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Preparing for an ultrasound of the spleen

An organ called the spleen performs a number of functions simultaneously. Thanks to its work, old platelets are destroyed, and hemoglobin is also transformed into enzymes such as bilirubin and hemosiderin.

In addition, the spleen produces red blood cells and lymphocytes, which accumulate in the organ up to a certain point. The spleen is able to trap various bacteria, producing the necessary antibodies.

Indications for ultrasound

An ultrasound examination of the spleen is performed if the following prerequisites are present:

• mechanical organ damage
• suspicion of incorrect or too late development of the organ
• having chronic liver disease
• the patient has infectious diseases, which include sepsis, mononucleosis, infectious syphilis, viral hepatitis, typhoid
• leukemia
• malignant tumor of the spleen or vice versa.

Preparation for the procedure

For proper conduct, preparation for ultrasound of the spleen is mandatory. It is imperative that the last meal of the day is eight or even ten hours before the start of the study. Based on this need, the ultrasound examination is carried out mainly in the daytime. In addition, a few days before the scheduled study, you must refuse to take such products as:

• all types of legumes
• raw vegetables
• milk.

Preparation for ultrasound of the spleen involves taking enterosorbents, such as festal, or activated charcoal for several days before it is carried out. These drugs are taken one tablet two to three times a day. The intake of this group of drugs is necessary in order to completely avoid gas formation, which can greatly complicate the study.

In rare cases, an exception is possible in the form of a light breakfast, consisting of crackers and tea. Such an exception is permissible only if the patient suffers from diabetes mellitus and too long an interval between meals can adversely affect his well-being.

Research objectives

Preparation for ultrasound of the spleen and its direct conduct are necessary to determine the volumetric parameters, as well as to identify local or diffuse changes in the structure. In addition, the study can reveal the presence of a cyst or tumor, as well as its location and nature.

Regular examination of the spleen by means of ultrasound is necessary for all patients diagnosed with chronic diseases of the liver, hematopoietic, and lymphatic systems.

Carrying out the procedure

Preparation for ultrasound of the spleen takes a much longer amount of time than its direct implementation. The whole procedure lasts from five to ten minutes. During the study, the patient does not feel any discomfort, and there are no contraindications to the study.

If the procedure is carried out correctly, the doctor receives a large number of necessary information about this organ, thanks to which it is possible to timely diagnose and eliminate a large number of diseases that are at an early stage.

Answers on questions

Ultrasound procedure the most affordable and safe diagnostic method. It does not irradiate like X-rays, it costs much less than MRI and CT, and ultrasound is also easier to use. The examination procedure is quick and painless, there is no need to remain still, which makes ultrasound the method of choice in pediatrics. In addition, the method has practically no contraindications.

Ultrasound diagnostics is most often used to obtain an image of organs. abdominal cavity and pelvis, mammary glands, heart, and in children the brain and joints.

History of the use of ultrasound in medicine. In the 1930s, Friedrich Dussik first used ultrasound waves to visualize a brain tumor. The next few decades, ultrasound was used mainly in veterinary medicine. It was used to determine the thickness of fat in animals.

The first ultrasound machines were invented in 1955, and for 20 years it has gained wide popularity. Now there are many varieties of this method that allow you to get color and 3D images. But the most common is black and white ultrasound, where more than 60 shades of these two colors are used to obtain an image.

There are also disadvantages to ultrasound diagnostics. In the study, a lot depends on the qualifications of the doctor and the error of the apparatus. In addition, it is impossible to diagnose the stomach and intestines, other abdominal organs, which contain gas.

Ultrasound is minimal, but still affects the structure of cells. Therefore, they should not be abused. There are indications for an ultrasound, so consult a specialist.

What is an ultrasound?

Ultrasound- sound waves having a frequency above 20,000 Hz. This sound is so high that the human ear does not perceive it. For diagnostics, devices with a frequency of 2 to 10 MHz are used. For ultrasound of the liver and gallbladder, devices with a frequency of 2.5-3.5 MHz are used. This makes it possible to consider objects with a size of 1-3 mm.

The maximum depth at which high-quality diagnostics is possible is up to 24 cm. Therefore, in very obese patients, ultrasound of the liver and gallbladder is not informative.

The principle of the survey.
i> The tissues of the body have different density and elasticity, which means that they absorb and reflect ultrasound to varying degrees. A beam of ultrasonic waves propagates in the tissues of the body. Having reached the boundary of two environments, part of it is reflected and returned back, while the other part continues its path in a new environment.
Simply put, a beam of ultrasonic waves passes through the tissues of the body. When it reaches the border of the organ, some of the waves are reflected and returned back. The sensor captures them, converts them into electrical impulses that create an image on the monitor.

The best image is obtained when the wave beam is directed perpendicular to the tissue border. Therefore, the body is examined from different angles and in different positions. With ultrasound of the liver and gallbladder, the study is carried out in the supine position, on the side. They may be asked to sit down, get on all fours, take a vertical position.
During the examination, a water-based gel must be used. It provides the entry of ultrasonic waves into the body. Without the gel, a beam of waves would reflect off the skin like a mirror and would not reach the internal organs.

Devices for ultrasound diagnostics are called ultrasound scanners. They are different types, differ in functionality.

• Echotomoscopes- devices designed to study the abdominal organs, pelvic organs and the condition of the fetus during pregnancy
• Echoophthalmoscopes- help ophthalmologists determine the size of the eyeball and the position of the lens.
• echoenceloscopes- are designed to detect diseases of the brain. They diagnose lesions, cysts, hematomas, tumors, the degree of circulatory disorders.
• Echocardioscopes- devices through the intercostal gap allow you to identify malformations of the heart and changes in its wall.

The main part of the ultrasound scanner is a sensor that emits ultrasound waves and captures their reflection from organs. There are sensors with high frequency ultrasonic waves.

Sensors for ultrasound scanners differ in their design and field of view.

• Linear sensors. They give a very detailed high quality image, using a frequency of 5-15 MHz, but at the same time they do not penetrate deep into tissues up to 10 cm. They are used to study the thyroid gland, mammary glands. It is shaped like a mop, so it can be difficult to achieve a snug fit to the skin.
• Convex Probes have a smaller length and fit better to the surface of the skin. They use a frequency of 1.8-7.5 MHz. Due to this, the image detail (resolution) decreases, but the penetration depth increases to 20-22 cm. They are used to study the abdominal organs and hip joints.
• Sector sensors allow to examine small areas body. They operate at a frequency of 1.5-5 MHz. The sensors have a small surface and with their help it is convenient to examine the heart through the intercostal spaces.

There are also other types of ultrasonic sensors:

• Intracavitary sensors inserted into the vagina or rectum. Their review can reach 360 °.
• Doppler transducers- allow you to assess the features of the movement of blood through the vessels.
• 3D Imaging Sensors.

Areas of use. Ultrasound is used not only for diagnosis, but also for treatment - it has analgesic, anti-inflammatory properties, accelerates the resorption of hematomas, crushes kidney stones and improves the administration of drugs through the skin.

They are used in cosmetology for micromassage of cells and acceleration of regeneration. As a result, the skin is cleansed, tightened and smoothed.

In addition, ultrasound is widely used in industry for defect detection, echolocation, cleaning and coating improvement.

Normal liver and gallbladder sizes

Ultrasound of the liver - the norm for adults

• Edges are crisp and even
• The structure is homogeneous
• Liver width (right to left) 23-27 cm
• The length of the liver (from the posterior blunt to the anterior sharp edge) 14-20 cm
• Diameter of the liver 20-22.5 cm
• Left lobe of the liver 6-8 cm
• Right lobe of the liver less than 12.5 cm
• Common hepatic duct diameter 3-5 mm
• Inferior vena cava diameter up to 15 mm

Ultrasound of the gallbladder - the norm

• Length 7-10 cm
• Width 3-5cm
• Diameter 3-3.5 cm
• Wall thickness up to 4 mm
• Common bile duct diameter 6-8 mm
• Shared bile ducts inner diameter up to 3 mm

Indications for ultrasound of the liver

• Pain in the right hypochondrium;
• Icteric coloration of the skin and whites of the eyes;
• Suspicion of the presence of neoplasms in the liver;
• Alcohol abuse long-term use of certain drugs;
• With deviations in the blood test, indicating liver pathology;
• With trauma to the abdominal organs;
• In acute and chronic diseases of the pancreas and gallbladder;
• Regularly in chronic liver diseases.

Purpose of liver ultrasound: identify focal (limited) and diffuse (diffuse) changes in the liver.

• Pain in the right hypochondrium
• Jaundice;
• Acute and chronic cholecystitis;
• Monitoring the effectiveness of treatment;
• Abdominal injuries;
• Suspicion of anomalies in the development of the gallbladder;
• Monitoring the result of surgery on the biliary tract.

The purpose of the appointment of ultrasound of the gallbladder - identify signs of gallbladder pathology, determine the presence of stones.

