-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
1/68
Emergent diagnostic sonography in patientspresenting with acute abdomen
1000302_
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
2/68
ACEP 2008 EUS guidelines
Ann Emerg Med. 2009;53:550-570
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
3/68
EUS EUS
EUS
(Binary thinking) EUS
EUS EUS
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
4/68
It is only by thorough history taking and
physical examination that one can propound a
diagnosis
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
5/68
Suspectedcondition
Modality
XR US CT
Appendicitis + ++ +++
Perforation +++ ++
Pancreatitis + ++ +++
Diverticulitis + +++
Cholecystitis + +++ ++
Abscess + ++ +++
Intestinal +++ + ++
Obstruction +++ + ++
Inflammation + ++
Ischemia + ++
Aortic aneurysm + +++ +++
Rupture + ++ +++
Renal colic ++ ++ ++
Gynecological + +++ ++
Ruptured follicle +++ +
Ectopic pregnancy +++ +
Tubo-ovarian abscess + +++ ++5
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
6/68
Pattern: Fluid
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
7/68
Anatomic consideration
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
8/68
Free peritoneal fluid
8
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
9/68
FAST for SLOH
Systematic look for occult hemorrhage
9
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
10/68
Clear ascitesCirrhosis
http://1.cirrhosis%20with%20ascities_43m_10098411.wmv/ -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
11/68
HemoperitoneumCorpus luteum cyst rupture
http://2.corpus%20luteum%20cyst%20rupture_22f_15706996.wmv/ -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
12/68
HemoperitoneumEctopic pregnancy
http://3.ectopic%20fetus_ectopic%20pregnancy_36f_03852548.wmv/ -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
13/68
HemoperitoneumHCC rupture
http://4.hcc%20rupture_85f_01377763/HCC%20rupture_85F_01377763.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
14/68
Dirty ascitesSBP
http://5.%20sbp_20100217_1446.mpg/ -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
15/68
Discriminatory Zone
Definition The level of hCG at which findings of an IUP
are expected on sonography Titinalli
TVS 1500 mIU/mL; TAS 6000 mIU/mL Rosen
TVS 3000 mIU/mL; TAS 6500 mIU/mL
15
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
16/68
Pattern: Gas
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
17/68
Anatomic consideration
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
18/68
Scanning Method
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
19/68
Intraperitoneal free air
Air Echogenic areas + Posterior reverberation (ring-down)artifacts Shifting phenomenon
Location Epigastric region (Supine) Left lateral decubitus position
Others: echogenic fluid
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
20/68
Pneumoperitoneum
Echogenic line
Ring-down artifacts
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
21/68
Air but not IPFA
Air in Lung Air in GI tract
Subcutaneous emphysema Chilaiditi syndrome
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
22/68
PneumoperitoneumDelayed PPU w/ ascites
http://6.ppu_81f_04668433/PPU_81F_04668433.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
23/68
PneumoperitoneumPPU
http://7.ppu_18m_16452446/PPU_18m_16452446.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
24/68
Subcuatneous emphysema
http://7_1.subcutaneous%20emphysema%20in%20an%20ohca%20patient_990817/Subcutaneous%20emphysema%20in%20an%20OHCA%20patient_990817.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
25/68
Pattern: Obstruction
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
26/68
Hydronephrosis
26
http://obstructive%20uropathy_05905469.wmv/ -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
27/68
HydronephrosisAPN w/o right ureteral stone
http://8.apn%20with%20obstruction_50f_03627228/20100202_1531.mpg -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
28/68
HydronephrosisPyonephrosis
http://9.pyonephrosis_59m_16496479/20100516_1908_59M_Pyonephrosis_16496479.mpg -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
29/68
Acute calculous cholecystitis
http://10.acute%20calculous%20cholecystitis.wmv/ -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
30/68
GB empyema
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
31/68
CBD stone and dilatation
http://12.cbd%20stone_62f_12363684/CBD%20stone_62F_12363684.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
32/68
GI tract
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
33/68
Graded compression technique
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
34/68
GI tract lesions on sonography
1. (>4mm)2. 3. 4. 5. 6. (LN, fat, ascites)
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
35/68
Alvarado Score
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
36/68
Acute appendicitis
The order of occurrence of the symptoms1. Pain, usually epigastric or umbilical
2. Anorexia, nausea, or vomiting3. Tenderness-somwhere in the abdomen or
pelvis
4. Fever 5. Leukocytosis
36
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
37/68
Appendicitis
Eur Radiol. 2002;12:1748-61
http://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdf -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
38/68
Acute appendicitis
http://13.xn--appendicitis_18m_15721675_-7j91d162ix29n.wmv/ -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
39/68
AppendicitisPregnancy @ 14 weeks
http://14.app%20with%20preg%2014wk_27f_15628768/App%20rupture.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
40/68
Dome sign:
acute colonic diverticulitis
J Clin Ultrasound. 2000;28:340-6.
