxins that the dog is unable
to get rid of them fast enough, and death by poisoning occurs. By the time
owners see symptoms such as discomfort when the abdomen is touched, attempts to
vomit, and excessive salivation, it is probably too late. Prevention may be
accomplished through dietary means (feeding Lactobacillus acidophilus, yogurt,
or cultured buttermilk), or by the same toxoid
vaccine that is given to lambs to prevent Clostridium perfringens
types C and D. As research is done on this recently defined syndrome, more will
become known as to the best treatment.
Other problems — Ulcers have been diagnosed
too frequently in German Shepherds and may be related to pancreatic problems or
other causes: it's difficult to tell, when several conditions exist at once,
whether one is the cause or effect of another. Necrotic bowel syndrome, a
disorder of unknown cause, is diagnosed usually on autopsy, when part of the
intestine is found to be dead and rotting away. This condition may be
synonymous with or overlap intussusception or other
diseases. It takes a small toll, mostly among heavily linebred
German Shepherd Dogs.
Eosinophilic ulcerative colitis — This
syndrome is most common in Cocker Spaniels and German Shepherd Dogs. If your
pup or adult has intermittent to constant diarrhea,
with or without blood, this disease may be the cause. Initial treatment may
include corticosteroids, antibiotics, and antispasmodics to see if the symptoms
can be halted.
Irritable colon — Also known as spastic colon, this disorder with mucus in or
on the surface of soft or frequent stools may be the result of stress. The best
cure is prevention — breed stable temperaments and
build confidence in puppies.
Anal glands — Occasionally,
anal sacs may become infected, and the dog may scoot along on the ground,
rubbing his rump in an effort to relieve the itch. This won't help, but you can
easily "express" these glands. Lift the tail high with almost enough
effort to lift the dog's rear off the table or floor, and very firmly pinch the
sphincter including the sacs. Be sure to use a couple of layers of paper towel
or some cotton to keep the liquid from squirting across the room or on you.
Most dogs do not need attention nearly as much as owners think they do.
Perianal fistulas — Known by a number of names, these abnormal passages between two
surfaces or an opening to the exterior, in the area of the anus, is a condition
seen more in German Shepherds than in other breeds. While probably familial or
congenital, the disorder is thought by some to be caused by an injury or an
abscess. More likely, however, it reflects an immune system weakness. Symptoms
include frequent licking or biting at the "vent,"
and a bad odor and pus may also be seen. If untreated,
ulceration will develop. Only fair results have been reported with cryotherapy, which is freezing with liquid nitrogen or
nitrous oxide. Since some veterinarians prefer to use familiar surgical
procedures rather than cryosurgery, ask for a second opinion if you aren't
sure, especially at a veterinary college clinic. Frankly, the prognosis has
historically been very poor; there has not been a high satisfaction rate
regardless of treatment method. But a pharmacological approach has come to the
foreground in the late 1990s, that being the use of the immuno-suppressive
drug cyclosporine in an oil base, fed twice a day for as long as 5 months. It
has had some success so far, though researchers warn that remission of symptoms
may not be permanent in all dogs (nor is it in the case of surgery), and this
immunosuppressive treatment is extremely expensive, thanks not only to the drug
but also to close monitoring by the veterinarian. However, even in those dogs
not “cured” by the drug alone, it improves the condition of
the lesions enough so that surgery is much less extensive and has a better
chance of success.
Polyps — Rectal
polyps are little round or teardrop shaped red to purplish balls. Sometimes
they are clustered like tiny grapes, and are found very close to the anal
opening or further inside the rectum. They should be surgically removed, since
they rupture easily and are a potential site for infection. A drop of bright
red blood recurring on the end of stools is a sign that you should have the dog
examined for polyps.
The Pancreas
The pancreas is a
rather long, V‑shaped gland that aids the digestion of food. It has two
major types of cells or tissues. One group is endocrine in nature, which means
it secretes hormones into the circulatory system, which in turn transports them
to other glands and body parts; the other group empties into the digestive
tract. Located near the stomach, it produces enzymes, bicarbonate, and
hormones; the first two are delivered to the intestine, the third is secreted
into the bloodstream. One major enzyme, amylase, breaks down the long starch
macromolecules, while others break down fats and proteins. The endocrine
(glandular) portion of the pancreas, which does not excrete into the alimentary
canal but rather secretes into the circulatory system, functions in control of
blood sugar level, and when defective, results in diabetes. Most GSD people, in
Clinical pancreatitis — The word clinical may be used to mean “frank” or “obvious”,
at least to a veterinarian with the training and equipment. Most causes of this
disorder are of unknown origin. Adult clinical pancreatitis
is not tremendously common in the German Shepherd Dog,
but when it does occur it is usually the middle‑aged, obese bitch on a
fatty diet that has it. Chronic pancreatitis symptoms
include emaciation, dull dry coat, and high appetite with poor digestion as
seen by fatty, loose stools containing undigested starches. Treatment is
accomplished mainly by correcting the diet.
Pancreatic atrophy — On the other
hand, German Shepherd Dogs seem to have a considerable
predisposition to pancreatic atrophy, also known as juvenile atrophy or
pancreatic insufficiency, and certain bloodlines have been much more associated
with it than others. For years I have referred to it as subclinical pancreatitis,
because people who are not familiar with familial and breed tendencies are
likely to miss the subtle signs. The disease usually starts before the dog is
one year old, though many are three before symptoms are noticed. When lack of
"drive," less coat lustre, coprophagia
and/or poor weight are seen, have the stool examined by your veterinarian for
abnormal fat level and absence or low level of the trypsin
enzyme. If the problem is discovered before it becomes severe and chronic, Viokase™, a brand of powdered raw pancreas, added to the
food half an hour or more before feeding usually produces good results. Another
similar product is called Pancreazyme™. Getting
enough to do the job without making the owner go broke is a tough balancing
act, though. By the way, these types of preparations are also good for non‑specific
diarrhea. Some owners with access to slaughterhouses
claim some benefit from feeding raw pancreas, but there is not enough data with
scientific controls to consider this anything more than anecdotal testimony. I
believe there is a strong possibility that subclinical
pancreatitis can worsen with neglect into an acute
attack by enzymes on the pancreatic and surrounding tissues themselves, and
that this condition may be the cause of many instances of diagnosed perforated
ulcers.
