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Flashcards in Normal U/S abdomen Deck (49):
1

T/F: Gastric gas hampers evaluation

TRUE

2

Where do you clip fur for an abdominal ultrasound?

10th-12th ICS

3

What veins/arteries are visible in the abdomen?

  • Veins are Visible, arteries are not
  • Portal veins
    • hyperechoic wall
    • enlarged = possible liver disease
  • Hepatic veins
    • isoechoic wall
    • enlarged = possible CHF (congestion)

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4

What are the arrows pointing to?

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5

What 6 things should you evaluate when examining the liver?

  1. Size
  2. Margins
  3. Margination
  4. Echogenicity
  5. Architecture 
  6. Lesions

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6

T/F: Parenchymal changes are often unspeific and a biopsy should be taken for definitive diagnosis.

TRUE

7

When evaluating parenchymal changes, what other changes should you look for?

  • Hepatomegaly
    • Irregular margins
  • Lymph node changes
  • Ascites
  • Assessment of other organs

8

What are the differential diagnoses for a diffusely hypoechoic parenchyma?

  • Acute hepatitis
  • Venous congestion (would also see enlarged hepatic veins)
  • Lymphosarcoma

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9

What are the differential diagnoses for a diffusely hyperechoic parenchyma?

  • Diabetes mellitus
  • Hyperadrenocorticism
  • Hepatic lipidosis 
  • Lymphosarcoma

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10

What diseases can be present even with a normal liver/parenchyma on an ultrasound?

  • Acute hepatitis
  • Toxic hepatopathy 
  • Diffuse infiltrative disease

11

What abdominal organ is this?

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Gall bladder (both are normal--one on the right has 'slush')

12

What approaches can be used to examine the gall bladder on U/S?

  • Retrocostal approach
  • Intercostal approach

13

How does a normal gall bladder appear on U/S?

  • The gall bladder is readily visualized 
  • Anechoic content, but sludge can be seen normally
  • Gets bigger with anorexia or fasting
  • Thin wall (1-2 mm), Isoechoic to liver parenchyma

14

Are intrahepatic biliary ducts normally seen on U/S?

No--they are not detected in the normal dog and cat

15

Can the common bile duct be seen in a normal U/S?

  • Can be traced in the normal cat
  • Usually not apparent in the normal dog due to overlying gas in the GI tract

16

How do the following appear on U/S of the gall bladder and biliary tree?

  • Sludge
  • Cholecystitis
  • Choleliths
  • Obstruction

  • Sludge = normal
  • Cholecystitis = thickened GB wall
  • Choleliths = mineral: hyperechoic casting a clean shadow
  • Obstruction = Dilation of GB and common bile duct

17

This is a normal gall bladder. What species is this?

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Pussy cat

18

Where can you find the spleen for U/S?

  • Splenic head fixated at the greater curvature of the stomach
    • At the level of the costal arch
  • Body and tail
    • Position very variable
    • Left and ventral abdominal wall
  • The entire spleen must be examined!

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19

What is the normal anatomy of the spleen on an U/S?

  • Size very variable
  • Hyperechoic capsule
  • Smooth margins
  • Splenic vein at hilus
  • Homogenous fine granular appearance (liver has coarser appearance)
  • Interior echo finer and denser than liver
  • Compare echogenicity to left kidney
    • Spleen > left kidney 

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20

What two organs are shown? Which has greater echogenicity?

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Spleen and kidney

The spleen is hyperechoic to the kidney

21

What organ is this? is the structure outlined in red normal?

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Spleen

Outlied structure is fat at the hilus--it is NORMAL!

22

What organ is this? What is represented by the red and blue areas?

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Spleen (cat)

Red = artery, blue = vein (both at the hilus)

23

What is the normal ultrasonographic anatomy of the kidney?

  • Renal medulla is segmented
  • Clear cortico-medullary distinction
  • Renal cortex < spleen
  • Renal cortex > renal medulla
  • Renal pelvis usually 1-2 mm wide
  • Proximal ureter is enlarged if greater than 3-4 mm

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24

T/F: Pelvic fat is causes the renal pelvis to be hypoechoic and is easily misdiagnosed.

FALSE--pelvic fat causes the renal pelvis to be HYPERechoic. DON'T misdiagnose this!

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25

What organ is this? Which plane is it being viewed in?

