Acute Abdomen

ACLS/AILS/NRP provider
ETTC/APLS instructor



Winfocus WBE/ULS instructor

Acute Abdomen

Real-time ()
2.5-3.5 MHZ Probe
Laser printer, VHS
Measurement capability
Portability ()

V scan

Echogenicity

Fluids
Panrechyma
Fats
Air
Calcifications

Acoustic shadow

Comet tail artifact

FAST for trauma

Pediatric Acute Abdomen

AIM - IH
A : Acute appendicitis
I : Intussusception
M : Malrotation
I : Incarcerated hernia
H : Hollow organ perforation / Hypertrophic
pyloric stenosis

Acute Abdomen

I G Get HIV
I : Inflammatory disease e.g. acute
appendicitis/cholecystitis
G : Gynecologic emergency e.g. ectopic
pregnancy, ovarian torsion
H : Hollow organ perforation
I : Ileus (Mechanical)
V : Vascular emergency e.g. AAA, ischemic colitis

Epigastralgia

1.Heart

2.Gall bladder and biliary duct

3.Abdominal aorta

Heart

Acute cholecystitis
:
(> 4 cm in transverse
diameter)(> 3 mm)
stone cystic duct
Murphys sign

Parallel channel sign

Shotgun sign

Stones

Pneumobilia

Aorta

Pancreatitis and pseudocyst

RUQ area pain

Liver abscess

RLL pneumonia

Flank pain

AAA (>50 y/o)

Bladder
Acute renal failurepost renal
obstruction

Acute renal failure

post-renal obstructive causes

Hydronephrosis

RLQ area pain

Appendix

Psoas mucle

appendix

muscle

Landmark of Appendix

Iliac crest
Psoas muscle

Acute appendicitis

Non-compressible
Diameter > 6mm
Appendicolith
Periappendiceal fluid
Enlarged lympth node
Ultrasound and CT scan is not for
diagnosis !! Clinical judgment

Acute appendicitis

Acute appendicitis

Abscess formation

Mimickers Mesenteric adenitis

Mimickers Epiploic appendagitis

Mimickers Omentum infarction

Mimickers Rectus sheath hematoma

Mimickers Diverticulitis

Mimickers Terminal ilietis

Appendiceal mucocele

Appendix 1.5cm
CT scan

TumorMucocele

Psoas muscle abscess

Female Pelvic pain

GYN

1.
2.
3.
4.

Cul-de-Sac

Gynecologic acute abdomen

Location of appendix

Pelvic sagittal scan

Pelvic transverse scan

Intrauterine Pregnancy

Color Doppler: Ring of Fire

Ovarian torsion

Corpus luteum cyst rupture

Tubo-ovarian abscess

Whole abdominal cramping

pain with persistent vomiting

Intussusception

Malrotation/Volvulus

Incarcerated hernia

Hypertrophic pyloric stenosis

2~4

Antral nipple sign

Ileus

Mechanical ileus

ABCH
A : Adhesion
B : Bezoar
C : Cancer (tumor obstruction)
H : Hernia (incarcerated hernia/torsion/volvulus)

Keyboard sign

Gastric cancer
+Amylase/Lipase

Causes of A-loop syndrome

Bisection Approximation Method

Whole abd pain with

peritoneal sign

Pneumoperitoneum

Scissors Maneuver

J Clin Ultrasound 2004; 32:381-385

()

Curtain sign

Aurora / Circle / Corona sign: Gas

within wall of GI tract

Pneumatosis intestinalis

Portal vein gas

Thanks for your attention !!