False GI obstruction patterns

Nancy: I am hoping you could comment specifically on the chest rads ( esp the VD) + also the lateral abd view. There was heavy debate among us about the likelihood of intestinal obstruction -though surgery was not pursued that particular evening. Now- in hindsight + with abd scan-can see that there either was no obstruction, or it “resolved”(?)

“Rads showed an obstructive gas pattern that did not reveal obstruction on ultrasound.”

The image posted is a true obstruction which was not present in the case that is discussed. More on sonographic criteria for Gi obstruction may be found in our abstract from ecvim 2009 in Porto, Portugal on Articles page.

EL: Hi Nancy good question.

The radiographic gas pattern is abnormal because the dilation is 3x the penultimate rib width so yes abnormal and continuing from the duodenum and stomach gas so likely either just a moment in time that may have moved through later or sometimes when generalized malaise occurs and potential dehydration, even minor, the GI acts like a shock organ and blood flow is shunted away from it. When this happens the GI messes with your head by just not functioning right and having focal or multifocal or complete ileus or partial ileus. That may be what was happening here.

Then you rehydrate the patient and everything starts kicking in again and what was abnormal before is likely not persistently there. This is why I always like to check for an obstructive pattern on ultrasound when the patient has been at least partially rehydrated so I know that shock bowel is less of an issue and streamlines the interpretation better. And of course barium  (god forbid:)) works the same way and can be hung up artificially in shock bowel cases and make you think there is an obstruction leading to an empty exploratory. This issue is even more frequent if underlying disease is present like chronic IBD or LSA or similar because diseased tissue is practically narcoleptic in this regard.  It really needs some fuel to work well and is the first part of the GI to fail to do its job.

If a GI case animal is sick enough to bring into the hospital.. anorexia 2 days and it isn’t from pain then they are usually at least 5% dehydrated so depends on the case. I am a big fan of rapid volume restitution initially first few hours then backing down for the reassessment. The GI motility usually kicks in if the GI shutdown and/or obstructive pattern is just metabolic within 5-6 hours or so. So if coming in at 10 am then by 3-4 pm you can reassess. If anorexia is owing to pain like a back or something then Iv lidocaine drip or aggressive pain management can help do the same thing because the GI will shut down on pain as well in a similar manner.

Best regards,
Eric Lindquist DMV (Italy) DABVP
Cert. IVUSS
Director SE NJ Mobile Associates, Founder/CEO SonoPath.com
“Make every obstacle an opportunity.” — Lance Armstrong