Diagnostic Imaging of GI Flashcards
Label the following radiograph
Lateral
- Orange - aorta
- Blue - trachea
- Green - caudal vena cava
DV
- Orange - right atrium and ventricle
- Blue - left atrium and ventricle
Explain the course of the oesophagus takes as it passes through the thorax
- Dorsal to the larynx
- Follows trachea on left and then medially once in the thorax in the mediastinum
- Runs over the heart and through eh oesophageal hiatus of the diaphragm
Identify each of the following numbers
What are the blue arrows pointing at in this radiograph?
Why is this structure visible?
- Arrows are pointing to the walls of the oesophagus. The walls are visible because the oesophagus is filled with air which is acting as a negative contrast agent.
At times the clinical history and physical examination suggest oesophageal disease but plain thoracic radiographs are not helpful.
- In these cases a positive contrast agent might be useful. Which positive contrast agent is typically used to identify abnormalities of the oesophagus in this situation?
- How can the agent be administered?
What risks are associated with use of positive contrast agents in patients with oesophageal disease? This is important to help you think about how you would try to minimise the need to use these agents in your patients
Do not use if you suspect perforation because it can cause granulomatous reaction and adhesions.
Take plain radiographs first to identify any obvious lesions or use other imaging techniques such as endoscopy. If the contrast agent is still required use the lowest dose possible
This is a positive contrast study of the oesophagus of a mature dog with an abnormal oesophagus.
What clinical signs would you expect in this patient?
- regurgitation
- gaging
- dysphagia
- repeated attempts to swallow
- ptyalism
- signs depend on site of obstruction and whether it is a full or partial obstruction
The following images shows endoscopic views of the oesophagus of a cat and dog.
How do they differ in appearance? Can you explain why they differ?
Dogs: Entire oesophagus striated muscle
Cats: Proximal oesophagus has striated muscle and the distal is smooth muscle
Look at the images in the attached image This is a GSD puppy which presented with a history of persistent regurgitation of most of the solid food he ate. This problem only became apparent after weaning.
- Identify the site of the lesion.
- What embryological anomaly could be causing the problem?
- What other clinical signs would/might this puppy be showing?
- Can you find any treatment options for this condition?
- What is the prognosis? will they grow out of the condition?
Identify the site of the lesion.
- Oesophagus
What embryological anomaly could be causing the problem?
- Congenital idiopathic megaoesophagus à GSDs are at high risk
- Cardiac vascular ring anomalies causing extraluminal compression of the oesophagus
- Megaoesophagus predisposes to oppolulsion diverticula
What other clinical signs would/might this puppy be showing?
- Infrequent defecation
- Systemic signs – lethargy, appetence, weight loss
- Neuromuscular problems
- Neurological deficits
Can you find any treatment options for this condition?
- Megaoesophagus:
- Supportive care
- Small frequent meals
- Special chair to keep them upright during and up to 20 mins after to allow gravity to assist in moving food to stomach
- Head feeding
- Pyridostigmine bromide
- Antibodies concentrations checked every 4-6 weeks
- Percutaneous Gastrotomy tube may be required due frequent regurgitation
- In idiopathic megaoesophagus firm food may help as the problem may be sensory related
Diverticula:
- Small: Bland soft diet fed in fright position
- Large: Surgical excision and reconstruction of the oesophageal wall
Treat aspiration pneumonia:
- IV therapy for shock/sepsis
- BS Abx
- Cephalosporin + fluoroquinolone (maybe IV if needed)
- Physiotherapy
- Coupage (percussion therapy)
What is the prognosis will grow out of the condition?
- Idiopathic has a poor prognosis
- Congenital 20-40% will recover
What are the orange arrows pointing to?
Position of the stomach
- Of the images provided, which one corresponds to a dog positioned in
- right lateral recumbency?
- left lateral recumbency?
- sternal recumbency?
- dorsal recumbency?
- right lateral recumbency?
- left lateral recumbency?
- sternal recumbency?
- dorsal recumbency?
1.
- dorsal recumbency?
Look at the images attached. The left shows a plain lateral thoracic radiograph of a cat exhibiting some respiratory signs. The owner thought the cat could have had some form of accident a few weeks previously.
Look at the right which shows a positive contrast radiograph of the upper gastro-intestinal tract of the same cat.
- Which anatomical structure has been damaged?
Diaphragm
Trachea dorsally displaced
Intestine too cranial in ventral image
Oesophageal and oropharyngeal disease can both cause an acute life threatening complication in dogs and cats.
What complication might this be?
Aspiration pneumonia
How would you diagnose aspiration pneumonia?
Radiographic findings - alveolar lung pattern
Tracheal wash with cytology
Think about whether these clinical signs might be present or absent or whether they can be useful in differentiating between the anatomical sites of disease
