Vet stumped by delayed gastric emptying/possible ileus
My dog has had a really complicated month medically and I’m looking for general thoughts from veterinary professionals because my primary vet says he is somewhat stumped and is currently taking a conservative “wait and see” approach while consulting with a specialist.
She is a ~25lb corgi currently recovering from TPLO surgery she had 10 weeks agp. About a month ago she developed pancreatitis (positive test at ER at the time) and recovered after hospitalization/supportive care. During recovery she was also found to have bacterial overgrowth on fecal testing and improved significantly on metronidazole.
A few days ago she vomited after breakfast (which was mostly kibble) and developed delayed gastric emptying/possible functional ileus. Barium X-rays showed delayed pyloric outflow and slowed GI motility, but contrast DID continue progressing through and there was no confirmed obstruction. My vet described the abdominal area on X-ray as looking somewhat “cloudy,” suggesting inflammation.
Ultrasound findings included:
- Mild upper abdominal inflammatory changes
- Mild pancreatic region changes/enlargement (radiologist said pancreatitis could explain the delayed gastric emptying)
- Mild gallbladder sludge/debris and mild wall thickening, but no mucocele/rupture/obstruction/cholecystitis
- Mild urinary bladder debris
- Mild bilateral chronic kidney changes
- No obvious foreign body or surgical emergency
Her pancreatitis panel this time was negative.
Current treatment plan:
- Metronidazole (10 days)
- Famotidine (10 days)
- Sucralfate (7 days)
- Proviable probiotics
- Hill’s i/d Low Fat wet food only
- 5-6 small meals daily
No prokinetics were prescribed. My vet currently wants to continue conservative management and monitor clinically.
The confusing part for me is that clinically she actually seems to be improving:
- Eating eagerly and asking for more food
- Keeping food down
- Pooping multiple times daily (stool color improving from bright yellow to orange/brown)
- Peeing normally
- Acting mostly like herself
- She seemed to have some slight nausea today after one of her meals but it passed quickly
My questions:
Does this overall picture sound consistent with functional ileus/lingering inflammatory GI disease?
Is it reasonable to manage conservatively without a prokinetic right now?
Would you personally recommend follow-up X-rays/bloodwork in about a week to assess improvement?
Does the current medication/diet plan sound appropriate?
Is it plausible that pancreatitis + bacterial overgrowth + GI inflammation could all be contributing to this?
I know nobody can diagnose over Reddit, I’m just trying to understand whether this approach sounds medically reasonable because I’m extremely anxious after multiple hospitalizations and I'm paranoid we aren't doing enough.
Thank you!