So, ladies and gentlemen, dear colleagues, and greetings from Germany. The topic for our session today is abdominal ultrasound. Ultrasound as a diagnostic tool is widely used in veterinary medicine.
In bovine medicine, practitioner routinely use ultrasound for examination of reproductive tract. The application of ultrasound for other systems in the field is unfortunately not routine at all. So, this presentation try to show the contribution of the ultrasound examination in the diagnostic of foreign body disease and in the second part, for Umbilical, umbilical disorders.
Reticuloperitonitis traumatica is still one of the important diseases of four stomach system in cattle, and its incidence range from 2 to 12%. According definition, it is perforation of reticular wall by a foreign body causing local, sometimes generalised peritonitis. The affection of other organs in the neighbourhood is possible.
The affected animals shows impaired general condition like anorexia, decreased milk yield, fever, alteration of heart, and respiratory rate. But first of all, symptoms of abdominal pain such as arching back, reduced mobility, increased abdominal tension, sometimes spontaneous grunting obbroxysm, and seldom acute colic symptoms. The specific examination of digestive tract reveals reduction of rumination, alteration of ruminal motility, fill layering, sometimes ruminal tympani.
The key role in the clinical examination of foreign body disease plays pain tests. First of all, poll test, pinching of the withers and pain percussion, which elicit, grunting as a positive pain reaction. During rectal examination, activated enlarged lymph node could be palpate on the right side of the rumen or long fibre particles in the faeces, poor digested fibre could be present, .
The evaluation of variability of clinical signs of radical peritonitis tra Martica described one large study published in 2018. Included patients showed clinical signs of vertical peritonitis traumatica, and this diagnosis was confirmed by radiography, ultrasonography, surgery, or necropsy. The all patients included in the study, have no concomital diseases causing pain in caudal thorax, such as pneumonia or pleurisy, or in cranial abdomen, such as abdominal ulcer.
Altogether 503 affected animals were included. So let us have a look on the results of this study. Rectal temperature, more than half of the patient, 52%, has normal rectal temperature.
If we define fever as an increase of rectal temperature over 39.5 degrees, only 14% of affected animals had fever. Heart rate and respiratory rate, more or less the same, about 70% completely in the normal range.
Special examination of Rumen. There are some parameters. We don't have to look at all of these numbers, but you can see rumen fill.
Everything is possible. Normal fill reduced or overloaded rumen. If we take stratification of the rumen.
Everything is possible in an affected animal normal, reduced, absent, tympanic human, or firm content of the rumen. So it means affected woman could show different clinical presentation. What about pain tests?
The poll test 42% of affected animals negative. Pinching of the virus 45% negative. Pain percussion, 57% of affected animals, and we are speaking about animals with a sure diagnosis radical peritonitis traumatica negative.
If we take all three tests together, 42% of these animals had no positive pain tests. So it means these results and not only these results, but I think our experience from the field shows the diagnostic only with the clinical methods, it's really complicated. So, Ultrasound diagnostic of foreign body disease could help.
Ultrasound examination of reticulum will be done on both sides, paramedian left and right from the sternum as longitudinal section holding the probe parallel to the midline, and lateral in the 6th and 7th intercostal space is a transversal section holding the probe parallel to the ribs. The suitable probes are convex and linear. Important is to use low frequencies.
Recommended preparation of the animal, we should remove the hair by clipping, then follows application of sufficient amount of, coupling gel, and the examination, should be done in dark room. This is, like it was, under clinic condition. I worked, years ago.
Now we see normal sonogram of a reticulum made in left parameian position. This is a longitudinal section. On the left side, cranial, on the right side, caudal position of the probe, we can recognise here body wall.
Fennahoraia Interna. They are from And reticulum itself as a half moon shaped hyperchoic, very thick line, immediately in Jason to the there are from or ventral abdominal wall. And the content of the reticulum is not visible, and there is no free fluid between reticulum and the other organs or ventral abdominal wall.
Very important part and big advantage of sonographical examination of reticulum is assessment of the mortality in the real time. This curve described reticular mortality. The first contraction.
