VREC’s 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. Ultrasounds 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 warranted, an ultrasound-guided biopsy can 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 is a flexible or rigid tube containing a camera and channels allowing instruments to be passed through. The camera allows an Internal Medicine clinician to examine for abnormalities. Channels allow the clinician to obtain samples and inject medications. 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 diagnose diseases such as esophagitis (inflammation,) esophageal masses, esophageal strictures (constrictive scarring,) and/or esophageal foreign bodies. The latter two conditions are oftentimes corrected 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 by visual inspection of the stomach only, an endoscopy allows samples to be 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. Ileoscopies typically are performed with colonoscopies. 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 when abnormal findings are noted on a rectal exam. The colon must be completely clean for the procedure. In addition to fasting, colonoscopies require oral medications and enemas 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 reaching the colon oftentimes are 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 special balloon catheters to the site. The catheter balloons inflate, expand, and release the scar tissue. Medication 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. Foreign bodies identified during a procedure are 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 directly observing airways, samples may be obtained using either bronchoalveolar lavage (BAL) or endoscopic brush. BAL utilizes saline fluid to capture materials within the airways to be evaluated. Endoscopic brushes are special tools to liberate 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.