CONTRAST RADIOGRAPHY OF THE OVINE GASTROINTESTINAL TRACT

Contrast radiography of the alimentary canal was conducted in six adult sheep with barium sulfate (70% W/V, 25–30 ml/kg). A period of 12 hours was adequate for opacification of most parts of the gastrointestinal tract. The presence of contrast medium in different parts of the alimentary canal was noted for as long as 60 hours. The right lateral view was adequate for visualization of most structures, but the typical laminar mucosal pattern of the omasum and the spiral mucosal folds of the abomasum were demonstrated better on the ventrodorsal view.     

SURVEY OF THE USE OF RADIOGRAPHY VS. ULTRASONOGRAPHY IN THE INVESTIGATION OF GASTROINTESTINAL FOREIGN BODIES IN SMALL ANIMALS

A question frequently asked by clinicians who are treating small animals suspected of having gastrointestinal foreign bodies is whether one imaging test such as survey radiography or ultrasonography is sufficient to make the diagnosis. A study was undertaken to try and answer this question. Survey abdominal radiography and ultrasonography was performed on 16 small animals (11 dogs, five cats) with clinical signs of an obstruction because of a confirmed gastrointestinal foreign body. The majority of the foreign bodies (14/16) were confirmed by surgical removal and were located in the small intestine. A gastric foreign body was retrieved endoscopically and a colonic foreign body was passed in the feces. Radiographically identifiable foreign bodies were evident in nine animals. Small intestinal overdistension was present radiographically in seven animals. Ultrasonography detected a foreign body in all 16 animals. The foreign bodies were identified by their distal acoustic shadowing and variable degrees of surface reflection. An intestinal perforation was detected sonographically but not radiographically. The value of additional sonographic findings including thickening of the gastrointestinal wall and loss of layering, free peritoneal fluid, and lymphadenopathy in these animals is discussed. The findings in this series suggest that in a small animal with a gastrointestinal foreign body, ultrasonography alone could be used to make the diagnosis and may be a more appropriate choice than survey radiography.     

USE OF IOHEXOL AS A GASTROINTESTINAL CONTRAST MEDIUM IN THE DOG

Iohexol was administered orally in five dogs. The dose, gastrointestinal (GI) transit time, appearance of mucosal patterns and side effects were studied. Three different doses (525, 700, 875 mgI/kg) were used in each dog at 1-week intervals. GI transit time was rapid. In each dose, gastric emptying commenced immediately after administration of the contrast medium, and was completed within 30–60 min with doses of 525–700 mgI/kg and 90–120 min with 875 mgI/kg. Large intestinal filling was observed within 60-90 min. In the majority of studies, the mucosal border appeared as a thin homogeneous halo of lucency surrounding the more opaque bowel lumen contents. The contrast intensity was not adequate with the lowest dose. The image quality did not deteriorate along the GI tract. No adverse reactions were found. Iohexol is an alternative GI contrast medium in the dog when contrast media are contraindicated.     

RADIOGRAPHIC GASTROINTESTINAL CONTRAST STUDY IN THE OSTRICH (STRUTHIO CAMELUS)

Ten gastrointestinal contrast studies were performed with barium on seven clinically healthy ostriches. Concentrations of 25-100% w/vol liquid barium sulfate at 7 and 10 ml/kg were administered by stomach tube after withholding food for 16 h. A 6-frame technique for left-to-right lateral views in standing and a 3-frame technique for the dorsoventral views in sternally recumbent adult ostriches were used for survey and contrast radiographs. Objectives were to describe the appearance of the normal gastrointestinal tract with contrast radiography and to provide a guideline for optimal dosage and concentration of barium sulfate as well as a reliable protocol for frequency of radiographs. Structures that were consistently identified included the esophagus, proventriculus, ventriculus, duodenum, jejunum, proximal, and distal rectum. Due to the superimposition of the remainder of the small intestine, individual components were difficult to differentiate. The caeca were inconsistently highlighted and only for a short time. The ventral pouch of the coprodeum never filled with contrast medium.     

