So tests for these conditions, including an ultrasound of the liver to look for non-alcoholic fatty liver disease, should be used first.
The initial tests for these rare conditions -- Wilson disease, hemochromatosis, autoimmune hepatitis primary biliary cholangitis -- set a low bar. That means many people who take them will get a false positive, and need a biopsy to rule the condition in or out. That can cause anxiety, pain, and in some cases worry about the genetic risk to relatives. Tapper and his former Harvard Medical School colleague offer new data on the issue of liver over-testing, and advice for hospital-based physicians, in the new Journal of Hospital Medicine paper.
They looked at liver testing orders placed at a large Harvard-affiliated hospital over a five-year period, in patients whose initial blood test suggested they were suffering some sort of severe acute liver injury. Of the nearly 5, patients, 86 percent had their blood sent out for specialized testing for a wide range of liver problems, including as well as the relatively common hepatitis B and C viral infections.
And many patients never got confirmatory tests for rare diseases. Over-testing for liver issues also comes with a financial cost, Tapper notes. Outcomes that indicate possible issues that have been identified will be presented by the medical professional, along with, a suitable treatment plan. Additional ultrasounds may be needed during this time. Thereby, check if the treatment is reacting well to the complication.
By becoming better-informed, individuals will be more comfortable in knowing what to expect during the process. Always remember to consult the doctor regarding any queries you may want to be answered. Live in Hialeah, Florida, or the surrounding area? The Carreras Medical Center and its highly qualified practitioners are on hand to deliver treatments and examinations you may need, including this one.
Book an appointment today. Save my name, email, and website in this browser for the next time I comment. View Larger Image. How Long Does an Ultrasound Take? What Occurs During an Ultrasound Exam? At the start of the exam, a hypoallergenic, odor-free, warm gel will be gently lathered onto the abdomen. The sonographer who will be performing the examination will move a transducer around the abdomen and rib cage area. The transducer will take pictures of your liver and surrounding organs, producing the ultrasound.
During the examination, you will be asked to maintain a continuous breathing pattern, and in some cases, to perform several different breathing techniques to get the best images. You will be asked to lay in a variety of different positions, and may even have to stand up to get in the best place possible for the image during the normal liver ultrasound.
Whilst it is taking place, you may experience minimal pressure when the sonographer is performing the screening. After this, a radiologist may enter the room and talk to you about the results. If not straight away, they will provide the written results at a later date. Preparing for Your Exam? Do not consume any food or liquid for eight hours before the test; water is sometimes allowed.
However, this is average and the doctor may advise a different amount of time. Wear clothes that fit comfortably. Take the mandatory medications that have been prescribed beforehand. Words to Learn Before Reading Your Report There are lots of confusing radiologist words you need to be aware of to properly understand your liver scan report.
What Is an Echogenic Liver? Are Further Tests Needed? Understanding Liver Ultrasound Fasting As previously touched on, individuals are required to avoid food and drinks for roughly eight hours in preparation for the ultrasound of the liver.
We do not use a coarse liver echo pattern alone as a reliable sign of cirrhosis unless it is very pronounced heterogeneously course or supported by evidence of portal hypertension see Column 4 below. Fatty liver disease FLD or steatohepatosis warrants some comments in this section. It is increasingly common and has a significant morbidity and mortality.
Mild FLD — slight increase in liver echogenicity. This is partly subjective and may be appreciated by an increase in liver to renal contrast echogenicity. Moderate FLD — greater increase in echogenicity to the point that the portal tract echogenicity blends with the surrounding liver parenchyma, so that the portal veins become less distinct. Marked FLD — as in 2 but with beam attenuation so that penetration is lost in the posterior part of the liver. Focal fatty sparing may be seen with grades 2 and 3.
The ligamentum teres is examined for signs to indicate portal hypertension. Both of these signs have been shown to be specific and in our experience together they represent the most sensitive ultrasound sign of portal hypertension.
A complete portal hypertension examination is not included as the yield is likely to be lower in this clinical group. The presence of a positive ligamentum teres study is, however, of value in this group as it may add supporting evidence for cirrhosis if other findings are equivocal. Negative statements should be brief and normally only related to the specific clinical question.
This approach to targeted ultrasound of the liver should be viewed in practice as a guideline for scanning. Guidelines in medicine, by their nature, need to be applied with cognisance of the local clinical environment and do not remove the need to exercise clinical judgement in the individual patient. This applies to both sonographers and the supervising medical practitioners.
Ready availability of consultation between sonographer and supervising medical practitioner, before or during the examination, is the best safeguard to ensure that the guidelines are not applied too rigidly. The clinical request or findings during the examination may mean that the study should be extended.
If the examination reveals something that is not clearly known from the request and is potentially significant, for example, the presence of ascites or biliary dilatation, or an obvious finding adjacent to the liver, the examination and the report should be extended appropriately. Examination times are substantially and often dramatically reduced when compared with the historical practice of performing comprehensive upper abdominal studies in this clinical group the details of this reduction are currently being examined.
The impact on diagnostic yield or accuracy is not known and would be very difficult to establish. It is, however, plausible that accuracy with respect to the specific clinical questions may be higher as a result of scanning being more focused. Indeed our sonographers feel that liver scanning is more thorough and therefore likely to be more accurate even though the total examination time is less. This probably results from removal of the distraction and time pressures of completing a comprehensive and often unnecessary upper abdominal study.
The matrix is adaptable to local practice and preferences. Emerging technologies such as quantitative shear wave elastography can also be added as a means of grading fibrosis. The concept is simple so lends itself to such modification depending on local circumstances. Targeted ultrasound of the liver TUSL provides a means of improving efficiency and possibly diagnostic accuracy in addressing the common clinical questions in chronic liver disease, an area of increasing burden on ultrasound services.
It is simple to introduce and can be modified according to local preferences and technologies. As with all guidelines it does not supplant the need for the exercise of clinical judgement by the ultrasound team. National Center for Biotechnology Information , U. Australas J Ultrasound Med. Published online Dec Author information Copyright and License information Disclaimer.
Corresponding author.
0コメント