Abdominal Ultrasound: A Picture is Worth a Thousand Words

When we experience stomach pain, bloating, or unexplained discomfort, we often find ourselves in a dilemma: do I need an ultrasound, or should I get a gastroscopy and colonoscopy? Many of us aren't sure which diagnostic method is right for our stomach issues.

In this blog, we will clarify any uncertainties. We will explore exactly what an abdominal ultrasound is, when it should be done, what it can show us, and how it compares to more invasive endoscopic examinations.

What is an Abdominal Ultrasound and Why is it so Important?

An abdominal ultrasound is a fast, completely non-invasive, and painless diagnostic procedure. This examination is most often performed by a radiology specialist, a gastroenterologist, or a general practitioner with special training in ultrasound diagnostics. Its biggest advantages are the absence of harmful radiation, unlike X-rays or CT scans, its significantly lower cost compared to endoscopic procedures, and its high accessibility.

When is it Done?

As a preventive measure, an ultrasound should be done once a year as part of a regular systematic check-up. If you have symptoms, it is the first-line diagnostic method for various types of pain in the liver, gallbladder, kidneys, pancreas, urinary bladder, or intestines.

Ultrasound vs. Endoscopy: The Perfect Team

The question often arises as to why an ultrasound cannot replace a gastroscopy or colonoscopy. The answer lies in physics: ultrasound waves have a hard time passing through air and gases, which are abundant in hollow organs like the intestines and stomach. Endoscopy is necessary for a detailed analysis of the actual interior, lumen, and mucous membrane of these organs.

"However, an ultrasound is a crucial first step! Even though it cannot directly diagnose mild gastritis, for example, it can show a thickening of the stomach wall. Such ultrasound results is a clear signal and indication for the doctor to refer the patient for a further, more detailed gastroscopy," explains Dr. Aleksandra Filipović.

What Can a Doctor See on an Ultrasound?

A simple sweep of the ultrasound probe over your stomach gives us incredible insight into the state of your internal organs.

Here is a more detailed overview of all the conditions we can observe on an ultrasound, categorized by organ. An ultrasound gives us incredible insight into what is happening inside your body, and here is exactly what that looks like in practice:

Liver

• Fatty liver: This is one of the most common conditions we see today. It is a clear signal of metabolic syndrome, unhealthy lifestyle habits, obesity, or insulin resistance. Although it doesn't cause pain, a fatty liver can lead to more serious damage over time if habits aren't changed.
• Cirrhosis: This represents the late stage of liver fibrosis. The liver loses its smooth structure, becomes nodular and uneven, and its volume decreases. It is most commonly associated with chronic alcoholism, but it can also be a consequence of untreated hepatitis or advanced fatty liver disease.
• Hemangiomas: These are benign changes that we can think of as moles on the liver. Most often, they are completely harmless, produce no symptoms, and only require routine ultrasound monitoring once a year. If they start to grow rapidly, the patient is referred for an MRI for a more detailed analysis.
• Echinococcal cyst: A specific occurrence caused by a parasite, Echinococcus granulosus, which is most often transmitted via infected dogs or sheep. It is extremely important for the doctor to recognize this cyst because it must not be punctured. It is treated exclusively surgically or with specific medications.
• Tumors and metastases: Ultrasound can detect primary liver tumors, as well as metastases that have spread from other organs, such as the colon or stomach.

Gallbladder

• Gallstones: Form due to an excess of cholesterol or bilirubin. They can be tiny or take up the entire gallbladder. The problem arises when they move and get stuck in the bile ducts.
• Polyps: Unlike stones, polyps are growths on the gallbladder wall itself and do not move when the patient changes their body position. Most often, these are harmless cholesterol deposits, but they are monitored because the larger ones have the potential to become malignant.
• Inflammation: Whether acute or chronic, inflammation is recognized on an ultrasound by a drastically thickened gallbladder wall and the presence of fluid around it, which causes the patient severe pain under the right rib cage.
• Necrosis and tumors: In the most severe, neglected cases of inflammation, the gallbladder tissue can begin to die off, which is a surgical emergency. Gallbladder tumors are rarer, but can also be detected as irregular masses growing into the wall.

