Fantastic. Thanks very much indeed, Antony, and thanks everyone for rejoining this final session for me of abdominal imaging. So the first case we're going to present is a Labrador retriever, six year old, male neutered called Galaxy.
And the history with Galaxy is that he had been intermittently vomiting for about 2 weeks, waxing and waning sort of course, but becoming more continuous, and more recently that was associated with cranial abdominal pain. So I'm going to show you the radiographs from from this dog. Here's the lateral.
This is the right lateral. There are differences between the right and the left lateral. They're not quite as marked as they are with the thorax, but particularly the position of the kidneys in the right lateral the right kidney, which is always cranial to the left, will move further forwards because the normal contents move further forwards under the weight of the abdominal contents.
And the ventro dorsal. We take the ventro dorsal because The animal is easier to position, often in the ventro dorsal projection, and certainly the abdomen will spread out, allowing us to visualise more organs than we can in the dorsal ventral where the abdomen tends to hang more underneath the lumbar spine. So the question from from me is what is your diagnosis?
Is this normal? Was there hepatic enlargement? Was there intestinal obstruction, ascites or peritonitis?
So again, we'll give people a chance to vote on that mic, but perhaps if you just go back over those two slides again. There's the ventro dorsal. And there's the lateral.
So don't be frightened to answer, you won't be picked out. Yes, it is anonymous, so do have a crack at it. It's always good even if you get it wrong to to know you've had a crack at it, so .
We'll just give a couple of more seconds as people are thinking what they want to. Say about it, so it looks like my 25% think it's normal. 17% think there is some hepatic enlargement, 25% of potential Intestinal obstruction and then 33% same peritonitis.
OK, well, let's have a look and see what we make of it. So on the lateral view, first of all, What can we see? Well, here's the diaphragm, we haven't got the whole of the diaphragm.
But those of you who said liver enlargement, here's the liver, coming down, just extending to the costal arch. This is spleen, if you were worried what that was, then this is the liver. And it's got quite a narrow angle to the ventral lobe of the liver.
So, the liver would be considered to be normal. We can also Associated with the axis of the stomach, here is the gas within the fundus on the left hand side, down to the pyloris, which is full of fluid on the right hand side. We draw a line by secting the fundus and the the pyloris, then it more or less follows the line of that overlying rib.
So we wouldn't really say that that was likely to be associated with . With, with, hepatic enlargement. The kidneys are dorsal, as I pointed out before, they're about 2.5 times the length of the body of L2, which would be normal, and slightly rounder in the left kidney because the left kidney will sort of flop down, so you get a slightly different.
Appearance of the kidney. And in the caudal abdomen, we've got the bladder, which is full of urine, or at least a soft tissue opacity, the shape of the bladder, so it's likely to contain, urine. As I mentioned, we have spleen down here.
But then the most striking feature to me is this sort of wispiness of the background. Now, If you think about what causes the contrast in the abdomen, most of the contrast is caused by intra-abdominal fat, which of course is radiolucent compared to soft tissue. And that usually gives us very clearly defined borders of the serosa, except in young animals or very thin animals where there's very little intraabdominal fat.
And yet where we see the fat down here, we can see this streaking of a soft tissue opacity, and this will be fluid percolating through the fat around the spleen, around the small intestine. Around the large intestine that we can see there. And that loss of serosal detail with this sort of mottled appearance is really typical of peritonitis.
So those of you who said peritonitis were correct. Ascites would usually have a lot more fluid, and so we lose this mottling and it just becomes a ground glass appearance to the abdomen with gas within the intestines showing up as loosened areas. We don't see the fat.
Now, when we look also closely at these levels, we can perhaps make out there's some Little spots that could actually be almost gas opacity within that fluid and fat. So again, that would tend to implicate the possibility that this has ascites. Similar changes on the ventral dorsal.
Here we can see the the colon coming up from the pelvic inlet, coming around to the ileocal colic junction here. There's the curl of the secum, the ilium comes off from there. So we can see small intestine, but it's not really clear, and it's lost its clarity because of that small amount of fluid and that mottled appearance within the fat.
