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ATE2653L Summer 2009

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contrast study

Contrast Study

ATE 2653L

Summer 2009

Lauren Keller

day 1 history
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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!”