Aktueller Stand der Sonographie in der Gastroenterologie

Abstract

GALLBLADDER: Ultrasound has become widely accepted for the diagnosis of gallbladder disease. Sensitivity for cholecystolithiasis is approximately 100%. Cholezystitis including its acute and chronic complications is also a domain of ultrasound techniques. An obstruction of the bile ducts and its localization are easily recognized. Clarifying the etiology is yet another question far more difficult to answer. Ultrasound contrast agents have proven to be useful for clarification of biliary tumors. Gallbladder polyps are well detectable. Adenomas of > 1 cm are an indication for surgery, the detection of a vessel at the polyps' base by color duplex ultrasound is helpful. Gallbladder carcinomas as a disease of the older age with few early symptoms are usually detected at a late stage when the liver is already infiltrated. BILE DUCT SYSTEM: Even with the most modern equipment the sensitivity for choledocholithiasis is still largely dependent on the examiner's expertise und differs between 25% and 100%. Endosonography is more efficient (94-100%). Primary sclerosing cholangitis shows bile duct dilation like "a string of pearls" and typical perihepatic lymph node enlargement. Differentiation from early cholangiocarcinoma is difficult. PANCREAS: In diagnostic imaging of the pancreas ultrasound stands at the beginning of a diagnostic cascade. In contrast to other competing examinations it can be repeated at any time and without X-ray exposure. The informative value, though, is largely dependent on the examiner's expertise. Usually, a CT scan is additionally performed when ultrasound examination is incomplete or limited through examination condition or if doubts on diagnostic accuracy arise. In cases of acute pancreatitis, especially the assessment and follow-up of complications (exudation, necrosis, pseudocysts, vascular complications, and obstructive effects) are precious. Ductal adenocarcinoma seems to be less vascularized in comparison to the surrounding tissue, while endocrine tumors and macro- and microcystic adenoma are rather hypervascularized.

EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones

“…The presence of more than one polyp favours a diagnosis of cholesterol polyps rather than adenomas. The depiction of vessels in the polyp base that are typical for adenomas is occasionally successful using color duplex sonography [333].…”

Role of ultrasound in the diagnosis of gallbladder disorders in KSA - Asian patients in associated of nationality and occupation

“…This was cross sectional study done in Saudi Arabia to assess gallbladder disorders in Asian patients and the correlation of gallbladder disease among Saudis compared to other Asian nationalities, the study done in 103 patients, after data collection, it was analyzed by SPSS and the following are the results: The results of this showed that 64 of them were male (62.14%) and 39 were female (37.86%) as displayed in Figure (1). In figure (3) Frequency distribution according to nationalities denoted by percentile where Saudi 38 (36.9%), Pakistani 14 (13.6%), Afghans 12 (11.7%), Indian 11 (10.7%), Philippine 9 (8.7%), Yemeni 5 (4.9%), Bangladesh 5 (4.9%), Nepalese 6 (5.8), Sri Lankans 3 (2.9%).…”

“…Abdominal pain can also arise from abnormalities in the gall bladder, kidneys, pancreas, stomach, duodenum, spleen, etc. All these conditions can be easily detected by ultrasound [1][2]. Ultrasound is the first imaging investigations used to diagnose gallbladder and bile duct defects.…”

“…Normal measurements are taken in the transverse plane rather than in the longitudinal plane to eliminate any possibility of thickening due to measurement in the off-axis plane. The usual appearance of the wall is not regularly measured at those studies [1,[15][16]. In this study, the goal is to see the incidence of different types of GB pathologies and to determine the accuracy of ultrasonography for the diagnosis of different gallbladder disorders.…”

Schmerz im rechten Oberbauch

“…Besonders im rechten Oberbauch besitzt die Sonographie eine hohe Sensitivität und Spezifität. So wird beispielsweise die Sensitivität bei Gallenblasensteinen mit bis zu 100% angegeben [14]. Auch in der Anwendung durch Notfallmediziner lässt sich eine hohe Sensitivität z.B.…”