Chapter Sixteen POCUS: Pediatrics Autumn P. Davidson, Autumn P. DavidsonSearch for more papers by this authorTomas W. Baker, Tomas W. BakerSearch for more papers by this author Autumn P. Davidson, Autumn P. DavidsonSearch for more papers by this authorTomas W. Baker, Tomas W. BakerSearch for more papers by this author Book Editor(s):Gregory R. Lisciandro, Gregory R. Lisciandro Co-owner Hill Country Veterinary Specialists CEO, FASTVet.com President International Veterinary Point-of-care Society (IVPOCUS), Spicewood, Texas, USASearch for more papers by this author First published: 08 January 2021 https://doi.org/10.1002/9781119461005.ch16 AboutPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShareShare a linkShare onFacebookTwitterLinked InRedditWechat Summary Cageside point-of-care ultrasound (POCUS) pediatrics and its abdominal ultrasound provide valuable clinical information about the peritoneal cavity, great vessels, abdominal viscera, and lymph nodes and can usually be obtained without sedation or anesthesia unless the patient is markedly painful. This chapter discusses the uses and limitations of POCUS pediatrics. It provides information on common pediatric abdominal disorders, including gastrointestinal disease, peritonitis/peritoneal effusion, bowel perforation, gastroenterocolitis, intussusception, enteric thrombosis, and congenital herniation. Portosystemic shunts are congenital malformations of the hepatic portal venous drainage system and can have either a familial, that is, genetic, or random occurrence. A ureterocele is an uncommon congenital dilation of the ureter near the bladder, appearing as a cystic structure within the bladder lumen or wall. Cystic calculi, visualized as discrete hyperechoic focal echogenicities in the dependent portion of the bladder, occur most commonly in pediatric patients with urinary tract infection and portosystemic shunts. Point-of-Care Ultrasound Techniques for the Small Animal Practitioner, Second Edition RelatedInformation

Leucaena (Leucaena leucocephala) is a leguminous tree that is nutritious forage for domestic livestock when ingested in limited amounts. Unfortunately, leucaena contains mimosine, a plant amino acid, that can be toxic when ingested at higher concentrations. Reported toxic effects include alopecia (fur loss), poor body condition, infertility, low birth weight, thyroid gland dysfunction, and organ toxicity. Originally native to Mexico and Central America, leucaena has been introduced throughout the tropics, including Berenty Reserve, Madagascar where it was planted as supplemental browse for livestock. In Berenty, a seasonal syndrome of alopecia in ringtailed lemurs (Lemur catta) is associated with eating leucaena. Although much is known about the toxic effects of leucaena and mimosine on domestic animals and humans, the systemic effects on wildlife had not been studied. In a comparison of lemurs that include leucaena in their diet and those that do not, we found that animals that ingest leucaena absorb mimosine but that ingestion does not affect body condition, cause kidney or liver toxicity, or affect the intestinal tract. Alopecia is due to mimosine's interference of the hair follicle cycle. Leucaena ingestion is associated with higher serum albumin, α‐tocopherol, and thyroxine concentrations, suggesting that leucaena may provide some nutritional benefit and that lemurs can detoxify and convert mimosine to a thyroid stimulating metabolite. The primary conservation consequence of leucaena ingestion at Berenty may be increased infant mortality due to the infants' inability cling to their alopecic mothers. The widespread introduction of leucaena throughout the tropics and its rapid spread in secondary forest conditions mean that many other leaf‐eating mammals may be including this tree in their diet. Thus, exposure to leucaena should be considered when wildlife health is being evaluated, and the potential effects on wildlife health should be considered when contemplating leucaena introduction into or near wildlife habitat. Am. J. Primatol. 77:633–641, 2015. © 2015 Wiley Periodicals, Inc.

Lymphangiectasia is one of the causes of protein-losing enteropathy in dogs and characteristic ultrasonographic small intestinal lesions have been previously described. The purpose of this study was to determine whether corn oil administered orally (COAO) would result in increased conspicuity of these characteristic small intestinal ultrasonographic lesions in dogs with lymphangiectasia. Affected dogs were included if they underwent corn oil administered orally and had a surgical full-thickness intestinal biopsy diagnosis of lymphangiectasia. Control dogs had normal clinical examination and standard laboratory test findings. Ultrasound images of duodenum, jejunum, and ileum were obtained prior to and 30, 60, 90, and 120 min after corn oil administered orally for all dogs. Parameters recorded for each ultrasound study were intestinal wall thickness, mucosal echogenicity, and presence or absence of hyperechoic mucosal striations (HMS) and a parallel hyperechoic mucosal line (PHML). Nine affected and five controls dogs were included in the study. Seven of the nine dogs with lymphangiectasia had hyperechoic mucosal striations prior to corn oil administered orally. Jejunal hyperechoic mucosal striations were significantly associated with lymphangiectasia at multiple time points (P < 0.05) and were best identified in dogs with lymphangiectasia 60 or 90 min after corn oil administered orally. Increased mucosal echogenicity was observed in all dogs at multiple time points after corn oil administered orally. A parallel hyperechoic mucosal line was present in the jejunum in 4/5 healthy and 6/9 dogs with lymphangiectasia at one or more time points after corn oil administered orally. Findings indicated that corn oil administered orally improves conspicuity of characteristic ultrasonographic lesions in dogs with lymphangiectasia, however some of these lesions may also be present in healthy dogs that recently received a fatty meal.

Ultrasonographic evaluation of the reproductive tract is an important component in the evaluation of the dog and tom with reproductive disorders. Information is obtained confirming normal anatomy as well as pathologic conditions (eg, testicular neoplasia). Serial ultrasonographic evaluation of the diseased reproductive tract can be very helpful in evaluating progression of disease (eg, testicular atrophy) and response to therapy (eg, benign prostatic hyperplasia).

Ultrasonographic evaluation of the reproductive tract is an important component in the evaluation of the bitch and queen. Information is obtained concerning normal events involving the reproductive system (eg, ovulation, pregnancy) as well as pathologic conditions (eg, ovarian cysts, metritis). The appearance of the female reproductive tract normally changes with phases of the cycle; these changes need to be interpreted with knowledge of the ovarian cycle. Serial ultrasonographic evaluation of the diseased reproductive tract can be very helpful in evaluating response to therapy.

Endoscopy is a minimally invasive method of evaluating the gross appearance of the mucosal surfaces of the gastrointestinal, respiratory and urogenital tracts (Guilford, 1996). Efficient methods of performing endoscopic evaluation of these systems have been developed in small and large animal medicine (Jones, 1997). Besides providing direct visualisation, endoscopy permits obtaining representative biopsy specimens for subsequent histopathological tissue assessments. Video endoscopy allows recorded observations (for retrospective evaluation) as well as group participation by investigators and students, thereby improving both diagnostics and training opportunities.

Pediatric patients are commonly presented to the veterinarian because of signs referable to the abdominal cavity caused by congenital anomalies, dietary indiscretion, parasitic infestation, and infectious disease. Abdominal ultrasound provides valuable clinical information about the peritoneal cavity, great vessels, abdominal viscera, and lymph nodes, which is obtained in a noninvasive fashion and usually does not necessitate sedation or anesthesia. Ultrasonography thus greatly facilitates diagnostic evaluation of the pediatric patient. Ultrasound equipment already in place in many small animal veterinary clinics is appropriate for most pediatric cases.