9%20ECOGRAFIA%20ABDOMINAL%20COMO%20CUANDO%20DONDE

Recommendations

Info

Chapter 11 253 Interventional and other techniques CHAPTER CONTENTS Ultrasound-guided biopsy: general considerations 253 Analgesia 254 Methods of ultrasound guidance 255 Ultrasound-guided biopsy procedures 257 Complications of ultrasound-guided biopsy 261 Ultrasound-guided drainage 261 Intraoperative ultrasound 264 Laparoscopic ultrasound 265 Ultrasound contrast agents in the abdomen 266 The treatment of primary and secondary hepatic tumours by percutaneous methods 268 Endoscopic ultrasound 269 The development of ultrasound-guided minimally invasive procedures, incorporating diagnostic biopsy, therapeutic drainage and treatment techniques, has developed significantly over the last decade and is now accepted practice, in many circumstances being used in isolation as a definitive treatment, and in others in conjunction with other radiological or surgical options. These minimally invasive methods are advantageous, with lower patient mortality and morbidity, increased patient acceptability, and are economically beneficial. The relative speed and ease with which these procedures can be carried out have resulted in a reduction of the diagnostic laparotomy and more prompt and appropriate patient treatment. Whilst both ultrasound and CT may be used for many of these procedures, in general, ultrasound is often the first-line method as it is effective in the vast majority, generally more accessible, and does not carry a radiation risk. Clearly, the choice of technique will depend upon the experience of the individual, machine availability and the site and depth of the lesion. ULTRASOUND-GUIDED BIOPSY: GENERAL CONSIDERATIONS Percutaneous biopsy of organs, masses or focal visceral lesions is an integral part of the diagnostic process for a large number of patients. Although changes on ultrasound may confirm the suspected clinical suspicion, that is, a bright liver may indicate fatty change, a nodular liver may suggest cirrhosis or enlarged kidneys of increased echogenicity may
254 ABDOMINAL ULTRASOUND suggest glomerulonephritis, imaging alone is not enough and a definitive histological diagnosis is required. The advantages of using ultrasound to guide such procedures are numerous: ● ● ● ● ● ● ● ● The needle tip is directed, in real time, along the biopsy path and visualized within the lesion. Greater precision is obtained; needle guidance is essential for all small lesions and lesions at depth. Fewer needle passes are required to obtain the desired result. The best route can be utilized and vital structures, such as blood vessels, avoided. Postprocedure complications, such as haematoma, are minimized. Confidence in the biopsy result, particularly a negative one, is increased due to direct visualization of the needle tip in the lesion. All the advantages of ultrasound over other imaging methods apply (quick, direct vision, no radiation hazard, low cost). The limitations due to bone and air-filled structures also apply. The capability to perform bedside procedures for critically ill patients and to use in conjunction with other imaging techniques, for example fluoroscopy, is advantageous. With ultrasound the biopsy procedure is quick, safe and accurate and is therefore acceptable to the patient. There are several accepted methods of performing a guided biopsy, but certain generic rules are common to the procedure, regardless of the organ under investigation: ● ● ● A written request form from a medical practitioner with