He Ate What???? GI Radiology Dr. LeeAnn Pack Dipl. AVCR

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

10 yo cat not eating and salivating

Puppy ate an Ear Bud

A Proud Canadian Dog

4 yo GRet. Vomiting

Dog ate Gorilla Glue

6 yo vomiting cat

Pony Tail Holdersinstyle.com

He Ate What?

3 mo M Lab puppy vomiting

Baby Bottle Nipple

Had stomach biopsy – 7 days later still very sick

4 mo M Lab - vomiting

Questions?

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