C10001170 / invoice 10000

Reason: Abdo u/s  +/- acth Appointment Notes: fastingadmission 1pmStill account for ear meds. EOSedation - Butorphanol 0.16/Midaz 0.32ml IM Good level Soft muzzle used for ultrasound ________________________Reason: Abdominal ultrasound: Key Sonographic findings are as follows:- mild chronic renal changes with hyperechoic renal cortices and some small hyperechoic foci at corticomedullary junction- moderated to marked hyperechoic dependant GB sediment/sludge - small subtle hyperechoic focal regions within left liver - favour benign ie nodular hyperplasia ddx: EMH, neoplasia Adrenals appeared WNL No clinical signs to support hyperadrenocorticism at this stagePlan: Recommend repeat bloods 2-3 months+/- review AUSConsider UDCA _______________________Urinary system. Left kidney measured 4.6cm length. Right kidney measured 4.88cm lengthBoth kidneys displayed hyperechoic slightly thickened renal cortices with some small numbers of hyperechoic foci at the corticmedullary junctionBladder lumen, wall thickness and appearance throughout apical, mid and trigone sectionsAdrenals - Left adrenal cranial pole 5.6mm, caudal pole 6.1mm. Right adrenal cranial pole 4.8mm_, caudal pole 6.4mmBoth adrenals appeared normal for shape with good corticomedullary differentation and smooth regular margins Spleen -  size, shape and echogenicity of the splenic parenchyma appeared normalMid splenic thickness ~1.7cm No significant nodular or echotextural abnormalitiescolour doppler flow normal Gastrointestinal tract - stomach - wall thickness 4mm, layering, peristalsis, pyloroduodenal junction appeared normal Jejunal  wall thickness measured 3.1mm-3.8mm in sections examined with normal wall layering and luminal appearance Dudodenal thickness measured 4.6mm with normal wall layering Colonic wall thickness 1.3mm. Mesenteric LN appeared normal in size and echogenicity up to 4.4mm width Pancreas - both pancreatic limbs appeared fairly isoechoic and imaging in expected anatomical location appeared normalHepatobiliary system - 1-2 subtle hyperechoic nodular regions deep within left to mid liver Measuring 2.23 X 1.6cm and 1.5cm width The liver appeared normal otherwise for echogenicity and echotexture with some mild rounding of liver margins Gall bladder appeared moderately dilated with a moderate to large amount of hyperechoic dependant non structured sediment wall thickness measuring 1.2mmCystic and common bile ducts normal Reproductive system - prostate - appeared small and hypoechoic with approx width 7mm No focal abnormalities    Vital Signs