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
6 Radiographic diagnosis Gastric Dilation:stomach in normal positiongas 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 changesNOTE: It is impossible to differentiate GD from GDV based on the ability to pass an orogastric tube!
9 GDV TreatmentDecompress stomach – trocarization at the point of maximal distentionTreat shock!Surgery: reposition the stomachevaluate devitalization(gastrectomy or invagination)Gastropexy+/- SplenectomyPost Op: Antibiotics if gastric resection neededenrofloxacin and ampicillin +/- metronidazoleFluid therapyMetoclopramide if ileus is presentFeed in first 24 hours (as soon as they will eat)
12 Linear Foreign Body Linear object fixed at one point tongue base pylorusIntestine attempts to push object forward via peristaltic wavesIntestines become plicatedPerforation of intestine at multiple sitesFatal Peritonitis
13 Linear Foreign Body : Diagnosis Bunched painful intestines on abdominal palpationString at the base of the tongue
14 Linear Foreign Body: Survey Radiographs VD and right lateralPlicated intestinesbunched appearance/tightly stacked
16 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 suspectedPerform all 4 viewsRepeat right lateral and VD viewsevery 30 minutes : dogsevery 15 minutes : catsPlicated 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 attachmentMay require intestinal resection and anastomosis
20 Mesenteric Root Torsion/Volvulus EPI GDV Intussusception BreedIntestines twist around the root of the mesenteryOcclusion of cranial mesenteric arteryDecreased blood supplyIschemic necrosis gastrointestinal toxin release shock
21 Mesenteric Root Torsion: Clinical Signs VERY ACUTE AND SEVERE!Signs of intestinal obstruction– less severe abdominal distentionShock
22 CINNAMON BUN/PINWHEEL DiagnosisPhysical Exam:abdominal pain and dilated loops of intestineRadiographs:moderate to severe dilation of small intestine with fluid and gasCINNAMON BUN/PINWHEEL+/- peritoneal effusion
31 Ileus : Contrast Mechanical Functional Reduced intestinal motility causes prolonged barium transit timeDilated loops with smooth barium/mucosa interfaceBarium will outline the foreign objectIntussusception is seen as a filling defectFunctionalReduced intestinal motility causes prolonged barium transit timeNonspecific changes of the barium/mucosa interfaceUniformly distended segments of bowel
32 Ileus: Ultrasound No specific ultrasound features are present to differentiate the two forms MechanicalAppearance of ingested foreign material varies depending on composition of the material ingestedIntusussception: target signsPresence of persitalsis on U/S rules out a diagnosis of functional ileus
34 Ileus : Treatment Foreign Body : Intussuception: Post-Surgical Ileus Enterotomy+/- Intestinal resection and anastomosisIntussuception:Surgically reduce the intussuception+/- Bowel plicationPost-Surgical IleusMetoclopramide
35 references http://people.upei.ca/lpack/vetrad/lectures.htm Thrall, Donald E Textbook of Veterinary Diagnostic Radiology, Fifth Edition, Elsevier Inc. pageNelson, R. W., Couto, C. Guillermo Small Animal Internal Medicine, Fourth Edition, Mosby Inc pages ,Fossum, T. W Small Animal Surgery, Third Edition, Mosby Inc. pagesBailey, T Companion Animal Medicine Lecture notes: Surgical Diseases of the Gastrointestinal Tract- Part 1Bailey, T Companion Animal Medicine Lecture notes: Surgical Diseases of the Gastrointestinal Tract- Part 2Veterinary Information Network (VIN) Message Board, Diagnostic Imaging.
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