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

=

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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