Ultrasound on the inside, what is intraoperative ultrasound? (Day -236)

Vet student intraoperative ultrasound

Many people know about ultrasound, its used all the time for pregnancy check-ups in women. However did you know it can also be used inside of an operating theatre during surgery when the body is open? So instead of looking through the skin you are directly looking at the organ.

Now when you first see an ultrasound like this it is a little bit strange – as you are so accustomed to seeing the skin and muscle in front of the organ of interest. So when we put the ultrasound probe directly onto a kidney it looks very different.

In this case I’d come into the operating room during a surgery on an exploratory laparotomy just as the surgery had stalled. You see the most important thing in surgery is information – and here there was a kidney that was enlarged with an enlarged ureter (tube from kidney to bladder) which contained a stone about halfway down its length.

Now here was where a decision that was going change the cats life needed to be taken. Was the correct action to remove the stone from the ureter and place a catheter from the bladder to kidney to keep the ureter working whilst it healed? Or was the correct course to remove the kidney?

A few months before this I had read an article on intraoperative ultrasound on sonopath (they give a free student membership!) which is the best ultrasound guide I’ve come across. This basically said that using ultrasound inside the body was even better than using it outside especially with surgery so that you could take samples from lesions identified by normal ultrasound before surgery. Even when you see a lesion on ultrasound, once you open the abdomen it can be very difficult to find the lesion to take a biopsy from it so using ultrasound during surgery helps with this.

The great thing about this that I remembered was that it did not need any specialised equipment; you can simply fill a sterile surgical glove with ultrasound gel and insert a ultrasound probe into it. Then you just use the probe through the glove in the area of interest (on sonopath is suggests using sterile saline between glove and viscera however I did not remember this at the time).

So randomly I just suggested that I bring an ultrasound machine in and we take a look at the structure of the kidney before we made the suggestion. After explaining that it could be done with a glove and some gel I was sent to get the machine and sonographer. I think the weirdest part of the entire experience was that as with normal ultrasound we turned the lights off in the operating theatre to see the picture on the screen better.

Now on ultrasound it was obvious that the kidney was no longer functional, and so the best option going forward was relatively obvious. The problem here however was that we did not know the status of the other kidney – kidneys only show clinical signs after around 75% of the functional part is destroyed – so the owner needed to decide which was a bigger risk leaving it or removing it and hoping the other kidney worked. The decision was made that the kidney was going come out (a nephrectomy), and after discussion with the owner this was what happened.

The patient was sitting up completely different (partially due to the good analgesia) and now 3 weeks after the surgery the patient is doing well and is at home.

The start of Veterinary Virology

Veterinary Virology kidney media preparation

Today’s Diary Entry is sponsored by Pets Bureau

Today we started looking at Virology, which is the study of viruses. Within the veterinary field this is extremely important as there are significant zoonotic diseases (diseases that pass between humans and animals) that are viral. Some of the best known of these is Rabies (Rhabdoviridae), Yellow Fever (Flaviviridae), Rotavirus, and Poxiviridae which is the case of chicken pox/small pox etc.

Veterinary Virology kidney media preparationNow the significant thing with viruses is that they are extremely small, which is because they lack the common features associated with other bacteria to allow replication and respiration. Instead viruses inject themselves into other cells which they then simply hijack to turn them into a virus replicating machine! This is because viruses are composed solely of either DNA or RNA, and depending on the family either 1 or two strands of this. Once a virus particle enters a cell, this genetic material enters the nucleus and the viral replication starts.

This leaves us with two problems when working with viruses, first of all we have the extremely small size – in some cases 100’s of times smaller than bacteria – which means to have a chance of seeing a virus we need to use an electron microscope. The second problem is actually cultivating or growing the virus, as the virus particle does not contain replication or respiration organs we cannot simply feed it like we do with bacteria. Instead when working with viruses we need to provide it with cells to use to replicate and grow in.

Now there are several different possible solutions here (some more distasteful than others) however the most common method is to use kidney cells. These are prepared using sterile technique from kidneys from various dead animals. The kidney is first cut up (or pulped) into extremely small pieces, which are then washed with trypsin (a digestion enzyme) and the cells from this collected in the liquid and centrifuged. This cell solution is then spread in a single layer onto a glass culture plate and the virus particles applied for growth.

At the moment I am still unsure as to how replication occurs in these cells after the death of the body that contains them and the removal of the blood supply that feeds them… However I will find out soon as my curiosity is now raised!

Nervous Tissue, Nerves, Kidneys and Urine… (Day 56)

Histology astrocyte nerve cell

Start of week 8, now I am getting really nervous about being able to raise enough money to allow me to continue in vet school next semester. Towards the end of term things are going to get more busy and my workload is going increase with more credit tests and preparation for my final exams in December and January. I really do need to find as many advertisers monthly sponsors in the next two weeks as I possibly can so I do apologise in advance for the crazy amount of tweets asking for help! If you can help please use the button to right to securely set up a monthly donation via Paypal (or contact me for Direct Debit details)

Anyways onto today, this morning when I woke up it was pouring with rain, not just a little but absolutely torrential. On the way back to dorms glancing at the stream that is between uni and the dorms which is usually a foot wide trickle I was pretty shocked to see raging waters…

Kosice Torrential Rain - Raging StreamAnyways back to my veterinary education as thats why you are here :p This morning was Histology where we looked at the different types of nerve cells, how they worked and their structure. Looking at nervous tissues cells can be broken down into neurones and glial cells, and glial cells broken down further in CNS (Central Nervous System) or PNS (Peripheral Nervous System) cells. Its amazing how much detail can be seen just with a lightmicroscope when you understand completely what you are looking for and more importantly looking at. Take for example a astrocyte

Histology astrocyte nerve cellThe astrocyte is the most numerous type of glial cell in the central nervous system (CNS) and contribute to the blood-brain barrier .which controls the flow of blood carried molecules to the brain tissue. Their processes (long strands from the main body) have feet which attach to blood vessels with the other side attaching to neurons. In addition they also store glycogen and release glucose which is used by cells for energy production.

Today I also did the resit for the Histology theory paper that I originally failed as I revised the wrong things. This time I did pass with a C which I was pretty pleased with as I knew I got 2 questions wrong as I keep getting the functions of the Rough Endoplastic Reticulum and the Golgi Aparatus back to front… Actually I wrote it the correct way round and then rubbed out the answer to switch it around (oooopss). Anyway onto the next one which will be next Monday and on everything we have covered since.

This afternoon was the Physiology lecture, today we had a specialised in the urinary system in as a guest lecturer which was pretty cool. For one of the smaller organs in the body the Kidney could said to be one of the most complicated. It has the function of removing waste products from the blood, and does this by either filtration or secretion. The most amazing thing I think I learnt here is that less than 1% of the volume that passes through the kidney is actually removed from the blood for excretion from the body. The kidneys deserve a post to themselves which they will be getting very shortly!

Until tommorow people 🙂