Basic Abdominal

Sonographic Anatomy and

Protocol
prepared by:
Jenny Babe Barrera

abdominal regions; 4 quadrants

The
important
regions:

The 4
quadrants?

epigastric

umbilical
inguinal,
(or iliac)

flank
(side but
in back)

Prepared by Dr.Awad Elkhadir

Ultrasonography
Ultrasound

is a painless procedure
in which images of internal tissue
and organs are produced by the
use of sound waves.
Because it is non invasive,
children accept ultrasound easily
and may even enjoy watching the
oscilloscope screen during the
procedure.

Instrumentation
The

transducer that is used on the

body surface to pick up internal
images can be compared to a
television camera.
The upper abdomen is scanned with the
highest-resolution transducer possible for the
size of the patient. The transducer may be a
sector or curved linear array, or in many cases,
a combination of the two. The transducer
frequency depends on the size, muscle and fat
composition of the patient.

Most transducers today actually are multifocal with multiple frequencies available in
one transducer; therefore, the liver may be
scanned with the lower frequency, while the
pancreas and gallbladder may be scanned
with the higher frequency transducer.
The lower-frequency transducers are often
necessary in patients with fatty infiltration or
cirrhosis of the liver.

Prepared by Dr.Awad Elkhadir

The

primary controls the sonographer

needs to utilize in the general abdominal
scan are the depth, time-gain
compensation, overall gain, and zoom
control. The depth controls the size of
the overall image.
This should be set so the image fills the
screen without loosing information
along the posterior border. Most normal
adult abdomens range in size from 15 to
20 cm deep.

The

time-gain compensation controls

individual gain pods within the image. These
pods are aligned to the depth control (i.e. if
the depth is set at 20 cm and there are 10
pods, each pod would adjust the gain at 2 cm
increments).
The sound beam is absorbed, attenuated, and
reflected as it strikes a surface; by adjusting
the time-gain controls, the sonographer is
able to electronically amplify the echo in a
certain area so the sound will be stronger and
produce a brighter echo return.

The

overall gain controls the amount of

echoes received by the transducer.
It is analogous to the volume control on
the radio, the higher you turn up the
volume, the louder the sound.
Such is the response of the overall gain
control, as the sonographer increases the
gain, more echoes are seen throughout the
image. If the gain is set "too high" the
sonographer will have difficulty in
distinguishing the various gray scale
interfaces.

The

vascular structures should be anechoic or

echo-free and may be used as a control to
make sure the gain is not set too high. On the
other hand, if the gain is set too low, the
overall image will be dark and texture
patterns within the organs difficult to see.
In addition to the instrument controls, the
sonographer must find the best "window" on
the patient's abdomen. The window refers to
the area which the transducer may be angled
to record the majority of abdominal
landmarks without interferance from the ribs,
bowel, stomach, or lungs.

Unlike other imaging techniques, ultrasound

uses no radiation, so it is preferred method
for viewing a developing fetus during
pregnancy.

Sectional Anatomy

Ultrasound

of the abdomen is
generally performed in at least two
image planes,
you know it?

transverse and........?

longitudinal.

Transverse Plane
The transverse sectional images are presented in descending
Transverse
order
from the dome of the diaphragm to the umbilicus.
image at the
dome of the
liver shows the
middle hepatic
vein draining
into the inferior
vena cava. The
homogeneous
liver texture is
well seen.

The right hepatic vein drains into the inferior

vena cava; the liver parenchyma shows the
portal and hepatic vascular structures within.

Transverse image with the transducer angled inferior, using

the left lobe of the liver as an acoustic window to image the
pancreas and vascular structures.

Transverse image of the pancreas and

vascular structures.

Longitudinal Plane
The longitudinal sectional images are presented from the midline of
the abdomen to the right abdominal border. Images of the spleen
and left kidney are made with the patient in a left lateral decubitus
position.
longitudinal image
of the midline of
the abdomen
shows the aorta
with the celiac axis
and superior
mesenteric artery
arising from the
anterior wall.

longitudinal image slightly to the right of midline shows the

left lobe of the liver, ligamentum venosum, and caudate lobe
of the liver anterior to the inferior vena cava.

longitudinal scan of the left lobe of the liver, with the middle
hepatic vein draining into the inferior vena cava.

longitudinal scan over the right lobe of the liver. The diaphragm is
shown to the left(towards the patient's head) of the liver.

