Ultrasound: Abdomen: Difference between revisions
(Prepared the page for translation)
 
Line 1: Line 1:
<languages/>
<translate>
==Background==
==Background==
*New techniques and findings on ultrasound of the abdomen can decrease time to diagnosis and patient/family satisfaction
*New techniques and findings on ultrasound of the abdomen can decrease time to diagnosis and patient/family satisfaction
*Ultrasound in not limited to FAST or aortic exams but can be used for appy’s, SBOs, and intussusception
*Ultrasound in not limited to FAST or aortic exams but can be used for appy’s, SBOs, and intussusception


==[[Appendicitis]]==
 
==[[Special:MyLanguage/Appendicitis|Appendicitis]]==
 
*Bedside ultrasound can be helpful in ruling in the diagnosis
*Bedside ultrasound can be helpful in ruling in the diagnosis
*EDUS in adults has a Sn of 0.68 and Sp of 0.98<ref>Mallin M, et al. Diagnosis of appendicitis by bedside ultrasound in the ED. The American Journal of Emergency Medicine. 2014. 33(3):430 – 432.</ref>
*EDUS in adults has a Sn of 0.68 and Sp of 0.98<ref>Mallin M, et al. Diagnosis of appendicitis by bedside ultrasound in the ED. The American Journal of Emergency Medicine. 2014. 33(3):430 – 432.</ref>
*EDUS in pediatric has a Sn of 0.85 and Sp of 0.93<ref>Sivitz A, et al. Evaluation of Acute Appendicitis by Pediatric Emergency Physician Sonography. Annals of Emergency Medicine. 2014. 64(4):358–364.</ref>
*EDUS in pediatric has a Sn of 0.85 and Sp of 0.93<ref>Sivitz A, et al. Evaluation of Acute Appendicitis by Pediatric Emergency Physician Sonography. Annals of Emergency Medicine. 2014. 64(4):358–364.</ref>


===Indications===
===Indications===
*Classically symptoms include periumbilical pain traveling to the RLQ pain, followed by nausea, anorexia, and vomiting
*Classically symptoms include periumbilical pain traveling to the RLQ pain, followed by nausea, anorexia, and vomiting


===Images===
===Images===
<gallery>
<gallery>
File:Appy short axis.png
File:Appy short axis.png
File:Appy long axis.png
File:Appy long axis.png
</gallery>
</gallery>


===Instructions===
===Instructions===
*Use linear probe (curvilinear in more obese patients)
*Use linear probe (curvilinear in more obese patients)
*Scan RLQ from ASIS to right iliac artery to identify a tubular structure
*Scan RLQ from ASIS to right iliac artery to identify a tubular structure
Line 23: Line 35:
*The appendix typically appears anterior to the psoas muscle and iliac vessels
*The appendix typically appears anterior to the psoas muscle and iliac vessels
*Once identified, evaluate if the tube is compressible in the transverse view
*Once identified, evaluate if the tube is compressible in the transverse view


===Evaluation===
===Evaluation===
*Accepted criteria for diagnosis includes<ref>Fox JC, et al. Prospective evaluation of emergency physician performed bedside ultrasound to detect acute appendicitis. Eur. J. Emerg. Med. 2008; 15(2):80-5.</ref>:
*Accepted criteria for diagnosis includes<ref>Fox JC, et al. Prospective evaluation of emergency physician performed bedside ultrasound to detect acute appendicitis. Eur. J. Emerg. Med. 2008; 15(2):80-5.</ref>:
**Noncompressible
**Noncompressible
Line 36: Line 50:
**Identification of fecalith
**Identification of fecalith


==[[Small Bowel Obstruction]]==
 
==[[Special:MyLanguage/Small Bowel Obstruction|Small Bowel Obstruction]]==
 
*EDUS had a Sn of 0.91 and Sp of 0.84 for SBO (compared to 0.02 and 0.67 respectively for Abd Xray)<ref>Jang TB, et al. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. J Emerg Med. 2011. 28(8):676-678.</ref>
*EDUS had a Sn of 0.91 and Sp of 0.84 for SBO (compared to 0.02 and 0.67 respectively for Abd Xray)<ref>Jang TB, et al. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. J Emerg Med. 2011. 28(8):676-678.</ref>


===Indications===
===Indications===
*Patients with crampy abdominal pain, paroxysms, and nausea/vomiting
*Patients with crampy abdominal pain, paroxysms, and nausea/vomiting


