腹部超聲課件

AbdominalSonography腹部超聲2Alsoknownas---Abdominalultrasound(US)scanning---AbdominalUSimaging---Abdominalultrasonography---Abdominalultrasound

3Aboutthecourse5WhatisAbdominalSonography?

Abdominalsonographyisamethodofobtainingimagesofinternalorgansbysendinghigh-frequencysoundwavesintothebody.

Thereflectedsoundwavesarereturnedasechoes.

Theechoesarethenrecordedanddisplayedasareal-timevisualimage.

Sinceultrasoundimagesarecapturedinreal-timetheyhavetheabilitytoshowmovementofinternaltissues,liverfunction,andbloodflow.6Ultrasonographyisanoninvasivemedicaltestthathelpsphysiciansdiagnoseandtreatmedicalconditions.Anabdominalultrasonographyproducesapictureoftheorgansandotherstructuresintheupperabdomen.WhatisAbdominalSonography?

7ADopplerultrasoundstudymaybepartofanabdominalultrasoundexamination.Dopplerultrasoundisaspecialultrasoundtechniquethatevaluatesbloodasitflowsthroughabloodvessel,includingthebody'smajorarteriesandveinsintheabdomen,arms,legsandneck.WhatisAbdominalSonography?

9WhatisanAbdominalSonogram?

Anabdominalsonographerwillberequiredtoimagesmallbodypartsaswell.

Thesepartsinclude:thyroidgland,testicles,breast,andvarioussofttissueofbodyparts.

Doctorscanalsouseabdominalsonographytoguidethemastheyperformneedlebiopsiesonabdominalorgans.

10Whataresomecommonusesoftheprocedure?

----Kidneys----Liver----Gallbladder----Pancreas----Spleen----AbdominalaortaandotherbloodvesselsAbdominalultrasoundimagingisperformedtoevaluatethe:11Whataresomecommonusesoftheprocedure?

AbdominalpainsAbnormalliverfunctionEnlargedabdominalorganAbnormalitiesintheabdomen

:gallstones,livercirrhosis,cyst,tumor,etc.Ananeurysmintheaorta

13Whataresomecommonusesoftheprocedure?

Guideinvasiveproceduressuchasneedlebiopsyandwithdrawaloffluid14Howwouldpatientsprepare?

－（√）wearcomfortable,loose-fittingclothing－（Х）bariumenemaorupperGI(gastrointestinal)tests鋇餐灌腸上消化道檢查15Forastudyoftheliver,gallbladder,spleen,andpancreas,patientmaybeaskedtoeatafat-freemealontheeveningbeforethetestandthentoavoideatingfor8to12hoursbeforethetest.Forultrasoundofthekidneys,maybeaskedtodrink4to6glassesofwateraboutanhourbeforethetesttofillyourbladder.maybeaskedtoavoideatingforeightto12hoursbeforethetesttoavoidgasbuildupintheintestines.Forultrasoundoftheaorta,youmayneedtoavoideatingforeightto12hoursbeforethetest.Howwouldpatientsprepare?

17Howdoestheprocedurework?

Youwillbepositionedonanexaminationtableandmadetoliedownonyourbackandlayyourhandsaboveyourhead.Itmaybecomenecessarytochangepositionsduringtheexam,andliedownonyoursideorsitup.Alubricatinggel（甘油凝膠/耦合劑）isappliedtothepatient'sabdominalarea.18Howdoestheprocedurework?

Anapparatusknownasatransducerisplacedontheabdominalareaandmovedaroundtogetrealtimeimages.Sometimesyouwillhavetobreatheinandholdyourbreathaccordingtothetechnologist,sonologist,orphysician'sinstructions.Examinationsusuallytake10-30minutes.

19Smallstructure---higher-frequencylineararrayAbdomen---curved/linear/arrayEchocardiography---sectorObstetric&gynecologic---curvedarrayInstrumentation21Whatarethebenefitsvs.risks?

Benefitsnoninvasive(noneedlesorinjections)andisusuallypainless.widelyavailable,videsreal-timeimaging,makingitagoodtoolforguidingminimallyinvasiveproceduressuchasinjections,needlebiopsiesandneedleaspirationoffluid22Whatarethebenefitsvs.risks?

RisksForstandarddiagnosticultrasoundtherearenoknownharmfuleffectsonhumans.Pregnantwomenandfetusescanbesafelyexamined.23WhatarethelimitationsofAbdominalUSG?

