Equine Abdominal Ultrasound by bfze2v

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									   Equine Colic:
Ultrasonographic and Radiographic
            Diagnosis

     Mattie McMaster and Friends
Introduction                          In the wild,
                                there is no healthcare.
   Colic
       ABDOMINAL PAIN
       Most commonly associated
        with gastrointestinal
        abnormalities
       Outcome:
            Resolve spontaneously
            Medical treatment
            Surgical treatment
Diagnostic Tools
   Patient history and
    signalment
   Physical exam
   CBC, biochemistry and
    blood-gas
   Naso-gastric intubation
   Rectal palpation
   Abdominocentesis
   ULTRASONOGRAPHY
   RADIOGRAPHY
   Exploratory surgery
Indications
                             This is a good day
                               to save lives…
   Obtain a more specific
    diagnosis
   Decide if surgical
    intervention is
    necessary
   Estimate prognosis
Ultrasonography: Equipment



      +     +       +/-   =
Preparation
Transducer
                             Game-face
   Low frequency
    transducer
   Sector transducer
   Curvilinear transducer
   Machine position
Scan Regions
Normal
     No surgery?
Equine Abdomen
Spleen

  Oh hey.




    Left
Stomach




    Left
Kidneys




Left      Right
Duodenum




   Right
Small Intestine




      Left
Large Intestine




Left              Right
           That’s what
            she said.

Cecum




   Right
Scan Patterns
   Three patterns
                             Mmmmm,
       Mucous
                           scan patterns.
       Fluid
       Gas
   Evaluate
       Wall thickness
       Layering
       Uniformity
       Luminal Contents
       Peristalsis
Abnormal   Through concentration,
            I can raise and lower
            my cholesterol at will.
Medical Colic
                             Brilliant diagnosis.
    Enteritis/ duodenitis
    Right dorsal colitis
    Verminous arteritis
    Gastric distension
    Gastric ulceration
    Gastric SCC
    Intestinal neoplasia
    Abdominal abscess
    Peritonitis
Enteritis/ Duodenitis
   Fluid distension of
    intestinal tract with
    increased peristalsis
       Developing enteritis
   Wall thickened,
    edematous and more
    hypoechoic
   Shreds of intestinal
    mucosa in lumen
                               Figure 1
   Marked fluid distension of
    stomach
Duodenitis




       Figure 2
Right Dorsal Colitis
   Non-steroidal anti-
    inflammatory drug
    toxicity
   Thickened right dorsal
    colon
       Ventral to liver in right
        10th-14th intercostal
        spaces
                                    Figure 3
Gastric Distension
   Stomach is enlarged
    and filled with fluid
   Hyperechoic ventral
    layer representing
    ingesta
   Hyperechoic dorsal
    layer casting dirty
                            Figure 4
    shadows consistent
    with gas
Intestinal Neoplasia
   Not routinely visualized
    on transcutaneous
    ultrasound
   Lymphosarcoma
       Within intestinal wall
            Diffuse irregular filling
       Marked enlargement of
        mesenteric lymph nodes

                                         Figure 5
Abdominal Abscess
   Found:
       Ventral abdomen
       Root of mesentery
       Cecum
       Large colon
   Fluid-filled or solid
   Movement of adjacent
    bowel should be
    examined:
       Adhesions between        Figure 6
        adjacent intestine and
        abscess
Peritonitis
   Ventral abdomen
       6.0 to 10.0 MHz transducer
   Evaluate fluid:
       Relative quantity
       Character
   Evaluate:
       Abdomen, gastrointestinal
        and abdominal viscera
        should be scanned for
        source of peritonitis
            Abdominal abscess or
             devitalized bowel
Surgical Colic                     Let’s have
                                  some fun….

   Herniation/ displacement
   Nephrosplenic ligament
    entrapment
   Sand colic/ enterolithiasis
   Intussusceptions
   Large colon torsion
   Strangulating small
    intestinal and small colon
    lesions
   Small intestine masses
   Impaction
Herniation/ Displacement
   Abnormal position of
    gastrointestinal viscera
    difficult to diagnose
       Exceptions:
            Scrotum
            Thoracic cavity
            Umbilical hernia


                                Figure 9
Nephrosplenic Ligament Entrapment
   Dorsal spleen and left
    kidney not visible in left
    caudal abdomen
   Visualize ingesta or gas-
    filled large bowel
   Spleen ventrally
    displaced
   Bright hyperechoic         Figure 10
    reflection dorsal to the
    spleen from the bowel
Sand Colic/ Enterolithiasis
   RADIOGRAPHS
       Not often used in adult
        horses
            Exceptions:
               Sand Colic
               Enteroliths




                                  Figure 11
Enterolithiasis




      Figure 12
Sand Colic
   Small, pinpoint
    granular hyperechoic
    echoes
   Multiple acoustic
    shadows
   Ventral most portion of
    the affected intestine
   Limits peristaltic
    movement
Enterolithiasis
   Enteroliths, bezoars,
    fecaliths, Hasselhoffs
   Affected bowel in                     Oh hey..
    ventral abdomen
   Hyperechoic mass
    casting strong
    acoustic shadow
    within intestine lumen
   Distension of intestine Figure 13: Badness.
    proximal
Intussusceptions

   Ileum and large bowel
   Right side of abdomen
   “Target sign”
   Fibrin tags between
    segments of intestine


                            Figure 14
Intussusceptions




       Figure 15
Large Colon Torsion
   Increased wall
    thickness of the large
    colon
       Increased wall thickness
        is diffusely hypoechoic

                Badness!



                                   Figure 16
Strangulating Small Intestinal Lesions
   Distended, fluid-filled small
    intestine proximal to
    strangulated portion of
    small intestine
   Strangulated small
    intestine
       Thickened, edematous,
        hypoechoic walls
                                    Figure 17
       Little or no peristaltic
        activity
   Ventral portion of abdomen
Small Intestinal Masses
   Within intestinal wall
       Thickened wall
       Anechoic to echogenic
       Carcinoids, leiomyomas,
        granulomas, hematomas,
        and fibrosis
       Stricture secondary to
        chronic colic
       Intestinal obstruction
   Within lumen
       Hemorrhage appears as
        echogenic clots or echoic   Figure 18
        swirling fluid
Impaction
   Round to oval distended
    viscus
   Lack visible sacculations
   Wall normal to
    increased thickness
   Large acoustic shadows
    from impacted ingesta
   Distension of intestine
    proximal
                                Figure 19
   Little to no motility
Conclusion
   Early referral and
    surgical intervention is
    key to successful
    outcome
   Ultrasonography and
    Radiology:
       Obtain a more specific
        diagnosis
       Decide if surgical
        intervention is
        necessary
       Estimate prognosis
QUESTIONS?

								
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