Has amplitude approximately 5 to 10 centimetres. It follows incomplete relaxation, and then the second, larger and longer contraction, normally more than 15 centimetres, and it comes to the break time, no movement of the reticular. Reticulum and then approximately one minute later, next biphasic contraction of reticulum.
This is the sonogram in the movement short movie, longitudinal section of the reticulum. We have 20 centimetres depth. Here is the probe.
This is a reticulum, and now we start the movie. We are waiting for the contraction, and it's coming now. The first contraction in complete relaxation, and the second contraction, the organ disappeared from the screen and is back on the abdominal wall.
So we can play it now again, you see, now here in 10 centimetres. The amplitude of the first contraction, approximately 10 centimetres, relaxation, another over 15 centimetres and follows contraction of the reticular atrium. OK, it was under condition at the clinic, but we as a practitioner, we possess in normal cases only small portable machine in the most of cases with only a rectal probe.
And now is the question Is it possible to perform the examination of reticulum, or does it make sense? I think, yes, it makes. So have a look at this, sonogram is made with a normal small portable machine and small linear probe.
Here is the position of the probe on the ventral abdominal wall on the left side cranial, on the right side caudal. We can identify. Ventral body wall here is there from and reticulum.
And now in the motion. Movement caused by respiration? And 1st contraction and immediately 2nd contraction.
So, I said it's possible to do an examination with these small machines, but as you can see, there are some limits, and the first limit is the depth of the examination. In most cases this portable machine it is not possible to see deeper than 8, maybe 10 centimetres. This is the first limitation.
The second One is the screen is small, and the probe is in the most of cases, very narrow. So we don't have this overview as, with making or using the big machines, but we have some information. We get some information about reticulum position, about reticular motility and I think, it's better to have this information or not to have.
So this is my opinion. And now the second point, what about preparation of the animal under field condition? Of course, you can, clip the hair, but it's a time-consuming, procedure.
So the alternative, I use, as as a coupling, medium, 70% alcohol, you just make the clean, hair coat, in the area completely wet down to the skin, using this spray bottle, and in most of cases it works perfect. What we can see in the cases of radical periton it is traumatica, the biggest disappointment on the beginning. The foreign body is not visible.
What is visible are signs of inflammation, fluid exudate, fibrine deposits, building of the carbon abscesses. The visible are changes of reticular contour and in most cases, alteration of the reticular motility. Now, I would like to show you three clinical cases include clinical, physical examination and ultrasound examination of reticulum.
The first patient of us is after 6 weeks after part duration, and the owner said she doesn't doesn't eat anymore and she has lower milk yield dropping from 45 litres to 10 litres per day. Clinical findings, the cow, was very nervous, was standing with the arching back, and all parameters, rectal temperature, heart rate, respiratory rate, were increased about the norm range. The woman was good filled, good liar, the result in panic, but there was no motility, not at all.
Tension of abdominal increased 2 + 3, and The pain test, both of them positive. Pinching of the vitals 3+, pain percussion 2+. During rectal abdo rectal examination, ruminal lymph node, was cherry-like and there were a few longer fibre particles, present in the faeces approximately 2 centimetres long.
Of course, this patient doesn't need think, I think so. Ultrasound examination, it more or less textbook patient with radiculoperitone, it is traumatic, but I did it for confirmation and you can see here portable machine, the position of the probe left paramedian on the ventral abdominal wall on the left side cranially, on the right side caudally. And what, what we can see is between diaphragm and reticulum there are space fulfilled with the fluid exudate and here you can see small.
Adhesions, fibrous adhesions. Now we play short video. Reticulum Exudate, we are waiting for the contraction.
And it is coming now. First one. And the 2nd 1.
We are in the depth of 11 centimetres even you saw and the first one was like 1 centimetre and the second one maybe 3 centimetres, so. Very short. So we have diagnosis reticulop peritonitis, traumatica seofibrinosad circumscriptum, the conservative therapy of this animal includes antibiotics during 5 consecutive days and anti-inflammatory drugs, and during 3 days, of course, therapeutical magnet, it's a left one.
