Ultrasonography can be

used to assess both the

structure and function of
the gastrointestinal tract

Ultrasonography of the
equine abdomen: techniques
and normal findings SARAH FREEMAN

ABDOMINAL ultrasonography is increasingly used in veterinary medicine and has an important role in
decision-making in horses with colic. The technique has been used predominantly in foals and smaller
horses, where rectal palpation is not possible, but is also a valuable diagnostic aid in the adult horse.
It enables the veterinary surgeon to image regions of the abdomen that are inaccessible to rectal
palpation, such as the duodenum and stomach. It allows abnormal rectal findings to be confirmed and,
in many cases, provides further information. For example, rectal palpation may detect distended loops
of small intestine, but ultrasonography will determine the degree of distension, any thickening of the
intestinal wall, and the presence or absence of motility. Based on this, features that distinguish between
Sarah Freeman surgical and non-surgical lesions can be identified. This, the first of two articles discussing the use of
graduated from ultrasonography in the equine acute abdomen, describes the techniques of abdominal ultrasonography,
the Royal Veterinary and normal ultrasonographic findings. The second article, to be published in the next issue, will describe
College (RVC) in 1994.
After a year working ultrasonographic changes occurring in the colic patient.
in mixed practice, she
returned to the RVC
where she developed ULTRASONOGRAPHY OF THE LIMITATIONS
an interest in equine
colic. She completed GASTROINTESTINAL TRACT One of the problemis of gastrointestinal ultrasonography
an equine internship in the horse is acoustic shadowing from gas and ingesta
and a PhD in equine Ultrasonography has a number of properties that are
anaesthesia, before within the large intestinc, and gas within the lungs. In
becoming a Home of useful in imaging the equine abdomen. It is a non- the horse, the large intestine is located along, most of the
Rest Clinical Training invasive, dynamic imaging technique, which can distin- lateral and ventral abdominal wall, and the lungs overlie
Scholar in Equine
Surgery. In 1999, guish between soft tissues of different echogenicity. much of the cranial and dorsal abdomen. These struc-
she was appointed Furthermore, it is easy to perform and allows the imme- tures reflect most or all of the ultrasound beam, making,
a lecturer at the RVC
in equine surgery. diate interpretation that is essential in the colic patient. imaging of any underlying structures difficult. In man,
She holds the RCVS Other methods of imaging the gastrointestinal tract, such the reflection of ultrasound from the large intestinal con-
certificates in as radiography and endoscopy, are of limited value in
radiology, tents is reduced by administering large volumes of oral
anaesthesia and the adult horse due to the size of the abdomen. fluids prior to imaging. This is not practical in the horse
equine surgery (soft and, instead, different techniques, such as combining
tissue).
ADVANTAGES transrectal and transcutaneous imaging, may have to be
Ultrasonography has a number of advantages over other used to visualise most of the abdomen.
imaging techniques. It enables different regions of the The ultrasonographer should always appreciate that it
(gastrointestinal tract to be identified, and their location, may not be possible to evaluate the deeper cranial
size, anatomical features (such as sacculations), luminal abdominal structures in the horse. This is a particular
contents and motility to be assessed. Fluid and soft tissue problem in patients with large intestinal distension and,
can be differentiated using ultrasonography. The small where feasible, sequential ultrasonographic examinations
intestinal wall can therefore be distinguished from its are of value. Nonetheless, deeper structures may remain
fluid contents, and parameters such as wall thickness and inaccessible and some lesions may not be identified.
the nature of the intestinal contents can be evaluated.
The ultrasound image is constantly updated, producing a
real-time moving image. Consequently, the position and ULTRASONOGRAPHIC TECHNIQUES
movement of structures relative to each other can be
assessed. The frequency, amplitude and velocity of the Transcutaneous and transrectal ultrasonography are the
peristaltic contractions can also be evaluated by B-mode, two techniques used in the horse (see table at the top of
M-mode and Doppler ultrasonography. the facing page).