Pathology	signs this disease
Acute cholecystitis	Thickening of the gallbladder wall more than 4 mm Enlargement of the gallbladder Multiple partitions inside the bladder Increased blood flow in the cystic artery
Chronic cholecystitis	Reducing the size of the gallbladder Wall thickening, its deformation The wall of the bladder is compacted, looks lighter than normal Edges are blurry and fuzzy Small particles are visible in the lumen of the bubble
Dyskinesia of the gallbladder	Inflection of the neck of the gallbladder Increased tone of the walls of the gallbladder, their compaction
Gallstone disease (cholelithiasis)	Stones in the cavity of the gallbladder. These are small bright formations that reflect the signal well. They move when the position of the body changes. Echo-shadow (dark area) behind the stone, as these formations are impenetrable to ultrasonic waves. Sludge or sediment of bilirubin crystals. However, a similar picture occurs with hemorrhage or accumulation of pus Wall thickening Irregular contour of the gallbladder Ultrasound does not detect small stones. But their presence is indicated by an enlarged bile duct above the site of blockage.
Gallbladder polyps	Rounded formations on the wall of the gallbladder
Tumors	Polyps larger than 2 cm Deformation of the contours of the gallbladder Significant wall thickening. The monitor screen can have both light and dark Tumor formation

Preparing for an ultrasound of the liver

Preparing for an ultrasound of the liver aims to eliminate the formation of gases in the intestines. Their presence interferes with the study and can lead to an incorrect diagnosis.

Preparation begins 3-5 days before the study. During this period it is necessary:

• Exclude from the diet foods that cause gas formation: cabbage, fruits, milk, black bread, yeast baked goods, carbonated drinks. Refuse strong tea, coffee and alcohol.
• Food should be fractional, in small portions 3-4 times a day.
• The amount of liquid should not exceed 1.5 liters per day.
• Take enzyme preparations: Festal, Panzinorm for indigestion and flatulence.
• Adsorbents: activated carbon, Smecta. Reduces flatulence and infusion of chamomile.
• Cleansing enemas are carried out in the evening on the eve of the procedure and immediately before it. They are necessary for persistent constipation and severe bloating. In other cases, enemas are not required.
• Ultrasound is performed in the morning on an empty stomach. The interval between the last meal and the ultrasound procedure should be at least 8 hours.

These recommendations are suitable for healthy people and those who have various chronic diseases. If you are constantly taking any medications, then there is no need to cancel them before an ultrasound of the liver and gallbladder.

There is no preparation for an emergency study.

What you need to have with you.

It is recommended to take a towel for examination at the municipal polyclinic. It can be spread on the couch and wipe the gel applied to the skin. If this study is carried out in a private clinic, then, as a rule, nothing needs to be taken. Disposable wipes are included in the price of the procedure.

Preparing for an ultrasound of the gallbladder

Preparation is aimed at reducing flatulence and begins 2-3 days before

• Exclude coarse-fiber vegetables and fruits: cabbage, radish, legumes, yeast baked goods, snacks (crackers, chips). These foods cause bloating and distort the results of the study.
• Prohibited fatty meats and fish, alcohol.
• They take adsorbents activated carbon, Espumizan, Motilium remove gas bubbles from the intestines without affecting the functioning of the digestive organs.
• Enzyme preparations Mezim, Festal, Panzinorm. Usually they are prescribed in 1-2 tablets with each meal.
• To combat constipation, you can take a tablespoon of Lactulose syrup every night before going to bed. On the day of the procedure, you can use glycerin suppositories.
• The last meal should be no later than 8 hours before the ultrasound. Cereal porridge is recommended for dinner. The food must be completely digested, and a new supply of bile will accumulate in the gallbladder during this time.
• Ultrasound of the gallbladder is performed only on an empty stomach. The ban applies to tea, coffee, water and even chewing gum. They cause bile to flow out of the gallbladder. It decreases in volume, which makes it difficult to diagnose.
• If you have previously done an ultrasound, then take the conclusion with you. This will enable the doctor to assess the dynamics, to determine whether there is an improvement.

If gallstones are suspected, ultrasound is performed in as soon as possible without preparation.

What to bring with you

In a hospital or city clinic, you will need a towel to dry your skin after using the gel. If you are assigned an ultrasound of the gallbladder with a function definition, then you need to have products for a trial choleretic breakfast with you. It can be 2 yolks of raw or boiled eggs, sour cream, cream, Sorbitol solution.

Contraindications for ultrasound of the liver and gallbladder

Ultrasound of the liver and gallbladder can be performed according to indications at any age and with any concomitant diseases. The only limitation may be purulent damage to the skin or a burn. In this case, the application of the gel and the pressure of the transducer may contribute to the spread of the infection. However, for emergency ultrasound, with acute pain in the right hypochondrium, there are no contraindications.

All changes identified during ultrasound require clarification and observation in dynamics. To do this, after the first ultrasound, a second examination is done in 2-3 weeks. The best option would be an ultrasound of all digestive organs.

Remember that treatment is not prescribed only by the results of ultrasound. To clarify the diagnosis, in addition to clinical symptoms, a biopsy or computed tomography may be needed.

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Organ location

The spleen is located in the left side of the upper abdomen. About 20% of the world's population has so-called accessory lobules. They are located at a certain distance from the organ itself (for example, scientists once discovered additional lobes in the scrotum), so in some cases, abdominal ultrasound does not help to fully determine the cause of the disease. Asplenia (absence of the spleen) occurs, but this is rare.

Indications for ultrasound

The most common indication for ultrasound of the spleen is splenomegaly (an increase in size of this organ), which indicates serious blood diseases. If cirrhosis of the liver is suspected, ultrasound of the spleen is mandatory. If there is a suspicion of a cyst / tumor in the organ, ultrasound diagnostics is also necessary. This procedure is carried out in parallel with ultrasound of other organs (pancreas, liver, gallbladder).

How to prepare for the procedure?

Preparing for an ultrasound of the spleen is similar to preparing for an ultrasound of the abdomen. A few days before the visit to the doctor, foods that cause gas formation (sweets, legumes, wheat flour bread, cabbage) should be excluded from the diet. As preparation for ultrasound, it is recommended to take drugs that promote digestion (Filtrum, Smecta). Ultrasound of the spleen is best done on an empty stomach.

Passage of ultrasound

Ultrasound of the spleen patients undergo lying on their backs. First, parallel sections will be made, after which the specialist will move the sensor from the costal arch to the lower pole of the organ. The patient is then asked to roll over to the right side. The probe is placed between the ribs for detailed scanning, rotating to obtain cross sections. If no abnormalities were found during the study, the patient will be asked to roll over on his stomach and the ultrasound will continue.

Norm with ultrasound

Immediately after the ultrasound of the spleen, its decoding follows. A normal, healthy organ should be located in the upper part of the abdominal cavity, on the left side, and it is localized on the left, in the lower part of the diaphragm. The stomach should be close to the middle of the organ, and the tail of the pancreas should be near the middle of the gate. In the area of ​​the gate, a grid of vessels can be seen, this is not considered a deviation. The diameter of the splenic vein should not exceed half a centimeter. The parenchyma of a healthy spleen has a homogeneous fine-grained structure.

Not only the size of the organ is important, but also its echostructure, which must be homogeneous. There should be no inclusions in the image. Normally, the shape of the spleen resembles a crescent. If the organ has a heterogeneous structure (it is the heterogeneous structure that indicates benign tumors), echogenicity is increased (with oncological diseases of the blood, it may not be increased, but splenomegaly is noted), the shape of the spleen is incorrect - these are signs of the disease. Even small deviations from the standard indicators are important and require consideration by a specialist.

For an adult

It is important that three linear dimensions are taken into account during ultrasound diagnostics. The scan protocol must contain specific numbers. There is not enough information about whether the spleen is enlarged. Normal sizes organ for adults are as follows: the length of the organ is 8-14, the thickness is 3-5, the width is 5-7 cm. In women, the mass of a healthy organ is 150-152 g, in men - 192-200 g. The area of ​​\u200b\u200bthe maximum cut is also measured: normally it is 40-50 square meters. see It should be remembered that the size of the body is individual for each person.

For kids

The size of the spleen in children varies with age. For example, in a one-year-old child, the spleen is relatively small: length - 50-65 mm, width - 17-25 mm. For a 15-year-old teenager, acceptable indicators are: length - 90-120 mm, width - 34-49 mm. The size of the organ for children of different ages is shown in the table:

Table of norm indicators for ultrasound of the spleen for children.

This table will help determine whether the size of the organ of a child of a certain age category is acceptable. If they are not within the normal range, there is a suspicion of the following diseases:

• hematological syndrome;
• anemia;
• leukemia;
• congenital heart disease;
• typhoid fever;
• tuberculosis.

Often, an enlarged spleen in children indicates that the liver is unhealthy.

Pathologies

Below is a breakdown of the diseases of the organ according to their main features. With leukemic infiltration:

• a noticeable increase in size;
• the spleen has convex contours and a pointed edge;
• compacted parenchyma;
• nearby lymph nodes are inflamed.

On break:

• the presence of fluid in the subdiaphragmatic space or in the abdominal cavity;
• uneven contour of the body.

