No side effects
IMPORTANT. We recommend that the patient develops a dossier that monitors his health status over his lifetime, preserve all the results of the ultrasounds performed over time, along with clinical and biochemical analysis or other investigations, and present himself to the doctor each time with this dossier – in order to be able to make a dynamic personal assessment. This will reveal possible improvements or worsening of the state of his health, and a correct diagnosis can be made. A complete diagnosis is not based on a single investigation, but on the evolution of the dynamics of clinical and biological changes.
Useful informations for patients
The ultrasound (also called sonography or ultrasonography) is a diagnostic method that uses ultrasound (US) in order to generate images from the human body. It is done with the aid of the device called ultrasound.
The ultrasound is one of the most dynamic procedures used in modern medical practice, being easy and fast to achieve. Having an ultrasound is a routine investigation, the ultrasound exam being a non-invasive, non-irritating and painless procedure that does not require any special previous training.
The ultrasound is not used when examining bones and lungs, however the ultrasound images clearly visualize the kidneys, liver, biliary bladder, pancreas, spleen, appendix, uterus, ovaries, bladder, and also blood vessels such as iliac vessels, aorta, carotid, femoral, helping to establish an easy and fast diagnosis, even in an emergency.
Scope of applicability
Endocrinology: echography of the thyroid for the evaluation of the eco-structure, visualization of solid or cystic images and vascularization of the thyroid parenchyma.
Gastroenterology: in abdominal ultrasonography solid organs are visualized, such as: pancreas, aorta, vena cava, liver, biliary bile, bile ducts, kidneys, spleen.
Neurology: estimation of blood flow and visualization of stenoses in the carotid arteries and in the cerebral arteries of large caliber.
Gynecology (transvaginal ultrasound: visualization of ovaries, uterus, cervix or other pelvic formations) and Obstetrics: obstetrical ultrasound is used in pregnancy to check the development of the fetus.
Urology: to determine, for example: the amount of fluid retained in the bladder, renal lithiasis, any bladder, ureter, or kidney formation.
Skeletal system: tendons, muscles, nerves, bone surfaces.
Vascular: Doppler ultrasound can be completed by doppler calculation to determine the direction and speed of blood flow to or from the sample.
Emergency medicine: FAST ('focused assessment with sonography for trauma') sonography trauma assessment to detect hemoperitoneum or post-traumatic pericardial swab.
Interventional ultrasound: for biopsy sampling, for intrauterine transfusions.
Contrast-substance ultrasound: It is based on the intravenous injection of a contrast medium, which is an inert gas which, by mixing with phospholipids and physiological saline, forms microbubbles by agitation. These in about 10 seconds reach the target organ level, making a map of the region or body concerned, based on the signal from the vessels. Approximately 15 minutes after injection, the substance is completely excreted.
Advantages and disadvantages of the ultrasound
The ultrasound is considered a routine investigation, the ultrasound examination being a fast, non-invasive, non-irritating and painless procedure that does not require any previous prior training.
Another advantage of the ultrasound is that it avoids the harmful effects of X-rays. Furthermore, the equipment is portable and accessible and can be used both in the hospital and in the office, at the patient's bed or even in the ambulance. A disadvantage lies in the fact that the result also depends on the experience and skill of the specialist who performs and interprets it, false negative or false positive results may be present due to the subjectivity that appears in the examination. The importance of ultrasonography education is very high. The World Health Organization has pointed out that because the ultrasound is an "addictive operator", you can reach a paradoxical situation where it is "more important for the presence of qualified human resources than that of the ultrasound equipment itself" (WHO, 1990).
In the current stage, the ultrasonographic practice is done through "clinical applications". It can be considered that an ultrasound is so good and of high performance, based on how well the practitioner knows how to get the most eloquent image and then integrate it into the clinical picture. Ultrasonography should be practiced where it yields real benefits and should be looked at with reserves where its intake or diagnosis is limited (Goldberg, 1988).An important strength of ultrasonography, which should not be overlooked, is its dynamic character. The ultrasound image is "dynamic" (the Anglo-Saxon term used is the "real time" procedure). This feature, resulting from the rapid succession of screen sections, allows information about cardiac contractility, fetal movements, or intestinal mobility exactly as these events take place. The dynamic image completes the static image and gives another perspective on the studied body, and gives the ultrasound the chance to generate a very rapid diagnosis during the examination. This feature validates the ultrasound method as a clinical procedure.
Unfortunately, unlike the image used in computer tomography or magnetic resonance imaging, the ultrasound image is not exhaustive, being unable to include on the screen only limited sections, interested in variable anatomical regions. However, due to the technological optimizations of the last 10-15 years, ultrasound exploration has gained images of better quality and resolution that help reduce the dose of subjectivity that occurs in diagnosis.
