小動物疾病系統

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胃腸道潰瘍
作者
林言品、賴政宏、鄭豐邦
中文病名 胃腸道潰瘍
英文病名 Gastrointestinal Ulceration
疾病描述

 病因:

機械性的病因包括攝入粗糙的食物、公園或花園中之植物、布料或居家裝飾物、頭髮、針線等等物質引起。

其他可能的原因包括:肥大細胞腫瘤(mast cell tumor) 引起胃酸大量分泌、原發胃腫瘤(primary gastric tumors) 對胃壁結構之直接破壞、意外攝入居家清潔劑等化學物品對胃壁的損害、及服用類固醇或NSAID等抑制炎症藥物所引起之分泌異常引起。

特殊品種,如賽犬用狗可發生因運動引起之潰瘍灶。

疾病亦可引起潰瘍,如:胰臟炎、瀰漫性出血(DIC)、腎上腺皮質功能低下,肝病及尿毒症等。

臨床症狀:

依不同病因有不同之症狀。一般可見局部或廣泛的腹部疼痛、犬隻採取躺姿並不願意移動。部分病畜可能會有黑便,然後無黑便之情形並不代表無胃潰瘍。部分動物可能因過度失血而有貧血的情形,黏膜可見蒼白,嚴重者臨床上可見虛弱或倦怠之情形。基於背後之病因,部分可見體重減少、食慾不振甚至嘔吐的情形。

持續之病情發展終可引起胃腸道穿孔,但此情形實屬少見。如發生胃穿孔時,腹部會有液體蓄積,並有炎症性或敗血性腹膜炎。部分動物會發生休克或單重炎症反應。

診斷方法

理學檢查、糞檢皆需進行。可對前腹腔進行觸診及視診皮膚有無潰瘍病灶,以評估腫瘤之可能。病史之檢視可判斷是否因藥物使用引起。如觸診下發現腫大之團塊或淋巴結,則應進行細針抽吸以判斷是否有腫瘤之情形。

血液學檢查:

血小板數、血液凝固時間可用以評估病畜之凝血功能,以判斷是否有嚴重或持續之失血情形。血鐵濃度低下可能為急性大量或慢性失血所引起。如因嗜酸細胞性胃腸炎,肥大細胞增多症,腎上腺皮質功能減退和嗜酸性細胞增多症等症病有關引起胃腸潰瘍,可見嗜酸性球增多。

血清生化學檢查併合尿檢,可判斷是否因尿毒症、肝病、胰臟炎等病因所引起。

影像學檢查:

雖然無法用作確診,但可用作排除可能病因之工具,故在本病上仍有進行影像學檢查之價值。有時可利用影像學發出胃穿孔之早期症狀,從而提早進行治療。腹部超音波可協助病灶定位、診斷有無穿孔,及找出穿孔之可能原因。此外,其可用於檢查胃壁之厚度變化及結構有無異常,對胃腸道做出整體性之評估。

 

此外亦可考慮進行內視鏡及生檢。

如無法找出明確病因,可考慮開腹探查

治療方法

 應針對其病因作處置,另需修正病畜體內液體、電解質、酸鹼值的情形。如有明顯疼痛,應給予止痛藥。

 

如藥物治療無效,可考慮使用外科方法。外科方法特別適用於胃異物、胃穿孔、或因腫瘤引起者。

預防控制方法

 收好家中物品避免動物誤食,動物外出時應注意有無誤食之情形。
定期進行身體檢查,及早發現潛在可能之系統性疾病,如肝、腎、胰病及腫瘤等。

相關圖片 <p>&nbsp;<span style="font-size:12.0pt;font-family:標楷體;
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EN-US;mso-fareast-language:ZH-TW;mso-bidi-language:AR-SA">圖一:圖中左下角為胃癌併發胃潰瘍。</span><span style="font-family: 'Times New Roman', serif;">( Hedlund </span><i style="font-family: 'Times New Roman', serif;">et al</i><span style="font-family: 'Times New Roman', serif;">., 2007)</span></p>
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Close<p>&nbsp;<span style="font-size:12.0pt;font-family:標楷體;
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EN-US;mso-fareast-language:ZH-TW;mso-bidi-language:AR-SA">圖一:圖中左下角為胃癌併發胃潰瘍。</span><span style="font-family: 'Times New Roman', serif;">( Hedlund </span><i style="font-family: 'Times New Roman', serif;">et al</i><span style="font-family: 'Times New Roman', serif;">., 2007)</span></p>
<p class="MsoNormal"><span lang="EN-US" style="mso-bidi-font-size:12.0pt;
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<p>&nbsp;<span style="font-size:12.0pt;font-family:標楷體; mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;; mso-bidi-font-family:&quot;Times New Roman&quot;;mso-font-kerning:1.0pt;mso-ansi-language: EN-US;mso-fareast-language:ZH-TW;mso-bidi-language:AR-SA">圖一:圖中左下角為胃癌併發胃潰瘍。</span><span style="font-family: 'Times New Roman', serif;">( Hedlund </span><i style="font-family: 'Times New Roman', serif;">et al</i><span style="font-family: 'Times New Roman', serif;">., 2007)</span></p> <p class="MsoNormal"><span lang="EN-US" style="mso-bidi-font-size:12.0pt; font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:標楷體"><o:p></o:p></span></p>


