Ins and Outs of Bowel US Stephanie G. Cohen MD Assistant Professor of Medicine and Pediatrics Emory University School of Medicine Overview • Discuss the use of ultrasound for evaluating abdominal pain • Review relevant anatomy and pertinent findings • Describe technique and pitfalls of sonographic evaluation General Concepts • Transducer selection • High vs Low frequency • Graded-compression • Displace bowel gas • Obtain images in 2 planes
23
Embed
Ins and Outs of Bowel US - SEMPA• Bowel wall thickening: IBD, Intramural hematoma • Psoas muscle, Stool Case • 9 yo boy presents with fever, HA, and abd pain • Nausea and anorexia,
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Ins and Outs of Bowel USStephanie G. Cohen MD
Assistant Professor of Medicine and PediatricsEmory University School of Medicine
Overview
• Discuss the use of ultrasound for evaluating abdominal pain
• Review relevant anatomy and pertinent findings
• Describe technique and pitfalls of sonographic evaluation
General Concepts
• Transducer selection• High vs Low
frequency
• Graded-compression• Displace bowel gas
• Obtain images in 2 planes
Case
• 75 yo woman presents to the ED feeling unwell for 1 day
• Vomited x 2, BM yesterday
• HR BP
• Right abdo pain
Decreased bowel gas
Imaging for SBO
Sensitivity 50-60% 92-96% 88%
Specificity 50-55% 93% 96%
AXR CT
Abdominal Imaging; 2005; 30:160-178
US
Small Bowel Obstruction
• Dilated bowel > 2.5 CM
• Peristalsis (To/fro)
• Bowel wall thickening >3 mm
• Keyboard sign
• Tanga sign
Tanga Sign
Technique: Lawn Mower
• Sensitivity 46% 91%
• Specificity 67% 84%
Emerg Med J 2011;28:676-678
AXR US
Limitations
• Miss “dilated” bowel loop
• Ileus vs SBO
• Cause of obstruction
• Decreased peristalsis is a late finding
Characteristics
• 2nd common cause of acute abdominal emergency in children
• Hyperplasia of Lymphoid tissue
• Typical age 5 mos-3 yrs • 50% < 1 year• > 5 years concern for PLP
Pathologic Lead Points
• Meckel Diverticulum
• Duplication cyst
• Polyp
• Tumor (lymphoma)
• HSP
• Intussusceptum: Donor loop
• Intussuscipiens:Receiving loop
• 90% ileocolic
Intussusceptum
Intussuscipiens
Clinical Features• Vomiting: bilious or non-bilious
• Colicky abdominal pain
• Irritable or lethargic
• RLQ mass
• “Currant jelly” stool or guaiac positive• Late finding
AXR: Intussusception
• Findings• No bowel gas in RLQ• Target sign• Meniscus sign
• Accuracy 40-90%• Misses 30% of cases
• Detect Pneumoperitoneum
US: Intussusception
• US is the imaging modality of choice• Sensitivity: 97-100% • Specificity 88-100%
• Ileocolic intussusceptions • Subhepatic• Size> 2.5 cm