Stomach comes across here, so fundus is over on the left hand side, pyloris. On the right hand side. Then we have duodenum.
Duodenum is always the most lateral part of the small intestine coming, usually is a fairly straight line caudally, and it'll flex and come cranially up to the stomach, and then after that it becomes the ilium, sorry, the dunum. And then finally, the ileum. So, What I would say from this is that it looks as though this animal has peritonitis.
And we could show that up in this particular dog by doing a decubituouss lateral. And so when we lie the animal on its left hand side, leave it there for a few moments for the gas that is free within the abdomen to percolate up, then we can see this gas cap, which is outside the intestines or the stomach, around. Heal the liver.
There's a free gas cap underneath the rib cage there. And of course, it percolates up there because that's the highest part of the abdomen, so it goes to the highest part and the abdominal structures fall away from the abdominal wall in that situation. So, ultrasound is also good for showing up peritonitis.
What we tend to see a number of different ultrasonographic signs. Here we can see a picture of the abdomen, that's probably spleen across here. But the striking feature is that the mesentry is really, really bright.
It's very hyper. Cate, we can see perhaps loops of bowel there, another abdominal structure here. This may be bladder, for example, but the surrounding area of mesentry is really, really bright, and that is typical of having a small amount of fluid or inflammatory reaction within the within the mesentery.
And then if we look and wait long enough, we will find in the dependent area of the abdomen that we find some fluid accumulation. Now this fluid is not going to be anechoic, because it's got cells within it in peritonitis inflammatory cells, maybe even free bacteria and bacteria within the white cells as well. But we can identify a little locus of fluid accumulation close to the spleen and this particular view.
But you have to hunt around to find these little pockets, and once you've found a pocket, then of course you could put a needle in to that pocket under ultrasound guidance. You'll see the end of the needle and you'll usually be able to collect some fluid from that little pocket. But as we looked around the rest of the abdomen, we were able to identify the duodenum coming from the stomach, and the duodenum had this consistent defect within the wall.
You can see another picture here with that same defect with the intestinal contents coming right deep into that . Cleft within the duodenal wall. And this was considered to be likely a duodenal ulcer that is ruptured, and the bright mesentry from the peritonitis will have then tried to wall off that leakage, but of course, the inflammatory fluid will be causing no end of problems.
The duodenum looks fairly abnormal in this. Situation here, normally it's quite a straight organ, but you can see that it's rather tortuous, and that can usually go along with the inflammation either within the duodenum or surrounding the duodenum. And we can follow the duodenum up to the pyloris, that's just the pyloricanttrim there, which is open and you could see some ingestor coming into the duodenum.
The pancreas also looked slightly odd. Now some of this will be because of the peritonitis that's around, so we've got these very bright focal spots within the structure of the pancreas. It's, it's slightly more hyperrechoic than the normal.
We know that it's pancreas from its position. This is the right limb of the pancreas, there's duodenum. There's the pancreat the duodenal pancreato duodenal vein coming along parallel to the duodenum that allows us to identify that.
But when we look in cross section again, we can see more normal pancreas, but with these hyperechoic areas within it, and these may well be associated with some scarring, associated with the change of the inflammation. So the pancreas doesn't look normal. It's got some rather undulating edges to the organ itself.
So we would be worried about, pancreatitis. So pancreatitis could, of course, cause a duodenal ulcer or the duodenal ulcer could start leaking and causing pancreatitis. Anyway, this is the fluid we got off and you can see that it's very turbid.
It's quite blood stained. We can't see clearly through the fluid. It contains active white cells with intracellular bacteria, which always means that you have peritonitis, present, and that that requires immediate surgery.
And that surgery, there was indeed a ruptured duodenal ulcer. That area of bowel was resected. The peritoneum cavity was flushed, and actually the dog made a very good recovery.
It had been on non-steroidal anti-inflammatories and probably that didn't help the ulcer or maybe have actually caused the ulceration within the duoden. The second case I want to present is a golden retriever, 10 year old male called Whiskey. And whiskey had a history which had thought to involve a gastric dilation and vulvullus on two occasions which had been decompressed with a needle in the last 36 hours.
