Acute Abdomen

/

ACLS/AILS/NRP provider

ETTC/APLS instructor

Winfocus WBE/ULS instructor

/

Acute Abdomen

Real-time ()

2.5-3.5 MHZ Probe

Laser printer, VHS

Measurement capability

Portability ()

V scan

Echogenicity

Fluids

Panrechyma

Fats

Air

Calcifications

Acoustic shadow

Comet tail artifact

FAST for trauma

Pediatric Acute Abdomen

AIM - IH

A : Acute appendicitis

I : Intussusception

M : Malrotation

I : Incarcerated hernia

H : Hollow organ perforation / Hypertrophic pyloric stenosis

Acute Abdomen

I G Get HIV

I : Inflammatory disease e.g. acute

appendicitis/cholecystitis

G : Gynecologic emergency e.g. ectopic

pregnancy, ovarian torsion

H : Hollow organ perforation

I : Ileus (Mechanical)

V : Vascular emergency e.g. AAA, ischemic colitis

Epigastralgia

1.Heart

2.Gall bladder and biliary duct

3.Abdominal aorta

Heart

Acute cholecystitis

:

(> 4 cm in transverse diameter)(> 3 mm)stone cystic duct Murphys sign

Parallel channel sign

Shotgun sign

Stones

Pneumobilia

Aorta

Pancreatitis and pseudocyst

RUQ area pain

Liver abscess

RLL pneumonia

Flank pain

AAA (>50 y/o)

Bladder

Acute renal failurepost renal obstruction

Acute renal failure

post-renal obstructive causes

Hydronephrosis

RLQ area pain

Appendix

muscle

Psoas mucle

appendix

Landmark of Appendix

Iliac crest

Psoas muscle

Acute appendicitis

Non-compressible

Diameter > 6mm

Appendicolith

Periappendiceal fluid

Enlarged lympth node

Ultrasound and CT scan is not for

diagnosis !! Clinical judgment

Acute appendicitis

Acute appendicitis

Abscess formation

Mimickers Mesenteric adenitis

Mimickers Epiploic appendagitis

Mimickers Omentum infarction

Mimickers Rectus sheath hematoma

Mimickers Diverticulitis

Mimickers Terminal ilietis

Appendiceal mucocele

Appendix 1.5cm CT scan

TumorMucocele

Psoas muscle abscess

Female Pelvic pain

GYN

1.2.3.4.

Cul-de-Sac

Gynecologic acute abdomen

Location of appendix

Pelvic sagittal scan

Pelvic transverse scan

Intrauterine Pregnancy

Color Doppler: Ring of Fire

Ovarian torsion

Corpus luteum cyst rupture

Tubo-ovarian abscess

Whole abdominal cramping

pain with persistent vomiting

Intussusception

Malrotation/Volvulus

Incarcerated hernia

Hypertrophic pyloric stenosis

2~4

,

Antral nipple sign

Ileus

Mechanical ileus

ABCH

A : Adhesion

B : Bezoar

C : Cancer (tumor obstruction)

H : Hernia (incarcerated hernia/torsion/volvulus)

Keyboard sign

Gastric cancer +Amylase/Lipase

Causes of A-loop syndrome

Bisection Approximation Method

Whole abd pain with

peritoneal sign

Pneumoperitoneum

Scissors Maneuver

J Clin Ultrasound 2004; 32:381-385

()

Curtain sign

Aurora / Circle / Corona sign: Gas

within wall of GI tract

Pneumatosis intestinalis

Portal vein gas

Thanks for your attention !!