Gastrointestinal Usg
Transcript of Gastrointestinal Usg
-
8/7/2019 Gastrointestinal Usg
1/27
-
8/7/2019 Gastrointestinal Usg
2/27
-
8/7/2019 Gastrointestinal Usg
3/27
GALL BLADDER
Normal anatomy
NORMAL ANATOMY
A normal gallbladder should be visible in virtually all adult pts if
it is physiologically distended following an 8-12 hr fast.
Anatomic position of GB fundus .
-
8/7/2019 Gastrointestinal Usg
4/27
-
8/7/2019 Gastrointestinal Usg
5/27
-
8/7/2019 Gastrointestinal Usg
6/27
-
8/7/2019 Gastrointestinal Usg
7/27
BASIC PRINCIPLES
Normal gut has a reproducible pattern or gut signature
Gestrointestinal tract sonography is frequently frustrating &
always challenging.
Gas content within the gut lumen can make visibility
difficult & even impossible, intraluminal fluid may mimic
cystic masses, & fecal material may create a variety of
artifacts & pseudotumors.
-
8/7/2019 Gastrointestinal Usg
8/27
-
8/7/2019 Gastrointestinal Usg
9/27
-
8/7/2019 Gastrointestinal Usg
10/27
-
8/7/2019 Gastrointestinal Usg
11/27
Pre-testprobability
-
8/7/2019 Gastrointestinal Usg
12/27
Age: In Women of 60 to 69
years of age adnexalmasses have 12 times the
malignancy risk of those
aged 20 to 30 ys.
-
8/7/2019 Gastrointestinal Usg
13/27
Family history:
The lifetime risk of ovarian cancer based on
family history alone:6.7% for 1 first-degree relative with the
disease to
40% for women with hereditary syndrome
-
8/7/2019 Gastrointestinal Usg
14/27
Transvaginal sonographic
approachThanks for the Transvaginal sonographic approach
as it yields the greatest amount of information
During real-time scanning.by placing pressure on the transvaginal probe and
on the patient's abdomen with the free hand you
can elicit pelvic tenderness and helps the
examiner assess the mobility and compressibilityof an ovarian mass, as well as the consistency
of its internal structures.
-
8/7/2019 Gastrointestinal Usg
15/27
By answering the next
you can determine whether or not
a specific patient requires surgicalintervention.
8 questions
-
8/7/2019 Gastrointestinal Usg
16/27
QuestionQuestion 11
What is the size of the lesion?
>10cm 5-10cm < 5 cm
unsuitable formorphologicassessment.and proceedto surgery.
morphologyand Doppler
studies mayyield relevantinformation.
morphologic
assessmentshould be
considered on
an individual
basis.
-
8/7/2019 Gastrointestinal Usg
17/27
QuestionQuestion 22
first exclude a pedunculated leiomyoma. By
visualizing a normal ovary on that side .
Is the mass solid?
Solid ovarian masses are generally the smallestsubset of ovarian tumors; approximately 10% are
malignant.Osmers RGW, Osmers M, VonMaydell B, WagnerB, Kuhn W.Preoperative evaluation of ovarian tumors in thepremenopause by transvaginosonography. Am J ObstetGynecol. 1996;175:428-434.
-
8/7/2019 Gastrointestinal Usg
18/27
QuestionQuestion 33
The risk that a simple, thin-walled cyst is malignantincreases with patient age and the size of thecyst.
Although the risk of malignancy rises as loculatedcysts become more complex, the Mucinouscystadenomas contain multiple septations andfluid with fine debris secondary to their thickmucinous content.
Is it a simple or complex cyst?
-
8/7/2019 Gastrointestinal Usg
19/27
QuestionQuestion 44
These represent localized overgrowth of the
epithelium. The likelihood of malignancy rises as
the number of excrescences increases *Papillary projections into the cyst cavity of less
than 3 mm are not strongly associated with
malignancy.**
* Granberg S, Norstrom A, Wikland M. Tumors in the lower pelvis as imaged by vaginalsonography. Gynecol Oncol. 1990;37:224-229.
** Timmerman D, Bourne TH, Tailor A, et al. A comparison of methods for preoperative
discrimination between malignant and benign adnexal masses: the development of a
new logistic regression model. Am J Obstet Gynecol. 1999;181:57-65.
Are papillary excrescences present?
-
8/7/2019 Gastrointestinal Usg
20/27
Question 5Question 5
benign cystic teratomas usually producesechogenic foci with acoustic shadowing, butsome malignant tumors may have components
that cast an acoustic shadow.
72% of cystic teratomas are avascular.
If the solid components of an apparent benigncystic teratoma have vascular flow, a strumaovarii consisting largely of thyroid tissue shouldbe considered.
Are there echo-dense foci?
-
8/7/2019 Gastrointestinal Usg
21/27
QuestionQuestion 66
a serous cyst generally contains clear fluid,
a mucinous cysts contain fine debris.
An endometrioma tends to containhomogeneous debris .
a hemorrhagic cyst may have a ground-glass
appearance . echogenic foci with acoustic shadowing are
characteristic of a benign cystic teratoma
Is there echogenicity of interior fluid?
-
8/7/2019 Gastrointestinal Usg
22/27
QuestionQuestion 77
the production of cul-de-sac fluid is proportionatewith ovarian activity. A postmenopausal patienthas < 7 mL of cul-de-sac fluid,
Since transvaginal ultrasound can consistentlydetect 8 mL or more of cul-de-sac fluid, no fluid isidentified in the majority of postmenopausal
patients. Thus, a moderate amount of cul-de-sac fluid in a
postmenopausal patient should raise thesonologist's index of suspicion concerning a
possible ovarian tumor.
Is measurable fluid in the cul-de-sac?
-
8/7/2019 Gastrointestinal Usg
23/27
QuestionQuestion 88
a follow-up ultrasound examination in 6
to 8 weeks may provide additionalinformation about a mass's etiology.
Repeat sonography is recommended in
cases without obvious stigmata of
malignancy or a size that would
mandate surgery.
How does the mass change over time?
-
8/7/2019 Gastrointestinal Usg
24/27
Ovarian Doppler.
Because of the many types of ovarian
masses, sonographic morphology is
usually not pathognomic andwhen
used aloneresults in a high false-
positive rate in the diagnosis of
malignancy. The role of color and pulse
Doppler is to reduce these false-positives.
-
8/7/2019 Gastrointestinal Usg
25/27
Malignant tumors characteristicallycontain dilated, saccular, and randomly
dispersed vessels. Centrally locatedflow, flow along septations, and flowwithin papillary excrescences alsosuggest malignancy.
Ovarian Doppler.
Findings suggestive
of malignancy.
-
8/7/2019 Gastrointestinal Usg
26/27
Peripheral flow is more consistent with a
benign neoplasm. Hemorrhage in a
mass is highly suggestive of a benignmass or cyst.
Ovarian Doppler.
Findings suggesting
a benign mass
-
8/7/2019 Gastrointestinal Usg
27/27