Bedside ultrasound in the diagnosis of nonalcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD)is the most common liver disease in the United States.While the American Association for the Study of Liver Diseases guidelines define NAFLD as hepatic steatosis detected either on histology or imaging without a secondary cause of abnormal hepatic fat accumulation,no imaging modality is recommended as standard of care for screening or diagnosis.Bedside ultrasound has been evaluated as a non-invasive method of diagnosing NAFLD with the presence of characteristic sonographic findings.Prior studies suggest characteristic sonographic findings for NAFLD include bright hepatic echoes,increased hepatorenal echogenicity,vascular blurring of portal or hepatic vein and subcutaneous tissue thickness.These sonographic characteristics have not been shown to aid bedside clinicians easily identify potential cases of NAFLD.While sonographic findings such as attenuation of image,diffuse echogenicity,uniform heterogeneous liver,thick subcutaneous depth,and enlarged liver filling of the entire field could be identifiedby clinicians from bedside ultrasound.The accessibility,ease of use,and low-side effect profile of ultrasound make bedside ultrasound an appealing imaging modality in the detection of hepatic steatosis.When used with appropriate clinical risk factors and steatosis involves greater than 33%of the liver,ultrasound can reliably diagnose NAFLD.Despite the ability of ultrasound in detecting moderate hepatic steatosis,it cannot replace liver biopsy in staging the degree of fibrosis.The purpose of this review is to examine the diagnostic accuracy,utility,and limitations of ultrasound in the diagnosis of NAFLD and its potential use by clinicians in routine practices.

A feasibility study to determine if minimally trained medical students can identify markers of chronic parasitic infection using bedside ultrasound in rural Tanzania

BACKGROUND: Parasitic infections pose a significant health risk in developing nations and are a major cause of morbidity and mortality worldwide. In the Republic of Tanzania, the CDC estimates that 51.5% of the population is infected with one or more intestinal parasites. If diagnosed early, the consequences of chronic parasitic infection can potentially be avoided.METHODS: Six first-year medical students were recruited to enroll patients in the study. They underwent ten hours of formal, hands-on, ultrasound which included basic cardiac, hepatobiliary, renal, pulmonary and FAST scan ultrasound. A World Health Organization protocol with published grading scales was adapted and used to assess for pathology in each patient's liver, bladder, kidneys, and spleen.RESULTS: A total of 59 patients were enrolled in the study. Students reported a sensitivity of 96% and specificity of 100% for the presence of a dome shaped bladder, a sensitivity and specificity of 100% for bladder thickening, a sensitivity and specificity of 100% for portal hypertension and ascites. The sensitivity was 81% with a specificity of 100% for presence of portal vein distention. The sensitivity was 100% with a specificity of 90% for dilated bowel.CONCLUSIONS: Ultrasound has shown a promise at helping to identify pathology in rural communities with limited resources such as Tanzania. Our data suggest that minimally trained first year medical students are able to perform basic ultrasound scans that can identify ultrasonographic markers of parasitic infections.

Seeing beneath the surface:Harnessing point-of-care ultrasound for internal jugular vein evaluation

Point-of-care ultrasound(POCUS)of the internal jugular vein(IJV)offers a noninvasive means of estimating right atrial pressure(RAP),especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery.While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein,this method lacks sensitivity.The utilization of POCUS significantly enhances the visualization of the vein,leading to a more accurate identification.It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation.This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein,drawing upon existing data.

Point-of-care ultrasound in nephrology:A private practice viewpoint

Point-of-care ultrasound(POCUS)is a limited ultrasound examination performed by the clinician at the bedside,emerging as a complement to physical examination across various medical specialties.In the field of nephrology,its integration has been gradual,primarily limited to guiding procedures like temporary dialysis catheter placement or,in some cases,diagnostic kidney ultrasounds.In reality,the assessment of hemodynamic status at the bedside holds immense value for nephrologists,yet there exists limited awareness among practitioners regarding its implementation.While there is a growing trend towards incorporating multiorgan POCUS training in fellowship programs,private practice nephrologists remain relatively uninformed.This discussion explores the untapped potential of POCUS as a valuable diagnostic tool in everyday nephrology practice,demonstrating its effectiveness in diverse clinical settings,ranging from medical wards to outpatient dialysis units.Additionally,we delve into the challenges hindering its widespread adoption and consider the future trajectory of this innovative approach.

