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SONOGRAPHIC FINDINGS IN PATIENTS WITH NON TRAUMATIC UPPER ABDOMINAL PAIN (CASE STUDY OF KET MEDICAL SERVICES AND LIFE CHART SCANNING CENTRE ENUGU, NIGERIA)

Dept: MEDICAL RADIOGRAPHY AND RADIOLOGICAL SCIENCE File: Word(doc) Chapters: 1-5 Views: 3

Abstract

This research was aimed at evaluating the usefulness of ultrasonography in the diagnosis and management of upper abdominal pain. A retrospective study was done atKet Medical Services and Lifechart Scanning Centre Abapka, Enugu. A total of 236 patients that were scanned for upper abdominal pain from March, 2011 to March, 2012 were studied.The sonographicreports showed that Fatty liver is the highest sonographic findings in patients with upper abdominal pain with a total number of 41 (17.37%),followed by hepatitis 36(15.25%),pyelonephritis 30(12.71%), hydronephrosis 19(8.05%), Splenomegaly 14(5.93%), 10(4.23%) each for cholecystitis and normal studies, 9 (3.81%) each for schistosomiasis and PUD, renal stone 8(3.38%), glomerulonephritis 7(2.96%), renal failure 4(1.69%), pancreatitis 3(1.27%), gall bladder sludge 2(0.88%), 1(0.42%) each for multiple hepatic cyst, haepatoma ,liver mass and poly cystic kidney. It was also found that 31-35years age group was mostly affected with upper abd

1.0     INTRODUCTION

1.1     BACKGROUND OF STUDY

          Abdominal ultrasound is a rapid and non-invasive method of examination of the abdomen. Abdominal ultrasound is an imaging procedure used to examine the internal organs of the abdomen including the liver, gallbladder, spleen pancreas and kidney.  The blood vessels that lead to some of these organs can also be looked at with ultrasound

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.Abdominal pain is the most frequent reasons for abdominal scan.  Ultrasound is one of the non- invasive modalities used for the investigation of patient with abdominal pain.  Upper abdominal pain is one of the commonest complaints in patients seeking medical advices

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.Upper abdominal ultrasound can reveal many possible conditions including abdominal aortic aneurysm, abscess, cholecystitis, gall stone, hydronephrosis, kidney stones, splenomegaly and pancreatitis

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.In preparation for ultrasound of the liver, gallbladder or digestive tract, the patient will be asked to fast overnight or for at least six hours prior to the test, which reduces bowel gas that can obscure the image and keeps the gallbladder filled with bile, making it easier to visualize its contents. In examination involving stomach and duodenum, the patient will be given water to drink immediately before the test because these organs are better visualized if there are filled with fluids

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.  Abdominal pain may not come from the abdomen; some surprising causes include heart attacks and pneumonias.The location of the pain within the abdomen can be an important clue in diagnosis during scanning

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.  Symptoms that occur with upper abdominal pain include back pain, chest pain, constipation, diarrhea, fever, nausea and vomiting

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.Upper abdominal pain can be acute or chronic.  Upper abdominal pain whether acute or chronic is caused by diseases of the liver, gallbladder kidneys pancreas, stomach, duodenum, spleen, pleura pericardium and basal lung segments

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. The characteristics of the pain, location and timing duration etc are Important in diagnosing its causes

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. All these conditions have useful sonographic features which help in their diagnosis except uncomplicated peptic ulcer disease acute myocardial infarction and pneumonitis

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.The frequency with which even relatively inexpensive and non-invasive diagnostic tests are performed clearly places a burden on healthcare.  Therefore, it is important that their influence on patient management is assessed.  Unnecessary diagnostic investigation may lead to incidental findings or to additional unnecessary diagnostic procedures or even over treatment

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1.2     STATEMENT OF PROBLEM

• An increase in the rate of patients presenting with upper abdominal pain for sonographic studies has made it imperative to take a critical look at the different diagnosis.