IOHEXOL AS A GASTROINTESTINAL CONTRAST MEDIUM IN THE CAT

Iohexol was evaluated as a radiologic contrast medium in the gastrointestinal (GI) tract in cats. Three different doses (525, 700, 875 mg iodine/kg with an iodine concentration of 300 mg iodine/mL) diluted with tap water until a total volume of 10 ml/kg, were administered via an orogastric tube, to 5 cats at weekly intervals. The GI transit time was rapid and variable. Gastric emptying commenced immediately after administration of the contrast medium and was complete within 10–30 min. In each dose, iohexol reached the large intestine within 10–20 min. In 73% (11/15) of studies, the mucosal border appeared as a thin homogeneous "halo" of lucency surrounding the more opaque contents of the small intestine. Radiographic image quality of the GI tract was inadequate with the lowest dose (525 mg iodine/kg). Image quality did not deteriorate along the GI tract. Absorption of iohexol from the GI tract was observed in 40% (6/15) of examinations, where opacification of the urinary bladder was seen. No side effects were observed. lohexol should be considered as an alternative GI contrast medium in the cat when the use of other radiologic contrast media is contraindicated.     

CONTRAST RADIOGRAPHY OF THE LOWER URINARY TRACT IN THE MANAGEMENT OF OBSRUCTIVE UROLITHIASIS IN SMALL RUMINANTS AND SWINE

Contrast radiographic visualization of the small ruminant and porcine lower urinary tract is an infrequently used modality for the evaluation and management of obstructive urolithiasis. The administration of contrast medium through a tube cystostomy catheter used to divert urine flow until the resolution of the obstruction may provide an easy method to evaluate the status of the urethral obstruction. Contrast fluoroscopy is utilized to monitor and visualize therapeutic flushing of the urethra. A review of 26 patients seen at the Veterinary Medical Teaching Hospital suggested that among the radiographic techniques used, positive contrast normograde cystourethrography through the tube cystostomy catheter allowed the best visualization of the lower urinary tract structures and enabled assessment of the resolution of the obstructive lesion.     

EVALUATION OF IOHEXOL AS A GASTROINTESTINAL CONTRAST MEDIUM IN NORMAL CATS

The non-ionic, iodinated contrast medium, iohexol (240 mg I/ml) was evaluated as a gastrointestinal (GI) contrast medium in cats. Iohexol, both undiluted and diluted with tap water, was administered via a percutaneous endoscopically-placed gastrotomy (PEG) tube to 4 mature clinically normal cats. The dilution of contrast medium administered was 1:1, 1:2, and 1:3, and doses were 10 ml/kg and 5 ml/kg body weight. All combinations of dilution and dose of iohexol provided adequate visualization of the contrast medium column within the GI tract, and results were not significantly different than those observed using 30% w/v barium sulfate. Dehydration and diarrhea were not observed after contrast medium administration, but vomiting occurred within 15–30 minutes after administration of undiluted iohexol in all experimental cats. Renal opacification did not occur on exposures made through a 2 hour period, and dilution in transit was not apparent.     

RADIOGRAPHIC ANATOMY AND BARIUM SULFATE CONTRAST TRANSIT TIME OF THE GASTROINTESTINAL TRACT OF BEARDED DRAGONS (Pogona vitticeps)

The positive contrast gastrointestinal study is a common non‐invasive diagnostic technique that does not require anesthesia and enables good visualization of the digestive tract. Radiographic anatomy and reference intervals for gastrointestinal contrast transit time in inland bearded dragons (Pogona vitticeps) were established using seven animals administered 15 ml/kg of a 35% w/v suspension of barium by esophageal gavage. Dorso‐ventral and lateral radiographic views were performed at 0, 15, 30 min, 1, 2, 4, 6, 8, 12 h, and then every 12 h up to 96 h after barium administration. Gastric emptying was complete at a median time of 10 h (range 4–24 h). Median jejunum and small intestinal emptying times were 1 h (range 30 min–2 h) and 29 h (range 24–48 h), respectively. Median transit time for cecum was 10 h (range 8–12 h). Median time for contrast to reach the colon was 31 h (range 12–72 h) after administration. Results were compared to those obtained in other reptilian species. This technique appeared safe in fasted bearded dragons and would be clinically applicable in other lizard species.     

THE UPPER GASTROINTESTINAL EXAMINATION IN THE CAT: NORMAL RADIOGRAPHIC APPEARANCE USING POSITIVE CONTRAST MEDIUM

The normal radiographic appearance of the feline upper gastrointestinal (UGI) examination following oral administration of barium sulfate suspensions was described. Important findings included the minimal gastric air and small bowel gas present on survey abdominal radiographs. Gastric appearance was nearly constant. A normal duodenal pattern, referred to as a "string of pearls", was described. Small bowel lumen size was consistently less than 12 mm. Small bowel mucosal patterns varied widely. The most commonly identified normal radiographic UGI patterns in this study were found consistently in a group of 26 cats thought to be without gastrointestinal disease. Because of the consistency of observation of many radiographic patterns, rapid gastric emptying, and a short small bowel transit time, normal UGI examinations in the cat present a more constant appearance than in the dog, thus making them more valuable as well as easier to conduct.     