===Images===
===Images===
<gallery>
<gallery>
File:SBO.png
File:SBO.png
Line 48: Line 68:
File:SBO_Singh.gif|US showing dilated loops of bowel, bidirectional peristalsis, "keyboard" sign, and free fluid<ref>http://www.thepocusatlas.com/bowel/</ref>
File:SBO_Singh.gif|US showing dilated loops of bowel, bidirectional peristalsis, "keyboard" sign, and free fluid<ref>http://www.thepocusatlas.com/bowel/</ref>
</gallery>
</gallery>


===Instructions===
===Instructions===
*Use curvilinear/phased array probe (linear probe can be used in very thin patients)
*Use curvilinear/phased array probe (linear probe can be used in very thin patients)
*Scan the entire abdomen using "lawn-mower" technique of horizontal tracks (or other systematic method)
*Scan the entire abdomen using "lawn-mower" technique of horizontal tracks (or other systematic method)
**Scanning over dependent areas yields the most success
**Scanning over dependent areas yields the most success
*Identify dilated loops of bowel
*Identify dilated loops of bowel


===Evaluation===
===Evaluation===
*SBO criteria include:
*SBO criteria include:
**Dilated loops of bowel >2.5cm
**Dilated loops of bowel >2.5cm
Line 65: Line 89:
**Sonographic transition point
**Sonographic transition point


==[[Intussusception]]==
 
==[[Special:MyLanguage/Intussusception|Intussusception]]==
 
*With minimal training, ED providers have a Sn of 0.85 and Sp 0.97<ref> Riera A, et al. Diagnosis of intussusception by physician novice sonographers in the emergency department. Ann Emerg Med. 2012; 60(3):264–268.</ref>
*With minimal training, ED providers have a Sn of 0.85 and Sp 0.97<ref> Riera A, et al. Diagnosis of intussusception by physician novice sonographers in the emergency department. Ann Emerg Med. 2012; 60(3):264–268.</ref>


===Indications===
===Indications===
*Classically a child from 3-36 mos with colicy pain, palpable mass on the right, and current jelly stool  
*Classically a child from 3-36 mos with colicy pain, palpable mass on the right, and current jelly stool  


===Images===
===Images===
<gallery>
<gallery>
File:Intussusception.png
File:Intussusception.png
File:Intussusception 2.png
File:Intussusception 2.png
</gallery>
</gallery>


===Instructions===
===Instructions===
*Use linear probe
*Use linear probe
*Scan from the cecum in the RLQ towards the RUQ
*Scan from the cecum in the RLQ towards the RUQ
**Scanning over a palpable mass if felt can be helpful
**Scanning over a palpable mass if felt can be helpful
*Identified the characteristic findings
*Identified the characteristic findings


===Evaluation===
===Evaluation===
*Longitudinal view shows a dilated intussuscipiens containing the intussusceptum  
*Longitudinal view shows a dilated intussuscipiens containing the intussusceptum  
**This forms three parallel hypoechoic layers separated by hyperechoic zones
**This forms three parallel hypoechoic layers separated by hyperechoic zones
*Pseudokidney sign can be seen if mesentery is only on one side of the bowel
*Pseudokidney sign can be seen if mesentery is only on one side of the bowel
*Short axis shows a target sign of three parallel hypoechoic areas separated by hyperechoic zones
*Short axis shows a target sign of three parallel hypoechoic areas separated by hyperechoic zones


==External Links==
==External Links==
*[http://www.acep.org/Continuing-Education-top-banner/Focus-On--Ultrasound-for-Appendicitis/ Focus On: Ultrasound for Appendicitis]
*[http://www.acep.org/Continuing-Education-top-banner/Focus-On--Ultrasound-for-Appendicitis/ Focus On: Ultrasound for Appendicitis]
*[http://www.acep.org/Membership/Sections/Emergency-Ultrasound-Section/Pediatric-Ultrasound-Tricks-of-the-Trade--Abdominal-Ultrasound---Emergency-Ultrasound-Section-Newsletter,-February-2012/ Pediatric Ultrasound Tricks of the Trade: Abdominal Ultrasound]
*[http://www.acep.org/Membership/Sections/Emergency-Ultrasound-Section/Pediatric-Ultrasound-Tricks-of-the-Trade--Abdominal-Ultrasound---Emergency-Ultrasound-Section-Newsletter,-February-2012/ Pediatric Ultrasound Tricks of the Trade: Abdominal Ultrasound]


==See Also==
==See Also==
*[[Aortic ultrasound]]
 
*[[Ultrasound (Main)]]
*[[Special:MyLanguage/Aortic ultrasound|Aortic ultrasound]]
*[[Special:MyLanguage/Ultrasound (Main)|Ultrasound (Main)]]
 


