《腹部超声》PPT课件

1、AbdominalSonography,腹部超声,2,Alsoknownas-Abdominalultrasound(US)scanning-AbdominalUSimaging-Abdominalultrasonography-Abdominalultrasound,3,Aboutthecourse,4,WhatisAbdominalSonography?WhatisanAbdominalSonogram?Whataresomecommonusesoftheprocedure?Howwouldpatientsprepare?Howdoestheprocedurework?Whatdoesth

2、eequipmentlooklike?Whointerpretstheresults?Whatarethebenefitsvs.risks?WhatarethelimitationsofAbdominalUSG?,UltrasonographyInfo,5,WhatisAbdominalSonography?,Abdominalsonographyisamethodofobtainingimagesofinternalorgansbysendinghigh-frequencysoundwavesintothebody.Thereflectedsoundwavesarereturnedasech

3、oes.Theechoesarethenrecordedanddisplayedasareal-timevisualimage.Sinceultrasoundimagesarecapturedinreal-timetheyhavetheabilitytoshowmovementofinternaltissues,liverfunction,andbloodflow.,6,Ultrasonographyisanoninvasivemedicaltestthathelpsphysiciansdiagnoseandtreatmedicalconditions.Anabdominalultrasono

4、graphyproducesapictureoftheorgansandotherstructuresintheupperabdomen.,WhatisAbdominalSonography?,7,ADopplerultrasoundstudymaybepartofanabdominalultrasoundexamination.Dopplerultrasoundisaspecialultrasoundtechniquethatevaluatesbloodasitflowsthroughabloodvessel,includingthebodysmajorarteriesandveinsint

5、heabdomen,arms,legsandneck.,WhatisAbdominalSonography?,8,WhatisanAbdominalSonogram?,Anabdominalsonogramcanhelptodiagnoseavarietyofconditionsandtoassessdamagecausedbyillness.Liver,gallbladder,spleen,pancreas,andkidneyswillbeevaluatedduringanabdominalsonogram.Variousreasonsare:abdominalpain,abnormalla

6、bresults,andenlargedabdominalorgans.,9,WhatisanAbdominalSonogram?,Anabdominalsonographerwillberequiredtoimagesmallbodypartsaswell.Thesepartsinclude:thyroidgland,testicles,breast,andvarioussofttissueofbodyparts.Doctorscanalsouseabdominalsonographytoguidethemastheyperformneedlebiopsiesonabdominalorgan

7、s.,10,Whataresomecommonusesoftheprocedure?,-Kidneys-Liver-Gallbladder-Pancreas-Spleen-Abdominalaortaandotherbloodvessels,Abdominalultrasoundimagingisperformedtoevaluatethe:,11,Whataresomecommonusesoftheprocedure?,AbdominalpainsAbnormalliverfunctionEnlargedabdominalorganAbnormalitiesintheabdomen:gall

8、stones,livercirrhosis,cyst,tumor,etc.Ananeurysmintheaorta,12,Whataresomecommonusesoftheprocedure?,Dopplerultrasoundimagescanhelpthephysiciantoseeandevaluate:,Blockagestobloodflow(bloodclots/atheroscleroticplaque)Narrowingofvessels(whichmaybecausedbyplaque)Tumorsandcongenitalmalformation,血凝块/动脉粥样硬化斑块

9、,13,Whataresomecommonusesoftheprocedure?,Guideinvasiveproceduressuchasneedlebiopsyandwithdrawaloffluid,14,Howwouldpatientsprepare?,（）wearcomfortable,loose-fittingclothing（）bariumenemaorupperGI(gastrointestinal)tests,钡餐灌肠上消化道检查,15,Forastudyoftheliver,gallbladder,spleen,andpancreas,patientmaybeaskedto

10、eatafat-freemealontheeveningbeforethetestandthentoavoideatingfor8to12hoursbeforethetest.Forultrasoundofthekidneys,maybeaskedtodrink4to6glassesofwateraboutanhourbeforethetesttofillyourbladder.maybeaskedtoavoideatingforeightto12hoursbeforethetesttoavoidgasbuildupintheintestines.Forultrasoundoftheaorta

11、,youmayneedtoavoideatingforeightto12hoursbeforethetest.,Howwouldpatientsprepare?,16,Incaseofanemergency,examscanbedonewithoutspecialpreparations.Tellthesonographer,sonologist,orphysicianconductingtheexaminationaboutpain,bleeding,oranyothersymptoms.Tellingtheexamineraboutpastultrasoundsandsurgeriesis

12、helpful,andsometimesprovidescrucialinformation.（重要信息）,Howwouldpatientsprepare?,17,Howdoestheprocedurework?,Youwillbepositionedonanexaminationtableandmadetoliedownonyourbackandlayyourhandsaboveyourhead.Itmaybecomenecessarytochangepositionsduringtheexam,andliedownonyoursideorsitup.Alubricatinggel（甘油凝胶

13、/耦合剂）isappliedtothepatientsabdominalarea.,18,Howdoestheprocedurework?,Anapparatusknownasatransducerisplacedontheabdominalareaandmovedaroundtogetrealtimeimages.Sometimesyouwillhavetobreatheinandholdyourbreathaccordingtothetechnologist,sonologist,orphysiciansinstructions.Examinationsusuallytake10-30mi