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Kidneyyyyyyyy

It is in the transverse plane!

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26

What is the normal renal size in the cat and dog?

  • Cat--3.66 +/- 0.46 cm
  • Dog--??

27

What are the indications for ultrasound of the lower urinary tract?

  • The urinary bladder and parts of the urethra not obscured by the pelvis are easily detected and identified
  • Ultrasound is very useful for examining bladder neoplasia and calculi

28

Lower urinary tract examination

  • Full urinary bladder
  • Positional scanning
    • Do both transverse and sagittal scan
  • Ballottement
  • Causing turbulences 

29

What are the ultrasound features of the urinary bladder?

  • U/S examination reveals an anechoic fluid-filled structure with a well defined wall visible
  • Wall thickness, shape, contents are easily evaluated
  • Normal wall thickness varies with bladder distention and weight of patient
  • An empty bladder can appear thickened artifactually 

30

Ultrasonographic anatomy of the stomach

  • In close apposition with the liver cranially
  • In the normal dog and cat the empty stomach lies cranial to the last pair of ribs
  • May extend slightly caudal to costal arch
  • Lies in a transverse plane, usually to the left of the midline

31

Let's review the anatomy of the stomach:

 

 

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  • Cardia (gastroesophageal junction)
  • Fundus
  • Body (largest portion)
  • Pyloric portion:
    • Antrum (2/3 oral)
    • Canal (1/3 aboral) contains double sphincter

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32

Why perform an ultrasonographic exam on the stomach?

  • May eliminate the need for gastric series
    • Faster, gives more info
  • Useful and complementary modality
  • Less expensive and faster
  • 12-hour fast

33

Normal measurement for the stomach on U/S?

What is the echogenicity of the various layers?

= 5 mm in diamter (must measure in the middle of the lumen space)

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34

What are the ultrasonographic features of the stomach?

  • With decreasing distention the rugal folds are more prominent
  • Stomach wall thickness in a dog is 3-5 mm
  • Stomach wall thickness in a cat is 2 mm
  • Measure between rugal folds
  • Peristaltic contractions 4-5 per minute

35

How do you assess the stomach on U/S?

  • Combination of factors:
    • Peristalsis
    • Stomach content
    • Wall appearance
    • Symmetry
    • Extend
    • Other findings
    • Major obstacle is gas in GIT

36

What organ is this?

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Stomach

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37

What is the intestinal wall thickness in dogs and cats?

  • Duodenum
    • Dog--5 mm
    • Cat--3 mm
  • Jejunum
    • Dog--2-4 mm
    • < 2.3 mm
  • Ileum
    • Dog--4 mm
    • Cat--3 mm

38

What are the 5 layers of the intestine?

  1. Serosa--hyperechoic
  2. Muscularis--hypoechoic
  3. Submucosa--hyperechoic
  4. Mucosa (thickest)--hypoechoic
  5. Lumen-mucosa-interface--hyperechoic

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39

Where is the normal feline ileum found? Which is the prominent layer?

  • In right cranial abdomen, medial and ventral to right kidney
  • Prominent hyperechoic submucosal layer

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40

What is the mucous pattern of the small bowel?

  • Collapsed state
  • Hyperechoic
  • Without acoustic shadowing

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41

What is the fluid pattern of the small bowel?

Anechoical luminal content

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42

What is the gas pattern of the small bowel?

  • Hyperechoic
  • With acoustic shadowing
  • Walls often appear less distinct

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43

What is the alimentary pattern of the small bowel?

  • Appearance depends on type of food

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44

What are the 2 comparisons for the ileus?

  1. Mechanical vs. functional
  2. Complete vs. partial

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45

What organ is this? Why does it look like this?

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Corrugated ileus

Secondary to peritonitis/pancreatitis

46

Normal wall layering of the large bowel?

  • 5 layers: hyper, hypo, hyper, hypo, hyper
  • More challenging to see due to a thinner wall
  • Need a high resolution probe to resolve layering

47

Large bowel wall thickness?

  • Dog--2-3mm
  • Cat-- <2mm
  • Always appears thinner than adjacent small bowel

48

U/S features of large bowel (2)

  • Often can only evaluate near the wall due to the presence of gas and feces
  • Cecum in dogs is often difficult to identify due to intraluminal gas

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49

What organs are these?

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Small (left) and large bowel (right)