ULTRASONOGRAPHY OF GASTROINTESTINAL FOREIGN BODIES

The ultrasonographic findings of fourteen animals having gastrointestinal foreign bodies are presented. Ultrasonography confirmed the presence and location of foreign material within the gastrointestinal tract when radiographic findings were unclear. The acoustic patterns arising from each foreign body varied depending on its physical properties and interaction with the ultrasound beam. These patterns, some of which seemed characteristic for certain types of foreign bodies, and the associated findings of mechanical ileus, ascites, mesenteric lymph node enlargement and localized pancreatitis are discussed.     

EVALUATION OF THE GASTROINTESTINAL TRACT IN DOGS USING COMPUTED TOMOGRAPHY

Abdominal computed tomography (CT) studies of 19 dogs with no history or clinical signs of gastrointestinal disease, and two dogs with a histological diagnosis of gastrointestinal neoplasia were examined retrospectively. Gastrointestinal segments were evaluated subjectively for conspicuity, contrast enhancement, and wall layering after contrast medium administration. In dogs without gastrointestinal disease, there were 62.8% of gastrointestinal segments (serosa to serosa) and 77.7% of gastrointestinal walls (serosa to mucosa) visualized. Wall layering on postcontrast images was seen in 21.8% of gastrointestinal segments. There was significant association between gastrointestinal diameter and wall thickness. There was significant association between weight and gastrointestinal wall thickness in the following regions: gastric fundus, gastric body, gastric pylorus, gastric pyloric antrum, duodenal cranial flexure, jejunum and ascending colon, and between patient weight and gastrointestinal diameter in cranial duodenal flexure, descending duodenum, transverse duodenum, ascending duodenum, and jejunum. Measurements acquired from CT studies correlated well with previously published normal reference ranges for radiographic and ultrasonographic studies. Gastrointestinal neoplasia, diagnosed in two dogs, had a gastrointestinal wall thickness greater than the range of the dogs without gastrointestinal disease. Computed tomography offers identification of the gastrointestinal tract segments in dogs, allows for evaluation of gastrointestinal diameter and aids in investigation of gastrointestinal wall thickness.     

SONOGRAPHY OF THE NORMAL FELINE GASTROINTESTINAL TRACT

The normal sonographic appearance of the stomach in various degrees of distension, the duodenum, the small intestine, and the large intestine was determined in awake and sedated cats. The mean stomach rugal fold thickness was 4.38 mm, and the interrugal thickness was 2.03 mm. No significant difference in stomach wall thickness was seen when the stomach was empty, half full, or full. The duodenal wall thickness was significantly greater than other parts of the small intestine, and this difference was accentuated by sedation (awake mean 2.4 mm; sedated mean 2.71 mm). The mean small intestinal wall thickness was 2.1 mm, and the mean colonic wall thickness was 1.67 mm. The five characteristic sonographic layers similar to that seen in the gastrointestinal tract of other species were routinely identified at all regions of the feline gastrointestinal tract.     

RADIOGRAPHY AND IMAGE-INTENSIFIED FLUOROSCOPY OF BARIUM PASSAGE THROUGH THE GASTROINTESTINAL TRACT IN SIX HEALTHY AMAZON PARROTS (AMAZONA AESTIVA)

Gastrointestinal contrast studies were performed in six clinically healthy blue-fronted Amazon parrots (Amazona aestiva) using radiography and image-intensified fluoroscopy. During examination, the birds were confined in a perspex cage. The quality of the lateral radiographs was adequate for assessment of the contrast medium-filled gastrointestinal tract. Thirty minutes after administration of 20 mL/kg of a 25% barium sulphate suspension directly in the crop, in all birds the ventriculus was totally outlined by barium. After 60 min, the small intestine was filled in five of six birds. After 180 min, the crop was empty in all birds. The barium-outlined ventriculus had differences in shape on radiographs of individual birds and also between birds. The colon and cloaca had further filling after 120 to 300 min. With image-intensified fluoroscopy, gastrointestinal motility was evaluated. Contractions of the crop were seen, and boluses of contrast medium passing through the esophagus toward the proventriculus were easily identified. Proventricular contractions were rarely noted, but ventriculus motility was present and clearly defined. The ventriculus had a mean of 3.7 contraction cycles/min. In the duodenum and small intestine, rapid antegrade and retrograde peristaltic movements in combination with segmental contractions were seen. In the colon, occasionally very slow peristaltic activity, mainly of segmental nature, was present. During the examinations, no defeacation was recorded. Confinement in a small perspex cage provides an adequate and handy radiological set-up for evaluation of gastrointestinal passage and motility in birds, minimizing the influences of stress and anesthesia.     

