小動物疾病系統

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慢性胃炎
作者
林言品、賴政宏、鄭豐邦
中文病名 慢性胃炎
英文病名 Chronic Gastritis
疾病描述

 病因:

    雖然胃炎於伴侶動物之發生率很高,但其確實的起因仍然不明。其引起原因可包括:系統性疾病、刺激性或引起潰瘍性藥物的服用、異物、寄生蟲甚至是少見的黴菌感染等皆可引起。除以上原因外,食物不耐或對不明病原的過敏,亦可引起慢性胃炎。

臨床症狀:

    動物可見嘔吐出食物或膽汁,食慾減退、體重變輕,黑糞或血便,症狀多變而無特異性症狀。如因食物過敏引起可見腸道症狀及皮膚病變症狀。

如因攝食植物引起,可因應四季而有不同之發生率。如因攝食Pythium spp顆粒球性胃炎 (granulomatous gastritis) ,較常見於秋冬及春季。

如因黴菌感染引起者,則較常可見腹部膨大、淋巴腺炎、眼球病變等症狀。

診斷方法

 血液學:

    應進行血清生化學檢查、全血球計數、尿液檢查或T4濃度檢測 (適用於大於5處貓隻) 以作一基礎篩檢,評估病畜因代謝性、內分泌性、傳染性或其他非消化道疾病引起之嘔吐、酸鹼不平衡、電解質平衡改變等症狀之可能。部分特殊品種犬(basenjis) 當其有胃腸道疾病時,可見高白蛋白及高球蛋白血症。

生檢:

    於胃部進行生檢及採樣,並將檢體進行病理學檢查。於食物過敏、內寄生蟲及肥大細胞腫瘤 (mast cell tumor) 之病患採取所得之檢體可見較多之嗜酸性球。

影像學:

    放射線影像學下常無特異性發現,偶可見胃擴張或胃排空時間延長。如投予顯影劑,則可能發現胃壁變厚或潰瘍病灶。

另可配合超音波或內視鏡進行檢查或採樣。內視鏡可直接看到胃內情形,如有無內寄生蟲、胃內之黏液分泌會否過多及胃內潰瘍情形。

病理學檢查:

    可以H&E染色法進行結構上之評估,亦可利用特殊染色 (Steiner stain) 以檢視有無螺旋菌體。利用針對16S23S之探針 (probe) 作螢光原位雜合可用於檢視有無幽門螺旋菌。

治療方法

 1.      主要基於檢查下發現為生理異常或藥物、異物、毒物、寄生蟲、黴菌等原因引起對症下藥。

2.      如確定非因幽門螺旋菌引起,且為輕度之淋巴球性組織球性胃炎者,可先投以驅蟲藥後再以飲食進行改善。如限制食物過敏原之擾食,自牛肉或雞肉成分改成羊肉成分飼料,或改攝食具水解蛋白的成分 (如果雞肉或大豆成分)。減少食物中之碳水化合物及脂肪成分,亦可改善胃排空之功能。食物中亦可投予抗氧化物 (維他命CE) 可改善發炎之情形。如持續食用2週後情況有所改善,則應找出會引起過敏之食物種類。

