Abdominal Sonography
NATIONAL JOURNAL OF HOMOEOPATHY 1993 May / Jun Vol II No 3.
Dr Shah R.
The liver plays a vital role in abdominal sonography. It provides a window not only for itself, but also for the rest of the upper abdomen and retroperitoneum.
Real time imaging allows easy identification and complete survey of the liver, gall bladder and other organs. Real time sonography has challenged the role of Technetium Sulphur colloid liver scanning, as the screening test of choice, in cases of suspected hepatic pathology. Sonography is more sensitive than nuclear medicine scanning, and a better characterisation of lesions is possible.
Advantages:
It is noninvasive, rapidly performed, safe (no radiation involved) and
provides excellent results. Moreover, it is least expensive (cost effective) and so it can
be easily repeated for a follow up. It is also portable and so an easy follow up of a
patients lesion is possible.
Disadvantages: Tissue diagnosis is not possible. It is also operator oriented.
Indications:
- Hepatomegaly
- Pain in Right hypochondrium
- PUO (Pyrexia of Unknown Origin)
- Jaundice (especially in obstructive variety)
- Alcoholics.
- Trauma
- Patients with malignancy
- X-ray shows elevation of right dome of diaphragm.
- X-ray shows radio opacity in right hypochondrium
- Interventional work (Drainage of abscess, biopsy)
Cases:
A 30 year old female came with fever since 2 days and severe pain in right
hypochondrium.
O/E tenderness and hepatomegaly
Ultrasonography:
Showed a large. 10 X 9 X 8 cms abscess in right lobe of liver. Incidentally
Gallstones were also seen. USG guided aspiration was done. The size after aspiration was 4
X 3 cms.
Treatment was given to the patient and she started showing signs of improvement.
A follow-up USG was done after 3 weeks showed abscess size of 2 X 1.5 cms. Patient was asymptomatic. Another follow-up after 3 weeks showed complete resolution.
Note- The rapid resolution of the abscess was partly due to aspiration. At times abscess may take upto six months for complete resolution although patient may be asymptomatic.
Preparation of the Patient
(For gall-bladder examination only) 6-8 hours fasting (can take water)
Preferably a 24 hours non-fatty meal.
The patient went to his doctor for a check up and the doctor wrote out a prescription for him in his usual illegible writing. The patient put it in his pocket but forgot to have it filled. He put it to various uses. Every morning for 2 years he showed it to the conductor as a railroad pass. Twice it got him into the movies, once into the baseball party and once into the symphony. He got a raise at work by showing it as a note from the boss. One day he mislaid it. His daughter picked it up, played it on the piano and won a scholarship to a musical academy.