Sharp FB in colon - what would you do?

Re: Sharp FB in colon - what would you do?

grumpyoldman — Thu, 11 Jun 2015 10:07:35 GMT

your both right : and concious rads in a good dog is fine but they are not all that good , I employ 14 young ladies of child bearing age and two young men who possibly also have aspirations in that direction, probably should book them a cheap monarch flight to tenerife in July surrounded by People travelling with hungry 2 year olds from Manchester at 6am, 4 hours of abject torture, I will probably find them all lying under the main beam .

Re: Sharp FB in colon - what would you do?

Hannah Wynne Richards — Thu, 11 Jun 2015 08:54:04 GMT

Sedation would slow intestinal motility, and I think grumpyoldman is probably worried about concious radiography, due to the dangers to women of reproductive age (even if gowned) I won't allow anyone else to be in the room during concious rads - and my ovaries succumbed to anno domini years ago!

Wynne

Re: Sharp FB in colon - what would you do?

Evelyn Barbour-Hill — Thu, 11 Jun 2015 00:57:04 GMT

[quote user="grumpyoldman"] its helpful sometimes I guess its the problem with health and safety and getting a series without repeated sedation . [/quote]

I'm sorry, I don't see a health and safety problem. Can you explain? And I've never used repeated sedation, that I can recall.

Re: Sharp FB in colon - what would you do?

grumpyoldman — Wed, 10 Jun 2015 23:59:53 GMT

[quote user="Hannah Wynne Richards"] Especially if given barium - followed by careful surgery.[/quote][quote user="Hannah Wynne Richards"] Especially if given barium - followed by careful surgery.[/quote]

we used to use it a lot ,but it seemed to fall out of favour in the late 90s probably as ultrasound became more available , its helpful sometimes I guess its the problem with health and safety and getting a series without repeated sedation .

Re: Sharp FB in colon - what would you do?

Hannah Wynne Richards — Wed, 10 Jun 2015 18:39:52 GMT

Especially if given barium - followed by careful surgery.

Wynne

Re: Sharp FB in colon - what would you do?

Evelyn Barbour-Hill — Wed, 10 Jun 2015 18:37:30 GMT

[quote user="grumpyoldman"]There was an article in a recent JSAP which said that unltrasound diagnosis of intussception and other intestinal disasters was only 57% reliable in the hands of ultrasound gurus which is probably about the same as my fingers .[/quote]

Hmm........ what are the rates of false positive and false negative in diagnosis of intussusception by radiography? Pretty low, as I recall.

Re: Sharp FB in colon - what would you do?

grumpyoldman — Wed, 10 Jun 2015 16:42:21 GMT

I think you can not really be criticised for doing an Ex Lap if you have X-ray changes or a history of waxing and waning illness , if nothing else you and your client will have peace of mind and you may get some biopsies . I hummed and har-ed for a few days over a boxer a few weeks ago and had what I thought was an unrewarding Ex lap but the duodenal biopsies sent for rapid histo came back as Alimentary lymphoma . We also recently opened up a Doberman with a 2d puo and vague peritonitis /peritoneal pain but still eating . It had a free floating cocktail stick and two lower bowel perforations , it unexpectedly survived and did extremely well ,but those sort of cases just survive to make you look like a pessimistic old fart to the owners.

There was an article in a recent JSAP which said that unltrasound diagnosis of intussception and other intestinal disasters was only 57% reliable in the hands of ultrasound gurus which is probably about the same as my fingers .....so "always trust in Allah but tie up your camel" and have a look inside.

Re: Sharp FB in colon - what would you do?

Evelyn Barbour-Hill — Sun, 07 Jun 2015 16:09:37 GMT

[quote user="Gillian Mostyn"]

OK. What time scale are you looking at for the barium getting to the colon, if the colon is blocked? I suppose I assumed it would take too long while the dog's getting sicker?

[/quote]

2 to 4 hours, about, usually. Maybe 5.

If the dog was so very ill I wouldn't be taking this approach, of course.

Re: Sharp FB in colon - what would you do?

Silvia Maldonado — Sun, 07 Jun 2015 03:18:35 GMT

Not only that there is a much better prognosis when it has already reached the large intestines, but also we know that the irrigation is much poorer that in small intestines and, therefore, any surgical approach would have been more risky. I would have also considered that, but I hand up with those who would not have gone into surgery at that point.

Re: Sharp FB in colon - what would you do?

Rob Davis — Tue, 02 Jun 2015 11:45:12 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Rob Davis"]

[quote user="Anthony Todd"]Don't people palpate abdomens these days?[/quote]

This is the sort of comment which has got folk riled on the other thread about forum clinical discussions. I have been on here long enough to take these comments from you with a pinch of salt, but I can see how others, particularly those new to the forums or with less clinical experience, could be put off posting.

I agree that the simple skills are sometimes forgotten, but there are more gentle ways of saying this.

[/quote]

Oh, come on, Anthony didn't post that as a reply to an OP seeking help, or to a newbie. It's a comment I've also made in the past at what seemed an appropriate point. It's a comment worth making.

