1. GI EMERGENCIES
Kelly DeHaan
Class of 2011

2. Gastric Dilation, Gastric Dilation Volvulus Intestinal Obstruction
Linear Foreign Body
Mesenteric Volvulus
Ileus
Mechanical
Functional

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

5. Gastric Dilation Volvulus
Clinical Signs
Anxious/uncomfortable
Retching
Salivation
Tachypnea
Distended, painful abdomen
Large tympanic anterior abdomen
Brick red mucous membranes

6. Radiographic diagnosis
Gastric Dilation:
stomach in normal position
gas distended body and fundus

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!

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)

11. Intestinal Obstruction: Clinical Signs
Vomiting
Diarrhea
Abdominal Pain
Abdominal Distention
Anorexia

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

13. Linear Foreign Body : Diagnosis
Bunched painful intestines on abdominal palpation
String at the base of the tongue

14. Linear Foreign Body: Survey Radiographs
VD and right lateral
Plicated intestines
bunched appearance/tightly stacked

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

18. Linear Foreign Body : Abdominal Ultrasound
Plication around an echogenic line is the most common finding on ultrasound

19. Treatment Enterotomy: multiple incisions
release at most proximal attachment
May require intestinal resection and anastomosis

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

21. Mesenteric Root Torsion: Clinical Signs
VERY ACUTE AND SEVERE!
Signs of intestinal obstruction
– less severe abdominal distention
Shock

22. CINNAMON BUN/PINWHEEL
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

24. Ultrasound Progressive intestinal wall thickening
Conversion to loss of wall layers
Generalized hypoechoic walls

25. Treatment Treat shock Emergency surgery:
derotate and decompress intestine
Prognosis – guarded/grave 

26. Ileus Mechanical Functional *Foreign body *Post-surgery
*Intussusception
Stricture
Granuloma
Neoplasia
Enterolith
Parasite
Adhesion
Trichobezoars
Functional
*Post-surgery
Peritonitis
Enteritis
Pain
Dysautonomia
Stress
Spinal trauma

27. Ileus Mechanical Functional Localized dilation
(oral to the site of obstruction)
Moderate to severe distention
Stacking/Hair-pin turns
Functional
Diffuse dilation
Moderate distention

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

29. Mechanical : Intestinal Foreign Body

30. Mechanical : Intusseception

31. Ileus : Contrast Mechanical Functional
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

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

33. Intussuception

34. Ileus : Treatment Foreign Body : Intussuception: Post-Surgical Ileus
Enterotomy
+/- Intestinal resection and anastomosis
Intussuception:
Surgically reduce the intussuception
+/- Bowel plication
Post-Surgical Ileus
Metoclopramide

35. references http://people.upei.ca/lpack/vetrad/lectures.htm
Thrall, Donald E Textbook of Veterinary Diagnostic Radiology, Fifth Edition, Elsevier Inc. page
Nelson, R. W., Couto, C. Guillermo Small Animal Internal Medicine, Fourth Edition, Mosby Inc pages ,
Fossum, T. W Small Animal Surgery, Third Edition, Mosby Inc. pages
Bailey, T Companion Animal Medicine Lecture notes: Surgical Diseases of the Gastrointestinal Tract- Part 1
Bailey, T Companion Animal Medicine Lecture notes: Surgical Diseases of the Gastrointestinal Tract- Part 2
Veterinary Information Network (VIN) Message Board, Diagnostic Imaging.

36. http://www. google. ca/imgres. imgurl=http://www. addl. purdue