GI REVIEW liver common complication and disease

想要回答的臨床問題。
選擇進行超音波掃描的部位。
掃描並判讀影像。
根據結果決策下一步處置。

1. 腹部急症之應用 [ II ] 腸道急症 Department of emergency medicine Kai Yuan Cheng.

2. History Taking

3. Physical Examination

4. Binary thinking Protocol based

5. Mowing the lawn technique

6. Manual anterior posterior compression

7. Anatomy Inner hyperechoic layer Second hypoechoic layer Third hyperechoic layer Fourth hypoechoic layer Last outer hyperechoic layer

8. UTLRASOUND IMAGE OF BOWEL PATHOLOGY: TECHNIQUE AND KEYS TO DIAGNOSIS IN THE ACUTE ABDOMEN. AJR:197, December 2011 Bowel wall thickening may be the most common sign of bowel disease.

9. Normal intestinal wall thickness < 3 mm in adult Normal intestinal wall thickness < 2 mm in children

10. Diseased bowel is generally easier to image because decreased motility and thickened bowel walls are larger and easier to see. UTLRASOUND IMAGE OF BOWEL PATHOLOGY: TECHNIQUE AND KEYS TO DIAGNOSIS IN THE ACUTE ABDOMEN. AJR:197, December 2011

11. Edema and infiltration of inflammatory cells tend to increased the echogenicity of fat. UTLRASOUND IMAGE OF BOWEL PATHOLOGY: TECHNIQUE AND KEYS TO DIAGNOSIS IN THE ACUTE ABDOMEN. AJR:197, December 2011

12. Peristalsis, Compression, Valsava maneuver. UTLRASOUND IMAGE OF BOWEL PATHOLOGY: TECHNIQUE AND KEYS TO DIAGNOSIS IN THE ACUTE ABDOMEN. AJR:197, December 2011

13. Bowel Wall Thicken No peristalsis Fat Stranding Compression

14. Location of gas Within bowel lumens Abnormal intraluminal gas Pneumoportal vein Pneumobilia Abnormal extraluminal gas Free air Localized air Intramural gas

15. 63Y F Epigastric pain since last night. Free air ???

16. Normal peritoneum

17. Pneumoperitoneum Visceral peritoneum Parietal peritoneum LIVER cartilage

18. Visceral peritoneum Parietal peritoneum

19. EPSS

20. Enhanced peritoneal stripe sign Sens: 100% Sepc:99% PPV:87.5% NPV:100% Ashwin Asrani , Emerg Radiol (2007) 14:29 – 39 20~35 mins examination time !!

21. Free air

22. Scissor maneuver

23. Curtain sign

24. Veiled kidney sign

25. Pneumoretroperitoneum Duodenal ulcer perforation

26. Dahine et al, Crit Ultrasound J (2016)8:2

27. Hollow Organ Perforation

28. EPSS CURTAIN SIGN VEILED KIDNEY SIGN AIR in ASCITS

29. BOWEL OBSTRUCTION

30. SBO Keyboard sign Tanga sign ~ high grade obstruction Wall thickeness > 3mm Dilated loop > 3.5 cm Absence of peristalsis

31. Sens: 83% Spec:100%

32. Keyboard sign Tanga sign

33. To-and-fro motion

34. Bisectional approximation method C-K Lin, H-M Chiu, W-C Lien, et al. Hepatogastroenterology 2006; 53:547-551

35. C-K Lin, H-M Chiu, W-C Lien, et al. Hepatogastroenterology 2006; 53:547-551

36. 38 Y F PMH: SLE PSH: cholecystectomy, appendectomy CC: vomiting 2 days. PI: Vomiting, diarrhea, periumbilical pain. Denied hematemesis or bloody stool.

37. http://pocusacademy.com/2018/02/08/lupus-mesenteric-vasculitis/

38. \

39. ESRD on CAPD

40. RLQ pain

41. LANDMARK

42. Psoas muscle Iliac vessel Cecum & Ilieocecal valve

43. Landmark >> Tubular structure.

44. Blind end structure

45. TUBULAR BLIND END

46. SIGNS of APPENDICITIS. Aperistaltic, non-compressible, dilated appendix (>6 mm outer diameter) Appendicolith

47. Aperistaltic, non-compressible, dilated appendix

48. Appendicolith

49. SECONDARY FEATURES Fluid/abscess in the periappendiceal region Increased echos of periappendiceal fat Enlarged mesenteric lymph nodes Hypervascularity

50. PERFORATION loss of the echogenic submucosal layer or a periappendiceal fluid collection

51. Epiploic appendagitis

52. Panniculitis

53. Intussusception 80%~90% ileo-colic type 3M~ 2Y Crampy abdominal pain, intermittently vomiting, strawberry jam stool.

54. Target sign

55. Target sign

56. Pseudokidney sign Pseudokidney Right Kidney

57. Crescent sign Mesenteric fat

58. Volvulus

59. Location of gas Within bowel lumens Abnormal intraluminal gas Pneumoportal veins Pneumobilia Abnormal extraluminal gas Free air Localized air Intramural gas

60. Pneumatosis intestinalis

61. Circle sign

62. Normal colon wall thickness< 2 mm in adult Normal colon diameter < 5 cm in adult

63. Diverticulitis Short-segment thickened colonic wall Hypoechoic diverticulum Dome sign

64. Hypertrophic muscularis Diverticulum Dome sign Inflammatory pericolic fat

65. Recap Direct signs Wall thickening Loss of layering Poor peristalsis Fixed structure Indirect signs Increased echogenic fat Abnormal gas