GI EMERGENCIES

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GI EMERGENCIES

• Kelly DeHaan
• Class of 2011

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• Gastric Dilation, Gastric Dilation Volvulus
• Intestinal Obstruction
• Linear Foreign Body
• Mesenteric Volvulus
• Ileus
• Mechanical
• Functional

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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

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Gastric Dilation Volvulus

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

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Radiographic diagnosis

• Gastric Dilation
• stomach in normal position
• gas distended body and fundus

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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!

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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)

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Intestinal Obstruction Clinical Signs

• Vomiting
• Diarrhea
• Abdominal Pain
• Abdominal Distention
• Anorexia

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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

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Linear Foreign Body Diagnosis

• Bunched painful intestines on abdominal palpation
• String at the base of the tongue

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Linear Foreign Body Survey Radiographs

• VD and right lateral
• Plicated intestines
• bunched appearance/tightly stacked

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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

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Linear Foreign Body Abdominal Ultrasound

• Plication around an echogenic line is the most
  common finding on ultrasound

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Treatment

• Enterotomy
• multiple incisions
• release at most proximal attachment
• May require intestinal resection and anastomosis

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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

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Mesenteric Root Torsion Clinical Signs

• VERY ACUTE AND SEVERE!
• Signs of intestinal obstruction
• less severe abdominal distention
• Shock

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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

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Ultrasound

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

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Treatment

• Treat shock
• Emergency surgery
• derotate and decompress intestine
• Prognosis guarded/grave ?

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Ileus

• Mechanical
• Foreign body
• Intussusception
• Stricture
• Granuloma
• Neoplasia
• Enterolith
• Parasite
• Adhesion
• Trichobezoars

• Functional
• Post-surgery
• Peritonitis
• Enteritis
• Pain
• Dysautonomia
• Stress
• Spinal trauma

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Ileus

• Mechanical
• Localized dilation
• (oral to the site of obstruction)
• Moderate to severe distention
• Stacking/Hair-pin turns

• Functional
• Diffuse dilation
• Moderate distention

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Normal Intestinal Lumen Widths

• Small Intestine
• Dog lt 3 rib widths
• Cat lt 12 mm
• Ferret lt 5-7 mm
• Foal lt length of L1
• Large Intestine
• lt 5 rib widths

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Mechanical Intestinal Foreign Body
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Mechanical Intusseception
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Ileus Contrast

• 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

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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

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Intussuception
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Ileus Treatment

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

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references

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• Thrall, Donald E. 2007. Textbook of Veterinary
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  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
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