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英文誌(2004-)

Journal of Medical Ultrasonics

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2016 - Vol.43

Vol.43 No.Supplement

特別プログラム 消化器
パネルディスカッション 消化器 1(一部英語) 急性腹症の超音波診断

(S326)

急性腹症の消化管診断 -消化管領域におけるアドバンテージ-

Gastrointestinal evaluation in acute abdomen: Merits in the gastrointestinal field

岩崎 信広1, 杉之下 与志樹2, 鄭 浩柄2, 杤尾 人司1, 簔輪 和士1, 今井 幸弘3

Nobuhiro IWASAKI1, Yoshiki SUGINOSHITA2, Hiroshi TEI2, Hitoshi TOCHIO1, Kazushi MINOWA1, Yukihiro IMAI3

1神戸市立医療センター中央市民病院臨床検査技術部, 2神戸市立医療センター中央市民病院消化器内科, 3神戸市立医療センター中央市民病院臨床病理科

1Clinical Laboratory, Kobe City Medical Center General Hospital, 2Gastroentelogy and Hepatology, Kobe City Medical Center General Hospital, 3Clinical Pathology, Kobe City Medical Center General Hospital

キーワード :

【Introduction】
Acute abdomen accounts for the large portion of gastrointestinal diseases, and gastrointestinal evaluation will become, therefore, a crucial point. The determination of early diagnosis and therapeutic strategy in acute abdomen often has a great influence on subsequent quality of life(QOL);however, if neglected, acute abdomen may lead to fatal outcome. Ultrasonography is a technique to non-invasively observe a wide range of diagnostic field and is utilized as initial response to diagnosis of acute abdomen. However, because there are various problems which hinder this definitive diagnosis, it will be necessary to organize and recognize the usage of more effective ultrasonography. Here, we examine the usability of gastrointestinal evaluation in acute abdomen, while considering merits and demerits, along with diseases etc., which can be diagnosed only using ultrasonography.
【Merits and demerits of ultrasonography in acute abdomen】
Acute abdominal pain is caused by mechanical abnormalities, as well as functional abnormalities consequent to stimuli of the autonomic nervous system, such as gastrointestinal contraction, spasms, elongation, and distension. Merits of ultrasonography are to perform functional and dynamic evaluation of the gastrointestinal tract with high-resolution real-time ultrasonography and to evaluate changes in shape of gastrointestinal tract caused by compression etc. A Doppler is a unique ultrasound method to visualize the blood flow including angioarchitectonic images as well as velocity and direction of blood flow. Dynamic evaluation of blood flow including the degree of inflammation and ischemia is useful even in acute abdomen caused by gastrointestinal diseases. Because a Doppler can be conducted in the constricted area without preparation, as well as is simple and speedy, this will be the test which becomes the initial diagnostic test of choice. On the other hand, one of the demerits of ultrasonography is to be highly operator-dependent or device-dependent. Moreover, only the operator who performed ultrasonography can explain the images saved on a computer. Although ultrasonography can examine a wide range of diagnostic field, it is uncertain whether the ultrasonography can adequately cover all the diagnostic field because of the blind areas; therefore, there is a problem with objectivity and validity of ultrasound imaging. However, these demerits can be overcome, to some extent, by acquiring proficiency in systematic scanning procedures, diagnostic methods, etc.
【Conclusion】
Ultrasonography is essential for diagnosis of acute abdomen. Both morphological and functional diagnoses based on ultrasonography are thought to have a high enough ability to overwhelm other diagnostic methods in the gastrointestinal field. Therefore, ultrasonography is the test which becomes the initial diagnostic test of choice.