Role of ultrasonography in acute abdominal conditions

 

 

Abstract               Many patients come to hospitals with acute abdominal conditions. These abdominal emergencies can actually range from simple gastritis to life threatening causes like intestinal obstruction and perforation of a hollow abdominal organ. Hence in such conditions the investigation and diagnosis should be accurate. This study puts a real effort to find the role of Ultrasonography in patients with acute abdominal conditions.

Key Words: USG, Abdomen, Acute, Role.

 

 

INTRODUCTION

Acute abdomen is a condition in which there is a sudden onset of abdominal pain and the patient reveals the signs and symptoms that has something to do with the viscera of the abdomen. It is a medical emergency because such patients in majority of cases are frightened and apprehensive. But as a physician we should understand the fact that only about 20 to 30 percent of such cases that present to us actually need a surgical intervention immediately. So the best alternative is to have a radiological opinion. Although Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) are options, the common man rarely has that kind of financial freedom to undergo these investigations. So the best alternative investigation is Ultrasonography (USG) which is cost effective. These emergencies can actually range from simple gastritis to life threatening causes like intestinal obstruction, perforation and rupture of a hollow abdominal organ like the stomach^1,2. So the investigation and diagnosis should be spot on. The region of the abdomen involved should also give the information pertaining to what should be the mode of investigation. It’s popularly believed that for the right upper quadrant of the abdomen ultrasonography is the preferred choice and in the right and left lower quadrants CT is the preferred choice3. However it should also be understood that clinical diagnosis, laboratory investigations and the imaging diagnosis together will be more accurate in majority of the cases rather than believing and burdening on the imaging diagnosis alone4. CT and MRI can be accurate but USG is still the most sought after imaging technique because of its basic simple nature and also cost effectiveness particularly in a country like ours^4,5,6. This study puts a real effort to find the role of USG in patients presenting with acute abdominal conditions.

 

AIMS AND OBJECTIVES

To study the role of Ultrasonography in patients presenting with acute abdominal conditions.

 

MATERIALS AND METHODS

This study was done in the Department of Radiodiagnosis at The Oxford Medical College, Hospital and Research Centre, Bangalore.

The study period was from November 2017 to October 2019.

Five hundred and forty patients who presented with acute abdominal conditions from different clinical departments of our hospital were chosen for this study.

Ultrasonography was done for all the patients in our department using GE Machines (Logiq P3, Logiq P5 and Voluson P8). Low frequency curved array and high frequency linear array transducers were used for ultrasonography. The ultrasound diagnosis was made and then the patients were followed up to find out the exact diagnosis. The final tally was made to find the role of ultrasonography in finding out the exact diagnosis.

Inclusion Criteria:

Only patients presenting with acute abdominal conditions.

Exclusion criteria:

Patients on steroid therapy and immunosuppresive drugs.

Patients who have already been diagnosed and have come with relapse.

RESULTS

Table 1: Age Distribution

 

Table 2: Sex Distribution

 

Table 3: USG Diagnosis (Based upon region)

     Image 1: Appendicitis         Image 2: Cholelithiasis with Cholecystitis Image 3: Pelvic Inflammatory Disease  Image 4: Ectopic Pregnancy

As the interpretation is concerned USG is highly specific in diagnosing the disease in the right upper and epigastric quadrants. But it is not specific in other quadrants.

 

Table 4: Percentage and Significance

 

The sensitivity was 87.2%; The specificity was 37.1%; Positive predictive value was 96.8%; Negative predictive value was 11.7%

 

DISCUSSION

The most common causes of acute abdomen depends upon the age of the patient. Causes of abdominal pain according to age of the patient. ²

 

 

USG diagnosis is very useful as it is very cost effective. It can also be used for diagnoses of acute abdominal conditions in pregnant females as it does not have ionising radiation. In this study it was found to be useful. It had highly sensitivity as well. Although a bit low on the specificity, it becomes a very important tool for initial diagnosis. The most common conditions that have to be diagnosed depends upon the age of the patient and the specific quadrant of the abdomen involved. The most commonly involved quadrants are:

 

 

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