Keywords : Ultrasound
Focused Abdominal Sonography for Trauma (Fast) At the Emergency Department of Kirkuk General Hospital
Iraqi Postgraduate Medical Journal,
2018, Volume 17, Issue 2, Pages 188-192
Blunt abdominal trauma (BAT) is a diagnostic challenge. The introduction of bedside ultrasound provides another diagnostic tool for the emergency physician (EP) to detect intra-abdominal injuries.
To assess the benefits of FAST in the evaluation of patients with blunt abdominal trauma in the emergency department of Kirkuk General Hospital in Kirkuk.
PATIENTS AND METHODS:
This was a prospective study including100 consecutive cases of blunt abdominal trauma in the emergency department of Kirkuk General Hospital in Kirkuk. The results of FAST scans were analyzed and compared with operative findings, diagnostic laparoscopy and CT scanning when the FAST was positive or followed by a period of clinical observation when the FAST was negative. Descriptive statistics, sensitivity, specificity, and predictive values were calculated.
There was a 100 consecutive blunt abdominal trauma cases during 9 months period, and FAST scans were performed in these cases. The sensitivity and specificity were 92% and 93.3%, respectively. The negative predictive value was 0.97, while the overall accuracy was 93%.
The high specificity of FAST (93.3%) makes it a good ‘rule in’ tool for BAT patients. The high negative predictive value also makes the FAST scan a useful screening tool. However, ultrasound examination is operator dependent, and FAST scan has its own limitations.
Iraqi Postgraduate Medical Journal,
2007, Volume 6, Issue 1, Pages 7-17
Evaluation of jaundiced patients should include proper history and examination, laboratory investigation and imaging investigations (non invasive like US, CT and MRI or invasive like ERCP and PTC).
AIM OF STUDY:
The aim of this prospective study is to evaluate the role of US and MRI-MRCP in patients with obstructive jaundice in clinical practice.
This is a prospective study performed on 80 patients (42 female and 38 male) with an average age of 53 years presented with obstructive jaundice for whom abdominal ultrasound (US) and magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) performed in the departments of radiology in Al-Kadhemiyyah teaching hospital and Specialized surgical hospital and Baghdad teaching hospital from October 2003 to October 2005. The final diagnosis was found by endoscopic retrograde cholangiopancreatography (ERCP) and or surgery and confirmed by histopathology.
The most common cause of obstructive jaundice in our study was tumors (41.25%) followed by common bile duct stones (36.25%) then benign strictures (13.75%), hydatid cyst (6.25%) & finally choledochal cyst (2.5%). In this study, MRI-MRCP could differentiate surgical from medical jaundice in all cases, while US could differentiate surgical from medical jaundice in 91.25% of cases. MRI-MRCP correctly defines the level of obstruction in all cases (100%).While US correctly define the level of obstruction in only 86.2 % of the total cases. MRI-MRCP correctly suggests the most possible cause of obstruction in 96.25% of cases. While US correctly suggests the most possible cause in only 36.2 %.
So that US, as a screening modality is useful to confirm or exclude biliary dilatation & to choose patients for MRCP examination. MRI-MRCP is a useful non-invasive and essential method in the preoperative evaluation of patients with obstructive jaundice. In addition MRI-MRCP was superior to US or ERCP in studying the extent & staging of malignant lesions