GIT Sonography

GIT Sonography


Gas content within the bowel lumen makes the visibility difficult (Table 41.1).


High-frequency linear probe is used.


For identification


Stomach—Gastric rugae


Jejunum—Valvulae conniventes


Large bowel—Haustra


Normal gut is compressible by probe. Abnormally thickened gut is noncompressible.


Graded compression is used in acute appendicitis. Slow-graded compression moves the bowel loops out of the way without any discomfort to the patient.


ACUTE ABDOMEN


1.    Free intraperitoneal gas—Difficult to detect on USG


  Echogenic peritoneal stripe


  Air (ring down artifacts) b/w the abdominal wall and the liver


2.    Loculated fluid collection—Aperistaltic collection with varying echogenicity


Table 41.1 Illustrating five layers of gut wall (Gut signature)



















Mucosa (innermost)


Hyperechoic


Muscularis mucosa


Hypoechoic


Submucosa


Hyperechoic


Muscularis propria


Hypoechoic


Serosa/adventitia


Hyperechoic


3.    Mesenteric lymphadenopathy—Focal discrete hypoechoic masses of varying size. Loss of echogenic hilum


4.    Edematous bowel loops


5.    Wall thickening—Normal gut wall—3 millimeters if distended and 5 millimeters if collapsed


6.    Loss of normal gut signature


Usually benign lesions involve long segment with concentric thickening and wall layer preservation.


Malignant lesions involve short segment with eccentric disease and wall layer destruction.


ACUTE APPENDICITIS


Normal appendix is compressible with <3 millimeters wall thickness. Graded compression technique (Puylaert) is required.


Presentation—RLQ pain, high WBC count


USG findings


  Blind ended, noncompressible, and aperistaltic tube with diameter >6 millimeters arising from the base of cecum


  Inflamed perienteric fat


  Pericecal collections


  Appendicolith


  Hyperemia of wall


Appendiceal perforation may occur leading to loculated pericecal collection, loss of wall layers (Figure 41.1).


Image


Figure 41.1 Varying presentations of appendicular lesions—appendicitis, mucocele, and appendicular lump.


Mucocele of appendix—Large hypoechoic well-defined RLQ cystic lesion with variable internal echoes.

Nov 6, 2018 | Posted by in ULTRASONOGRAPHY | Comments Off on GIT Sonography
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