General Ultrasound

#MedicalPhysicistOnTourPart3

Christmas Eve Eve saw me heading to General Ultrasound. I’ve had a good few ultrasounds in my time but never on my liver so it was very interesting to watch a specialist sonographer and radiology consultant who specialises in ultrasound performing liver ultrasounds in advance of a liver clinic later on in the morning.

Learning Points

• The echogenicity of a healthy liver is approximately that of the echogenicity of the cortex of the right kidney. Brighter livers indicate fatty deposits.
• The Common Bile Duct has a diameter of approximately 1 mm/decade of life on ultrasound.
• A Comet tail artifact can be from cholesterol reverberations, indicating adenomyomatosis, one example of where artifacts help with diagnosis!

Fatty Liver

Most of the livers we saw had a degree of fattyness associated with them ranging from “mild” to “severe” in the complex hierarchy that radiologists use to classify what they see. But what actually causes a fatty liver?

Consultant’s answer: Everything good in life!

A liver is classified as fatty if more than 10% of the liver’s weight is fat. Eating excess calories, alcohol abuse and rapid weight loss can lead to fatty liver disease. The risk factors most commonly linked to fatty liver disease are: obesity, diabetes and elevated triglyceride levels.

Main take away messages from #MedicalPhysicistOnTour

• Ultrasound is a great imaging modality for very non-specific queries and very specific queries. The grey area in the middle is where MRI comes into its own according to the consultant radiologist specialising in ultrasound!
• Hospitals are so complex! There are so many pockets of specialties that you would never have imagined!
• When asked whether you’re a doctor or a nurse when working in the hospital, a good response is to explain that you’re part of the bigger picture!