Abdominal ultrasound Flashcards
When is emergency eval with US indicated?
- Identify and sample free fluid
- Identify free gas
- Evaluation the intestines for obstruction
- Evaluate pancreas region for signs of inflammation
- Evaluation the biliary tract for signs of obstruction or perforation
- Evaluation of the urinary tract for obstruction or rupture
What does POCUS scan stand for? AFAST?
Point of Care US
Abdo focused assessment with sonography for triage
cIndiations for elective US?
- MEdial and surgical workup
- Staging of neoplasia
- ## Abdominal organ/ mass sampling
What equipment and patient prep for US abdo
- Microconvex transducer 5-8 MHz
- Withold food 12 hrs
- Appropriate environment
- Abdo hair clip
- Dorsal or lateral
- Restraint
Describe the Checklist for US with regards to abdo
- Number – correct number organs / single or multiple abnormalities
- Location – does an abnormality displace an organ
- Function – is the heart beating/the GI tract peristalsis etc
- Size – can you compare to breed ‘normal’
- Echogenicity – focal or diffuse changes
- Architecture – disruptions often marked in chronic disease
- Shape – very subjective, although can be affected by masses
- Margins – normally smooth and well defined
What sites for POCUs scan?
- Diaphragmatic-hepatic view (DH)
- Cystocolic view (CC)
- Splenorenal view (SR)
- Hepatorenal view (HR)
Scan each site in two planes at 90°
How do we do abdominal fluid score?
grade 0-4 for number of fluid-positive areas
-> inc score = ongoing accumulation of fluid
-> dec score = resorption of fluid
Liver position?
Cranial abdo , begin scanning from xiphoid process of sternum
Normal Anatomy liver?
▪ Hepatic Vein – enter via CVC ventrally
▪ Portal Vein – bright white walls due to fibrous content
▪ Gall Bladder
▪ Pear shaped / bi-lobed in cats
▪ Thin wall gives echogenic line
▪ Biliary tree not normally seen (if dilated “too many tubes”)
Abnormal liver
Abnormal Gall Bladder?
Spleen position?
Normal anatomy?
Position
▪ Left body wall
Normal Anatomy
▪ Fine granular texture
▪ Hyperechoic to liver
▪ Should be more echogenic than renal cortex
▪ Variable in size
Splenic neoplasia
What are GIT layers?
▪ Serosa (hyperechoic)
▪ Muscularis (hypoechoic)
▪ Submucosa (hyperechoic)
▪ Mucosa (thick hypoechoic)
▪ Lumen interface (hyperechoic)
Stomach position ?
▪ Caudal to liver
▪ Rugal folds (spoke wheel)
▪ Measure wall thickness between rugal
folds
▪ Areas often obscured by gas / ingesta
Abnormalities
- Position
- size
- mural lesions
SI - anatomy
▪ Duodenum – identified by straight course
curving to join pylorus
▪ Ileum – more prominent submucosal
layer/ ileocolic junction in fixed position
right mid abdo.
▪ Large intestine – thin wall, assessment
difficult due to shadowing from faeces
Abnormal SI?
Pancreas
if you can’t find it its probably normal
What does PAncreatitis look like ?
Hyperchoic mesenteric fat, localised free fluid
-> Pancreas may appear enlarged, hypoechoic and heterogenous
-> Cnanot be distinguished from neoplasia by US
Position of Kidneys?
Righ tmore difficult to image as more cranial and orsal
Recap normal anatomy of Kidneys
▪ Capsule – thin hyperechoic line
▪ Cortex – medium echogenicity (glomeruli and vasculature)
▪ Medulla – hypoechoic triangular sections caused by intralobar vessels
▪ Renal Sinus – hyperechoic (fat)
▪ Ureter – anechoic but not seen unless dilated
Abnormal kidneys
Where would u find left adrenal?
▪ Between kidney and aorta, cranial
to left renal artery
▪ Bean or peanut shape
▪ Hypoechoic
Where woudl you find right adrenal ?
▪ Medial to right kidney
▪ Superimposed over caudal vena
cava
▪ Bent arrow shape
▪ Hypoechoic
What size or adrenal glands?
▪ 7 - 8mm maximum size in a dog
▪ 4mm maximum size in cats
Potential visibel issues in adrenals?
▪ Mineralisation in dogs suspicious of
carcinoma
▪ Pituitary dependent HAC – both
moderately enlarged and hypoechoic
Bladder wall size?
1.5 – 2.5 mm (dog) / 1.3 – 1.7mm (cat)
Bladder US appearance?
▪ Wall will appear thicker if bladder empty
▪ Contents should be anechoic
▪ Echogenic material seen in suspension (cellular
debris/sediment/crystals)
What artefacts can be seen when looking at the bladder?
▪ Slice thickness – pseudo sludge (will not move with
gravity)
▪ Acoustic enhancement
▪ Acoustic Shadow ( if urinary calculi)
Abnormal bladder ?
Position of Prosate ?
Caudal to bldder and ventral to descneding colon
Normal anatomy of Prostate?
- Thin capsule
- Bilobed and symmetrical either side of urethra
- Will appear more hypoechoic in castrated animals
Abnormal prostate
Uterus US
