Читать книгу Point-of-Care Ultrasound Techniques for the Small Animal Practitioner - Группа авторов - Страница 195

 Adult dogs and cats should have no free fluid within their peritoneal cavity or retroperitoneal space (or within the pleural cavity or pericardial sac); however, recent research evaluating anesthetized adult dogs and cats, and puppies and kittens has documented small pockets of free intraabdominal fluid in clinically normal canines and felines.

 The originally published AFAST‐applied abdominal fluid scoring system was scored according to number for positive AFAST views (range 0–4) excluding the bonus 5th view that is not part of the AFS. However, to better categorize small‐volume bleed/effusion from large‐volume bleed/effusion, AFS at each respective AFAST view now ranges from 0 (negative) to ½ (small pocket <5 mm in cats and <10 mm in dogs) to 1 (>5 mm cats and >10 mm dogs).

 Total AFS remains as originally published, with the categorization of small‐volume bleed/effusion defined as AFS <3 (AFS ranges from 0 to 2½, thus including AFS of 1, 1½, 2 and 2½) and large‐volume bleed/effusion defined as AFS ≥3 (AFS ranges from 3 to 4, including AFS of 3, 3½ and 4).

 Expect that ~50% of adult dogs will have an AFS of ½ along the diaphragm at the DH view with maximum dimensions of <3 mm that may not be noticeable in unsedated, unanesthetized adults (Lisciandro et al. 2019).Figure 6.35. AFAST‐focused spleen. The spleen represented by the banana is interrogated by the “slide and fan” approach, overlapping each section as scanning cranially until there is no more spleen and then scanning caudally until there is no more spleen. The author repeats the technique twice. Its hyperechoic capsule and the blood vessels splitting the capsule as in (A) identify the spleen. (B–E) A scan in a dog that has a splenic mass. In (B) and (C) the spleen is unremarkable until at (D) and (E) a mass that disrupts the contour of the splenic capsule is noted, a serious finding.Source: Reproduced with permission of Dr Gregory Lisciandro, Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX.

 Expect ~90% of puppies <6 months of age to have an AFS of ½ to 1 along the diaphragm at the DH view and then with fairly equal distribution between the other three AFAST views of ½ to 1 with maximum dimensions of <3 mm (Lisciandro et al. 2019).

 Expect that ~70% of adult cats and kittens <6 months of age will have AFS of ½ along the diaphragm at the DH view and then next most commonly positive in both age groups at the most gravity‐dependent umbilical view (SR view in left lateral recumbency) with maximum dimensions at either of these AFAST views of <3 mm that may or may not be noticeable in unsedated, unanesthetized adult cats and kittens (Lisciandro et al. 2015).

 The finding of sonographic striation of the canine gallbladder wall should be considered abnormal in the acute setting (acute collapse and weakness) even when the thickness is in the normal range of 1–3 mm; anaphylaxis, “anaphylactic gallbladder,” and right‐sided congestive heart failure, “cardiac gallbladder,” should be ruled out using the Global FAST approach.

 Although rare in cats, a “cardiac gallbladder” may occur with feline congestive heart failure.

 Characterization of the caudal vena cava may be grouped as a “bounce” and fluid responsive, “FAT” and fluid intolerant, and “flat” and hypovolemic.

 Maximum heights at the FAST DH view may be used to additionally characterize the caudal vena cava (see Tables 7.6 and 36.3).