Abdominal and thoracic focused assessment with sonography for trauma, triage, and monitoring in small animals

Gregory R. Lisciandro, DVM, DABVP, DACVECC
Journal of Veterinary Emergency and Critical Care 21(2) 
2011. 

Objectives – To review the nonradiologist use of ultrasound (US) in the setting of emergency and critical care, the development, clinical applications, and standardization of veterinary abdominal and thoracic focused assessment with sonography for trauma (FAST) techniques.

Etiology – Since the 1990s, the 4-point FAST US technique has been used for injury surveillance in people with blunt and penetrating trauma. FAST screens for free fluid in the abdominal, pleural, and pericardial cavities with high sensitivity and specificity. More recently, an extended FAST scan was developed for the rapid detection of pneumothorax. These techniques and newly created scans have been applied to other critically ill, nontraumatized, subsets of human patients. As a result, the terminology related to this field, eg, extended FAST, HHFAST, FFAST, FAFF, BOAST, SLOH, bedside US, ‘$ Approach,’ protocols, and objectives have become convoluted despite having similar goals.

Diagnosis – The importance of US in the setting of emergency medicine is highlighted by the fact that this diagnostic modality has become an integral part of the core curriculum for nonradiologists including the American College of Surgeons, American College of Emergency Physicians, American Board of Emergency Medicine, Society of Academic Emergency Medicine, and all United States Accreditation Council for Graduate Medical Education Emergency Medicine residency programs.

Therapy – Veterinary applications of FAST techniques include an abdominal FAST technique with an abdominal FAST applied fluid scoring system, and a thoracic FAST technique. In an attempt to avoid the creation of numerous acronyms, veterinarians would be well served by making the ‘T’ in ‘FAST’ stand for ‘Trauma,’ ‘Triage,’ and ‘Tracking.’ Prognosis – These veterinary FAST techniques provide an extension of the physical examination for the emergency and critical care veterinarian potentially expediting diagnosis, prompting life-saving maneuvers, and guiding patient management. Further clinical research to determine sensitivity, specificity, and accuracy for specific conditions is warranted.

Enteropathogenic Bacteria in Dogs and Cats: Diagnosis, Epidemiology, Treatment, and Control

S.L. Marks, S.C. Rankin, B.A. Byrne, and J.S. Wee
J Vet Intern Med 2011;25:1195–120. 

2011.

This report offers a consensus opinion on the diagnosis, epidemiology, treatment, and control of the primary enteropathogenic bacteria in dogs and cats, with an emphasis on Clostridium difficile, Clostridium perfringens, Campylobacter spp., Salmonella spp., and Escherichia coli associated with granulomatous colitis in Boxers. Veterinarians are challenged when attempting to diagnose animals with suspected bacterial-associated diarrhea because well-scrutinized practice guidelines that provide objective recommendations for implementing fecal testing are lacking. This problem is compounded by similar isolation rates for putative bacterial enteropathogens in animals with and without diarrhea, and by the lack of consensus among veterinary diagnostic laboratories as to which diagnostic assays should be utilized. Most bacterial enteropathogens are associated with self-limiting diarrhea, and injudicious administration of antimicrobials could be more harmful than beneficial. Salmonella and Campylobacter are well-documented zoonoses, but antimicrobial administration is not routinely advocated in uncomplicated cases and supportive therapy is recommended. Basic practices of isolation, use of appropriate protective equipment, and proper cleaning and disinfection are the mainstays of control. Handwashing with soap and water is preferred over use of alcohol-based hand sanitizers because spores of C. difficile and C. perfringens are alcohol-resistant, but susceptible to bleach (1:10 to 1:20 dilution of regular household bleach) and accelerated hydrogen peroxide. The implementation of practice guidelines in combination with the integration of validated molecular-based testing and conventional testing is pivotal if we are to optimize the identification and management of enteropathogenic bacteria in dogs and cats

Ultrasound of the Gastrointestinal Tract

Martha Moon Larson, DVM, MS,
David S. Biller, DV

Vet Clin Small Anim 39 (2009) 747–759

Familiarity with the normal and abnormal ultrasound appearance of the canine and feline gastrointestinal (GI) tract provides a marked advantage in the diagnosis of GI disease. Although gas may inhibit complete visualization, in many cases, ultrasound is able to confirm or rule out suspected disease. It should be noted that ultrasound of the GI tract does not preclude the need for abdominal radiographs. The two imaging modalities are complementary, and each adds individual information. Ultrasound evaluation of the GI tract provides information about bowel wall thickness and layers, assessment of motility, and visualization of important adjacent structures such as lymph nodes and peritoneum. In the hands of experienced sonographers, abdominal ultrasound has replaced the need for GI contrast studies in many cases, saving time, money, radiation exposure, and stress to the patient.

