- Abdominal pain. Whether acute or chronic, pain can signal a serious problem—from organ malfunction or injury to the presence of malignant growths. Ultrasound scanning can help doctors quickly sort through potential causes when presented with general or ambiguous symptoms. All of the major abdominal organs can be studied for signs of disease that appear as changes in size, shape and internal structure.
- Abdominal trauma. After a serious accident, such as a car crash or a fall, internal bleeding from injured abdominal organs is often the most serious threat to survival. Neither the injuries nor the bleeding are immediately apparent. Ultrasound is very useful as an initial scan when abdominal trauma is suspected, and it can be used to pinpoint the location, cause, and severity of hemorrhaging. In the case of puncture wounds, from a bullet for example, ultrasound can locate the foreign object and provide a preliminary survey of the damage. The easy portability and versatility of ultrasound technology has brought it into common emergency room use, and even into limited ambulance service.
- Abdominal mass. Abnormal growths—tumors, cysts, abscesses, scar tissue and accessory organs—can be located and tentatively identified with ultrasound. In particular, potentially malignant solid tumors can be distinguished from benign fluid-filled cysts and abscesses. Masses and malformations in any organ or part of the abdomen can be found.
- Liver disease. The types and underlying causes of liver disease are numerous, though jaundice tends to be a general symptom. Ultrasound can differentiate between many of the types and causes of liver malfunction, and is particularly good at identifying obstruction of the bile ducts and cirrhosis, which is characterized by abnormal fibrous growths and reduced blood flow.
- Pancreatic disease. Inflammation and malformation of the pancreas are readily identified by ultrasound, as are pancreatic stones (calculi), which can disrupt proper functioning.
- Gallstones. Gallstones cause more hospital admissions than any other digestive malady. These calculi can cause painful inflammation of the gallbladder and also obstruct the bile ducts that carry digestive enzymes from the gallbladder and liver to the intestines. Gallstones are readily identifiable with ultrasound.
- Spleen disease. The spleen is particularly prone to injury during abdominal trauma. It may also become painfully inflamed when beset with infection or cancer. These conditions also lend themselves well to ultrasonic inspection and diagnosis.
- Kidney disease. The kidneys are also prone to traumatic injury and are the organs most likely to form calculi, which can block the flow of urine and cause blood poisoning (uremia). A variety of diseases causing distinct changes in kidney morphology can also lead to complete kidney failure. Ultrasound imaging has proven extremely useful in diagnosing kidney disorders.
- Abdominal aortic aneurysm. This is a bulging weak spot in the abdominal aorta, which supplies blood directly from the heart to the entire lower body. These aneurysms are relatively common and increase in prevalence with age. A burst aortic aneurysm is imminently life-threatening. However, they can be readily identified and monitored with ultrasound before acute complications result.
- A-mode. This is the simplest type of ultrasound in which a single transducer scans a line through the body with the echoes plotted on screen as a function of depth. This method is used to measure distances within the body and the size of internal organs. Therapeutic ultrasound aimed at a specific tumor or calculus is also A-mode, to allow for pinpoint accurate focus of the destructive wave energy.
- B-mode. In B-mode ultrasound, a linear array of transducers simultaneously scans a plane through the body that can be viewed as a two-dimensional image on screen. Ultrasound probes containing more than 100 transducers in sequence form the basis for these most commonly used scanners, which cost about $50,000.
- M-Mode. The M stands for motion. A rapid sequence of B-mode scans whose images follow each other in sequence on screen enables doctors to see and measure range of motion, as the organ boundaries that produce reflections move relative to the probe. M-mode ultrasound has been put to particular use in studying heart motion.
- Doppler mode. Doppler ultrasonography includes the capability of accurately measuring velocities of moving material, such as blood in arteries and veins. The principle is the same as that used in radar guns that measure the speed of a car on the highway. Doppler capability is most often combined with B-mode scanning to produce images of blood vessels from which blood flow can be directly measured. This technique is used extensively to investigate valve defects, arteriosclerosis and hypertension, particularly in the heart, but also in the abdominal aorta and the portal vein of the liver. These machines cost about $250,000.
Area of applicationAbdomen from the xiphoid process to the umbilicus.
ContrastDone without contrast.
Abdominal US is valuable in determining aortic aneurysms, the internal components of organ masses (solid versus cystic), and for evaluating other abdominal diseases, ascites, and abdominal obstruction. Abdominal US can be performed on the same day as a radionuclide scan or other radiological procedure and is especially valuable in patients who have hypersensitivity to contrast medium or are pregnant. US is also widely used for pediatric patients to help diagnose appendicitis and for infants to assign cause for recurrent vomiting.
