Abdominal sonography protocols

PREPARATION

Patient Preparation
Fasting: 6–8 hours (especially for liver/gallbladder).
Purpose of Fasting
1. Reduces Bowel Gas:

Gas in the stomach and intestines can scatter or block ultrasound waves.

Fasting helps to minimize gastrointestinal gas, which improves visibility of deeper structures like the pancreas, aorta, and biliary tree.

2. Ensures Gallbladder Distension:

When a person eats, the hormone cholecystokinin (CCK) is released, causing the gallbladder to contract and expel bile.

A contracted gallbladder is more difficult to evaluate, and pathology like sludge or small stones can be missed.

Fasting keeps the gallbladder fully distended, making its walls and internal contents easier to assess.

3. Improves Liver and Pancreas Visualization:

A fasted state reduces stomach and bowel contents, providing a better acoustic window for organs like the liver, pancreas, and common bile duct.

The left lobe of the liver often acts as a sonographic window for the pancreas — this is much more effective when the stomach is empty.

4. Recommended Timing:

Minimum: 6 hours.

Optimal: 8 hours.

Clear liquids (water, black coffee, tea) may be allowed in some protocols, but no food or milk.

5. Exceptions or Modifications:

Emergency scans: May proceed without fasting, though image quality may be reduced.

Diabetic patients: Require careful scheduling or modified fasting to avoid hypoglycemia.

Infants or children: Fasting time may be shorter (usually 4 hours for infants).

Hydration: Full bladder if bladder or pelvic organs are to be assessed.
Why hydration (full bladder) is important?

• Acts as an acoustic window: A full bladder pushes bowel loops and gas away, allowing better visualization of pelvic structures.
• Enhances pelvic imaging: Especially useful for examining the uterus, ovaries, prostate, and bladder wall.
• Essential for bladder evaluation: Wall thickness, internal masses, and residual urine are assessed more accurately when the bladder is distended.

How to prepare: Drink 32 oz (about 1 liter) of water 1 hour before the scan and do not urinate until after the procedure.
Note: Not required for upper abdominal studies (e.g., liver/gallbladder).

Patient Positioning

• Primary: Supine.
• Alternate positions: Left lateral decubitus, erect, oblique as needed.

Equipment

• Curvilinear probe: 2–5 MHz (standard).
• Linear probe: 7–12 MHz (for superficial structures).
• Adjust gain, depth, focus, and use harmonics as necessary.

STRUCTURED SCANNING SEQUENCE

1. Liver

• Views: Transverse and sagittal, subcostal, intercostal if needed.
• Assess for:
  • Size and contour.
  • Echotexture and echogenicity.
  • Intrahepatic ducts and vasculature.
  • Masses, cysts, abscesses, or fatty infiltration.

2. Gallbladder & Biliary Tree

• Views: Longitudinal and transverse; patient may need to be upright or LLD.
• Assess for:
  • Gallstones, sludge.
  • Wall thickening (>3 mm = abnormal).
  • Pericholecystic fluid.
  • CBD size (<6 mm normal; <10 mm post-cholecystectomy).

3. Pancreas

• Views: Transverse epigastric, using liver/stomach as window.
• Assess for:
  • Shape, size, margins, echotexture.
  • Ductal dilatation.
  • Masses, cysts, pseudocysts.

4. Spleen

• Views: Longitudinal and transverse via left flank.
• Assess for:
  • Size and shape.
  • Echotexture.
  • Masses, trauma (hematomas), infarcts.

5. Kidney

• Views: Longitudinal and transverse.
• Assess for:
  • Size, shape, cortical thickness.
  • Corticomedullary differentiation.
  • Hydronephrosis, stones, cysts.
  • Perirenal fluid.

6. Abdominal Aorta & IVC

• Views: Longitudinal and transverse.
• Aorta:
  • Measure diameter (normal <3 cm).
  • Look for aneurysms or dissection.
• IVC:
  • Assess collapsibility and patency.

7. Urinary Bladder

• Only if full.
• Views: Transverse and longitudinal.
• Assess for:
  • Wall thickness (<5 mm full).
  • Residual urine (post-void).
  • Masses or diverticula.

8. Pelvic Organs (if applicable)

• Prostate (in males):
  • Size, echotexture, and masses.
• Uterus/Ovaries (in females):
  • Uterine size, endometrial stripe.
  • Ovarian volume, follicles, cysts.

