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ATE2653L Summer 2009

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Contrast Study

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Contrast study l.jpg

Contrast Study

ATE 2653L

Summer 2009

Lauren Keller


Jackson 10 month old male neutered great dane l.jpg

Jackson10 month oldMale Neutered Great Dane


Day 1 history l.jpg

Day 1 - History

  • Chief Complaint

    • Patient presents to the clinic for pacing, dry heaving and vomiting

  • Vitals

    • Weight: 115.4#; 52.45kg

    • Temperature: 102.9°f (slightly elevated)

    • Heartrate: 120 bpm; strong pulses

    • MM pink; CRT < 2 seconds


Day 1 diagnostics l.jpg

Day 1 - Diagnostics

  • Patient is sedated with 1ml valium IV

    • Sedation did not work – patient was still very agitated/restless

  • Critique

    • Positioning

      • Ok – he was too large to include the entire abdomen

    • Landmarks

      • He was too big to fit on one large plate so the veterinarian suggested focusing on the cranial abdomen

    • Collimation

      • ok – there wasn’t much space for collimation due to patient size

    • Technique

      • Contrast and detail are much better than shown in the picture

    • Markers/Labels

      • A patient label is present but I covered it to ensure patient confidentiality

      • The left marker is not present

  • Conclusion

    • Unremarkable - NSF

  • Lateral Abdominal Radiograph


    Day 1 differential treatment l.jpg

    Day 1 – Differential & Treatment

    • Rule out GI foreign body, Decreased GI motility, Bloat

    • The owners opted for conservative treatment for the time being

    • Medications

      • 2.6 ml famotadine given SQ

      • 6 ml Cerenia given SQ

      • 500 mls lactated ringers given SQ

      • No medications were sent home with the patient


    Day 2 history l.jpg

    Day 2 – History

    • Chief Complaint

      • Patient still seems very nauseous – swallowing, licking, drooling

      • Lethargic

      • Pacing

    • Vitals

      • Weight: 114#; 51.8kg

      • Temperature: 103.1°f (slightly elevated)

      • Heart rate: 124bpm; strong pulses

      • MM pink; CRT < 2 sec; gums slightly tachy

    • Physical Exam

      • Non-painful abdomen

      • Rectum full of formed stool

      • No other significant findings


    Day 2 diagnostics treatment l.jpg

    Day 2 – Diagnostics & Treatment

    • Blood is drawn and sent to the lab to run amylase and lipase levels

    • Results

      • Amylase 762 U/L (300-1000) – WNL

      • Lipase 65 U/L (30-150) – WNL

    • Medications Dispensed

      • Carafate 1g – crush 1 tab in water and give by mouth 30 minutes prior to pepcid for 5 days

      • OTC Pepcid 10mg – give 1 tablet by mouth 30 minutes after carafate for 5 days


    Day 4 history l.jpg

    Day 4 - History

    • Chief Complaint

      • Patient vomited 3 times overnight – food & bile

      • Patient is eating and drinking but decreased amounts

      • Very restless – stretching, yawning, licking lips, pacing every 10 minutes

      • No bowel movement since day 1

    • Vitals

      • Weight: 115#; 52.3kg

      • Temperature: 102.4°f

      • Heart rate: 136bpm; strong pulses

      • MM pink & moist; CRT < 2 sec

    • Physical Exam

      • Non-painful abdomen

      • Rectal - NSF

      • BCS 5/9


    Day 4 diagnostics l.jpg

    Day 4 - Diagnostics

    • Patient much more cooperative today

    • Critique

      • Positioning

        • Ok – he was too large to include the entire abdomen

      • Landmarks

        • He was too big to fit on one large plate so the veterinarian suggested focusing on the mid abdomen

      • Collimation

        • ok – there wasn’t much space for collimation due to patient size

      • Technique

        • Contrast and detail are much better than shown in the picture

      • Markers/Labels

        • A patient label is present but I covered it to ensure patient confidentiality

        • The left marker is not present

    • Conclusion

      • V/D recommended due to pearl appearance mid, ventral abdomen

    Lateral Abdominal Radiograph


    Day 4 diagnostics cont l.jpg

    Day 4 – Diagnostics Cont.

    • Patient was not cooperative for this position

    • Critique

      • Positioning

        • Ok – he was too large to include the entire abdomen, should have included more caudal abdomen

      • Landmarks

        • Bad – could have been tighter

      • Collimation

        • Bad – could have been tighter

      • Technique

        • Patient was not at all cooperative – radiograph is very blurry

      • Markers/Labels

        • A patient label is present but I covered it to ensure patient confidentiality

    • Conclusion

      • Radiograph not diagnostically significant due to patient movement

      • Recommend barium series – owner to return next morning for barium series

    V/D Abdomen

    L


    Day 5 barium series l.jpg

    Day 5 – Barium Series

    • Chief Complaint

      • Patient vomited multiple times overnight – food & bile

      • Patient is eating and drinking but decreased amounts

      • Still no bowel movement

    • Vitals

      • Weight: 115#; 52.3kg

      • Temperature: 102.4°f

      • Heart rate: 136bpm; strong pulses

      • MM pink & moist; CRT < 2 sec

    • Physical Exam

      • Non-painful abdomen

      • Rectal - NSF

      • BCS 5/9

    • Patient is given 575mls barium mixed with PVD Canned EN by mouth


    Barium series pre barium l.jpg

    Barium Series – Pre Barium

    • Critique

      • Positioning

        • Ok – he was too large to include the entire abdomen

      • Landmarks

        • He was too big to fit on one large plate so the veterinarian suggested focusing on the cranial abdomen

