Lecture 27

Question 1

What can cause gastric displacement?

Answer 1

-abnormalities in adjacent organs
-hiatal hernia
-acute dilatation +/- volvulus

Question 2

What is a hiatal hernia?

Answer 2

-varying degrees of herniation of stomach into thorax
-can be sliding or fixed

Question 3

What are the imaging findings in a hiatal hernia?

Answer 3

*caudal mediastinal structure in area of esophagus
-at margin of diaphragm
-soft tissue opacity +/- gas

*may appear continuous with the stomach
*may disappear if sliding

Question 4

What is shown in this image?

Answer 4

hiatal hernia (feline)

Question 5

What are the imaging findings in acute gastric dilation?

Answer 5

-stomach is primarily gas distended
-stomach remains in normal position
-must recognize location of pylorus via right and left lateral views to evaluate

Question 6

What is shown in these images?

Answer 6

canine acute gastric dilation
-pylorus is still in the normal place; right and more ventral

Question 7

What are the imaging findings in acute gastric dilatation and volvulus?

Answer 7

*pylorus moves dorsally, cranially, and to the left
-greater curvature moves to right body wall
-may be accompanied by the spleen

*compartmentalization
-soft tissue band projected across lumen of the stomach; represents folding of distended organ
-can occur with GD or GDV

*small intestinal and esophageal dilation

Question 8

What is shown in these images?

Answer 8

gastric dilatation and volvulus
-“popeye arm” or “smurf hat”
-pylorus has moved dorsally and cranially; not seen well on VD view
-compartmentalization band seen
-pylorus is gas-filled on right lateral view

Question 9

What are the imaging findings in the case of gastric foreign body?

Answer 9

*opacity:
-soft tissue opaque foreign body vs other opacities
-can be difficult to differentiate from other ingesta if not fasted

*shape/texture:
-margins or pattern may suggest type of FB

*positional:
-can use existing gas in stomach as “contrast” to see if potential FB moves

*contrast study findings:
-filling defects
-residue
-mobile FB

Question 10

What is shown in these images?

Answer 10

canine gastric foreign body
-rock
-within fundus; can move and block pylorus

Question 11

What is shown in these images?

Answer 11

canine gastric foreign body
-rubber duck

Question 12

What are the possible etiologies of pyloric (gastric) outflow obstruction?

Answer 12

*acute:
-foreign body
-GDV

*chronic:
-pylorospasm (functional)
-narrowing

Question 13

What can cause narrowing of the pylorus?

Answer 13

-muscular hypertrophy
-inflammation, fibrosis, or scarring
-neoplasia

Question 14

What are the imaging findings in pyloric outflow obstruction?

Answer 14

-gastric distention with fluid and/or gas
-possible radiopaque foreign body or mass
-gravel sign possible if chronic

Question 15

What are the ultrasound findings in pyloric outflow obstruction?

Answer 15

-possible mural thickening
-possible mass

Question 16

What are the contrast study findings in pyloric outflow obstruction?

Answer 16

-delayed gastric emptying
-possible narrowing or filling defect in pyloric outflow tract

Question 17

What is shown in these images?

Answer 17

canine acute gastric outflow obstruction:
-stomach slightly distended with fluid and gas
-hard to see stomach margins

Question 18

What is shown in this image?

Answer 18

canine acute gastric outflow obstruction:
-can see object/mass within the pylorus

Question 19

What is shown in these images?

Answer 19

canine chronic gastric outflow obstruction:
-stomach distended with gas and fluid
-nothing sitting in/blocking pylorus
-gravel sign

Question 20

What is shown in the image on the left?

Answer 20

canine chronic pyloric obstruction due to hypertrophic stenosis

Question 21

What are the imaging findings in the event of gastric neoplasia?

Answer 21

-mass extending into the lumen
-wall thickening
-defects seen on multiple radiograph views

Question 22

What are the ultrasound findings in gastric neoplasia?

Answer 22

-mass
-altered wall layering or loss of wall layering

Question 23

What are the contrast study findings in gastric neoplasia?

Answer 23

-filling defect
-mass
-focal wall thickening

Question 24

What is shown in these images?

Answer 24

canine gastric lymphoma
-infiltrative lesion throughout entire stomach and small intestinal wall

Question 25

What is shown in these images?

Answer 25

canine gastric lymphoma -very thick gastric wall with very little in the lumen -dark appearance, but not anechoic like gas

Question 26

What is shown in these images?

Answer 26

canine gastric lymphoma -large mass within stomach

Question 27

What is shown in these images?

Answer 27

canine gastric leiomyoma -contrast not filling in region of the stomach

Question 28

What are the possible etiologies of gastrointestinal perforation?

Answer 28

-gastric neoplasia -NSAIDs -foreign body

Question 29

What are the imaging findings of GI perforation?

Answer 29

-peritoneal free gas -loss of detail/peritonitis -ulcer often present; may not see on rads

Question 30

What are the ultrasound findings of GI perforation?

Answer 30

*may see an ulcer -focal wall thickening with gas extending into wall -not seeing an ulcer does not rule it out *free gas that may or may not be evident on rads *surrounding free fluid or hyperechoic fat

Question 31

What are the potential pitfalls to using ultrasound to diagnosed GI perforation/ulcers?

Answer 31

-gas between rugal folds in stomach -normal peyer's patches in dudoenum

Question 32

What is shown in this image?

Answer 32

perforated gastric ulcer -free gas (especially over liver) -fluid streaking

Question 33

What is shown in this image?

Answer 33

gastric ulcer that is not yet perforated -can see small bubbles of gas going into the gastric wall