NEGATIVE CONTRAST PERITONEOGRAPHY IN THE HORSE

A method of negative contrast peritoneography using CO₂ peritoneal insufflation technique was investigated in adult horses. Radiographic visualization of anatomic structures in the dorsal abdomen, including the kidneys, portions of the spleen and liver, dorsal stomach and mesenteric root region, was enhanced. Visualization of ventral abdominal structures was not enhanced. Negative contrast peritoneography allowed reduction in the radiographic technique from 140 kVp and 40 mAs before insufflation to 100 kVp and 5–10 mAs following insufflation. The technique was easily and safely performed with minimal patient discomfort and risk.     

ULTRASONOGRAPHY OF THE NORMAL CANINE GASTROINTESTINAL TRACT

The normal sonographic appearance of stomach, small bowel, and colon was determined in normal dogs of small, medium, and large breeds. In all dogs studied, the stomach wall ranged from 3 mm to 5 mm in thickness, and the small and large bowel wall ranged from 2 mm to 3 mm in thickness. Peristalsis was routinely observed in the stomach and small bowel, but not in the colon. Ultrasonic identification of five gastrointestinal wall layers corresponding to the mucosal surface, mucosa, submucosa, muscularis propria, and subserosa/serosa was possible. Specific segments of the gastrointestinal (GI) tract were isolated and scanned in a water bath. In one dog, ultrasonic and histologic findings were compared and confirmed the anatomical identification found with ultrasound. Similarities and differences between the ultrasonic appearance of the GI tract of humans and small animals are discussed.     

DIAGNOSIS OF COMMON CONGENITAL HEART ANOMALIES IN THE DOG USING SURVEY AND NONSELECTIVE CONTRAST RADIOGRAPHY

The most common canine congenital heart anomalies include patient ductus arteriosus, ventricular septal defects, tetralogy of Fallot, pulmonic stenosis, and aortic stenosis. Survey radiography and nonselective (venous) angiography can allow the practicing veterinarian to confirm the diagnosis in many of these patients. Typical radiographic findings using these diagnostic procedures are reviewed. Nonselective angiocardiography is a relatively easy, rapid, and noninvasive procedure which can be performed using conventional equipment. The major disadvantage of this special procedure is that the superimposition of opacified structures can make the identification of some left-to-right shunts difficult. Dilution of contrast medium can occur if a rapid bolus injection is not made.     

COMPARATIVE ORGAN IMAGING: THE GASTROINTESTINAL TRACT

Diagnostic radiology of the esophagus, stomach, small and large intestine, mesentery, and pancreas is reviewed. Survey and contrast radiography remain the principal imaging methods used to evaluate gastrointestinal diseases in animals. Of the other imaging techniques, scintigraphy has potential in assessment of esophageal and gastric motility disorders, and detection of intestinal hemorrhage. Ultrasonography is useful for imaging the pancreas and gastrointestinal mass lesions.     

EFFECT OF SEDATION ON TRANSIT TIME OF FELINE GASTROINTESTINAL CONTRAST STUDIES

The effect of commonly used sedatives on gastrointestinal motility and transit time in cats was evaluated using barium sulfate in gastrointestinal contrast studies. Control studies were performed in nonsedated animals, and the results were compared with those obtained from each of five sedation studies (ANOVA; p < 0.05). The ketamine/acepromazine transit time (18 minutes) was shortened significantly compared with the control group (42 minutes), and both ketamine/acepromazine and ketamine alone resulted in significant increase in the number of gastric contractions. The level of sedation was evaluated subjectively and compared with the transit times to determine a chemical restraint method for potential clinical use that would have the least effect on transit time and motility yet provide adequate sedation. When sedation is necessary and motility is not a primary concern, the ketamine/acepromazine combination if recommended. If a gastrointestinal motility problem is suspected, the ketamine/valium combination should be used.