the results of any previous investigations should be available. The reason for biopsy should be appropriate. Assessment of blood clotting status. Normally the prothrombin time should be within 3 s of the control, platelet count > 75 000/ml and international normalized ratio (INR) < 1.3. Identification of possible contraindications to biopsy, for example an uncooperative patient, coagulopathy. ● ● ● ● ● ● ● Careful explanation of the procedure to the patient, including risks and benefits. Informed, written consent for the procedure. Procedure should be performed in a quiet and clean environment. Appropriate measures should be taken to preserve pre-, peri- and postprocedure sterility. A prebiopsy scan to identify a suitable biopsy route avoiding vital structures. Satisfactory care of the patient both during and after the biopsy procedure with relevant observations of vital signs. A pulse oximeter and appropriate nurse cover are now recommended. Appropriate preparation of the specimen. Contraindications are relative and include the biopsy pathway, an uncooperative patient and uncorrectable coagulation and should be assessed on an individual basis. Analgesia For the vast majority of biopsy procedures local anaesthetic is administered following localization of the biopsy site on ultrasound. Either 1% or 2% lidocaine (lignocaine) is commonly used; the volume will depend upon patient build, depth of lesion and patient anxiety. Normally a short period of time, commonly 4–5 min, is allowed to pass so that the anaesthetic can work, after which a small scalpel incision is made in the skin to facilitate the biopsy needle’s introduction, with little or no discomfort to the patient. In cases of, for example, simple aspiration with a 22-gauge needle or smaller, local anaesthetic is normally unnecessary. Patients who are particularly apprehensive may require preprocedure medication with a sedative such as diazepam or similar anxiolytic agent; however this is not common. Very occasionally intravenous analgesia and/or sedation may be required during the procedure; it is often a good idea to have an intravenous cannula in situ prior to biopsy. The use of a general anaesthetic for children is common practice, to enable the procedure to be carried out quickly and accurately while the child remains still.
Page 2 and 3:
Abdominal Ultrasound
Page 4 and 5:
Abdominal Ultrasound How, Why and W
Page 6 and 7:
v Contents Contributors Preface ix
Page 8 and 9:
vii Contributors Rosemary Arthur FR
Page 10 and 11:
ix Preface Ultrasound continues to
Page 12 and 13:
ABBREVIATIONS xi MHA MHV MI MPV MRA
Page 14 and 15:
Chapter 1 1 Optimizing the diagnost
Page 16 and 17:
OPTIMIZING THE DIAGNOSTIC INFORMATI
Page 18 and 19:
Page 20 and 21:
Page 22 and 23:
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Chapter 2 17 The normal hepatobilia
Page 32 and 33:
THE NORMAL HEPATOBILIARY SYSTEM 19
Page 34 and 35:
Page 36 and 37:
Page 38 and 39:
Page 40 and 41:
Page 42 and 43:
Page 44 and 45:
Page 46 and 47:
Page 48 and 49:
Page 50 and 51:
Page 52 and 53:
Page 54 and 55:
Chapter 3 41 Pathology of the gallb
Page 56 and 57:
PATHOLOGY OF THE GALLBLADDER AND BI
Page 58 and 59:
Page 60 and 61:
Page 62 and 63:
Page 64 and 65:
Page 66 and 67:
Page 68 and 69:
Page 70 and 71:
Page 72 and 73:
Page 74 and 75:
Page 76 and 77:
Page 78 and 79:
Page 80 and 81:
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
Page 90 and 91:
Page 92 and 93:
Chapter 4 79 Pathology of the liver
Page 94 and 95:
PATHOLOGY OF THE LIVER AND PORTAL V
