肝胆系统扫查.ppt

Haga clic para cambiar el estilo de ttulo,Haga clic para modificar el estilo de texto del patrn,Segundo nivel,Tercer nivel,Cuarto nivel,Quinto nivel,*,肝胆系统超声,Hepatobiliary,Ultrasound,内蒙古农业大学教学兽医院,李伟超,做肝脏超声的原因,Reasons for Hepatic,ultrsound,X,线检查,肝肿大,Radiographs,Hepatomegaly,生化检查异常,Biochemical abnormalities,前腹部肿物,Cranial abdominal masses,黄疸,Lcterus,肿瘤分期,Tumor staging,做肝脏超声的原因,Reasons for Hepatic,ultrsound,无名高热,Fever of unknown origin,腹水,Ascites,怀疑门静脉短路,Suspected,portosystemic,shunt,解剖,Anatomy,左内侧叶,Left,mediale,lobus,左外侧叶,Left,laterale,lobus,右内侧叶,Right medial,lobus,右外侧叶,Right lateral,lobus,尾叶,Caudate,lobus,方叶,Quadrate,lobus,肝脏分六个叶，如果没有渗出液，几乎看不到不同叶的分界。,解剖,Anatomy,腔静脉,Vena cava,肝静脉,Hepatic veins,肝动脉,Hepatic artery,胆囊管,Cystic duct,总胆管,Common bile duct,总肝管,Common hepatic duct,十二指肠大乳头,Duodenal papilla,解剖,Anatomy,扫查方法,Sane planes,纵切,sagittal,扫查方法,sane planes,横切,transverse,技巧,technique,肋骨下扫查,subcostal,sacn,在肋下扫查时，探头和皮肤的位置尽量保持不变。,在大型犬和肝脏肿大的犬可沿肋弓进行扫查。,正常肝脏,Normal liver,均质、中等强度回声,血管,Vasculature,门静脉,Portal vein,肝静脉,Hepatic vein,胆囊,Gallbladder,肝动脉,Hepatic artery,（通常不可见）,正常肝脏,Normal liver,镰状脂肪,Falciform,fat,看起来回声均一，很像肝脏。,总的来讲更粗糙,和肝脏组织相比可能高回声或低回声，大多数成低回声。,镰状脂肪,Falciform,fat,门静脉,portal veins,将血液送入肝脏在肝门处进入肝脏,在胆管背侧,在后腔静脉左下方,强回声血管壁,分左右两支,门静脉,portal veins,肝静脉,Hepatic veins,从肝窦中收集血液,送入后腔静脉,扩张原因：心包积液、心丝虫、右心衰竭、后腔静脉栓塞。,肝静脉,Hepatic veins,肝动脉,Hepatic artery,和门静脉相邻,需要多普勒探头或高分辨率探头才能分辨,只有,20%,传入血液来自肝动脉,80%,来自门静脉,肝动脉,Hepatic artery,正常胆囊,Normal,Gallbaldder,胆囊壁：薄且光滑，强回声。,内容物：无回声,大小变化很大,壁厚度：犬,1-2mm,、猫,1mm,。,正常胆囊管,Normal Cystic Duct,猫的胆囊通常是双叶的,In cats gallbladder often,bilobed,由折叠引起,大小,Size,深胸犬肝脏在肋弓内，相对较小,当探头在剑突处及垂直体表时仍能看见肝脏,肝脏增大,肝脏后缘超过胃和右肾,肝脏边缘钝圆,肝肿大,Heapthomegaly,固醇类肝病,Steroid,hepathopathy,脂沉积,Lipidosis,糖尿病,Diabetes mellitus,淀粉样变,Amylodosis,充血,Congestion,炎症,Inflammation,肿瘤,Neoplasia,结节增生,Nodulary,hyperplasia,急性肝炎,Acute hepatitis,肝肿大,Heapthomegaly,肝脏变小,Microhepathy,纤维化,Fibrosis,硬化,Cirrhosis,门体系统分流,Porto-systemic shunt,微血管发育不良,Porto-systemic shunt,门静脉发育不全,Portal vein,hypoplasia,正常肝脏组织回声,Echogenicity,normal liver tissue,比脾脏回声低,和肾皮质等回声,受脂肪和水的含量、年龄等因素影响,肝脏局部异常,Focal Hepatic Abnormalities,肿瘤,原发或转移,增生结节血肿,脓肿,囊肿,肝囊肿,Hepatic Cyst,无回声,高回声壁,远端回声增强,大小不一,肝囊肿,Hepatic Cyst,肝钙化,Hepatic Mineralization,强回声光团后带声影,肝脓肿,Hepatic Abscess,通常由大肠杆菌引起,无回声、弱回声、混合回声,脓肿区域后方声束衰减,和其他器官感染有关,和异物有关,肝脓肿,Hepatic Abscess,血肿,Hematoma,无回声到弱回声或混合回声,随着时间推移可能出现强回声,有创伤史,与脓肿和肿瘤鉴别诊断,结节增生,Nodular Hyperplasia,强回声和弱回声,大小差异,老年犬很常见,需要活检来帮助诊断,低回声肝脏结节,Hypoechoic,Hepatic Nodule,多为良性增生结节，不排除转移灶,老年犬,固醇类肝病增生结节,高回声肝脏结节,Hyperechoic,Hepatic Nodule,局部高回声结节通常是良性的,血管瘤,弥散性肝脏疾病,Diffuse Liver Disease,肝脏均匀病变较难诊断,与脾脏对比与肾皮质对比,肾脏髓质,肾脏皮质,肝脏,脾脏,壁水肿,门静脉高压（水肿）,胆囊炎,/,胆管炎,胆囊增生,淋巴瘤,犬传染性肝炎,脓毒血症,肿瘤,胆囊壁增厚,Gallbalader,wall thickening,息肉,Polyps,常继发于慢性胆囊炎,粘液囊肿,Mucocoele,与胆汁静置有关,过程：粘液增生,-,过度分泌粘液,-,减少胆汁流动,-,淤积的胆汁酸的毒性作用,-,胆囊壁过度扩张导致缺血,-,细菌过度增殖,-,胆囊炎,-,压迫性坏死,-,破裂,常见于小型犬和中型犬,猕猴桃样变,壁增厚,扩张,胆结石,Cholelithiasis,犬通常没有临床表现,胆囊阻塞,Gallbladder obstruction,胆囊阻塞,Gallbladder obstruction,胆囊阻塞,Gallbladder obstruction,实验性结扎总胆管,24,小时后：胆囊和胆管扩张：胆管变大而且曲曲,48,小时后：总胆管扩张,5-7,天后肝内的胆管扩张：扩张的胆管与门静脉平行，用多普勒区别,胆汁抽吸,Aspiration of bile,如果怀疑有胆囊炎,/,胆管炎,先穿过肝组织：这样可以避免泄漏,用,22,号针头或者更小,欢迎批评指导,liweichao1988,