Point-of-Care Ultrasound Techniques for the Small Animal Practitioner

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Stephanie C. Lisciandro, Jennifer M. Gambino, and Sarah Young

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.