Unfortunately, if a rupture occurs, the organ can be saved in 1% of cases. Therefore, for the prevention of rupture, it is important not to sharply increase physical exercise, observe bed rest for colds, avoid stressful situations on the roads, try not to lift weights. Pregnant women are advised to wear a bandage to avoid injury to the spleen.

For an abscess:

• hypoegoic or mixed echostructure;
• visible cyst (oval formation with uneven contours).

Some pathologies are not visible immediately after ultrasound, but the specialist will be able to determine them by calculating the area of ​​\u200b\u200bthe largest oblique cut. This indicator is easy to calculate: multiply the largest linear size by the smallest. Thus, this value should be equal to 15.5 - 23.5 square meters. cm.

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The liver is an unpaired parenchymal organ located in the right hypochondrium. Damage to this organ does not affect its activity for a long time, since nature endowed it with a significant functional reserve. Symptoms of liver failure appear only when 70% of the tissue of the organ is affected. The state of the liver affects the work of all systems and organs. So with liver failure, symptoms such as bradycardia, arrhythmia, edema, dropsy of serous cavities are recorded.

When conducting an ultrasound examination, it is possible to distinguish between acute hepatitis of infectious and toxic etiology, chronic and degenerative changes- hepatosis - when the normal parenchyma is replaced by connective tissue. There are different types of hepatitis.

Cirrhosis is a severe pathology with a number of clear clinical signs and a specific ultrasound picture. Already in preparation for the ultrasound, when shaving the hair, you can see * the head of a jellyfish * on the stomach - a characteristic pattern of tortuous veins, reminiscent of the head of the mythological character Medusa Gorgon. In addition to the listed pathologies, a large group of liver diseases includes various generalized and focal lesions. An important fact is the diagnosis of free fluid in the abdominal cavity.

The spleen is an unpaired multifunctional immunocompetent parenchymal organ. It performs an important function of the blood depot and participates in the circulatory system. The spleen cushions the increase in blood pressure. historical fact- The ancient Romans and Greeks removed the spleen of runners to increase the speed of running. In an adult organism, the destruction of old cells, mainly erythrocytes, occurs in the spleen. From the point of view of ultrasound, it is an unpaired organ located in the left hypochondrium. When conducting a sonographic study, many parameters are taken into account (topography, mobility, contours, echogenicity of the organ).

The pancreas is a parenchymal organ. It secretes a large amount of pancreatic secretion into the 12th ring, containing enzymes that break down proteins, fats and carbohydrates. Inside the gland are pancreatic islets that produce the hormones insulin and glucagon. In cats and dogs, the pancreas is ribbon-shaped, located in the right hypochondrium. During an ultrasound examination of the pancreas, it is possible to identify conditions associated with acute and chronic pancreatitis, various neoplasms, rarely detected pathologies - abscesses and cysts in the parenchyma of the organ.

Ultrasound examination of the spleen is indicated in cases where the face is clearly enlarged spleen, confirmed radiographically or clinically. Other indications for research are unexplained anemia, contraction, stretching of the abdominal cavity due to fluid. In most cases, the spleen is included in a general abdominal examination.

Ultrasound of the liver is indicated for the manifestation of clinical symptoms or biochemical changes associated with liver disease, as well as for an obscure disorder, ascites, or fever of unknown origin. Jaundice, weight loss, vomiting, excessive salivation, and lethargy are symptoms that could be associated with liver disease.
In animals with persistent hypoglycemia, anorexia and vomiting, pain in the right hypochondrium, pancreatic ultrasonography is an essential research method.

The liver, spleen, pancreas are anatomically located in close proximity to the organs, in which there is always a gas component in the normal state, which produces a lot of artifacts and makes it difficult to conduct ultrasound. That's why important point before the procedure is to prepare the animal. Firstly, this is a preliminary starvation diet - 12 to 24 hours before the study. Secondly, drugs that reduce gas formation in the intestines, which impede qualitative research. It can be - activated carbon - every 4 hours at a dose of 1 t per 10 kg of animal weight 24 hours before ultrasound and additionally in the morning. If the drug is difficult to give every 4 hours, an alternative drug can be Espumizan - 1 caps per 25 kg of animal weight (for cats - 1-4 caps) or 1 teaspoon of the emulsion per 25 kg of animal weight (for cats - 1-4 teaspoons) spoons) 3 times a day 24 hours before the ultrasound and additionally in the morning.

Ultrasound examination cannot display the functioning, but only shows the structural structure of organs. BUT this is important for choosing the tactics of further treatment and making the correct diagnosis, taking into account the whole range of other additional research methods.

Veterinarian
Becker Olga Vladimirovna

rostovvet.ru

Liver

This is one of the few organs whose dimensions are measured not only through its entire surface, but also for each individual lobe. Normally, four lobes can be visualized on ultrasound: right and left, caudate and square. The following sizes are accepted as standards by national recommendations:

1. The length of the liver (more precisely, the right lobe, since this parameter is measured along the midclavicular line) - for asthenics no more than 14 cm; for hypersthenics less than 12 cm.

Asthenics - as a rule, these are faces of a thin physique. Their body length prevails over transverse dimensions (width);

Hypersthenics are people whose transverse dimensions (body width) are equal to or greater than the length.

1. Oblique measurement / size - no more than 13 cm;
2. Square lobe - thickness (anteroposterior size) of about 4 cm. Normally, there may be a deviation within 1 cm up / down;
3. Caudate lobe - thickness 1.6-2.0 cm. Length - 6.1-7.0 cm.

A normal liver should not only correspond to the above dimensions, but also have a homogeneous, slightly echoic structure - without seals / melting of its tissues. Normally, the contour of the organ is even, without any deformations and volumetric formations (abscesses, cysts, tumors, and so on).

In addition to standard measurements, clinicians may use the right lobe/caudate ratio. Such an index helps to make an objective conclusion about the increase in the liver. The normal result is less than 0.55.

Doppler indicators can take the following values:

Index	Norm
Diameter of the central vein (refers to hepatic)	Less than 10 mm
Portal/portal vein diameter	Not more than 13 mm
Splenic vein diameter	On inspiration - 7-10 mm;
	On exhalation - 3-6 mm.
Diameter of the mesenteric (superior) vein	On inspiration - 9-11 mm;
	On exhalation - 4-6 mm.
Velocity of blood flow in the hepatic artery	About 0.96 m/s. Deviations up / down by 1.2 m / s are possible

For a more accurate interpretation of the results, clinicians can use additional indices (congestion, spleno-portal index, and so on). However, these parameters are not included in the standard ultrasound examination protocol.

Spleen

When assessing the state of the spleen, the priority tasks are to determine its size and the quality of blood flow. The following indicators are considered normal:

• Length (longitudinal measurement) - less than 12 cm;
• Width (transverse measurement) - no more than 5 cm;
• Thickness (anterior-posterior size) - within 7 cm.

It should be noted that normally the spleen also weakly conducts the signal of ultrasound sensors, so on the monitor it looks like a weakly echogenic homogeneous formation with even contours. This factor prevents the visualization of blood vessels, however, when they are detected, the speed is determined using dopplerometry. Norm:

• The splenic artery is about 0.9 m/s. There may be deviation within 0.7mm;
• The splenic vein is about 0.2 m/s.

The spleen is a very indicative organ, since its condition can change not only with the pathology of the blood system, but also with impaired circulation in the portal (or portal) vein pool, which is often observed in cirrhosis or liver tumors.

Gallbladder and bile ducts (GI)

With the help of ultrasound equipment, in most cases, it is possible to visualize only the choledochus (synonymous with the common bile duct) and gallbladder(JP). Other structures of the biliary system are rarely accessible for inspection. It should be noted that in women, pathologies of the GI are more common.

Form ZhP - Pear-shaped / rounded;

Echogenicity of the common bile duct and gallbladder - Anechogenic (the ultrasound signal does not pass through the filled structures of bile secretion);

• The nature of the wall of the organs of the bile duct is smooth and uniform;
• Gallbladder dimensions - less than 80 mm * 3 mm * 35 mm
• The dimensions (diameter) of the choledochus are within 10 mm.

Inside these organs can only be bile. If stones are found in the cavity, an appropriate diagnosis (cholelithiasis) is made.

Pancreas

When studying this organ, close attention should be paid to the echogenic structure. In the normal state, the pancreas has the appearance of a coarse-grained homogeneous structure of high echogenicity (light on the monitor). Changes in the tissue that can be detected during the examination indicate any pathological process: pancreatitis, pancreatic necrosis, neoplasm, and so on.

