Sonographic Findings In Patients With Non Traumatic Upper Abdominal Pain At Ket Medical Services And Life Chart Scanning Centre Enugu, Nigeria

ABSTRACT This research was aimed at evaluating the usefulness of ultrasonography in the diagnosis and management of upper abdominal pain. A retrospective study was done at Ket Medical Services   and Life chart Scanning Centre Abapka, Enugu. A total of 236 patients that were scanned for upper abdominal pain from March, 2011 to March, 2012 were studied. The sonographic reports showed that Fatty liver is the highest sonographic findings in patients with upper abdominal pain with a total number of 41 (17.37%), followed by   hepatitis 36(15.25%),pyelonephritis 30(12.71%), hydronephrosis 19(8.05%), Splenomegaly 14(5.93%), 10(4.23%) each for cholecystitis and normal studies, 9 (3.81%) each for schistosomiasis and PUD, renal stone 8(3.38%), glomerulonephritis 7(2.96%), renal failure 4(1.69%), pancreatitis 3(1.27%), gall bladder sludge 2(0.88%), 1(0.42%) each for multiple hepatic cyst, haepatoma ,liver mass and poly cystic kidney. It was also found that 31-35years age group was mostly affected with upper abdominal pain and 0-5 years age group was the least affected. Finally, the incidence of upper abdominal pain was greater in female than in male. 
TABLE OF CONTENTS  Title page - - - - - - - - - i Approval Page - - - - - - - - - ii Certification- - - - - - - - - iii Dedication  - - - - - - - - - iv Acknowledgement - - - - - - - - v Abstract - - - - - - - - - vi Table of Contents  - - - - - - - - vii
CHAPTER ONE 1.0 Introduction - -  - - - - - 1 1.1 Background of Study- - - - - - - 1 1.2 Statement of Problem- - - - - - - 3 1.3 Purpose of Study- - - - - - - - 3 1.4 Significance of Study- - -- - - - - 3 1.5 Scope of the Study- - - - - - - 4 1.6 Definition of Terms - - - - - - - 4 1.7 Literature Review- - - - - - - - 6
CHAPTER TWO 2.1 Theoretical Background- - - - - - - 11 2.2 Modes of sonography- - - - - - - 13 2.3 Strengths of ultrasound- - - - - - - 16 2.4 Weaknesses of ultrasound- - - - - - 17 2.5 Risks and side-effects of ultrasound. - - - - - 18 2.6 Studies on the safety of ultrasound. - - - - - 19 2.7 Abdomen- - - - - - - - - 20 2.8  Regions    - - -  - - - - - 22 2.9 Causes of Abdominal Pain and their Sonographic Features - 24
CHAPTER THREE 3.1 Research Methodology- - - - - - - 32 3.2 Research design - - - - - - - - 32 3.3 Target population- - - - - - - - 32 3.4 Sampling technique- - - - -- - - 32 3.5 Sample size- - - - - - - - - 32 3.6 Source of data/material for the study - - - - - 33 3.7 Method of data collection - - - - - - 33 3.8 Selection criteria- - - - - - - - 33 3.9 Data analysis- - - - - - - - 33 3.10 Data presentation and results- - - - - - 34
CHAPTER FOUR 4.1 Discussion - - - - - - - - 54 4.2 The Summary of Results- - - - - - 55  4.3 Limitations of the study - - - - - - - 56 4.4 Recommendations - - - - - - - 56 4.5 Areas of further study - - - - - - - 57 4.6 Conclusion - - - - - - - - - 57 REFERENCES- - - - - - - - - 58 Appendix- - - - - - - - - - 62
LIST OF TABLES Table 1:  Age distribution of sonographic findings in  patients with upper Abdominal pain  - - - - - - 35  Table 2:  Organ Distribution of cases in Patients with Upper Abdominal Pain and their Percentages - - - - 37  Table 3:  Sonographic Findings in Patients with Upper Abdominal Pain and their Gender Distributions  - - - - 38  Table 4:  Age Distribution of Sonographic findings in Patients with upper Abdominal Pain.  - - - - - - 40  Table 5: Organs Distribution of Cases in Patients with Upper Abdominal Pain and Their Percentages  - - - - 42  Table 6:  Sonograhic Findings in Patients with Upper  Abdominal Pain and their Gender Distribution   - - - - 43  Table7: Age Distribution Of Sonograptic Findings In Patients With Upper Abonminal Pain  - - - - - 45   Table 8: Organ Distributions of Cases in Patients with Upper Abdominal Pain and their Percentages  - - - - 47  Table 9: Organ Distribution of Cases in Gender of Patients with Upper Abdominal Pain and Their Percentages  - - 48 Table 10: Sonographic Findings in the Liver and Their Gender Distribution in Patients with Upper Abdominal Pain 49 Table 11: Sonographic Findings in the Kidney and Their Gender Distributions - - - - - - 50 Table 12: Sonograhic Finding in the Gall Bladder and Their Gender Distributions  - - - - - - 51 Table 13: Sonographic findings in patients with Upper Abdominal Pain and their Gender Distributions  - - - - 52

INTRODUCTION Abdominal ultrasound is a rapid and non-invasive method of examination of the abdomen. Abdominal ultrasound is an imaging procedure used to examine the internal organs of the abdomen including the liver, gallbladder, spleen pancreas and kidney.  The blood vessels that lead to some of these organs can also be looked at with ultrasound.  Abdominal pain is the most frequent reasons for abdominal scan.  Ultrasound is one of the non- invasive modalities used for the investigation of patient with abdominal pain.  Upper abdominal pain is one of the commonest complaints in patients seeking medical advices.  Upper abdominal ultrasound can reveal many possible conditions including abdominal aortic aneurysm, abscess, cholecystitis, gall stone, hydronephrosis, kidney stones, splenomegaly and pancreatitis.  In preparation for ultrasound of the liver, gallbladder or digestive tract, the patient will be asked to fast overnight or for at least six hours prior to the test, which reduces bowel gas that can obscure the image and keeps the gallbladder filled with bile, making it easier to visualize its contents. In examination involving stomach and duodenum, the patient will be given water to drink immediately before the test because these organs are better visualized if there are filled with fluids4.  Abdominal pain may not come from the abdomen; some surprising causes include heart attacks and pneumonias.  The location of the pain within the abdomen can be an important clue in diagnosis during scanning5.  Symptoms that occur with upper abdominal pain include back pain, chest pain, constipation, diarrhea, fever, nausea and vomiting.   Upper abdominal pain can be acute or chronic.  Upper abdominal pain whether acute or chronic is caused by diseases of the liver, gallbladder kidneys pancreas, stomach, duodenum, spleen, pleura pericardium and basal lung segments. The characteristics of the pain, location and timing duration etc are Important in diagnosing its causes. All these conditions have useful sonographic features which help in their diagnosis except uncomplicated peptic ulcer disease acute myocardial infarction and pneumonitis.  The frequency with which even relatively inexpensive and non-invasive diagnostic tests are performed clearly places a burden on healthcare.  Therefore, it is important that their influence on patient management is assessed.  Unnecessary diagnostic investigation may lead to incidental findings or to additional unnecessary diagnostic procedures or even over treatment