Helping Solve Challenging Pet Problems
Just like humans, pets can develop illnesses requiring the specific expertise and knowledge of an internal medicine professional. The Internal Medicine department at VREC is committed to providing comprehensive care for your pet.
Our Internal Medicine department is qualified to diagnose and treat everything inside your pet’s body – vital organs, blood disorders, infectious diseases, metabolic diseases, endocrine diseases, gastrointestinal diseases, and more. Employing the use of minimally-invasive tools and techniques such as ultrasound and endoscopy, the Internal Medicine focuses on reducing a pet’s time in the hospital.
Our Internal Medicine department frequently sees cases that include:
- Issues involving anemia or other bleeding disorders
- Chronic vomiting or diarrhea
- Coughing or breathing problems
- Acquired heart diseases
- Endocrine diseases (adrenal tumors, diabetes, thyroid disorders)
- Infectious diseases
- Kidney or bladder diseases
- Liver diseases
- Unexplained weight loss
- We also diagnose and manage cancer and degenerative heart diseases
When follow-up care is indicated, we work closely with primary care veterinarians to continue to meet the needs of you and your pet. We strive to provide heartfelt care while supporting and enriching the bond between you and your pet.
Why would my pet need to see an internal medicine clinician?
An internist may routinely perform internal medicine procedures that are uncommon or unavailable to your primary veterinarian, such as:
- Advanced laboratory testing
- Ultrasound-guided aspirates
- Bone marrow aspiration or biopsy
- Feeding tube placement
- Tru-cut biopsies
- Digital radiography
- Tracheal wash
When Oliver began experiencing stomach issues, his owners trusted VREC to perform internal medicine tests and treatment plans to provide him the quality of life he deserves.
Endoscopy & Ultrasound
Our Internal Medicine department employs the use of two effective tools used to examine a pet’s insides: ultrasound and endoscopy. Ultrasounds are a non-invasive imaging technique that allow the veterinarian to observe internal body structures by using harmless ultrasonic waves. They are commonly performed to address liver, gall bladder, small intestine, pancreas, colon, peritoneum, spleen, prostate/uterus, kidney, adrenal gland, or lymph node concerns. Ultrasounds are painless and infrequently require sedatives or anesthesia. If a pet’s condition warrants, an ultrasound-guided biopsy may be performed to obtain tissue for examination. Biopsy tests may require sedation or anesthesia. In many cases ultrasound and/or ultrasound guided biopsies eliminate the need for a major surgery and helps shorten a pet’s recovery time.
Endoscopy is the use of specialized equipment to evaluate the interior of hollow organs or cavities within the body. An endoscope a flexible or rigid tube containing a camera and channels to allow instruments to be passed through. The camera allows an Internal Medicine clinician to examine for abnormalities. The tube’s channels allow for samples to be obtained or medications to be injected. Endoscopy is performed for both diagnostic purposes (allowing observation and sampling of tissues) as well as therapeutic purposes (interventional endoscopy.)
There are many kinds of endoscopic procedures available at VREC:
Upper & Lower Gastrointestinal Endoscopy
Upper GI endoscopy typically involves performing esophagoscopy, gastroscopy, and duodenoscopy (esophagus, stomach, and upper small intestine) together. Lower GI endoscopy involves performing colonoscopy and sometimes ileoscopy (colon and lower small intestine.)
• Esophagoscopy is the evaluation of the esophagus, or the tube between mouth and stomach. Evaluation of the esophagus is useful in patients with regurgitation, excessive drooling, or difficulty swallowing. Esophagoscopy can be used to diagnose diseases such as esophagitis (inflammation,) esophageal masses, esophageal strictures (constrictive scarring,) and/or esophageal foreign bodies. Treatment of the latter two conditions can often be performed during the same procedure.
• Gascroscopy allows the evaluation of the inside of the stomach. This procedure benefits patients with conditions like chronic vomiting, anorexia, suspected GI bleeding (ulcers), or gastric masses. Although a diagnosis cannot be made only by visual inspection of the stomach, endoscopy allows samples to be obtained and submitted for evaluation. This minimally-invasive method often provides a definitive diagnosis without the need for surgery.
• Duodenoscopy examines the duodenum, the first segment of the small intestine immediately adjacent to the stomach. Some patients may also have the jejeunum (the beginning of the next segment) evaluated. Indications and benefits are the same as for gastroscopy but also include evaluation of patients with chronic diarrhea.
• Ileoscopy examines the ileum, the last segment of the small intestine. This is performed in conjunction with a colonoscopy. Ileoscopy can be beneficial in patients with small intestinal disease as it adds another segment of the small intestine that can be biopsied in conjunction with performing upper GI tract endoscopy, or in patients with known ileal diseases.
• A colonoscopy is performed to evaluate patients with large intestine concerns, including large bowel diarrhea, fresh blood in the stool, difficulty defecating, or with abnormal findings on a rectal exam. The colon must be completely clean for the procedure. In addition to fasting, this procedure requires oral medications and enemas to be administered in hospital 24 hours prior. Similar to upper GI endoscopy, biopsy samples can be obtained to provide a definitive diagnosis.