204 In Practice a A P R L 2 0 0 2
TRANSCUTANEOUS IMAGING
Transcutaneous ultrasonography requires routine skin Sg%S-VilM CYIA AIoaIt IM11:
preparation, including clipping of the hair in most
patients, cleansing of the skin and application of a cou-
pling gel. The transducer required depends on the size of
the patient but, in general, a 2 5 to 5 MHz convex or sec-
tor probe is adequate. Higher frequencies (5 to 10 MHz)
will provide better resolution but less depth of penetra-
tion; they are useful in animals with less body fat and
thinner skin, such as thoroughbreds and foals. Lower
frequencies, such as 2-5 to 3-5 MHz, will penetrate up to
30 cm, although the image quality will be poor at this
depth; these lower frequencies are required for deeper
abdominal structures, and in larger or obese patients.
Transcutaneous ultrasonography should be used for
sternum caudally) and along the body wall, may obscure imaging between the loops of large intestine
imaging the ventral abdomen (the
the left and right flank regions. The left and right flank
should be imaged both within the paralumbar regions
(extending from the last rib caudally) and the intercostal ultrasonographic features
spaces (extending cranially to the level of the lung mar-
gins). Linear transducers can be used, but the intercostal NB The optimal technique is a combination of both transrectal and transcutaneous ultrasonography,
spaces in the horse are narrow and a sector or convex
probe is easier to manipulate in this region.
TRANSRECTAL IMAGING
Transrectal ultrasonography requires little patient prepa-
ration, apart from suitable restraint of the animal,
removal of all faecal contents, and adequate lubrication
with an obstetrical lubricant. It is performed in a similar
way to a transrectal reproductive examination, and, as
for all rectal palpation techniques, the horse should be
adequately restrained and care taken to avoid trauma or
iatrogenic damage to the rectum. In some patients,
administration of an %c2-agonist or hyoscine (0 1 mg/kg
intravenously) may facilitate manipulation of the trans-
ducer. If these drugs are given, it should be remembered
that they may have an effect on motility and this should
be carefully considered before interpretation of any find-
ings (see second article).
Transrectal ultrasonography can be performed with
either a linear or convex probe, and frequencies of 5 to
10 MHz are most suitable. With some machines, a
penetration depth of up to 20 cm can be achieved at
these frequencies. This allows imaging of cranial
abdominal structures that cannot be reached by rectal
palpation alone, and is particularly useful in large horses,
where structures such as the nephrosplenic space may be
difficult to palpate.
NORMAL ULTRASONOGRAPHIC FINDINGS
LOCATION OF ABDOMINAL ORGANS
This article will concentrate mainly on the gastrointesti-
nal tract. However, other organs, such as the spleen,
kidneys and bladder, should also be assessed in the colic
patient and, therefore, brief details will be given, where
appropriate.
Transcutaneous ultrasonography
The structures that may be identified by transcutaneous
ultrasonography, and their locations within the abdomen,
are listed in the table on the right. Large intestine will be
identified consistently in every region. The presence of
small intestine is more variable; in most horses, small
intestine can only be imaged in the ventral abdomen. It
In Practice * APRIL 2002
O S12_
Vis_oe aSI.,
.
Transcutaneous ultrasonography Transrectal ultrasonography
Requires little patient preparation
Requires more patient preparation,
including clipping
Non-invasive - no risk to the patient More invasive - risk of rectal tear similar to routine
rectal examination
Requires lower frequency transducer, Reasonable image quality with 7-5 MHz transducer,
which may not be available in all practices as routinely used for reproductive or tendon imaging
