LIVER ULTRASOUND

Preparation:

  • Starved patient

  • Sedated where possible

  • Full abdominal clip

  • Lots of ultrasound gel

In these articles the approach to abdominal ultrasound will be via a right lateral recumbency and then a left lateral recumbency approach. It is equally valid to image in dorsal recumbency

Approach

Cats and smaller breeds of dog:

  • Abdominal approach starting at the xiphisternum

Medium to larger breeds of dog:

  • Often require imaging via intercostal approach as well as via the abdomen

  • Intercostal approach is especially important for larger deeper chested dogs - especially to image the right liver lobes

In both cases the liver is scanned in longitudinal and transverse plains

The different lobes of the liver cannot be distinguished via ultrasound unless there is an abdominal effusion

  • LONGITUDINAL IMAGE OF THE LIVER - FAN UP TO ASSESS THE LEFT LIVER

    • With the probe marker towards you place the probe on the midline at the xiphisternum and angle cranially

    • In cats and smaller dogs drop the tail of the probe to fan upwards to assess the left liver lobes

    • In larger dogs it is often necessary to move the probe up the body wall/ image via an intercostal space

    • Compare the echogenicity of the liver to the spleen

LONGITUDINAL IMAGE OF THE GALL BLADDER AND RIGHT LIVER

  • Return the probe to the xiphisternum/midline and then fan down, lifting the tail of the probe to bring in the gall bladder

  • Further fanning down towards the table brings in the right side of the liver

TRANSVERSE VIEWS OF THE LIVER

  • Next move the probe back to the xiphisternum/midline position and rotate the probe 90 degrees so that the marker is pointing to the right side of the patient (down towards the table when in right lateral recumbency

  • Fan the probe in cranial and caudal directions to image the liver in cross section at the midline, left and right side of the liver

Note

  • In larger dogs it will not be possible to adequately assess the right liver fully with the patient in right lateral recumbency

  • The dog will need to be moved into left lateral recumbency and the liver scanned sub-costally from the right and through the ribs in large deep chested dogs