Ch 46 Stomach Flashcards
The gastrosplenic ligament is part of the __________and connects the ___________ to the __________.
- greater omentum
- hilus of the spleen
- greater curvature of the gastric fundus/body
The lesser omentum connects the _________ and ___________.
liver
lesser curvature and cranial duodenum
In immature dogs the pylorus may be located _________ than in adults.
A: cranial
B: caudal
C: closer to midline
D: further from midline
C: closer to midline
These are both normal. Which is a cat and which is a dog?
A - dog
B - cat
Which species has fewer rugal folds - dogs or cats?
cats
What is the significance of a radiolucent line in the stomach wall of a cat?
submucosal fat, can often be seen normally
Immediately after administering contrast for gastrography, LL, RL, DV AND VD views should be taken. After that, which views and when?
LL and VD
15min, 30min, 45min,
1 hour, 2h, 3h, 4h, and/or until empty
What is the risk if using an iodinated, contrast-soluble contrast media for gastrograms, and the patient inhales it?
It’s hyperosmolar and can cause pulmonary edema.
Dose (mg/kg) of iodine for a gastrogram?
600-700 mg/kg
When should gastric emptying START and FINISH in most normal patients after administration of barium?
Start: 15 minutes
Finish: within 1-4 hours (wet food), up to 16 hours (dry food)
What is the significance of rapid emptying of the stomach?
There is none. It’s only a potential problem if there is delayed emptying.
Gastric emptying time is affected by the intraluminal volume - true or false?
True. For example, low contrast dosages can result in delayed emptying.
Factors that affect gastric emptying:
- Volume of gastric content
- chemical / physical makeup of the chyme
- medications
- type of contrast
- emotional stress
In the stomach, the mucosa and muscular are:
A: equal in size
B: mucosa > muscular
C: mucosa < muscular
A: equal in size (unlike in small intestine, where mucosa > muscular, in healthy animals)
Normal stomach wall thickness in dogs and cats?
dogs: 3-5mm
cats: 2-5mm
(including at pylorus)
How many gastric peristaltic contractions are normal in dogs?
4-5/minute
cranial gastric displacement due to small liver (PSS)
Scintigraphy can be useful in which gastric diseases?
delayed gastric emptying
gastrointestinal bleeding
why does scintigraphy have limited use in diagnosing delayed gastric emptying?
outcomes are too variable
Caudal gastric displacement caused by hepatomegaly
Causes of cranial displacement of the stomach
- diaphragmatic rupture or hernia (either direct displacement of the stomach through the hernia, or indirectly where the liver herniates, and the stomach is just displaced cranially)
- microhepatica e.g. PSS, cirrhosis
- abnormal gastroesophageal junction - gastroesophageal intussusception or hiatal hernia
sentinel loop sign
Which 2 things need to occur (following e.g. vehicular trauma) for a traumatic diaphragmatic rupture to occur?
increased abdominal pressure
open glottis
What are the 2 types of hiatal hernias?
Type I (sliding) - the stomach and esophagus both move cranially
Type II (paraesophageal) - the stomach (usually the fundus) moves through the esophageal hiatus, and ends up next to the esophagus (which hasn’t moved, the esophagogastric junction is in the same place)
Which type of hiatal hernia is the most common in cats/dogs?
Sliding (type I)
Why might sliding hernias be challenging to diagnose on radiographs?
They’re dynamic, it might not be displaced at the time of the projection.
Applying abdominal pressure or stimulating a cough might help.
PPDH is acquired or congenital?
acquired
radiographic signs of a PPDH?
- Marked enlargement of the cardiac silhouette, which is often of a heterogenous opacity (due to herniated omentum / organs)
- lack of distinction between the caudal cardiac silhouette and the diaphragm
+/- absence of abdominal organs in the abdomen
sliding hiatal hernia
(and R caudal lung mass)
Note gas-dilated esophagus and duodenum
PPDH in a cat
Gastroesophageal intussusception can only occur if a predisposing condition is present:
megaesophagus
dilation of the esophageal sphincter
chronic vomiting
gastrogastric (aka pylorogastric, duodenogastric) intussusception, LL projection
gastrogastric (aka pylorogastric, duodenogastric) intussusception
gastrogastric (aka pylorogastric, duodenogastric) intussusception, RL projection
Negative gastrography - condition?
gastrogastric intussusception (antrum into the body)
Possible predisposing factors of GDV in dogs (7)? in cats (1)?