Access to most regions of the abdomen Only caudal region of the abdomen is accessible
Poorer image quality due to imaging Excellent image quality regardless of body condition
through the body wall - this is a particular due to direct placement of the transducer over the
problem in large or obese adult patients region of interest
Gas within the large intestine, which lies Bowel can be manipulated and the transducer placed
of other structures
Regions of intestine can only be identified Regions of intestine can be identified by palpation,
by their location within the abdomen and allowing distinction between, for example,
small and large colon, based on their diameter
and number of taenial bands.
which will allow most of the abdomen to be imaged
should be possible to identify the liver, spleen and kid-
neys in all normal animals. However, the stomach and
bladder may not always be visible, depending on their
degree of filling. The size and contents of the large intes-
tine can affect which structures are identified. For exam-
ple, in six horses which were switched from a diet of
grass onto hay and concentrate, the small intestine was
identified more consistently on the hay and concentrate
diet, presumably due to changes in the size and contents
of the large intestine (V. Nicholls and S. L. Freeman,
unpublished observations).
Transrectal ultrasonography
During transrectal ultrasonography, the transducer is
manipulated in an arc across all regions of the abdomen,
including dorsal structures such as the aorta, iliac arter-
ies, sublumbar lymph nodes and kidneys. The table over-
leaf lists the abdominal structures identified and their
location. There is some variation between different
patients; for example, the right kidney and renal arteries
may not be accessible in larger patients.
a 9:fil 0 P1401 li 0 1*011MI el SI*Ltil : or1vel rei S,* jlava[O 9 0 1, ,m 9lo 1 lMl : FA
S~~~~~~~~~~~~~~~~~~~~~~~~~~-
Region of the abdomen Abdominal structures
Cranial right flank Large intestine (sternal flexure, diaphragmatic flexure,
right ventral colon, right dorsal colon), small intestine, duodenum,
liver
Caudal right flank Large intestine (right ventral colon, right dorsal colon), caecum,
right kidney
Cranial left flank Large intestine (sternal flexure, diaphragmatic flexure, left ventral
colon, left dorsal colon), small intestine, liver, stomach
Caudal left flank Large intestine (pelvic flexure, left ventral colon, left dorsal colon),
left kidney, spleen
Cranioventral abdomen Large intestine (sternal flexure, left ventral colon, right ventral
colon), small intestine, spleen
Caudoventral abdomen Large intestine (pelvic flexure, left ventral colon, right ventral
colon), small intestine, spleen, bladder
205
 IIId;--I ,I 4vElW--
I V I 0YA lllkLT1S LT18
Region of the abdomen
Left dorsal region
Left ventral region
Right dorsal region
Right ventral region
*The right kidney and associated structures can be difficult to reach, and are usually only accessible
in small patients that are relaxed on examination. Often imaging is limited to the caudal pole of the
right kidney
Magnified ultrasonogram of
small intestine, imaged in
a water bath using a 10 MHz
linear transducer, showing
the five layers of the
intestinal wall. 1 Serosa,
2 Muscularis, 3 Submucosa,
4 Mucosa, 5 Mucosal
interface. The total wall
thickness (double arrow) was
3 mm
*V.- differenit cchocenicitics andct. hen imagzed nlnder optimal
conditions. fitve alterniatilln ultrasonographic layers can
Abdominal structures bc identified (illustrated belo ). The ultrasonographic
la yers Lare hypcrechoic scrosal. hypoechoic mLiscilSlaris.
Large intestine (pelvic flexure, left dorsal colon), small intestine,
small colon, spleen, aorta, iliac arteries, left kidney, left renal artery, hypcr-echloic subLmIucosa1. hypoechoiC ImLIcosa andt hyper-
left ovary echoiic mucosSal intel-face. Thc cxtr-a layer. the mucosal
Large intestine (pelvic flexure, left ventral colon), small intestine,