On the picture, if the treatment in generally, if the treatment is, effective, it comes to improvement of the clinical science and it comes to the resorption of the fluid exudate in the abdominal cavity and adhesions may shrunk or disappear completely within 3 to 6 months. So this patient improved, very quickly. On the next day, no fever, and the cow was eating.
And, one week later, 40 litres of milk per day. So it was, we were really happy. And now we can see, just for comparison, ultrasound, picture of the same reticulum in the same position.
This is a ventral abdominal wall in position of the probe cranial caudal, and you can see now the difference that the first picture it is there from and the reticulum is. Close to the diaphragm immediately Jason on it. There is no fluid exudite anymore.
We play video now. We can see the movement. This movement is caused by the respiration and now in the forest.
And the second contraction. So it's a completely different situation. The reticro is more or less.
Maybe not completely, but but really free. The clinical case number 2, it was cow and lactation 3 months after partition and there are very dramatically conditions with the uterus torsion and rear rolling the cow using the board. With the absolute two large calf, which means y Cesarea was following on the laying animal because she was completely tired and on the end calf was dead.
She developed a moderate wound infection. It's, not surprising, but she recovered very quickly during a few weeks, and, she gave a lot of milk, milk over 50 litres per day. And after 3 months, I called the owner, the cow, has decreased milk yield, a few 2 to 3 days.
Please check the situation. During clinical examination, the cow was eating high. The rectal temperature, respiratory rate completely normal.
Heart rate increased with 100. Human moderate filled, but very, very soft layered. And the fluid phase was increased motility, frequency more or less OK, but a decreased intensity.
Swinging auscultation ventral on the both sides, positive, percussion auscultation negative. But now tension of abdominal wall negative, which means really soft abdominal wall. Pinching of the vis negative.
Pain percussion. 1 + of 3, it means question number. Operation 1, perfect, no abnormalities.
During rectal examination, the ruminal lymph node was, was really, really huge, mm but not like, and faeces, only small amount smearing patient. So this patient, this is not really a textbook patient from reticular peritonitis romatica. Of course there are some symptoms for, first of all, ruminal lymph node and some alteration of Roman filling and motility, but Not really like in textbooks.
So ultrasound examination is very helpful in my opinion. This is the reticulum left paramium in longitudinal section. Here is the position of the probe on the ventral abdominal wall, cranial and caudal, and we can see here.
They are from and here is reticulum between these two structures, a lot of fluid exudate in here hyperechoic. Fibrinos adhesions. Now we play the movie.
Movement on reticulum, your respiration, and now the first contraction. And the second contraction. Here are Fibri nose adhesions, and now you can see we follow this fluid exudite under the Roman direction caudally.
And the 2nd Picture on the 2nd movie is made completely caudally behind the rumen. Here is the ventral abdominal wall on the right side for this case is cranial on the left side caudal. You can see behind the Romans still a huge amount of, of, Presence of fluid exudate, the fibrine deposits.
Now, I start video and we moved to the cranially to the rumen. You can see fibrine deposits. Adhesions, Rominal wall, and everywhere is fluid exudate.
Now, the formation. Or building of the cavern and the next one. So the ultrasound examination was really helpful and now we have diagnosis raulopericon it is traumatic againralizada with recommendation because of very poor prognosis to perform euthanasia.
But The owner wanted to try, even despite of very poor prognosis to treat the animal we gave her antibiotics, anti-inflammatory drugs, a magnet, during the next two days, the general condition of the sku was became very, very worse and the euthanasia was performed. The third clinical case is a cow in Fort Plantation calving 10 weeks ago, and the owner reported about decreased milk yield within 3 to 4 days. It dropped from 35 litres to 5 litres a day.
Clinical findings by arriving off the farm, the cow was eating silage and was standing. With the arching back. The res the rectal temperature, heart rate and respiratory rate, all of them completely in the norm, range.ru, good field, good light, but decreased motility frequency as well as intensity, only 1 + 3.