14、nutes.,19,Smallstructure-higher-frequencylineararrayAbdomen-curved/linear/arrayEchocardiography-sectorObstetricthereforeultrasoundisnotanidealimagingtechniqueforthebowelororgansobscuredbythebowel.Inmostcases,bariumexams,CTscanning,andMRIarethemethodsofchoiceinthissetting.,24,WhatarethelimitationsofA

15、bdominalUSG?,Ultrasoundwavesdonotpassthroughair;thereforeanevaluationofthestomach,smallintestineandlargeintestinemaybelimited.Intestinalgasmayalsopreventvisualizationofdeeperstructuressuchasthepancreasandaorta.Largepatientsaremoredifficulttoimagebecausetissueattenuates(weakens)thesoundwavesastheypas

16、sdeeperintothebody,25,Gallstonesandcholecystitis胆结石，胆管炎Hepatitis/livercirrhosis肝炎/肝硬化Kidney/Bladderstones肾/胆囊结石Hydronephrosis肾积水Tumors肿瘤Cancersoftheliver,kidneys,pancreas,gallbladder,biliarytree癌Lymphoma淋巴瘤Metastasis转移灶Cysts囊肿Infections感染,CommonconditionsrevealedbyAbdominalsonography,26,Abscesses脓肿A

17、ppendicitis阑尾炎Enlargedliver,spleen,kidneys,lymphnodes增大Pancreatitis胰腺炎Congenitalmalformation先天畸形Injury-hematoma,tear,rupture创伤（血肿、撕裂、破裂）Hemorrhageoftheadrenalgland肾上腺出血Abdominalaorticaneurysm腹主动脉瘤Ascites腹水Peritonitis腹膜炎Bowelobstruction肠梗阻Hernia疝气,FOUNDATIONS,28,SonographicTerminology,Descriptiveterm

18、inologyHyperechoic-Hypoechoic(高回声低回声)Isoechoic（等回声）Anechoicorsonolucent（无回声）Enhancement（回声增强）Heterogeneous-Homogeneous（非均质/均质）Shadowing（声影）,29,Hyperechoic,shadowing,Hypoechoic,Hyperechoic,Hypoechoic,shadowing,30,Heterogeneous,Homogenous,AnechoicSonolucent,Enhancement,Isoechoic,31,SonographicEvaluati

19、on,ThesizeTheechoandattenuationoftheorganParenchyma实质Thetexture质地Thepresenceofvascularstructures,ligaments,andfissures裂隙Abnormality异常andmass占位,32,Thenormalorabnormalimagesofabdominalorgans,33,TheLiver,Ultrasoundisoftenthefirstlineofinvestigationforsuspectedliverpathologyandthedecisiontoproceedtoseco

20、ndaryinvestigativeprocedures,suchasfurtherradiologyorhistology.Ultrasoundisusedinthediagnosis,stagingandmonitoringofliverdisordersandalsocontributestotheirtreatmentwithultrasound-guidedinvasiveprocedures.Developingtechnologyandtechniquesnowresultinimproveddiagnosticaccuracyandareincreasinglyobviatin

21、gtheneedforfurtherradiology.Intraoperativeandlaparoscopicultrasound,usinghigh-frequency,direct-contacttechniques,setthestandardforliverimaginginmanycases.,34,35,Thesimplecysthasthreeacousticpropertiesanechoichasawell-definedsmoothcapsuleexhibitsposteriorenhancement(increasedthroughtransmissionofsoun

22、d),肝囊肿hepaticcyst,36,肝血管瘤Hepatichemangioma,SmallsolitaryormultiplenodularlesionRoundedwell-definedHyperechoicmassUsuallynotvisualizecolourflow,37,术语Terms,Thistermdescribestheeffectofafocalmass,whetherbenignormalignant,onsurroundingstructuresandisausefuldiagnostictool.Itimpliesthelesionsdisplacingori

23、nvasivenature,i.e.thedisplacementofvesselsand/orinvasionordistortionofadjacentstructuresandtissuesasaresultoftheincreasingbulkofalesion.Thiseffectdifferentiatesatruemassfromaninfiltrativeprocess,占位效应Masseffect,38,39,Benignhepatictumorshemangioma,hepatocellularadenoma,hepaticcystadenoma,FNH(focalnodu

24、larhyperplasia)etc.Malignanttumorshepatocarcinoma,hepatocholangiocarcinoma,metastases,lymphomaetc,Hepatictumors,40,TypesmassivetypenodulartypediffuselyinfiltratingtypeVascularinvasion,Pathology,PrimaryCarcinoma,Hepatictumors,41,EchoicpatternSonographictypesInvasionColorDopplerFlowImage,USGFeature,He

25、patictumors,42,hyperechoic,hypoechoic,hypoechoic,isoechoic,43,44,45,VIDifferentialDiagnoses,CystHemangiomaMetastases,PrimaryCarcinoma,46,47,hemangioma,Simplehepaticcyst,48,49,hyperechoic,hypoechoic,hypoechoic,isoechoic,Hepaticcarcinoma,50,Metastatictumor,51,USG-GuidedLiverBiopsy,Liverbiopsyisadiagno

26、sticprocedureusedtoobtainasmallamountoflivertissue,whichcanbeexaminedunderamicroscopetohelpidentifythecauseorstageofliverdisease.,52,Thegallbladder,Ultrasoundisanessentialfirst-lineinvestigationinsuspectedgallbladderandbiliaryductdiseaseItishighlysensitive,accurateandcomparativelycheapGallbladderpathologyiscommonandisasymptomaticinover13%ofthepopulation,53,Therearethreecl