interlface, resIlts rol-01m (cals or incyesta onl thlC suIr-IfLac of
spleen, bladder, uterus tIlC ImnLCOSai. This fis e-laVCIe-Cd Ultl-rsonoI araphic appear-
Large intestine (right dorsal colon), small intestine, small colon,
aince is present throughout the smniall and lari e intestilne
caecum, aorta, iliac arteries, right kidney*, right renal artery, ol thc horse, except foir the ilCLiI Which hats aI SCtenI1
right ovary layeced appearanceCIdne to aI aIdditiOnal ImIusICIC aIVC1r
(Wol-thi 1995).
Large intestine (right ventral colon), small intestine, caecum,
bladder, uterus Optimall condclitioins tOr imacwing the initestinal stall iie
ai transducer angle of 900 to the intestinal swall, anid flUid
sWithill thc lumIeCII. This meanes that it is easier to obtaill
imalcs of the snxdli intestinal talC.cduc to its more fluid
conlteilts compared to the largc intestine. Ho\ esver, c ith
mllnlilN castrointestinal diseases, suchl .1s strailgulations.
Neithel- ULltr.Lsonlogral-1pllic technliqluc sWill Consistentls enteritis a.nd colitis. thelic- is Ln icrIeas il ninallil flnid
distillnuish diffcrent IcionIs sof the I arce intcstine. aLnd the stall is mor-e easils v isible. The totdl tall
Chariacte-istieS SLIChI .IS SaCCulations. tihe oricletation ot tlilckn,ess ot normal initcstiec, illeaLsuei-dc hy ulltl-rsoIno-
contractions and the location of- the intcstille can11 c-istC aI grlaphy, is between 200( and 375 mim thr-oughouIt tilh
incdic,ation in the normi'al boisc. Hosctcr, reliable idecintil- castrlointcstinl tract (Rcel 1998, f rccman and others
Cation,l pa1rtiCulai ly\ in the colic patient. (lepends oit reectal 2(0(0(). FaLctors thalt could potenti.ally alter the w.all
palpatilon co mbinied s ith Ultl-rasonci graph-.ll-ic finding-'s. thlilckicss in the normal animI'al i -c the site of thec
hoi-se, the decircc of intestinal disteisioni and prCSSuL-C
APPEARANCE OF THE INTESTINAL WALL exce-ted by the ultrasouLId tiansduLei ChIan 0 hCS in thc
The intestinal stAll Cc)mpr-ises touL- laNy ers: thC sCI-osat. echocnilcitv andicl tthe thilckincss of tth wall Lav ers oCeni
m1isuLISUiMS, SUbmILuCOSat andC MUCOSat. Tlhcsc lasvcis hatvc ws ith diSCasC.
ASSESSMENT OF INTESTINAL MOTILITY
Motility is an illmportaint aspect otf g.astrointcstinal 'luneic-
tion alnd can bc aLltei-cl bhy a lliuimbel- of LlCtoi-s inCeludingo
diet. exercise le els, dIne aldmiistlration. cncdotoxacmia
andici c,astrointestinal disease. 13- o M- modew Lliltl-Lsoiloci a-Z-
phy caiin bc uLsCd to assess the mov ement of the intestinal
stall ol- its contents. t)opllCI- uIltr-Lsonograph-Lyl)11 has hcbee
used to Imea,suIreC ilItestinall m1otility ill othel- species. but
tIlhI-C is 1no daltal onl tIlis techniqIiCLle ill tIlh 11ho-SC.
'I'ih motifit ot, differe-nit ecions i ot tile ilntestine.
based on dcatatai-oiom 18 noi mal hoi-ses, is cit en in the
table oni thie t.villa Pag.c Gastrointestinal dl isealse usulSly
i-Csuilts in1 aI reduCLcition Ill mOtilits, althoulla ltess disclses
Imay InIcr'ealse Motility
Transcutaneous image of the sternal flexure illustrating
the five-layered appearance of the intestinal wall (arrows).
Transcutaneous image of a transverse section of two loops The sternal flexure is lying immediately adjacent to the
of small intestine (1 and 2) illustrating the five-layered body wall. This image was obtained in the mid-cranial
appearance of the intestinal wall (arrows). This image was abdomen, immediately caudal to the sternum, using a
obtained in the mid-ventral abdomen using a 10 MHz convex 10 MHz convex transducer. The upper part of the image is
transducer. The right side of the image is towards the ventral and the lower part is dorsal. The right side of the
sternum, and the left side is towards the caudal aspect of image is towards the sternum, and the left side is towards
the abdomen. BW Body wall, PF Peritoneal fluid the caudal aspect of the abdomen
206 In Practice APRIL 2002

