Pulmonary drug delivery system M.pharm -2nd sem P'ceutics
sonographic presentation of abd org-2.pptx
1. Sonographic Technique and anatomy
of solid abdominal organ
By
DR Md. Shahed Hossain
MBBS. MD (Phase A)
BSMMU
2. • Ultrasound is the named given to high frequency sound wave
over 20000 cycles per second which can be transmitted in beams
and are used to scan the tissue of the body.
• Ultrasound image is formed by the reflection of ultrasonic waves
emitted by the transducer. Reflected waves from tissues are
captured by the transducer and then processed electronically, the
resulting ultrasound images are projected on the monitor.
• It is often called “physician's extended finger”.
4. Transducer:
Coupling agents: It is prepared by using ingredient like Carbomer,
EDTA, Propuline glycol, Trolamine Distilled water
5. Conventional transducer -- 3.5 MHz for scanning deeper structure
High frequency ( 7.5-15 MHz) for superficial structures (tendons,
ligaments, and small joints)
Low frequency transducers (3.5–5 MHz) for larger or deeper sited joints
( Hip joint)
6. • Transducers are both transmitters and receivers of ultrasound.
• Denser material—greater reflectivity—appears white
• Water—least reflectivity—appears black
7. Advantage
•Non-invasiveness, portability, relative
inexpensiveness, lack of ionizing radiation, and its
ability to be repeated as often as necessary, making
it particularly useful for the monitoring of
treatment. Real time visualization can be possible
which is impossible in CT and MRI.
8. Disadvantage
➨It has poor penetration through bone or air. Moreover it
has limited penetration in obese patients. These are the
disadvantages in imaging domain.
➨The quality of results and use of equipment depend on
skills of operator.
➨Images can be difficult to interpret and requires
experienced operators or radiologists.
➨Image resolution is less, compare to CT and MRI scan.
➨Air or bowel gas prevents visualization of structures
9. Preparation of patient
• The patient should take nothing by mouth for 8 hours preceding the
examination. Only water should be given.
• For infant –clinical condition permitting – should be given nothing by
mouth for 3 hours preceding the examination
• Drinking of appropriate amount of water will help to scan pancreas, the
lower abdomen and pelvis.
Position of the patient
• The patient should lie comfortably on his / her back (supine). Head may
rest on small pillow and if there is much abdominal tenderness, a pillow
may also be placed under the patient knee. (most of the organ )
10. • For scanning of spleen- Patient should be supine initially and later on
right decubitous position. .
• For scanning of kidney: Start with the patient lying on his/ her back
(supine) then right and left side. Both kidneys can also be examined with
the patient sitting or standing erect and prone position.
11. Anatomy of liver
• Liver is the largest gland in
human body after skin
• Liver lies mainly in right upper
quadrant of abdomen under
cover of 7-11 ribs on right side
occupying predominantly right
Hypochondium and
Epigastrium
13. • Segmental anatomy of the liver: Liver is devided into 8 segments
Each liver segments has own vascular inflow , outflow, and biliary
drainage. Liver is divided into eight independent segment (The Couinaud
classification)
14. Scanning of liver
• Position of the patient: Supine
• Choice of transducer: 3.5 MHz transducer for adult, 5 MHz for children
• Scanning technique : Scanning should be Longitudinal, Transverse, Oblique ( 10*
rotation left side down), subcostal and intercostal
• Instruction: For a good ultrasound "window" we usually ask the patient to take a
deep inspiration and hold the breath in.
• Parenchyma of liver:The normal liver is considered to be normoechoic (as a fine
blend of salt and pepper)
15. •Normal measurements are:
Liver: Adult less then 15 cm and for
children (Age/2 +6) along mid clavicular
line (Longitudinal )
Portal vein: < 12 mm
Gall bladder: Diameter: < 4 cm
Wall thickness: Fasting
patient it is normally 3mm or less
CBD: < 9mm
After cholecystectomy: 10-12 mm
Common hepatic duct: 5mm
Hepatic vein : <10mm
24. Scanning of Pancreas
• Positions of the patient: Supine
• Choice of transducer: 3.5 MHz transducer for adult, 5 MHz
for children
• Scanning technique: Transverse and longitudinal scan in
epigastrium. Give gentle compression with the transducer
and Patient is asked to take a deep breath and hold the
breath in. If bowel gas obscure the image then window is
make by giving the patient 3-4 glasses of water and wait for
3-4 min for disappearing bubble. And continue the scanning
29. • Position of the patient : supine initially and later on patient
lie obliquely on right side.
• Choice of transducer: 3.5 MHz transducer for adult, 5 MHz
for children
• Scanning technique: Scan the patient in supine, oblique
position. Scan from below the costal margin , angling the
beam towards the diaphragm. Then in the 9th intercostal
space downward. Repeat through all lower intercostal space.
• Instruction: Patient is asked to take a deep breath and hold
the breath so that spleen moves downward.
Scanning of spleen
30. • Spleen is crescent in shape.
• Measurements are:
Length: Adult : <12 cm and children ( Age 3) + 6
Breath : 6cm
Splenic vein at hilum: < 10mm ( if > 10mm indicate portal
hypertension.
33. •Preparation of the patient: No preparation is
required , if urinary bladder is to be
examined the patient should drink water.
•Position of the patient : Start with the patient
lying on his/ her back (supine) then right and
left decubitus position.