You should also take into account the size of the gland and the diameter of its main (Wirsung) excretory duct. Usually thickness is measured (anteroposterior measurement) different parts organ. Norm:

Doppler is rarely used to assess the condition of the pancreas.

kidneys

Despite the fact that the kidneys lie outside the abdominal cavity, their study is included in the standard ultrasound protocol. Evaluate a number of indicators, including the definition of position, shape, size and blood flow. Currently, the following standards are recommended for the above characteristics:

Kidney score	Norm
Position	The level of the XIIth rib (the right kidney is lower by 2-3 cm)
Dimensions	Length - 10-12 cm; Anteroposterior size - 4-5 cm; Width - 5-6 cm
Capsule	Smooth uniform continuous
The relief of the outer surface	Clear/somewhat wavy outline. The surface is smooth
The thickness of the renal tissue (parenchyma)	From 18 to 60 years old about 2 cm (there may be a deviation of 0.7 cm); After 60 years - more than 110 mm
Layer boundary (cortical and medulla)	clear
Sinus (calyces and pelvis) of the kidney	It is ½ of the size of the parenchyma
Blood flow rate	Less than 100 cm/sec

The above characteristics are enough to form a complete picture of the state of the kidneys.

What does an ultrasound show? This is an affordable study of the abdominal organs, which have echogenicity. It allows you to quickly assess their condition, which includes not only classical parameters (position, structure, size, and so on), but also Doppler. Because of this, ultrasound can be extremely useful in finding the cause of many diseases.

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Research methodology

The modern technique of ultrasound examination (ultrasound) allows with high diagnostic accuracy to assess the shape, size and location of the abdominal organs (liver, gallbladder, pancreas, spleen, etc.), to identify focal formations in them (cancer of the liver, pancreas, tumor metastases). , abscesses, cysts, hematomas, adenomas, etc.), assess the density and structure of the liver and pancreas parenchyma in their diffuse lesions, diagnose even small amounts (100–200 ml) of free fluid in the abdominal cavity, identify stones in the biliary tract , evaluate changes in large vessels, bile ducts, etc.

AT last years Ultrasound examination is widely used in the clinic as a method to help choose the optimal access for puncture liver biopsy, drainage of the abdominal cavity, and other manipulations.

Patient preparation. 3 days before the study, the patient is advised to exclude from the diet milk, black bread, fruits and vegetables, sweet juices and other foods that promote gas formation in the intestines. With a tendency to flatulence, enzyme preparations (festal, panzinorm, etc.) and adsorbents (activated carbon, chamomile infusion, etc.) should be prescribed.

On the evening before the study and in the morning immediately before the study, two cleansing enemas are given. However, this procedure is not mandatory in the absence of flatulence in the patient.

If an emergency ultrasound examination is required, special training gastrointestinal tract not carried out.

It should be remembered that it is advisable to conduct an ultrasound examination of the abdominal organs no earlier than 2 days after an X-ray examination of the stomach with contrast or esophagogastroduodenoscopy and 3–5 days after laparoscopy or pneumoperitoneum.

Research technique. Liver echography is usually carried out from subcostal and/or intercostal access in real time. The study of the liver is carried out while holding the breath while inhaling, when the liver goes down a little and becomes more accessible for visualization. With longitudinal scanning in the epigastric region, the sensor is placed 2 cm to the left of the anterior midline, with transverse scanning, the sensor is moved to the navel (Fig. 1). The technique of the so-called "oblique" scanning of the liver is also used, when the ultrasound sensor is located parallel to the right costal arch at an angle of 45 ° in the cranial direction, and other positions of the sensor.

Rice. 1. Ultrasound examination of the liver

Thus, it is possible to visualize the right and left lobes of the liver, gallbladder, common hepatic, common bile ducts, anatomical structures that make up the gates of the liver, and the head of the pancreas.

The study ends with a scan of the abdominal cavity to detect free fluid.

Analysis and interpretation of research results

Normal ultrasonic liver picture

On fig. 2. shows a normal echogram of the liver. At healthy person the sagittal dimensions of the liver along the mid-clavicular line are, on average, 10.5 ± 1.5 cm with fluctuations from 9 to 12 cm, and along the anterior midline - 8.3 ± 1.7 cm. The diameter of the liver is 20–22 .5 cm

The lower corner of the liver, formed by the dorsal and ventral surfaces of the organ, is acute: in the region of the left lobe it does not exceed 45°, and in the region of the right lobe - 75°.

Rice. 2. Normal echogram of the liver.

The portal vein is well visualized (in the center), below it is the right hepatic vein (longitudinal section)

Normally, the contours of the liver are clear and even throughout almost the entire length. The liver has a homogeneous structure with a uniform distribution of signals of the same intensity, an image of echostructures (vessels, ligaments, ducts). The inferior vena cava is constantly located in the form of a ribbon-like echo-negative formation with a diameter of up to 15 mm.

The portal vein, after its formation from the superior mesenteric and splenic veins, flows into the portal of the liver, which are located at the transverse and sagittal position of the probe. Intrahepatic ducts are normally traced with difficulty, their lumen increases from the periphery to the gates of the liver. Unlike veins, the intrahepatic ducts do not have walls.

Thus, the normal ultrasound picture of the liver is characterized by the presence of small, non-intense, relatively far apart echo signals, as a result of which echo-negative spaces remain between them. The echoes are homogeneous in size and evenly distributed throughout the liver. Portal vessels are traced along the periphery of the liver; the echostructure of their walls is more pronounced than the echostructure of the liver parenchyma surrounding them, the sound conductivity of the liver is completely preserved; sagittal size is 9–12 cm; the liver is elastic and has a smooth, clear contour.

Diffuse liver disease

The most common diffuse liver lesions include hepatitis (acute and chronic), fatty degeneration and cirrhosis of the liver. The correct diagnosis on ultrasound depends on a number of objective and subjective reasons (Table 1). The first of them include the type of device, its sensitivity, resolution, the presence of factors that worsen the image (obesity, gas formation in the intestine, etc.). The experience of the specialist and the thoroughness of the study are of great importance. The most difficult is the diagnosis early stages fatty degeneration and cirrhosis of the liver.

Table 1. The frequency of correct echographic diagnosis in diseases accompanied by diffuse liver damage (in percent)

Rice. 3. Echogram of the liver in a patient with chronic hepatitis

At acute and chronic hepatitis echographic picture is very nonspecific. Usually, an increase in the liver due to one or both lobes, rounding of its edges is determined. The echostructure is often normal, weakly echogenic (Fig. 3). Only for long-term illness echostructure of the liver becomes "variegated" and there is an alternation of areas of low and high echogenicity. In some cases, in particular, with the development of portal hypertension, an increase in spleen and expansion of the splenic and portal vein.

Fatty degeneration of the liver(fatty liver). The main echographic sign of fatty degeneration of the liver is an increase in the echostructure of the liver in the form of a uniform increase in the number and size of echo signals. This is due to the deposition of fat in the liver lobules, the distance between which and their size increase so much that ultrasonic waves are reflected from them.

Important but less specific features include liver enlargement, an increase in the lower angle of the left lobe of more than 45°, indistinct contours of the liver, and the inability to identify the portal vein.

The echographic picture in fatty degeneration of the liver depends on the degree of involvement of liver cells in the process. At the first stage of the disease, the liver is slightly enlarged, the edge is rounded. The echostructure has a variegated picture, the parenchyma is unevenly finely compacted. This is the so-called insular "type of lesion liver, which is also found in hepatitis. In the second stage, the liver bigger size, the lower edge is rounded, the structure of the parenchyma is small-focal, the liver is diffusely and evenly compacted. In the third stage of the disease, the liver is of considerable size due to an increase in both lobes. It has a rounded shape. The structure of the parenchyma of high density (echogenicity), portal vessels are not located.

Cirrhosis of the liver. There are direct and indirect echographic signs of liver cirrhosis (Table 2). The diagnosis of cirrhosis of the liver is considered reliable if ultrasound reveals 3 direct or 2 direct and 2 indirect signs of the disease.

Table 2. Direct and indirect echographic signs of liver cirrhosis

In most cases liver size enlarged, often predominantly due to the left lobe of the liver. In the final stage of the disease, with the predominance of atrophic processes, the size of the organ decreases.

Significant bottom edge rounding liver and irregularity of its contours.

echostructure of the liver significantly enhanced due to the appearance of more frequent and large echo signals, which is associated with a significant restructuring of the liver architectonics, characteristic of cirrhosis. During the atrophic stage, the number and size of echo signals decrease.

Finally, important signs of cirrhosis are decreased elasticity and sound conductivity of the liver.

Indirect echographic signs cirrhosis are associated mainly with the development of portal hypertension syndrome. Expansion of the splenic vein greater than 10 mm and portal vein greater than 15 mm considered reliable signs of increased pressure in the system v. porta.

An increase in the size of the spleen and an increase in its echostructure are observed in 60-70% of cases of liver cirrhosis, although this feature is not specific to portal hypertension.

Ascitic fluid in the abdominal cavity on ultrasound looks like an echo-negative structure that accumulates in the lateral parts of the abdomen, in the pelvis, or (with small amounts of fluid) is located around the liver. In these cases, it is advisable to study when changing the position of the patient's body (lying and standing).

"Congested" liver. In all cases of congestive circulatory insufficiency, an increase in the size of the liver and rounding of its edges are noted (Fig. 4). A pathognomonic sign of a "stagnant" liver is the expansion of the inferior vena cava and hepatic veins, branching of the hepatic veins at an angle close to 90 °. It is characteristic that the inferior vena cava loses the ability to change its diameter during breathing: it does not narrow at all during inspiration or narrows very little.