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 116 and 117:
Page 118 and 119:
Page 120 and 121:
Page 122 and 123:
Page 124 and 125:
Page 126 and 127:
Page 128 and 129:
Page 130 and 131:
Page 132 and 133:
Page 134 and 135:
Chapter 5 121 The pancreas CHAPTER
Page 136 and 137:
THE PANCREAS 123 the patient’s le
Page 138 and 139:
THE PANCREAS 125 Acute pancreatitis
Page 140 and 141:
THE PANCREAS 127 E F G Figure 5.3 c
Page 142 and 143:
A C DISTANCE = 3.43 CM 5%. 13 Over
Page 144 and 145:
THE PANCREAS 131 G H I Figure 5.5 c
Page 146 and 147:
THE PANCREAS 133 head of pancreas.
Page 148 and 149:
THE PANCREAS 135 pancreatic juice i
Page 150 and 151:
Chapter 6 137 The spleen and lympha
Page 152 and 153:
THE SPLEEN AND LYMPHATIC SYSTEM 139
Page 154 and 155:
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
Page 162 and 163:
Page 164 and 165:
Page 166 and 167:
Chapter 7 153 The renal tract CHAPT
Page 168 and 169:
THE RENAL TRACT 155 As with any oth
Page 170 and 171:
THE RENAL TRACT 157 A B q 0 LRA AO
Page 172 and 173:
THE RENAL TRACT 159 junctions of or
Page 174 and 175:
THE RENAL TRACT 161 A B Figure 7.5
Page 176 and 177:
THE RENAL TRACT 163 carcinomas, the
Page 178 and 179:
THE RENAL TRACT 165 the vesicourete
Page 180 and 181:
THE RENAL TRACT 167 Table 7.1 Sourc
Page 182 and 183:
THE RENAL TRACT 169 A B Figure 7.13
Page 184 and 185:
THE RENAL TRACT 171 Table 7.2 Diffe
Page 186 and 187:
THE RENAL TRACT 173 Ultrasound stil
Page 188 and 189:
THE RENAL TRACT 175 CT is useful fo
Page 190 and 191:
THE RENAL TRACT 177 Xanthogranuloma
Page 192 and 193:
THE RENAL TRACT 179 As with acute t
Page 194 and 195:
THE RENAL TRACT 181 der with increa
Page 196 and 197:
THE RENAL TRACT 183 ● ● Morphol
Page 198 and 199:
THE RENAL TRACT 185 ● ● hydrone
Page 200 and 201:
THE RENAL TRACT 187 A Figure 7.27 A
Page 202 and 203:
THE RENAL TRACT 189 vascular reject
Page 204 and 205:
THE RENAL TRACT 191 B A C Figure 7.
Page 206 and 207:
THE RENAL TRACT 193 computerised ul
Page 208 and 209:
Chapter 8 195 The retroperitoneum a
Page 210 and 211:
THE RETROPERITONEUM AND GASTROINTES
Page 212 and 213:
Page 214 and 215:
Page 216 and 217: THE RETROPERITONEUM AND GASTROINTES
Page 228 and 229: Chapter 9 215 The paediatric abdome
Page 230 and 231: THE PAEDIATRIC ABDOMEN 217 A B SPLE
Page 232 and 233: THE PAEDIATRIC ABDOMEN 219 B A B Fi
Page 234 and 235: THE PAEDIATRIC ABDOMEN 221 probe de
Page 236 and 237: THE PAEDIATRIC ABDOMEN 223 When the
Page 238 and 239: THE PAEDIATRIC ABDOMEN 225 + 78 A 2
Page 240 and 241: THE PAEDIATRIC ABDOMEN 227 A B C D
Page 242 and 243: THE PAEDIATRIC ABDOMEN 229 Table 9.
Page 244 and 245: THE PAEDIATRIC ABDOMEN 231 A LT B C
Page 250 and 251: THE PAEDIATRIC ABDOMEN 237 mesenter
Page 252 and 253: THE PAEDIATRIC ABDOMEN 239 E F G Fi
Page 254 and 255: THE PAEDIATRIC ABDOMEN 241 system i
Page 256 and 257: Chapter 10 The acute abdomen 243 CH
Page 258 and 259: THE ACUTE ABDOMEN 245 scan of the p
Page 260 and 261: THE ACUTE ABDOMEN 247 LIVER LS GB S
Page 262 and 263: THE ACUTE ABDOMEN 249 D A RT B C E
Page 264 and 265: THE ACUTE ABDOMEN 251 17. Patlas M,
Page 268 and 269: INTERVENTIONAL AND OTHER TECHNIQUES
Page 288 and 289: 275 Bibliography and further readin
Page 290 and 291: 277 Index A Abdomen, acute gastroin
Page 292 and 293: INDEX 279 Continuous ambulatory per
Page 294 and 295: INDEX 281 Intravenous urography (IV
Page 296 and 297: INDEX 283 Phrygian cap, 29 Pneumobi
show all

9%20ECOGRAFIA%20ABDOMINAL%20COMO%20CUANDO%20DONDE

Create successful ePaper yourself

Delete template?

Save as template?