Hata Jiro
Rinsho Byori. 2015 Jun;63(6):717-24.
In this paper, abdominal ultrasound examination as a point-of-care examination (POCUS) is discussed. POCUS is very useful in various clinical situations, especially for the diagnosis of critically ill patients with non-specific symptoms. In patients with an unknown fever origin, POCUS can detect unexpected infection foci such as liver abscesses. Pseudomembranous colitis, which is one of the important causes of fever during/after the use of broad-spectrum antibiotics and sometimes difficult to diagnose or even suspect as the cause of fever, can also be diagnosed with POCUS. Malignancies such as malignant lymphoma are also frequent causes of fever of unknown origin and, with POCUS, we have diagnosed many cases with malignant tumors presenting only with low-grade fever. Abdominal fullness is another common symptom of critically ill patients. POCUS is very useful for differentiation among several diseases causing abdominal fullness. Ascites is expressed as anechoic fluid in the abdominal cavity, while bowel obstruction as bowel distention presenting the so-called keyboard sign. Urinary retention, often misdiagnosed as bowel obstruction or an abdominal tumor, is also easily diagnosed by POCUS. It is very difficult to detect the occult causes of exacerbation of the general condition and/or markedly abnormal laboratory data in critically ill patients under endotracheal intubation or the influence of sedative agents, which make it difficult for the patients to complain of their symptoms. Attending physicians should make the best of POCUS as a useful diagnostic modality for these patients.
本文讨论了腹部超声检查作为床旁检查(POCUS)的应用。POCUS在各种临床情况下都非常有用,特别是对于诊断有非特异性症状的危重病患者。对于不明发热原因的患者,POCUS可以检测到意外的感染灶,如肝脓肿。伪膜性结肠炎是使用广谱抗生素期间/之后发热的重要原因之一,有时难以诊断甚至难以怀疑是发热原因,POCUS也可对其进行诊断。恶性淋巴瘤等恶性肿瘤也是不明原因发热的常见原因,通过POCUS,我们已经诊断了许多仅表现为低热的恶性肿瘤病例。腹部胀满是危重病患者的另一个常见症状。POCUS对于鉴别导致腹部胀满的几种疾病非常有用。腹水在腹腔内表现为无回声液性暗区,而肠梗阻表现为肠扩张,呈现所谓的键盘征。尿潴留常被误诊为肠梗阻或腹部肿瘤,POCUS也很容易对其进行诊断。在气管插管或镇静剂影响下的危重病患者中,很难检测到导致病情加重和/或实验室数据明显异常的隐匿原因,这使得患者难以诉说自己的症状。主治医生应充分利用POCUS作为这些患者有用的诊断手段。