This procedure is contraindicated for
- Determine the patency and function of abdominal blood vessels, including the abdominal aorta; vena cava; and portal, splenic, renal, and superior and inferior mesenteric veins
- Detect and measure an abdominal aortic aneurysm
- Monitor abdominal aortic aneurysm expansion to prevent rupture
- Determine changes within small aortic aneurysms pre- and postsurgery
- Evaluate abdominal ascites
- Evaluate size, shape, and pathology of intra-abdominal organs
- Absence of ascites, aortic aneurysm, cysts, obstruction, or tumors
- Normal size, position, and shape of intra-abdominal organs and associated structures
Abnormal findings related to
- Abdominal abscess, ascitic fluid, or hematoma
- Aortic aneurysm greater than 4 cm
- Congenital absence or malplacement of organs
- Gallbladder or renal calculi
- Tumor, liver, spleen, or retroperitoneal space
- Aortic aneurysm measuring 5 cm or more in diameter.
It is essential that a critical finding be communicated immediately to the requesting health-care provider (HCP). A listing of these findings varies among facilities.
Timely notification of a critical finding for lab or diagnostic studies is a role expectation of the professional nurse. Notification processes will vary among facilities. Upon receipt of the critical value the information should be read back to the caller to verify accuracy. Most policies require immediate notification of the primary HCP, Hospitalist, or on-call HCP. Reported information includes the patient’s name, unique identifiers, critical value, name of the person giving the report, and name of the person receiving the report. Documentation of notification should be made in the medical record with the name of the HCP notified, time and date of notification, and any orders received. Any delay in a timely report of a critical finding may require completion of a notification form with review by Risk Management.
Factors that may impair clear imaging
- Attenuation of the sound waves by the ribs, which can impair clear imaging of the upper abdominal structures
- Incorrect placement of the transducer over the desired test site; quality of the US study is very dependent upon the skill of the ultrasonographer
- Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images
- Inability of the patient to cooperate or remain still during the procedure because of age, significant pain, or mental status
- Retained gas or barium from a previous radiological procedure
- Failure to follow dietary and fluid restrictions and other pretesting preparations may cause the procedure to be canceled or repeated.
Nursing Implications and Procedure
- Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
- Inform the patient this procedure can assist in assessing abdominal abnormalities.
- Obtain a history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or sensitivities to latex.
- Obtain a history of results of the patient’s cardiovascular, gastrointestinal, genitourinary, and hepatobiliary systems, symptoms, and results of previously performed laboratory tests, diagnostic and surgical procedures.
- Note any recent procedures that can interfere with test results (i.e., barium procedures, surgery, or biopsy). There should be 24 hours between administration of barium and this test.
- Endoscopic retrograde cholangiopancreatography, colonoscopy, and computed tomography of the abdomen, if ordered, should be scheduled after this procedure.
- Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
- Review the procedure with the patient. Address concerns about pain related to the procedure. Explain to the patient that there may be moments of discomfort experienced during the test. Inform the patient that the procedure is performed in a ultrasound department, by a health-care provider (HCP) specializing in this procedure, with support staff, and takes approximately 30 to 60 minutes.
- Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
- Instruct the patient to remove jewelry and other metallic objects in the area to be examined.
- Note that there are no food or fluid restrictions for US of the aorta. Restrictions for US studies of other abdominal organs may be imposed by medical direction.
- Potential complications: N/A
- Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
- Ensure that food and fluids have been restricted, if required, prior to the procedure.
- Ensure that the patient has removed external metallic objects prior to the procedure.
- Instruct the patient to void prior to the procedure and to change into the gown, robe, and foot coverings provided.
- Instruct the patient to cooperate fully and to follow directions. Instruct the patient to remain still throughout the procedure because movement produces unreliable results.
- Place the patient in the supine position on an examination table. The right- or left-side-up positions may be used to allow gravity to reposition the liver, gas, and fluid to facilitate better organ visualization.
- Expose the abdominal area and drape the patient.
- Conductive gel is applied to the skin, and a Doppler transducer is moved over the skin to obtain images of the area of interest.
- Ask the patient to breathe normally during the examination. If necessary for better organ visualization, ask the patient to inhale deeply and hold his or her breath.
- Inform the patient that a report of the results will be sent to the requesting HCP, who will discuss the results with the patient.
- When the study is completed, remove the gel from the skin.
- Instruct the patient to resume usual diet and fluids, as directed by the HCP.
- Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate.
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
- Depending on the results of this procedure, additional testing may be needed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
- Related tests include ACTH and challenge tests, albumin, ALKP, ALT, amylase, angiography abdomen, AST, biopsy intestinal, biopsy liver, bilirubin and fractions, BUN, calcium, calculus kidney stone panel, cancer antigens, carbon dioxide, CBC, CBC hematocrit, CBC hemoglobin, CBC WBC and differential, chloride, cortisol and challenge tests, creatinine, CT abdomen, GGT, HCG, hepatobiliary scan, infectious mononucleosis, IVP, KUB, LDH, lipase, magnesium, MRI abdomen, peritoneal fluid analysis, phosphorus, potassium, PT/INR, renogram, sodium, US kidney, US liver and biliary, US pancreas, US spleen, uric acid, urinalysis, and WBC scan.
- Refer to the Cardiovascular, Gastrointestinal, Genitourinary, and Hepatobiliary systems tables at the end of the book for related tests by body system.