Today's Veterinary Practice

MAR-APR 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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63 MARCH/APRIL 2018 ‚óŹ TVPJOURNAL.COM CLINICAL INSIGHTS NORMAL ULTRASONOGRAPHIC FEATURES OF THE GASTROINTESTINAL TRACT Canine and feline gastrointestinal wall thicknesses vary depending on the segment assessed ( TABLE 1 ). Ileum and Cecum The ileum of cats has prominent submucosa and muscularis layers ( FIGURE 3 ) and, due to a limited accumulation of mucus and gas, commonly has an ultrasonographically absent lumen-mucosal surface. The ileum of dogs has a prominent submucosa ( FIGURE 4 ). Anatomically, the ileum is contiguous to the ileocecocolic junction in the cat, leading to the ascending colon. In the dog, there is a separate ileocolic junction and cecocolic orifice. The normally gas filled cecum has an appearance similar to a segment of normal gas filled colon. In the normal dog cecum, the wall layers of the mucosa, submucosa, and muscularis have a uniform thickness. 13 Ultrasonographically, the normal feline cecum has a hypoechoic nodular inner layer (composed of multiple lymphoid follicles) and an adjacent hyperechoic submucosal layer. 8 The combined mucosal and submucosal layer is referred to as the follicular layer. Colon The colon is divided into three parts: ascending, transverse, and descending. The colon typically has the thinnest wall of all intestinal segments ( FIGURE 2 ), and the wall layering is normally indistinguishable due to distension with gas and feces. Gas and feces are seen as hyperechoic reverberation artifact with irregularly marginated, hyperechoic, partial distal acoustic shadowing material. Foreign material within the small intestines should be distinguished from gas and feces within the colon. An empty colon may appear undulating with distinguishable layers ( FIGURE 5 ). ILEUM ABNORMALITIES Nonneoplastic Ileal Wall Thickening Common inflammatory diseases affecting the ileum can be found in "Ultrasonography of the Gastrointestinal Tract: Stomach, Duodenum, and Jejunum" (January/February 2018) where duodenal and jejunal wall thickening was discussed. FIGURE 5. Long axis view of the descending colon in a dog. In this case, the colon is empty, allowing identification of both the near and far walls of the colon (calipers) at the level of the urinary bladder. FIGURE 3. Short axis view of the ileum of a cat. Note the normal, prominent, hyperechoic submucosal layer ( white arrowhead ) and the normal, prominent, hypoechoic muscularis layer. FIGURE 4. Long axis view of the ileum and ileocolic junction of a dog. Note the normal, prominent, hyperechoic submucosal layer ( white arrowhead ).

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