So we have radiographs here. And what I want you to tell me is whether you think there is gastric dilation and torsion. So this is the dorsoventral view, left hand side to the right of your screen, right hand side to the left of your screen.
This is a ventral dorsal with the animal lying on its back again, right hand, left hand side of the abdomen is on the right hand side of your screen, the right hand side of the abdomen is on the left hand side of your screen. And here is the right lateral. And here is the left lateral.
And obviously you need to think about how the gas would move around in that three dimensional structure of the stomach, to give those separate positions. So right lateral. Left lateral.
And the question I want to ask is, is there gastric dilation and vulbulus? Yes or no? So just letting people vote the mic and again encouraging people to have a go.
It's always more fun if you have a go at it, so do just click on the link and we'll see how we get on. So, looking reasonably going more for the yes, so. About 2/3 saying yes and about 1/3 saying no there isn't gastric dilatation and vulvulus.
OK. So this is quite a difficult one, but it's quite important to know whether or not this animal actually requires, surgery in terms of fixing the the stomach. So let's have a look again at those radiographs.
So on the dorsoventral view, we've got gas within the fundus. That gas within the fundus on the left hand side would be normal. The greater curvature of the stomach comes across to the right hand side, and you've got a gas cap in the pyloris on the right hand side.
So from that single view, it would appear that the funders and pyloris are in the normal position. OK, in the ventral dorsal view, again, we've got gas. The gas is now in the body of the fundus because that'll be uppermost, but we can see, sorry, in the body of the stomach.
The fundus is here, present on the left hand side, the pyloris is here on the right hand side, and gas can be seen coming out of the of the duodenum here into the gas-filled duodenum. So the pyloris here is, is slightly malpositioned in that the pyloris comes around here and then into the duodenum. Some of you will perhaps have noted that the gas within the stomach is giving rise to this area here, so we've got some rugal folds.
But if we look at the serosal surface of the stomach. We can perhaps identify that the stomach wall appears to be rather thickened in this area. On this view, the thickened stomach wall is even more obvious.
So here we've got the ventral border, serosal surface of the stomach, looking through the body of the stomach, and we can see the mucosal surface up here. Normally, with gas-filled stomach, the stomach wall is fairly thin, perhaps getting up to this sort of thickness around here. Now, where's the Pyloris and where's the funders, this is a right lateral view.
So the gaps will tend to move to the left hand side. So the gas in the funders comes up here, goes over here and down here. But the pyloris is gas-filled also, and they've got pyloris is in a view cranial and overlying the fundus.
That wouldn't be quite normal. So the stomach is certainly dilated, dilated enough to have some folds and trapping of gas within it. The left lateral view shows, of course, gas coming or should show gas coming over towards the pyloris and fluid filling the fundus.
So we may lose much of the fundus. Again, we can see this thickening of the wall with perhaps some gasluisances within it. We'll come back to that in a moment.
But the pyloris is not particularly clear, and the pyloris should be, right at the end of this round area, that's the pylorianttrim coming out into the duodenum, and it's not quite clear where the duodenum is. So there is the answer to the question, and it's not really straightforward, is that there is evidence of dilation of the stomach. But the vululus is minor.
The vulvulus is just a displacement, perhaps a 90 degree displacement of the pyloris, not enough really to rush insurgically because the animal should be able to disperse that gas normally, and I think in this view here, we can see that the spleen in transaction is not enlarged. And of course, one of the features of gastric dilation and torsion is that you get compression of the venous drainage from the spleen, and the spleen becomes very large and congested. But what's going on in this wall?
So looking with ultrasound. We can identify this thickening of the wall of the stomach. Here's the mucosal surface.
It's quite bright and sparkly. There may be some ulceration along the surface of that mucosa. But undoubtedly, looking at the measures on the side, that's getting on for 2 to 3 centimetres thick at its thickest part.
