Foreign body

• Foreign Body

  • An object or material that is not made for consumption
  • Also call animals who make a habit of eating such things “garbage gut” animals
  • ○ Poster child is labrador retrievers
• Signs of a Foreign Body Obstruction

  • Typical
  • Profuse vomiting/inability to keep anything down
  • Consistent diarrhea, often with blood
  • Painful/hunched appearance
• Signs of a Foreign Body Obstruction

  • Typical
  • Significant inappetence/excessive drinking (polydipsia)
  • Lethargy Weight loss:
  • ○ More common in animals with 7 days or more of signs bloated / rigid abdomen
• Sign of a foreign body obstruction

  • Atypical
  • Intermittent vomiting or ability to keep water down but not food
  • Normal stools
• Sign of a foreign body obstruction

  • Atypical
  • No appearance of pain
  • Mild lethargy but otherwise bright and alert
• Why the owner is bringing them in

  • Age is NOT a contributing factor
  • Owner saw pet eat the object vs. unknown cause of clinical signs
  • Owners will often say their pet never eats anything inappropriate- DO NOT rule out an obstruction based on this
  • Just because an owner doesn’t see it, doesn’t mean it didn’t happen
• Why the owner is bringing them in

  • Most often that pet has been consistently vomiting/diarrhea for several days
  • ○ Some owners, especially with repeat offenders, will come in within 1-2 days, some will wait weeks
  • Painful, lack of appetite, and/or lethargy can be present without other signs
  • ○ These are often known as ADR cases- “ain’t doing right”
• Physical Exam Findings

  • Attitude ranges from BAR (bright, alert, response) to dull/limited response to stimuli
• Physical Exam Findings

  • +/- painful reaction when abdomen is palpated
  • Sometimes capable of feeling the foreign material depending on what it is
  • If painful, pet will flinch, wince, or try to bite
• Physical Exam Findings

  • In severe cases, pale gums are a possible finding
  • Tachycardia (fast heart rate) and tachypnea (fast breathing) are possible but not always present
• What do we do next?

  • Have to cover testing for differentials (other options for clinical signs)
  • Pancreatitis (inflamed pancreas), gastroenteritis, bacterial/viral GI infection, liver disease, diabetes mellitus, kidney disease, Addison’s disease, intussusception, neoplasia (cancer)
• What do we do next?

  • Most common plan of action is to do rads and bloodwork
  • Will do at least CBC/chemistry, but may do CPLi/FPLi (canine/feline pancreatic lipase snap test), urinalysis to quickly confirm diabetes +/- fructosamine level, resting cortisol level
  • An ultrasound may be necessary depending on what is found on other diagnostics
• What do we do next?

  • If rads are not conclusive, can do a barium study
  • Barium is a radiopaque liquid material safe for ingestion that helps map out the GI tract
  • If an obstruction is present, barium will get stuck in area
  • Do pre-administration rads, 30min post, and then every hour until barium is in the colon
  • Administration must be done with care- if aspirated, it will NOT be absorbed and can cause permanent damage
• Types of obstructions

  • Partial
  • Some material is too big to pass out of stomach and so will move in and out of way of material moving into duodenum
  • Other material, like fabric, or items with holes in them, will allow some water/stool to pass
• Types of obstructions

  • Full
  • No ingesta can pass through stomach or intestines
  • This can cause significant damage to the lining of the stomach and small intestines
  • If damage is too severe, parts of intestines may become necrotic
• Types of obstruction

  • Linear
  • Pet eats an object like string that is caught on something in the GI tract to impede movement but intestines keep attempting to move it along
  • Causes plication- ex: causes appearance like fabric on an elastic band of clothes
• Radiographic Findings

  • Lateral and VD are very important to have
  • Often see significant gas distension in stomach if object is there or BEFORE where the obstruction is in the small intestine
• Radiographic Findings

  • Lateral and VD are very important to have
  • If gas distension is 1.6 wider than height of L5 in dogs or 1.2 times wider of L2 in cats, good indication of mechanical ileus (stalled GI movement)
• Radiographic Findings

  • Lateral and VD are very important to have
  • Plication- c-shaped small intestine loops
  • Some objects are very obvious, others not so much
• Radiographic findings

  • Barium either gets absorbed by object (generally fabric) which shows shape, gets completely stopped, or only small amounts are passing
• What after radiographic findings?

  • 3 options
  • Conservation management
  • Endoscopic removal
  • surgical removal
• Conservative management

  If object appears to be moving, albeit slowly, can do conservative management of IV fluids, pain medication, and bland diet
• Endoscopic removal

  • If the object is still in the stomach and it is not fragile or dangerous for the esophagus, can do a less invasive route of removal with endoscope
  • Owner would need to take pet to a specialist as most GP do not have that equipment
• Surgical removal

  • Most common treatment out of 3
  • If not already done, bloodwork is performed to ensure pet is stable for anesthesia
• Surgical treatment (1)

  • An IV catheter is placed and IV fluids (isotonic) are started
  • Pet is then given pre-medication to begin sedation, then induction medications, and maintained on gas anesthesia
• Surgical treatment (2)

  • They’re shaved and cleaned on ventrum from xiphoid process to groin
  • Incision is done cranial to umbilicus to just cranial of pelvis
  • ALL of the abdomen is explored to check that other organs are norm
• Surgical treatment (3)

  • Intestines are ran from stomach to colon to find any foreign objects, and stomach is palpated
  • Small incision is made into stomach and/or intestines over object, avoiding major blood supplies
• Surgical treatment (4)

  • Material is removed and incision is closed with monofilament absorbable suture
  • In some cases, if the intestines have become necrotic, they have to be resected and then perform an anastomosis
• Surgical treatment (5)

  • Abdomen is flushed with sterile saline, incisions checked again, and then abdominal incision is close
• What can go wrong with surgical removal?

  • The type of object ingested may be very dangerous to remove for the pet and/or the surgeon (i.e. sharp metals or bone)
• What can go wrong with surgical removal?

  • It could cause necrosis to an area that is very hard to resect
  • Anastomosis of an area with a major blood supply or part of duodenum where the pancreatic and bile ducts are located
• What can go wrong with surgical removal?

  • Object, especially a linear foreign body, may require multiple incisions to remove to avoid causing worse tissue damage
• What can go wrong with surgical removal?

  • Dehiscence of incision(s)--> can lead to septic peritonitis
  • In severe cases, can lead to death
• What can go wrong with surgical removal?

  • Incisions damage blood supply to intestines and/or stomach causing necrosis later
  • A 2nd surgery will be required to remove the dead tissue
• What can go wrong with surgical removal?

  • Pet is not stable enough for surgery and has complications /arrests under anesthesia
• ADR- “ain’t doing right”, colloquial term for a sick animal with vague signs
• Analgesic medication= pain medication
• Anastomosis- joining of two sides of intestine, blood supply, or other body channels
• Dehiscence- opening of an incision or wound
• Differential diagnoses- other diseases on a list of possibilities based on the clinical signs