basic+abdominal+sonographic+anatomy+and+protocol

*Basic Abdominal Sonographic Anatomy and Protocol prepared by: Jenny Babe Barrera

9 abdominal regions; 4 quadrantsPrepared by Dr.Awad Elkhadir*epigastricinguinal,(or iliac)umbilicalflank(side but in back)The important regions:The 4 quadrants?

Prepared by Dr.Awad Elkhadir

UltrasonographyUltrasound is a painless procedure in which images of internal tissue and organs are produced by the use of sound waves.Because it is non invasive, children accept ultrasound easily and may even enjoy watching the oscilloscope screen during the procedure.

InstrumentationThe transducer that is used on the body surface to pick up internal images can be compared to a television camera.The upper abdomen is scanned with the highest-resolution transducer possible for the size of the patient. The transducer may be a sector or curved linear array, or in many cases, a combination of the two. The transducer frequency depends on the size, muscle and fat composition of the patient.

Most transducers today actually are multi-focal with multiple frequencies available in one transducer; therefore, the liver may be scanned with the lower frequency, while the pancreas and gallbladder may be scanned with the higher frequency transducer. The lower-frequency transducers are often necessary in patients with fatty infiltration or cirrhosis of the liver.

Prepared by Dr.Awad Elkhadir*


The primary controls the sonographer needs to utilize in the general abdominal scan are the depth, time-gain compensation, overall gain, and zoom control. The depth controls the size of the overall image. This should be set so the image fills the screen without loosing information along the posterior border. Most normal adult abdomens range in size from 15 to 20 cm deep.

The time-gain compensation controls individual gain pods within the image. These pods are aligned to the depth control (i.e. if the depth is set at 20 cm and there are 10 pods, each pod would adjust the gain at 2 cm increments). The sound beam is absorbed, attenuated, and reflected as it strikes a surface; by adjusting the time-gain controls, the sonographer is able to electronically amplify the echo in a certain area so the sound will be stronger and produce a brighter echo return.

The overall gain controls the amount of echoes received by the transducer. It is analogous to the volume control on the radio, the higher you turn up the volume, the louder the sound. Such is the response of the overall gain control, as the sonographer increases the gain, more echoes are seen throughout the image. If the gain is set "too high" the sonographer will have difficulty in distinguishing the various gray scale interfaces.

The vascular structures should be anechoic or echo-free and may be used as a control to make sure the gain is not set too high. On the other hand, if the gain is set too low, the overall image will be dark and texture patterns within the organs difficult to see.In addition to the instrument controls, the sonographer must find the best "window" on the patient's abdomen. The window refers to the area which the transducer may be angled to record the majority of abdominal landmarks without interferance from the ribs, bowel, stomach, or lungs.

Unlike other imaging techniques, ultrasound uses no radiation, so it is preferred method for viewing a developing fetus during pregnancy.

Sectional Anatomy

Ultrasound of the abdomen is generally performed in at least two image planes, you know it?*


transverse and........?*


longitudinal.*


Transverse PlaneThe transverse sectional images are presented in descending order from the dome of the diaphragm to the umbilicus.

*Transverse image at the dome of the liver shows the middle hepatic vein draining into the inferior vena cava. The homogeneous liver texture is well seen.


The right hepatic vein drains into the inferior vena cava; the liver parenchyma shows the portal and hepatic vascular structures within.*


Transverse image with the transducer angled inferior, using the left lobe of the liver as an acoustic window to image the pancreas and vascular structures.*


Transverse image of the pancreas and vascular structures.*


Longitudinal PlaneThe longitudinal sectional images are presented from the midline of the abdomen to the right abdominal border. Images of the spleen and left kidney are made with the patient in a left lateral decubitus position.*longitudinal image of the midline of the abdomen shows the aorta with the celiac axis and superior mesenteric artery arising from the anterior wall.


longitudinal image slightly to the right of midline shows the left lobe of the liver, ligamentum venosum, and caudate lobe of the liver anterior to the inferior vena cava.*


longitudinal scan of the left lobe of the liver, with the middle hepatic vein draining into the inferior vena cava.*


longitudinal scan over the right lobe of the liver. The diaphragm is shown to the left(towards the patient's head) of the liver.*


IndicationAllows doctor to see problems with organs, vessels, tissues, without needing to make an inciaion.According to the Radiological Society of North America, your doctor may order an ultrasound if you are experiencing pain, swelling, or other symptoms that require an internal view of your organs (RSNA, 2012).