And that comes across the body of the stomach on the greater curvature towards the pyloric area. There may be some speckles within the wall, but certainly the most obvious feature is that the wall has lost its normal layered appearance. There's a pattern to the mucosa, the submucosa, the muscularis, and the serosa that allows you to identify multiple layers of the wall of the stomach passing.
Through, and those have been lost in this area, that is thickened. Well, we took fine needle aspiration, biopsies. Fine needle aspiration biopsies of the stomach wall are most helpful if you've got lymphoma in the stomach, which is one of the neoplastic, processes, less so for a carcinoma because Sometimes the carcinoma cells do not exfoliate.
So the result of the FNA of the stomach wall was that there was inflammation. There was some mesenchymal cell proliferation, but although there were no neoplastic cells, a neoplastic process cannot be ruled out. And because this is a 10 year old dog and therefore you're worried that you might be missing a gastric tumour, particularly a gastric carcinoma, then a full thickness biopsy was, was done.
And that showed severe gastritis with massive necrosis of the stomach wall, thromy formation consistent with the history of gastric dilation and torsion, with subsequent vascular damage to the stomach wall. So, although the stomach was not Particularly towards or twisted at the time of the radiographs, it obviously had been twisted previously and that had caused substantial vascular damage to the gastric wall and then the thickening of the gastric wall to follow that. But knowing that, that's a better outcome to some extent.
The animal had a gastroplexy to prevent gastric volulus reoccurring, and the dog made a good recovery in that area of stomach wall was not totally devitalized and so it slowly resolved. And that's also just to show you, this is another case with an animal actually which had chronic gastric ulceration, is that thickening of the gastric wall and loss of the normal layering, that's the cut surface, doesn't always mean that you have a gastric tumour. So getting a biopsy to be absolutely sure.
Looking for metastasis in the local lymph nodes, all important to be able to define. We know that gastric carcinomas are not good tumours. They're usually much more extensive than you think at the time of your imaging, and they're not usually treatable.
And you don't want to put these animals down for a gastric tumour when they have Chronic ulceration or damage to the wall. The next case I'd like to present is a 9 month old Labrador retriever, male. This Labrador retriever had been vomiting for two days, was taken to their primary vet who gave some BIS.
Now, those of you who use BIPS, I think you will appreciate by the end of this talk that I'm not a great Believer in bits. I prefer barium if you're going to use a contrast technique, because these barium impregnated polystyrene spheres, I think can be very misleading. Anyway, they were given by the referring veterinary surgeon.
The owner couldn't afford any more investigations, so they were referred to our RSPCA clinic, and there they get reduced costs for investigations. So this is now looking 48 hours after the BIPs have been given. Now, the idea of these BIPs is you get larger ones and smaller ones.
The larger ones should be held up by any obstruction. The smaller ones may be able to pass through a, a small or partial obstruction, and so you can get an idea of perhaps that's the theory of where the obstruction might be. Well, in this case, we've got large spheres and small spheres still present within the stomach.
We've got some small spheres, probably overlying small intestine. We've got these two larger spheres there. So it's not really clear whether there is an obstruction from the appearance of the BIPs.
This is the left lateral view, and the left lateral view, the gas will come over into the pylorus, which is in the normal position coming off into the duodenum. As would be normally present, and this is the ventral dorsal view long coming around, from the ileocecal colic junction there. So what I want to know is, is this normal?
Is there a gastric foreign body? Is there an intestinal foreign body? Is there a linear foreign body, or is there gastroenteritis?
And like just letting people vote to see what they what they think. Should we go back through the pictures? Yeah, that would be helpful, yeah.
So that's the ventro dorsal. Yeah. That's the left lateral and that's the right lateral.
Great, so we've got, again, people are not sure, but do go ahead and vote. You've got a couple of more seconds. Give it a, give it a go.
And We've got 8% thinks it's normal, 16% saying gastric foreign body. A 25% intestinal obstruction, 32% linear foreign body, and 21% gastroenteritis, so fairly even spread but with the majority saying, or the most saying linear foreign body. Excellent.