•Choice of transducer:3.5 MHz transducer for
adult, 5 MHz for children
Scanning of kidney
34. •Scanning technique: Right kidney best seen in
supine position , using the liver as an acoustic
window. Ask the patient to take a deep breath and
hold the breath in. Start with longitudinal scan over
the right upper abdomen then follow with the
transverse scan. Then rotate the patient left lateral
decubitus position to visualized right kidney in
coronal view.
To visualized left kidney apply the coupling
agent to the left upper abdomen. Scan the left
kidney in a similar sequence.
35. Measurements of a normal kidney
• Length: 9-12 cm
• Width : 4-6 cm
• Thickness: up to 3.5 cm
• In new born : length : 4cm, width: 2cm
• Renal sinus : 1/3 of the kidney.
• ##Adrenal glands are not easily seen with ultrasound. The adrenal
glands are situated above and medial to the kidney. If they are easy
to see, they are likely to be pathological enlarge.
• ## ureters are also not seen easily as their position is behind the
bowel. But it can be seen when they are dilated.
36.
37.
38. Pelvic organ :
• To scanning the pelvic organ Bladder must be full
• Position of the patient : supine but may need to be rotate
obliquely.
• Pelvic organs are examined in transverse and
longitudinal sections above the pubes
• Choice of transducer: 3.5 MHz for adult and 5MHz for
children . Endovaginal ultrasound is also used to
scanning female genital organ
45. Female genital organ
• In women the uterus is visualized posteriorly of the urinary bladder,
as an echoic structure, pear shaped in longitudinal section.
52. Reference
• Manual of Diagnostic Ultrasound
By Organisation mondiale de la santé, World Health
Organization
Editor's Notes
Before starting usg we should prepare the patient
Porta hepatis: through which portal vein hepatic artery enter into the liver and hepatic duct and lymphatics exit through it
To understand easily we can say: in the Rt lobe, segments 7 and 8 and in the left lobe segment 4a & 2 are in contact with the diaphragm; segment 6 comes into contact with the right kidney; the caudate lobe which segment 1 , the gallbladder bed is surrounded by the segments 4, 5 and 6;
Measurements are very important to comment a diseased. In case of children normal length of spleen can be calculated by a equasion
patient may have CCF
Here shows uniform homogenous echopatern liver parenchyma, thin hyper echogenic diaphragm.
Here the longitudinal measurement is taken from dome of diaphragm to inferior border of liver along the mid clavicular line.
In this scanning showing
Here shows subcostal scanning of gallbladder by displacing the bowel downward by rotate the patient towards to left
It is very much difficult for beginner to differentiate Portal vein, hepatic vein and hepatic ducts when they are dilated,
The hepatic vein and portal vein are differentiate from dilated hepatic duct by color flow. they both take color flow when Doppler usg is applied but Hepatic duct do not take color.
In between portal vein and hepatic vein--- the portal vein have echogenic wall.
Here I am trying to show you ultrasonographically ,the segments of liver . This is IVC..
Pancreas is retroperitoneal organ approximately L 1 level. It is described as having a head, neck, body and tail, uncinate process. It is surrounded by duodenum.
This is the MPD, this is Accessory pancreatic duct. Splenic artery run above and splenic vein run behind the pancreas. Portal vein is form behind the neck of pancreas.
SMA and IMV lie just in front of uncinated process of pancreas.
MPD usually not seen. When its drainage is obstructed become dilated then we can see…
This picture shows spleen is in left hypochondrium below the diaphragm which lies in between 9-11 rib
These are hilar vessel . Tail of pancreas extend up to splenic hilum
This is splenic flexure just in front of lower end of spleen.
In case of children normal length of spleen can be calculated by a equasion
uniform homogenous echopatern
The kidneys lie retroperitoneal in the paravertebral gutters of the posterior abdominal wall. The hilum of the kidney lies in the left at L 1 vertebral level and the right slightly lower at L 1 /L 2 level. Both ureter go downward along the tip of transverse process insert into both ureter.
On cross-section each kidney is seen to have an outer cortex and an inner medulla. This is hilum of kidney where we see renal artery, renal vein, ureter.
This is the sinus of kidney.
The term CMD is very much difficult to understand for the beginner– lets discuss on it…
This hypoechogenic structure is renal pyramid or (renal medulla) . Comparative hyper echogenic structure surrounding the pyramid is cortex.
So the CMD is the ecogenical differentiation between the cortex and medulla. And in this kidney CMD is maintained.
Though bladder is not a solid organ but it is very much important to know for all….
It is a parenchymal structure with uniform homogenous echopatern with the maximum normal volume is 25 ml . More then 25 ml suggestive for prostate adenoma
Placed the transducer longitudinally in hypogastrium
Placed the transducer longitudinally in hypogastrium . Here shows sagittal view of uterus
Here shows transverse view of uterus
Uterus has 2 different zone of echogenicity. The muscle in the uterine wall are hypoechogenic but the pattern of endometrium varies. 1st ½ of men..cycle the
Endometrium is thin & hypoechogenic. 2nd ½ of men..cycle the endometrium hyper echogenic
Uterine dimension increased by 1.o-1.2 cm with parity
Appear as an ovoid (egg structure) , less homogenous then urerus ,
A physiological cyst in the ovary may be up to 5cm in diameter.
