he ate what???? gi radiology dr. leeann pack dipl. avcr
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He Ate What????GI Radiology
Dr. LeeAnn Pack
Dipl. AVCR
Esophageal Foreign Bodies
Soft Tissue, Mineral or Metal density Common sites:
– thoracic inlet, heart base, LES
Radiographic appearance– focal distention of the esophagus
• pneumomediastinum, pleural effusion, mediastinal fluid, strictures
Fish Hook with String
Stomach - Anatomy Cardia, fundus, body, pyloric antrum,
pyloric canal Where are they located??? Air and fluid are our friends!
– Left lateral - air in pylorus, fluid in fundus– Right lateral - air in fundus, fluid in pylorus– VD – Gas in body and pyloric antrum– DV – Gas in the fundus
The Normal Stomach
FB in pylorus? Um no
See how you can move things around?
The Gastrogram!
Patient must be fasted! Contrast Media
– Barium suspension (5-8ml/lb)– Organic Iodine (if suspect perforation)– Room air
All are administered by orogastric tube
The Gastrogram!
Double contrast study - 1-2ml/lb Barium suspension followed by 5-10ml/lb of room air
All 4 views are made (VD, DV, both laterals) usually
Gastric Dilation/Volvulus Emergency Must take both lateral views
– stomach distended with gas and fluid– pylorus displaced dorsally and to left– compartmentalization – +/- splenomegaly, +/- hypovolemic
changes Gastric distention without torsion has
normal location
Popeye Arm = GDV
GDV
GDV with paralytic ileus
GDV – note air in esophagus
Gastric Distension (Bloat)
Stomach remains in the normal position but is significantly distended
Often seen after eating abnormal amounts of food
Usually just time to treat – frequent walks - monitor progression of ingesta
Gastric Distension
Gastric Foreign Body
May see on survey films– Bones, fish hooks, needles
FB’s not in the pylorus appear as filling defects
Porous FB (cloth) retain contrast Room air can be used
– Don’t be afraid to repeat rads in few hours
Gastric FB
Dummy
Rock FB
Sock FB
In 2007 VPI Pet insurance paid out how much money in claims for FB ingestion?– A. $170,000– B. $ 580,000– C. $1.5 million– D. $ 3.2 million
1- confident 2 – have good idea 3- just guessing
In 2007 VPI Pet insurance paid out how much money in claims for FB ingestion?– A. $170,000– B. $ 580,000– C. $1.5 million– D. $ 3.2 million
Bones most common – others needles, wood, rawhides and fish hooks
Small Intestine - Anatomy
Duodenum, jejunum, ileum Jejunum and ileum are mobile Normal SI diameter is 3 times the width
of the last rib Bowel wall thickness should not be
“guestimated” on survey radiographs
Ileus Mechanical (Obstructive)
– localized– moderate to severe distention
• greater than 3 rib widths (dog)
– non-uniform distention– “stacking” and “hair-pin” turns– Causes: FB, strictures, granulomas,
neoplasia, enteroliths, trichobezoars, parasites, adhesions
What is too big?
Dog = > 3 rib widths Cat = > 12mm Ferrets = > 5-7mm Foals = > length of L1
Lion ate a garden hose
Obstructive Ileus
Obstructive Ileus – Corn Cob
Corn Cob
Obstructive Ileus
Fairly Caudal Obstruction
Ileus
Functional (Paralytic)– Not as common– Generalized, moderate, uniform distention– See with:
• peritonitis, enteritis• pain, dysautonomia• stress, spinal trauma• post-surgery
Mesenteric Volvulus
Mesenteric Root Torsion– Occulsion of Cranial mesenteric artery
Emergency Large breed dogs
Mesenteric Root Torsion
Linear Foreign Body
Can often be seen on survey films Centralization and clumping of bowel Plication of bowel loops (especially in
the duodenum) Emergency FB stuck orad commonly
– Dogs = most in stomach, duodenum– Cat = look for something under tongue
Linear Foreign Body
In cats 90% are thread In dogs, linear FB are about twice as
fatal– More severe bowel lacerations– Plastic, ingested fabric– 25% have concurrent intussusception– Older
Reminder of Normal
Plicated Small Intestines
Linear FB
Cat – string under tongue
Linear FB
Shoe String Bowel
Foreign objects/material in GI tract
May not cause obstructive ileus Can do repeat rads to follow progress
Midnight
8am
Do you see the FB?
What is the FB and would you take it out?
Rocks and Needle…they passed
Colon FB
Free Air
Pneumoperitoneum Etiologies
– Penetrating external wound• Trauma• Iatrogenic
– Abdominocentesis– Laparotomy - may persist for time after surgery
– Rupture of internal viscous• Gastrointestinal tract most common
– Most air originates from stomach and colon rupture
Pneumoperitoneum
Roentgen signs– Enhanced visceral/serosal margin detail– Visualization of abdominal structures not
normally seen – Intra-abdominal gas opacities not
conforming to or visualized within GI structures
• Often looks like small little gas bubbles
Improved Serosal Surface Detail
Free Peritoneal Air
Large to moderate volume
Caudal surface of diaphragm
Enhanced organ outline
Can you see the free air?
Pneumoperitoneum
Diagnosis– Positional radiography = horizontal beam
• Position animal to allow gas to accumulate in area where easily visualized
• Take advantage of gravity to localize gas– Elevated Dorsal recumbency: accumulation of gas in area
of liver, diaphragm, and falciform fat
– Left lateral recumbency: accumulation of gas in right cranial quadrant away from fundus of stomach
» Air seen against the liver
Elevated Dorsal Recumbency
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Questions?
Everything that goes in must come out...one way or another...
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