Sonography of
the liver, not only depends on a very good machine, but also on the
person who is doing it. Remember that it can be very difficult to
diagnose necrosis of liver or a real pathological fatty infiltration,
which is often wrongly reported. Nowadays, Doppler sonography with
B-mode combination (Duplex sonography) is also available and can be
done with the modern probes. Ofcourse, the results will depend on
how good the sonologist is and how clear is his conscience, so that
he spends enough time in looking for the veins and the ducts, in addition
to liver.
Also remember that pain is not a common symptom in a patient who comes
to you for jaundice. The most common causes are viral or drug hepatitis
and the less common ones being auto-immune or congenital disorders.
All of them are painless.
The following is the list of conditions, which can be diagnosed by
a good sonologist in a patient of jaundice having acute severe abdominal
pain:-
1. Biliary colic due to stones in gall bladder, where further movement
of stones can cause jaundice.
2. Acute cholecystitis, where jaundice is due to pressure of the oedematous
duct.
3. Choledocholithiasis due to stone in common bile duct, which may
be present without any stone in gall bladder.
4. Acute pancreatitis.
5. Amoebic liver abscess or pyogenic liver abscess.
6. Alcoholic hepatitis, where the sonologist shows extensive fatty
infiltration of liver and the patient having the above symptom is
a heavy alcoholic.
7. Acute thrombosis of portal vein.
8. Acute thrombosis of mesenteric vein.
9. Acute congestive hepatopathy due to sudden onset of congestive
cardiac failure, often following atrial fibrillation, where the sonologist
can demonstrate dilated hepatic veins.
10. Budd Chiari syndrome due to hepatic vein thrombosis.
11. Finally, even a rare case of painful severe acute viral hepatitis
could be suggested by a good sonologist.
Apart from these, there are some other conditions, where the patient
has been having chronic pain, but neglects it and comes to the doctor,
when there is acute pain superadded to his previous complaint and
is now associated with jaundice.
These conditions are:
1. Hepatoma
2. Secondary deposits of liver
3. Choledochal cyst
4. Cancer of the pancreas
5. Pseudo pancreatic cyst
Acknowledgement
I would like to thank Dr. Nitin Chaubal for going through the
script and giving his suggestions.
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital,
Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital,
Mumbai 400 008.