Well, that's good news. So what we have, and the clue to this really being a linear foreign body, is these abnormal loops of small intestine. They're not particularly distended with gas, but they are very concertinaed and curled in their appearance, and they are consistent.
In a consistent position of the small intestine on both the lateral. Views and also on the ventral dorsal view in this area here, so the, Small intestine appears to be bunched up. Now what happens in a linear foreign body?
Is that you have something like a piece of material, a piece of string that is fixed at some point, either around the base of the tongue or within the stomach, but the rest of it passes into the small intestine, and then with peristaltic activity, the small intestine marches up on that fixed piece of linear material until it becomes fully bunched up. Now, when you look with ultrasound, ultrasound can be very helpful. You see here in the stomach, there appears to be some changes, some very bright, very linear changes that seem to pass on through the stomach, into the small intestine.
So coming down here, from the stomach into the small intestine, the small intestine then starts to bunch up. Further down the small intestine, there's a lot more bunching that's around the end of the linear foreign body, which you can see occasionally is very bright spots. And the problem is that once it bunches up like that, it'll start to cut through and lacerate the the small intestines.
So it's important to try and get these sooner rather than later. Well, the linear foreign body was confirmed at surgery. A mass of cotton was present in the stomach, which then passed into the small intestine, and there was placation of over 40 centimetres of small bowel, mainly the jujunum, but obviously being fixed in the stomach, you could see some changes also in the duodenum.
. Only a small amount of that had to be resected. This is a separate case, but one that had been going on for perhaps a little bit longer, moderately dilated loops of small intestine, all fixed in this very concertina and placated manner. And in this particular case, the linear foreign body had cut through all the the walls at multiple points, so you end up with a sort of sieve-like small intestine once you've freed up the fixed linear foreign body.
OK, we'll move on now to our next case, which is a golden retriever, 12 year old female neutered called Molly. And Molly had acute onset of vomiting for 4 days, was vomiting, water, food, but no blood. There was moderate weight loss.
More recently, Melina had been apparent, and at that point, the referring veterinary surgeon gave some of these barium impregnated polystyrene spheres. This was 2 days before we saw Molly. So these are the radiographs.
Right lateral view. Oops, giving you the answer. Right.
Anyway, I thought there was going to be a question, but there's no question there. So you can see again that these are mostly within the stomach, maybe some are going out into the small intestine, but what you could see, and what you could have seen on the plane radiographs before bits were given, is this very obvious peach stone. Sitting in a loop of small intestine, the gas abutting the end, gas around the kernel of the within the peach stone itself, a pretty typical appearance.
And as the animal vomits becomes more dehydrated, so the bowel adheres more closely to that peach stone, meaning that it's less likely to move on and to be passed. And the next case is a British shorthair, 11 year old female called Indigo. And the history with Indigo is that she had a 4 week history of abdominal pain, intermittent vomiting, nausea, anorexia, and weight loss.
Laboratory tests done at the referring veterinarian showed that there was an increase, quite a marked increase in the ALT. ALT, of course, is a hepatocellular enzyme, suggesting that the hepatocytes were being damaged, not necessarily killed in this process, but certainly significant damage to those hepatocytes had occurred. Total bilirubin was increased.
And therefore you would expect at 86 for her to look slightly jaundiced. Pre-perennial bile acids were normal, which is a slight surprise because normally, bile acids are raised along with bilirubin, and so there's no particular advantage of doing bile acids in a jaundiced animal. Anyway, she was treated with potentiated amoxicillin, metronidazole, and dietary supplements, Salin and dietary management with Hill's LD.
And the thought was, of course, that she had some form of chelangia hepatitis. But after 4 weeks, the ALT and the total bilirubin had gradually gone back to normal, but the clinical signs of occasional vomiting anorexia and weight loss continued. So it looked as though there had been some cholangio hepatitis that had perhaps resolved.
And so we were she was referred to us. A clinical examination, she was fairly thin, a body score of 2 out of 5. She was pyrexic at 39.8.
