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進階急診超音波於腸 胃道掃描之應用 彰化基督教醫院 急診醫學部 蔡揚名

EUS GI Tract

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CurvedLow frequency (2.53.5 MHZ Probe)

High frequency (7~12 MHz) soft tissue

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Acute Abdomen

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?? ??

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* * * * *

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Mowing-the-lawn technique

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Graded compression technique

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GI tract lesions on sonography1.(>4mm) 2. 3. 4. 5. 6.(LN, fat, ascites, etc.)

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Normal Stomach

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Hypertrophic pyloric stenosis

2~4 ,

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Antral nipple sign

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1.6 cm 0.3 cm 1.4 cm

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Gastric cancer +Amylase/Lipase

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Causes of A-loop syndrome

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Duodenum

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Duodenal ulcer

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SBO - Keyboard sign

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Bisection Approximation Method

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Incarcerated hernia

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Target sign in RUQ.

Crescent sign in LUQ.

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Intussusception 80% ~90% (ileo-colic). 3~2, 5 ~9 : Cramping abdominal pain, intermittent vomiting and irritability, strawberry jam stool

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Intussusception

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Intussusception

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US-guided Reduction

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Aurora / Circle / Corona sign: Gas within wall of GI tract

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Pneumatosis intestinalis

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Large Bowel

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35 ?

?

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Psoas mucle

Appendixappendix

muscle 48

Landmark of Appendix

Iliac crest

Psoas muscle49

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Acute appendicitis

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Acute appendicitis

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Acute appendicitis

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TVS

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Location of appendix

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Abscess formation

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Mimickers Mesenteric adenitis

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Mimickers Epiploic appendagitis

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Mimickers Omentum infarction

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Mimickers Rectus sheath hematoma

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Mimickers Diverticulitis

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Mimickers Terminal ilietis

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Appendiceal mucocele

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Appendix 1.5cm CT scan TumorMucocele

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Pneumoperitoneum

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Pneumoperitoneum

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Scissors Maneuver

J Clin Ultrasound 2004; 32:381-385

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() Curtain sign

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Special thanks to~~

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Practice makes perfect !!!91

http://vimeo.com/hqmeded/videos92

Thanks for your attention !!

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