==References==
==References==
<references/>
<references/>


Line 104: Line 144:
[[Category:Ultrasound]]
[[Category:Ultrasound]]
[[Category:Surgery]]
[[Category:Surgery]]
</translate>

Latest revision as of 00:02, 5 January 2026


Background

  • New techniques and findings on ultrasound of the abdomen can decrease time to diagnosis and patient/family satisfaction
  • Ultrasound in not limited to FAST or aortic exams but can be used for appy’s, SBOs, and intussusception


Appendicitis

  • Bedside ultrasound can be helpful in ruling in the diagnosis
  • EDUS in adults has a Sn of 0.68 and Sp of 0.98[1]
  • EDUS in pediatric has a Sn of 0.85 and Sp of 0.93[2]


Indications

  • Classically symptoms include periumbilical pain traveling to the RLQ pain, followed by nausea, anorexia, and vomiting


Images

  • Appy short axis.png
  • Appy long axis.png


Instructions

  • Use linear probe (curvilinear in more obese patients)
  • Scan RLQ from ASIS to right iliac artery to identify a tubular structure
    • Scanning over the point of maximal tenderness can be helpful
  • The appendix typically appears anterior to the psoas muscle and iliac vessels
  • Once identified, evaluate if the tube is compressible in the transverse view


Evaluation

  • Accepted criteria for diagnosis includes[3]:
    • Noncompressible
    • Blind-ending tubular structure in the longitudinal axis
    • Measures >6 mm in diameter from outer wall to outer wall
    • Lacks peristalsis
  • Other attributes can add to identification:
    • Target-like appearance in the transverse axis
    • Abdominal free fluid
    • Wall edema
    • Identification of fecalith


Small Bowel Obstruction

  • EDUS had a Sn of 0.91 and Sp of 0.84 for SBO (compared to 0.02 and 0.67 respectively for Abd Xray)[4]


Indications

  • Patients with crampy abdominal pain, paroxysms, and nausea/vomiting


Images

  • SBO.png
  • SBO 2.png

  • US showing dilated loops of bowel, bidirectional peristalsis, "keyboard" sign, and free fluid[5]


Instructions

  • Use curvilinear/phased array probe (linear probe can be used in very thin patients)
  • Scan the entire abdomen using "lawn-mower" technique of horizontal tracks (or other systematic method)
    • Scanning over dependent areas yields the most success
  • Identify dilated loops of bowel


Evaluation

  • SBO criteria include:
    • Dilated loops of bowel >2.5cm
    • Bidirectional peristalsis
  • Additional findings include:
    • "Keyboard" sign which are finger-like projections that represent plicae circulares
    • Bowel wall edema
    • Intraabdominal free fluid
    • Sonographic transition point


Intussusception

  • With minimal training, ED providers have a Sn of 0.85 and Sp 0.97[6]


Indications

  • Classically a child from 3-36 mos with colicy pain, palpable mass on the right, and current jelly stool


Images

  • Intussusception.png
  • Intussusception 2.png


Instructions

  • Use linear probe
  • Scan from the cecum in the RLQ towards the RUQ
    • Scanning over a palpable mass if felt can be helpful
  • Identified the characteristic findings


Evaluation

  • Longitudinal view shows a dilated intussuscipiens containing the intussusceptum
    • This forms three parallel hypoechoic layers separated by hyperechoic zones
  • Pseudokidney sign can be seen if mesentery is only on one side of the bowel
  • Short axis shows a target sign of three parallel hypoechoic areas separated by hyperechoic zones


External Links


See Also


References

  1. ↑ Mallin M, et al. Diagnosis of appendicitis by bedside ultrasound in the ED. The American Journal of Emergency Medicine. 2014. 33(3):430 – 432.
  2. ↑ Sivitz A, et al. Evaluation of Acute Appendicitis by Pediatric Emergency Physician Sonography. Annals of Emergency Medicine. 2014. 64(4):358–364.
  3. ↑ Fox JC, et al. Prospective evaluation of emergency physician performed bedside ultrasound to detect acute appendicitis. Eur. J. Emerg. Med. 2008; 15(2):80-5.
  4. ↑ Jang TB, et al. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. J Emerg Med. 2011. 28(8):676-678.
  5. ↑ http://www.thepocusatlas.com/bowel/
  6. ↑ Riera A, et al. Diagnosis of intussusception by physician novice sonographers in the emergency department. Ann Emerg Med. 2012; 60(3):264–268.
Retrieved from "https://www.wikem.org/w/index.php?title=Ultrasound:_Abdomen&oldid=379091"