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• Many of the predisposition factors may also be related to age and gender.

 

1.3     PURPOSE OF STUDY

• To evaluate the common ultrasound findings in patients with upper abdominal pain.
• To correlate the sonographic findings in patients with upper abdominal pain with age and gender.

 

1.4     SIGNIFICANCE OF STUDY

• The study will help us to know the pertinent role that ultrasound plays in the diagnosis of upper abdominal pain.
• The documentation of this work may serve as a guide to sonographers during scanning for accurate diagnosis.

 

1.5     SCOPE OF THE STUDY

          It was carried out atKet medical services and Life chart Scanning Centre  Enugu, Nigeria.  It covered a period of one year (from March 2011– March 2012).

 

1.6     DEFINITION OF TERMS

1. Fatty liver: Accumulation of fat in the liver, an indication of liver disease or benign changes, demonstrated using grey scale ultrasound.
2. Hepatomegaly: Enlargement of the liver to such an extent that it is can felt below the rib margin. This may be due to congestion as in heart failure, inflammation or tumour.
3. Hepatitis: Inflammation of the liver caused by viruses, toxic substance or immunological abnormalities.
4. Schistomosmiasis: A tropical disease caused by blood flukes of the genus schistosoma
5. Haemangioma: A benign tumour of blood vessels, it often appears on the skin as types of birthmark.
6. Hydronephrosis:- Distension and dilation of the pelvis of the kidney. This is due to an obstruction to the free flow of urine from the kidney
7. Pyelonephritis: It is the bacteria infection of the kidney substance. In acute pyelonephritis the patient has pain in the loins, a high temperature and shivering fits. In chronic pyelonephritis the kidney becomes small and scarred and kidney failure ensures.
8. Glomerulonephritis: It is any of a group of kidney disease involving the glomeruli usually thought to kind disease involving the glomeruli, usually thought to be the results of antibody – antigen reactions that localize in the kidneys because of their filtering function.
9. Renal stone: It is the calculi in the kidney.
10. Renal failure: It can be described as acute or chronic acute renal failure occurs when previously healthy kidney suddenly fail because of a variety of problems affecting the kidney and its perfusion with blood. Chronic renal failure occurs when irreversible and progressive pathological destruction of the kidney leads to end-stage renal disease.
11. Cholelithiasis: This is the formation of stones in the gall bladder
12. Cholecystitis: It is the inflammation of the gall bladder. It may be acute or chronic.
13. Splenomegaly: This is the enlargement of the spleen. It is most commonly occurs in malaria, schistosomiasis and other disorders caused by parasites
14. Pancreatitis: It is the inflammation of the pancreas. It can be acute or chronics.

1.7     LITERATURE REVIEW

          According to Jeffery B and Ralls P

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Patients presenting with upper abdominal pain comprise the largest group of people reporting to medical and surgical out-patient department/OPDs

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.  Following the history and clinical examination, ultrasonography has become one of the first and most useful methods of investigation

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.  Upper abdominal pain whether acute or chronic, is caused by diseases of the liver gallbladder, kidneys, pancreas stomach duodenum, spleen, pleura, pericardium and basal lung segment

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.  Rare causes include aortic aneurysm and acute myocardial infarction

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.  All these conditions have useful sonographic features which help in their diagnosis except uncomplicated peptic ulcer disease, acute myocardial infarction and based pneumonitis

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A retrospective study done by Okike I. F

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, in the ultrasound unit of Radiation Medicine Department in University of Nigeria Teaching Hospital, Ituku-Ozalla in Enugu.  588 patients were scanned for abdominal pain in 2009. The sonographic report showed that 171 (29.08%) had kidney pathologies, 154(26-19) had liver disease, 73(12.41%) had normal scan, 72(12.24%) had obstetrics and gynecological problems, 49(8.33%) had gastrointestinal tract problems, 37(6.29%) had spleen pathologies, 5(0.85%) had pancreatic disease and 2(0.34%) had aortic and Para-aortic diseases. It was also found that 61-70years age group was mostly affected with abdominal pain and 81-90years age group was the least affected.  And generally the incidence of abdominal pain was greater in females than in males.A research done by Cyoyal M