9. Additrional areas (As needed)
Ascites: Check Morison’s pouch, paracolic gutters, pelvis.
Lymphadenopathy: Para-aortic, porta hepatis, mesenteric nodes.
Appendix:

• Graded compression in RLQ.
• Diameter >6 mm or non-compressible = suspicious for appendicitis.

Bowel

• Dilated loops, wall thickening, free fluid = obstruction/inflammation.

REPORTING STRUCTURE

• Indication
• Technique and patient condition
• Organ-by-organ findings
• Measurements (where applicable)
• Doppler results (if used)
• Comparison to prior exams
• Conclusion/Impression
• Limitations (e.g., due to bowel gas, obesity)

A comprehensive list of abdominal ultrasound report samples and structured templates for different types of abdominal sonography exams. These templates are formatted professionally and include:
Report samples

• Upper Abdomen – Male/Female
• Whole Abdomen – Male
• Whole Abdomen – Female (with pelvic organs)
• KUB - Male
• KUB - Female
• Lower abdomen - Male
• Lower abdomen (Pelvis)- Female

Structured templates

Upper Abdomen – Male/Female

Indication: Abdominal pain / RUQ pain / Routine check
Technique: Real-time ultrasound examination of the upper abdomen was performed using a curvilinear transducer.
Organs Evaluated:
Liver
Gallbladder & biliary tree
Pancreas
Spleen
Kidneys
Abdominal aorta
IVC (Inferior vena cava)

Whole Abdomen – Male

Indication: Abdominal pain / Urinary symptoms / General screening
Technique: Real-time ultrasound examination of the abdomen and pelvis was performed.
Organs Evaluated:
Liver
Gallbladder and bile ducts
Pancreas
Spleen
Kidneys and urinary bladder
Abdominal aorta and IVC
Prostate and seminal vesicles (transabdominal)

Whole Abdomen – Female (with pelvic organs)

Indication: Lower abdominal pain / Menstrual irregularity / Pelvic evaluation
Technique: Transabdominal real-time ultrasound of the abdomen and pelvis was performed.
Organs Evaluated:
Liver
gallbladder
pancreas
spleen, kidneys
Urinary bladder
Uterus and ovaries (pelvis)
Aorta and IVC

KUB - Male

Indication: Flank pain / Hematuria / Urinary tract symptoms / Follow-up renal pathology
Technique:Real-time ultrasound examination of the kidneys, ureters (visualized portions), and urinary bladder was performed using a curvilinear transducer.
Organs Evaluated:
Right Kidney,br> Left Kidney
Urinary Bladder (Prostate, if visible transabdominally)

KUB - Female

Indication: Flank pain / UTI symptoms / Hematuria / Urinary retention / Evaluation of renal function
Technique: Real-time ultrasound of the kidneys, visualized ureters, and urinary bladder was performed using a curvilinear transducer.
Organs Evaluated:
Right Kidney
Left Kidney
Urinary Bladder Ureters (visualized segments)
Uterus (if visualized incidentally)

Lower abdomen - Male

Indication:/ Lower abdominal pain Dysuria / urinary retention
Suspected prostatomegaly
Hernia / Inguinal swelling
Infertility / Ejaculatory symptoms
Technique: Transabdominal ultrasound was performed using a low-frequency curvilinear probe. The urinary bladder was adequately distended. The prostate and seminal vesicles were evaluated transabdominally.
Organs Evaluated: Urinary Bladder
Prostate
Seminal Vesicles
Inguinal Region
Pelvic Vessels (if indicated)
(Rectum – limited view unless specifically targeted)

Lower abdomen (Pelvis)- Female

Indication:
Lower abdominal pain
Dysuria or urinary symptoms
Menstrual irregularities
Suspected ovarian pathology
Follow-up for fibroids/cysts
Infertility evaluation
Technique: Transabdominal ultrasound of the pelvis was performed with the urinary bladder adequately distended to serve as an acoustic window. A curvilinear transducer was used.
Organs Evaluated:
Urinary Bladder
Uterus
Endometrium
Ovaries (Right and Left)
Adnexa
Cul-de-sac (Pouch of Douglas)
(Inguinal region, if requested)

TIPS FOR OPTIMAL SCANNING

• Ask the patient to inhale and hold breath for liver/spleen views.
• Use harmonics to improve image resolution.
• Use color Doppler for vessels or questionable masses.
• Adjust gain/depth continuously for optimal visualization.