腹部超声扫查技术abdominal scanning techniques

ElissaRandall,DVM,DACVRObjectives1.PatientPreparation2.Probes–whichtouseand3.Dorsalversus l4.SystematicApproach5. nes/6.ErgonomicsPatient1.Cliphair–fordorsalrecumbencyclipalonglastribandrestRightside–mayneedtoclipmorebycaudalribFor lrecumbencyneedtocliphigheronPatient2.CleanofflooseBrushoff,usevacuum,orwet3.ApplygeltoentireGelVersusAlcohol比较耦合剂和酒UsegelwhenpossibleforUsealcoholforsmallareaswhenhavetolookthroughUsealcoholforaspiratesandPatientDoIHavetoCliptheYes!WheneverpossibleWeuseelectricclippersImagingthroughfuris Probes:whattoLowermHzprobes(5-7.5mHz)fordeeperstructuresin低频率(5-7.5mHz)UsuallysectororcurvilinearLiver,headofspleen,maybekidneysand*DoquickscanofentireabdomenbeforeswitchingtomakesurenotmissingdeeplesionsProbes:whattoHighermHzprobes(7.5-13mHz)formoresuperficialstructuresindogsandentirecatabdomen高频率(7.5-13mHz)用于犬浅表的 Usuallylinearprobe,maybeBodyofspleen,kidneys,adrenals,bladder,GItract,lymphnodes PatientDorsalrecumbency(patientonits Mypreferred Keepsanatomystraightinmy Use lRecumbency(patientonits Goodifpatientinrespiratory Maybeeasiertofindcertainstructuresin Dorsal槽 lSystematicLikeanythinginDiagnosticImaging–useasystematicapproachLookatorgansinsameordereverytime,soyoudon’tforgetthings Don’tjumptoobviousMysytematicIuseacombinationofregionandorgan Liver,spleen,urinary,GI,ImagingOrder12Liver12SpleenImagingOrderandAdrenals 44 Pancreas,Smallintestines,Colon 5Lymph CVCand ImagingOrderOther:ovaries,uterus,testicles,masses,otherabnormalitiesnotalready其他：，，睾查Order(startwithlowerfrequencyLiver,headofspleen,kidneysandadrenals,“deepSwitchtohigherfrequencyprobeinSpleen(again–bodyandtail),kidneysandadrenals(again),urinarybladder,urethraandprostate,GItract–stomach(pancreas,)duodenum(pancreas,)restofsmallintestineandcolon,lymphnodes(andcaudalaortaandCVC),testes,uterusandovaries脾（-体和尾）、肾脏和肾上腺（再次扫查）、、尿道和、胃肠道-胃（胰腺）十二指肠（胰腺）小肠和结肠、淋（主动脉和后腔静脉），、、 nesImageENTIREorganin Followtoallmarginstobesureyouhaveseenthewholeorgan Someorgansyouneedtofollow Smallintestinescannotbefollowedwellforentire nesSagittaland nesof nesImageallorgans/structuresinsagittal(ordorsal) Sagittal纵 Transverse横 nes:sagittalProbeisparalleltolongaxisof nes:sagittalProbeisparalleltolongaxisof nes:transverseProbeisperpendiculartolongaxisofRotateprobetowardyouandtopatient’s nes:transverseProbeisperpendiculartolongaxisofpatientRotateprobetowardyouandtopatient’sright nes:ProbeisparalleltolongaxisofpatientBUTon aspectof nes:Notchononeendofprobecorrelateswithimage Notchonendofprobefacescranial/towardthe nes:orientationforNotchcorrespondstomarker(*)onscreen,whichalsoisthecranialaspectofthestructure NotchonprobeistowardtheRIGHTaspectofpatientandstructure Notchcorrespondstomarker(*)onscreen,whichalsoistheRIGHTaspectofthepatientandstructure，， Ifthisisasagittalviewoftheleftkidney,whichisthecranialpole?Ifthisisatransverseviewoftheleftkidney,whichsideistowardsmidlineofthebody?Probemovement:ProbeMovement:Sedation–DoIneedto——我需 Noteverypatient–weusuallydonotUse1-2holders用1-2Sedateifanxious,pantingalot,aggressive,struggling(willnotbequiet)Sedation–DoIneedto——我需 ButorphanolIfneedheaviersedation–medetomidine, Mor