The thing about a skill such as palpation is that the more you do, the better you get, lifelong; and you have to keep doing it to maintain your skill.

[/quote]

I totally agree that it is a point worth making. It was the way in which the point was raised which has the potential to cause offense. As it turns out, palpation obviously had already been done. If everybody wrote down everything in every clinical post we'd never have time to read them all.

Re: Sharp FB in colon - what would you do?

Gillian Mostyn — Tue, 02 Jun 2015 07:54:56 GMT

OK. What time scale are you looking at for the barium getting to the colon, if the colon is blocked? I suppose I assumed it would take too long while the dog's getting sicker?

Re: Sharp FB in colon - what would you do?

Evelyn Barbour-Hill — Mon, 01 Jun 2015 22:52:11 GMT

[quote user="Gillian Mostyn"]

[quote user="Evelyn Barbour-Hill"] And a bit of barium shows it up on Xray.[/quote]

I assume you mean a barium enema, rather than orally? I rarely use barium but that does sound like a good idea for diagnosis of a colonic FB. Does it cause a problem if you later need to do surgery?

[/quote]

I meant per os. If there's a slightly incomplete obstruction anywhere in the tract, the barium coats the foreign body and often enables you to recognise it. And it tells you what the rest of the tract is like too. Barium per rectum in thes circumstances might just confirm that you've got an obstruction.

There's no problem if you later need to do surgery. If you are opening the gut, you need to take many precautions against spillage of its contents anyway.

Re: Sharp FB in colon - what would you do?

Anthony Todd — Mon, 01 Jun 2015 19:39:14 GMT

[quote user="Gillian Mostyn"]....yet you now say that it isn't always so easy to feel a FB?[/quote]

No, but if you don't practise you won't get to Carnegie Hall.....

Re: Sharp FB in colon - what would you do?

Evelyn Barbour-Hill — Mon, 01 Jun 2015 18:37:41 GMT

[quote user="Rob Davis"]

[quote user="Anthony Todd"]Don't people palpate abdomens these days?[/quote]

I agree that the simple skills are sometimes forgotten, but there are more gentle ways of saying this.

[/quote]

Oh, come on, Anthony didn't post that as a reply to an OP seeking help, or to a newbie. It's a comment I've also made in the past at what seemed an appropriate point. It's a comment worth making.

The thing about a skill such as palpation is that the more you do, the better you get, lifelong; and you have to keep doing it to maintain your skill.

Re: Sharp FB in colon - what would you do?

Gillian Mostyn — Mon, 01 Jun 2015 18:19:49 GMT

[quote user="Anthony Todd"]. Easy to feel.[/quote]

....yet you now say that it isn't always so easy to feel a FB?

Re: Sharp FB in colon - what would you do?

Anthony Todd — Mon, 01 Jun 2015 18:07:30 GMT

[quote user="Matt Hilary"]Or uncooperative! I've missed a huge splenic mass on abdominal palpation - dog was so tense all I could feel was muscle.[/quote]

Sure, and this is stuff that should reassure newbies, which is partly why I've been banging on,'cos I'm sure new graduates think that it's all so easy and so foolproof.

This is a touchy feelie "manual", profession, as is medicine and dentistry. How often has the expression on a dog's face told you there was an abdominal problem? How do you learn that with CPD?

It's also very good at creating client confidence if you can palpate an abdomen and pick up an FB, confirm by Xray and they're clients for life; have to X-ray it and they think you haven't a clue, or they used to.

Even just say "I'm suspicious of a FB" still earns you brownie points.

This is for the newbies who might lose faith in the forum..............

Re: Sharp FB in colon - what would you do?

Matt Hilary — Mon, 01 Jun 2015 18:00:39 GMT

[quote]It's amazing what you can miss if it's a fat animal.

Wynne[/quote]

Or uncooperative! I've missed a huge splenic mass on abdominal palpation - dog was so tense all I could feel was muscle.

Re: Sharp FB in colon - what would you do?

mariette asselbergs — Mon, 01 Jun 2015 17:54:26 GMT

Thanks Anthony, also I often do agree with you re the importance of simple clinical examination before all the fancy stuff, but then, so much of the fancy stuff is now so easily available (bedside EPOCs, inhouse blood tests - but who takes the time to study the good old Giemsa smear? - , ultrasound and digital x rays), it all makes life miles easier.

Mariette

Re: Sharp FB in colon - what would you do?

Hannah Wynne Richards — Mon, 01 Jun 2015 17:20:42 GMT

It's amazing what you can miss if it's a fat animal.

Wynne

Re: Sharp FB in colon - what would you do?

Anthony Todd — Mon, 01 Jun 2015 17:16:06 GMT

[quote user="mariette asselbergs"]Of course I palpated, classical labrador with chunky abdomen and certainly not possible to palpate this 1 1/2 inch diameter corncob which could just as well have been a chunk of hard faeces.[/quote]

Sorry again, wrong again, that's me not you.