Ultrasoundwavesaredisruptedbyairorgas;thereforeultrasoundisnotanidealimagingtechniqueforthebowelororgansobscuredbythebowel.Inmostcases,bariumexams,CTscanning,andMRIarethemethodsofchoiceinthissetting.25Gallstonesandcholecystitis膽結(jié)石，膽管炎Hepatitis/livercirrhosis肝炎/肝硬化Kidney/Bladderstones腎/膽囊結(jié)石Hydronephrosis腎積水Tumors腫瘤Cancersoftheliver,kidneys,pancreas,gallbladder,biliarytree癌Lymphoma淋巴瘤Metastasis轉(zhuǎn)移灶Cysts囊腫Infections感染CommonconditionsrevealedbyAbdominalsonography26Abscesses膿腫Appendicitis闌尾炎Enlargedliver,spleen,kidneys,lymphnodes增大Pancreatitis胰腺炎Congenitalmalformation先天畸形Injury--hematoma,tear,rupture創(chuàng)傷（血腫、撕裂、破裂）Hemorrhageoftheadrenalgland腎上腺出血Abdominalaorticaneurysm腹主動脈瘤Ascites腹水Peritonitis腹膜炎Bowelobstruction腸梗阻Hernia疝氣29HyperechoicshadowingHypoechoicHyperechoicHypoechoicshadowing30HeterogeneousHomogenousAnechoicSonolucentEnhancementIsoechoic31SonographicEvaluationThesizeTheechoandattenuationoftheorganParenchyma實質(zhì)Thetexture質(zhì)地Thepresenceofvascularstructures,ligaments,andfissures裂隙Abnormality異常andmass占位32Thenormalorabnormalimagesofabdominalorgans33TheLiverUltrasoundisoftenthefirstlineofinvestigationforsuspectedliverpathologyandthedecisiontoproceedtosecondaryinvestigativeprocedures,suchasfurtherradiologyorhistology.Ultrasoundisusedinthediagnosis,stagingandmonitoringofliverdisordersandalsocontributestotheirtreatmentwithultrasound-guidedinvasiveprocedures.Developingtechnologyandtechniquesnowresultinimproveddiagnosticaccuracyandareincreasinglyobviatingtheneedforfurtherradiology.Intraoperativeandlaparoscopicultrasound,usinghigh-frequency,direct-contacttechniques,setthestandardforliverimaginginmanycases.3435Thesimplecysthasthreeacousticproperties－－anechoic－－h(huán)asawell-definedsmoothcapsule－－exhibitsposteriorenhancement

(increasedthroughtransmissionofsound)肝囊腫hepaticcyst36肝血管瘤HepatichemangiomaSmallsolitaryormultiplenodularlesionRoundedwell-definedHyperechoicmassUsuallynotvisualizecolourflow37術(shù)語TermsThistermdescribestheeffectofafocalmass,whetherbenignormalignant,onsurroundingstructuresandisausefuldiagnostictool.Itimpliesthelesion’sdisplacingorinvasivenature,i.e.thedisplacementofvesselsand/orinvasionordistortionofadjacentstructuresandtissuesasaresultoftheincreasingbulkofalesion.Thiseffectdifferentiatesatruemassfromaninfiltrativeprocess占位效應(yīng)Masseffect3839Benignhepatictumors

hemangioma,hepatocellularadenoma,hepaticcystadenoma,FNH(focalnodularhyperplasia)etc.Malignanttumors

hepatocarcinoma,hepatocholangiocarcinoma,

metastases,lymphomaetcHepatictumors40TypesmassivetypenodulartypediffuselyinfiltratingtypeVascularinvasionPathologyPrimaryCarcinomaHepatictumors41EchoicpatternSonographictypesInvasionColorDopplerFlowImageUSGFeatureHepatictumors42hyperechoichypoechoichypoechoicisoechoic434445VI

DifferentialDiagnosesCystHemangiomaMetastasesPrimaryCarcinoma46ClinicalFindingsUSGFindingsHemangiomaN/ASolitaryormultipleRoundorovalWell-definedborderHyperechoic（mostparts）ColorflowPrimaryCa80%HCC70%HCCAFP?AbnormalLFTsSolitaryormultipleInfiltrative,diffuseHypoechoic,isoechoic,hyperechoicPortalveins/hepaticveinsinvadedthrombusMetastases轉(zhuǎn)移性肝癌AbnormalLFTsSolitaryormultipleWell-,ill-definedHypoechoicorhyperechoicDiffusedistortionofbull’seyepattern47hemangiomaSimplehepaticcyst4849hyperechoichypoechoichypoechoicisoechoicHepaticcarcinoma50Metastatictumor51

USG-GuidedLiverBiopsy

Liverbiopsyisadiagnosticprocedureusedtoobtainasmallamountoflivertissue,whichcanbeexaminedunderamicroscopetohelpidentifythecauseorstageofliverdisease.

52ThegallbladderUltrasoundisanessentialfirst-lineinvestigationinsuspectedgallbladderandbiliaryductdiseaseItishighlysensitive,accurateandcomparativelycheapGallbladderpathologyiscommonandisasymptomaticinover13%ofthepopulation53Therearethreeclassicacousticpropertiesassociatedwithstonesinthega