Today's Veterinary Practice

MAY-JUN 2018

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PEER REVIEWED 66 IMAGING ESSENTIALS In some dogs and cats, the ultrasound findings lag behind clinical signs, and the initial ultrasound may be normal. Conversely, recheck ultrasound scans can document persistent severe changes while, clinically, the patient is doing better and is back on a feeding regimen. Additionally, pancreatitis can be incited by a pancreatic mass, therefore, a recheck evaluation 2 weeks following pancreatitis may be useful in older patients to evaluate for pancreatic neoplasia. 6 Pancreatitis in cats has been reported in conjunction with hepatic lipidosis, inflammatory bowel disease, and cholangiohepatitis. This concomitant presence of inflammatory bowel disease and cholangiohepatitis with pancreatitis is a common pathologic entity in cats called feline triaditis; the intestinal tract and liver should be carefully scrutinized for concurrent abnormalities in cats with pancreatitis. 1 In cases of necrotizing pancreatitis, hypo- to anechoic regions of hemorrhage and necrosis can be seen. One can use color or power Doppler to assess for blood flow in areas of the pancreas that are affected, in order to rule out necrotizing pancreatitis, although motion artifacts often make accurate color Doppler examination challenging in these patients with cranial abdominal pain. Possible sequelae to pancreatitis include pancreatic cysts (retention cysts or pseudocysts) or abscesses. Pancreatic cystic lesions typically form rounded, anechoic structures associated with distal enhancement artifact; however, it is not possible to differentiate between congenital cysts, pseudocysts secondary to cavitation from pancreatitis, and retention cysts secondary to ductal obstruction. The appearance of a pancreatic abscess is similar to that of other intraabdominal abscesses. Abscesses are associated with distal acoustic shadowing but may, in addition, have a thick, irregular wall associated with perilesional inflammation (markedly hyperechoic fat and effusion) and may also show reverberation artifact from gas producing bacteria. Another common sequela of pancreatitis is extrahepatic obstruction of the common bile duct, resulting in dilation of the common bile duct, cystic duct, gallbladder, and eventually extra- and intrahepatic biliary ducts ( FIGURE 13 ). FIGURE 11. Dystrophic mineralization ( white arrows/MI with distal acoustic shadowing) within the areas of prior fat saponification secondary to pancreatitis in a dog. The descending duodenum ( DD ) is fluid distended consistent with an ileus secondary to a current bout of pancreatitis. PA , pancreas; PV , portal vein. FIGURE 12. Corrugation of the descending duodenum in a dog with pancreatitis in the right lobe. The duodenum is corrugated secondary to the surrounding pancreatic inflammation. The mesentery deep to the duodenum is hyperechoic as a result of focal steatitis and peritonitis. The pancreas is one of the most difficult structures to identify in the normal patient due to the similar echogenicity and echostructure of the pancreas and the adjacent mesentery and fat. Recognition of normal anatomic landmarks is key to finding the normal pancreas and should allow, at minimum, visualization of the region of where the pancreas should be located if one cannot directly visualize the pancreas itself.

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