Page 2136 - Cote clinical veterinary advisor dogs and cats 4th

Blood Pressure Measurement 1065

• Manual instrument
○ Manually advance the inner cutting needle
VetBooks.ir ○ Manually advance the external shaft over
to desired biopsy depth.
the cutting needle to obtain sample.
○ Requires two hands to operate, and two
people are required for biopsy procedure.
• Withdraw instrument from animal. + + +
• Use a 25-gauge needle to gently lift sample
from biopsy needle or gently flush the sample
from the needle using a syringe filled with A B C D
saline.
• Place sample in cassette and place in formalin
container.
• Two to three samples of each organ or lesion
are obtained. Procedures and Techniques
Postprocedure
• Scan to evaluate for hemorrhage. A very small
amount of hemorrhage is not uncommon. E
• If small amount of hemorrhage is noted,
re-evaluate after several additional minutes, BIOPSY, ULTRASOUND-GUIDED PERCUTANEOUS A, Semiautomatic-type instrument used for ultrasound-
ensuring that the patient is monitored guided core biopsy. B, Ultrasound of a dog’s liver in preparation for core biopsy. Targeted area chosen for
(mucous membrane color, blood pressure) biopsy is marked (+). C, Ultrasound of same dog’s liver, with the biopsy under way. Semiautomatic instrument
and is kept recumbent with the biopsied shown in panel A has been advanced (arrowheads) until its tip (arrow) is immediately above the target. D,
Internal stylet advancing. With instrument held immobile, internal stylet is slowly advanced, crossing through the
side down (e.g., sternal recumbency if a liver targeted area or lesion. After the stylet is in the fully advanced/deployed position shown, the instrument can be
biopsy was near or on the ventral midline). triggered, which obtains the sample. E, Core of liver tissue (between arrows) is shown within chamber of stylet.
• Hematuria is common after renal biopsy.
Alternatives and Their
Relative Merits gastric fundus can interfere with visualization SUGGESTED READING
Laparoscopic (p. 1128) and surgical biopsies of the left aspect of the liver. Mattoon JS, et al: Ultrasound-guided aspiration and
are more invasive but have higher diagnostic • Performing a percutaneous biopsy can be dif- biopsy procedures. In Mattoon JS, et al, editors:
quality in some cases. ficult if the patient has moderate or marked Small animal diagnostic ultrasound, ed 3, St. Louis,
peritoneal effusion. Laparoscopic or surgical 2015, Saunders, pp 50-77.
Pearls biopsy may be preferred in those cases.
• Confirm that the patient has been properly • If the liver is small and has highly irregular AUTHOR: Wendy D. Fife, DVM, MS, DACVR
EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
fasted, with an empty stomach, before margins suggesting cirrhosis, laparoscopic Thompson, DVM, DABVP
performing a liver biopsy. Distention of the biopsy or surgical biopsy may be preferred.

Blood Pressure Measurement

Difficulty level: ♦ • Presence of systemic disease known to be • Pliable measuring tape to measure animal
associated with systemic hypertension (e.g., limb circumference
Overview and Goal renal disease, hyperthyroidism [p. 503]), • Ultrasound coupling gel
• The goal of noninvasive blood pressure hyperadrenocorticism (p. 485), diabetes • Hair clippers and isopropyl alcohol, if
(BP) assessment in animals in a veterinary mellitus (p. 251), pheochromocytoma (p. 785) desired, for preparation of site of piezoelectric
setting is to accurately measure arterial BP crystal application
and detect abnormal BP, particularly systemic Contraindications Oscillometric method (automated system used
hypertension. Random BP screening in young, healthy in dogs, less reliable in cats):
• Doppler sphygmomanometric methods or animals is not recommended. • Commercial automated oscillometric
automated oscillometric methods may be used. BP monitor with print or data storage
• Doppler methods deliver systolic BP values. Equipment, Anesthesia capability
• Oscillometric methods deliver systolic, Doppler method (used in dogs and cats; the • A variety of cuff sizes based on animal limb
diastolic, and mean BP values. preferred method for cats): circumference
• Systolic BP is the value of interest in • Commercial Doppler amplifier with attached • Pliable measuring tape to measure animal
most clinical cases of systemic hypertension piezoelectric crystal for detection of blood limb circumference
(p. 501). flow
• Sphygmomanometer previously calibrated Anticipated Time
Indications for accuracy • Doppler method: approximately 10 minutes
• Presence of clinical signs of systemic hyper- • A variety of cuff sizes based on animal limb • Oscillometric method: approximately 20
tension (p. 501) circumference minutes

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