Clinical Services

Medical ultrasound

Primary Care Clinical Services

Skills and interest Medical ultrasound Is performing ultrasound scanning in general practice irrelevant and not safe enough? Because of its noninvasive and comparatively accessible nature, ultrasound is a useful adjunct investigation for some clinical problems in general practice. The advantages of medical ultrasound are many: 1. It is safe and non-invasive. There is lack of ionizing radiation and no need for contrast material.     2. It is portable and convenient to use.     3. It can be done in multiple planes, thus increasing the diagnostic accuracy.     4. Cystic and solid lesions can be differentiated. It is highly accurate in diagnosing simple cysts.     5. Measurements can be done, e.g. to measure kidney sizes, bile duct diameter.     6. It has high sensitivity and accuracy for detecting gallstones and intrahepatic and extrahepatic duct dilatation. One of the areas where ultrasound is widely used is in upper abdominal problems. Some of the indications for upper abdominal ultrasound are: 1. Suspected gallstones Ultrasound is the primary and mostly definitive investigation of gall bladder disease despite recent improvements in other noninvasive imaging modalities. Oral cholecystography and intravenous cholecystography are no longer performed. CAT scan is not helpful and MRI is expensive and not readily available. Ultrasound has very high diagnostic accuracy for gallstones. 2. Jaundice Ultrasound is the best initial imaging procedure and is accurate in diagnosing biliary dilatation which suggest obstructive jaundice, and in localizing the level of obstruction. 3. Upper abdominal pain In problems such as acute cholecystitis, ultrasound shows thickened gall bladder wall and often presence of gallstones, and the RUQ pain can be elicited by gently pressing the gall bladder with the ultrasound transducer (positive ultrasound Murphy's sign). One important thing to notice is that ultrasound scanning is operator dependent. It depends on the operator's clinical knowledge, technical skill and knowledge of the equipment being used. When there is any query about the diagnosis, the client should be referred to specialist for further investigation/management. Common diseases of the abdomen encountered in general practice are gallstones, gall bladder polyps (potential of malignant change if >1cm), fatty liver (generalized or focal), liver haemangioma, liver and renal cysts, renal stones. Less common ones are hepatomegaly, cirrhosis, enlarged or atrophied kidneys Local course that may interest you is the Diploma in Medical Ultrasound jointly organized by SPACE, HKU and Hong Kong College of Family Physicians. Basic principles of ultrasound are taught, and practice on use of ultrasound on abdomen is supervised by experienced radiologists. Details of the course are printed in the College News in Vol.24 No. 7, July 2002 of the "The Hong Kong Practitioner" Some overseas courses in Australia and USA, etc. can also be found in the following website (click 'Links' and find "Australian Institute of Ultrasound"): http://www.aiu.edu.au/ References 1. Lecture Notes, Diploma in Medical Ultrasound (jointly organized by SPACE, HKU and HKCFP).     2 Janes A Bates. Abdominal Ultrasound: How, Why and When. 1999. Churchill Livingstone.

[go back] [back to top]

End of Page

[Clinical Services] [Public Health Nursing Service] [Study] [Health Promotion] [Newsletter]