Contrast Study

1. Contrast Study ATE 2653L Summer 2009 Lauren Keller

2. Jackson10 month oldMale Neutered Great Dane

3. Day 1 - History • Chief Complaint • Patient presents to the clinic for pacing, dry heaving and vomiting • Vitals • Weight: 115.4#; 52.45kg • Temperature: 102.9°f (slightly elevated) • Heartrate: 120 bpm; strong pulses • MM pink; CRT < 2 seconds

4. Day 1 - Diagnostics • Patient is sedated with 1ml valium IV • Sedation did not work – patient was still very agitated/restless • Critique • Positioning • Ok – he was too large to include the entire abdomen • Landmarks • He was too big to fit on one large plate so the veterinarian suggested focusing on the cranial abdomen • Collimation • ok – there wasn’t much space for collimation due to patient size • Technique • Contrast and detail are much better than shown in the picture • Markers/Labels • A patient label is present but I covered it to ensure patient confidentiality • The left marker is not present • Conclusion • Unremarkable - NSF Lateral Abdominal Radiograph

5. Day 1 – Differential & Treatment • Rule out GI foreign body, Decreased GI motility, Bloat • The owners opted for conservative treatment for the time being • Medications • 2.6 ml famotadine given SQ • 6 ml Cerenia given SQ • 500 mls lactated ringers given SQ • No medications were sent home with the patient

6. Day 2 – History • Chief Complaint • Patient still seems very nauseous – swallowing, licking, drooling • Lethargic • Pacing • Vitals • Weight: 114#; 51.8kg • Temperature: 103.1°f (slightly elevated) • Heart rate: 124bpm; strong pulses • MM pink; CRT < 2 sec; gums slightly tachy • Physical Exam • Non-painful abdomen • Rectum full of formed stool • No other significant findings

7. Day 2 – Diagnostics & Treatment • Blood is drawn and sent to the lab to run amylase and lipase levels • Results • Amylase 762 U/L (300-1000) – WNL • Lipase 65 U/L (30-150) – WNL • Medications Dispensed • Carafate 1g – crush 1 tab in water and give by mouth 30 minutes prior to pepcid for 5 days • OTC Pepcid 10mg – give 1 tablet by mouth 30 minutes after carafate for 5 days

8. Day 4 - History • Chief Complaint • Patient vomited 3 times overnight – food & bile • Patient is eating and drinking but decreased amounts • Very restless – stretching, yawning, licking lips, pacing every 10 minutes • No bowel movement since day 1 • Vitals • Weight: 115#; 52.3kg • Temperature: 102.4°f • Heart rate: 136bpm; strong pulses • MM pink & moist; CRT < 2 sec • Physical Exam • Non-painful abdomen • Rectal - NSF • BCS 5/9

9. Day 4 - Diagnostics • Patient much more cooperative today • Critique • Positioning • Ok – he was too large to include the entire abdomen • Landmarks • He was too big to fit on one large plate so the veterinarian suggested focusing on the mid abdomen • Collimation • ok – there wasn’t much space for collimation due to patient size • Technique • Contrast and detail are much better than shown in the picture • Markers/Labels • A patient label is present but I covered it to ensure patient confidentiality • The left marker is not present • Conclusion • V/D recommended due to pearl appearance mid, ventral abdomen Lateral Abdominal Radiograph

10. Day 4 – Diagnostics Cont. • Patient was not cooperative for this position • Critique • Positioning • Ok – he was too large to include the entire abdomen, should have included more caudal abdomen • Landmarks • Bad – could have been tighter • Collimation • Bad – could have been tighter • Technique • Patient was not at all cooperative – radiograph is very blurry • Markers/Labels • A patient label is present but I covered it to ensure patient confidentiality • Conclusion • Radiograph not diagnostically significant due to patient movement • Recommend barium series – owner to return next morning for barium series V/D Abdomen L

11. Day 5 – Barium Series • Chief Complaint • Patient vomited multiple times overnight – food & bile • Patient is eating and drinking but decreased amounts • Still no bowel movement • Vitals • Weight: 115#; 52.3kg • Temperature: 102.4°f • Heart rate: 136bpm; strong pulses • MM pink & moist; CRT < 2 sec • Physical Exam • Non-painful abdomen • Rectal - NSF • BCS 5/9 • Patient is given 575mls barium mixed with PVD Canned EN by mouth

