Lesson 19 (Part 2) Flashcards
What kind of patents history should you have if getting your bowel scanned? (2)
- Crohn’s disease
2. Ulcerative colitis
What are clinical indications for scanning the bowel? (4)
- Symptoms
- Acute pain
- RLQ and/or LLQ - Increase WBC
- Change in Bowel patterns
How do you prepare for a bowl ultrasound? (5)
- Patient fasting
- 3.5 -5 MHz overall look at bowel
- Pelvis full bladder
- to assess sigmoid colon and rectum - Empty bladder
- Areas of interest (pain) receive detailed attention with higher frequency transducer 5 to 9MHz
What kind of transducer can you use for areas of interest with the bowel? (4)
- Linear
- Convex linear probes
- Some sector probes
- Transvaginal for women
What is the transvaginal ultrasound good to look at when scanning the bowel?(2)
- Sigmoid colon
2. Rectum
What does a normal bowel do?
Compresses when pushed on
- gas pockets will be displaced
How can you tell if a bowl is abnormal?
It will not compress if you push on it
- will remain unchanged
Can you see all the layers of the bowl sonographically?
You might be able to
What is the gut signature variation sonographically?
Bulls eye in cross section
- echogenic central area and hypoechoic rim
What determines the degree you are able to see the layers of the bowel? (2)
- Quality of scan
- good patient vs bad patient - Resolution of transducer
What is the average thickness of the GI track? (2)
Distended = 3mm
Not distended = 5mm
How do we tell the difference between the whole GI tract? (2)
- Know the location
- know anatomy - Look for traits between small and large bowel
What is the key difference between large and small bowel appearance?
Peristalsis is normally seen in the small bowel and stomach
- looking for motion
Where is peristalsis not typically seen?
In the large bowel
What are challenges when scanning the GI tract? (4)
- Appearance varies depending on the contents on the bowel
- air, feces or fluid - Gas content within gut lumen
- intraluminal air - Intraluminal fluid
- mimic cystic masses - Fecal material can create artifacts and pseudotumors
What does the normal gut show with doppler?
Little signal
What makes it difficult to interrogate the gut wall with doppler? (2)
- Normal bowel
2. Mobile bowel
What does motion create in the gut wall when using doppler?
An artifact
What occurs at abnormal places in the gut wall with doppler?
Hypervascular or hypovascular where tenderness felt
- provides supportive evidence
Why are young patients better to scan the appendix?
Better seen typically smaller size
Where does the appendix extend from?
The cecum
- long, tubular structure
Where is the appendix located?
On the abdominal wall under McBurney’s point
What does the small canal of the appendix communicate with?
The cecum by an orifice that is below and behind the ileocecal opening
What are the layers of the appendix?
Same layers as the colon
How long is a normal appendix length considered to be?
Less than 6mm in AP diameter
- varies in length
What does the appendix have with a sonographic appearance?
Blind end or tip