Intervention endoscopy is the use of endoscopic equipment to perform therapeutic procedures. Procedures may replace more invasive surgical techniques or be preferred therapies.
• Foreign body retrieval. VREC commonly treats patients who ingest foreign material. After ingestion objects can become lodged in the esophagus, stomach, or small intestine, nasal cavity, or trachea, which becomes an emergency situation. Foreign material can often retrieved using endoscopy and specialized endoscopy instruments. Endoscopy is the preferred diagnostic and treatment modality over surgery as it is minimally invasive and avoids the need for surgery, which result in larger expenses and longer hospitalization. Objects obstructing the small intestines will require surgery. Objects which have reached colon will often be passed by the patient.
• Balloon dilation of strictures. A stricture is an abnormal narrowing that occurs within a tubular tissue structure such as the esophagus (the tube between mouth and stomach.) Strictures can be congenital (from birth/development) or acquired due to damage to the esophagus which scars and tightens as it heals. Most common in the esophagus, strictures can occur in the colon, nasal cavity, or urethra. Esophageal strictures
may occur from reflux of acid from GI disease or anesthesia, secondary to certain oral medications stuck in the esophagus, or as a result of esophageal foreign bodies. Strictures are treated by guiding a special balloon catheter to the site. The balloon is inflated to expand and release the scar tissue. Medications can also be injected into the site through the endoscope. Most patients require 3-6 treatments to achieve adequate expansion and prevent further scarring.
• Feeding tube placement. Feeding tubes can be essential for providing adequate nutrition to anorexic patients and those unable to adequately process food due to oral or esophageal disease. The type of feeding tube used will vary depending on the patient’s disease process and how long they will need a tube. Done surgically or using endoscopy, gastrostomy tubes are placed into the stomach through the abdominal wall. Placing a Percutaneous Endoscopic Gastrostomy (PEG) tube is minimally invasive and provides the same results. PEG tubes are safe for long-term use and have the advantage of bypassing the esophagus. The tube also offers a larger diameter to provide increased volumes of food.
Respiratory Tract Endoscopy
• Rhinoscopy evaluates patients with sneezing, nasal discharge, nasal congestion, and/or nasal bleeding. It allows observation of the nasal cavity and the back of the throat. Tissue samples can be obtained during the procedure for analysis to determine a cause. If the procedure identifies a foreign body it will be removed.
• Tracheoscopy or bronchoscopy evaluate the upper airway (trachea) and the lower airways (bronchi.) Patients with chronic cough, respiratory difficulties, pneumonia, or airway disease can benefit from these evaluations. In addition to observing the airways directly, samples can be obtained using bronchoalveolar lavage (BAL) where saline fluid is introduced to capture materials within the airways and then retrieved for evaluation, or an endoscopic brush, which liberates debris and cells. Both methods allow a clinician to obtain material and cells for evaluation and culture. There may also be the opportunity for foreign body removal or biopsy.
Urogenital Tract Endoscopy
• Cyscoscopy, urethroscopy, and vaginoscopy procedures evaluate the urinary bladder, urethra, and vagina, respectively. These procedures are often performed concurrently. Patients with chronic or recurrent lower urinary tract disease and infections may benefit from this form of endoscopy. These procedures identify abnormalities such as anatomic irregularities (ectopic ureters), urinary stones, masses, or polyps. They also allow for samples and biopsies to be obtained.
Internal Medicine FAQ
How long do consultations take?
Most internal medicine consultations average approximately 90 minutes to two hours. Records from your veterinarian are highly beneficial to have on hand during consultations, including medical history, lab work, radiographs (x-rays), and a list of current medications. Our Client Service Representatives will contact your primary care vet prior to the appointment for this information.
Will my pet need sedation for an abdominal ultrasound?
The only thing required of pets during an ultrasound is the ability to lie relatively still with minimal restraint. Abdominal ultrasounds require your pet’s abdomen to be shaved. Our staff will also apply special, non-toxic ultrasound gel. The special gel allows the waves to penetrate abdominal organs without interference. It is non-toxic and water-soluble so it will not stain nor will it harm you or your pet if ingested.
Most animals do not require sedation or anesthesia for an ultrasound. It is in your pet’s best interest that owners not be present during the ultrasound. Animals can pick up on their owner’s anxiety, oftentimes making it difficult for them to remain still. It is also beneficial for the internist so they can concentrate on the procedure.
Why would a pet need an ultrasound if they had x-rays?
Unlike x-rays which give a static view, ultrasounds give a dynamic real-time view. This enables the internist to visualize the internal architecture and vessels of organs and their function. Certain structures, such as lymph nodes, can be seen on ultrasound but not on radiographs.
My pet already had an ultrasound. Why might they need another?
An ultrasound is a real-time capture that allows the internist to obtain various views of the abdominal organs. It captures dynamic changes that occur with blood flow and respiration, and the most subtle movements may alter an image. Our internist has special training and experience that helps detect small abnormalities that can make all the difference in a diagnosis.
When will I receive ultrasound results?
The doctor will review the results of the ultrasound upon completion. Your primary care veterinarian also receives our findings.