Rice. 4. Echogram of the liver in a patient with congestive circulatory failure

Focal changes in the liver

Ultrasound examination of the liver with focal liver changes is more informative than with diffuse lesions. At the same time, there is a local decrease or increase in the echostructure, a diffuse or focal increase in the size of the liver and the unevenness of its contour with the appearance of a bulge. Volumetric focal processes in the liver can cause compression of the bile ducts with the occurrence of obstructive jaundice.

The most common sign of focal liver changes is a violation of the normal echostructure of the liver. There are several types of focal violations of the echostructure.

Foci devoid of echostructure (liver cysts, hematoma, liver abscess, necrotic tumors).

Foci with reduced echostructure (metastases of poorly differentiated cancer, sarcoma, malignant lymphoma, hepatocellular cancer, adenoma, hemangioma, abscess, hematoma, etc.).

Foci with enhanced echostructure (metastases of highly differentiated cancer, hepatoma, adenoma, hemangioma, scars, foci of calcification) (Fig. 5–8).

The “target” symptom is a decrease in the echostructure along the periphery of the focus and its strengthening in the center (malignant tumor of the liver).

Rice. 5. Echogram of the liver in a patient with liver cancer

Rice. 6. Liver hemangioma

Rice. 7. Echogram of the liver in a patient with hepatoma

Rice. 8. Echogram of a patient with liver metastases

Thus, the information content of ultrasound examination of the liver is quite high, especially in case of focal lesions of the organ. However, the potential for false positives and false negatives should be considered. Therefore, when analyzing and interpreting the results of the study, it is necessary to take into account the clinical picture of the disease as a whole, as well as data from other laboratory and instrumental research methods.

It's important to know:

1. A normal ultrasound picture, including the sagittal dimensions of the liver along the mid-clavicular line, not exceeding 12–15 cm, does not exclude the presence of a disease of this organ.
2. Diffuse or focal changes in the echostructure of the liver reliably testify in favor of its pathology.
3. Cannot be reliably differentiated by ultrasound various forms hepatitis, the initial stages of fatty degeneration and cirrhosis of the liver.
4. At diffuse changes liver, the final diagnosis should be verified histologically (see below).
5. To clarify the diagnosis with focal changes in the liver, in most cases it is advisable to conduct targeted biopsy under echographic control for subsequent cytological and histological analysis.

Gallbladder and bile ducts

Ultrasound examination of the gallbladder and bile ducts has certain advantages over X-ray examination (cholecystography, intravenous cholegraphy, etc.), since it completely eliminates radiation exposure to the patient, allows examination in children and pregnant women, as well as with a decrease in liver and kidney function.

The most common indications for the study of the gallbladder and bile ducts are:

acute and chronic cholecystitis;

cholelithiasis;

• dropsy and empyema of the gallbladder;

  condition after cholecystectomy or other operations on the biliary tract.

When examining the gallbladder, its position, shape, size, respiratory mobility, the state of external and internal contours, wall thickness, wall structure, additional inclusions in the gallbladder cavity, and evacuation function of the organ are evaluated.

In the study of extrahepatic bile ducts, their position, diameter, condition of the walls, the presence of additional inclusions in the lumen are determined.

Fine the gallbladder appears as an echo-negative structure on the dorsal surface of the right lobe of the liver. The bottom of the gallbladder often protrudes from under the lower edge of the liver by 1.0–1.5 cm. Its length does not exceed 7–10 cm, and its width is 3–4 cm. The gallbladder has an elongated pear-shaped, oval or rounded shape, clear and smooth outline.

Intrahepatic bile ducts in a healthy person are not detected. The diameter of the common hepatic duct does not exceed 3–5 mm, and that of the common bile duct is 4–6 mm (Fig. 9).

Rice. 9. Normal echogram of the liver.

In the center, the common bile duct and under it the portal vein are visible (longitudinal section)

Acute cholecystitis. The characteristic echographic signs of acute cholecystitis is a thickening of the gallbladder wall of more than 4 mm. Its size may remain normal or even reduced, although a slight increase in the gallbladder is more often observed.

The echostructure of the gallbladder, primarily its internal contour, is usually reduced. With phlegmonous cholecystitis, the internal and external contours of the bladder are fuzzy. When pericholecystitis is attached, the wall of the gallbladder has a double contour with an increase in the echostructure of the outer and a decrease in the echostructure of the inner contour. The appearance of a strip of fluid around the gallbladder indicates the presence of local peritonitis.

Chronic (calculous) cholecystitis. During the period of remission of chronic cholecystitis, the size of the gallbladder is reduced or normal. The most reliable signs are the thickening of the bladder wall with its simultaneous compaction (strengthening of the echostructure) and the presence of clear contours. This distinguishes the echographic picture from that of acute cholecystitis.

The shape of the gallbladder often changes: bends, retractions of the walls and a more pronounced deformation of its walls appear (Fig. 10).

Rice. 10. Deformation of the gallbladder

At the same time, it should be remembered that the diagnosis of chronic cholecystitis cannot be made only on the basis of the results of an ultrasound examination: mandatory clinical confirmation is required.

Cholelithiasis. The problem of cholelithiasis (cholelithiasis) occupies a leading place in the pathology of the gallbladder. Ultrasound signs of gallbladder calculosis are divided into direct and indirect. Direct signs include the presence in the lumen of the gallbladder against the background of the echo-negative structure of bile, an enhanced echo signal corresponding to the location of the stone (Fig. 11). The size of the signal is slightly smaller than the true size of the stone. When examining a patient in a horizontal position, the stones are located mainly on the dorsal surface and in the neck of the gallbladder.

Rice. 11. Multiple gallbladder stones.

A solid acoustic shadow is clearly visible of considerable size

An important sign of calculosis is the displacement of stones with a change in body position. In an upright position, the stones "roll" to the bottom of the gallbladder. An echostructure coming from a calculus larger than 4 mm always forms a shadow track after itself - an acoustic shadow resulting from the absorption of ultrasonic waves by the calculus.

One of the indirect signs of gallbladder calculosis is an increase in its size of more than 5 cm in diameter and up to 10 cm or more in length, as well as thickening of its wall and uneven contour.

The echographic picture in the presence of stones in the extrahepatic bile ducts resembles that of gallbladder calculosis. Stones larger than 3-4 mm in diameter give an enhanced echo signal. If the diameter of the stone exceeds 5 mm, an acoustic shadow is determined behind its dorsal wall.

Small stones are usually not detected by ultrasound. In these cases, an indirect sign of calculosis is the expansion of the duct proximal to the place of its obturation.

Differential diagnosis of mechanical and parenchymal jaundice. Echolocation turned out to be one of the most informative and valuable methods of differential diagnosis of obstructive and parenchymal jaundice. It should be borne in mind that one of the main echographic signs of obstructive jaundice is the expansion of the biliary tract.

The differential diagnosis is based on the following principles.

If the intrahepatic and extrahepatic ducts are not dilated and the size of the gallbladder is not enlarged, the obstructive cause of jaundice is doubtful. In these cases, it is most likely the result of diffuse liver damage (hepatitis, cirrhosis, etc.).

If the intrahepatic ducts are significantly dilated, and the gallbladder and extrahepatic ducts are of normal size, the cause of jaundice should be seen in high obstruction, for example, at the level of the common hepatic duct.

If the dimensions of the extra- and intrahepatic bile ducts, as well as the gallbladder, are significantly increased, and these dimensions do not change with the use of choleretic agents, the most likely cause of jaundice is obstruction of the distal common bile duct (“impacted” stone, cancer of the sphincter of Oddi, carcinoma of the pancreatic head glands, etc.). It should be borne in mind that compression of the common bile duct with a tumor of the head of the pancreas is often accompanied by Courvoisier's symptom (an increase in the size of the gallbladder against the background of obstructive jaundice). In the presence of a stone in the common bile duct, the expansion of the ducts is determined, but the gallbladder is often not enlarged.

Ultrasound examination of the pancreas

Sonography makes it possible to visualize the pancreas in different projections and assess its condition in the dynamics of the development of the pathological process, although due to the peculiarities of the anatomical structure and location of the pancreas, the study is associated with certain difficulties.

Testimony for ultrasound examination of the pancreas are:

any recurrent or long-lasting pain in the epigastric region;

palpable formation in the epigastric region or tenderness on palpation;

verified acute or chronic pancreatitis in order to timely detect complications (formation of cysts, abscess, necrosis);

suspicion of a cyst, abscess, hematoma, pancreatic cancer;

deformation of the posterior wall of the stomach during gastroscopy;

change in the shape and contours of the loop of the duodenum during x-ray examination.

Ultrasound examination of the pancreas is started in the horizontal position of the patient by sagittal scanning. The sensor is installed longitudinally in the epigastric region to the left of the midline.

