C09990922 / invoice 10000

Reason for ultrasound: Haematochezia - chronic. Sedation given:     Butorphanol 0.1mls then alfax 0.2mls as needed Study: Abdominal ultrasoundFindings:Hepatobiliary: Hypoechoic liver with normal margins. The gallbladder has a minimal amount of echogenic debris in the lumen and the wall measures 1 mm. The cystic duct and common bile duct are mildly tortuous.CBD (RR <4mm) 2.9 mm.Gastrointestinal tract:Stomach contents: Minimal gas and fluid. Gastric wall: 2.3 mm. Duodenal wall: 2.3 mm. Jejunum: Small intestine measures 2.2 mm.Some jejunal loops have a prominent muscularis layer, measuring up to 3.2 mm.Ileum: 2.4 mm Colon: Wall measures 1.8 mm with preserved layering. A moderate amount of echogenic faeces is present in the lumen.Spleen: Varies in thickness from 10 mm to 14.7 mm.Pancreas:Nomral (Right lobe: 2.9 mm, Body: 6.5 mm, Left Lobe: 5.9 mm, (RR: 5.9, 9.4, and 9.0 mm, respectively for the R, body, and L lobes. Pancreatic duct up to 1.3 mm)Urinary tract: Moderately full bladder with anechoic urine and minimal echogenic debris.Kidneys are normal in structure, margination and echogenicity. (L: 3.7 cm, R: 4.3 cm ) (RR: 3.2-4.2cm)Adrenal glands:(L Cr: 2.5 mm Ca: 2.3 mm) , R Not seen. RR: up to L Cr 5.9 mm Cd 5.5 mm, R Cr 6.7 mm Cd 5.3 mm);Lymph nodes: Mesenteric lymph node 7.8 mm. Gastric lymph node measures 5.6 mm. ICLN: 6 mm.Ultrasound guided FNA performed with 25g needles on Mesneteric LN and spleen. Cystocentesis also performed with no immediate issues. Interpretation:- Thickened loops of jejunum with prominent muscularis DDx: Inflammatory bowel disease, Infiltrative disease (lymphoma)- Tortuous common bile duct iwth miniaml echogenic sediment DDx: Cholangitis/ cholangiohepatiits, cholestasis- Enlarged mesenteric, ICLC, gastric LN DDx: Reactive, neoplasiaI spoke to O.  WE will call with results. If more likely IVD --> Hydrolysed protein diet. If more likley neoplasia - discuss biopsy and referral. Dr. Suzanne Leibel BSc (Hons) BVSc (Hons) Grad. Cert. (SAU-A), MANZCVS (SA Radiology)    Vital Signs    Weight: 4.95;