Hello,
Toby is a 7 years old Daschund M/N X that presented with acute onset of vomiting
Bloodwork revealed established mild inflamation, high Amylase, Lipase.
On U/S the pancreas is heterogenous with mid hyperechoic reactive fat surrounding it but also thickening of the stomach wall which measured 0.7-0.9 cm . The muscularis has speckles wich can be a sign of IBD? When woud you consider recommending full thickness biopsies? would you do a treatment trial with H2 blocker, etc first ?
Thank you
Hello,
Toby is a 7 years old Daschund M/N X that presented with acute onset of vomiting
Bloodwork revealed established mild inflamation, high Amylase, Lipase.
On U/S the pancreas is heterogenous with mid hyperechoic reactive fat surrounding it but also thickening of the stomach wall which measured 0.7-0.9 cm . The muscularis has speckles wich can be a sign of IBD? When woud you consider recommending full thickness biopsies? would you do a treatment trial with H2 blocker, etc first ?
Thank you
Comments
Full thickness for sure
Full thickness for sure here… but you may get exfoliation on corkscrew technique on us guided fna 20 gauge as well.
If there is no mucosal
If there is no mucosal perforation then H2 blockers (even proton pump inbibitors) are not effective. As Eric states ideal is a full thickeness but may get an answer from FNA. Gastroscopy may help but is there is no mucosal perforation or actual intra-luminal mass effect then may be non-diagnostic. Can prep the patient for laparotomy but scope before and can get representive samples then possibly no need. However, laparotomy could be both diagnostic and therapeutic (able to resect the mass).
Thank you Remo
Patient is on
Thank you Remo
Patient is on PPI- Omeprazole and reportedly doing a bit better ( that to me sounds like not improving….). The only way to see if there is mucosal perforation is to scope, right ? and we can also take initial biopsies.
That is correct – can also do
That is correct – can also do an impression smear from a biopsy sample looking for lymphoma.
Perfect. thank you.
Perfect. thank you.
You may want to consider
You may want to consider imaging with a linear transducer as the gastrfic wall is so superficial. Doing this may allow you to better image the layering and what is occuring within each one individually. The images that you have posted here are not allowing that fine distinction to be seen. Sometimes all of the real histiological changes are demonstrated whithin the sub-mucosa. If you measure the full thickness of the mucosa layering, it may reveal that an endoscopic biopsy ( cup size) may not reach the deeper tissues where the true lesion lies. I would go to a repeat US first if you do in fact have a linear transducer available to you. It is simpler and much less expensive.
The speckling in the muscularis layering that you are describing is seen mainly with hypertrophy of the layer in my experience. I suspect that it is the results of better contrast between the musculature and the connective tissue which is seen as hyperechoic linear stripping . Those streaks are as expected, paralell to the musculature. I believe that they are often associated with food hypersensitivity but could also be the result of increased resistance to the outflow path by the pyloris.
Thank you Dr. Hylands. I was
Thank you Dr. Hylands. I was gona rescan the patient to asess response to conservative therapy and will uses a linear ( I always forget about linear) .
I do remember seeing in the past your presentation in regards to pathologic adrenal architecture appearance on US and clinical/ histopath correlation. Great work. Different scanning approach. More use of linear probes:)