Indication
Allows

doctor to see problems with

organs, vessels, tissues, without
needing to make an inciaion.
According to the Radiological
Society of North America, your
doctor may order an ultrasound if
you are experiencing pain,
swelling, or other symptoms that
require an internal view of your
organs (RSNA, 2012).

 An

ultrasound can provide a view of the:

bladder
brain (in infants)
eyes
gallbladder
kidneys
liver
ovaries
pancreas
spleen
thyroid
testicles
uterus
blood vessels

An

ultrasound is also a
helpful way to guide
surgeons movements during
certain medical procedures,
such as biopsies.

Preparation of Client
The

ultrasound examination is most

effective if the patient has been NPO for
at least 6 hours.

>This allows the biliary system to be

distended and easily imaged by the
sonographer.

When

a patient is fasting there is a a

decreased opportunity for gas to
accumulate within the colon; gas
prohibits the passage of the sound and
thus limits visualization of abdominal
structures.

If

the patient is able to consume liquids and

the pancreas is not well-visualized, the
administration of water may be given to fill
the stomach and duodenum to better
delineate the pancreas.
The kidneys are best imaged when the
patient is fully hydrated, therefore no
patient preparation is necessary when only
the kidneys are examined. Full hydration
will also enable the sonographer to image
the distended urinary bladder.

The

position of the patient for the general

abdominal scan is usually supine for the
initial images. The patient is then rolled into
various degrees of obliquity to better
demonstrate the biliary system, pancreas,
liver, kidneys, or spleen.
If the scanning plane is oblique, the
sonographer should indicate the change of
position on the documented image without
specifying the exact degree of obliquity. The
same would apply if the patient were in a
lateral, upright, or prone position.

Steps of
Procedure

Before

the exam, you will change into

a hospital gown. You will most likely be
lying down on a table with a section of
your body exposed for the test.
An ultrasound technician, called a
sonographer, will apply a special
lubricating jelly to your skin. This
prevents friction so he or she can rub
the ultrasound transducersimilar in
appearance to a microphoneon your
skin. The jelly also helps transmit the
sound waves.

The

transducer sends highfrequency sound waves through

your body. The waves echo as they
hit a dense object, such as an organ
or bone. Those echoes are then
reflected back into a computer. The
sound waves are at too high of a
pitch for the human ear to hear.
Depending on the area being
examined, you may need to change
positions so the technician can have
better access.

After

the procedure, the gel will

be cleaned off your abdomen.
The whole procedure typically
lasts less than 30 minutes.
Following it, you will be free to go
about your day and normal
activities.

After an Ultrasound
Following the exam, your doctor will
review the images and check for any
abnormalities. He or she will call you
to discuss the findings, or to
schedule a follow-up appointment.
Should anything abnormal turn up
on the ultrasound, you may need to
undergo other diagnostic techniques,
such as a CT scan, MRI, or a biopsy
sample of tissue.

If

your doctor is able to make a

diagnosis of your condition based on
your ultrasound, he or she may begin
your treatment immediately.

Nursing Responsibilities
Ensure that patients are afforded the
highest quality care possible during their
ultrasound procedure.
This entails identifying the patient
properly, ensuring confidentiality of
information and patient privacy.
Maintain clean sanitary equipment and
examination rooms.

Be

certain that parents understand

that ultrasound is not an x-ray and
appears to have no long-term
effects, so it can be repeated over
and over for serial determinations.
Alert child that a clear gel will be
applied to the skin over the body
part to be studied to aid sound
conduction. The gel can feel cold
and sticky.

Thank
you!!!
^_^
Prepared by Dr.Awad Elkhadir

40

Quiz:
1.

Used on the body surface to pick up internal organs that can

be compared to a television camera?

2.

Is a painless procedure in which images of internal tissue and

organs are produced by the use of sound waves?

3.

What is use to produce images of internal tissue and organs

in ultrasound?

4.

What controls the size of overall image?

5.

Most normal adult abdomen range in size from ______ to _____

in depth?

6-8: Preparation in client

9-10: Two image planes which ultrasound of abdomen generally
performed?
11-12: Indication of ultrasound
13-15: Nursing Responsibilities

Prepared by Dr.Awad Elkhadir

41