General

Synonym/Acronym:
Abdominal ultrasound, abdomen sonography.

Common Use:
To visualize and assess the solid organs of the abdomen, including the aorta, bile ducts, gallbladder, kidneys, pancreas, spleen, and other large abdominal blood vessels. This study is used to perform biopsies and assist in diagnosing disorders such as aortic aneurysm, infections, fluid collections, masses, and obstructions. This procedure can also be used to evaluate therapeutic interventions such as organ transplants.

Area Of Application:
Abdomen from the xiphoid process to the umbilicus.

Description

Ultrasound (US) procedures are diagnostic, noninvasive, and relatively inexpensive. They take a short time to complete, do not use radiation, and cause no harm to the patient. High-frequency sound waves of various intensities are delivered by a transducer, a flashlight-shaped device, pressed against the skin. The waves are bounced back off internal anatomical structures and fluids, converted to electrical energy, amplified by the transducer, and displayed as images on a monitor. US is often used as a diagnostic and therapeutic tool for guiding minimally invasive procedures such as needle biopsies and fluid aspiration (paracentesis). The contraindications and complications for biopsy and fluid aspiration are discussed in detail in the individual related studies.

Different types of transducers and imaging systems are sometimes used in clinical settings. Conventional US systems assume that sound waves pass through tissue at a constant speed. Advances in technology have led to the development of “smart” transducers that can compensate for tissue aberrations in technically difficult patients. Other advancements in imaging systems include three-dimensional and Doppler US. Color Doppler US uses color to indicate the velocity and direction of blood flow. Power Doppler is a more sensitive Doppler variation, capable of providing detailed images of blood flow; a limitation of power Doppler is that it cannot provide information regarding the direction of blood flow. Spectral Doppler provides data from blood flow measurements in formats other than color—for example, it can convert the measurements into a graph representing distance of blood flow against time or as a unique sound heard with every heartbeat.

Abdominal US is valuable in determining aortic aneurysms, determining the internal components of organ masses (solid versus cystic), and evaluating other abdominal diseases, ascites, and abdominal obstruction. Abdominal US can be performed on the same day as a radionuclide scan or other radiological procedure and is especially valuable in patients who have hypersensitivity to contrast medium or are pregnant. US is also widely used for pediatric patients to help diagnose appendicitis and for infants to assign cause for recurrent vomiting.

This procedure is contraindicated for

N/A

Indications

  • Determine the patency and function of abdominal blood vessels, including the abdominal aorta; vena cava; and portal, splenic, renal, and superior and inferior mesenteric veins.
  • Detect and measure an abdominal aortic aneurysm.
  • Monitor abdominal aortic aneurysm expansion to prevent rupture.
  • Determine changes within small aortic aneurysms pre- and postsurgery.
  • Evaluate abdominal ascites.
  • Evaluate size, shape, and pathology of intra-abdominal organs.

Potential Diagnosis

Normal Findings In:

  • Absence of ascites, aortic aneurysm, cysts, obstruction, or tumors
  • Normal size, position, and shape of intra-abdominal organs and associated structures

Abnormal Findings In:

Identification of abnormal findings is assisted by comparison of parameters such as size, shape, symmetry, and location; for example, areas of altered echo patterns in either an expected or unexpected location may indicate enlargement of an organ or the presence of blood or other fluids, tumors, or cysts. Comparison by type of abnormal findings may also assist in evaluating areas of altered patterns; for example, small round or oval areas with well-defined borders and clear central areas can differentiate a fluid-filled cyst from a solid tumor

  • Abdominal abscess, ascitic fluid, or hematoma
  • Aortic aneurysm greater than 4 cm
  • Congenital absence or malplacement of organs
  • Gallbladder or renal calculi
  • Tumor, liver, spleen, or retroperitoneal space

Critical Findings

  • Aortic aneurysm measuring 5 cm or more in diameter.

Note and immediately report to the requesting health-care provider (HCP) any critical findings and related symptoms. A listing of these findings varies among facilities. Timely notification of a critical finding for laboratory or diagnostic studies is a role expectation of the professional nurse. The notification processes vary among facilities. Upon receipt of the critical finding, the information should be read back to the caller to verify accuracy.

Interfering Factors

Factors that may alter the results of the study

  • Attenuation of the sound waves by bony structures which can impair clear imaging of the upper abdominal structures.
  • Incorrect placement of the transducer over the desired test site; quality of the US study is very dependent upon the skill of the ultrasonographer.
  • Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images.
  • Inability of the patient to cooperate or remain still during the procedure because of age, significant pain, or mental status.
  • Retained air, barium, or gas from a previous radiological procedure may block the transmission of sound waves.
  • Gas or feces in the gastrointestinal (GI) tract resulting from inadequate cleansing or failure to restrict food intake before the study.
  • Patients who are technically difficult and who present challenges in obtaining reliable results (e.g., who are obese; have reduced rib spaces; present with fatty liver; have postoperative incisions, bandages, or dressings; have significant scarring in the area of interest). Aberrations in tissue composition may attenuate the sound waves and alter findings.

Other Considerations:

  • Failure to follow dietary and fluid restrictions and other pretesting preparations may cause the procedure to be canceled or repeated.
  • The procedure may be canceled if the patient’s weight exceeds the safety limit for the equipment.

