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Further Reading
1 Boston SE, Higginson G, Monteith G. 2011. Concurrent splenic and right atrial mass at presentation in dogs with HSA: a retrospective study. J Am Anim Hosp Assoc 47(5):336–341.
2 Grimes JA, Fletcher JM, Schmiedt CW. 2018. Outcomes in dogs with uroabdomen: 43 cases (2006–2015). J Am Vet Med Assoc 252(1):92–97.
3 Hoffberg JE, Koenigshof AM, Guiot LP. 2016. Retrospective evaluation of concurrent intra‐abdominal injuries in dogs with traumatic pelvic fractures: 83 cases (2008–2013). J Vet Emerg Crit Care 26:288–294.
4 Kim SY, Park KT, Yeon SC, et al. 2014. Accuracy of sonographic diagnosis of pneumoperitoneum using the enhanced peritoneal stripe sign in beagle dogs. J Vet Sci 15(2):195–198.
5 Kolata RJ, Dudley EJ. 1975. Motor vehicle accidents in urban dogs: a study of 600 cases. J Am Vet Med Assoc 167:938–941.
6 Mongil CM, Drobatz KJ, Hendricks JC. 1995. Traumatic hemoperitoneum in 28 cases: a retrospective review. J Am Anim Hosp Assoc 31:217–222.
7 Sigrist NE, Adamik KN, Doherr MG, et al. 2011. Evaluation of respiratory parameters at presentation as clinical indicators of the respiratory localization in dogs and cats with respiratory distress. J Vet Emerg Crit Care 21(1):13–23.
8 Simpson SA, Syring R, Otto CM. 2009. Severe blunt trauma in dogs: 235 cases (1997–2003). J Vet Emerg Crit Care 19(6):588–602.
Chapter Eight POCUS: Liver and Gallbladder
Stephanie C. Lisciandro, Jennifer M. Gambino, and Sarah Young
Introduction
The goals of using POCUS for evaluation of the liver include recognizing focal and multifocal mass lesions and evaluating diffuse parenchymal echotexture and obvious changes in echogenicity. Evaluation for hepatic venous congestion may also be accomplished. The goals for the POCUS examination of the gallbladder include recognizing gallbladder wall abnormalities, luminal disease processes (e.g., accumulation of echogenic debris and wall nodules or mass lesions), and identification of signs that may support biliary obstruction. The POCUS liver and gallbladder examination can help guide clinical decisions by providing initial information that may not otherwise be evident with radiography.
The POCUS liver and gallbladder examination does not replace a complete detailed abdominal ultrasound study by a veterinarian with advanced training (veterinary radiologist or internist). The use of the POCUS examination may direct the clinician to obtain a complete study since the comprehensive evaluation of the liver and biliary tract is inherently more technically challenging for the novice sonographer than other abdominal organs. It is especially important to note that an unremarkable POCUS liver and gallbladder examination does not rule out the possibility of significant hepatobiliary dysfunction and disease. Liver biopsy may still be indicated when there is evidence of hepatic dysfunction, even with a lack of ultrasound abnormalities.
AFAST and the abdominal fluid scoring system (better the Global FAST approach) should be performed in conjunction with all POCUS abdominal exams, so as not to miss abdominal and retroperitoneal effusion including peritonitis and hemorrhage. Global FAST would be an even better approach to survey for pleural and pericardial effusion, and obvious cardiac and pulmonary abnormalities, and Global FAST is used as a screening test to rapidly discriminate between localized versus disseminated disease and identify complicating comorbidities.
What POCUS Liver and Gallbladder Can Do
Screen for differences in echogenicity between liver lobes.
Identify focal or multifocal masses or nodules.
Evaluate gallbladder wall and luminal contents (mobile vs consolidated, evidence of mucocele).
Screen for vascular congestion.
Evaluate for evidence of anaphylaxis if there is an index of suspicion.
What POCUS Liver and Gallbladder Cannot Do
Cannot differentiate between benign and malignant liver masses.
Cannot be the sole diagnostic indicator used in the diagnosis of biliary obstruction.
Cannot diagnose liver conditions based on echogenicity.
Cannot reliably determine liver size, or hepatomegaly versus microhepatica.
Cannot rule out severe liver disease such as hepatic neoplasia and cirrhosis or infiltrative processes based on an unremarkable focused liver examination.
Indications
Increased