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Abdomen

How an abdominal ultrasound is done

The most common exam in any ultrasound room. In one session you assess the liver, gallbladder, pancreas and spleen, and the report is longer than for any other routine study: four organs, about twenty numbers, texture descriptions. Here is the scan order and an honest count of how much time the paperwork takes.

What is examined

The patient comes fasting, usually after six to eight hours without food: bowel gas hides the pancreas, and after a meal the gallbladder contracts and becomes uninformative. A curvilinear probe at 3.5-5 MHz is used, starting with the patient supine.

The liver is scanned through the intercostal spaces and from below the costal margin: thickness of the right and left lobes, oblique craniocaudal dimension of the right lobe, contours, echogenicity, homogeneity and vascular pattern. The portal vein, hepatic veins and common bile duct are assessed separately.

The gallbladder is measured fasting: length, width, wall thickness, content, stones with size and mobility. The pancreas is examined in the epigastrium on breath hold: head, body, tail, contours, echogenicity and the main pancreatic duct. The spleen is found in the left upper quadrant with the patient on the right side: length, thickness, texture and splenic vein.

Finally, check for free fluid in the dependent areas and for lymph nodes. If something is obscured by gas, say so in the report: an honest line "limited visualization" is more useful than an empty field.

How long it takes

10-15minutes of scanning
+13minutes of typing
0minutes of typing by voice

The scan takes ten to fifteen minutes in a prepared patient. The report is the longest of all routine studies: about twenty values plus descriptions. A physician who types it themselves spends twelve to fifteen minutes on it, and with fifteen patients a day that is almost four hours at the keyboard. Having someone else type helps, but then the physician dictates the same words they could dictate straight into the report.

The same study by voice

By voice, the report builds itself during the exam. The physician names the organ and the values, and the service places them in the right sections and adds reference ranges. Play the whole dictation or click the lines: each value lands in its own row.

0:00 / 0:00
Tap a line to jump to that point of the recording.
ABDOMINAL ULTRASOUND0
ParameterValueReference
Liver
Right lobe, thickness≤ 125
Left lobe, thickness≤ 70
Right lobe oblique craniocaudal dimension≤ 150
Liver contours
Liver echogenicity
Liver parenchyma
Portal vein≤ 13
Hepatic veins
Common bile duct≤ 6
Gallbladder
Gallbladder length60-100
Gallbladder width≤ 40
Gallbladder wall≤ 3
Gallbladder content
Gallstones
Pancreas
Pancreatic head≤ 30
Pancreatic body≤ 25
Pancreatic tail≤ 30
Pancreas contours
Pancreas echogenicity
Main pancreatic duct≤ 3
Spleen
Spleen length≤ 120
Spleen thickness≤ 60
Spleen area≤ 50
Spleen parenchyma
Splenic vein≤ 10
Other
Free abdominal fluid
Abdominal lymph nodes

Organs do not get mixed up: until the physician names the next one, all values go to the current section. Numbers are recognized together with their units, and the reference range appears next to each value, so a deviation is visible before the report is printed.

Adult orientation values. The common bile duct widens by roughly one millimeter per decade after sixty, and after cholecystectomy up to ten millimeters is considered normal. Interpretation always belongs to the physician.

What the finished document looks like

The finished document is built from the same data. The table is better for comparison with a previous study; the narrative version is used when the report goes into a discharge summary.

ABDOMINAL ULTRASOUNDdocument sample

Liver

Right lobe, thickness118 mm≤ 125
Left lobe, thickness62 mm≤ 70
Right lobe oblique craniocaudal dimension142 mm≤ 150
Liver contourssmooth, well defined
Liver echogenicitynormal
Liver parenchymahomogeneous
Portal vein11 mm≤ 13
Hepatic veinsnot dilated
Common bile duct4 mm≤ 6

Gallbladder

Gallbladder length72 mm60-100
Gallbladder width28 mm≤ 40
Gallbladder wall2 mm≤ 3
Gallbladder contentanechoic
Gallstonesnone

Pancreas

Pancreatic head26 mm≤ 30
Pancreatic body18 mm≤ 25
Pancreatic tail22 mm≤ 30
Pancreas contourssmooth
Pancreas echogenicitynormal
Main pancreatic duct2 mm≤ 3

Spleen

Spleen length105 mm≤ 120
Spleen thickness45 mm≤ 60
Spleen area38 cm2≤ 50
Spleen parenchymahomogeneous
Splenic vein7 mm≤ 10

Other

Free abdominal fluidnone
Abdominal lymph nodesnot enlarged

Impression

No sonographic evidence of abdominal pathology.