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
41/68
Diverticulitis
http://15.diverticulitis_cecal_50f_03482439/Cecal%20diverticulitis.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
42/68
Enterocolitis
http://16.enterocolitis_53m_01611496.wmv/ -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
43/68
Bisection Approximation Methodfor GI obstruction
1 2
3
4
5
Hepatogastroenterology. 2006;53:547-51.
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
44/68
Bisection Approximation MethodLocation of US examination (From 1 5)
Possiblelesion site
1. A-C
2. D-C
3. Rectum
4. IC region
5. Gastricoutlet or
duodenum Dilated
Collapsed
From 1-2
Dilated
Dilated
Collapsed
From 2-3
Collapsed - - Dilated From 1-4
Collapsed
-
-
Collapsed
Dilated
From 4-5
Collapsed
-
-
Collapsed
Collapsed
Above 5
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
45/68
Acute intestinal obstruction
Fold of Kerckring
Eur Radiol. 2002;12:1748-61 45
http://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdfhttp://www.springerlink.com/content/g5k8hrh2d88p4bff/fulltext.pdf -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
46/68
Enteritis with bowel obstruction
http://17.enteritis%20%26%20ileus_64f_11373207/Enteritis%20&%20ileus_64F_11373207.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
47/68
Ileitis with bowel obstruction
http://18.sbo_ileitis_52f_15941400/SBO_Ileitis_52F_15941400.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
48/68
Adhesion ileus with SBO
http://19.sbo_ai_54f_03260792/SBO_Adhesion%20ileus_55F_03260792.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
49/68
Gallstone ileus
http://20.gallstone%20ileus_58m_14165763_fan/Gallstone%20ileus.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
50/68
Intussusception
http://21.intussusception_1f_14840821/Intussusception_1F_14840821.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
51/68
IntussusceptionLymphoma
http://22.intussusception_ileocolic%20by%20lymphoma_84m_15724462/Ileocolic%20intussusception.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
52/68
HerniaIncarcerated inguinal hernia
i
http://23.incarcerated%20hernia_75m_04174853/20100126_1447_75M_04174853.mpg -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
53/68
HerniaIncarcerated umbilical hernia
http://24.incarcerated%20umbilical%20hernia_48m_12384060/20100515_2041_48M_Incarcerated%20umbilical%20hernia_12384060.mpg -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
54/68
Colitis
http://25.colitis_sigmoid-rectal%20colitis_70m_05466295/Sigmoid-rectal%20colitis_70M_05466295.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
55/68
Colon cancer
http://26.colon%20cancer_a_07442934/Colon%20cancer_A_07442934.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
56/68
Colon cancer
http://27.t-colon%20cancer_58m_16276291/T-colon%20cancer_58M_16276291.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
57/68
Carcinomatosis
http://28.carcinomatosis_89f_14714131/Carcinomatosis_89F_14714131.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
58/68
Sclerosing encapsulating peritonitis
http://29.sclerosing%20encapsulating%20peritonitis_57m_01926966/Encapsulating%20sclerosing%20peritonitis_57M_01926966_990630.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
59/68
Epiploic appendagitis
http://30.epiploic%20appendagitis_65f_06372284/Epiploic%20appendagitis_65F_06372284.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
60/68
Vascular system
-
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
61/68
Abdominal aortic aneurysm
http://31.aaa_hematuria_59m_07064093/AAA_Hematuria_59M_07064093_%E8%AC%9D%E5%BF%A0%E7%BE%A96hrs%20later.wmvhttp://31.aaa_hematuria_59m_07064093/AAA_Hematuria_59M_07064093.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
62/68
Aortic dissection
http://32.aortic%20disscetion_65f_01160760/Aortic%20disscetion_65F_01160760_2.mpg -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
63/68
SMA occlusion
http://33.sma%20%20occlusion_76f_09430999/SMA%20%20occlusion_76F_09430999_1.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
64/68
Volvulus
http://34.volvulus_45m_08585333/Volvulus.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
65/68
Angiomyolipoma
Extra abdominal cause
http://35.angiomyolipoma_36f_12051707/Angiomyolipoma_36F_12051707_2.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
66/68
Extra-abdominal causeAbdominal wall hematoma
Extra abdominal cause
http://36.abdominal%20hematoma_42f_04058441/Abdominal%20wall%20hematoma_43F_04058441.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
67/68
Extra-abdominal causePneumonia
http://37.lll%20pneumonia_severe%20pain_40m_16311928/LLL%20pneumonia_severe%20pain_40M_16311928.wmv -
8/7/2019 Emergent Diagnostic Sonography in Patients Presenting With Acute Abdomen
68/68
Take Home Message
,
: Pattern