ABDOMINALULTRASONOGRAPHY IN CRITICAL CARE                 Pierre Kory, MPA, MDAssistant Professor, Albert Einstein College...
General Abdominal            Ultrasonography•   Complex anatomical structures with    numerous variants    •   Not necessa...
Clinical Questions in Critical Illness    •   Free Fluid? - FAST exam    •   Perforated Bowel? - Free Air - lack of gut sl...
Remember:•   Use “Abdominal” exam setting•   3.5 to 5.0 MHz transducer•   orientation marker on left of screen•   Doppler ...
ABDOMINAL FREE FLUID•   US detects small amounts of free fluid•   FAST exam saves lives in trauma•   Real-time analysis of ...
DIAGNOSTIC AREAS•   Areas to search - start with ID of diaphragm and scan below!    •   Hepatorenal recess, “Morrison’s po...
PARACENTESIS•   Allows safe ‘point of care’ diagnosis/ treatment    •   Avoids delay/transport for “mark” placement    •  ...
PITFALLS    •   Compression artifact when needle enters abdomen (estimate safe        margin with ultrasound)    •   Dilat...
ABDOMINAL FREE AIR•   “Gut Sliding” sign similar to “lung sliding” sign for PTX    •   Air outside visceral peritoneum blo...
ABDOMINAL FREE AIR•   Where to look    •   Non-dependent areas of abdomen! (Air FLoats)        •   Probe on top of liver, ...
TOXIC MEGACOLON - AIR WITHIN BOWEL
GUT SLIDING
•   Once again…….    •   The presence of sliding gut and/or a        splanchnogram rules out free air    •   Their absence...
URINARY TRACT OBSTRUCTION •   Acute renal failure and oliguric/anuric     patients should have prompt US evaluation •   As...
•   KIDNEY DIAGNRAM
NORMAL KIDNEY
MILD HYDRONEPHROSIS
HYDRONEPHROSIS•   May take time to appear•   Always scan the bladder
BLOCKED FOLEY
BLADDER COLLAPSED AROUND FOLEY
SEE HYDRO?   CHECK BLADDER
PITFALL - Renal Cysts•   Common - can be confused with hydronephrosis
ISCHEMIC BOWEL•   Peritonitis and Ischemic Bowel    •   Evidence of peristalsis virtually rules out these disorders    •  ...
DILATED, FLUID FILLED, ILEUS.... ISCHEMIC?
PERISTALSIS (bowel is not sick)
ABDOMINAL AORTIC ANEURYSM•   Clinical relevance    •   Abdominal pain, hemodynamic instability, prior surgery•   How to lo...
AORTIC ANEURYSM WITH MURAL THROMBUS
STOMACH ULTRASOUND•   Main Application: Pre-Intubation Scan!    •   If stomach filled/distended with fluid or blood:        ...
MASSIVE CLOT FILLING STOMACH
“SWAMP WATER” FILLING STOMACH
Miscellaneous Applications•   Liver, spleen, and kidney    •   Size, echo texture    •   Gross abnormalities: Abscess, tum...
Ultrasound stuff(1)
Ultrasound stuff(1)
Ultrasound stuff(1)
Ultrasound stuff(1)
Ultrasound stuff(1)
Upcoming SlideShare
Loading in …5
×

Ultrasound stuff(1)

990
-1

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
990
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
50
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • Ultrasound stuff(1)