ABDOMINAL ULTRASOUNDdocument sample

Liver. Right lobe, thickness 118 mm; Left lobe, thickness 62 mm; Right lobe oblique craniocaudal dimension 142 mm; Liver contours smooth, well defined; Liver echogenicity normal; Liver parenchyma homogeneous; Portal vein 11 mm; Hepatic veins not dilated; Common bile duct 4 mm.

Gallbladder. Gallbladder length 72 mm; Gallbladder width 28 mm; Gallbladder wall 2 mm; Gallbladder content anechoic; Gallstones none.

Pancreas. Pancreatic head 26 mm; Pancreatic body 18 mm; Pancreatic tail 22 mm; Pancreas contours smooth; Pancreas echogenicity normal; Main pancreatic duct 2 mm.

Spleen. Spleen length 105 mm; Spleen thickness 45 mm; Spleen area 38 cm2; Spleen parenchyma homogeneous; Splenic vein 7 mm.

Other. Free abdominal fluid none; Abdominal lymph nodes not enlarged.

Impression

No sonographic evidence of abdominal pathology.

ABDOMINAL ULTRASOUNDPDF

The PDF is built from the same report and is ready to print or send to the patient.

Liver

Right lobe, thickness118 mm≤ 125
Left lobe, thickness62 mm≤ 70
Right lobe oblique craniocaudal dimension142 mm≤ 150
Liver contourssmooth, well defined
Liver echogenicitynormal
Liver parenchymahomogeneous
Portal vein11 mm≤ 13
Hepatic veinsnot dilated
Common bile duct4 mm≤ 6

Gallbladder

Gallbladder length72 mm60-100
Gallbladder width28 mm≤ 40
Gallbladder wall2 mm≤ 3
Gallbladder contentanechoic
Gallstonesnone

Pancreas

Pancreatic head26 mm≤ 30
Pancreatic body18 mm≤ 25
Pancreatic tail22 mm≤ 30
Pancreas contourssmooth
Pancreas echogenicitynormal
Main pancreatic duct2 mm≤ 3

Spleen

Spleen length105 mm≤ 120
Spleen thickness45 mm≤ 60
Spleen area38 cm2≤ 50
Spleen parenchymahomogeneous
Splenic vein7 mm≤ 10

Other

Free abdominal fluidnone
Abdominal lymph nodesnot enlarged

Impression

No sonographic evidence of abdominal pathology.

Frequent questions

Does the patient have to fast?

For the gallbladder and pancreas, yes: after a meal the gallbladder contracts and bowel gas hides the pancreas. The liver and spleen can be assessed without preparation, but the report will be incomplete.

Why do common bile duct norms differ between reports?

Age. Up to sixty, 6-7 mm is the usual reference, after that roughly one millimeter is added per decade, and after cholecystectomy up to 10 mm is accepted.

What if some organs are hidden by gas?

Say so in the report. A line about limited visualization protects both physician and patient: it explains why a section is incomplete and suggests when the exam should be repeated.

Are the kidneys part of this exam?

Not in our package: kidneys and bladder have a separate protocol, so each document stays focused on its own organs. If you scan everything in one session, it is easier to create two reports.

What it changes on a shift

The abdomen is where dictation saves the most. The scan is not the longest, but the report is, and that report is what eats the time between patients.

The first 15 reports are free. After that the price depends on the pack size: from 0.42 to 0.53 USD per report, whatever the length of the dictation. No subscription.

20 reports · 0.53 USD per report50 reports · 0.50 USD per report · -5 %100 reports · 0.48 USD per report · -10 %200 reports · 0.45 USD per report · -15 %500 reports · 0.42 USD per report · -20 %
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