title: Gastrointestinal dysmotility disorders in critically ill dogs and cats.
abstract: OBJECTIVE
  To review the human and veterinary literature regarding gastrointestinal (GI) dysmotility disorders in respect to pathogenesis, patient risk factors, and treatment options in critically ill dogs and cats.
  
  
  BACKGROUND
  GI dysmotility is a common sequela of critical illness in people and small animals. The most common GI motility disorders in critically ill people and small animals include esophageal dysmotility, delayed gastric emptying, functional intestinal obstruction (ie, ileus), and colonic motility abnormalities. Medical conditions associated with the highest risk of GI dysmotility include mechanical ventilation, sepsis, shock, trauma, systemic inflammatory response syndrome, and multiple organ failure. The incidence and pathophysiology of GI dysmotility in critically ill small animals is incompletely understood.
  
  
  METHODS
  A presumptive diagnosis of GI dysmotility is often made in high-risk patient populations following detection of persistent regurgitation, vomiting, lack of tolerance of enteral nutrition, abdominal pain, and constipation. Definitive diagnosis is established via radioscintigraphy; however, this diagnostic tool is not readily available and is difficult to perform on small animals. Other diagnostic modalities that have been evaluated include abdominal ultrasonography, radiographic contrast, and tracer studies.
  
  
  METHODS
  Therapy is centered at optimizing GI perfusion, enhancement of GI motility, and early enteral nutrition. Pharmacological interventions are instituted to promote gastric emptying and effective intestinal motility and prevention of complications. Promotility agents, including ranitidine/nizatidine, metoclopramide, erythromycin, and cisapride are the mainstays of therapy in small animals.
  
  
  CONCLUSIONS
  The development of complications related to GI dysmotility (eg, gastroesophageal reflux and aspiration) have been associated with increased mortality risk. Institution of prophylaxic therapy is recommended in high-risk patients, however, no consensus exists regarding optimal timing of initiating prophylaxic measures, preference of treatment, or duration of therapy. The prognosis for affected small animal patients remains unknown.
authors.affiliation: Emergency and Critical Care Department, Oradell Animal Hospital, Paramus, NJ, 07452.
authors.forename: KimMi
authors.initials: K
authors.lastname: Whitehead
authors.affiliation: Emergency and Critical Care Department, Oradell Animal Hospital, Paramus, NJ, 07452.
authors.forename: Yonaira
authors.initials: Y
authors.lastname: Cortes
authors.affiliation: the Nutrition Department (Eirmann), Oradell Animal Hospital, Paramus, NJ, 07452.
authors.forename: Laura
authors.initials: L
authors.lastname: Eirmann
mesh_terms: D000818:Animals; D002371:Cat Diseases / Q000503:physiopathology / Q000628:therapy*; D002415:Cats; D016638:Critical Illness; D004283:Dog Diseases / Q000503:physiopathology / Q000628:therapy*; D004285:Dogs; D005769:Gastrointestinal Motility; D007415:Intestinal Obstruction / Q000503:physiopathology / Q000628:therapy / Q000662:veterinary*
keywords: delayed gastric emptying; enteral feeding; gastrointestinal stasis; hypomotility; ileus