Equine Abd Rads and US

7/31/2019 Equine Abd Rads and US

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Equine Colic:Ultrasonographic and RadiographicDiagnosis

Mattie McMaster and Friends


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Introduction Colic

ABDOMINAL PAIN

Most commonly associated

with gastrointestinalabnormalities

Outcome:

Resolve spontaneously

Medical treatment Surgical treatment

In the wild,there is no healthcare.


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Diagnostic Tools Patient history and

signalment

Physical exam

CBC, biochemistry andblood-gas

Naso-gastric intubation

Rectal palpation

Abdominocentesis

ULTRASONOGRAPHY

RADIOGRAPHY

Exploratory surgery


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Indications Obtain a more specific

diagnosis

Decide if surgicalintervention isnecessary

Estimate prognosis

This is a good dayto save lives


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Ultrasonography: Equipment

+ + +/- =


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Preparation


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Transducer Low frequency

transducer

Sector transducer

Curvilinear transducer

Machine position

Game-face


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Scan Regions


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Normal

No surgery?


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Spleen

Left

Oh hey.


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Stomach

Left


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Kidneys

Left Right


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Duodenum

Right


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Small Intestine

Left


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Large Intestine

Left Right


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Cecum

Right

Thats what

she said.


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Scan Patterns Three patterns

Mucous

Fluid

Gas Evaluate

Wall thickness

Layering

Uniformity Luminal Contents

Peristalsis

Mmmmm,scan patterns.


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Abnormal Through concentration,I can raise and lowermy cholesterol at will.


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Medical Colic Enteritis/ duodenitis

Right dorsal colitis

Verminous arteritis

Gastric distension

Gastric ulceration

Gastric SCC

Intestinal neoplasia Abdominal abscess

Peritonitis

Brilliant diagnosis.


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Enteritis/ Duodenitis Fluid distension of

intestinal tract withincreased peristalsis

Developing enteritis Wall thickened,

edematous and morehypoechoic

Shreds of intestinalmucosa in lumen

Marked fluid distension ofstomach

Figure 1


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Duodenitis

Figure 2


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Right Dorsal Colitis Non-steroidal anti-

inflammatory drugtoxicity

Thickened right dorsalcolon

Ventral to liver in right10th-14th intercostal

spacesFigure 3


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Gastric Distension Stomach is enlarged

and filled with fluid

Hyperechoic ventrallayer representingingesta

Hyperechoic dorsal

layer casting dirtyshadows consistentwith gas

Figure 4


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Intestinal Neoplasia Not routinely visualized

on transcutaneousultrasound

Lymphosarcoma

Within intestinal wall

Diffuse irregular filling

Marked enlargement of

mesenteric lymph nodes

Figure 5


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Abdominal Abscess Found:

Ventral abdomen

Root of mesentery

Cecum

Large colon

Fluid-filled or solid

Movement of adjacentbowel should beexamined: Adhesions between

adjacent intestine andabscess

Figure 6


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Peritonitis Ventral abdomen

6.0 to 10.0 MHz transducer

Evaluate fluid: Relative quantity

Character

Evaluate: Abdomen, gastrointestinal

and abdominal viscerashould be scanned forsource of peritonitis

Abdominal abscess ordevitalized bowel


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Surgical Colic Herniation/ displacement

Nephrosplenic ligamententrapment

Sand colic/ enterolithiasis

Intussusceptions

Large colon torsion

Strangulating smallintestinal and small colonlesions

Small intestine masses

Impaction

Lets havesome fun.


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Herniation/ Displacement Abnormal position of

gastrointestinal visceradifficult to diagnose

Exceptions:

Scrotum

Thoracic cavity

Umbilical hernia

Figure 9


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Nephrosplenic Ligament Entrapment Dorsal spleen and left

kidney not visible in leftcaudal abdomen

Visualize ingesta or gas-filled large bowel

Spleen ventrallydisplaced

Bright hyperechoicreflection dorsal to thespleen from the bowel

Figure 10


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Sand Colic/ Enterolithiasis RADIOGRAPHS

Not often used in adulthorses

Exceptions: Sand Colic

Enteroliths

Figure 11


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Enterolithiasis

Figure 12


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Sand Colic Small, pinpoint

granular hyperechoicechoes

Multiple acousticshadows

Ventral most portion ofthe affected intestine

Limits peristalticmovement


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Enterolithiasis Enteroliths, bezoars,

fecaliths, Hasselhoffs

Affected bowel in

ventral abdomen Hyperechoic mass

casting strongacoustic shadow

within intestine lumen Distension of intestine

proximal

Oh hey..

Figure 13: Badness.


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Intussusceptions Ileum and large bowel

Right side of abdomen

Target sign

Fibrin tags betweensegments of intestine

Figure 14


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Intussusceptions

Figure 15


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Large Colon Torsion Increased wall

thickness of the largecolon

Increased wall thicknessis diffusely hypoechoic

Figure 16

Badness!


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Strangulating Small Intestinal Lesions Distended, fluid-filled small

intestine proximal tostrangulated portion of

small intestine Strangulated small

intestine

Thickened, edematous,

hypoechoic walls Little or no peristaltic

activity

Ventral portion of abdomen

Figure 17


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Small Intestinal Masses Within intestinal wall

Thickened wall

Anechoic to echogenic

Carcinoids, leiomyomas,

granulomas, hematomas,and fibrosis

Stricture secondary tochronic colic

Intestinal obstruction

Within lumen Hemorrhage appears as

echogenic clots or echoicswirling fluid

Figure 18


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Impaction Round to oval distended

viscus

Lack visible sacculations

Wall normal toincreased thickness

Large acoustic shadowsfrom impacted ingesta

Distension of intestineproximal

Little to no motilityFigure 19


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Conclusion Early referral and

surgical intervention iskey to successful

outcome Ultrasonography and

Radiology:

Obtain a more specific

diagnosis Decide if surgical

intervention isnecessary

Estimate prognosis


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QUESTIONS?

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