A female of 54years of age, (born in May 1949), was requested to have an abdominal ultrasound scan performed, on her. The clinical indications stated on her request form read that she was suffering from pain in her abdomen, and back and the GP wanted to query gallstones. The clinical indications of this patient had suggested that gallstones might have been present. Ultrasound was therefore chosen as the modality of choice, because it is by far the best imaging modality for making a diagnosis of gallstones. Ultrasound also has the added advantage of having a short waiting list, being quick, non-invasive, convenient, and known to carry no radiation risk. It would also be able to scan the rest of the abdomen at the same time to rule out any other pathologies.
Prior to the examination, a letter was sent out to the patient, explaining what procedure they were going to have done, and stating the date and time of their examination. The letter also included how the patient should prepare for the examination. They were instructed not to eat or drink for six hours prior to the examination. This would allow the gallbladder to become distended, aiding better visualisation for the sonographer. The equipment used was real time, B mode grey-scale imaging. A 3.5mHz frequency was used, which would provide adequate penetration for this patient. A sector transducer was used, to allow access to intercostal spaces. This also provides a wide field of view, with depth.
The patient was supine on the table, and using a trans abdominal approach, the gallbladder was first located, by following the reflective main lobular fissure. This was from the right portal vein, to the gallbladder fossa. The gallbladder was then scanned slowly along the axis of it, and transversely from the fundus to the neck, leading to the cystic duct. The gallbladder was then re-scanned in the left lateral decubitis position, so any stones would not be missed, from just looking in the supine position. The rest of the patient’s abdomen was scanned in both the longitudinal and transverse scan planes. Chapman &. Nakielny, (2001).
Though not very large, quite a few gallstones were seen. The gallstones showed up as an echogenic focus which casted an acoustic shadow, and had sinked to the bottom of the gallbladder. After the procedure had finished, the patient was wiped clear of any remaining jelly, and made sure they were feeling well. The sonographer told the patient when and where she could obtain her results. Her results would be sent to her GP, and she would have to wait around a week, before she could see her GP. In the report it was stated that further treatment would be necessary to eliminate these gallstones. These treatments included laparotomy, or extracorporeal shockwave lithotripsy.
OBSTRUCTIVE JAUNDICE
Jaundice is yellowing of the skin, and the whites of the eyes. This is caused by an accumulation of bilirubin in the blood. Jaundice is the main sign of many disorders of the liver and biliary system. In obstructive jaundice, also known as cholestatic jaundice, bile cannot leave the liver, this is due to bile duct obstruction. Obstructive jaundice can also occur if the bile ducts are not present. Cholestasis then occurs and bilirubin is forced back into the blood, Peters, (2002). Ultrasound can demonstrate the cause of the obstructive jaundice, such as a liver mass or any stones in the common bile duct, or cancer of the pancreas.
PANCREATITIS
This is known as the inflammation of the pancreas, which may be acute or chronic. The main cause of this is due to alcohol abuse, or gallstones. Chronic pancreatitis leads to permanent damage. Symptoms of acute pancreatitis are a sudden attack of severe upper abdominal pain, which may lead to the back, along with nausea and vomiting. Chronic pancreatits usually has the same symptoms. Treatment is usually an IV infusion of fluids and salts, and with drugs. Pancreatectomy maybe performed, and any gallstones removed. Peters, (2002). Ultrasound is usually the first line investigation in acute pancreatitis. Both the gallbladder and biliary tree are also examined to exclude the presence of gallstones, which are a cause of pancreatitis.
PROSTATE CANCER
This is a cancerous growth in the prostate gland of unknown cause. This mainly occurs in elderly men. An enlarged prostate may cause symptoms including difficulty in passing urine, and poor urine flow. Ultrasound and a biopsy can confirm the diagnosis of Ca prostate. Ultrasound can examine the size and shape of the prostate. The prostate has a good blood supply to it, and so ultrasound can be used for the assessment of this blood flow, using Doppler, to help diagnose a benign or malignant mass. Ultrasound can also aid in the biopsy guidance. Other advantages of using ultrasound include its no known radiation risk. It is cheap and the scans are quick to perform. It is easily available, and non-invasive.