Normal gut ultrasound

Posted on June 8, 2017

Images and text Genevieve Carbonatto. I would like to thank the IBUS group , in no particular order, Torsten
Kucharzik, Christian Masser,Giovanni Maconi, Frauke Petersen, Kim Nylund, Ruediger Goertz, Emma Calbrese,
Anil Kumar Asthana, Kerri Kovak, Rune Wilkens and Stefania Carmagnola for their fantastic course on gut
ultrasound which has spurred the following post and no doubt more to come

A recent study by Bein et al (1) showed that 812 patients presented to Emergency Departments on
average across NSW (Australia) per day in 2014 . This number appears to be climbing ( 905 a day in Nov
’14) . Abdominal / gastrointestinal presentations account for around 12 % of all ED presentations (3) The
ability to use ultrasound in the context of abdominal pain, is in my opinion, very rewarding. The  probe is
capable of directly insonating the location of   a patient’s pain. Very little attention is given to the
gastrointestinal tract in Emergency Medicine ultrasound and yet appendicitis, diverticulitis , acute
in ammatory bowel disease and bowel obstruction are every day Emergency Department presentations.
 Ultrasound can provide an excellent, non radiating alternative to CT.

What does normal gut look like on ultrasound?

  Reference: Kim Nylund

On ultrasound the 4 layers have distinct echogenicity. These alternate between hyperechoic and
hypoechoic.The nal layer is the mucosal interface in the centre which appears hyperechoic.
  

1 Serosa, hyperechoic, 2   Muscularis propria, hypoechoic, 3 Submucosa, hyperechoic 4 Mucosa,

hypoechoic  5 Mucosal interface Hyperechoic. Bowel wall thickness is 2.1cm.

This is the clip. The distinct layers of the gut can be seen throughout the bowel. Just below the abdominal
wall, the bowel can be seen sliding and moving and distinct layers are visible. The 5 layers as described
are referred to as the gut signature and indicates normal bowel.
What probe do you use?

Depends on body habitus but in general

Low frequency curvilinear probe for abdomen

High frequency probe for interrogation of  small gut

What are the features of small bowel?

Presence of peristalsis – which is forward motion of bowel content not a “to and fro” of gut
content, the latter suggests a bowel obstruction.
Good visualisation of the gut wall if the body habitus allows this and the probe frequency is
between  5 and 9 MHz
In general – no air within the lumen of the small bowel.

What is be the normal thickness of the bowel wall?

less than 3mm

Measurement is made from the hyperechoic mucosal luminal interface to the outer edge of the
hypoechoic mucosa

What are the features of large bowel?

Little peristalisis
Air “like clouds” within the lumen unless the bowel is collapsed
Haustra

References

Emerg Med Austr  doi: 10.1111/1742-6723.12712 ORIGINAL RESEARCH Feeling the HEAT:
Using Hourly Emergency Activity Tracking to demonstrate a novel method of describing activity
 and patient ow Kendall J BEIN,1 Saartje BERENDSEN RUSSELL,1,2 David MUSCATELLO,3 Dane
CHALKLEY,1 Rebecca IVERS4,5 and Michael M DINH1,
Rumack Diagnostic Ultrasound Chapter 8
Destiny trials – unpublished data Bein et al
Interbational ultrasound group : Module 1

This entry was posted in Cases, Bowel. Bookmark the permalink.

← Bowel oedema Appendicitis →

1 thought on “Normal gut ultrasound”

Gynecologist in Lahore says: Reply

September 22, 2017 at 5:01 pm

Very informative post

Leave a Reply
Your email address will not be published. Required elds are marked *

Comment

Name *

Email *

Website

POST COMMENT