Tension of abdominal wall clearly increased 2 + of 3. But now, both pain tests, pinching of the virus and pain percussion negative. During rectal examination, lymph node of the, on the ruinal side, on the right side, like a piece.
And faeces, watery and small amount. Again, not completely clear case. So, mm the ultrasound was performed.
Now we see longitudinal section of the reticulum. Here is the position of the probe. Here is a cranial, here is a caudal part.
Here is diaphragm, and here is a reticulum. And Huge amount of fluid exudate in Fibrine intersection and building of the. Cavern, as we will see now in the movie.
But to colo Cavern building, now we're waiting for them. Contraction, be careful, it comes. It comes now.
And that's it. So completely without possibility to make contraction this carbon and fibrine deposits. Went to the caudal part of the abdomen, now we're moving back to the reticulum again.
Cavern building. This is radiculum very uneven control the sign of inflammation and the formation of the wall. So, after, ultrasound examination, we have Diagnosis rat peritonitis stramatica generalizata with a clear recommendation to perform euthanasia.
But the owner didn't want to do that. He wanted, send this cow to slaughterhouse because she had no fever and she was, fit enough for the transportation. But at the slaughterhouse, she was rejected.
Clear because of the findings in the abdominal cavity and they found big wire perforating radicular wall into the abdominal cavity. So it was the confirmation. Of our diagnosis on the slaughterhouse as well.
And now we are, by second part of this presentation, umbilical disorders. Umbilical disorders may involve external umbilicals as well as internal umbilical structures, and we are starting now with the external umbilical disorders. The clinical diagnostics of external umbilicus is based on inspection, palpation, and eventually puncture.
But this method has a clear limitations. First of all, in a case of identification of hernal content, we can Not really distinguished between omentum abomaism or intestine just from the palpation and in a differentiation of non-reducible swellings such incarcerated hernia, abscess hematoma ceroma or healthy, it's really hard to differentiate these structures, just with inspection or palpation. So, Ultrasound examination in such cases, could be very helpful and I would like to show you some sonographic appearance of external umbilicus, suffering on different disorders.
The first one is navel abscess. We have patients with hand-like swelling and on external umbilicus. It's a fluctuating structure, not painful and not reducible into the abdominal cavity.
Making these pictures, the sonogram on the right side, the probe was placed on the border between abdominal wall and external, umbilical structure. So here's the position of the probe, and you can see on the right side, extra abdominal part and on the left side, dorsal intraabdominal part of the huge cavern. Fulfilled with the typical pattern for mature abscesses, multiple small dots, middle to hyperechoic, and this.
Suggestion was confirmed by the pun. The second picture is a picture of hernia incarcerata with the momentum myos inside of the hernia sac. You can see here on the left side on the picture, like your feet, feast, .
Size, non-reducible, swelling in on external abdomen. It was, with the questionable fluctuation, not painful. For making excuse me, this, Sonogram, the rope was placed, on the border between abdominal wall and, extra abdominal structure.
The rope is placed here. This is probe near field on the left side, intraabdominal part on the right side, extra abdominal part, and we can see here the abdominal wall. Yeah, another part.
This is disruption of the abdominal wall, hernia larynx, and protrusion of the Momentum Mao as a structure without fluid content, without own motility, with the heterogeneous ecostructure, . Anechoic parts and hypoechoic parts. Now we can see this.
Picture in the movement. Here is an intraabdominal part and extra abdominal part. Abdominal wall.
Here is the hernia ring disruption of the wall. Now we see the structure by pushing with the fingers, there is no fluctuation and no possibility to reduce this swelling inside of the abdomen. This patient was not operated.
It is not necessary in the case of protrusion of. Amano Mahao. The next The case had the two diagnoses.
First, was, umbilical obsession. It came to rupture spontaneous rupture, and the swelling was, smaller and smaller, but with the time it appeared second structure. It was reducible into abdominal cavity.
It was, hernia umbilicalis and for the identification of the content of the hernia sac ultrasound examination was performed. He, was placed the probe for making the sonogram. Here is the probe, and we can see the hernal sac.
