Transcript GI Emergencies

Kelly DeHaan
Class of 2011
 Gastric Dilation, Gastric Dilation Volvulus
 Intestinal Obstruction
 Linear Foreign Body
 Mesenteric Volvulus
 Ileus


Mechanical
Functional
Gastric Dilation Volvulus
Over-distended stomach
Pylorus rotates from right of abdomen
Pylorus dorsal to the gastric cardia on the left side of the abdomen
Gastric outflow obstruction
Progressive distention of the stomach with air
Cardiovascular effects
Respiratory effects
GI effects
Gastric Dilation Volvulus
 Clinical Signs
 Anxious/uncomfortable
 Retching
 Salivation
 Tachypnea
 Distended, painful abdomen
 Large tympanic anterior abdomen
 Brick red mucous membranes
Radiographic diagnosis
Gastric Dilation:
stomach in normal position
gas distended body and fundus
Gastric Dilation Volvulus
POPEYE ARM
-stomach is distended with gas and fluid
-pylorus is gas filled displaced dorsally and to the left in the
abdomen
+/- splenomegaly – splenic torsion
+/- hypovolemic changes
NOTE: It is impossible to differentiate GD from GDV based
on the ability to pass an orogastric tube!
GDV Treatment
 Decompress stomach – trocarization at the point of maximal distention
 Treat shock!
 Surgery: reposition the stomach
evaluate devitalization
(gastrectomy or invagination)
Gastropexy
+/- Splenectomy
Post Op: Antibiotics if gastric resection needed
enrofloxacin and ampicillin +/- metronidazole
Fluid therapy
Metoclopramide if ileus is present
Feed in first 24 hours (as soon as they will eat)
Intestinal Obstruction
Linear Foreign Body
Mesenteric
Volvulus
Ileus
Mechanical
Functional
Intestinal Obstruction: Clinical Signs
Vomiting
Diarrhea
Abdominal Pain
Abdominal Distention
Anorexia
Linear Foreign Body
Linear object fixed at one point
tongue base
pylorus
Intestine attempts to push object
forward via peristaltic waves
Intestines become plicated
Perforation of intestine at multiple
sites
Fatal Peritonitis
Linear Foreign Body : Diagnosis
 Bunched painful intestines on abdominal palpation
 String at the base of the tongue
Linear Foreign Body:
Survey Radiographs
 VD and right lateral
Plicated intestines
bunched appearance/tightly stacked
Positive Contrast (UGI)
 Patient is fasted overnight and colon is emptied via enemas
 Increase kVp 10%
 5-8 mls/lb barium sulfate via orogastric tube or 5 mls/lb of
organic iodine if intestinal perforation is suspected
 Perform all 4 views
 Repeat right lateral and VD views
every 30 minutes : dogs
every 15 minutes : cats
 Plicated loops of intestine with abnormal luminal content
pattern
Linear Foreign Body :
Abdominal Ultrasound
 Plication around an echogenic line is the most
common finding on ultrasound
Treatment
 Enterotomy:
multiple incisions
release at most proximal attachment
May require intestinal resection and anastomosis
Mesenteric Root Torsion/Volvulus
EPI
GDV
Intussusception Breed
Intestines twist around the root of the mesentery
Occlusion of cranial mesenteric artery
Decreased blood supply
Ischemic necrosis gastrointestinal toxin release shock
Mesenteric Root Torsion:
Clinical Signs
VERY ACUTE AND SEVERE!
Signs of intestinal obstruction
– less severe abdominal distention
Shock
Diagnosis
 Physical Exam:
abdominal pain and dilated loops of intestine
 Radiographs:
moderate to severe dilation of small intestine with
fluid and gas
CINNAMON BUN/PINWHEEL
+/- peritoneal effusion
Ultrasound
 Progressive intestinal
wall thickening
 Conversion to loss of
wall layers
 Generalized
hypoechoic walls
Treatment
 Treat shock
 Emergency surgery:
derotate and decompress intestine
Prognosis – guarded/grave 
Ileus
Mechanical
Functional
*Foreign body
*Intussusception
Stricture
Granuloma
Neoplasia
Enterolith
Parasite
Adhesion
Trichobezoars
*Post-surgery
Peritonitis
Enteritis
Pain
Dysautonomia
Stress
Spinal trauma
Ileus
Mechanical
Functional
Localized dilation
Diffuse dilation
(oral to the site of obstruction)
Moderate distention
Moderate to severe
distention
Stacking/Hair-pin turns
Normal Intestinal Lumen Widths
Small Intestine
Dog < 3 rib widths
Cat < 12 mm
Ferret < 5-7 mm
Foal < length of L1
Large Intestine
< 5 rib widths
Mechanical : Intestinal Foreign Body
Mechanical : Intusseception
Ileus : Contrast
Mechanical
Functional
 Reduced intestinal motility
 Reduced intestinal motility
causes prolonged barium
transit time
 Dilated loops with smooth
barium/mucosa interface
 Barium will outline the
foreign object
 Intussusception is seen as a
filling defect
causes prolonged barium
transit time
 Nonspecific changes of the
barium/mucosa interface
 Uniformly distended
segments of bowel
Ileus: Ultrasound
No specific ultrasound features are present to differentiate the
two forms
Mechanical
 Appearance of ingested foreign material varies
depending on composition of the material ingested
 Intusussception: target signs
 Presence of persitalsis on U/S rules out a diagnosis of
functional ileus
Intussuception
Ileus : Treatment
 Foreign Body :


Enterotomy
+/- Intestinal resection and anastomosis
 Intussuception:
 Surgically reduce the intussuception
 +/- Intestinal resection and anastomosis
 +/- Bowel plication
 Post-Surgical Ileus
 Metoclopramide
references
 http://people.upei.ca/lpack/vetrad/lectures.htm
 Thrall, Donald E. 2007. Textbook of Veterinary Diagnostic Radiology, Fifth Edition, Elsevier
Inc. page 760-788
 Nelson, R. W., Couto, C. Guillermo. 2009. Small Animal Internal Medicine, Fourth Edition,
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Mosby Inc pages 433-435, 462-466
Fossum, T. W. 2007. Small Animal Surgery, Third Edition, Mosby Inc. pages 443-498
Bailey, T. 2009. Companion Animal Medicine Lecture notes: Surgical Diseases of the
Gastrointestinal Tract- Part 1
Bailey, T. 2009. Companion Animal Medicine Lecture notes: Surgical Diseases of the
Gastrointestinal Tract- Part 2
Veterinary Information Network (VIN) Message Board, Diagnostic Imaging. www.vin.com
 http://www.catfacts.org/play-cat-facts.htm
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