The Observation on Risk of Ventilator Failure Weaning by Ultrasound bedside Monitoring of Inferior Vena Cava and Lung B Line

Objective: This study was designed to investigate risk of ventilator weaning by ultrasound bedside monitoring of the width of inferior vena cava (IVC) and the number of lung B-lines (B-lines). Methods: This study was conducted on 106 patients from January 2019 to January 2020 who had mechanical ventilation for more than 48 hours in an emergency care unit. They were clinically stable and had the criteria for weaning from the ventilator. Before Spontaneous Breathing Test (SBT) and 30 min or 120 min after SBT, the width of IVC and the number of B-lines in patients were monitored via bedside ultrasound. There were 87 cases of successful weaning as a control group and 19 cases of ventilator failure weaning as a study group. Changes of the width of IVC and the number of B-lines were compared in the different stages of SBT. Results: A total of 106 patients were included in this study. There were 87 cases of ventilator successful weaning and 19 cases failure weaning. The weaning success rate was 82.08%. The width of IVC and the number of B-lines in the study group were higher than those in the control group in same stage of SBT, the difference was statistically significant (P < 0.05), and which increased significantly with time. There was no significant difference in the width of IVC and the number of B-lines on the different stage of SBT in the control group (P > 0.05), and significant difference in the study group. Conclusion: The width of IVC and the number of B-lines monitored by bedside ultrasound can assess the risk of ventilator weaning, it may be caused by cardiopulmonary interaction.

Sound waves and solutions:Point-of-care ultrasonography for acute kidney injury in cirrhosis

This article delves into the intricate challenges of acute kidney injury(AKI)in cirrhosis,a condition fraught with high morbidity and mortality.The complexities arise from distinguishing between various causes of AKI,particularly hemodynamic AKI,in cirrhotic patients,who experience hemodynamic changes due to portal hypertension.The term"hepatocardiorenal syndrome"is introduced to encapsulate the intricate interplay among the liver,heart,and kidneys.The narrative emphasizes the often-overlooked aspect of cardiac function in AKI assessments in cirrhosis,unveiling the prevalence of cirrhotic cardiomyopathy marked by impaired diastolic function.The conventional empiric approach involving volume expansion and vasopressors for hepatorenal syndrome is critically analyzed,highlighting potential risks and variable patient responses.We advocate for a nuanced algorithm for AKI evaluation in cirrhosis,prominently featuring point-of-care ultrasonography(POCUS).POCUS applications encompass assessing fluid tolerance,detecting venous congestion,and evaluating cardiac function.

Application of scoring systems with point-of-care ultrasonography for bedside diagnosis of appendicitis

BACKGROUND: Appendicitis is a common disease requiring surgery. Bedside ultrasound(BUS) is a core technique for emergency medicine(EM). The Alvarado score is a well-studied diagnostic tool for appendicitis. This study aimed to investigate the relationship between patients' symptoms, Alvarado score and ultrasound(US) findings, as performed by emergency physicians(EPs) and radiologists, of patients with suspected appendicitis.METHODS: Three EM specialists underwent the BUS course and core course for appendicitis assessment. Patients suspected of having appendicitis were selected and their Alvarado and modif ied(m) Alvarado scores calculated. The specialists performed the BUS. Then, patients were given a formal US and surgery consultation if necessary. Preliminary diagnoses, admission or discharge from the emergency department(ED) and fi nal diagnosis were documented. The patients were also followed up after discharge from the hospital.RESULTS: The determined cut-off value was 2 for Alvarado and 3 for m Alvarado scores. The sensitivities of the two scores were 100%. Each score was used to rule out appendicitis. The results of EP-performed BUS were as follows: accuracy 70%, sensitivity 0.733, specifi city 0.673, + LR 2.24, and – LR 0.40(95%CI). Radiologists were better than EPs at diagnosing appendicitis and radiologists and EPs were equally strong at ruling out appendicitis by US. When US was combined with Alvarado and m Alvarado scores, EP US+Alvarado/m Alvarado scores ≤3 and radiology US+Alvarado/m Alvarado scores ≤4 perfectly ruled out appendicitis.CONCLUSION: BUS performed by EPs is moderately useful in detecting appendicitis. Combined with scoring systems, BUS may be a perfect tool for ruling out decisions in EDs.