Sonographic findings in patients with an acute pain in Right Upper Quadrant
DOI:
https://doi.org/10.54393/pbmj.v5i1.236Keywords:
Ultrasonography, Right Upper Quadrant pain, Cholecystitis, Fatty Liver DiseaseAbstract
Abdominal pain is a common presentation in the outpatient setting. Patients presenting to the emergency department with RUQ pain are often diagnosed with acute cholecystitis. The spectrum of diseases is also associated with RUQ pain including choledocholithiasis, biliary colic and liver pathologies. Ultrasoundis the first-line imaging modality opted to diagnose the cause of RUQ pain. More than one-third of patients suspected of having acute cholecystitis and right upper quadrant pain after the initial clinical evaluation are ultimately proved to have a different diagnosis.The objective of this study is to find sonographic findings in patients with acute RUQ pain and establish reasons of using Ultrasound in these circumstances. Material and Method: A total of 385 cases who were presented with RUQ pain in Sanabil Health Services Hospital were included in this descriptive observational study. 190 were female and 195 were male with a mean age of 44.7±13.4 years. A thorough scan of complete abdomen was done and results were analyzed through IBM SPSS statistics 28.0 version 2021. Results:Out of total 385 patients, 91 patients (23.6%) were suffering from cholelithiasis and only 19 (5.0%) of them had cholecystitis which are major causes of right upper quadrant pain. Majority of patients (26.8%) were diagnosed with Fatty liver disease, Obstructive kidney disease (17.4%) and a significant number of patients (14.5%) were also normal on Ultrasound scan. Conclusion:The Ultrasonographic diagnosis of majority of patients who are presented with right upper quadrant pain is fatty liver disease and other pathologies which are known to not cause any pain in right upper quadrant
References
Suri S, Muttukrishna S, Jauniaux E. 2D-ultrasound and endocrinologic evaluation of placentation in early pregnancy and its relationship to fetal birthweight in normal pregnancies and pre-eclampsia. Placenta. 2013 Jun 8. DOI: 10.1016/j.placenta.2013.05.003. [Epub ahead of print]
https://doi.org/10.1016/j.placenta.2013.05.003
Park SJ, Yi BH, Lee HK, Kim YH, Kim GJ, Kim HC. Evaluation of patients with suspected ureteral calculi using sonography as an initial diagnostic tool: how can we improve diagnostic accuracy?. Journal of Ultrasound in Medicine. 2008 Oct;27(10):1441-50.
https://doi.org/10.7863/jum.2008.27.10.1441
Kiewiet JJ, Leeuwenburgh MM, Bipat S, Bossuyt PM, Stoker J, Boermeester MA. A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis. Radiology. 2012 Sep;264(3):708-20.
https://doi.org/10.1148/radiol.12111561
Yang MH, Chen TH, Wang SE, Tsai YF, Su CH, Wu CW, Lui WY, Shyr YM. Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Surgical endoscopy. 2008 Jul;22(7):1620-4.
https://doi.org/10.1007/s00464-007-9665-2
Bingener J, Richards ML, Schwesinger WH, Strodel WE, Sirinek KR. Laparoscopic cholecystectomy for elderly patients: gold standard for golden years?. Archives of surgery. 2003 May 1;138(5):531-6.
https://doi.org/10.1001/archsurg.138.5.531
Chang L, Chang M, Chang HM, Chang AI, Chang F. Clinical and radiological diagnosis of gallstone ileus: a mini review. Emergency radiology. 2018 Apr 1;25(2):189-96.
https://doi.org/10.1007/s10140-017-1568-5
Yu CY, Lin CC, Shyu RY, Hsieh CB, Wu HS, Tyan YS, Hwang JI, Liou CH, Chang WC, Chen CY. Value of CT in the diagnosis and management of gallstone ileus. World journal of gastroenterology: WJG. 2005 Apr 14;11(14):2142.
https://doi.org/10.3748/wjg.v11.i14.2142
Aldo C, Lorenzo M, Olgerta L, Alberto C, Licia U, Melchiore G. Rolling in the Deep: Imaging Findings and Diagnostic Pearls in Gallstone Ileus. Surgery Research and Practice. 2020 Apr 24;2020.
https://doi.org/10.1155/2020/1421753
Lassandro F, Gagliardi N, Scuderi M, Pinto A, Gatta G, Mazzeo R. Gallstone ileus analysis of radiological findings in 27 patients. European journal of radiology. 2004 Apr 1;50(1):23-9.
https://doi.org/10.1016/j.ejrad.2003.11.011
Chang L, Chang M, Chang HM, Chang AI, Chang F. Clinical and radiological diagnosis of gallstone ileus: a mini review. Emergency radiology. 2018 Apr 1;25(2):189-96.
https://doi.org/10.1007/s10140-017-1568-5
Osagiede O, Pacurari P, Colibaseanu D, Jrebi N. Unusual Presentation of Recurrent Gallstone Ileus: A Case Report and Literature Review. Case reports in gastrointestinal medicine. 2019 Oct 3;2019.
https://doi.org/10.1155/2019/8907068
Meyenberger C, Michel C, Metzger U, Koelz HR. Gallstone ileus treated by extracorporeal shockwave lithotripsy. Gastrointestinal endoscopy. 1996 May 1;43(5):508-11.
https://doi.org/10.1016/S0016-5107(96)70297-3
Bennett GL. Evaluating patients with right upper quadrant pain. Radiologic Clinics. 2015 Nov 1;53(6):1093-130.
https://doi.org/10.1016/j.rcl.2015.06.002
Johnson Jr H, Cooper B. The value of HIDA scans in the initial evaluation of patients for cholecystitis. Journal of the National Medical Association. 1995 Jan;87(1):27.
Laing FC, Federle MP, Jeffrey RB, Brown TW. Ultrasonic evaluation of patients with acute right upper quadrant pain. Radiology. 1981 Aug;140(2):449-55.
https://doi.org/10.1148/radiology.140.2.7255722
Revzin MV, Scoutt LM, Garner JG, Moore CL. Right upper quadrant pain: ultrasound first!. Journal of Ultrasound in Medicine. 2017 Oct;36(10):1975-85.
https://doi.org/10.1002/jum.14274
Joshi G, Crawford KA, Hanna TN, Herr KD, Dahiya N, Menias CO. US of right upper quadrant pain in the emergency department: diagnosing beyond gallbladder and biliary disease. Radiographics. 2018 May;38(3):766-93.
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