It is the abdominal wall. Disruption is a hernia ring. This hyperchoic line is inside of, of the wall.
You can see it's a pyogenic membrane from the former abscess and From intraabdominal part protruding into the hernal sac organ with own motility with the fluid content and very typical mucosal falls hypoechoic. You can see it here and here. And here.
This is a typical picture. For abomaism this The patient was treated surgically. And here, the last one is the hernia funicoli umbilicalis.
It's a very special form of hernia. The patient is only 1 day, one day old, the hernia sac is, inside of the MN sheet. It is, structure approximately from the diameter of 10 centimetres, very painful, clear fluctuation, not reducible into the abdominal cavity.
It was clear, it's a patient from the clinic as I worked, . It was clear this patient must be operated and, now, so, as a preoperative preparer, for the surgeon, ultrasound examination was performed. Here is the position of the linear probe.
Here is the hernia sac on the left side ventrally, and we can see typical picture of intestinal loops. The first one in the longitudinal section and the second one in transversal section, the wall is very thick knit. And on the surface on the part of serosal code of the intestine is.
Hyperchoic material, fibrine deposits, and fluid. And here, just to compare, is the Structure after resection, here are intestinal loops covered with the fibrine we saw here, and here is the fluid inside of the amnion sheet. The last part of our session for today is internal umbilical disorders part.
The gold standard of diagnostic of internal umbilical diseases is deep emmanual palpation. You can see it here on this picture, but this . The diagnostic method has clear limitations.
They are, first of all, in the cases with increased tension of abdominal wall caused by pain. And in the older animals with increased abdominal volume, you can Not perform this palpation to identify some intraabdominal structures. On the one side and on the other side, there are some so-called non palpable structures and they are all intrahepatic pathological changes, so you cannot palpate them.
And in such cases, ultrasound examination is only one possibility, how you can assess the intraabdominal structures. So how we can do it, the position in of patient and the best one is, best way is to examinate the patient in a standing position from the right side, alternatively in the left lateral recumbency. The suitable probe, linear with the frequencies 5 to 7 megahertz.
It means, our portable machine with the rectal probe is, good one, good option, in the older animals or, structures with, larger diameter convex probe, with the lower frequencies is, advantages. The standard examination steps are 2 or 3 of them. It depends on if the liver is involved or not in inflammation process.
Normally, we start, with the examination of the caudal structures. Immediately, cranial and the pubs, caudal, in the pubvis area, with the probe, held perpendicularly to the linear alva in the, vertical position and moving the probe slowly along linear alva towards external umbilicus for visualisation of the caudal structures. For the visualisation of the umbilical vein, we are starting on external umbilicus.
The probe is placed on the cranial aspect of the external umbilicus on the apex of it, and, is held in the horizontal position and slowly moved to the Towards the abdominal wall, by reaching of the base of the external umbilicus is the probe tilted from the horizontal position into the vertical position. And then as the next part, the intraabdominal part of the umbilical vein is examinated and moving the probe cranially towards costal arc, you have to move, slightly, to the right, of the middle line. And the third step is examination of the liver, as I already mentioned, if the, umbilical vein parts inside of the liver are affected, it's recommended to examine whole liver to evaluate extension of, of the, affection of the liver tissue as well.
So, You have to examinate in all intercostal spaces, starting in the 12th intercostal space to the 5th intercostal space and holding the probe parallel to the ripes. And generally, all intraabdominal structures of umbilicus are examinated, first in transversal section, and if there are some pathological changes, the examination in longitudinal section is recommended. Now, for clinical cases with a section of intraabdominal umbilical structures.
First one is a calf with a wet abdomen. Calf was 4 weeks old, a reduced appetite, and the statement of the owner was this calf is all the time wet on ventral abdomen. So, general examination revealed slightly increased temperature.
The calf was standing apathetic and with the arching back in the box, as we can see on these pictures, with the increased abdominal tension. Of the Of the abdominal wall, and the special examination of the umbilicus, . Yes, there were wet hair on the ventral abdomen, and, during the deep palpation of, intraabdominal structures of the umbilicus, the vein was, not palpable anymore and to the caudal cord, 2 to 3.