An ultrasound can provide a view of the:bladderbrain (in infants)eyesgallbladderkidneysliverovariespancreasspleenthyroidtesticlesuterusblood vessels

An ultrasound is also a helpful way to guide surgeons movements during certain medical procedures, such as biopsies.

Preparation of ClientThe ultrasound examination is most effective if the patient has been NPO for at least 6 hours.

>This allows the biliary system to be distended and easily imaged by the sonographer.

When a patient is fasting there is a a decreased opportunity for gas to accumulate within the colon; gas prohibits the passage of the sound and thus limits visualization of abdominal structures.

If the patient is able to consume liquids and the pancreas is not well-visualized, the administration of water may be given to fill the stomach and duodenum to better delineate the pancreas.The kidneys are best imaged when the patient is fully hydrated, therefore no patient preparation is necessary when only the kidneys are examined. Full hydration will also enable the sonographer to image the distended urinary bladder.

The position of the patient for the general abdominal scan is usually supine for the initial images. The patient is then rolled into various degrees of obliquity to better demonstrate the biliary system, pancreas, liver, kidneys, or spleen. If the scanning plane is oblique, the sonographer should indicate the change of position on the documented image without specifying the exact degree of obliquity. The same would apply if the patient were in a lateral, upright, or prone position.

Steps of Procedure

Before the exam, you will change into a hospital gown. You will most likely be lying down on a table with a section of your body exposed for the test.An ultrasound technician, called a sonographer, will apply a special lubricating jelly to your skin. This prevents friction so he or she can rub the ultrasound transducersimilar in appearance to a microphoneon your skin. The jelly also helps transmit the sound waves.

The transducer sends high-frequency sound waves through your body. The waves echo as they hit a dense object, such as an organ or bone. Those echoes are then reflected back into a computer. The sound waves are at too high of a pitch for the human ear to hear.Depending on the area being examined, you may need to change positions so the technician can have better access.

After the procedure, the gel will be cleaned off your abdomen. The whole procedure typically lasts less than 30 minutes. Following it, you will be free to go about your day and normal activities.

After an UltrasoundFollowing the exam, your doctor will review the images and check for any abnormalities. He or she will call you to discuss the findings, or to schedule a follow-up appointment. Should anything abnormal turn up on the ultrasound, you may need to undergo other diagnostic techniques, such as a CT scan, MRI, or a biopsy sample of tissue.

If your doctor is able to make a diagnosis of your condition based on your ultrasound, he or she may begin your treatment immediately.

Nursing Responsibilities Ensure that patients are afforded the highest quality care possible during their ultrasound procedure. This entails identifying the patient properly, ensuring confidentiality of information and patient privacy.Maintain clean sanitary equipment and examination rooms. *


Be certain that parents understand that ultrasound is not an x-ray and appears to have no long-term effects, so it can be repeated over and over for serial determinations.Alert child that a clear gel will be applied to the skin over the body part to be studied to aid sound conduction. The gel can feel cold and sticky.

Thank you!!!^_^Prepared by Dr.Awad Elkhadir*


Quiz:Used on the body surface to pick up internal organs that can be compared to a television camera?Is a painless procedure in which images of internal tissue and organs are produced by the use of sound waves?What is use to produce images of internal tissue and organs in ultrasound?What controls the size of overall image?Most normal adult abdomen range in size from ______ to _____ in depth?6-8: Preparation in client9-10: Two image planes which ultrasound of abdomen generally performed?11-12: Indication of ultrasound13-15: Nursing ResponsibilitiesPrepared by Dr.Awad Elkhadir*


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