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Liver and Biliary Tract
Begin doing a full sweep through the liver.You will need the patient to take deep inspirations to fully visualise the diaphragmatic borders of the liver.Look in transverse up and down the left lobe from asubcostal approach.Look in transverse through the right lobe subcostally andintercostally.Roll the patient in a left semi-lateral decubitus position for assessment of the right lobe only after checking for fluid along the liver edge.Bowel gas can overlie the liver in a subcostal approach so getting the patient to distend their abdomen can help visualisation. Also looking intercostally between each rib space can ensure thorough visualisation.
- Homogenous v's Attenuative(normal v'sfatty liver)
- Smooth v's coarse echotexture
- Size:To measure the size of the liver, use a sagittal approach in the mid clavicular line. Measure from the superior to the inferior border. This can be very subjective. Also look at the lower edge of liver in relation to the Right Kidney.It should finish half way down the kidney although a normal variant is a Reidel's lobe which is a tongue of liver extending below the kidney. An enlarged liver will have rounded borders.
- Look for SOLs due to benign cysts or secondary deposits, amoebic abscess, echinococcus
- Also look for dilated intrahepatic biliary radicles due to obstructed CBD
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