Ultrasound of the Gastrointestinal Tract

Martha Moon Larson, DVM, MS, David S. Biller, DVM
Vet Clin Small Anim 39 (2009) 747–759

Familiarity with the normal and abnormal ultrasound appearance of the canine and feline gastrointestinal (GI) tract provides a marked advantage in the diagnosis of GI disease. Although gas may inhibit complete visualization, in many cases, ultrasound is able to confirm or rule out suspected disease. It should be noted that ultrasound of the GI tract does not preclude the need for abdominal radiographs. The two imaging modalities are complementary, and each adds individual information. Ultrasound evaluation of the GI tract provides information about bowel wall thickness and layers, assessment of motility, and visualization of important adjacent structures such as lymph nodes and peritoneum. In the hands of experienced sonographers, abdominal ultrasound has replaced the need for GI contrast studies in many cases, saving time, money, radiation exposure, and stress to the patient.

Complications of Gastrointestinal Surgery in Companion Animals

Gary W. Ellison, DVM, MS
Vet Clin Small Anim 41 (2011) 915–934. 

September 2011

The small animal surgeon routinely creates wounds in the gastrointestinal (GI) tract for biopsy, for foreign body or neoplasm removal for correction of gastric dilatation volvulus, or to relieve intestinal and colonic obstruction. Unlike dehiscence of a skin wound, which is often easily remedied with appropriate local wound treatment, dehiscence of a wound of the GI tract often leads to generalized bacterial peritonitis and potentially death. Consequently, technical failures and factors that negatively affect GI healing are of great clinical significance to the surgeon. Surgery of the GI tract must be considered clean-contaminated at best, and as one progresses aborally down the GI tract, the bacterial population increases. Therefore, intraoperative spillage, wound dehiscence, or perforations that occur in the lower small intestine or colon tend to be associated with a higher mortality rate than those of the stomach or upper small intestine.

Acute pancreatitis in dogs: a review article

I. Kalli, K. Adamama-Moraitou, T. S. Rallis
EJCAP - Vol. 19 - Issue 2 
October 2009

Canine acute pancreatitis is a relatively common disease, but it is often misdiagnosed. The most common causes of acute pancreatitis in dogs include malnutrition, drug administration, infection, trauma, refl ux of duodenum contents into the pancreatic duct and ischaemia. Idiopathic causes have also been encountered. The clinical signs of the disease are not specifi c and are often associated with a number of life-threatening, severe systemic complications. Despite the continuing new knowledge of pancreatic pathophysiology, the aetiopathogenesis of canine pancreatitis is still unclear and subsequently treatment is supportive.

Pathophysiology of diarrhoea

Theresa McCann BVSc CertSAM MRCVS
James W Simpson BVM&S MPhil MRCVS, RCVS 
UK Vet - Vol 11 No 5 
June 2006

Diarrhoea is one of the commonest presenting complaints seen in small animal practice and is associated with a large number of differential diagnoses. This paper will review the underlying pathophysiology of diarrhoea, an understanding of which will assist the clinician when investigating individual cases and their subsequent treatment.

Portal Hypertension: Pathophysiology, Diagnosis, and Treatment

S. Buob, A.N. Johnston, and 
C.R.L. Webster

J Vet Intern Med 

2011;25:169–18

Portal hypertension (PH) is the result of increased vascular resistance in the portal circulation, increased portal venous blood flow, or both. In veterinary medicine, where portal pressure is seldom measured directly, the diagnosis of PH often is inferred from identification of associated complications including multiple acquired portosystemic shunts, ascites, and hepatic encephalopathy. Likewise, treatment of PH primarily is aimed at controlling these complications. The goal of this review is to provide an update on the pathophysiology, diagnosis, and treatment of PH. The review draws from information in the veterinary hepatology literature, reviews, and consensus statements in human hepatology and the literature on experimental models of PH.

Laboratory Tests for Diagnosis of Gastrointestinal and Pancreatic Diseases

Olivier Dossin DVM, PhD, Dipl. ECVIM-C

Topics in Companion Animal Medicine
Volume 26, Issue 2 , Pages 86-97, May 2011

The panel of laboratory tests available for diagnosis of gastrointestinal (GI) diseases in dogs and cats is wide, and, recently, several new tests have been developed. This article will focus on advances in laboratory tests that are available for the general practitioner for diagnosis of GI diseases. Laboratory tests for diagnosis of gastric and intestinal infectious diseases include fecal parasite screening tests, enzyme-linked immunosorbent assays for parvoviral enteritis, and some specific bacterial tests like fluorescent in situ hybridization for identification of specific bacteria attached to the intestinal epithelial cells. Serum concentrations of folate and cobalamin are markers of intestinal absorption, but are also changed in exocrine pancreatic insufficiency and intestinal bacterial overgrowth. Hypocobalaminemia is common in GI and pancreatic disease. Decreased serum trypsin-like immunoreactivity is a very sensitive and specific test for the diagnosis of exocrine pancreatic insufficiency in dogs and cats. Serum pancreatic lipase is currently the most sensitive and specific test to identify pancreatic cell damage and acute pancreatitis. However, serum canine pancreas-specific lipase is less sensitive in canine chronic pancreatitis. Increased serum trypsin-like immunoreactivity is also specific for pancreatic damage but is less sensitive. It is very likely that further studies will help to better specify the role of these new tests in the diagnosis of canine and feline