By Jane Bates
Ultrasound remains to be the most vital diagnostic instruments in medication and is utilized by a variety of healthcare pros throughout many functions. This e-book presents a pragmatic, clinically appropriate advisor for all practitioners operating within the box of belly ultrasound. Its goal is to let the operator to maximise the diagnostic details and realize the constraints of ultrasound scans.
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Additional resources for Abdominal Ultrasound: How, Why and When (3rd Edition)
This allows subsequent correlation with other imaging, such as computed tomography (CT) or magnetic resonance imaging (MRI), and is invaluable in planning surgical procedures. The segmental anatomy system, proposed by Couinaud in 1900,2 divides the liver into eight segments, numbered in a clockwise direction. They are divided by the portal and hepatic veins and the system is used by surgeons today when planning surgical procedures (Fig. 17). This system is also used when localizing lesions with CT and MRI.
D) Turning the patient decubitus, right side raised, unfolds the gallbladder, enabling the neck to be fully examined (arrows). (E) The unwary operator may miss the neck of gallbladder altogether (left hand image) if not aware that it is folded back (right hand image); always ensure the technique used is comprehensive, rather than simply aimed at getting images. 39 2 The normal hepato-biliary system Fig. 31 • Double gallbladder: an incidental finding in a young woman. A • Check the patient has fasted • Look for an ectopic gallbladder – positioned low in the pelvis for example • Check that near-field artefact has not obscured an anterior gallbladder – a particular problem in very thin patients.
In most cases the single, main RHV flows directly into the IVC, and the middle and left have a common trunk. In 15–35% of patients the LHV and MHV are separate. This usually has no significance to the operator. However, it may be a significant factor in planning and performing hepatic surgery, especially tumour resection, as the surgeon attempts to retain as much viable hepatic tissue as possible with intact venous outflow4 (Fig. 23). Haemodynamics of the liver Fig. 19 • The portal vein radicle is associated with a branch of the hepatic artery and a biliary duct (arrows) within the hyperechoic fibrous sheath.