Nursing Implications Procedure

Related Studies

Potential Nursing Problems

ProblemSigns & SymptomsInterventions
Grief (related to diagnosis; fear; poor prognosis; surgery; disease staging; tumor)Verbalization of fear and distress; crying; expressions of anxiety; restlessnessAssess level of anxiety and possible coping mechanisms to mitigate that anxiety; allow verbalization of fears, concerns related to possible death, and poor prognosis; consider spiritual advisor support; provide clear and easy-to-understand information related to disease and treatment options; provide appropriate, calming reassurance; consider cultural aspects of grieving in planning care; discuss applicability of home health care
Anxiety (related to pain; diagnosis; fear of unknown; tumor; aneurysm)Stated anxiety; restlessness; increased heart rate; appears apprehensive; may be confused or distracted; sleeplessness; fatigueDiscuss use of alternative measures to decrease anxiety (relaxation techniques, imagery, music, etc.); explain the purpose of all diagnostic studies in clear, age-appropriate, and culturally appropriate terms; stay with the patient during critical moments to decrease anxiety
Knowledge (related to new disease process, new treatment plan; new information; prognosis)Asking multiple questions; states lack of understandingAssess for clear understanding of provided information related to disease process and treatment options; use language that is age-, culture-, and literacy-appropriate; move from simple to complex concepts when teaching; consider the learning style of the patient when selecting teaching methods

Pretest

  • Positively identify the patient using at least two person-specific identifiers before services, treatments, or procedures are performed.
  • Inform the patient this procedure can assist in assessing abdominal abnormalities.
  • Obtain a history of the patient’s health concerns, symptoms, surgical procedures, and results of previously performed laboratory and diagnostic studies. Include a list of known allergens, especially allergies or sensitivities to latex.
  • Note any recent procedures that can interfere with test results (e.g., surgery, biopsy, barium studies, colonoscopy, endoscopic retrograde cholangiopancreatography). Ensure that interfering studies were performed at least 24 hr before this test or can be rescheduled after this procedure.
  • Obtain a list of the patient’s current medications, including over-the-counter medications and dietary supplements (see Effects of Dietary Supplements online at DavisPlus).
  • Review the procedure with the patient. Address concerns about pain related to the procedure. Explain to the patient that there may be moments of discomfort experienced during the test. Inform the patient that the procedure is performed in a US department, by a HCP specializing in this procedure, with support staff, and takes approximately 30 to 60 min.

Pediatric Considerations Preparing children for an abdominal US depends on the age of the child. Encourage parents to be truthful about what the child may experience during the procedure and to use words that they know their child will understand. Toddlers and preschool-age children have a short attention span, so the best time to talk about the test is right before the procedure. The child should be assured that he or she will be allowed to bring a favorite comfort item into the examination room and, if appropriate, that a parent will be with the child during the procedure. Provide older children with information about the test, and allow them to participate in as many decisions as possible (e.g., choice of clothes to wear to the appointment) in order to reduce anxiety and encourage cooperation. If the child will be asked to maintain a certain position for the test, encourage the child to practice the required position, provide a CD that demonstrates the procedure, and teach strategies to remain calm, such as deep breathing, humming, or counting to himself or herself.

  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Instruct the patient to remove jewelry and other metallic objects in the area to be examined.
  • Instruct the patient to fast and restrict fluids for 8 hr prior to the procedure; instruct the caregiver of a pediatric patient to have the patient fast and restrict fluids for 8 hr prior to the procedure or as ordered. Food restrictions help ensure reduction of bowel gas, which can interfere with the transmission of US waves. Protocols may vary among facilities.

Intratest

Potential Complications:
N/A

  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection online at DavisPlus. Positively identify the patient.
  • Ensure that the patient has complied with dietary and fluid restrictions prior to the procedure, as instructed.
  • Ensure that the patient has removed external metallic objects prior to the procedure.
  • Instruct the patient to void prior to the procedure and to change into the gown, robe, and foot coverings provided.
  • Instruct the patient to cooperate fully and to follow directions. Instruct the patient to remain still throughout the procedure because movement produces unreliable results.
  • Place the patient in the supine position on an examination table. The right- or left-side-up positions may be used to allow gravity to reposition the liver, gas, and fluid to facilitate better organ visualization.
  • Expose the abdominal area and drape the patient.
  • Conductive gel is applied to the skin, and a Doppler transducer is moved over the skin to obtain images of the area of interest.
  • Ask the patient to breathe normally during the examination. If necessary for better organ visualization, ask the patient to inhale deeply and hold his or her breath.

Post Test

  • Inform the patient that a report of the results will be sent to the requesting HCP, who will discuss the results with the patient.
  • When the study is completed, remove the gel from the skin.
  • Instruct the patient to resume usual diet and fluids, as directed by the HCP.
  • Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be needed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Patient Education:

  • Teach the pathophysiology associated with the diagnosis.
  • Teach the patient treatment options for diagnosis.

Expected Patient Outcomes:


Understanding
  • The patient and family accurately describe treatment options in relation to diagnosis.
  • The patient and family state the effects selected treatment options may have on current lifestyle.

Ability
  • The patient demonstrates grief over personal concerns appropriately with the support of family and significant other.
  • The patient demonstrates effective coping mechanisms to decrease anxiety.

Response
  • The patient agrees to discuss concerns with identified support (family, friends, group, spiritual advisor).
  • The patient agrees to lifestyle modifications to control disease process and symptoms.
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