<p>&nbsp;<span style="font-family: 'Times New Roman', serif; text-indent: 192pt;">(J&ouml;rg, 2008)</span></p>
<p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體;
mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖二:一隻雄性</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體">8</span><span style="mso-bidi-font-size:12.0pt;
font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:
&quot;Times New Roman&quot;">歲的巴吉度獵犬,在胃部切角</span><span lang="EN-US" style="mso-bidi-font-size:
12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:標楷體"> (incisura angularis) </span><span style="mso-bidi-font-size:12.0pt;font-family:
標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">處之潰瘍病灶。</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"><o:p></o:p></span></p>
Close<p>&nbsp;<span style="font-family: 'Times New Roman', serif; text-indent: 192pt;">(J&ouml;rg, 2008)</span></p>
<p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體;
mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖二:一隻雄性</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體">8</span><span style="mso-bidi-font-size:12.0pt;
font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:
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標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">處之潰瘍病灶。</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體"><o:p></o:p></span></p>

<p>&nbsp;<span style="font-family: 'Times New Roman', serif; text-indent: 192pt;">(J&ouml;rg, 2008)</span></p> <p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體; mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖二:一隻雄性</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;; mso-fareast-font-family:標楷體">8</span><span style="mso-bidi-font-size:12.0pt; font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family: &quot;Times New Roman&quot;">歲的巴吉度獵犬,在胃部切角</span><span lang="EN-US" style="mso-bidi-font-size: 12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:標楷體"> (incisura angularis) </span><span style="mso-bidi-font-size:12.0pt;font-family: 標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">處之潰瘍病灶。</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;; mso-fareast-font-family:標楷體"><o:p></o:p></span></p>


<p>&nbsp;<span style="font-family: 'Times New Roman', serif; text-indent: 144pt;">(Richard , 2014)</span></p>
<p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體;
mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖三:一隻鬆獅犬以內視鏡進行檢查,在胃大彎處有胃潰瘍之病灶。</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
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<p class="MsoNormal">&nbsp;</p>
Close<p>&nbsp;<span style="font-family: 'Times New Roman', serif; text-indent: 144pt;">(Richard , 2014)</span></p>
<p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體;
mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖三:一隻鬆獅犬以內視鏡進行檢查,在胃大彎處有胃潰瘍之病灶。</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體;mso-font-kerning:0pt"><o:p></o:p></span></p>
<p class="MsoNormal">&nbsp;</p>

<p>&nbsp;<span style="font-family: 'Times New Roman', serif; text-indent: 144pt;">(Richard , 2014)</span></p> <p class="MsoNormal"><span style="mso-bidi-font-size:12.0pt;font-family:標楷體; mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">圖三:一隻鬆獅犬以內視鏡進行檢查,在胃大彎處有胃潰瘍之病灶。</span><span lang="EN-US" style="mso-bidi-font-size:12.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;; mso-fareast-font-family:標楷體;mso-font-kerning:0pt"><o:p></o:p></span></p> <p class="MsoNormal">&nbsp;</p>


<p>&nbsp;<span style="font-family: 'Times New Roman', serif; text-indent: 168pt;">(James, 2007)</span><br />
<span style="font-size:12.0pt;font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;
mso-hansi-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:&quot;Times New Roman&quot;;
mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:ZH-TW;
mso-bidi-language:AR-SA">圖四:犬胃內含大量來自胃潰瘍處之凝結以及未凝結血液。</span></p>
Close<p>&nbsp;<span style="font-family: 'Times New Roman', serif; text-indent: 168pt;">(James, 2007)</span><br />
<span style="font-size:12.0pt;font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;
mso-hansi-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:&quot;Times New Roman&quot;;
mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:ZH-TW;
mso-bidi-language:AR-SA">圖四:犬胃內含大量來自胃潰瘍處之凝結以及未凝結血液。</span></p>

<p>&nbsp;<span style="font-family: 'Times New Roman', serif; text-indent: 168pt;">(James, 2007)</span><br /> <span style="font-size:12.0pt;font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;; mso-hansi-font-family:&quot;Times New Roman&quot;;mso-bidi-font-family:&quot;Times New Roman&quot;; mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:ZH-TW; mso-bidi-language:AR-SA">圖四:犬胃內含大量來自胃潰瘍處之凝結以及未凝結血液。</span></p>


參考文獻

 1.          Robert JW. Diseases of the Gastrointestinal Tract: Stomach. In: Robert JW, Michael JD, ed. Elsevier Saunders, USA, 2012: 334-336, 637-642.

2.          Donald M, McGavin, James F Z. Pathologic basis of veterinary disease 4th edition, 2007: 337.

3.          Hedlund CS, Johnson AL, Schulz KS, Seim HB, Willard MD. Small animal surgery 3rd, 2007: 979.

4.          Jörg S. Small animal gastroenterology, 2008: 167.

5.          Richard WN, Couto CG. Small animal internal medicine 5th, 2014: 405.

Richard WN, Couto CG. Small animal internal medicine 5th, 2014: 588-597.

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