如給予類固醇、抗酸劑、免疫抑制劑或改變飲食皆無法改善情形,則應進行生檢進一步檢查。

預防控制方法
相關圖片 <p>&nbsp;<span lang="EN-US" style="text-indent: 180pt; font-family: 'Times New Roman', serif;">(</span><span lang="EN-US" style="text-indent: 180pt; font-family: 'Times New Roman', serif;">J&ouml;rg, 2008</span><span lang="EN-US" style="text-indent: 180pt; font-family: 'Times New Roman', serif;">)</span></p>
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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;">五歲之雌性混種犬患有淋巴漿細胞性胃炎。並續之未必黏膜受到淋巴球以及漿細胞浸潤。此為</span><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:
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Close<p>&nbsp;<span lang="EN-US" style="text-indent: 180pt; font-family: 'Times New Roman', serif;">(</span><span lang="EN-US" style="text-indent: 180pt; font-family: 'Times New Roman', serif;">J&ouml;rg, 2008</span><span lang="EN-US" style="text-indent: 180pt; font-family: 'Times New Roman', serif;">)</span></p>
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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;">五歲之雌性混種犬患有淋巴漿細胞性胃炎。並續之未必黏膜受到淋巴球以及漿細胞浸潤。此為</span><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:
標楷體">HE</span><span style="font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;
mso-hansi-font-family:&quot;Times New Roman&quot;">染色,</span><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:標楷體">120</span><span style="font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:
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<p>&nbsp;<span lang="EN-US" style="text-indent: 180pt; font-family: 'Times New Roman', serif;">(</span><span lang="EN-US" style="text-indent: 180pt; font-family: 'Times New Roman', serif;">J&ouml;rg, 2008</span><span lang="EN-US" style="text-indent: 180pt; font-family: 'Times New Roman', serif;">)</span></p> <p class="MsoNormal"><b><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;">圖一:</span></b><span style="font-family: 標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family:&quot;Times New Roman&quot;">五歲之雌性混種犬患有淋巴漿細胞性胃炎。並續之未必黏膜受到淋巴球以及漿細胞浸潤。此為</span><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family: 標楷體">HE</span><span style="font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;; mso-hansi-font-family:&quot;Times New Roman&quot;">染色,</span><span lang="EN-US" style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:標楷體">120</span><span style="font-family:標楷體;mso-ascii-font-family:&quot;Times New Roman&quot;;mso-hansi-font-family: &quot;Times New Roman&quot;">倍下之組織病理學圖片</span><span style="font-family:&quot;新細明體&quot;,&quot;serif&quot;; mso-ascii-font-family:Calibri;mso-hansi-font-family:Calibri">。</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 lang="EN-US" style="font-family: 'Times New Roman', serif;">(</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;">J&ouml;rg, 2008</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;">)</span><br />
<b><span style="font-size:12.0pt;
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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">圖二:</span></b><span style="font-size:12.0pt;
mso-bidi-font-size:11.0pt;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">十三歲之公貓有食慾不振和體重下降之病史,其胃部黏膜有多量之嗜酸性球,最終診斷為嗜酸球性胃炎。此為</span><span lang="EN-US" style="font-size:12.0pt;mso-bidi-font-size:11.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體;mso-font-kerning:1.0pt;mso-ansi-language:EN-US;
mso-fareast-language:ZH-TW;mso-bidi-language:AR-SA">HE</span><span style="font-size:12.0pt;mso-bidi-font-size:11.0pt;font-family:標楷體;mso-ascii-font-family:
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ZH-TW;mso-bidi-language:AR-SA">染色,</span><span lang="EN-US" style="font-size:
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mso-fareast-font-family:標楷體;mso-font-kerning:1.0pt;mso-ansi-language:EN-US;
mso-fareast-language:ZH-TW;mso-bidi-language:AR-SA">120</span><span style="font-size:12.0pt;mso-bidi-font-size:11.0pt;font-family:標楷體;mso-ascii-font-family:
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ZH-TW;mso-bidi-language:AR-SA">倍下之組織病理學圖片。</span></p>
Close<p>&nbsp;<span lang="EN-US" style="font-family: 'Times New Roman', serif;">(</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;">J&ouml;rg, 2008</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;">)</span><br />
<b><span style="font-size:12.0pt;
mso-bidi-font-size:11.0pt;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">圖二:</span></b><span style="font-size:12.0pt;
mso-bidi-font-size:11.0pt;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">十三歲之公貓有食慾不振和體重下降之病史,其胃部黏膜有多量之嗜酸性球,最終診斷為嗜酸球性胃炎。此為</span><span lang="EN-US" style="font-size:12.0pt;mso-bidi-font-size:11.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體;mso-font-kerning:1.0pt;mso-ansi-language:EN-US;
mso-fareast-language:ZH-TW;mso-bidi-language:AR-SA">HE</span><span style="font-size:12.0pt;mso-bidi-font-size:11.0pt;font-family:標楷體;mso-ascii-font-family:
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&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">染色,</span><span lang="EN-US" style="font-size:
12.0pt;mso-bidi-font-size:11.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;
mso-fareast-font-family:標楷體;mso-font-kerning:1.0pt;mso-ansi-language:EN-US;
mso-fareast-language:ZH-TW;mso-bidi-language:AR-SA">120</span><span style="font-size:12.0pt;mso-bidi-font-size:11.0pt;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">倍下之組織病理學圖片。</span></p>

<p>&nbsp;<span lang="EN-US" style="font-family: 'Times New Roman', serif;">(</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;">J&ouml;rg, 2008</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;">)</span><br /> <b><span style="font-size:12.0pt; mso-bidi-font-size:11.0pt;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">圖二:</span></b><span style="font-size:12.0pt; mso-bidi-font-size:11.0pt;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">十三歲之公貓有食慾不振和體重下降之病史,其胃部黏膜有多量之嗜酸性球,最終診斷為嗜酸球性胃炎。此為</span><span lang="EN-US" style="font-size:12.0pt;mso-bidi-font-size:11.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;; mso-fareast-font-family:標楷體;mso-font-kerning:1.0pt;mso-ansi-language:EN-US; mso-fareast-language:ZH-TW;mso-bidi-language:AR-SA">HE</span><span style="font-size:12.0pt;mso-bidi-font-size:11.0pt;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">染色,</span><span lang="EN-US" style="font-size: 12.0pt;mso-bidi-font-size:11.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;; mso-fareast-font-family:標楷體;mso-font-kerning:1.0pt;mso-ansi-language:EN-US; mso-fareast-language:ZH-TW;mso-bidi-language:AR-SA">120</span><span style="font-size:12.0pt;mso-bidi-font-size:11.0pt;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">倍下之組織病理學圖片。</span></p>


參考文獻

 1.      Robert JW. Diseases of the Gastrointestinal Tract: Stomach. In: Robert JW, Michael JD, ed. 1st. Elsevier Saunders, USA, 2012: 617-619.

2.      Jörg M. Steiner. Small animal gastroenterology, 2008: 161.

Richard WN, Couto CG. Small animal internal medicine 5th, 2014: 442-454.

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