Specific SA Disease that cause Regurg. & Vomiting

Question 1

Key Causes of vomiting that are treated surgically:

Answer 1

-Most common cause in dogs & cats that require surgery is a foreign body!!!
-Other causes include: Intestinal mass, intestinal stricture, and intussusception

Question 2

Common Clinical signs of GI Obstruction:

Answer 2

-Clinical Presentation: Acute or chronic vomiting; Abd. pain; Decreased appetite or anorexia; Diarrhea
-Diagnostics: Radiographs (Gold standard for GI obstruction!!! Don’t give barium if you suspect perforation; Plication); Abd. US (Second line for FB obstructions; Useful for intussusceptions and intestinal masses); Bloodwork (Will show metabolic alkalosis fairly often due to vomiting and decreased absorption)

Question 3

Gastric Foreign Bodies:

Answer 3

-Foreign material within the stomach: Typically not-obstructive, but can cause pyloric outflow obstruction; Can move into SI
-Clin. signs: Vomiting; Anorexia/hyporexia; Abd. pain
-Treatment: Endoscopic removal; Gastrotomy (always if there is a chance obstruction is in the duodenum)

Question 4

SI Foreign Bodies:

Answer 4

-Foreign material in any segment of the SI
-Can cause partial or complete obstruction
-Can lead to necrosis or rupture of the intestinal wall due to pressure-related wall necrosis or sharp edges on the foreign body
-Can also occur in small mammals (ferrets, rabbits)
-Clin. signs: Vomiting, Abd. pain, anorexia/hyporexia
-Diagnosis: Rads or abdominal US
-Treatment: Enterotomy or intestinal resection and anastomosis (R&A)

Question 5

How to determine Intestinal Viability in GI Obstruction cases:

Answer 5

-Color of Intestine:
-White/gray/green/black = bad!
-Dark Purple = may be ok (if improves)
-Red = Usually ok!
-If intestine is ruptured/leaking: R&A typically needed
-Check for presence of blood supply to intestine: Feel for arterial pulses in mesentery to that segment; May not be able to feel pulses if BP is very low
-Test for presence of peristalsis via pinch test (Should make a wave)

Question 6

SI Linear Foreign Bodies:

Answer 6

-Typically anchored either under the tongue or in the stomach (Always check under the tongue for anchor before surgery!!)
-Moved through via peristalsis
-Treatment: Gastrotomy +/- enterotomy +/- intestinal R&A (Up to 40% of dogs with a linear FB have intestinal leakage/perforation!!)

Question 7

Instussusception:

Answer 7

-Invagination of one portion of the GI tract into the lumen of an adjoining segment
-Typically occurs at the ICJ
-Usually less than 1 year old
-May be associated with enteritis
-Will look “telescopic” on US!!!
-Clin. signs similar to other obstructive GI diseases
-Diagnosis: Palpable cylindrical mass in abd; Radiographs: Mass effects & 2 populations of bowels; AUS: Concentric rings, will look telescopic!!!!
-Treatment: Explore entire bowel for abnormalities;
-Manual reduction +/- resection: Aided by gentle traction on the intussusceptum and pressure on the intussuscipiens; Only attempt if no evidence of bowel necrosis and if visible vasculature is patent; May not be possible (Especially if more chronic); Manual reduction is not possible in 81% of dogs so you have to do an R&A of the ileum which is bad!

Question 8

Hiatal Hernias:

Answer 8

-Occurs when abd. contents herniate through the esophageal hiatus into the mediastinum
-Stomach is most commonly herniated spot!!
-4 Types
-Clin. Signs: Regurgitation!! Hypersalivation, vomiting, dysphagia, resp. distress, anorexia, and weight loss
-Diagnosis: Thoracic radiographs (Cranial displacement of stomach; Soft tissue mass effect in caudal thorax adjacent to diaphragm; Gas-filled viscera in thorax); Positive-contrast esophagram; Fluoroscopy is very beneficial for type I
-Medical Management: Effective!! 30 day trial prior to surgery whenever possible; Goals are to reduce gastric acid secretion (H2 blockers; Proton pump inhibitors), provide esophageal mucosal protection (sucralfate), and increase rate of gastric emptying & augment LES tone (Prokinetics, elevated feeeding, low-fat diet)
-Rarely need surgical treatment

Question 9

Types of Hiatal Hernias:

Answer 9

-Type I: Sliding hiatal hernias; Most common in brachycephalic dogs!!
-Type II: Paraesophageal hernia
-Type III: Combines Types I & II
-Type IV: Organs other than the tomach herniating through esophageal hiatus

Question 10

PRAA (Persistent Right Aortic Arch):

Answer 10

-Congenital Disease: Vascular ring anomaly; Most common is a PRAA with left ligamentum arteriosum
-Embryology: AA should develop from the left fourth AA; PRAAs occur when it develops from the 4th right AA instead
-Signalment: Mostly large breed dogs (GSDs and Irish setters are predisposed); Usually 2-6 months old
-Clin. signs: Regurgitation (Typically starting with solid food ingestion); Failure to gain weight
-Diagnosis: Radiographs; Fluoroscopy; Esophagoscopy; CT scans
-Treatment: Surgical ligation and transection of the ligamentum arteriosum