SONOGRAPHIC FINDINGS IN PATIENTS WITH NON TRAUMATIC UPPER ABDOMINAL PAIN (CASE STUDY OF KET MEDICAL SERVICES AND LIFE CHART SCANNING CENTRE ENUGU, NIGERIA)

ABSTRACT

This research was aimed at evaluating the usefulness of ultrasonography in the diagnosis and management of upper abdominal pain. A retrospective study was done atKet Medical Services   and Lifechart Scanning Centre Abapka, Enugu. A total of 236 patients that were scanned for upper abdominal pain from March, 2011 to March, 2012 were studied.The sonographicreports showed that Fatty liver is the highest sonographic findings in patients with upper abdominal pain with a total number of 41 (17.37%),followed by  hepatitis 36(15.25%),pyelonephritis 30(12.71%), hydronephrosis 19(8.05%), Splenomegaly 14(5.93%), 10(4.23%) each for cholecystitis and normal studies, 9 (3.81%) each for schistosomiasis and PUD, renal stone 8(3.38%), glomerulonephritis 7(2.96%), renal failure 4(1.69%), pancreatitis 3(1.27%), gall bladder sludge 2(0.88%), 1(0.42%) each for multiple hepatic cyst, haepatoma ,liver mass and poly cystic kidney. It was also found that 31-35years age group was mostly affected with upper abdominal pain and 0-5years age group was the least affected. Finally, the incidence of upper abdominal pain was greater in female than in male.

TABLE OF CONTENTS

Title page    –        –        –        –        –        –        –        –        –        i

Approval Page –   –        –        –        –        –        –        –        –        ii

Certification-        –        –        –        –        –        –        –        –        iii

Dedication  –        –        –        –        –        –        –        –        –        iv

Acknowledgement         –        –        –        –        –        –        –        –        v

Abstract      –        –        –        –        –        –        –        –        –        vi

Table of Contents          –        –        –        –        –        –        –        –        vii

CHAPTER ONE

1.0     Introduction –       –                  –        –        –        –        –        1

1.1     Background of Study-   –        –        –        –        –        –        1

1.2     Statement of Problem-   –        –        –        –        –        –        3

1.3     Purpose of Study-          –        –        –        –        –        –        –        3

1.4     Significance of Study-    –        —       –        –        –        –        3

1.5     Scope of the Study-       –        –        –        –        –        –        4

1.6     Definition of Terms –     –        –        –        –        –        –        4

1.7     Literature Review-         –        –        –        –        –        –        –        6

CHAPTER TWO

2.1     Theoretical Background-         –        –        –        –        –        –        11

2.2     Modes of sonography-   –        –        –        –        –        –        13

2.3     Strengths of ultrasound-          –        –        –        –        –        –        16

2.4     Weaknesses of ultrasound-      –        –        –        –        –        17

2.5     Risks and side-effects of ultrasound.-         –        –        –        –        18

2.6     Studies on the safety of ultrasound.- –        –        –        –        19

2.7     Abdomen-   –        –        –        –        –        –        –        –        20

2.8     Regions    – –        –                  –        –        –        –        –        22

2.9     Causes of Abdominal Pain and their Sonographic Features – 24

CHAPTER THREE

3.1     Research Methodology- –        –        –        –        –        –        32

3.2     Research design – –        –        –        –        –        –        –        32

3.3     Target population-         –        –        –        –        –        –        –        32

3.4     Sampling technique-      –        –        –        —       –        –        32

3.5     Sample size-         –        –        –        –        –        –        –        –        32

3.6     Source of data/material for the study –       –        –        –        –        33

3.7     Method of data collection –      –        –        –        –        –        33

3.8     Selection criteria- –        –        –        –        –        –        –        33

3.9     Data analysis-      –        –        –        –        –        –        –        33

3.10   Data presentation and results- –        –        –        –        –        34

CHAPTER FOUR

4.1     Discussion –         –        –        –        –        –        –        –        54

4.2     The Summary of Results-        –        –        –        –        –        55

4.3     Limitations of the study –        –        –        –        –        –        –        56

4.4     Recommendations –       –        –        –        –        –        –        56

4.5     Areas of further study – –        –        –        –        –        –        57

4.6     Conclusion –         –        –        –        –        –        –        –        –        57

REFERENCES–  –        –        –        –        –        –        –        –        58

Appendix–  –        –        –        –        –        –        –        –        –        62

LIST OF TABLES

Table 1:      Age distribution of sonographic findings in         patients with upper

Abdominal pain   –        –        –        –        –        –        35

Table 2:      Organ Distribution of cases in Patients with Upper Abdominal Pain and their Percentages –        –        –        –        37

Table 3:      Sonographic Findings in Patients with Upper Abdominal Pain and their Gender Distributions     –        –        –        –        38

Table 4:      Age Distribution of Sonographic findings in Patients with upper

Abdominal Pain. –        –        –        –        –        –        40

Table 5:      Organs Distribution of Cases in Patients with Upper Abdominal Pain and Their Percentages           –        –        –        –        42

Table 6:      Sonograhic Findings in Patients with Upper        Abdominal Pain and their Gender Distribution       –        –        –        –        43

Table7:       Age Distribution Of Sonograptic Findings In Patients With Upper Abonminal Pain   –        –        –        –        –        45

Table 8:      Organ Distributions of Cases in Patients with Upper Abdominal Pain and their Percentages –        –        –        –        47