    1. 1. ABDOMINALULTRASONOGRAPHY IN CRITICAL CARE Pierre Kory, MPA, MDAssistant Professor, Albert Einstein College of Medicine Beth Israel Medical Center, New York
    2. 2. General Abdominal Ultrasonography• Complex anatomical structures with numerous variants • Not necessary to become fully competent in Abdominal Ultrasonography • Goal-Directed abdominal ultrasound is practical and achievable • keep clinical questions few and simple
    3. 3. Clinical Questions in Critical Illness • Free Fluid? - FAST exam • Perforated Bowel? - Free Air - lack of gut sliding, A line pattern • Urinary Tract Obstruction? - Hydronephrosis, bladder obstruction • Abdominal Aortic Aneurysm? - dilated aorta • Ischemic bowel? - peristalsis vs. ileus, dilated loops • Colitis? - thick walled, fluid filled loops of bowel • Hepatic Abscess? - anechoic intrahepatic space• Guide Diagnostic/therapeutic interventions
    4. 4. Remember:• Use “Abdominal” exam setting• 3.5 to 5.0 MHz transducer• orientation marker on left of screen• Doppler not needed• Can use transverse and longitudinal scans
    5. 5. ABDOMINAL FREE FLUID• US detects small amounts of free fluid• FAST exam saves lives in trauma• Real-time analysis of fluid • No tattoo mark needed!• Fluid usually black (anechoic), but may not be……
    6. 6. DIAGNOSTIC AREAS• Areas to search - start with ID of diaphragm and scan below! • Hepatorenal recess, “Morrison’s pouch” • Splenorenal recess • Pelvic region • Remember the bladder! • Perihepatic and perisplenic regions
    7. 7. PARACENTESIS• Allows safe ‘point of care’ diagnosis/ treatment • Avoids delay/transport for “mark” placement • Avoids danger of subsequent fluid/organ shift • Ultrasound characteristics of fluid can give diagnostic clues • Septations due to infectious etiology or malignancy, echogenic mass - hematoma?
    8. 8. PITFALLS • Compression artifact when needle enters abdomen (estimate safe margin with ultrasound) • Dilated, fluid filled bowel can be mistaken for pocket of free fluid! • I.D bowel wall and shape, peristalsis, air admixed with fluid, haustra • Free peritoneal effusion changes shape under manual pressure, bowel ‘floats’ in ascites • Ascites is usually echo free• Is that fluid pocket a massively distended bladder? • Typical shape, Foley catheter
    9. 9. ABDOMINAL FREE AIR• “Gut Sliding” sign similar to “lung sliding” sign for PTX • Air outside visceral peritoneum blocks US beam • Gut sliding sign- can “see” visceral and parietal peritoneum sliding against each other • When “free” air interposed between them - cannot SEE SLIDING, only see a “quiet” a line pattern • Careful of confusing “free” air and “bowel air”- bowel air also causes an A line pattern (gut sliding is preserved) • Presence of gut sliding rules out abdominal free air in that locatio
    10. 10. ABDOMINAL FREE AIR• Where to look • Non-dependent areas of abdomen! (Air FLoats) • Probe on top of liver, under diaphragm, in semi- recumbent patient (xiphoid) • Absence of gut sliding is not specific for free air • May have peritoneal symphysis • Poor visualization due to body habitus• “Splanchnogram” - if splanchnic organs seen, NO AIR
    11. 11. TOXIC MEGACOLON - AIR WITHIN BOWEL
    12. 12. GUT SLIDING
    13. 13. • Once again……. • The presence of sliding gut and/or a splanchnogram rules out free air • Their absence is highly suggestive in the correct clinical circumstance
    14. 14. URINARY TRACT OBSTRUCTION • Acute renal failure and oliguric/anuric patients should have prompt US evaluation • Assessment of kidneys and bladder • Size, echo texture, central echogenic space • Hydronephrosis is recognized with a dilated renal pelvis and calices. • Differentiate between renal cysts and hydronephrosis
    15. 15. • KIDNEY DIAGNRAM
    16. 16. NORMAL KIDNEY
    17. 17. MILD HYDRONEPHROSIS
    18. 18. HYDRONEPHROSIS• May take time to appear• Always scan the bladder
    19. 19. BLOCKED FOLEY
    20. 20. BLADDER COLLAPSED AROUND FOLEY
    21. 21. SEE HYDRO? CHECK BLADDER
    22. 22. PITFALL - Renal Cysts• Common - can be confused with hydronephrosis
    23. 23. ISCHEMIC BOWEL• Peritonitis and Ischemic Bowel • Evidence of peristalsis virtually rules out these disorders • Scan for peristalsis; may take time ~minute • Acute disorders usually affect the whole bowel so unimportant to be precise with anatomy• Important: Absence of peristalsis does not rule in peritonitis and/or ischemic bowel• Clinical context very important
    24. 24. DILATED, FLUID FILLED, ILEUS.... ISCHEMIC?
    25. 25. PERISTALSIS (bowel is not sick)
    26. 26. ABDOMINAL AORTIC ANEURYSM• Clinical relevance • Abdominal pain, hemodynamic instability, prior surgery• How to locate • Transverse scan sub-costal, left paramedian, transducer marker to right of patient • Tubular, anechoic structure • Rotate 90 degrees clockwise for longitudinal view • Size, Atherosclerosis, thrombosis
    27. 27. AORTIC ANEURYSM WITH MURAL THROMBUS
    28. 28. STOMACH ULTRASOUND• Main Application: Pre-Intubation Scan! • If stomach filled/distended with fluid or blood: • drain promptly to avoid massive emesis during inutbation! • Can be life-saving in unconscious patients • Highly Effective in Patients with GI bleed Koenig S. J Int Care Med, 2011
    29. 29. MASSIVE CLOT FILLING STOMACH
    30. 30. “SWAMP WATER” FILLING STOMACH
    31. 31. Miscellaneous Applications• Liver, spleen, and kidney • Size, echo texture • Gross abnormalities: Abscess, tumor• Advanced US • Hepatobiliary system. Retroperitoneal space,Vascular disease• Competence obtainable but requires additional training
    1. ¿Le ha llamado la atención una diapositiva en particular?

      Recortar diapositivas es una manera útil de recopilar información importante para consultarla más tarde.

    ×