5 Minute Sono Gastrointestinal - Click to learn more

CLINICAL INDICATION

Acute abdominal pain, peritonitis, abdominal distention/mass, persistent nausea/vomiting

PROBE SELECTION

Curvilinear

VIEWS AND MEASUREMENTS

  • Small Bowel Obstruction: evaluate each abdominal quadrant for mechanical obstruction, looking for dilated loops of small bowel, evaluating peristalsis and assessing for free fluid.

  • A “lawnmower technique” can be used to scan the entire abdomen in a sagittal and transverse plane, special attention should be made to the epigastrum (gastric outlet obstruction) and RLQ (ileocecal junction)

  • Normal Small Bowel is filled with air with unidirectional peristalsis, with no extraluminal free fluid, is compressible, < 2.5 cm in luminal diameter with a bowel wall thickness < 3 mm. Often normal bowel will only be visualized with the anterior bowel wall with echogenic band/artifact underneath from gas/air.

TIPS

  • Patient should be supine or semi-erect, elevate their arms to spread the ribs and apply gentle pressure during exhalation

  • Gentle compression can move gas aside

  • Haustra are farther apart and not circumferential, which differentiates large bowel from small bowel - small bowel contains plicae circularis which are closer together and circumferential

  • Rugae are visible when the stomach is decompressed, they unfold when the stomach is distended - plicae circularis remain folded regardless of distention

  • Ultrasound is more specific for COMPLETE SBO, difficult to distinguish partial SBO/ileus, but in general ileus will show reduced peristalsis but not “to-and-fro”

  • Hernia: obtain orthogonal images over the area of interest, graded compression can assess for reducibility and allow for serial exams, color flow to assess for strangulation.