Region
m]I o:IaofhI:I
e int te Feun
ofi
Ihd.int i and almost complete occlusion of the smiiall intestinal
Region of the intestine Frequency of intestinal contractions
Small intestine 6-15 per minute
Caecum 2-6 per minute
Large colon 2-6 per minute
Small colon 0-3 per minute
Data from Freeman and England (2001) and Freeman and others
(2001 b)
FEATURES OF THE SMALL INTESTINE
The small intestine can be recognised by its small diaime-
ter, f'luid contents and frequent peristaltic contractions. It
has a tubular appearance on ultrasonography, and images
vary betsveen transversc and longitudinal sections (as
illustrated belosv). The cointents are predominantly fluicl,
but vary in echogenicity depending on the 'amount of
fluid, ingesta and gas (illustrated overleaf). Fluid has a
hypocchoic appearance; ingesta is echog-enic, often
producing a heterogeneous pattern with mixed fluid and
particulate matter visible, but svithout acoustic shadow-
ing; gasls is highly reflective. producing a hyperechoic
reflection with acoustiC shadowving. Norimial small
Transrectal transverse image of empty small intestine
overlying hyperechoic large intestine. The intestine is
contracted, there are no luminal contents and the
mucosal wall is folded, producing a corrugated appearance.
This image was obtained in the right caudal abdomen
using a 10 MHz convex transducer. The right side of the
image is dorsal within the abdomen, and the left side is
ventral
In Practice * APRIL 2002
Assessment of small
intestinal motility by
ultrasonography. These
images were obtained in the
mid-ventral abdomen, by a
transcutaneous technique
using a 10 MHz convex
transducer. The upper image
shows transverse sections
of two loops of small
intestine using B-mode
ultrasonography. The lower
image shows movement
of the small intestine
with time using M-mode
ultrasonography
intestin,al contractions cause rapid propulsion of inuesta
lumen.
The location of the small intestine is very vsariable,
and normally only a small proportion will be imaged.
The cluodciumii is coinsistently located along the right
flank, accessible to ti-aniscutaneous L_ltrasonogclaphy at
thc 16th and 17th intercostal space immediately ventral
to the kidney. The normal duodenum has frequeint
conti-actions, ingest'a is passed rapidly and there is never
pci-sistent distension. The remainder of the small intes-
tine can be imaged at valriable sites in norm-al horses.
It is most frequently identified in the vsentral abdomen
\vith both the transr-ectal and transcutaneous techniques.
Ho\wever-, is not alwvays possible to identify small intes-
tine on cvery examinaction, and a combination of the twvo
imaging tcchniques, or repeated examinations, may be
requil-ed.
Jejunum cannot be consisteintly distinguished froIml
ileumIl using ultrasonogriaphy. The ileum is located
craniall aind medial to the caecum, but can be difficult
to image in larger horses. In vitro, the w,all of the ileum
has a seven-layered appearance (due to ain additional
muscle layer), compared with the five-layered appecar-
ancc of the jejunum; in vsiv o, this feature is difficult to
ileititfy.
Transrectal longitudinal image of ingesta-filled small intestine, overlying hyperechoic
large intestine. The small intestine has a hyperechoic appearance without acoustic
shadowing. In contrast, the underlying large intestine has contents that produce acoustic
shadowing. This image was obtained in the mid-caudal abdomen using a 10 MHz convex
transducer. The right side of the image is towards the left abdominal wall, and the left side
is towards the right abdominal wall
2 07
Transrectal image of three loops of small intestine (1 to 3) with overlying
peritoneal fluid: 1 is a longitudinal section of small intestine containing
mixed fluid and ingesta, hypoechoic fluid is lying dorsally, and hyperechoic
ingesta has accumulated in the ventral portion of the intestine; 2 and 3 are
transverse images of small intestine during contraction, with no luminal
contents visible. There is hypoechoic peritoneal fluid surrounding loops 2
and 3. This image was obtained in the mid-caudal abdomen using a 10 MHz
convex transducer oriented towards the cranioventral abdomen. The right
side of the image is dorsal within the abdomen, and the left side is ventral
Transcutaneous image of ingesta-filled small intestine overlying hyperechoic
large intestine. There are two loops of small intestine imaged in the
transverse plane. The luminal contents have a heterogeneous pattern
without acoustic shadowing, typical of ingesta. This image was obtained in
the caudoventral abdomen in the midline using a 5 MHz convex transducer.
The right side of the image is towards the sternum and the left side is
towards the caudal abdomen. Body wall and abdominal fat is between the
intestine and transducer