12. Barium Series – Pre Barium • Critique • Positioning • Ok – he was too large to include the entire abdomen • Landmarks • He was too big to fit on one large plate so the veterinarian suggested focusing on the cranial abdomen • Collimation • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter ventrally • Technique • Good – contrast and detail well defined • Markers/Labels • A patient label is present but I covered it to ensure patient confidentiality • Conclusion • Air in stomach (FYI: patient had gastropexy done at time of neuter) • Pearling still present at ventral mid abdomen L

13. Barium Series – 0 Minutes • Critique • Positioning • Ok – he was too large to include the entire abdomen • Landmarks • He was too big to fit on one large plate so the veterinarian suggested focusing on the cranial abdomen • Collimation • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter dorsally • Technique • Good – contrast and detail well defined • Markers/Labels • A patient label is present but I covered it to ensure patient confidentiality • Time of 0 minutes is recorded in upper right hand corner • Conclusion • Stomach large and full of contrast L

14. Barium Series – 15 Minutes • Critique • Positioning • Ok – he was too large to include the entire abdomen; radiograph should have been slightly more caudal – more of the chest was included than necessary • Landmarks • He was too big to fit on one large plate so the veterinarian suggested focusing on the cranial abdomen • Collimation • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter venterally • Technique • Good – contrast and detail well defined • Markers/Labels • A patient label is present but I covered it to ensure patient confidentiality • Time of 15 minutes is recorded in lower left hand corner • Conclusion • Stomach large and full of contrast, slight movement into the small intestine L

15. Barium Series – 30 Minutes • Critique • Positioning • Ok – he was too large to include the entire abdomen; radiograph should have been slightly more cranial • Landmarks • He was too big to fit on one large plate so the veterinarian suggested focusing on the mid abdomen • Collimation • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter ventrally and dorsally • Technique • Good – contrast and detail well defined • Markers/Labels • A patient label is present but I covered it to ensure patient confidentiality • Time of 30 minutes is recorded in upper right hand corner • Conclusion • Stomach large and full of contrast, movement into the small intestine L

16. Barium Series – 1 Hour • Patient began to resist restraint • Critique • Positioning • Ok – he was too large to include the entire abdomen; radiograph should have been slightly more cranial • Landmarks • He was too big to fit on one large plate so the veterinarian suggested focusing on the mid abdomen • Collimation • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter dorsally • Technique • Ok – radiograph is blurry due to patient movement • Markers/Labels • A patient label is present but I covered it to ensure patient confidentiality • Time of 1 hour is recorded in upper right hand corner • Conclusion • Movement of barium into the small intestine L

17. Barium Series – 2 Hours • Patient much more relaxed for this radiograph • Critique • Positioning • Good – he was too large to include the entire abdomen but almost all the barium is included • Landmarks • He was too big to fit on one large plate • Collimation • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter dorsally and ventrally • Technique • Good – Detail and Contrast are well defined • Markers/Labels • A patient label is present but I covered it to ensure patient confidentiality • Time of 2 hours is recorded in upper right hand corner • Conclusion • Decrease size of stomach, movement through intestines • Decrease GI Transit Time L

18. Barium Series – 4 Hours • Patient slightly resistant • Critique • Positioning • Good – he was too large to include the entire abdomen but all the barium is included • Landmarks • He was too big to fit on one large plate • Collimation • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter ventrally • Technique • OK – Detail and Contrast are defined but blurry due to patient movement • Markers/Labels • A patient label is present but I covered it to ensure patient confidentiality • Time of 4 hours is recorded in upper right hand corner • Conclusion • Barium moving into colon L

19. Barium Series – 6 Hours • Patient slightly resistant • Critique • Positioning • Good – he was too large to include the entire abdomen but all the barium is included • Landmarks • He was too big to fit on one large plate • Collimation • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter ventrally • Technique • OK – Detail and Contrast are defined • Markers/Labels • A patient label is present but I covered it to ensure patient confidentiality • Time of 6 hours is recorded in upper right hand corner • Conclusion • Barium is in the colon; no evidence of a foreign body in the GI tract • Patient is to return next morning for 24 hour post barium L

20. Day 5 - Treatments • 2 ml metaclopramide given SQ • Recommend feeding Hills Science Diet W/D can food often and in small amounts • Dispense Metoclopramide 10mg – give 1 tab by mouth every 8 hours for 2 days (start tomorrow)

21. Day 6 – Update Clients called to cancel recheck appointment and let us know that Jackson had defecated a sock, along with A LOT of barium that morning and seemed much better! • This case continued to prove our clinic’s motto that, “Barium fixes everything!”