The finger, thick, was palpated. The examination was extremely painful. So, for detail, evaluation, ultrasound examination was performed, and now we will see 2 videos, two movies, of the structures.
We are starting immediately cordially. To external naval and moving the probe. To the caudal position and then we are.
Going back and forth, back and forth, back and forth in the area of the pole of the urinary bladder and coming back to the external nasal. So this is the transfer. Section of the oral cord.
Here is the position of the probe and I start video now. You can see. By moving the probe caudally, this structure becomes larger and we can see the lumen, filled with the hyperchoic material.
No, more cow Day. Appear two round structures on the dorsal aspect of the oracle cord and two arteries. And later on caudally and urinary bladder.
Filled with anechoic urine. Now we move back and forth, back and forth. This is a It's like a singing frog with the eyes and arteries and mouth.
It's a urinary bladder. Now we are going back to the. External umbilicus.
And you can see and Very cranial part, just immediately caudally from the external umbilicus, there is no lumen, to identify anymore. The same structures. Now in the longitudinal section, the position of the probe on the ventral abdomen, here is the cranial, here is the caudal part of the abdomen, and I start the video.
So again, You can see in the very cranial part of the structure, there is no lumen and then appears lumen and it's fulfilled with a hyperchoic material. And then disappear lumen of the urachus again and we see caudally from it, cranial pole of the urinary bladder as a sharp angle. This is a sign of a cranial fixation of urinary bladder, which, caused an impairment of emptying.
Normally, in the cases with no fixation to the cranial, causing by, Oracle remnants, it should be rounded. So now. You go ahead.
Here on the dorsal part of the urinary bladder is one of the arteries. And urinary bladder with an anechoic urine. So the animal underwent surgery and the structure was removed and we can see the structure on the picture.
Here is an extra abdominal part. Here is a Uracle cord in here. The arteries on the right side resected on cranial pore of the urinary bladder in destruction, open, you can see purulent necrotic material as we saw as a hyperchoic material on the sonogram.
The second case is a hay with chronicical weight loss. This animal is 9 months old. Chronicle weight loss and was treated a few times with antibiotics by all the time, again and again, fever periods and the general condition became poorer and poorer.
At the time of clinical examination, the animal had, had no fever, but it was in really poor general condition and complete hay. During rectal examination, dilatated urinary bladder, football like was, palpated and cranially to urinary bladder, was, fluctuating structure, palpable, and the structure was, to the cra cranially not definable. So, We made ultrasound examination.
Here is the position of the probe. Here is caudally. He is a cranial.
Now, the movie agnosis pubis, and here is the urinary bladder, bladder dilatated. And immediately cranially from it, it's one big cavern with a thick capsula. You can see this is 1 centimetre.
This is more than 1 centimetre, and the content we saw already this content is typical for the mature, pure and obsessions. Yeah. By the movement and snow flurry phenomenon typical for mature abscesses.
Because, this structure was not definable to the cranial, we made ultrasound examination in the caudal abdomen transcutaneously as well. Here is the position of the probe on the ventral abdomen on the left side caudal part of the abdomen on the right side, and cranial part, and now we are playing video. This is the same structure as we saw rally with the same content and by so of palpation, you can see this snow flurry phenomenon to the cranial becomes this structure to be smaller and smaller and it ends directly on the scale of former external umbilicus.
Unfortunately, we don't have necruptcy findings from this animal, but from the clinic, from the ultrasound examination, it's more or less clear that it was Affection of the oral remnant with the purulent infection because of poor condition and poor prognosis for this animal euthanasia was performed and postmortem, we made a puncture here in the caudal abdomen, and this is the content of this. Cover. So Back to the last, case, in some cases, we have to even by older in older animals think that the intraabdominal structures could be a problem, and, and just to keep in mind, it is possible even if the animal is 6789 months old.
