Pain is a universal human experience. It is an unpleasant sensory experience associated with actual or potential tissue damage. Pain is a manifestation of an underlying disorder or disease. Abdominal pain is pain in the belly which could be a burning, throbbing or cramping type of pain.
Abdominal pain can be of either rapid onset, short duration, or slow onset and long duration, which can be due to different conditions affecting various abdominal organs such as the liver, gall bladder, pancreas, spleen, kidneys, urinary bladder, ovaries, uterus and intestines.
Why should one have an ultrasound for abdominal pain?
Ultrasound is the only easily available and affordable technique to see disease in the abdominal organs. It is a cheap and convenient diagnostic tool which can give us a diagnosis of the cause of the pain so that treatment can be started immediately.
Some common conditions causing rapid onset, severe abdominal pain are: –
Liver abscess
Gall bladder stones
Kidney stones
Inflammation of the
pancreas
Inflammation of the
appendix
Inflammation of the
spleen.
Twisting of the ovaries or
ovarian cysts
Urinary bladder infection
Inflammation of the
intestine
Slow onset and longer duration abdominal pain can be due to: –
Tumours of liver,
intestines and kidneys
Longstanding inflam-
mation of the pancreas
Longstanding infections
When should one have an ultrasound examination of the abdomen?
Ultrasound is a non-invasive and radiation-free modality which can be done on any patient at any time. It is also advisable for screening patients over 40 years of age during their annual health check-up.
What preparation does a patient need for abdominal ultrasound?
In an acute emergency there is no preparation required. But for routine abdominal ultrasound it is advisable the patient fast for at least three hours (to be able to see the gall bladder) and have a full urinary bladder.
What can cause acute abdominal pain and can an ultrasound diagnose these disorders?
1. Kidney and ureteric stones:
Pain due to kidney stones would be on the right or left side of the abdomen which can be transmitted from the back to the groin. Kidney stones are easily seen on ultrasound. The stones can be in any of the two kidneys and may also be in the ureters which could cause obstruction to the flow of urine to the bladder.
2. Gall bladder stones:
Stones in the gall bladder sometimes do not cause any pain, but once the stone blocks the gall bladder drainage the bile gets infected and will lead to infection in gall bladder and cause its inflammation. Patients with this condition typically have a pain on the right side under the ribs. Ultrasound is the preferred modality for diagnosis of this condition.
3. Inflammation of the appendix:
The appendix is a small tubular organ attached to the large intestine serving no useful function in humans. Everybody has an appendix, but once the mouth of the appendix is blocked by faecal matter or a stone, it causes infection of the appendix, producing excruciating pain on the right side of the lower abdomen. Ultrasound can pick up an inflamed appendix which is commonly treated by surgical removal to prevent life-threatening complications.
4. Inflammation of the pancreas:
The inflammation of the pancreas is known as pancreatitis. One of the main causes of pancreatitis is alcohol abuse. The other causes would be pancreatic stones, drug abuse or any pancreatic tumour. Pancreatic pain is typically in the midline of the belly and is transmitted to the back. The size and shape of the affected pancreas is clearly seen on ultrasound.
5. Cystitis:
Infection of the urinary bladder is called cystitis. The patient has a burning sensation and pain during urination in the lower abdominal region. The bladder wall thickens in cystitis which can be clearly measured with a sonogram.
6. Twisting of Ovaries:
This is an emergency requiring prompt surgical intervention. Twisting may occur in normal ovaries or in association with a pre-existing ovarian cyst/mass. Twisting usually occurs in childhood and during the reproductive years. The patient will have severe pelvic pain, nausea and vomiting. With the use of ultrasound and Doppler the size of the ovaries and its blood supply can be clearly seen.
7. Pelvic Inflammatory Disease (PID):
PID is a common condition. It is usually due to sexually transmitted disease, the most common being chlamydia and gonorrhoea. Infection usually spreads from the mouth of the womb. The presence of an intra-uterine contraceptive device (Loop or Copper T) increases the risk of PID. In the long term, it results in protracted pelvic pain, difficulty in conceiving and increased risk of ectopic pregnancy.
8. Liver abscess:
A liver abscess is an infection of the liver. Symptoms initially could be pain and jaundice. If the abscess bursts it is an emergency, where the abdomen has to be opened and cleaned surgically. But if the abscess is detected early by sonogram and is easily accessible it could be aspirated under ultrasound guidance with a needle and syringe.
Can ultrasound be used to treat abdominal conditions?
Accessible fluid collections and abscesses can be drained using a needle and syringe under ultrasound guidance. Fluid collected in the abdomen (ascites) and in lung spaces can be fully drained to ease the patient’s symptoms as well as aid in the diagnosis. Biopsies can be obtained from masses in the abdomen and pelvis. Ectopic pregnancies can be treated and ovarian cysts can be aspirated and injected under ultrasound guidance.
Conclusion
Ultrasound is the preliminary investigation of choice in patients with abdominal pain. It is widely available, easy to use and cheaper than other imaging modalities. A clearer picture of soft tissues that do not show up well on X-Rays is seen on ultrasound. No health risks are related to the use of ultrasound and hence it may be repeated if necessary. Real-time imaging is a good tool for guiding minimally invasive procedures such as needle biopsies and the aspiration of fluids.