Inspection of the pancreas is preceded by the identification of large vessels of the abdominal cavity - the aorta, the inferior vena cava, the splenic and portal veins, the superior mesenteric arteries and veins, which serve as landmarks for finding the pancreas, as well as the celiac trunk. At the same time, the position of the vessels, their diameter, external and internal contours, pulsation, change in diameter during inhalation and exhalation, the presence of intraluminal inclusions are determined.

The body of the pancreas is adjacent to the dorsal surface of the left lobe of the liver, and the head is adjacent to the duodenum. Inspection of the pancreas is carried out at the height of maximum inspiration, when the left lobe of the liver descends into the abdominal cavity.

The study is continued with the transverse position of the ultrasound probe, which is gradually moved downward until the splenic vein is visualized. With transverse scanning, it is often possible to visualize the entire pancreas. If necessary, the study is carried out in other positions: with the patient on the right and left side, in a vertical position.

When examining the pancreas, its position relative to the “landmark vessels” and the spinal column is studied, the shape, contours and dimensions of the organ, the state of the pancreatic duct, the echostructure of the gland are determined, and the presence of focal changes in it is detected.

The pancreas is located retroperitoneally across the posterior abdominal wall at the level of I and II lumbar vertebrae. Although its shape may vary, the head is always the largest part of the gland. For practical purposes, it should be taken into account that the size of the head over 35 mm, the body over 25 mm and the tail over 30 mm reliably indicate an increase in the pancreas and associated pathology.

Normal echostructure of the pancreas in intensity resembles the echostructure of the liver. Small echo signals predominate, which are evenly distributed throughout the gland. With age, due to fibrotization and fat deposition, the echostructure of the pancreas increases.

With various pathological processes in the gland, its echostructure changes significantly. For acute pancreatitis, it is characterized by a significant decrease due to gland edema, and in chronic pancreatitis and cancer, it is increased and heterogeneous (due to the development of fibrosis and cicatricial changes).

Normally, the diameter of the Wirsung duct does not exceed 1.5–2 mm. After intravenous administration of secretin, its diameter increases to 2.5–5 mm. In chronic pancreatitis, an expansion of the pancreatic duct (up to 2.5–3.5 mm) is often detected. After the introduction of secretin, the diameter of its lumen almost does not change, which is an important diagnostic criterion for chronic pancreatitis.

In table. 3. Direct and indirect signs some of the most common diseases of the pancreas.

Table 3 Direct and indirect echographic signs of some diseases of the pancreas (according to M. M. Boger and S. A. Mordvov in modification)

On fig. 12-15 shows two-dimensional echograms of the pancreas with various diseases this organ.

Rice. 12. Echogram of the pancreas in a patient with chronic pancreatitis

Rice. 13. Changes in the echogram of the pancreas in a patient with pancreatic necrosis (clinical diagnosis)

Rice. 14. Two echograms of the pancreas (a, b) in a patient with small cystic transformation of the pancreatic head. Small cysts are visualized as small rounded anechoic areas.

Rice. 15. Cancer of the head of the pancreas

Without ultrasound data, it is almost impossible to diagnose some diseases. This category includes pathologies of the spleen. spleen ultrasound- a non-invasive and affordable diagnostic method.

CONSULTATION OF DOCTORS ON THE RESULTS OF ULTRASOUND, ANALYSIS - 500 rubles!

With the help of ultrasound diagnostics, with a high degree of certainty, it is possible to determine the size of an organ, local and diffuse structures, as well as confirm or refute the presence of neoplasms in it. This diagnostic method is safe and is used for both adults and children.

Indications for ultrasound diagnostics

The spleen (splen) is the largest lymphoid parenchymal organ. It has a peculiar shape of a flat hemisphere. The spleen is located in the upper left part of the abdominal cavity, behind the stomach.

Despite the fact that the organ is not considered vital, it performs the most important functions, which, by the way, are still not fully understood:

• Lymphopoiesis- production of antibodies and circulating blood lymphocytes - a kind of filter for bacteria, foreign particles and protozoa.
• Destruction of damaged red blood cells and platelets. The spleen, through the destruction of blood elements, participates in the formation of bile and in the metabolism of iron.
• Accumulation of platelets. A third of all platelets are stored in the organ.
• Production of lymphocytes and monocytes.
• Hormonal regulation of bone marrow function.

The procedure is carried out both for individual indications, in which case the doctor examines this particular organ, and for standard diagnostics of the abdominal cavity. The circulatory system of the spleen is interconnected with the vessels of other organs, and its tissues react to any abdominal pathology, so the organ must be examined during .

Ultrasound of the spleen is prescribed for the following disorders:

• All groups of blood diseases.
• or suspicion of their presence. Determining the location and degree of localization of metastases.
• Improper development of the organ. Congenital anomalies (absence of an organ, "wandering" spleen, several spleens, etc.).
• Abdominal injuries.
• Numerous infectious diseases, including (syphilis, malaria, sepsis, typhus, etc.).
• Liver diseases (cirrhosis, hepatitis, etc.). Determination of foci of purulent processes.
• Monitoring the results of the prescribed treatment.

Abdominal injuries, falls from a height and traffic accidents are especially important indications for the study of the spleen, since rupture of the organ, accompanied by blood loss, can be fatal.

What diseases of the spleen can be detected by ultrasound

Ultrasound examination of the spleen can detect a number of diseases even at the initial stage of pathology development. This explains the value of this survey.

These pathological changes include:

• cysts.
• Malignant, benign tumors.
• Abscess (purulent inflammation, life-threatening)
• Necrosis (death) of tissues.
• Mechanical damage that can lead to organ rupture or hematoma (hemorrhage, bruising).
• Inflammation.
• Sepsis (blood poisoning).
• Mononucleosis.

Despite the rather short list of pathologies, most of them, if left untreated, can lead to death.

Training

Ultrasound of the spleen is performed in the morning, on an empty stomach. Most exact result research is possible subject to high-quality preparation for the procedure:

• The last meal should be at least 7-8 hours before the examination. The exception is patients diabetes: they are allowed it is easy to have a snack in the morning (ideally - tea with crackers).
• 2 days before the procedure, it is necessary to adjust the diet - exclude foods that promote gas formation (beans, raw vegetables, black bread, carbonated drinks, dairy products, etc.). This is necessary to prevent fermentation in the intestines: air interferes with the examination of the spleen and distorts the result.
• Recommended taking sorbents and enzyme preparations that stimulate digestion (smecta, festal, mezim, etc.).
• If a person has increased gas formation, then he is additionally shown a reception activated carbon the day before the procedure. The dosage is calculated individually at the rate of 1 tablet per 10 kg of body weight.
• It is forbidden to smoke and drink alcohol at least a day before the procedure, as this can cause stomach cramps, which in turn will lead to a distortion of the results.

Preparing for an ultrasound scan of a child is somewhat more complicated, since it must be prepared not only physically, but psychologically. Though this procedure completely painless and safe, the child may experience irresistible excitement and fear. It is possible to reduce the examination procedure to a kind of game.

Difficulties are also present in the matter of nutrition. Children do not always tolerate hunger well, especially infants and children under 3 years of age. A pause in feeding the baby must be done 3 hours before the ultrasound, in children 2-3 years old - 4 hours, older than 3 years - at least 6 hours. Do not drink within 1 hour.

How is the procedure carried out

The duration of an ultrasound examination of the spleen does not exceed 15 minutes. The patient can receive the results of the examination immediately after the procedure. The survey is carried out as follows:

• The patient lies on the couch with his back and exposes his stomach.
• The doctor applies a special gel to the abdomen, which improves the glide of the probe and the penetration of ultrasonic waves deep into the tissues.
• The specialist performs the examination. The sensor is located along the midline of the abdomen, shifted to the left by 10 cm, and then parallel sections are made. After the doctor changes the direction of movement from the costal arch to the lower pole of the spleen.
• The received data is decrypted.

With congenital anomalies of the spleen, even if this is a conditional norm of development, it may be difficult to carry out the procedure. The solution to the problem is an ultrasound of the spleen through the intercostal space. To do this, the patient needs to take a certain position: lie on his right side, left hand raise by the head, then inhale deeply and hold your breath - in this state, the doctor examines the condition of the organ.

If no suspected pathologies have been identified, ultrasound continues with the patient in the prone position.

Deciphering ultrasound of the spleen: the norm of indicators

Normal results of an ultrasound examination of the spleen are as follows:

• Echogenicity: medium.
• The size splenic vein - no more than 0.5 cm (in diameter).
• Possible presence of a vascular network in the zone of the gate of the organ.
• Shape: in the form of a sickle.
• Location: in the abdominal cavity, in the left upper quadrant (between the diaphragm and the stomach).
• Localization of the stomach: at the center of the spleen (or slightly below).
• Location of the tail of the pancreas: at the middle organ gate.
• Localization of the left kidney: just below the spleen in the middle.
• Size: with an oblique cut - within 12 cm, transverse - up to 8 cm, thickness - about 4 cm.
• Weight: 150-250 g.
• The structure of the parenchyma is homogeneous, the contour is continuous.

The size of the spleen in children

In children, the normal size of the spleen depends not only on age, but also on height, therefore, individual fluctuations in indicators in children within 10% of the age norm are acceptable. Organ sizes for children of different ages are presented in the table.

