For all of you practicing ultrasound out there, I thought I would talk about abdominal ultrasound on weekly basis. It’s a discipline that requires a lot of skill, and the more cases you see, the better. One part is being able to get the images you would like, and the others are recognizing what you see, and knowing what you are looking for.
One of the diseases we commonly enounter in cats is fatty liver, or lipidosis. Cats who become anorexic for one reason or another accumulate fat in the hepatocytes, which alters normal metabolism. The fat accumulation causes reduced liver function, and results in a vicious cycle.
The goal of ultrasound in a cat with suspected hepatic lipidosis is to evaluate the liver itself, and identify any possible predisposing cause such as pancreatitis. In hepatic lipidosis the liver appears hypererchoic. The way I judge this is to compare it to the falciform fat that lies just ventral to it, and to see how far peripherally the hyperechoic walls of the portal veins are visible. If they are visible only around the hilus, rather than to the mid-portion of the liver as usual, the liver is hyperechoic. The second change I look for is hepatic enlargment. Hepatocytes that are filled with fat cause rounding of the hepatic borders, and protrusion of the liver lobes beyond the costal arch and stomach.
Obese cats also often have hyperechoic livers from excessive fat. However, their hepatic margins tend to stay sharp, and the portal vein walls do not lose their definition. Keep these points in mind, and you’ll have a head start on differentiating an obese cat’s liver from one with lipidosis.
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