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CR

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Acute Abdomen

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Acute Abdomen

I GGet HIV

I : Inflammatory disease e.g. acute

appendicitis/cholecystitis

G : Gynecologic emergency e.g. ectopic pregnancy,

ovarian torsion

H : Hollow organ perforation

I : Ileus (Mechanical)

V : Vascular emergency e.g. AAA, ischemic colitis

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Gynecologic ultrasound

Longitudinal view - 1.2.

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Pelvic sagittal scan

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Pelvic transverse scan

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Role of EUS for OB/GYN Identify an IUP

Establish fetal viability

Hemodynamic instability in a female patient

Trauma and pregnancy

Localization of IUD/foreign body

Identify sources of pelvic pain and bleeding

in

pregnant & non-pregnant patients

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Trans-abdominal US

1st choice for emergency physician

Better penetration, larger field of view

It should be the initial imaging window to

assess for

Advanced IUP

Fibroids/masses

Pelvic fluidThe bladder should be full to provide an

acoustic window

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Transvaginal US

Use a higher frequency transducer: 6.0-7.5mHz

Provides optimal imaging of:

EndometriumMyometrium

Cul-de-sac

OvariesA full bladder is not necessary for this

approach is usually better tolerated by

patients

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Endovaginal probes

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TAS versus TVS

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The Uterus

Early in the menstrual cycle

endometrium measures 4-8mm

Secretory phase

endometrium measures 7-14 mm

Post-menopausal patient

endometrial stripe usually less than 9mm

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In the post-partum patient, a thickened

ES is suggestive of retained products ofconception

In the pregnant patient, an ESmeasurement of < 8mm in the absenceof an IUP is suggestive of EP

Thickening of the endometrial stripe inthe postmenopausal patient with vaginalbleeding should raise suspicions forendometrial carcinoma

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Ovarian Cysts

Follicular cyst (2.510 cm)

Thin, round, unilocular

Functional corpus luteum cyst

Normal up to 16 weeks GA

Appears as a unilateral, unilocular 5-11 cm

cystAppearance can be highly variable

Hemorrhage inside the cyst not uncommon

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Intrauterine Pregnancy

http://iup%20with%20double%20decidual%20sac%20sign.mpg/

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Gestational Sac

Anechoic area within the uterussurrounded by two bright echogenic rings

Decidua vera (the outer ring)

Decidua capsularis (the inner ring)

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Intrauterine embryo & yolk sac

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Dichorionic Twins

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Rule-out Ectopic Pregnancy

(saves time and money)

Find an IUP

Chance of both IUP and EP is 1/8000

As high as 1/100 if pt takes fertility agents

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Discriminatory Zone

The level of -hCG at which findings of an

IUP are expected on sonography

Titinalli

TVS 1500 mIU/mL; TAS 6000 mIU/mL

Rosen

TVS 3000 mIU/mL; TAS 6500 mIU/mL

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-hCG >discriminatory zone and

empty

uterus is EP until proven otherwise

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Sonographic Spectrum of EP

Ruptured ectopic pregnancy

Definite ectopic pregnancy

Extrauterine empty gestational sac

Adenexal mass

Pseudogestational sac

Empty uterus

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http://pseudosac.flv/

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http://pseudosac.flv/

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Ectopic pregnancy

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Color Doppler: Ring of Fire

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Adnexa mass

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Ovarian torsion

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Corpus luteum cyst rupture

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Subchorionic hemorrhage

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Main Goals in Late Pregnancy

Determination of gestational age

Fetal cardiac activity, fetal movement

Head positionPlacenta - placenta previa

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Location of the placenta

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Placenta Previa

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Abruptio placenta

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Molar pregnancy

Snowstorm sign

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Gynecologic acute abdomen

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Location of appendix

Main Goals in Non pregnant

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Main Goals in Non-pregnant

Patients

Determining the etiology of abdominalpain -pelvic organs or other etiology

Hemorrhagic ovarian cyst

Ovarian torsion

Ovarian hyperstimulation syndrome(OHSS)

Tubo-ovarian abscess

Fibroid (Leiomyoma)

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Hemorrhagic ovarian cyst

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OHSS

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Submucosal myoma

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Adenomyosis

Poor-defined area

Mottled heterogeneous appearing myometrium A globular asymmetric uterus

Small myometrial lucent areas,

An indistinct endometrial stripe

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Vaginal hematoma

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Nabothian Cysts

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Intrauterine Device

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Special thanks to~~

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~~Practice makes

perfect !!!

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Thanks for your attention !!