11/30/2018 Properties of Purdue Properties … · 11/30/2018 1 IMAGING APPROACHES FOR VOMITING Hock...
Transcript of 11/30/2018 Properties of Purdue Properties … · 11/30/2018 1 IMAGING APPROACHES FOR VOMITING Hock...
11/30/2018
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IMAGING APPROACHES FOR VOMITING
Hock Gan Heng,DVM, MVS, MS, DACVR, DECVDI,
Purdue University
Causes of Vomiting
Gastrointestinal tract Foreign body obstruction, GDV, gastroenteritis, neoplasia, ulceration,
intussusception
Non gastrointestinal tract Renal disease, poison, parasite infection, pancreatitis, liver disease,
drug induced
Diagnostic Imaging Modalities
Radiography Initial approach to have an overview of the abdomen
Ultrasonography Targeted/focus ultrasound of the organ(s)
Computed tomography $$, available, research
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5 YO MN mixed breed dog, 33 KG
Presented due to severe weakness and anorexia. Physical examination revealed tachycardic and tachypneic. Vomited partially and fully digested food.
Advantages
Radiography
Readily available
Overview of the abdomen
“Easier” to read
Easy to get second opinion
Ultrasonography
Readily available ±
Detection of small amount of effusion
Able to evaluation thickness of the overall and individual layer wall thickness
Available to evaluate pancreas
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Disadvantages
Radiography
Radiation
Quality
Ultrasonography
Resolution
Expertise / experience
Time consuming
Sensitivity for pancreatitis is low
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Soft tissue
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fluid opacity
NOT ABLE TO ASSESS THE WALL THICKNESS !!
Gas distribution in relation to the position of the patient
Ventral recumbency (DV)
Dorsal recumbency (VD)
Gas distribution in relation to the position of the patient
LeftRight
Left recumbency
Right recumbency
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How many views ??
Some suggest 4 views
At least 2. Which views?
Left lateral or right lateral and VD
Right lateral for GDV
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Right lateral recumbency
Left lateral recumbency
GDV
Foreign body Soft tissue opacity
Mineral or metal opacity
No obstruction
Obstruction
Gastric distension with gas and fluid
Mostly gas distended SI (shorter segment)
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Diameter SI diameter ≤ 1.5 x Height of L5
Obstruction ≥ 2.4 x Height of L5
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Diameter SI diameter ≤ 2 x Height of cranial end plate of L2
SI diameter ≤ 12 mm
Obstruction ≥ 2 x Height of cranial end plate of L2
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3 YO F St Bernard –vomiting for 10 daysLinear foreing body abnormal gas
pattern:
Round, tapered, short tubular, crescent-shaped
Linear foreign body
Plication
7 YO M Cavalier King Charles was presented due to vomiting and diarrhea for 3 days.
743-321
Investigating vomiting patient:Day 1, vomiting patient, +ve gastric contents If there is ingesta in the stomach the SI not significantly distended and the patient is stable (i.e. NOT so ill that emergency
surgery is indicated) then Hospitalize the patient in a cage in your clinic with only
water to drink (no food) Re-radiograph the patient 12 hours later (by which time
the stomach should normally be empty)
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Day 2
If there is still material in the stomach, then do a surgical explore or gastroscopy.
Ultrasound may be helpful.
If the stomach is empty, but the SI is now significantly distended, then do a surgical explore
Day 2
If the stomach appears to be empty and
the SI appears to be normal
But the patient is ill and continues to vomit,
Consider a barium upper GI study or ultrasound
Any Day
If the SI is distended greater than 2.4 x the height of L5 and
The patient is NOT stable, to the point that emergency surgery is clearly indicated
Then a surgical explore or endoscopy is indicated, not an upper GI study
XX ultrasound
Ultrasound of small intestines: 5-layer appearance
Serosa
muscularis
submucosa
Mucosal surface
mucosa
SI foreign body
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Linear foreign body
2 YO CM Mixed breed dogAte a full meal at night. Start vomiting after 10
hours. Every 20-30 minutes
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Pancreatitis
Rads Not seen unless disease,
mass effect, effusion, inflammation
Ultrasonography –pancreatitis Not sensitive
Even if it appears normal, it still could be diseased
7.5 YO MC American DSH.Vomiting for 3 days Right limb of pancreas
Pancreaticodeodenalvein
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Hypoechoic, enlarged, para-pancreatic hyperechoic fat, effusion 37
Conclusion
Radiographic views and how many are needed
Radiographic features of GIT obstruction
Common obvious ultrasonographic abnormalities of GIT
Pancreatitis
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Thank you
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