So the third clinical case is a calf with a fever, despite of antibiotic treatment. Calf, 3 months old, 120 kg body weight. 2 weeks ago, underwent antibiotic treatment because of pneumonia.
But it had still fever and actually since a few days was under a second antibiotic treatment and it had still fever, so this was the reason for examination. Rectal temperature, 40.1 degrees, so it means clear fever, respiratory rate was, in the normal range, and there was no nasal discharge, the spot, there was no dyspnea, so no signs of respiratory problem at the moment.
And the only one that we see was an umbilical area. The hair were dirty and yeah, from the smear dried exudate. But the deep manual palpation was not possible, not at all, because increased abdominal volume, you, you can remember 120 kg.
So only one way how to get some information about the umbilical structures is To perform ultrasound. And here we have longitudinal section of umbilical vein, . The position of the convex probe on the right side is cranial.
We can see liver tissue here. This is a cow down part and here is the longitudinal section through the Umbilical vein, we can see thickened wall. Of the vein.
And the content Yeah, you remember? We saw it today twice. It's purulent content, multiple dots, middle echo hyperechoic.
The same animal, of course, more cranially in the transversal section. This is the point where the umbilical vein has an entrance into the portal vein and we can see inside of the vein this compact middle structure. It is septic thrombus.
The animal was euthanized because of very poor prognosis. And this is a corresponding part of umbilical vein and liver, . On the necrotic examination here you can see.
So Vein fulfilled with the pus and inside of the Brahma sinister of portal vein is septic thrombos we saw in ultrasound. And the last clinical case for today is a lame calf, 5 weeks old, 70 kilogrammes body weight, since last 5 days, severe lame with a reduced appetite. Current therapy, antibiotics, and anti-inflammatory drugs, but there was no improvement, not at all.
General examination, no fever, good general condition, and the lameness, severe lameness on the left hind limb. Special examination of locomotion system, over the lateral claw of the left hind limb coronate region was painful, was swollen, but the palpation of the claw with the forceps, revealed no pain. It was really not painful.
We made a punction of the pedal joint. And this is the results. It came, purulent synovia out of the cannula.
So we have now diagnosis, short diagnosis purulent arthritis of the pedal joint. And We had no findings on the glow itself and no signs of some. Injuries in this area, so it must be of metastatic origin.
It's really seldom that the Small joints are affected by a metastatic infection, but it was in this case, and the most, cause for hematogenous seedings of the bacteria is, Infection of the umbilicus, but, external umbilicus as well as umbilical arteries and neurachus, there were no special findings on it. Umbilical vein by deep Emanual palpation, we can feel. Firm cord, approximately finger thick.
It was not painful, no fluctuated, but 5 weeks old, and, umbilical veins still palpable. It's definitely not normal. So ultrasound examination of the umbilical vein was performed.
This is a transversal section. Here is the position of the probe and the the umbilical vein is a firm, cord fibrotic without any signs of infection. It's a hypergen, without any lumen.
Another situation, completely another situation is inside of the liver tissue, we can see here the liver. And inside of the liver is an umbilical vein with a very thick wall and inside of it, it's a lumen fulfilled with hyperchoic content. Another picture of this vein in the longitudinal section on the right side cranial.
Here is the liver tissue and This is the vein. In the caudal part as we already saw on the previous sonogram, it's a hyperechoic purulent content in here compact mass. Inside of the vein, this is the septic thrombus.
So examination of the liver tissue, complete fallout, and it reveals presence of rounded structures. 4 of them you can see on these pictures with a hypoechoic solid capsula we can see. At Centrelink.
And Enhancement of the ultrasound. This is typical for liver abscession. So the prognosis for them, of course, metastatic origin origin, the same as arthritis.
So, and the prognosis for this animal is very, very poor and euthanasia was performed. So this was the last, dead animal for today, for this session. I would like to thank you, for listening to me.
I hope I could give you some new information. I hope you can, use your portable machine for, another organs, not only for a reproductive, and I wish you have fun, keep trying, have fun on your veterinary job and see you later. Take care and God bless you.