Age	Length (mm)	Thickness (mm)
Newborn
1 year
3 years
5 years
7 years
10 years
14 years

If the indicators go beyond the normal range, the following pathologies may be suspected:

• hematological syndrome.
• anemia.
• leukemia.
• congenital heart disease.
• typhoid fever.
• tuberculosis.

Often, an enlarged spleen in children indicates a liver disorder.

Pathological indicators of the spleen: a list of changes by disease

Deciphering the pathology	Research indications
Leukemic infiltration	Enlarged spleen.Pointed edge.Excessive bulge of the contour.Increased density of the parenchyma.Inflammation of the lymph nodes at the gates of the organ.Enhancement of the echostructure.
Abscess	Transformation echostructures (mixed or hypoechoic).The appearance of a cyst (on ultrasound it looks like an oval formation with uneven contours).
Hematoma	Mixed or anechoic echostructure.Irregular borders of the contour of the spleen.
Gap	The appearance of fluid in the abdominal cavity or under the diaphragm. Wrong, uneven contour of the body.
heart attack	A compacted or thinned area was found on the spleen tissue.

Some diseases cannot be seen directly after an ultrasound examination of the spleen, but the doctor is able to determine them by the area of ​​\u200b\u200bthe largest oblique section. To find it, you need to multiply the largest linear size by the smallest. The norm of this indicator: 15.5-23.5 cm 2 .

Contraindications

Despite the fact that initially this method of research was perceived with skepticism, and for some it caused concern and fear, direct contraindications to ultrasound of the spleen have not yet been identified.

What to do after the study: who to contact?

Diagnostic specialist performing sonography. must provide the patient with a study protocol describing the location, shape, size, structure of the spleen, the state of the capsule, the diameter of the vessels and the calculated area of ​​​​the maximum oblique section. Also in the protocol, the doctor describes the identified pathology and disorders.

With the conclusion received, the patient should consult a doctor who sent for an ultrasound scan of the spleen.

Alternative Research

In medicine, there are many methods for examining the spleen:

• Computed and magnetic resonance imaging.
• Radionuclide scanning.
• Puncture.

Ultrasound of the spleen compared to other methods has a lot of advantages.

• Painless - the study does not require invasive procedures. Then, as a biopsy (tissue sampling for further analysis), although it is performed with anesthesia, the procedure is still unpleasant.
• Short time - obtaining the necessary information about the state of the organ and making a preliminary diagnosis takes only 15 minutes.
• It has no contraindications, which allows you to carry out the procedure many times. And this is very convenient for monitoring the course of the disease and adjusting the treatment.
• Affordable cost - Ultrasound has the lowest price among all methods.

Features and difficulties of diagnosis

The main disadvantage of diagnosing the spleen by ultrasound in pure form- the accuracy of the method is only with an increased size of the spleen. Therefore, it is better to study the organ with a comprehensive ultrasound of the abdominal cavity. If hepatitis and other generalized infections (mononucleosis, sepsis, etc.) are suspected, it is advisable to examine the spleen in combination with .

Where to do an ultrasound of the spleen in St. Petersburg

In St. Petersburg, the examination is carried out at. We have purchased , which allows you to accurately and accurately examine any organs. Diagnosis is carried out by a doctor of the highest qualification category.

It happens that the patient goes to the doctor, not knowing how to explain where he hurts. The phrase that the stomach constantly (often) hurts is not very informative for a specialist. However, it is necessary to find out the cause of the pain, and the doctor prescribes tests, as well as ultrasound of the spleen and other abdominal organs.

What is an ultrasound?

Ultrasound examination is a method of obtaining information about the state of an organ without instrumental penetration into the internal cavities of the body. The method is based on the piezoelectric effect associated with exposure to ultrasonic waves. The procedure allows you to display the organ under study, find out its size, examine defects and determine the general condition.

Why is an ultrasound of the spleen performed?

There are quite a few indications for an ultrasound of the spleen. The doctor will definitely prescribe a procedure if an organ injury is suspected and not only. There is a whole group of diseases in which such an examination is carried out regularly. It is performed with an interval of 6 months or a year.

And the spleen is prescribed regularly for the following pathologies:

• anomalies in the development of organs;
• blood leukemia;
• benign or malignant tumors or suspicion of their presence;
• determination of the exact site of metastasis formation;
• cirrhosis;
• hepatitis;
• numerous infectious diseases.

The procedures are carried out without complex manipulations, but there are still some medical recommendations for the liver and spleen.

It is especially worth pointing out that it is impossible to carry out the usual one in children. Therefore, for any suspicion of injury or pathology, ultrasound is prescribed. This is the only way to confirm or disprove fears. Children are prepared for the procedure in much the same way as adults.

Preparatory measures

If the patient is scheduled for an ultrasound of the spleen, the preparation is as follows:

1. It is better to sign up for an ultrasound in the morning. The last meal can be at least 9 hours before the examination. Patients with diabetes can drink some tea and eat some dried bread, since long-term fasting is contraindicated for them.
2. 2 days before the ultrasound, a sparing diet is established. It excludes raw vegetables, dairy products, bread and legumes. Such restrictions are not a doctor's whim, they allow you to avoid fermentation in the intestines, which, with ultrasound of the spleen, blocks the organ, preventing it from being examined.
3. With increased gas formation, a person is additionally prescribed the intake of activated charcoal. The dosage is calculated individually. For every 10 kg of body weight, 1 tablet is taken.

It is slightly more difficult to conduct a qualitative examination in children. Children do not tolerate hunger, especially breastfed babies and toddlers under the age of three. In preparation for the study, a break in feeding the baby should be at least three hours. A child whose age is 2-3 years old must endure 4 hours, and children over three years old - at least 6 hours. The remaining recommendations are followed in the same way as for adults.

When prescribing an ultrasound scan of the spleen, preparation for the examination will be better if you eat fractionally 2 days before the procedure. Portions of food should be minimal, it is better to eat every 4 hours.

Preparing for an ultrasound of the liver is not much different from the above steps. Additional measures are taken only by people with a high degree of obesity. They are recommended to conduct cleansing enemas in the morning and evening on the eve of the procedure.

Normal readings, decoding

If the form indicates the average echogenicity, a slight vascular network at the gates of the organ, the splenic vein is about 0.5 cm in diameter, the shape of the organ is smoothly curved, and its location is the upper left side of the abdominal cavity, then you can calm down. These are normal indicators.

During the examination, it is necessary to determine whether the spleen is enlarged. Ultrasound determines the dimensions of the organ in an oblique section - within 12 cm, and in the transverse section - within 8 cm. The normal thickness of the organ is about four cm.

Determination of the normal size of the children's spleen

If the doctor managed to feel the child's spleen during palpation, then the organ is enlarged by almost 2 times. In addition, there is an approximate table linking the height of the child and the size that his spleen should have. Ultrasound adults determine the size visually, and the norm for children should be viewed according to a special table. For example, it shows that with a height of 60-69 cm, the length of the spleen can vary from 47.8 to 61.3 mm. The thickness and width of the organ are also given here. The step of the table is every 10 cm of growth.

Pathological indicators of the spleen

If a patient has leukemic infiltration, then a study of the spleen can show the following pathologies:

• transformation of the size of the organ (increase);
• sharp edge of the spleen;
• excessive bulge along the contour;
• increase in density;
• inflammation of the lymph nodes in the region of the hilum of the spleen.

If there is an abscess, then the ultrasound will reveal:

• change in echostructure (mixed or hypoechoic);
• the appearance of a cyst.

If an injury is caused and there is a hematoma or organ rupture, then the examination will show:

• change in echostructure (mixed or anechoic);
• irregular, uneven contours;
• the appearance of fluid in the peritoneum or under the diaphragm.

A timely examination will allow you to make an accurate diagnosis and facilitate the process of treating the patient.

Norm and pathological parameters of ultrasound of the liver

If the patient underwent an ultrasound of the liver, then the size of the right lobe - up to 12 cm, the left - up to 7 cm, and the bile duct - up to 8 mm can be considered the norm. The outer edges of the organ should be even, and its structure should be uniform.

With the help of ultrasound, cirrhosis, hepatitis are detected, metastases, hemangioma are determined, hepatoma, steatosis, cystic neoplasms and other pathologies are detected.

At the same time, the information content of the examination for the doctor is very high. He can draw accurate conclusions based on the data obtained. In many cases, it is impossible to do without an ultrasound of the liver when making or clarifying the diagnosis.

To maintain health, you should take care of your body and, if symptoms appear, consult a doctor. Only a specialist is able to understand the problem. The doctor will prescribe tests, perhaps an ultrasound scan will be required to determine the diagnosis. Do not neglect medical help, as self-medication can harm your health.

Everyone understands that without a normal healthy liver, a person cannot fully exist. That is why parents have many questions regarding the increased size of this organ in children. What to do if a child has an enlarged liver, you will learn from this article.