FEATURFS OF THE CAECUM FEATURES OF THE LARGE INTESTINE

Thethe cmCLIai 111 hC ideCnltifieId bs its loCttio Ii tin the The fargc in1tCstinC haS aI sillilii Li1ltraIson1or6aphii
r IT Ilt CTIICIaId aIbtdomen.01 itits katC Chdillamtei-r Sacen laioS .afia1ranCe to tilC tac ntCLI. I li1 Vtsti oaf all IiSx isible
and colit i act o(s. The ca.cca.tl conitcnts m"ii1s be citlici Ntit thlC LtiCndiANi11 N n oliteints pi-odnLeC a hi olii hi eIcheloic
slitIC.I,i.],itl O mii\eCd iII the no1ill.tl mIo-SC. b nti ae1lc nlsntlil shadCos so tlalt onINr thle sinLice can li maoed Sac
Ios(no s
clI e Clatioiitscai lie iCenlti'iCeI LIftra-soLioiaticall1N and(
helvi. 011Nl the Ce al I w ail and the eacca contcits to thicsc alloss the dlisti netion betsw ccii i lie doi-Sal and
leCss ccintimictI es diclptlh. can bc Hmaced. an tI notifits is si1ti. CoIoII as illoLsti atCd aIt tilh top of thie acino( pae1.
CV a1al1 ted fim111 theC nIoI0 Cenlenit of theC caICClI ;xatIandt the MotilitN can lie assessetd t'i-omi the iiiose\Ceni otot tl wall
_nIdeVillii hy perechoic shadoss The imaill cointractiolis antIllndCrtic-Nin 11fiNfi-Crcli)ic sllaosv, land lchanLcs
hr in
5 itllill the CICttIIImare 0(-iCietCC \ertica'l1) (CIC -isoVCetrlslN thlC saICenlattiolls of'tllh stitrl1oot11.
v cIitid()i()r salk 5 II ceacs iII the tcst the t1at 'C [le tdilfeterit ircoiis oIt the 1.l-tte iiitcsttiic 1nia thc
lintestline the tnWIn iicontraIct tons ae owi ented 1iOIiioiialI li estiiiifLtisclN idciitilici ttN l tilili- location ini tie iiorimal
I
11

c aiiicanIallNllI
L ()
-11tt;()11tallIsIV ().
1tC 11iSti 0CAI11Ck1 11N O)i11 candoerai
CA,,)I
S t Ijt1

hol-scs ol his I-Ctal f.iafalptiOi of the tactilatbatinds and

It tial-IsreCtatal ultrlasonlo-rlaphs is Llsed. tticii dniitl- sa.ICClatiotiO]S.
tiCtio011 ()ot te CaCLm ca11n be confirmliedl bv falaItioll of Tlie
l riit scntrial cofoii artiscs i-oni- the laiteral a sfcct
the medlial caccatl bind. Tacnial halnds arc dlCittiCLt theO ot calccm in the CitLhI sIntral ahbdonien. It ruILns erl-a
to idntlt`t ulltralsooOrll-lphialIll\ bhUt thC b:IoOc sCssCIs 1i.ial s to tIlh stCl-rltil I1CXl -nc b )toreL t Iii I ili-ooIli 1 8
associalted withi the ilel'diatl and1bl latciLalt C'ace;' 1f baiids caiil andCt coniltilLillioii 11011an the lcft -aiik. as tthe let s entialf
be idecnltitficdl. and n1o1imaIl bIlood flo\s cv af1nated seC coloti. The senlti-af coloii hla1s toiI- taiCiiIal hba1ndCs and1l
beIo w I. sactiCl ations or tIanLstl-iatioIs. TheC lett \rCiiti Cofoi tiis

Transrectal image of the caecum showing sacculations
(arrow) and hyperechoic intestinal contents. The intestinal
wall is visible only as a hypoechoic line overlying the
ingesta. The ingesta produce a hyperechoic reflection with
acoustic shadowing. This image was obtained in the right
caudal abdomen using a 10 MHz convex transducer oriented
towards the right lateral body wall. The right side of the
image is dorsal within the abdomen, and the left side is
ventral
Transrectal image of the caecum. The blood vessels
associated with the medial band of the caecum can be
identified (MB). There is a collapsed loop of small intestine
(SI) adjacent to the caecum. This image was obtained in the
right caudal abdomen using a 5 MHz convex transducer.
The transducer was positioned horizontally over the caecum
and oriented towards the right body wall. The right side of
the image is dorsal within the abdomen, and the left side is
ventral