Table 9:      Organ Distribution of Cases in Gender of Patients with Upper

Abdominal Pain and Their Percentages      –        –        48

Table 10:    Sonographic Findings in the Liver and Their Gender

Distribution in Patients with Upper Abdominal Pain    49

Table 11:    Sonographic Findings in the Kidney and Their Gender

Distributions        –        –        –        –        –        –        50

Table 12:    Sonograhic Finding in the Gall Bladder and Their Gender

Distributions        –        –        –        –        –        –        51

Table 13:    Sonographic findings in patients with Upper Abdominal Pain and their Gender Distributions     –        –        –        –        52

CHAPTER ONE

1.0     INTRODUCTION

1.1     BACKGROUND OF STUDY

          Abdominal ultrasound is a rapid and non-invasive method of examination of the abdomen. Abdominal ultrasound is an imaging procedure used to examine the internal organs of the abdomen including the liver, gallbladder, spleen pancreas and kidney.  The blood vessels that lead to some of these organs can also be looked at with ultrasound¹.

Abdominal pain is the most frequent reasons for abdominal scan.  Ultrasound is one of the non- invasive modalities used for the investigation of patient with abdominal pain.  Upper abdominal pain is one of the commonest complaints in patients seeking medical advices².

Upper abdominal ultrasound can reveal many possible conditions including abdominal aortic aneurysm, abscess, cholecystitis, gall stone, hydronephrosis, kidney stones, splenomegaly and pancreatitis³.

In preparation for ultrasound of the liver, gallbladder or digestive tract, the patient will be asked to fast overnight or for at least six hours prior to the test, which reduces bowel gas that can obscure the image and keeps the gallbladder filled with bile, making it easier to visualize its contents. In examination involving stomach and duodenum, the patient will be given water to drink immediately before the test because these organs are better visualized if there are filled with fluids⁴.  Abdominal pain may not come from the abdomen; some surprising causes include heart attacks and pneumonias.

The location of the pain within the abdomen can be an important clue in diagnosis during scanning⁵.  Symptoms that occur with upper abdominal pain include back pain, chest pain, constipation, diarrhea, fever, nausea and vomiting⁵.

Upper abdominal pain can be acute or chronic.  Upper abdominal pain whether acute or chronic is caused by diseases of the liver, gallbladder kidneys pancreas, stomach, duodenum, spleen, pleura pericardium and basal lung segments⁶. The characteristics of the pain, location and timing duration etc are Important in diagnosing its causes⁷. All these conditions have useful sonographic features which help in their diagnosis except uncomplicated peptic ulcer disease acute myocardial infarction and pneumonitis⁷.

The frequency with which even relatively inexpensive and non-invasive diagnostic tests are performed clearly places a burden on healthcare.  Therefore, it is important that their influence on patient management is assessed.  Unnecessary diagnostic investigation may lead to incidental findings or to additional unnecessary diagnostic procedures or even over treatment^.8

1.2     STATEMENT OF PROBLEM

• An increase in the rate of patients presenting with upper abdominal pain for sonographic studies has made it imperative to take a critical look at the different diagnosis.⁹
• Many of the predisposition factors may also be related to age and gender.

1.3     PURPOSE OF STUDY

• To evaluate the common ultrasound findings in patients with upper abdominal pain.
• To correlate the sonographic findings in patients with upper abdominal pain with age and gender.

1.4     SIGNIFICANCE OF STUDY

• The study will help us to know the pertinent role that ultrasound plays in the diagnosis of upper abdominal pain.
• The documentation of this work may serve as a guide to sonographers during scanning for accurate diagnosis.

1.5     SCOPE OF THE STUDY

          It was carried out atKet medical services and Life chart Scanning Centre  Enugu, Nigeria.  It covered a period of one year (from March 2011– March 2012).

1.6     DEFINITION OF TERMS

1. Fatty liver: Accumulation of fat in the liver, an indication of liver disease or benign changes, demonstrated using grey scale ultrasound.
2. Hepatomegaly: Enlargement of the liver to such an extent that it is can felt below the rib margin. This may be due to congestion as in heart failure, inflammation or tumour.
3. Hepatitis: Inflammation of the liver caused by viruses, toxic substance or immunological abnormalities.
4. Schistomosmiasis: A tropical disease caused by blood flukes of the genus schistosoma
5. Haemangioma: A benign tumour of blood vessels, it often appears on the skin as types of birthmark.
6. Hydronephrosis:- Distension and dilation of the pelvis of the kidney. This is due to an obstruction to the free flow of urine from the kidney
7. Pyelonephritis: It is the bacteria infection of the kidney substance. In acute pyelonephritis the patient has pain in the loins, a high temperature and shivering fits. In chronic pyelonephritis the kidney becomes small and scarred and kidney failure ensures.
8. Glomerulonephritis: It is any of a group of kidney disease involving the glomeruli usually thought to kind disease involving the glomeruli, usually thought to be the results of antibody – antigen reactions that localize in the kidneys because of their filtering function.
9. Renal stone: It is the calculi in the kidney.
10. Renal failure: It can be described as acute or chronic acute renal failure occurs when previously healthy kidney suddenly fail because of a variety of problems affecting the kidney and its perfusion with blood. Chronic renal failure occurs when irreversible and progressive pathological destruction of the kidney leads to end-stage renal disease.
11. Cholelithiasis: This is the formation of stones in the gall bladder
12. Cholecystitis: It is the inflammation of the gall bladder. It may be acute or chronic.
13. Splenomegaly: This is the enlargement of the spleen. It is most commonly occurs in malaria, schistosomiasis and other disorders caused by parasites

Pancreatitis: It is the inflammation of the pancreas. It can be acute or chronic.

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