Liver sizes - norms

It is customary to determine the size of the liver according to three parameters: on the right along the areola line, on the left along the oblique line and along the midline of the chest. How the lines go can be seen in the figure. The normal size of the liver in a healthy child is as follows:

• Up to 3 years - on the right side of the nipple line - 5 cm, on the midline - 4 cm, and on the left oblique line - no more than 3 cm.
• Up to 7 years - on the right side of the nipple line - no more than 6 centimeters, along the median sternal line - 5 centimeters, on the left oblique - no more than 4 centimeters.
• Up to 12 years - on the right along the areola line - no more than 8 centimeters, along the midline - 7 centimeters, along the left oblique - 6 centimeters.
• Over 12 years old - on the right along the areola line - 10 centimeters, along the midline - 9 centimeters, along the oblique left line - 8 centimeters.

In a healthy child, the normal liver should not be enlarged. Also, it should not go beyond the costal arch.

The exception is newborns and children who have not yet turned 1 year old. In them, such an exit beyond the costal arch can be a completely normal physiological phenomenon, if the exit does not exceed 2 centimeters.

In children aged 5-6 years, the exit of the liver beyond the costal arch may also be present, however, it should not normally exceed 1 centimeter. Any deviations from the above norms are considered an increase in the liver and may indicate possible pathologies.

What are the deviations?

An enlarged liver is not an independent disease, but only a symptom of a disease. The symptom itself in medicine is called hepatomegaly. Not every increase should be considered a warning sign. If the child is not yet seven years old, if his size is slightly enlarged, doctors do not consider this condition to require medical intervention.

If the size of the liver is significantly enlarged or hepatomegaly is first detected after the age of seven, this symptom will be regarded as pathological, and all the efforts of the doctor will be directed to finding the true cause of the liver enlargement.

A vital organ can "grow" in size due to congenital pathologies:

• intrauterine infections;
• viral diseases that affected the fetus during pregnancy (primarily rubella, toxoplasmosis and cytomegalovirus);
• congenital absence or infection of the bile ducts (artresia);
• diseases of the cardiovascular system, during which one or another degree of heart failure develops;
• hemolytic disease that occurred to the fetus during pregnancy due to a Rh conflict with the mother, as well as a disease that “started” after the baby was born for the same reason (usually happens with Rh-positive babies born from Rh-negative mothers );
• numerous cysts;
• hereditary diseases of the blood circulation and blood vessels, in which the vessels expand pathologically, which is accompanied by spontaneous bleeding.

The liver can also increase for other reasons that are not congenital:

• Infectious mononucleosis;
• viral hepatitis;
• severe toxic poisoning with poisons or chemicals;
• inflammation of the gallbladder;
• tuberculosis;
• syphilis;
• obesity and metabolic diseases;
• diabetes;
• oncological diseases and blood diseases (lymphoma, leukemia, etc.).

Can lead to enlargement of the liver violations of the principle of balanced baby food, especially if carbohydrates and fats predominate in the baby's diet, and there are not enough proteins. If the pathology has congenital causes, then it is usually possible to establish it even in the first year of the baby's life, because the pediatrician during the examination will not be able to fail to notice the excess size of the liver during palpation. Pathological changes of an acquired nature are usually diagnosed later, closer to 5-7 years.

Since the list possible causes extremely wide, on your own it is better not to try to find out the true one.

Hepatomegaly - a syndrome that cannot be ignored, because not only the health of the crumbs in the future, but also his life depends on how quickly and correctly the child will be provided with qualified assistance.

Signs of pathologies

It is clear that parents cannot independently measure the baby's liver in order to understand if he has deviations from the norm. But any mother can suspect something is wrong for a number of signs that may indirectly indicate problems with the liver:

• the child often complains of heaviness in the abdomen, while the upper abdomen on the right is somewhat painful when lightly pressed by the hand;
• the skin has a yellow or yellowish tint, the eyeballs turn yellow;
• the baby has nutritional problems - lack of appetite, nausea and vomiting, stool instability, frequent diarrhea;
• feces become very light, sometimes almost white, and urine, on the contrary, darkens;
• prolonged jaundice in newborns (if more than two weeks have passed since discharge from the hospital, and the child is still yellow, this is a reason to check the liver);
• characteristic bitter smell from the mouth (not a mandatory sign!).

Where to apply?

If parents suspect a child has liver problems, you should definitely visit a pediatrician with your child. Of course, such a specialist as a hepatologist will be able to sort out the problem much faster, but there are not so many doctors of such a rare and narrow specialization in Russia, and they are not accepted in every clinic.

If there is an opportunity to visit such a doctor, then it is better to do it. If there is no hepatologist, a pediatrician and a gastroenterologist will help. In such a duet, two specialists will definitely find pathological causes, if any, and will be able to prescribe adequate treatment. It is strictly forbidden to delay the start of the examination. Any malfunction in the liver, and an increase is also considered a malfunction, increase the likelihood of intoxication. After all, the body's natural "filter" created by nature - the liver - does not fully operate.

Usually, an experienced pediatrician can already determine whether the child's liver and spleen are enlarged with the help of his hands - by palpating and tapping the liver area. Suspicions are confirmed by ultrasound diagnostics.

On ultrasound, you can see not only the exact dimensions of the liver (up to millimeters), but also possible changes in its tissues, disorders in the right or left lobe.

Treatment

For children under 7-8 years old, a slight increase in the liver (slightly more than 2 centimeters) is corrected with the help of medications. Surgical intervention is permissible only in case of gross and severe congenital liver damage associated with structural abnormalities. Treatment always begins with the treatment of the underlying disease identified. If a viral infection is to blame for everything, the child can be hospitalized and in a hospital they can pierce a course of effective antiviral drugs ( "Tamiflu"). At home, such drugs are not prescribed, but antiviral drugs available to everyone from a pharmacy ( "Anaferon" and others) officially effective and influencing the course viral infection are not considered.

Bacterial infections or diseases with associated inflammatory processes are usually treated with antibiotics, choosing the least severe, so as not to put additional medicinal "pressure" on the liver. Metabolic diseases are treated by an endocrinologist using special drugs that improve and normalize metabolic processes. Simultaneously with the treatment of the underlying disease, a child with an enlarged liver is prescribed special hepatoprotective therapy. It includes funds whose task is to support an already suffering liver during a drug load.

Usually in maintenance therapy for the liver there are drugs such as "Essentiale", "No-shpa", Karsil, "Heptral" and "Duspatalin". Among the hepatoprotectors most often prescribed in childhood, one can note "Galsten", "Ursosan", "Holenzim".

In order for the child's body to work better, drugs containing important enzymes are prescribed during treatment, which may be produced in insufficient quantities due to pathology. These drugs include Creon,"Mezim".

It is not worth taking enzymes for too long, so as not to "spoil" the child's body. Otherwise, it will reduce the production of its own enzymes to nothing, which will then lead to very disastrous consequences.

The child, regardless of the cause that led to the liver enlargement, prescribed a special diet. Fatty foods are completely removed from the child's menu for a long time - butter, lard, cheeses with a high percentage of fat, full-fat milk and sour cream. A baby with hepatomegaly is strictly forbidden cocoa, chocolate, eggs, mushrooms, nuts, fatty meats, acidic drinks, including fruit juices, canned and smoked meats, spices and even ice cream. Adhering to a diet is very important, otherwise the treatment may not be effective, despite taking the prescribed drugs. The child needs lean meats, vegetables, steamed and baked foods. Fried and fresh pastries should be avoided. You need to eat fractionally, at least 5 times a day in small portions.

Not a single doctor will give forecasts in the treatment of an enlarged liver in advance, because many things affect the outcome of the pathology - the underlying disease, the state of the baby's immunity, and the degree of enlargement of the liver itself. However, timely treatment and promptly started treatment, according to the statistics of the Ministry of Health for 2016, provide a favorable prognosis in more than 90% of cases.

It is most difficult to predict an increase in liver if it is caused by toxic poisoning, as well as complicated onset cirrhosis. Such problems are much less amenable to therapy, but even here a positive outcome is estimated at more than 60%.

Mom can protect her child from liver problems even at the stage of pregnancy. If she is attentive to her health, to beware of infections, viruses, then the chances of pathological changes in the laying and functioning of the digestive organs in the body of the crumbs will be minimal.

A child of 2 years old, like a child of 3-4 years old and older, should not have an abundance of fatty and carbohydrate foods on the table, especially with a sedentary lifestyle. Passion for fast food at an older age - at 8-10 years old, can also lead to fatty liver, and this will be quite dangerous, since such an increase will never be considered physiological. Tip one - you need to be careful about the nutrition of the child.

Prevention also includes precautions that parents should take when storing toxic substances at home that they need in everyday life. Free access can cause severe poisoning in a child with irreversible changes in the liver.

Quite often, parents, on the advice of friends and relatives, take themselves and give their children “to cleanse the liver” some decoctions, tablets and powders. Now a large and profitable business has been built on such pseudo-drugs. No decoctions and pills can be given to a child to prevent liver problems.! If there are problems, you need to go to the doctor. If not, enough healthy eating, active leisure, sports, so that you don’t need to “clean” anything.

All about the size of the liver, see the following educational video.