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GI EMERGENCIES Kelly DeHaan Class of 2011.

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Presentation on theme: "GI EMERGENCIES Kelly DeHaan Class of 2011."— Presentation transcript:

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

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
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

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