US Abdomen Complete Protocol

Summary

This video provides a comprehensive guide for conducting an upper abdominal ultrasound, covering key organs such as the liver, gallbladder, kidneys, pancreas, spleen, and bladder. The protocol includes specific techniques for capturing sagittal and transverse images, measuring organ sizes, and identifying key anatomical structures like the portal vein, IVC, and hepatic veins. The video also emphasizes the importance of adjusting angles, using appropriate gel for contact, and employing color Doppler for blood flow assessment. The instructor highlights the need for consistent technique and offers practical tips for optimal imaging.

Takeaways

• 😀 The upper abdominal exam includes the liver, gallbladder, kidneys, pancreas, spleen, and bladder. In some cases, the lower quadrants are also examined to check for bowel issues.
• 😀 A curved, curvilinear array transducer is commonly used for this examination. If needed, adjust the angle to capture all relevant structures, such as the liver and aorta.
• 😀 The liver examination includes images of the left lobe, right lobe, and key structures like the portal vein, hepatic veins, and inferior vena cava (IVC).
• 😀 To visualize the gallbladder, you may need to adjust the angle based on the patient's anatomy. The gallbladder can be S-shaped or lie at various angles to the floor.
• 😀 The common bile duct (CBD) is measured, typically less than 3 mm in diameter, with values over 8 mm considered enlarged.
• 😀 For the pancreas, both sagittal and transverse views are important. The pancreas lies across the body, so imaging will capture it in a transverse plane, with attention to the surrounding organs like the stomach and spleen.
• 😀 The right kidney should be imaged with the liver interface clearly visible. The kidney should be less echogenic than the liver.
• 😀 Spleen imaging should be done in both sagittal and transverse views. The spleen’s echogenicity should be higher than that of the kidney, and its size should be measured. Anything over 13 cm is considered splenomegaly.
• 😀 When using a curved transducer, be mindful of potential dropout due to the exaggerated convex shape. This can be managed with extra gel or by segmenting images.
• 😀 The bladder should be imaged in both sagittal and transverse planes. Its wall should be measured, and its appearance checked for abnormalities. After covering all key structures, the protocol is complete.

Q & A

What is the main focus of the upper abdominal ultrasound protocol discussed in the video?

The protocol focuses on imaging the upper abdomen, specifically the liver, gallbladder, pancreas, spleen, kidneys, and bladder. It involves taking detailed images to assess these organs for abnormalities.

What type of transducer is primarily used for the abdominal ultrasound, and why?

The curved, linear array transducer is typically used because it provides better image quality, especially for viewing the internal organs of the upper abdomen.

How should the liver be imaged during the ultrasound examination?

The liver should be imaged using sagittal and transverse views. Start with the left lobe in a sagittal plane, then angle the transducer to capture the right lobe, including key structures such as the aorta, celiac axis, and superior mesenteric artery.

What should be done if the entire liver is not captured in one image?

If the entire liver cannot be captured in one image, the transducer should be rocked or angled up and down to capture different sections of the liver in separate images.

How should the gallbladder be imaged, and what variations should be considered?

The gallbladder should be imaged in both sagittal and transverse planes. The position of the gallbladder varies between individuals, so adjustments in the angle may be necessary to achieve a proper view, especially if the gallbladder is not perfectly aligned with the body.

What is the typical wall thickness measurement for the gallbladder, and what is considered abnormal?

The normal gallbladder wall thickness is less than 3mm. If the wall thickness exceeds 4mm, it may indicate an abnormality, such as inflammation.

What role does Doppler imaging play in the abdominal ultrasound exam?

Doppler imaging is used to assess blood flow in the liver and other organs. For example, color Doppler can help differentiate between the hepatic artery and portal vein in the liver, and show hepatopedal flow towards the liver.

How is the pancreas typically imaged, and what anatomical landmarks should be identified?

The pancreas is imaged using both sagittal and transverse planes. Key landmarks include the superior mesenteric artery, the portal splenic confluence, and the relation of the pancreas to the spleen and kidneys.

What is the significance of measuring the spleen size, and what are the normal limits?

Spleen size is measured to detect splenomegaly, which may indicate underlying conditions. The upper limit for normal spleen size is typically 12-13 cm; anything larger may be considered splenomegaly.

What specific measurements are taken for the kidneys during the ultrasound exam?

The kidneys should be imaged in both sagittal and transverse planes. Measurements of kidney length, width, and height may be required, with the length typically ranging from 9-13 cm in adults.