She had moderate abdominal discomfort on palpation. And so a problem list now was intermittent vomiting, abdominal pain, pyrexia, and she had this history of elevated ALT and total bilirubin that was now improving following the initial treatment. Haematology with us was unremarkable.
Our coagulation times were done in case we wanted to do a liver biopsy, and they were reasonably normal, slight increase in the one stage prothrombin time, mild increase in the APTT. And on the biochemistry. There was a slight increase in the creatinine, and the ALT was above our reference range, but not more than twice above our reference range, so therefore, probably not too significant.
Urinalysis was relatively normal. It's fairly concentrated, pH of 61 plus protein, but it's quite concentrated urine. But there was evidence of perhaps hematuria, faecal parasitology was negative.
So what you're going to see now are the radiographs of of Indigo. So we've got a lateral radiograph, a right lateral radiograph of the abdomen. Obviously, that's not going to show much when we're thinking of cholangia hepatitis.
We know that the liver might be enlarged, it may be a little bit rounded here, may extend a little bit beyond the costarch, but it's really not a tremendous amount of enlargement. Most of what you can see is the spleen. Small intestine gas within the colon, both kidneys superimposed on each other, and the fundus of stomach coming down to the pyloris with the axis of that stomach being more or less parallel with the ribs.
So, looking at ultrasound, I'm gonna show you some ultrasound pictures of the liver. And I'm gonna ask you what your diagnosis is. Has this cat got hepatic lipidosis?
Is it likely that it has cholangio hepatitis, duplex gallbladder, or feline infectious peritonitis? Knowing of course that feline infectious peritonitis is a difficult diagnosis to make. OK I'll go back through those ultrasound.
It's just really from the ultrasound. Remember, there wasn't that much. Information you can get from the radiograph.
So people who have voted Mike, we've got 7% saying hepatic lipiddosis, 25% saying cholangio hepatitis, but the big winner, 69% duplex gallbladder. Good, good, well you can all recognise the duplex gallbladder. Hepatic libidosis usually causes quite marked enlargement of the liver, and then the liver becomes very hypoechoic, often with a greater ecogenicity than the surrounding fat in the falciform ligament.
So what we saw on this particular view, it represents dilated bile ducts because we can see the flow of blood in the veins and then the portal circulation, and then we still have these dilated anechoically filled, rather tortuous. Tubes through the liver. And they're going to be dilated bile ducts.
Now, the thing about dilated bile ducts, if you know that the animal might have had cholangio hepatitis, is that this may now be incidental, because once they've got enlarged, we think very much that they remain enlarged for the rest or for a long time after the disease has been gone. Certainly there is a duplex gallbladder. The gallbladder has two particular compartments, that is a sort of classic duplex gallbladder.
Really, you should identify those because they're, they're a normal variation. But as we started looking at the common bile duct, we followed the common bile duct down towards the duodenum, we recognised this hyper-echoic structure, linear structure within the lumen. You can see it here.
This is the common bile duct. It's got a slightly thickened wall, or apparently thickened wall around here, around there with this structure within the middle, lumen. And that goes very closely to the duodenum.
Here in cross section, you can see the common bile duct with this structure within the centre. Again, another view, showing that it's a consistent finding. There's nothing .
That else we can sort of think of at that point. So. What we do, we thought that there was common bile duct dilation.
It's mildly dilated, its diameter was up to 7 millimetres in the distal portion close to the duodenum, that's probably twice of what we would recommend as being normal. There's a tortuous spindle shaped structure within the the Lumen with reflecting surfaces that we thought probably was some sort of foreign material, possibly a parasite. There's some parasites that can go into the common bile duct roundworms.
So what did we find? Well, at surgery, they confirmed the dilated bile duct. They did a duodenal enterotomy to identify the papilla, and they were going to catheterize the the bile duct, but they didn't need to do that because sticking out of the, the lumen of the common bile duct was this foreign body, and they removed the foreign body and they thought that that was probably the end of the story.
