By J. Bates
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Extra info for Abdominal Ultrasound - How, Why and When
8 LS just to the left of midline. 9 LS, left lobe of liver. 10 Transverse section (TS) through the liver, above the confluence of the hepatic veins. 11 TS at the confluence of the hepatic veins (HV). 12 TS at the porta hepatis. PV = portal vein. 13 TS through the right kidney. 14 TS at the epigastrium. CBD = common bile duct. 15 TS at the inferior edge of the left lobe. 16 LS through the right lobe, demonstrating a Reidel’s lobe extending below the right kidney. ) The segments of the liver It is often sufficient to talk about the ‘right’ or ‘left’ lobes of the liver for the purposes of many diagnoses.
Where possible, scan in at least two patient positions. It is surprising how the available ultrasound information can be enhanced by turning your patient oblique, decubitus or erect. Inaccessible organs flop into better view and bowel moves away from the area of interest. ● Use a combination of sub- and intercostal scanning for all upper-abdominal scanning. The different angles of insonation can reveal pathology and eliminate artefact. ● Don’t limit yourself to longitudinal and transverse sections.
Be suspicious of a diameter of 10 mm or more as this is associated with obstruction due to formation of stones in the duct. relative to the portal branches is highly variable. Don’t assume that a channel anterior to the PV branch is always a biliary duct—if in doubt, use colour Doppler to distinguish the bile duct from the portal vein or hepatic artery. The proximal bile duct is best seen either with the patient supine, using an intercostal approach from the right, or turning the patient oblique, right side raised.