Your patients can present with a variety of clinical signs. Based on our experience here are the 8 most common clinical signs where you should request an abdominal ultrasound.
1. Abdominal distension
2. Weight loss
3. Elevated liver enzymes
4. Jaundice
5. Polyuria/Polydipsia
6. Vomiting (+/- diarrhea)
7. Haematuria/Stranguria/Dysuria
8. Palpable mass or organomegaly
Ultrasound findings are often the doorway to the diagnosis for these clinical signs.
Read on to see why
1. Abdominal distension
Ultrasound can provide the distinction between organomegaly and abdominal effusion, two of the most common causes of abdominal distention.
Organomegaly can be caused by: (see 8. Organomegaly)
Ultrasound can visualize abdominal effusion, and ultrasound-guided abdominocentesis can help to obtain fluid for analysis to
determine the source especially where small sampling windows are present.
• Ascites (cirrhosis or cardiogenic),
• Haemoabdomen (secondary to neoplasia like haemangiosarcoma, carcinomatosis, metastasis),
• Peritonitis (secondary to pancreatitis, intestinal rupture, gallbladder rupture),
• Uroabdomen (secondary to ureteral or bladder rupture).
2. Weight loss
• Neoplasia (origin and invasion into other structures) (fine needle biopsy is required for
a definitive
• Inflammatory bowel disease (IBD)
• Chronic renal disease
• Carcinomatosis
• FIP
3. Elevated liver enzymes
Ultrasound can visualize changes to the liver, very important for distinguishing between the most common causes of elevated liver enzymes
• Endocrine diseases (hyperadrenocorticism, diabetes mellitus, and hypothyroidism which can develop vacuolar hepatopathy)
• Hepatic disease (cholangiohepatitis, chronic hepatitis, hepatic lipidosis (feline))
• Biliary tract (mucocele, cholecystitis, intraluminal biliary tract obstruction)
• Pancreatitis (extrahepatic compression of bile duct)
• Cholangitis and cholangiohepatitis (feline)
• Pancreatitis, pancreatic pseudocyst or abscess, pancreatic neoplasia
• Biliary neoplasia including neoplasia in the duodenal papillae
• Cholelithiasis
• Porto Systemic Shunts (PSS)
• Microhepatia (PSS, fibrosis, cirrhosis)
• Metastatic disease in the liver
4. Jaundice
Ultrasound can help to differentiate if the jaundice and hyperbilirubinemia are extrahepatic or hepatic based on evaluation of the liver, gallbladder, common bile duct, duodenal papillae, and the adjacent structures (hepatic lymph nodes, pancreas).
Cholangitis / cholangiohepatitis
Lymphoma
Hepatitis
Triaditis
Mucocele
Cirrhosis
Diffuse hepatic neoplasia
Hepatic lipidosis
FIP
Intraluminal obstruction of the common bile duct less commonly by choleliths, masses
Extrabilliary obstruction secondary to pancreatitis or pancreatic mass
Gallbladder rupture (by evaluation of the gallbladder wall, peritoneal fat surrounding it and performing guided abdominocentesis to determine if bile is present)
5. Polyuria/Polydipsia
Ultrasound can help determine the cause of polyuria/polydipsia
Hyperadrenocorticism (pituitary dependent or adrenal tumor)
Pyometra
Renal disease
Pyelonephritis
Diabetes mellitus
Lower urinary tract (uroliths, neoplasia, infection).
6. Vomiting (+/- diarrhea)
Together with bloods and physical examination, ultrasound can help identify if vomiting is due to
Primary gastrointestinal (GI) disease: Intussusception, foreign body, IBD, intestinal mass (obstructing), gastric ulcer, pyloric obstruction (congenital stenosis, hypertrophic gastropathy, neoplasia, foreign bodies), functional ileus (parvovirus), gastritis (garbage induced, drug induced, infection)
Secondary GI disease: pancreatitis, liver disease, renal disease, mastocytoma, hypoadrenocorticism.
7. Haematuria/Stranguria/Dysuria
Ultrasound can help to identify or rule out the source of hematuria.
Kidneys: Renal disease (e.g. Neoplasia like haemangiosarcoma, carcinoma),nephrolithiasis, renal infarct,
Ureter: Ureterolithiasis,
Urinary bladder: Urolithiasis, Transitional cell carcinoma (TCC), Cystitis, FLUTD, urinary bladder rupture.
Urethra: Urethral calculi, neoplasia.
Prostate: Prostatic hyperplasia, prostatitis, prostatic abscessation, prostatic neoplasia, paraprostatic cyst.
External pressure on the bladder/urethra by a mass.
8. Palpable mass or organomegaly
Ultrasound can identify the origin of the mass and is essential to performing ultrasound-guided fine needle aspirate or biopsy of this tissue.
Hepatomegaly: cardiogenic hepatic congestion, Infiltrative disease like lymphoma, hepatopathy, metastasis.
Splenomegaly: Congestion, neoplasia/hematoma, splenic torsion, splenitis
Adrenomegaly: even if not palpable adrenal glands can be enlarged secondary to pituitary dependant hyperadrenocorticism or adrenal tumors.
Renomegaly (differentiating between hydronephrosis, perirenal pseudocyst (cats), renal tumor,
Others; Intestinal/gastric mass, lymphadenomegaly (lymphoma, inflammatory, granulomatous), FIP
Conclusion
Ultrasound is an excellent diagnostic tool and Soundiagnosis routinely helps to identify or orient the diagnosis towards the diseases listed above. We help many clinicians across Melbourne with their case work-ups and we can help you.
Call us on 0430 343 802 or email info@soundiagnosis.com.au for further information or to make an appointment.