Re: Sharp FB in colon - what would you do?

bob lehner — Mon, 01 Jun 2015 17:14:28 GMT

[quote user="mariette asselbergs"] Also I was a bit shocked to see how something relatively soft pre-eating can turn hard and nasty once been incubated in GE juices[/quote]

Agree - I saw an odd one last week -lab with intestinal fb - on removal it was a lump of inspissated vegetable-origin material. On very close examination and dissection it appeared to be a whole baked potato...!

I've never seen that before (seen lots of corn cobs) - and would have thought it would have been broken down in the stomach.

Re abdo palpation - I think any experienced vet would agree that it is a very inexact science - e.g. the classsic big, fat labrador - palpate one day - nothing felt - next day something obvious. (The case above was a good example - palpated on day one by a very thorough and experienced v.s. - nad - next day obvious mass palpable). Deep chested dog - things hide behind the rib cage and then maybe move onwards.

[quote user="Gillian Mostyn"]I assume you mean a barium enema, rather than orally? I rarely use barium but that does sound like a good idea for diagnosis of a colonic FB. Does it cause a problem if you later need to do surgery?[/quote]

Re question on barium - I would often use it if in doubt re a f.b - per os or enema - but p.o. by choice. Don't believe it's an issue if you then go onto surgery - laparotomy towels and lavage should avoid any probs. Possibly not a good idea if you think there may be a bowel rupture - but that's pretty rare.

Re: Sharp FB in colon - what would you do?

mariette asselbergs — Mon, 01 Jun 2015 16:42:15 GMT

[quote user="Anthony Todd"]

[quote user="mariette asselbergs"]

Yes what to do with a sharp fb in a colon?

I had a labrador in last weekend, 3 years old, known to eat socks and underwear which always passed, now vomiting and increasingly getting sad and uncomfortable for 48 hours, owner on holliday, dog with parents. X rays gas filled intestines up to a sudden stop after the caecum. Did a laparotomy and found two lumps of very hard material with sharp sticking out points stuck in the colon. I know it is not wise to open up the colon if not absolutely necessary and tried initially if I could milk them through but it felt and looked too traumatising and risky and so I did operate and it turned out to be corncobs which for some reason in the guts had turned into very hard spiky lumps. My own dog normally loves them and we used to give them to her to chew up, but no longer! Fortunately all went well, but ot was very helpful to read the contributions on this forum.Mariette

[/quote]

Not being rude or nasty and with the greatest respect and gentility, and I know you're not sensitive, but did you feel the hard material with sharp sticking out points somewhere in the abdomen when you palpated it because you didn't mention it in your post and I'm told by others much more experienced than I that it's easy to forget to do this?

Everyone happy now?

[/quote]

Of course I palpated, classical labrador with chunky abdomen and certainly not possible to palpate this 1 1/2 inch diameter corncob which could just as well have been a chunk of hard faeces. I didn't give all the details of the clinical exam because my main question was: colonic fb, milk it or remove it? Also I was a bit shocked to see how something relatively soft pre-eating can turn hard and nasty once been incubated in GE juices. So just thought to share this.

Mariette

Re: Sharp FB in colon - what would you do?

Kate Richardson — Mon, 01 Jun 2015 16:40:56 GMT

[quote user="Gillian Mostyn"]

[quote user="Anthony Todd"]Skins are always swabbed or scraped, bloods are taken often even for simple diarrhoeas, Xrays and ultrasounds always for abdomens, and palpation and visualisation hardly ever mentioned so I think I have a reason to mention it[/quote]

From what I see, and have seen, in first opinion practice every day over the last 16 years, I have to disagree.

However, based on the case load posted on this forum, I would agree with you.

I do hope you're not basing your assumptions on how 'modern vets treat animals' on the UNUSUAL cases people ask about online?

[/quote]

100% agree Gillian, I think it's safe to assume that abdomens are palpated and if not mentioned that there was nothing abnormal to find. Most recent grads I have worked with probably do a more thorough examination than I do sometimes! I think your opinion Anthony, may be being swayed by the cases posted on here, as Gillian quite right points out, unusual ones

Re: Sharp FB in colon - what would you do?

Gillian Mostyn — Mon, 01 Jun 2015 16:28:49 GMT

From what I see, and have seen, in first opinion practice every day over the last 16 years, I have to disagree.

However, based on the case load posted on this forum, I would agree with you.

I do hope you're not basing your assumptions on how 'modern vets treat animals' on the UNUSUAL cases people ask about online?

Re: Sharp FB in colon - what would you do?

Anthony Todd — Mon, 01 Jun 2015 16:24:28 GMT

[quote user="Gillian Mostyn"] maybe you could give someone the benefit of the doubt and assume there is a good reason.....???[/quote]

Yes, fair enough, but you've got to admit that the modern approach is to rely muchly, or at least much more, only on ancillary aids as we see on almost every post on almost every thread; often the poster doesn't even mention the body temperature, let alone the impossibility, or whatever, of abdominal palpation.

Skins are always swabbed or scraped, bloods are taken often even for simple diarrhoeas, Xrays and ultrasounds always for abdomens, and palpation and visualisation hardly ever mentioned so I think I have a reason to mention it.

Corncobs are a classic example where palpation is vital and diagnostic, well, at least for an ex lap.