Ex 1 - Stomach

Question 1

Cat vs Dog - Stomach position

Answer 1

Dog: cardia, fundus, and body located to the left of midline and pyloric portion on the right

Cat: stomach is more acutely angle with the pylorus located at or near midline (stomach on left)

Question 2

Positive Contrast Gastropgraphy - Indications

Answer 2

1. Acute & chronic vomiting: surgery rads don’t show definitive obstructive pattern
2. Recurrent vomiting: esp in patients not responding to supportive therapy or other systemic dz to cause vomiting
3. Suspect GI FB, mass, or outflow disorder
4. Hematemesis (vomiting blood): suspect GI ulcer
5. Evaluate liver size
6. GI emptying times
7. Positive & size of stomach (ex. GDV - if not well visualized on rads)

Question 3

Negative contrast gastrogram

Answer 3

Intubate into the stomach –> pump with air

Question 4

Causes of an enlarged stomach

Answer 4

1. Gastric dilation –> dietary indiscretion “food bloat”
2. GDV
3. Pyloric outflow obstruction
   - pyloric stenosis
   - neoplasia
   - FB
4. Gastric motility disorder

Question 5

GDV - stomach position

Answer 5

Pylorus (& duodenum) –> left dorsal quadrant

Fundus –> right ventral quadrant

Question 6

GDV - Rad findings

Answer 6

• large gas filled stomach
• double bubble sign
• gas w/in the gastric wall = necrosis
• displacement and enlargement of spleen
• functional ileum, esophageal dilation, microcardia, pulmonary hypovolemia

Question 7

Double bubble sign (GDV)

Answer 7

Compartmentalization

Soft tissue bands that project into or across the gas-filled lumen of the rotated stomach

Result from the stomach folding upon itself

Question 8

GDV; RLR

Answer 8

Pop-eye arm or angry bunny sign

• gas in the pylorus should outline it and enable ID of pyloric positioning
• start with RLR view

Question 9

Pyloric Outflow Obstruction - underlying cause

Answer 9

Narrowing or occlusion of the pyloric orifice

Acute vs Chronic

Question 10

Pyloric Outflow Obstruction - Dz’s affecting the wall or blocking the opening

Answer 10

• Hypertrophic pyloric stenosis
• Pylorospasm
• Pyloric tumors or granulomas
• Pyloric inflammation or fibrosis
• FB, GDV (acute outflow obstruction)

Question 11

Pyloric Outflow Obstruction - Rad Findings

Answer 11

** Fluid-filled gastric distention (soft tissue opacity - compared to gas as in GDV)

** Particulate matter in lumen (“Gravel Sign”)

+/- gas bubble

intestines pushed caudally

Question 12

Pyloric stenosis

Answer 12

Hypertrophy of the circular mm fibers

On rads (contrast) it looks “cut off” from stomach to duodenum

• congenital and acquired forms
• cause is unknown
• brachycephalic breeds and siamese cats

Question 13

Gastric Neoplasia - Dogs and Cats

Answer 13

Dogs: Adenocarcinoma (most often in pylorus)

Cats: Lymphoma

**Neoplasia may be more readily ID’d with US

Question 14

Apply Core sign

Answer 14

Compression of pylorus creates apple core sign between stomach and duodenum

Question 15

Challenges of Gastric FB

Answer 15

1. Non-descript radiopage material in lumen
2. Radiolucent FB

**hard to see: look at CS, move patient to utilize gas in stomach lumen. repeat rads, +/- contrast, endoscopy if available