Principles of Interpretation
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Transcript Principles of Interpretation
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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
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 Holders
instyle.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?
Everything that goes in must come
out...one way or another...
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