Pancreas

• Inflammation: In acute inflammation, often caused by a dislodged gallstone or alcohol, the pancreas looks enlarged, swollen, and darker on the ultrasound due to fluid accumulation.
• Cysts and pseudocysts: These often arise as a consequence of a previous episode of pancreatitis.
• Pancreatic cancer: Due to its anatomical position, the pancreas is harder to see if the patient has a lot of gas. However, ultrasound is excellent for spotting tumors in the head of the pancreas, as they often block the bile ducts and cause jaundice, which is a clear sign for further CT scan diagnostics.

Kidneys

• Kidney stones: If they are located within the kidney itself, they often don't hurt, but their passage through the urinary tract causes some of the most severe pain in medicine.
• Urinary retention: If a stone gets stuck in the canal, urine cannot drain into the bladder and backs up into the kidney. An ultrasound perfectly clearly shows how the kidney swells and expands under the pressure of that fluid.
• Cysts: These are very common, especially in older people, and in 99% of cases, they are completely benign and do not require treatment.
• Tumors: These can be seen as solid masses that disrupt the normal structure of the kidney.
• Why can't sand be seen? Fine sand does not have enough density and size to reflect ultrasound waves and create an image on the screen. Therefore, the doctor may send you for a urine analysis, where the presence of crystals is confirmed microscopically, even if the ultrasound is clear.

Intestines

• Acute appendicitis: Even though the intestines are full of gases that interfere with the ultrasound, an inflamed appendix is clearly seen as a thickened, immobile, and painful sausage-shaped structure in the lower right corner of the abdomen, often bordered by free fluid.
• Diverticula: These are dilations, or pockets, on the wall of the large intestine. When they become inflamed, the ultrasound shows a thickening of the intestinal wall and an inflammatory reaction in the surrounding fat tissue.
• Severe inflammatory processes and tumors: Chronic inflammatory bowel diseases like Crohn's disease or large tumors can be seen as coarse, asymmetrical thickenings of the intestinal wall that narrow its flow.

Urinary Bladder

• Inflammation: In severe urinary tract infections, the bladder mucosa reacts by swelling, so the bladder wall appears thickened and uneven on the screen.
• Proliferations and polyps: Benign mucosal growths that protrude into the urine-filled interior of the bladder.
• Tumors: Malignant changes are seen as cauliflower-like masses attached to the bladder wall that do not move. The most common symptom that brings a patient in for this examination is the painless appearance of blood in the urine.

Stomach

• Coarse wall thickening: A normal stomach wall is thin. If the ultrasound shows significant thickening, it can indicate severe gastritis, a stomach ulcer, or in worse cases, infiltrative tumors.
• Emptying problems: If you came to the examination fasting, your stomach should be empty. If the doctor sees on the ultrasound that the stomach is still full of fluid or food debris, it indicates a problem with stomach motility or a physical obstruction blocking the emptying into the intestines.

How to Prepare and What to Expect

Given that it is completely non-invasive, the examination is absolutely painless. The only discomfort you might feel is the coldness of the gel and the mild pressure of the probe on your stomach as the doctor thoroughly examines all regions.

For the picture to be worth a thousand words, your cooperation through adequate preparation is necessary:

• Fasting before the exam: You need to avoid eating 6 to 8 hours before the ultrasound. Food stimulates gas production in the intestines, and gases act like a curtain that blocks ultrasound waves and hides the organs behind them.
• Full urinary bladder: It is recommended that you drink about 3 to 4 glasses of plain water an hour before the examination and do not urinate. A full bladder acts as an acoustic window since fluid perfectly conducts ultrasound waves and allows the doctor to clearly see the bladder itself, as well as the pelvic organs, for example, the prostate in men, or the uterus and ovaries in women.

Your Health Comes First with Primea Polyclinic

An abdominal ultrasound is truly an examination that provides the maximum amount of information about your body with minimal effort and no pain at all. Don't wait for severe pain to appear to check your health. Prevention is always the best medicine.

At Primea, you will be welcomed by top experts and state-of-the-art ultrasound equipment. Whether you are coming in for a regular annual systematic check-up or have specific symptoms that worry you, our team is here to provide you with a clear diagnosis and safe guidelines for further treatment. Schedule your appointment today and see for yourself why a single image from our ultrasound speaks a thousand words about your health!

Services:
Abdominal ultrasound