But as they were closing up, they found this anomalous vessel, coming out of the portal vasculature. And they then wondered whether or not there might be a porto systemic shunt. So having got this far, they wanted to confirm that there wasn't a porto systemic shunt, so they put a catheter into this vessel and injected some contrast, and in Indeed, there is no shunt because it goes straight to the liver and it pacifies the liver rather than going into the cordal vena cava and into the heart or into the zygous vein.
So that is a normal and that vessel was just an anomalous vessel. Indigo made an uneventful recovery from surgery. The clinical signs have subsided, and at the recheck two weeks post surgery, the owner reported she was back to her normal self, no vomiting, putting on weight and eating well.
The final case that I have for you tonight is a Labrador retriever, 5 month old male called Dylan. Dylan had a history of 2 weeks of vomiting and diarrhoea. She passed her sock after the first week.
So it was thought that there was the possibility of a foreign body. On clinical examination, she had a midabdominal mass. So she was radiographed, and this is the radiograph.
So what would you do next? You've got this lateral radiograph. You can look at that for a few moments.
Would you do a ventral dorsal projection, a barium series? Would you use BIS, or would you do abdominal ultrasound? Just letting people vote, Mike, but I would guess it's not, the answer isn't bits, is it?
You've you've telegraphed that one for us, haven't you really during the webinar. And if you put bits, you know, somebody will punch you out of the computer. We don't know if you have, but nobody's nobody's done bits, you'll be pleased to hear.
Somebody has been listening. So, yeah, we, we've got 58% saying to do with intra dorsal. 30% saying doing an abdominal ultrasound and 12% same barium series.
OK. Well, there's, there's probably no single right answer, although I think most people would have gone for abdominal ultrasound, . So the reason for that is that when you look at where the soft tissue mass was in this area here, pushing the stomach forwards and pushing the liver forwards, small intestine down here, a large intestine coming up here.
This area could be large intestine, could be the end of small intestine, there's a bit of gas here in what looks like ilium. So we're around about the ileocal colic junction. You would have got some information probably from a ventral dorsal, but it would be through this thickness of tissue and therefore, you know, it might have been quite difficult to actually identify what was going on in that position.
The reason I would have gone for abdominal ultrasound is that, you know, if you can feel a mass in the abdomen. Hold the mass and put the probe on it. Then you're looking at the mass.
And, and you know that you're looking at the mass because you're holding it. And that might then give you an idea as to what the mass is. And so, this is what it looked like.
And so what the mass is, is here. And the mass has a layered appearance of a small intestinal wall. But then inside it, you've got some fat.
You've got some mesentry and mesenteric vessels, and then you've got this other structure, which also has a layered appearance, multiple layers going around. So this is a classic interception. One.
A moment of scanning and you would have got that information. Now, obviously, you need to think as to why this animal might have an interception. Could there be some foreign material still there?
Could it have had a little polyp that had pulled through? It's a 5 month old dog. Maybe there were some worms that had produced the interception, but this is a really classic.
Interception with, multiple, layers of small intestinal wall or intestinal wall with, going on much more than normal. In, in, longitudinal phase, we normally see, the mucosa. The submucosa, the muscularis, and the serosa.
But here we can just see multiple layer on layer on layer on layer, and that's because we've got two layers of wall plus all the mesentry going through. It's just a very nice appearance. So here's the normal wall of a loop of small intestine, mucosa.
Submucosa, muscularis, which are hypoechoic with the mucosa, and then the serosal surface and the mucosal surface are bright. So, looking at that, you should be able to make that diagnosis. It's obviously not got a tumour even if you go to the end of the .
The mass, we weren't able to see that there was perhaps a polyp pulling the duo pulling the small intestine through. The position of the mass would suggest that this was at the ileocecal. Colic Junction and some of the additional layers that you might have thought, well, that looks more than just two layers of wall, it could be because of the secu present within there as well.
Here you can see it actually going through, so we've got the loop of bowel going into the interception into the intercipiens. So this was an interception involving the lysical colic junction. And I hope you've enjoyed these cases.
I hope you've learned something from them. I'm happy to answer any questions and perhaps we can see the dog from the flowers is it's spring.