Abdomen/GI

notice anechoic fluid collection near field - patient with ascites, negative spine sign far field

good example of echogenic fatty liver - compare to liver in image on left - parenchyma brighter from deposition of fat

cool RUQ view with a lil ring down artifact coming off the diaphragm

caudal tip of the liver is the most sensitive location in the FAST exam for detecting free abdominal fluid

spine at about 8 cm - could've decreased the depth quite a bit here but a decent RUQ view that includes the diaphragm early on, then the liver and kidney with background spine reflection

normal liver/kidney combo

Don't think I clocked it at the time but that is an uber hyperechoic liver. Usually shouldn't be too far off the echogenicity of the renal cortex. Reference the image to the left for normal. Probably fatty liver.

small, nodular cirrhotic liver surrounded by ascites, then kidney and bowel

spleen + some stomach deep to the spleen, barely see the upper pole of the kidney at about 5-8 cm depth far right of the screen; when you're seeing stomach deep to spleen in your RUQ view you're fanning too anteriorly (unless stomach is what you're after)

positive FAST LUQ - there wasn't fluid between the spleen and the diaphragm or between the kidney and spleen

good example of aiming too anterior with beam - you see artifact from air in the stomach where you should see kidney and spine

nice plumb gallbladder

bit of GB with portal triad bottom left - the portal vein (large circle with echogenic walls) and hepatic artery (just superior and a little to the right of portal vein) are visible

shoulda increased the depth a smidge to catch the portal triad

large gallbladder but no stones or pericholeycystic fluid or thickened walls

this was a large GB in a patient with persistent RUQ abdominal pain - HIDA showed poor contractility

short axis view of a pretty sizable GB

incidentally discovered gallstone

you can see the pancreas in the near field just superficial to the aorta at about 4 cm early on in the image; the splenic veins aids in its identification (running east to west across image superficial to aorta)

Easy to see the aorta ticking away at about 7-9 cm. This view is from the epigastrium and I just like it on account of how much is goin on. You can see so many vessels and organs and I think it's incredible how much is packed so efficiently into a space about 8 cm from peritoneum to spine.

normal peristalsis

Dilated loops of small bowel with visible plicae - plicae differentiate small from large bowel. The haustra of large bowel don't extend all the way across to the other wall.

Same pt as image to left - diagnosed with high grade SBO following CT abd/pelvis. Clues to SBO include to-and-fro movement of contents early on followed by reduced peristalsis later on (as above) and dilated loops > or = 3 cm. Real talk, though, you shouldn't be able to see bowel that well. In a patient with abdominal pain, PO intolerance, and abdominal distention it's SBO until proven otherwise.

just a nice lil bit of bowel caught in cross section just deep to the caudal tip of the liver

distended abdomen and PO intolerance in patient with history of short gut and multiple abdominal surgeries

More dedicated look at the bowel in the patient whose RUQ is depicted to the left - super dilated with some dramatic to-and-fro.

this was a paracolic gutter view looking for a safe pocket for paracentesis - bowel floats into view like a space caterpillar

peritoneal carcinomatosis - note the clumps of malignant cells in the otherwise anechoic ascites

just deep to the bladder you can sometimes see the rectum as an arc - an increased transrectal diameter (different values reported in literature but generally >3.8 cm) can confirm constipation in the right clinical context

transrectal diameter (a little shortchanged) of 4.3 cm pre coffee

post coffee - view's a bit different due to decompression of bladder, diameter of rectum decreased due to bm

this is a cool image with a lot going on
1. left upper - loop of bowel with peristalsis, bladder in sagittal plane; walls of bladder look a bit thick but it's relatively decompressed

2. right upper/upper central - prostate deep to and between pubic bone and bladder

3. far field between about 8 and 11.5 cm you can see the anterior and posterior walls of the rectum - they look like hyperechoic lines running horizontally toward the end of the clip

patient with encoparesis and visible rectum posterior to bladder