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Enema: Evacuation or Retention 1099

including obtaining a retroflexed view to
visualize the gastric cardia. This maneuver U
VetBooks.ir tip such that the endoscope is seen emerging P
requires maximal flexion of the endoscope
through the cardia. Identify any mucosal
irregularities, masses, ulcers, or foreign bodies.
• Obtain multiple (6-12) biopsies of any
irregular structures and normal mucosa. Be P
cautious about taking a biopsy of deep gastric
ulcers, because this could cause perforation
of the stomach wall.
• Deflate the stomach before withdrawing the
endoscope into the esophagus.
• Deflate the esophagus while slowly continu-
ing to withdraw the endoscope from the
esophagus. Suction any fluid in the esophagus Procedures and Techniques
because it may be refluxed gastric acid that A B
can ulcerate the esophagus if left behind.
• Take the scope out of the animal, remove ENDOSCOPY, UPPER GI (GASTRODUODENOSCOPY) A, Endoscopic view of the normal pylorus (P).
the mouth gag, and recover the animal from B, Endoscopic view of the pylorus (P) and a large crater-like gastric ulcer (U).
anesthesia.
• More invasive, may be more costly, may be while the veterinarian controls the rest of
Postprocedure more time consuming the endoscope with both hands. This is
• This procedure is minimally invasive, and • More painful for the animal, longer recovery particularly the case with veterinarians new
analgesics are rarely required. time to the technology or during particularly
• Clean the endoscope (internal and external • Greater risk of peritonitis and incisional delicate portions of the procedure.
surfaces) immediately, before secretions and dehiscence
fluid have dried. • Unable to visualize the esophagus SUGGESTED READING
• Unable to visualize the mucosal surface of Tolbert MK: Gastrointestinal endoscopy. In Ettinger
Alternatives and Their stomach or intestines unless a gastrotomy SJ, et al, editors: Textbook of veterinary internal
Relative Merits or an enterotomy is performed medicine, ed 8, St. Louis, 2017, Elsevier.
Exploratory laparotomy:
• Large, full-thickness biopsies may be taken Pearls RELATED CLIENT EDUCATION
from anywhere in the GI tract. • Immediately before gastroscopy to retrieve a SHEETS
• All the abdominal organs can be visualized foreign body, always perform an abdominal
and biopsied if needed. radiograph to ensure the foreign body has Consent to Perform Endoscopy, Upper GI
• Virtually any foreign body may be retrieved not advanced beyond the endoscope’s reach (Gastroduodenoscopy)
anywhere in the stomach or intestine. into the small or large intestine. Inflammatory Bowel Disease
• Serosal surfaces and wall thickness can be • If endoscopy is being planned for a dog with Lymphangiectasia
evaluated. chronic vomiting, an ACTH stimulation test Lymphoma, Gastrointestinal
• Gastrostomy tube or jejunostomy tube may or baseline cortisol should be considered first,
be placed. to rule out hypoadrenocorticism. AUTHOR: Peter M. Foley, DVM, MSc, DACVIM
• Tumors or abnormal tissue may be surgically • It may be helpful for an assistant to feed EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
Thompson, DVM, DABVP
excised. the endoscope into or out of the patient

Enema: Evacuation or Retention Bonus Material
Online

Difficulty level: ♦ • Patient preparation for colonoscopy Contraindications
• Preparation for imaging procedures when • Rectal or anal pain
Synonym the presence of fecal matter in the colon • Fractious animal
Introduction of fluid into the rectum and might interfere with image interpretation • Hypervolemic patient or risk for volume
colon (e.g., contrast CT to identify ectopic overload
ureter) • Cool water enemas are NOT recommended
Overview and Goal Retention enema: for treating heat stroke.
To promote evacuation of feces or to administer • Fermentable substrate (e.g., lactulose), • Sodium phosphate enemas can cause
medicinal substances to adjust colonic pH for hepatic enceph- hyperphosphatemia and hypocalcemia and
alopathy when animal is unable to are NOT recommended in cats and dogs.
Indications swallow
Evacuation enema: • Administration of fecal microbiota transplant Equipment, Anesthesia
• Constipation (p. 202) (especially in cats), (p. 1105) • Materials
obstipation, or colonic foreign body • Rarely, administration of medications (e.g., ○ Rounded edge, nontraumatic tubing (e.g.,
(rare) benzodiazepines for seizures, lactulose red rubber catheter, Foley catheter)

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