      • Collimation

        • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter ventrally

      • Technique

        • Good – contrast and detail well defined

      • Markers/Labels

        • A patient label is present but I covered it to ensure patient confidentiality

    • Conclusion

      • Air in stomach (FYI: patient had gastropexy done at time of neuter)

      • Pearling still present at ventral mid abdomen

    L


    Barium series 0 minutes l.jpg

    Barium Series – 0 Minutes

    • Critique

      • Positioning

        • Ok – he was too large to include the entire abdomen

      • Landmarks

        • He was too big to fit on one large plate so the veterinarian suggested focusing on the cranial abdomen

      • Collimation

        • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter dorsally

      • Technique

        • Good – contrast and detail well defined

      • Markers/Labels

        • A patient label is present but I covered it to ensure patient confidentiality

        • Time of 0 minutes is recorded in upper right hand corner

    • Conclusion

      • Stomach large and full of contrast

    L


    Barium series 15 minutes l.jpg

    Barium Series – 15 Minutes

    • Critique

      • Positioning

        • Ok – he was too large to include the entire abdomen; radiograph should have been slightly more caudal – more of the chest was included than necessary

      • Landmarks

        • He was too big to fit on one large plate so the veterinarian suggested focusing on the cranial abdomen

      • Collimation

        • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter venterally

      • Technique

        • Good – contrast and detail well defined

      • Markers/Labels

        • A patient label is present but I covered it to ensure patient confidentiality

        • Time of 15 minutes is recorded in lower left hand corner

    • Conclusion

      • Stomach large and full of contrast, slight movement into the small intestine

    L


    Barium series 30 minutes l.jpg

    Barium Series – 30 Minutes

    • Critique

      • Positioning

        • Ok – he was too large to include the entire abdomen; radiograph should have been slightly more cranial

      • Landmarks

        • He was too big to fit on one large plate so the veterinarian suggested focusing on the mid abdomen

      • Collimation

        • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter ventrally and dorsally

      • Technique

        • Good – contrast and detail well defined

      • Markers/Labels

        • A patient label is present but I covered it to ensure patient confidentiality

        • Time of 30 minutes is recorded in upper right hand corner

    • Conclusion

      • Stomach large and full of contrast, movement into the small intestine

    L


    Barium series 1 hour l.jpg

    Barium Series – 1 Hour

    • Patient began to resist restraint

    • Critique

      • Positioning

        • Ok – he was too large to include the entire abdomen; radiograph should have been slightly more cranial

      • Landmarks

        • He was too big to fit on one large plate so the veterinarian suggested focusing on the mid abdomen

      • Collimation

        • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter dorsally

      • Technique

        • Ok – radiograph is blurry due to patient movement

      • Markers/Labels

        • A patient label is present but I covered it to ensure patient confidentiality

        • Time of 1 hour is recorded in upper right hand corner

    • Conclusion

      • Movement of barium into the small intestine

    L


    Barium series 2 hours l.jpg

    Barium Series – 2 Hours

    • Patient much more relaxed for this radiograph

    • Critique

      • Positioning

        • Good – he was too large to include the entire abdomen but almost all the barium is included

      • Landmarks

        • He was too big to fit on one large plate

      • Collimation

        • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter dorsally and ventrally

      • Technique

        • Good – Detail and Contrast are well defined

      • Markers/Labels

        • A patient label is present but I covered it to ensure patient confidentiality

        • Time of 2 hours is recorded in upper right hand corner

    • Conclusion

      • Decrease size of stomach, movement through intestines

      • Decrease GI Transit Time

    L


    Barium series 4 hours l.jpg

    Barium Series – 4 Hours

    • Patient slightly resistant

    • Critique

      • Positioning

        • Good – he was too large to include the entire abdomen but all the barium is included

      • Landmarks

        • He was too big to fit on one large plate

      • Collimation

        • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter ventrally

      • Technique

        • OK – Detail and Contrast are defined but blurry due to patient movement

      • Markers/Labels

        • A patient label is present but I covered it to ensure patient confidentiality

        • Time of 4 hours is recorded in upper right hand corner

    • Conclusion

      • Barium moving into colon

    L


    Barium series 6 hours l.jpg

    Barium Series – 6 Hours

    • Patient slightly resistant

    • Critique

      • Positioning

        • Good – he was too large to include the entire abdomen but all the barium is included

      • Landmarks

        • He was too big to fit on one large plate

      • Collimation

        • ok – there wasn’t much space for collimation due to patient size; could have been slightly tighter ventrally

      • Technique

        • OK – Detail and Contrast are defined

      • Markers/Labels

        • A patient label is present but I covered it to ensure patient confidentiality

        • Time of 6 hours is recorded in upper right hand corner

    • Conclusion

      • Barium is in the colon; no evidence of a foreign body in the GI tract

      • Patient is to return next morning for 24 hour post barium

    L


    Day 5 treatments l.jpg

    Day 5 - Treatments

    • 2 ml metaclopramide given SQ

    • Recommend feeding Hills Science Diet W/D can food often and in small amounts

    • Dispense Metoclopramide 10mg – give 1 tab by mouth every 8 hours for 2 days (start tomorrow)


    Day 6 update l.jpg

    Day 6 – Update

    Clients called to cancel recheck appointment and let us know that Jackson had defecated a sock, along with A LOT of barium that morning and seemed much better!

    • This case continued to prove our clinic’s motto that, “Barium fixes everything!”


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