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 showed that 82 cases for upper abdominal ultrasound were scanned.  It reveal that 18 have gallstone, 4 have fatty liver, 4 have dilated common duct, 2 have thick walled gallbladder, 2 have hepatic cyst and one patient each for the following has splenomegaly, focal liver abnormalities, renal cyst, partial nephrectomy, gallbladder poly and abnormal liver texture.The  research done by Mir Ali et al

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,   on upper abdominal ultrasound, ultrasound findings expressed as percentage of all patients were Fatty liver (90.58%), auto-splenoectomy (55.4%) markedly reduced splenic size (31.0%) reduced renal size (27.1%), cholelithiasis (25.7%) splenomagely (4.1%) and renal enlargement (2.78%).The prospective study by B.Wibulpolprasert and T .D Hiensiri

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  involved 251 patients ranged 2-77 years who were hospitalized with brucellosis during a 4-years period. Patient were classified as having acute (<3 months) sub acute (3-12) months, or chronic (> 12 months) disease.  Physical, laboratory and abdominal sonographic findings were analyzed.  The disease was acute in 92 cases (36.7%), subacute in 48(19.1%) and chronic in 111 (44.2%). Sonographic examination of the abdomen showed enlarged periportal lymph nodes in 23 patients (9.2%) splenomegaly in 21(8.4%), hepatomegaly in 15(6%), pleural effusion in 7(2.8%), splenic abscesses in 4(1.6%), splenic cysts in 2(0.8%), acute appendicitis in 2(0.8%) and acute calculus cholecystitis in 1 patient (0.4%).According to the work done by Bakhieta   I. A

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., his sonograms and records of 80 patients with melioidosis were retrospectively reviewed.  The number, size, sonographic appearances and distribution of abscesses in the abdominal visceral organs were analysed. There most common suspected diagnosis upon hospital admission was septicemia and pyrexia of unknown origin (39%). Abdominal visceral organ abscess was suspected in only 28% of patients. Fifty-seven patients (71%) had single organ involvement and 23 (29%) had multiple organ involvement. There were lessons in the spleen in 59 patients (74%), liver in 37(46%), and kidney in 10(12%) multiple abscesses were much more common than a solitary abscess in each organ and were demonstrated in 83%, 68% and 78% of patients with spleen, liver and kidney involvement respectively.In a work done by Thulkar O.S

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, abdominal sonographic imaging of patients with sickle cell anemia revealed a high prevalence of abnormalities in the liver, gallbladder and spleen but a low prevalence in the kidney.In a research done by Roman S.et al

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, sonographic findings in 40 patients with dengue hemorrhagie fever, including pleural effusion, ascites and gallbladder wall thickening, splenomegaly was not mentioned.  In our series, we found that splenomegaly was a frequently, sonographic finding.  Liver size was not measured in our study, therefore hepatomegaly was not considered.In work done by Speets A. M

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,abdominal ultrasound is a valuable investigation in patients with suspected of biliary pathology and in evaluating abdominal masses. Patients with localized pain and tenderness are more likely to have a positive findings on ultrasound examination than are those with defuse abdominal pain and tenderness pain ultrasound is less useful in patients who are less than 25 years of age especially when there symptoms and signs are non specific and the laboratory results are normal.Another study done by Raman S. I

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, showed that the mean age of the patient at the time of the abdominal ultrasound was 54 years and were 35% male.  10% of the patients had a prior diagnosis of choleliathiasis and 7% had a prior cholecystectomy. Almost 80% of the patients had complaints of abdominal pain. Abnormalities with physical examination were found in 44% of the patients. The most common suspected diagnosis was cholelithiasis (47%) and nephrolithiasis (13%).