Collaborative Imaging: A Team-Based Approach Resolves Complex Gastric Distress

• Gastric distention; rule out functional ileus/atony secondary to pain or inflammation (gastritis, ulceration, peritonitis, pancreatitis).

• No gastric foreign material or outflow obstruction is identified on this study.

• Nasogastric tube placement to reduce distention and discomfort is recommended. 

• Continue medical management for nonspecific gastroenteritis.

• Consider snap cPLI testing to assess for pancreatitis, even if sonographically normal.

• If the patient continues to decline, consider barium study or abdominal CT.

INTERNIST'S CONCLUSIONS

• The previously identified ileal foreign body appears to have passed into the colon, with no current evidence of obstruction.
• The enlarged lymph nodes are likely reactive due to the previous foreign body obstruction and do not appear neoplastic.
• The stomach is diffusely enlarged with hypoechoic fluid, but no gastric foreign body or pyloric outflow obstruction is present at this time.

Prognosis

• The prognosis appears good. With supportive care, the patient is expected to improve. However, if clinical signs persist, further diagnostic interventions such as endoscopy or surgery may be warranted.

Recommendations

Supportive Care

• Continue supportive care, including monitoring of the patient’s stool for the passage of previously seen foreign material.
• Consider placing a nasogastric tube to decompress the stomach and start feeding a liquid diet to facilitate gastric motility.

Diagnostic Testing

• Submit a quantitative cPLI test to screen for possible occult pancreatitis, which may be contributing to the patient's gastritis.

Medications

• Recommend prokinetics such as erythromycin at a dosage of 0.5 to 1 mg/kg, administered either orally or IV every 8 hours.
• Initiate trickle feeding with a low-fat liquid diet to promote gastric motility.

Further Evaluation

• If the patient does not show improvement with supportive care, consider endoscopy or surgical intervention for biopsies of the stomach to evaluate for inflammatory diseases such as inflammatory bowel disease.

Collaborative Approach in action

This case exemplifies the synergy between veterinary imaging and clinical

expertise. 

• Multi-Modality Approach: Integrating ultrasound and radiographic findings.
• Radiologist’s Precision: High-quality imaging and detailed analysis of subtle abnormalities.
• Internist’s Insight: Synthesis of imaging findings with the patient’s clinical presentation to highlight differential diagnoses, including possible functional gastric outflow obstruction. Recommended supportive care to alleviate gastric stasis, including nasogastric tube placement, prokinetics, and ongoing diagnostics to rule out pancreatitis or delayed gastric emptying.
• Outcome: A comprehensive care plan that empowered the referring veterinarian to confidently proceed with a clear treatment strategy. Early indications showed improvement, thanks to the combined efforts of SVS Imaging’s specialists and the referring veterinary emergency team.