208 Ini Practice * APR 200 2

Transcutaneous image of the sternal flexure (right ventral
and left ventral colon). The sternal flexure is lying adjacent
to the body wall. There are three sacculations visible
(1 to 3), and the contents of the intestine are hyperechoic
with acoustic shadowing. This image was obtained in
the mid-cranioventral abdomen using a 10 MHz convex
transducer. The right side of the image is towards the left
body wall, and the left side is towards the right body wall
1 80' in the lcft caudal abdomen at the pelvic flexure to
form the left dorsal colon. At this point there is only a
taenial band on the mesenteric border, and the saccula-
tions disappear. These features allow the left dorsal and
ventral colon to be distinguished, both on rectal palpa-
tion and on ultrasonographic imaging (see above). The
left dorsal colon widens in diameter as it passes cranial-
ly, and turns through 180' at the diaphragmatic flexure,
continuing as the right dorsal colon along the dorsal
aspect of the right flank. The right dorsal colon has three
taenial bands and sacculations.
FEATURES OF THE SMALL COLON
The small colon is located in the dorsal abdomen and is
most easily imaged using transrectal ultrasonography
(Freeman and othcrs 2001 a). It has a similar ultrasono-
graphic appearance to the larrge intestine in the normal
horse, and reliable identification will require palpation
of its smnaller diamiieter, sacculations and two mesenteric
bands. The contents of the small colon can vary in con-
sistency, depending on the diet and hydration status of
the horse.
FEATURES OF OTHER ABDOMINAL STRUCTURES
Abdominal pain or colic is not always related to gastro-
intestinal disecase. Therefore, other abdominal structures,
such a,s the spleen, kidney, bladder, reproductive organs,
mesenteric root and liver, should also be evaluated in
horses presenting with colic. Ultrasonography of these
structures has been well documented (Rantanen 1986,
Reef 1998), and hence only brief mention of specific
structures will be made here.
Spleen
The spleen is imaged along the left abdominal wall. It
can extend ventrally to the level of the midline and
occasionally across the midline into the right ventral
abdomen. The nephrosplenic space may be imaged trans-
cutaneously by following the spleen dorsally to the level
of the transverse processes of the lumbar vertebrae. In
some normal horses, gas shadowing can obscure the left
kidney, and transrectal ultrasonography of this region
In Practice 0 APRIL 2002
Transrectal image of the left dorsal colon. A longitudinal section of small intestine, overlying
the left dorsal colon, has a hyperechoic appearance with no acoustic shadowing. The black
hypoechoic line between the small intestine and left dorsal colon represents the intestinal
walls of these two structures. The left dorsal colon has a smooth, non-sacculated appearance.
The contents are hyperechoic with acoustic shadowing. This image was obtained in the
right caudal abdomen using a 10 MHz convex transducer oriented dorsoventrally within the
abdomen. The right side of the image is dorsal within the abdomen, and the left side is ventral
can be useful to confirm that there is no large intestinal
entrapment (see below).
Kidneys
The left and right kidney can both be identified by trans-
cutaneous ultrasonography. Transrectal ultrasonography
will produce higher quality images, allowing visualisa-
tion of the renal vasculature and ureters, as higher fre-
quency transducers can be used. However, the transrectal
technique is limited by the sue of the horse and, in large
animals, only the caudal pole of the left kidney may be
visualised. A combination of transcutaneous and trans- Transrectal image of the
rectal techniques is probably necessary for optimal space. The
nephrosplenicnephrosplenic
hyperechoic
examination. ligament is visible between
the caudal pole of the left
kidney and the spleen. This
Mesenteric root image was obtained in the
The mesenteric root arises from the mid-dorsal left caudodorsal abdomen
using a 5 MHz convex
albdomen. It caln be imaged cranial to the left kidney in transducer. The transducer
small patients, using either transcutaneous or transrectal was positioned horizontally
and oriented cranially
ultrasonography. Normal fealtures are unobstructed blood towards the diaphragm. The
flow through the vessels and a lack of fibrosis. right side of the image is
medial, and the left side is
lateral
209
Blood vessels
The aorta, renal arteries and internal and external iliac
arteries can be imaged in the dorsocaudal abdomen using
transrectal ultrasonography. The size, shape and blood
flow through these vessels should be assessed, and any
associated structures, such as the sublumbar lymph
nodes, should also be evaluated.