- large breed dog
- old age (although has been reported in as young as 5 weeks)
- deep chested (increased thorax depth:height)
- thin BCS
- large food volume
- gastric FB
- splenectomy
*in cats and small brachycephalics: diaphragmatic hernia
Where would a spleen move towards in a GDV?
towards the right
Which direction does a GDV normally occur?
clockwise (if viewed from caudal to cranial, the fundus and greater curvature move ventrally, and the pylorus moves dorsally and to the left)
gastric dilation without volvulus
LL view with gas in the pylorus (P) and body (B)
peristaltic contraction between P and B, normal
gastric dilation in a cat
cardiogenic pulmonary edema, HCM with L-CHF
gastric dilation without volvulus
RL view, distended fundus (F, white arrows), small amount of gas in the pylorus (black arrows)
Differentials for chronic pyloric outflow obstruction
- hypertrophic pyloric stenosis
- pylorospasm
- inflammation or fibrosis
- mucosal antral hypertrophy
- neoplasia
- disease of the pancreas or duodenum
If most of the contrast is still in the stomach after 3-4 hours, what should you suspect?
pyloric OBSTRUCTIVE disease e.g. FB, mucosal hypertrophy, mural lesions of the antrum (polyp?)
what is the difference between a beak sign and a string sign and a tit sign?
beak sign - contrast fills the entrance to the sphincter
string sign - contrast fills the lumen, but it’s very very tiny/thin
tit sign - contrast fills an outpouching in the antrum as it pushes against a mass in the sphincter
What are the cut-off values for mild/moderate and marked pyloric muscular hypertrophy?
> 3mm : mild/moderate
8mm : marked
Why would a US penny be a dangerous gastric foreign body?
if minted after 1982, contains zinc and can cause intravascular hemolysis > hemolytic anemia
gas in the wall of the antrum
Metallic foreign bodies are always metal attenuating - true or false?
false, e.g. aluminum is relatively radiolucent
VD radiographs 10h after barium
gastric outflow obstruction
pylorus - which ‘‘sign’’ is this?
string sign, compatible with restrictive pyloric disease
pylorus - which ‘‘sign’’ is this?
tit sign, compatible with restrictive pyloric disease
obstructive pyloric disease, filling defect that projects into the lumen
Gastric ulcers are commonly _________.
A: inflammatory
B: neoplastic
C: traumatic
D: vascular
B: neoplastic
specifically, carcinomas (e.g. adenocarcinoma)
large gastric FB
similar appearance of ingested polyurethane glue, which expands in the stomach
stomach wall
ulcer, underlying adenocarcinoma
hyperechoic mucosa, thickened wall with lack of layering distinction
What is the most common malignant tumour in the dog and its most common location?
Adenocarcinoma, pylorus
most common gastric neoplasm in the cat
lymphosarcoma
Non-neoplastic differentials for gastric masses in dogs, and in cats
dogs: pythiosis, zygomycosis
cats: eosinophilic gastritis, actonomycosis
gastric mass in a cat along the greater curvature
what is pseudolayering of the stomach wall, and what is it associated with?
carcinoma, due to uneven distribution of tumour within different layers of the gastric wall
What is pseudolayering of the stomach wall, and what is it associated with?
A) A radiologic artifact seen in barium studies of the stomach, typically associated with gastritis
B) A pattern seen on endoscopic ultrasound (EUS) indicating chronic gastric ulceration
C) The appearance of alternating hyperdense/echoic and hypodense/echoic layers, associated with gastric carcinoma
D) A normal anatomical variant of the stomach wall seen on CT, associated with gastric polyps
C) The appearance of alternating hyperdense/echoic and hypodense/echoic layers, associated with gastric carcinoma
normal gastric wall thickness in CATS
2-5mm
normal gastric wall thickness in DOGS
3-5mm
which parasitic disease can cause calcification of the gastric wall?
heterobilharzia americana
which metabolic disease can cause calcification of the gastric wall?
CKD
(subtle) mineralisation (seen parallel to rugal folds) of the stomach, secondary to chronic renal failure in a dog
In which layer(s) of the small intestine does heterobilharzia americana cause mineralisation?
muscular and submucosa
