Rectal ultrasound.pptx

Tips and Tricks for Transrectal Ultrasound in a Cow By Samuel Henry Hickling, Charlotte Elizabeth Mason and the star of the show, LAST BUT NOT LEAST... CHLOE JADE WILLARS Content • Ultrasound equipment • Restraint of the patient • Safety for operator and patient • Views for ovaries and uterus • C...

Tips and Tricks for Transrectal Ultrasound in a Cow By Samuel Henry Hickling, Charlotte Elizabeth Mason and the star of the show, LAST BUT NOT LEAST... CHLOE JADE WILLARS Content • Ultrasound equipment • Restraint of the patient • Safety for operator and patient • Views for ovaries and uterus • Common reasons for undertaking a trans-rectal ultrasound Ultrasound Equipment • Portable tans rectal ultrasound machine with a linear transducer • Can be connected to a screen or goggles • Sholder length gloves • Lubrication Restraint • Crush! Gold standard • Head locker • Headcollar? Probably a bit dangerous • Gate crush • Possible sedation, but very unlikely. Safety Handler • Keep close to animal to Patient prevent kicking • Well restrained to prevent • Be aware of the flight injuries zone • Quiet environment • Competency to perform the task • Possible sedation Views for ovaries and uterus Ovaries • Simple doppler applied transrectally • Longitudinal • No pregnancy • • Follicle 30 day embryo! Uterus • Simple doppler applied transrectally • Longitudinal • Hard to detect as the uterus goes deep into the abdomen • Uterine horns – left and right Common Reasons • Pregnancy diagnosis and status • Examination of uterus and ovaries • Assistance of Artificial Insemination Cases Image 1. Transverse ultrasound image of one of the cow’s uterine horns (hint the uterus contains echogenic fluid). Image Assessment: Image Report Hyperechoic heterogenous – colon Patient: Cattle Imaging Modality: Ultrasound Image Orientation: Transverse image of the uterine horn Technical Assessment: The area of interest is not central nor taking up 75% of the screen. Dark hypoechoic area could suggest poor contact. There is near field noise so we cant assess the uterine wall lining Hyperechoic homogenous – perimetrium (outer lining of the uterus) Medium echogenicity heterogenous – uterine wall Heterogenous – fluid/pus Hyper/medium echogenicity – ultrasonographic effect Conclusions: Medium echogenicity fluid within the uterine hall with thickened walls Diagnosis/ differential diagnosis: Pyometra Myometrial Mucometra Endometritis Metritis Pregnancy Further investigations/recommen dations: Sample of fluid and vaginal discharge Endometrial biopsy Image 2. Longitudinal image of the cow’s right ovary. Image Report Patient: Cattle Imaging Modality: Ultrasound Image Orientation: longitudinal Technical Assessment: Image appears to be of diagnostic quality Image Assessment: Anechoic structure = follicle/external lacuna Medium echogenicity, heterogenic structure = corpus luteum/cyst Hyperechoic = ultrasonographic artefact Conclusions: Corpus luteum and follicle present. Corpus luteum is dominant structure suggesting possible pregnancy Diagnosis/ differential diagnosis: Pregnancy External lacuna PRID use – inducing heat Further investigations/recommen dations: Take a thorough history Ultrasound whole uterus and ovaries If in doubt, take it out (of life)!