gastrointestinal usg

Upload: drshamimr

Post on 09-Apr-2018

230 views

Category:

Documents


0 download

TRANSCRIPT

  • 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