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ToDay's VeTeriNary PracTice | November/December 2015 | tvpjournal.com eNDoscoPy esseNTiaLs Peer reviewed 78 Radiography survey radiographs of the chest and abdomen are indicated if a: • Foreign body is suspected based on supportive clinical signs • client witnessed the pet ingest a foreign object • Patient presents with fever or signs of shock indicative of luminal perforation (ie, esophageal, gastric, intestinal). When planning and evaluating radiographs: • include the neck in lateral projections if an esophageal foreign body is suspected (Figure 1, page 77) • characterize the foreign body; noting its location, size, and configuration • Note whether pneumomediastinum or pleural effusion—suggestive of esophageal perforation— is present • remember that not all commonly ingested foreign objects are radiopaque (eg, plastic, wood). Ultrasonography in practices with an ultrasound machine and an experienced ultrasonographer (ideally board certifed), this imaging modality can be used—as an initial diagnostic study or adjunct to radiography—to evaluate patients for nonesophageal Gi foreign bodies. Ultrasound has been shown to have a higher sensitivity than radiographs for identifcation of Gi foreign material, 1 but is a more expensive, user-dependent modality that may not be readily available on an emergency basis. in addition, gastric ultrasound can be challenging when food and/or gas, which can obscure the view of potential foreign material, is present. Further, it may be diffcult to determine whether the material present is normal ingesta or a foreign body. However, additional benefts of ultrasonography include identifcation of abdominal lymphadenopathy, peritoneal fuid, and abnormal intestinal wall layering. Further Imaging Studies if a gastric foreign body is still suspected despite normal radiography and ultrasonography studies, alternative imaging studies can be considered. Negative contrast gastrograms highlight radiolucent foreign bodies, while positive contrast agents, such as barium, outline radiopaque objects in the stomach (Figure 2 ). WHEN TO PURSUE ENDOSCOPY Many foreign objects pass through the Gi tract with little consequence; however, knowing which objects will take a benign course is diffcult. Therefore, recommending a conservative "wait and see" approach is best reserved for pets that do not have signifcant clinical signs and have ingested small, round, or blunt foreign objects. endoscopic removal should be pursued for: • sharp objects, such as needles; although some needles pass uneventfully, others may puncture the Gi tract, resulting in peritonitis • Toxic materials, which commonly include lead, zinc (pennies minted after 1982), and small disk batteries containing alkali (eg, watch batteries) (Figure 3) • objects that have been retained for more than 2 to 3 weeks. Figure 2. Ventrodorsal view of a barium study in a cat; the barium highlights a tubular foreign body (circled) in the stomach. Figure 3. Lateral abdominal radiograph of gastric foreign bodies; multiple stacked coins can be seen in the antrum of the stomach.