2025.07.10-Vet_The Aspire UCS 8-Step Abdominal Survey - Step 4_v11F.txt
English (US)

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So now we're going to scan step four of the abdominal. Eight step abdominal survey. And to do this we want to start in the long axis plane. Make sure once more that our orientation marker corresponds to both the left hand side of the screen and the patient's head. For a long axis section, I'm going to put the probe on.

So they will annually down almost perpendicular to the tabletop. So let's locate that left kidney. Here we go. And you can see that that's right over the hip axial area. And we're pointing down. And obviously as with any step that we're going to perform, we want to make sure that we optimize our image. Now we've got good quarter coma delivery differentiation here.

So we can just adjust the gain a little bit. So it's a little bit brighter. Now if we're looking at the kidney we want that to be in the middle of the screen. So we'll just come off that now and we'll just go down a bit on the depth. Here we go. Sorry. There we go. So we've got more of a near-field view here now. So there's our left kidney and we're going to scan all the way through it.

So that means we're going to fan towards myself until I run out of kidney. No more kidney visible. And then we're going to go away from myself towards the jewels until we go all the way through that kidney, trying to keep it as horizontal as possible on the screen. So sometimes you might need to just rock the probe like that.

Just tiny little bit of rotation in this direction. You can see that this makes a difference to whether the kidney points uphill or whether it's horizontal. Now, the more 90 degrees the sound is to the structure that you're interested in, then the better the view you will get and you'll get much nicer capsular mode.

I'm just going to increase the gain with the tweaks there a little bit. So we see this near field. Brilliant okay let's take that off now. Good. So there's our kidney scan all the way through towards me. All the way through away from me. Then when we get back to the kidney, when it's big on the screen once more like this, we're just going to rotate now counterclockwise so that we see the kidney becomes round.

We're now looking at the short axis view of that kidney. And the orientation mark is pointing to me now. So now it's important that we also scan all the way through this kidney and short axis beyond the caudal margin. So I'm just sliding down cordially. Very slight movements in Lilly because she's only a short dog, a little dog.

And then we're going to scan all the way up underneath towards the head, underneath that rib, until we run out of that cranial pole. And you can see also here that we start to get the head of spleen coming into view. So there's our kidney. We've had a good look at it now in long and short. And it's really important to do this with a kidney in particular because often we see people missing masses that are beyond the borders.

So please remember, if there's one thing you must always go beyond the borders of every structure you're looking at. So I would always measure the kidney now just so that you've got a good representative measurement. And that way you can compare the two. So we're going to go on to this which is the caliper.

So the lily and the longest axis here. And we've got a good um measurement there. That's nice. Lovely. Take an image. And now we're going to have a look at the ovary on the left. So where do we find this. We're going to find the left kidney on oat. So there's our spleen over here. I'm just going to reduce the image so we can navigate properly.

There's colon. Now remember that your kidneys are retroperitoneal. So they're going to be the other side more towards the spine when you see your colon. So don't think you've missed your kidney. Just carry on fanning away from you. And then we come into that left kidney. So there's her left kidney. It's the caudal pole we're going to focus on.

So I'm just sliding down a little bit and I'm taking the pressure off slightly. And this is the area where we want to be finding an ovary. And it is actually quite subtle. This is her left ovary. So how can I improve that image. Well, first of all what I want to do is I just want to adjust the dynamic range. So let's just bring that down a little bit.

Because this adjusts ups the dynamic range I think we have to go actually go small first down on our dynamic range a little bit. So it makes it more contrasty. And then we're just going to increase the image and just see if we could take the pressure off. Just see if we can see that little ovary. Just lost it a minute.

Let's just find it again.

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There we go. So this is her ovary in here. This is her ovary just in there. And we've just enhanced the contrast of it and adjust it there so that we're picking up these little follicles. And so it's a good tip. Dynamic range can be really helpful for looking at something. If you're struggling to see the borders it might be the answer.

So obviously we're looking in this over. We're going to be checking out making sure that there's no big sis masses or lumps and bumps in that area. So we've scanned the kidney again. I'm going to just optimize the image, just reduce this. Because now we're going to be looking at the anechoic structure here, which is the abdominal aorta.

