II. Precautions

  1. Decreased efficacy in obese patients or in excessive bowel gas
  2. Abdominal Ultrasound is a developed skill, and higher efficacy and avoidance of pitfalls improves with experience

III. Protocol: Duodenal-Antral Sweep

  1. Indications: Epigastric Pain Evaluation
    1. Differentiates Antacid responsive pain (Gastritis, Duodenitis) from other etiologies (Pancreatitis, referred pain)
    2. Graded compression with focal significant tenderness over the duodenum, pylorus, antrum suggests pain source
  2. Starting position
    1. Curvilinear probe over the epigastrium in longitudinal orientation (sagittal axis, 12:00)
    2. Identify the pylorus as key landmark
    3. Directly compress pylorus with increasing pressure
  3. Slide probe gradually into patient's right, over the duodenum
    1. Follow the pylorus into the duodenum
    2. Apply graded compression along the path of the duodenum
  4. Slide probe back over the duodenum, pylorus and over the Stomach antrum
    1. Slide back over the pylorus and move toward patient's left over the antrum
    2. Antrum will appear as stack of pancakes when empty
  5. At each position, apply graded compression
    1. Upward (cephalad) pressure over the Abdomen will isolate tenderness over the Stomach and Small Bowel
    2. Posterior pressure will be applied to Pancreas and other deeper structures

IV. Protocol: Small Bowel Evaluation

  1. Indications
    1. Evaluate for Small Bowel Obstruction
  2. Starting position
    1. Patient may direct position of maximal pain or
    2. Sweep the Abdomen from side to side to find characteristic fluid filled Small Bowel
  3. Findings suggestive of Small Bowel Obstruction
    1. Small Bowel dilation >2.5 cm
    2. No peristalsis (typically seen in normal Small Bowel on Ultrasound)
      1. Alternatively, bidirectional (back and forth flow) or whirlpooling (swirling fluid) may be seen
      2. Skip areas (focal ileus interspersed with peristalsis) may be seen with Gastroenteritis
    3. Small Bowel wall thickness >4 mm may be seen with Small Bowel ischemia
  4. Efficacy in Small Bowel Obstruction diagnosis
    1. Test Sensitivity: 88%
    2. Test Specificity: 96%

V. Protocol: Abdominal Free Air Evaluation

  1. Indications
    1. Evaluate for intraabdominal free-air (e.g. bowel perforation)
  2. Starting position
    1. Right upper quadrant at inferior liver edge
    2. Curvilinear probe in longitudinal orientation (sagittal axis, 12:00)
    3. Identify the peritoneal stripe (linear white, echogenic line)
      1. Soft tissue boundary between peritoneum and intraabdominal space
  3. Findings of intraabdominal free air
    1. Reverberation (ring-down) artifact below peritoneal stripe (White rays or descending from peritoneal stripe)
  4. Precautions
    1. Intraluminal air may be confused with free air (intraluminal air should curve away from the abdominal wall)
    2. Small amounts of free air may not demonstrate reverberation artifact
  5. Efficacy in free air diagnosis
    1. Test Sensitivity: 85%
    2. Test Specificity: 100%

VI. References

  1. Bacon and Brader (2018) Crit Dec Emerg Med 32(2): 23-9

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Ontology: Ultrasonography of abdomen (C0203464)

Concepts Diagnostic Procedure (T060)
ICD10 BW40ZZZ , 55036-00
SnomedCT 146460003, 45036003
CPT 76700, 76705
Italian Ecografia dell'addome
English US scan of abdomen, ultrasound of abdomen (procedure), ultrasound of abdomen, Ultrasonography of Abdomen, Imaging @ Anatomical Regions @ Ultrasonography @ Abdomen @ None @ None @ None, abdomen ultrasound, ultrasound abdomen, abdomen ultrasonography, Ultrasound abdomen, Ultrasound of abdomen, US scan of abdomen (procedure), US abdominal scan, Ultrasonography of abdomen (procedure), Ultrasonography of abdomen, Ultrasonography of abdomen, NOS, ultrasound of the abdomen, Ultrasound;abdomen
Japanese 腹部超音波検査, フクブチョウオンパケンサ
Czech Ultrazvuk břicha
Hungarian Ultrahang hasi
Spanish ecografía de abdomen (procedimiento), ecografía de abdomen, Ecografía abdominal
Portuguese Ultra-som abdominal
Dutch buikecho
French Ultrason de l'abdomen
German Ultraschall des Abdomens