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Introduction ⬇

An abdominal ultrasound is a noninvasive imaging procedure that visualizes all organs of the upper abdomen, including the liver, GB, bile ducts, pancreas, kidneys, spleen, and large abdominal blood vessels. Some practitioners may prefer organ-specific studies, such as a kidney or hepatobiliary ultrasound, with or without an abdominal ultrasound. This study is valuable in detecting a variety of pathologies, including fluid collections, masses, infections, and obstructions.

Procedure ⬆ ⬇

  1. Ask the patient to lie still on the examination table. Scans are generally performed with the patient in the supine and decubitus positions.

  2. Cover the skin with a layer of couplant (ultrasound gel).

  3. Explain to the patient that they will be asked to regulate breathing patterns as instructed during the examination.

  4. Tell the patient that total examination time is about 30–60 minutes.

  5. See Chapter 1 guidelines for intratest care.

Procedural Alert

  1. Scans cannot be done over open wounds or through dressings.

  2. This examination must be performed before x-ray studies involving barium. If such scheduling is not possible, at least 24 hours must elapse between the barium procedure and the sonogram.

Clinical Implications ⬆ ⬇

  1. Liver abnormalities reveal:

    1. Cysts, abscesses, tumors, and metastases

    2. Parenchymal disease (e.g., cirrhosis)

    3. Variations in portal venous flow

    4. Hepatic arterial and venous flow patterns

  2. GB and bile duct abnormalities reveal:

    1. Duct dilation or obstruction

    2. Gallstones

    3. Cholecystitis

    4. Tumors

  3. Pancreas abnormalities reveal:

    1. Pancreatitis

    2. Pseudocyst

    3. Cysts and tumors, including adenocarcinoma

  4. Kidney abnormalities reveal:

    1. Hydronephrosis

    2. Cysts, tumors, abscesses

    3. Abnormal size, number, location of kidneys

    4. Calculi

    5. Perirenal fluid collections

    6. Patency and flow through renal artery; patency of renal vein

  5. Adrenal abnormalities reveal:

    1. Pheochromocytoma

    2. Adrenal hemorrhage

    3. Metastases

  6. Spleen abnormalities reveal:

    1. Splenomegaly

    2. Evidence of lymphatic disease, lymph node enlargement

    3. Evidence of trauma

  7. Vascular abnormalities in the upper abdomen reveal:

    1. Aneurysm

    2. Thrombi

    3. Abnormal blood flow patterns

  8. Miscellaneous pathologies include:

    1. Ascites

    2. Mesenteric or omental cysts or tumors

    3. Congenital absence or malplacement of organs

    4. Retroperitoneal tumors

    5. Hematomas

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain test purpose, benefits, and procedure.

  2. Instruct the patient to remain NPO for a minimum of 8 hours before the examination to fully dilate the GB and to improve anatomic visualization of all structures. Some facilities prefer that the last meal before the study contain low quantities of fat.

  3. Assure the patient that there is no pain involved. However, the patient may feel uncomfortable lying still for a long period.

  4. Explain that a liberal coating of coupling agent must be applied to the skin so that there is no air between the skin and the transducer and to allow for easy movement of the transducer over the skin. A sensation of warmth or wetness may be felt. The couplant (ultrasound gel) does not stain or discolor clothing, but the patient may prefer to don a gown.

  5. Explain that they will be instructed to control breathing patterns while the images are being made.

  6. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Have the patient resume a normal diet and fluids.

  2. Review test results; report and record findings. Modify the nursing care plan as needed.

  3. Counsel the patient appropriately.

  4. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Clinical Alert

The results of ultrasounds alone cannot differentiate malignant from benign conditions

Interfering Factors ⬆ ⬇

  1. Intestinal gas overlying the area of interest interferes with ultrasound visualization.

  2. Barium from recent radiology studies compromises the study.

  3. Obesity adversely affects tissue visualization.

Reference Values ⬆

Normal