Diseases of the Abdomen and Ultrasonography

Some diseases of the abdomen may also remain undetected for a long time. This is particularly true of gallbladder diseases – gallstones (cholelithiasis), inflammation of the gallbladder (cholecystitis), or even cancer of the gallbladder. Either gallstones or an inflamed gallbladder may lead to cancer of the gallbladder. Therefore, it is necessary to detect early cases of gallstones and inflamed gallbladder, so that once diagnosed, it can be removed surgically, and cancer of the gallbladder can be prevented.

It is a common finding that diseases of the gallbladder remain silent in the abdomen. Hence, all cases in whom the slightest clinical suspicion of gallbladder pathology exists must be subjected to ultrasonography, so that the disease can be detected at the earliest.

Ultrasonography has a significant role to play in the detection of subclinical diseases of the abdomen. This test is of vital value and has no radiation hazards. Before the availability of this test, it was at times impossible to detect diseases of the abdomen, and the last resort was to surgically open up the abdomen (laparotomy), so that the surgeon could see the suspected part and diagnose and treat the case. Sometimes, the diagnosis turned out to be quite different from what the surgeon thought it to be before he opened up the abdomen. Some doctors, therefore, used to call the abdomen a magic box. Thanks to ultrasonography, there is no such difficulty now.

An ultrasonographic examination, however, must be carried out by an experienced ultrasonologist, as this test is , operator-dependent’, i.e., the operator / ultrasonologist, before giving his/her opinion, has to examine a particular organ from different angles, regarding the pathology of the concerned organ. A single casual view of an organ taken/recorded on an ultrasound film may not serve the purpose, and may even prove to be misleading altogether.

It is advisable that all persons, especially above the age of 40, undergo an ultrasonographic examination of the abdomen, so that various hidden diseases can be detected in time. The test must be carried out in all symptomless persons, irrespective of age. It should not be ignored or delayed if the patient has some symptoms relating to any of the organs of the abdomen. It is indeed an important test for detecting diseases of the abdomen. The author participated in an ‘Ultrasound Update’ in 1991, so as to have an inside view of this vital investigation.

Besides gallbladder diseases, some liver disorders may also remain undiagnosed for long, especially cirrhosis of the liver, which may remain undetected, particularly in a chronic alcoholic. If this liver disease is not diagnosed in time, its treatment may not be possible. Similarly, early viral/serum hepatitis may remain undetected, since early jaundice/pallor of the eyes may not be noticed by the patient. If timely action is not taken, the patient is likely to be miserable at a young age. Besides an ultrasonographic examination of the liver, blood tests like serum bilirubin, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), alkaline phosphatase, etc. are also useful in the diagnosis of various liver disorders.

It is remarkable that ultrasonography helps in discovering very early pleurisy.

Tests like upper gastrointestinal endoscopy, colonoscopy and sigmoidoscoy are useful in diagnosing early lesions of the gastrointestinal tract. Again, trained medical personnel are required for carrying out endoscopy, colonoscopy and sigmoidoscopy. As in the case of ultrasonography, these tests too are entirely dependent on the skill of the operator. The suspected areal s of the gastrointestinal tract are visualized by the operator with the help of endoscope, colonoscope or sigmoidoscope, and he finally forms his opinion regar9-ing the exact pathology inflicting the specific site. It may be cautioned that an inaccurate diagnosis may have serious consequences, and hence the vital need for a specialist approach. Besides the above tests, computed tomographic (CT) scanning, etc. also helps in diagnosing various lesions of the gastrointestinal tract.