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22

Gastrointestinal Disease
Judith Hudson

Department of Clinical Sciences, College of Veterinary Medicine, Auburn, AL, USA

Esophageal disease can be acquired or congenital. In a study media instead of barium [2]. A small lesion could be missed
of 33 cats with esophageal disease, 28 cats had acquired because iodine adheres poorly to the esophageal mucosa.
disease: six cats with strictures, two with hiatal hernias and If iodinated contrast fails to demonstrate perforation,
secondary esophagitis, five with esophagitis secondary esophagography can be repeated using a small amount of
to gastritis, pancreatitis, gastroesophageal reflux, or trauma liquid barium, then barium paste to conclusively exclude
from an endotracheal tube, five with foreign bodies, five perforation.
with neoplasia, three with external compression, and four Remember that ionic contrast media should never be
with decreased motility. Congenital lesions included three used when aspiration is likely. A small amount of aspirated
vascular ring anomalies and two hiatal hernias with second- barium generally does not cause severe problems but a
ary esophagitis [1]. large amount is deadly. Make sure that if an esophagogas-
tric tube is used, the tube is placed correctly. If aspiration
occurs, the procedure should be stopped immediately.
22.1 Esophageal Disorders Some research has suggested that low osmolar nonionic
iodinated products can be used for bronchoscopy but no
22.1.1 Foreign Bodies product should be considered completely safe [4–6].

Radiopaque mineral or metallic foreign bodies can be seen
on survey radiography [2]. Some fluid‐opaque foreign bod- 22.1.2 Dysphagia and Motility Disorders
ies may be surrounded by air, causing them to be visible.
Blood vessels, nerves, and lymph nodes in the mediasti- Dysphagia and motility problems are usually diagnosed
num are all fluid opaque so that they are not normally visu- using contrast radiography preferably during fluoroscopy
alized as separate structures. Visualization of blood vessels (Figure 22.1). Barium is usually administered as a paste, a
or the outer esophageal wall can indicate free mediastinal liquid using a catheter‐tipped syringe, or as barium soaked
gas and suggests possible perforation of the esophagus. in kibble. Contrast should be administered carefully to
Some esophageal foreign bodies may even migrate into the avoid aspiration. Survey radiography should be performed
pleural space, resulting in pleural effusion. In these cases, prior to contrast radiography to evaluate the lungs and to
fluid opacity will be seen outside the margins of the lung check for evidence of disease such as visible radiopaque
and the lungs will be retracted away from the chest wall. foreign bodies or dilation of the esophagus. If the oral
Impending perforation is particularly likely when the phase is problematic, there will be retention of barium in
history suggests chronicity or if the object is irregular, the mouth and oropharynx but the pharyngeal and cri-
sharp, or large [3]. Large foreign bodies can cause perfora- copharyngeal stages will appear normal. When the phar-
tion even when smooth because of pressure necrosis that is yngeal or cricopharyngeal stages are abnormal, barium
exacerbated by peristaltic waves. If perforation is apparent may be seen refluxing into the nasopharynx, mouth, and
on survey radiography, contrast radiography is unneces- larynx [7].
sary. When the diagnosis is unclear, esophagography Few studies on dysphagia have been performed in cats
should be performed initially using iodinated contrast compared to dogs but one study described dysphagia in

Feline Diagnostic Imaging, First Edition. Edited by Merrilee Holland and Judith Hudson.
© 2020 John Wiley & Sons, Inc. Published 2020 by John Wiley & Sons, Inc.