APPEARANCE OF THE ABDOMINAL WALL

AND PERITONEAL FLUID
The main region of interest for assessing the abdominal
wall and peritoneal fluid is the ventral abdominal wall,
which comprises skin, subcutaneous tissue, rectus abdo-
minis and abdominal fat (see right). The fat layer can be
substantial in obese horses, and ultrasonographic assess-
ment of the thickness of the abdominal wall can be use-
ful in selecting equipment for abdominocentesis. The Transcutaneous image of the ventral abdomen showing small amounts of peritoneal
abdominal wall should also be assessed for evidence of fluid lying between the sternal flexure and the body wall. The sternal flexure has
hernias or ruptures, previous surgery and adhesions to sacculations visible, and the ingesta is hyperechoic with acoustic shadowing. The
peritoneal fluid is hypoechoic and visible only in small pockets between the intestinal
the incision line. In stallions, the scrotum and inguinal sacculations and the body wall. The body wall comprises skin, subcutaneous tissue, rectus
region should be evaluated to determine the presence or abdominis and fat. The linea alba has a hyperechoic appearance. This image was obtained
in the cranioventral abdomen over the midline. The right side of the image is towards the
absence of a hernia or rupture, and its contents. Ruptures left abdominal wall, and the left side is towards the right abdominal wall
of other regions of the abdominal wall occur less fre-
quently, but can also be assessed using ultrasonography.
Peritoneal fluid is often identified in the ventral References
FREEMAN, S. L., BOSWELL, J. C. & SMITH, R. K. W. (2001a) Use
abdomen, but can also occur normally between organs in of transrectal ultrasonography to aid diagnosis of small colon
the mid- and dorsal abdomen. In normal horses, there are strangulation in two horses. Veterinary Record 148, 812-813
FREEMAN, S. L. & ENGLAND, G. C. W. (2001) The effect of
small amounts of fluid with a homogeneous, hypoechoic romifidine on gastrointestinal motility, assessed by transrectal
appearance. ultrasonography. Equine Veterinary Journal 33, 570-577
FREEMAN, S. L., McGAHAN, J. S. M., GARLAND, E. & CUDDEFORD,
D. (2001b) Effect of water intake on gastrointestinal function in the
horse. Proceedings of the BEVA Congress, Harrogate. p 213
SUMMARY FREEMAN, S. L., MASON, P. J. & STALEY, C. (2000) Comparison of
ultrasonographic and histological assessment of normal and
strangulated intestine in the horse. European Journal of Ultrasound
Knowledge of normal abdominal anatomy and ultrasono- (Supplement) 13, S5
RANTANEN, N. W. (1986) Diseases of the abdomen. Veterinary
graphic features is essential for the interpretation of Clinics of North America: Equine Practice 2, 67-88
changes occurring with disease. Ultrasonography can be REEF, V. B. (1998) Adult abdominal ultrasonography. In Equine
Diagnostic Ultrasound. W. B. Saunders, Philadelphia. pp 273-364
used to assess both the structure and function of the gas- WORTH, L. T. (1995) Ultrasonography of the normal equine small
trointestinal tract. A combination of transcutaneous and intestine. Veterinary Radiology and Ultrasound 36, 355
transrectal techniques will image most of the abdominal
organs in the horse and thus allow a logical investigation
of gastrointestinal disease. The deeper abdominal struc-
tures, such as the stomach, some regions of the small
intestine and the mesenteric root, cannot be completely
evaluated, and the potential limitations associated with
the size and anatomy of the equine abdomen should be
considered.
As will be discussed in the next article, ultrasono-
graphic evaluation in the colic patient should include an
HVejfrina1jY In Practice
assessment of the location of the intestine, its shape,
diameter, wall thickness and motility, and comparison of
these parameters with normal findings. Displacement or
distension can change the location, shape and diameter of
the intestine and adjacent abdominal organs, and knowl-
www.vetrecord .co. u k
edge of normal anatomy and ultrasonographic features is
important to identify this. Changes in wall thickness and The Veterinary Record/In Practice website,
motility are features of several gastrointestinal condi-
tions. Assessment of wall thickness and motility is most updated weekly, gives details of the contents of
useful in small intestinal diseases. Ultrasonographic each of the two journals. It provides an extensive
changes can differentiate between diseases such as enteri-
tis and strangulation which may present with very similar and up-to-date listing of forthcoming CPD events
clinical findings.
and also lists recruitment advertisements
Acknowledgements
The author would like to acknowledge Mr A. Gemmell, appearing in The Veterinary Record.
Mr J. Lyons and Mr P. Mason for their work on the normal
ultrasonographic appearance of the equine gastrointestinal
tract.

In Practice * APRIL 2002 2211