When is abdominal ultrasound recommended
Due to its non-invasive, non-irritating and painless quality, abdominal ultrasound is recommended for both abdominal pathology suspicion and routine annual examinations in the absence of any symptom.
Abdominal ultrasound - symptoms that indicate its usage:
- acute or chronic abdominal pain, irrespective of duration or associated symptoms (renal, hepatic, cholecystic, pancreatic pathology)
- abdominal trauma with possible organ breakages and internal hemorrhage
- menstrual cycle disorders (visualization of the uterus and ovaries)
- unidentified fever (can be explained by abdominal pathology)
- weight loss due to an undetermined cause (possible tumor)
- the existence of an extra-abdominal tumor, in order to detect possible abdominal metastases in the organs or ganglia
- transit disorders - constipation, diarrhea, abdominal meteorism (bloating)
- jaundice (yellowing of the skin and mucous membranes), which may be due to liver disease, bile duct disease, cholecystitis or pancreas disease (pancreatic head tumors causing obstruction in the main biliary tract)
- the appearance of abdominal tumors, a palpable or otherwise detected mass
- abdominal volume increase due to an undetermined cause
- urinary disorders - frequent, painful or followed by bleeding micturitions
- changes in urine - color, smell, clarity- inflammatory or infectious disease of unknown cause
- the existence of peripheral, painful or painless lymphadenopathy (ganglia) usually detected by palpation by the patient
- suspected illness of one of the following organs: pancreas, liver and gall bladder, kidney, spleen, uterus, ovary, bladder, prostate, abdominal lymph or abdominal vessels
- nausea, vomiting (possible liver damage, cholecystitis, pancreas)- feeling of chronic fatigue (possible liver pathology)- anxious syndrome (possible adrenal damage)
Abdominal ultrasound - The result of this leads us to various diagnoses:
The information obtained by the examining physician after the ultrasound, regarding the appearance of some changes in the size and structure of the examined organs, may lead to a diagnosis, for example:
– liver diseases (steatosis, cirrhosis, liver tumours, etc.)
- pancreatic (pancreatitis, pancreatic tumors, pancreatic cysts and pseudochists, etc.)
- biliary (gallstones, cholecystitis, tumors, etc.)
- kidneys (stones, tumors, inflammation, dilation of excretory pathways, etc.)
- urinary bladder (stones, tumors, diverticulosis, etc.)
- uterus and ovary (uterine fibroids, ovarian tumors, ovarian cysts, pregnancy, etc.
Sometimes when the data obtained from the abdominal ultrasound is not conclusive in order to establish a certain diagnosis, the patient is advised by the examining physician to perform additional investigations (CT, upper digestive endoscopy, colonoscopy, abdominal MRI). Besides the information obtained on the parenchymal organs (liver, pancreas, spleen, kidney, uterus and ovary, prostate) and the cavities (stomach, colon, bladder, gallbladder), the ultrasound can bring information about the presence of fluid in the abdominal cavity (ascites), in the pericardium (around the heart), in the pleura.
Evaluation of the diameter of some blood vessels and their alterations - aneurism- enlargement of the vessel calibre, stenosis-straining of the vasculature, etc.), which have significance in the diagnosis of present pathologies, ex. in the aorta, renal arteries, splenic artery etc.).
Due to the possibility of using the Doppler signal in ultrasound, it is possible to obtain useful information about possible thrombosis (obstruction of some vessels by the presence of thrombi (blood clots)) –i.e. portal vein thrombosis, inferior vena cava, renal vessels, etc.
How should the patient prepare before performing an abdominal ultrasound so that it is as conclusive as possible:
1. The ultrasound is indicated to be performed after a fast of at least 6 hours (if the ultrasound is performed postprandial (after eating), gall bladder information can not be obtained, since it is empty after food intake, in order to facilitate digestion).
2. The patient should consume about 1-1.5 l of liquids (still water, tea) with approx. an hour before the ultrasound, with the mention that water intake should be stopped about 30-40 minutes before the ultrasound, otherwise the ingested water will stagnate in the stomach and will make it difficult, sometimes impossible, to examine the pancreas.
3. The patient will NOT urinate before the ultrasound, in order for the bladder to be examined, it must be replenished (full), emptying it will it impossible to examine it; an empty bladder makes it difficult to examine the pelvic organs (uterus, ovary, prostate).
4. The day before the ultrasound is done, the patient is advised to avoid food that favours abdominal meteorism (bloating) – i.e., beans, peas, milk, and fruit, and preferably the last meal is served at 18-19.