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And what we want to do is we want to look for the two vessels that come off the aorta, which are the celiac vessel and the cranial mesenteric. And sometimes we get a really good view of these. Only there's one there and there's one there. And we call this the slug sign because it looks like a little slug with the feelers of these vessels.

Now, look what you can see above those vessels in between the kidney and the aorta. We have the beautiful left adrenal gland. So I'm just going to quickly increase that there in a size. So obviously the beauty of having skinny loop is that you can actually go back through and capture that image if the dog moves or she's a bit grumpy because obviously Lily is not sedated and we don't want to be hurting her or pressing on her.

It's really important that we get a nice view there. Good girl. So this is your typical buy load appearance for a left adrenal gland. Now, conventionally, if we're going to measure the adrenal gland, we want to be measuring the caudal pole height or the VD diameter. So again, when we go into our distance here and we just tap either side there and just adjust them accordingly.

Very simply done. And it's four millimeters in Lili. So a nice normal adrenal gland less than seven millimeters when you start to encroach in the dog's adrenal gland towards the ten millimeter mark. Then we start to question whether there's any pathology in there. So that's lovely. Left adrenal gland.

Take a representative image. Again always evidence what you're going to comment on in a report. It's a really good practice. And it corroborates not only your competency and your technique, but also your findings and why you're going to manage things. So now we've seen the kidney and long and short axes.

We've had a look at the adrenal gland in long axis and short axis. We saw it in short axes where we were looking at the kidney and short axis. We've got a view of the aorta here, and I'm just going to slide down the aorta on Lily. She'll let me just towards the Trifurcula, and where the angle of that left iliac vessel sweeps off the aorta.

That's where we're going to hopefully identify our left medial iliac lymph node. Okay. Okay, Lily. So let's try again. Good girl. That's brilliant. Is it gorgeous, girl? You just need a little rest. So I'm just going to put a little bit more gel on. And again we're going to find this aorta. Because if you remember we looked at the kidney towards that hip axial area.

And if you think about it the kidneys are a lot more dorsal than you expect. I'm going to locate dorsal to that kidney in the near field. In the far field we will find our aorta. So let's just get. There we go. So there's our aorta. And the vessel below is our caudal vena cava. So if you think about it the aorta is on the left side of the dog normally.

So if we're coming from the left, it's going to be the first vessel we the sound hits, and then we have the vena cava below. And if we're scanning the other way later on in step six and seven, we will see the vessels as if they have flipped, because we're coming from underneath the dog. Now there's our aorta.

Now you can tell the difference in short axis quite easily of the aorta and the vena cava. Our vena cava is quite squashy and compressible. And you can just see it there squashing in there. And the aorta stays around. It's a lot more muscular. The artery also we tend to see the branches of the aorta, whereas we don't really see branches other than the renal off the vena cava.

So it's a great way to distinguish it. You can see that the walls also are slightly brighter because of that intima layer. So we're just going to slide down the aorta from the adrenal which is up here. There's a kidney coming into view. So slide down the aorta all the way down. And then we should see the trifecta, which is here.

And this up sweep here as we go off, that vessel goes off down the left leg. And obviously this vessel goes off down towards the tail. And then you'll have the other vessel which goes off to the right down there. So you can prove to yourself that you're on the trifecta by going short axis. And you can see that the vessels split into three here.

There we go. One, two, three. So go back long axis. And then normally you would find the medial iliac lymph node is just there and just see it there. Just again good old Sydney loop. It's our friend this best friend. And then just use a little bit of pinching so that we zoom it. This here is our left medial lymph node.

Now why do we want to look at that. Well it's a good reason to look at that is because it's going to be an indicator of whether there might be any caudal disease going on. So if you are worrying about any sort of, for example, anal carcinoma, you know, whether or not there's any spread can often be indicated by looking at these caudal lymph nodes.

So this is one of the ones that's the most easy and standardized to find. So what we would do routinely is we would measure the length of that. And they tend to be elliptical when normal. And then we'd measure the height of it as well. So just let me just go there

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second measurement and go there and there. So we've got 12.1 by 3.0. So that's a normal medial iliac lymph node. That's great. So take a representative image again to prove that we've had a look at that area. And of course we've looked in long and short axes. So if there's gross lymphadenopathy along that aorta we're hopefully going to have seen it with that kind of standardized approach.