Kelly DeHaanClass of 2011

Gastric Dilation, Gastric Dilation VolvulusIntestinal Obstruction

Linear Foreign BodyMesenteric VolvulusIleus

Mechanical Functional

Gastric Dilation VolvulusOver-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 SignsAnxious/uncomfortableRetchingSalivationTachypneaDistended, painful abdomenLarge tympanic anterior abdomenBrick red mucous membranes

Radiographic diagnosisGastric Dilation:

stomach in normal positiongas 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

VolvulusIleus

Mechanical Functional

Intestinal Obstruction: Clinical Signs

VomitingDiarrhea

Abdominal PainAbdominal Distention

Anorexia

Linear Foreign BodyLinear 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 : DiagnosisBunched painful intestines on abdominal

palpationString at the base of the tongue

Linear Foreign Body: Survey Radiographs

VD and right lateralPlicated intestines bunched appearance/tightly

stacked

Positive Contrast (UGI)Patient is fasted overnight and colon is emptied

via enemasIncrease 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 viewsRepeat right lateral and VD views

every 30 minutes : dogsevery 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

TreatmentEnterotomy:

multiple incisionsrelease at most proximal attachment

May require intestinal resection and anastomosis

Mesenteric Root Torsion/VolvulusEPI 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 distentionShock

DiagnosisPhysical Exam:

abdominal pain and dilated loops of intestine

Radiographs:moderate to severe dilation of small

intestine with fluid and gasCINNAMON BUN/PINWHEEL

+/- peritoneal effusion

UltrasoundProgressive

intestinal wall thickening

Conversion to loss of wall layers

Generalized hypoechoic walls

TreatmentTreat shockEmergency surgery:

derotate and decompress intestine

Prognosis – guarded/grave

IleusMechanical*Foreign body

*IntussusceptionStricture

GranulomaNeoplasiaEnterolithParasiteAdhesion

Trichobezoars

Functional*Post-surgery

PeritonitisEnteritis

PainDysautonomia

StressSpinal trauma

IleusMechanical

Localized dilation (oral to the site of

obstruction)

Moderate to severe distention

Stacking/Hair-pin turns

FunctionalDiffuse dilation

Moderate distention

Normal Intestinal Lumen Widths

Small IntestineDog < 3 rib widths

Cat < 12 mmFerret < 5-7 mm

Foal < length of L1

Large Intestine< 5 rib widths

Mechanical : Intestinal Foreign Body

Mechanical : Intusseception

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

FunctionalReduced intestinal

motility causes prolonged barium transit time

Nonspecific changes of the barium/mucosa interface

Uniformly distended segments of bowel

Ileus: UltrasoundNo specific ultrasound features are present to differentiate the

two forms

MechanicalAppearance 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 : TreatmentForeign Body :

Enterotomy +/- Intestinal resection and anastomosis

Intussuception:Surgically reduce the intussuception+/- Intestinal resection and anastomosis+/- Bowel plication

Post-Surgical IleusMetoclopramide

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, 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.

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