Kelly DeHaan Class of 2011. Gastric Dilation, Gastric Dilation Volvulus Intestinal Obstruction...

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Transcript of Kelly DeHaan Class of 2011. Gastric Dilation, Gastric Dilation Volvulus Intestinal Obstruction...

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Kelly DeHaan Class of 2011 Slide 2 Gastric Dilation, Gastric Dilation Volvulus Intestinal Obstruction Linear Foreign Body Mesenteric Volvulus Ileus Mechanical Functional Slide 3 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 Slide 4 Slide 5 Gastric Dilation Volvulus Clinical Signs Anxious/uncomfortable Retching Salivation Tachypnea Distended, painful abdomen Large tympanic anterior abdomen Brick red mucous membranes Slide 6 Radiographic diagnosis Gastric Dilation: stomach in normal position gas distended body and fundus Slide 7 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! Slide 8 Slide 9 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) Slide 10 Intestinal Obstruction Linear Foreign Body Mesenteric Volvulus Ileus MechanicalFunctional Slide 11 Intestinal Obstruction: Clinical Signs Vomiting Diarrhea Abdominal Pain Abdominal Distention Anorexia Slide 12 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 Slide 13 Linear Foreign Body : Diagnosis Bunched painful intestines on abdominal palpation String at the base of the tongue Slide 14 Linear Foreign Body: Survey Radiographs VD and right lateral Plicated intestines bunched appearance/tightly stacked Slide 15 Slide 16 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 Slide 17 Slide 18 Linear Foreign Body : Abdominal Ultrasound Plication around an echogenic line is the most common finding on ultrasound Slide 19 Treatment Enterotomy: multiple incisions release at most proximal attachment May require intestinal resection and anastomosis Slide 20 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 Slide 21 Mesenteric Root Torsion: Clinical Signs VERY ACUTE AND SEVERE! Signs of intestinal obstruction less severe abdominal distention Shock Slide 22 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 Slide 23 Slide 24 Ultrasound Progressive intestinal wall thickening Conversion to loss of wall layers Generalized hypoechoic walls Slide 25 Treatment Treat shock Emergency surgery: derotate and decompress intestine Prognosis guarded/grave Slide 26 Ileus Mechanical *Foreign body *Intussusception Stricture Granuloma Neoplasia Enterolith Parasite Adhesion Trichobezoars Functional *Post-surgery Peritonitis Enteritis Pain Dysautonomia Stress Spinal trauma Slide 27 Ileus Mechanical Localized dilation (oral to the site of obstruction) Moderate to severe distention Stacking/Hair-pin turns Functional Diffuse dilation Moderate distention Slide 28 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 Slide 29 Mechanical : Intestinal Foreign Body Slide 30 Mechanical : Intusseception Slide 31 Ileus : Contrast Mechanical 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 Functional Reduced intestinal motility causes prolonged barium transit time Nonspecific changes of the barium/mucosa interface Uniformly distended segments of bowel Slide 32 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 Slide 33 Intussuception Slide 34 Ileus : Treatment Foreign Body : Enterotomy +/- Intestinal resection and anastomosis Intussuception: Surgically reduce the intussuception +/- Intestinal resection and anastomosis +/- Bowel plication Post-Surgical Ileus Metoclopramide Slide 35 references 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, 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. ed_int.gif&imgrefurl= D1181&usg=__R-THfsKAIjOZg59K5rqkS- UdD00=&h=144&w=109&sz=5&hl=en&start=9&um=1&itbs=1&tbnid=50X5UTksT0BpeM:&tbnh =94&tbnw=71&prev=/images%3Fq%3Dlinear%2Bforeign%2Bbody%26um%3D1%26hl%3Den% 26sa%3DN%26rlz%3D1T4GGLG_enCA310CA310%26tbs%3Disch:1 2/&usg=__lgRJRO_vX8YHrolp27XaJxDr2CU=&h=257&w=350&sz=30&hl=en&start=12&um=1&it bs=1&tbnid=v8k8y3wgRgW4JM:&tbnh=88&tbnw=120&prev=/images%3Fq%3Dpopeye%26um Slide 36 es/image001.gif&imgrefurl= acd.htm&usg=__DLimSrjehIUW5hQtaTxysdO9zEw=&h=232&w=103&sz=6&hl=en&start=12&um=1&it bs=1&tbnid=3dnNedCI1vYX3M:&tbnh=109&tbnw=48&prev=/images%3Fq%3Dgastric%2Bdilation%2B dog-bloat-500x.jpg&imgrefurl= bloat.html&usg=__WD3kqbrgLJiLU_Q_p7fmyNasL_4=&h=260&w=500&sz=30&hl=en&start=34&um= 1&itbs=1&tbnid=uu- NTUQHKAZaoM:&tbnh=68&tbnw=130&prev=/images%3Fq%3Dgastric%2Bdilation%2Bvolvulus%26 ca%26ndsp%3D20%26tbs%3Disch:1 t14506.jpg&imgrefurl= abdominal-pain- i14506.html&usg=__oEzxncKAatYVkW12SfzJz0uHBs0=&h=283&w=283&sz=15&hl=en&start=20&um=1 &itbs=1&tbnid=5Rsg8l4GoZc7eM:&tbnh=114&tbnw=114&prev=/images%3Fq%3Dabdominal%2Bpain%