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GI EMERGENCIES

GI EMERGENCIES. Kelly DeHaan Class of 2011. Gastric Dilation, Gastric Dilation Volvulus Intestinal Obstruction Linear Foreign Body Mesenteric Volvulus Ileus Mechanical Functional. Gastric Dilation Volvulus. Over-distended stomach Pylorus rotates from right of abdomen

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GI EMERGENCIES

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  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

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

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

  6. 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!

  7. 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)

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

  9. 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

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

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

  12. 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

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

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

  15. 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

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

  17. 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

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

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

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

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

  22. 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

  23. Mechanical : Intestinal Foreign Body

  24. Mechanical : Intusseception

  25. Mechanical 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 Ileus : Contrast

  26. Ileus: UltrasoundNo 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

  27. Intussuception

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

  29. references • http://people.upei.ca/lpack/vetrad/lectures.htm • Thrall, Donald E. 2007. Textbook of Veterinary Diagnostic Radiology, Fifth Edition, Elsevier Inc. page 760-788 • Nelson, R. W., Couto, C. Guillermo. 2009. Small Animal Internal Medicine, Fourth Edition, Mosby Inc pages 433-435, 462-466 • Fossum, T. W. 2007. Small Animal Surgery, Third Edition, Mosby Inc. pages 443-498 • Bailey, T. 2009. Companion Animal Medicine Lecture notes: Surgical Diseases of the Gastrointestinal Tract- Part 1 • Bailey, T. 2009. Companion Animal Medicine Lecture notes: Surgical Diseases of the Gastrointestinal Tract- Part 2 • Veterinary Information Network (VIN) Message Board, Diagnostic Imaging. www.vin.com • http://www.catfacts.org/play-cat-facts.htm • http://www.google.ca/imgres?imgurl=http://www.peteducation.com/images/articles/ill_plicated_int.gif&imgrefurl=http://www.peteducation.com/article.cfm%3Fc%3D0%2B1276%26aid%3D1181&usg=__R-THfsKAIjOZg59K5rqkS-UdD00=&h=144&w=109&sz=5&hl=en&start=9&um=1&itbs=1&tbnid=50X5UTksT0BpeM:&tbnh=94&tbnw=71&prev=/images%3Fq%3Dlinear%2Bforeign%2Bbody%26um%3D1%26hl%3Den%26sa%3DN%26rlz%3D1T4GGLG_enCA310CA310%26tbs%3Disch:1 • http://www.edupics.com/tummy-ache-abdominal-pain-t14506.jpg • http://www.google.ca/imgres?imgurl=http://stemcelldoc.files.wordpress.com/2009/03/popeye.jpg&imgrefurl=http://stemcelldoc.wordpress.com/2009/03/02/biceps-tendon-repair-2/&usg=__lgRJRO_vX8YHrolp27XaJxDr2CU=&h=257&w=350&sz=30&hl=en&start=12&um=1&itbs=1&tbnid=v8k8y3wgRgW4JM:&tbnh=88&tbnw=120&prev=/images%3Fq%3Dpopeye%26um%3D1%26hl%3Den%26sa%3DN%26rls%3Dcom.microsoft:en-ca%26tbs%3Disch:1

  30. http://www.google.ca/imgres?imgurl=http://www.addl.purdue.edu/newsletters/2005/Summer/Images/image001.gif&imgrefurl=http://www.addl.purdue.edu/newsletters/2005/Summer/canine-acd.htm&usg=__DLimSrjehIUW5hQtaTxysdO9zEw=&h=232&w=103&sz=6&hl=en&start=12&um=1&itbs=1&tbnid=3dnNedCI1vYX3M:&tbnh=109&tbnw=48&prev=/images%3Fq%3Dgastric%2Bdilation%2Bvolvulus%26um%3D1%26hl%3Den%26sa%3DN%26rls%3Dcom.microsoft:en-ca%26tbs%3Disch:1http://www.google.ca/imgres?imgurl=http://www.addl.purdue.edu/newsletters/2005/Summer/Images/image001.gif&imgrefurl=http://www.addl.purdue.edu/newsletters/2005/Summer/canine-acd.htm&usg=__DLimSrjehIUW5hQtaTxysdO9zEw=&h=232&w=103&sz=6&hl=en&start=12&um=1&itbs=1&tbnid=3dnNedCI1vYX3M:&tbnh=109&tbnw=48&prev=/images%3Fq%3Dgastric%2Bdilation%2Bvolvulus%26um%3D1%26hl%3Den%26sa%3DN%26rls%3Dcom.microsoft:en-ca%26tbs%3Disch:1 • http://www.google.ca/imgres?imgurl=http://www.weimaraner-puppies.com/images/illustration-dog-bloat-500x.jpg&imgrefurl=http://www.weimaraner-puppies.com/dog-bloat.html&usg=__WD3kqbrgLJiLU_Q_p7fmyNasL_4=&h=260&w=500&sz=30&hl=en&start=34&um=1&itbs=1&tbnid=uu-NTUQHKAZaoM:&tbnh=68&tbnw=130&prev=/images%3Fq%3Dgastric%2Bdilation%2Bvolvulus%26start%3D20%26um%3D1%26hl%3Den%26sa%3DN%26rls%3Dcom.microsoft:en-ca%26ndsp%3D20%26tbs%3Disch:1 • http://www.google.ca/imgres?imgurl=http://www.edupics.com/tummy-ache-abdominal-pain-t14506.jpg&imgrefurl=http://www.edupics.com/en-coloring-pictures-pages-photo-tummy-ache-abdominal-pain-i14506.html&usg=__oEzxncKAatYVkW12SfzJz0uHBs0=&h=283&w=283&sz=15&hl=en&start=20&um=1&itbs=1&tbnid=5Rsg8l4GoZc7eM:&tbnh=114&tbnw=114&prev=/images%3Fq%3Dabdominal%2Bpain%26um%3D1%26hl%3Den%26sa%3DN%26rls%3Dcom.microsoft:en-ca%26tbs%3Disch:1

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