Some of the instructors from the abdominal POCUS workshop (focussing on biliary & renal applications) at the SONIC Conference, share their top tips for the skills they taught.
AAA/eFAST
by: Dr Chris Tang
AAA
Use two hands to push gas away
Look for the vertebral body
Scan from the mid-axillary line if you can’t see the aorta
eFAST
eFAST doesn’t have to be FAST (take your time to look for fluid)
Don’t stay still, move the probe to scan the whole area
Repeat the scan if things change
Common Bile Duct
by: Dr Stephen Risson
Scan patient during inspiration in the left posterior oblique position
Use Colour Doppler to identify the main portal vein
In longitudinal section of the portal vein, look for the CBD anteriorly to the portal vein
In transverse section of the portal vein, look for the 'mickey mouse' sign to identify the CBD
Common Bile Duct
by: Carolynne Cormack
Roll patient semi-decubitus away from you & raise their right arm to give easier subcostal access to GB fossa
Use the MPV as a key landmark
Zoom image
Use color Doppler to distinguish CBD from Hep A & MPV at porta
Place calipers carefully inner-inner walls (normal <6mm)
Use a high intercostal approach for difficult pts
Gallbladder
by: Lynne Johnson
Roll patient left decubitis with back support
Raise right arm if possible
Identify right kidney in transverse and slide probe medially to find the gallbladder. This is particularly useful in patients where it is difficult to scan subcostally and an intercostal approach is the only alternative
Measure gallbladder wall in the transverse plane at the anterior wall with depth reduced
Be aware that there may be other reasons for a thickened gallbladder wall that are not related to cholecystitis eg low albumin, non-fasting. Test for positive Murphy's sign with probe pressure
Gallbladder
by: Dr Allan Whitehead
1. Have multiple strategies to find the gallbladder eg subcostal sweep +/- inspiration +/- L lateral decubitus, RUQ eFAST, X-7/intercostal
2. Must see all of the gallbladder and especially the neck for an impacted stone
3. Focal probe tenderness (compress the gallbladder in a transverse/short axis view) is an excellent indicator of cholecystitis even when the condition is early/mild