Introduction to intestinal Ultrasonography

追加: 2026-05-18

[00:00:02]Welcome you all and thank you for being a member of the Intestinal Ultrasonography Group.

[00:00:13]This group is formed by the Egyptian Society of Bowel Ultrasonography.

[00:00:19]Actually, the Intestinal Ultrasonography is a great way to examine the bowel.

[00:00:26]Why I'm saying this?

[00:00:28]Because of several advantages that Ultrasonography are giving to us that are not present in other imaging modalities.

[00:00:40]It's widely available, cheap, non-invasive.

[00:00:43]It's a safe. It's perfect for point of care examination that shows you the result immediately making you take a decision in your patient on the spot.

[00:00:56]It can be safely repeated without any hazard to the patient. And in my opinion, it's a superb way for real-time examination of the bowel.

[00:01:08]Actually, I'm doing Ultrasonography of the bowel every day, but you are not taking care of this. You are not observing this. What I mean by this is that look at this picture.

[00:01:20]Every day you are examining your patient with Ultrasonography putting the transducer in the epigastric region looking at the liver, the pancreas, part of the kidneys, the vessels, and so on.

[00:01:34]But at the same time, you are seeing the left lobe of the liver and just beneath it, between the pancreas and the left lobe of the liver, you are seeing the stomach.

[00:01:48]But you are not concentrating on it.

[00:01:51]You are looking at the vessels, you are looking at everything. But here, an organ which needs your attention and your care.

[00:02:00]The same way when you are examining from the mid-axillary line on the right side looking for the kidney, you will see the liver and at the same side you see the gas shadow of the hepatic flexure of the colon in addition to the kidney and the liver.

[00:02:18]And that's again part maybe you are looking at it as an artifact, but now it comes the time to pay attention to this part as it needs more examination from your side looking at diseases of the bowel particularly not to the organs around the bowel.

[00:02:43]Ultrasonography actually has a more to give.

[00:02:47]Ultrasonography, if you look at the anatomy, you will find the bowel all of it is just beneath the skin, muscles of the abdominal wall, and few centimeters from your transducer.

[00:03:01]All the bowel is here to be examined except for the upper parts which is covered by the chest and the lower part which is covered by the pelvic bones.

[00:03:14]All these parts can be examined whether the colon or the small bowel. You can just appreciate this very much when you look at the CT scan of the patients.

[00:03:24]Just beneath this is the skin and the muscles of the abdominal wall which are actually few of them, three on either side, the external oblique, internal oblique, and transversus abdominis, and in the middle the two rectus muscles with the rectus sheath between them.

[00:03:44]Just under this, as you can see, you can see the ascending colon on the left side and here you can see the small bowel.

[00:03:54]On the right side you can see the ascending colon on the left side, you can see the descending colon.

[00:04:02]And again, four parts of this are very fixed.

[00:04:06]The right iliac fossa, every time you go there you find the cecum. Every time you go to the left iliac fossa you find the sigmoid colon. And the same applies to the hepatic and the splenic flexure.

[00:04:19]What I need to examine these parts the right way, I need a good machine.

[00:04:24]What I mean the good by good machine?

[00:04:27]The best machine you can ever buy.

[00:04:30]I know some of you are very experts and you can use a less efficient machine in examining the bowel.

[00:04:37]But let me give you uh something which is similar to this.

[00:04:42]We all worked with the scopes of the olden time and we worked with the high definition scopes.

[00:04:50]Have you seen the difference between them?

[00:04:52]It's even the difference between the ultrasonography machines of the olden time and the ultrasonography machines of the new generations.

[00:05:02]It clears your way, it shows you things the way you should show it. If you are way you would you would like to see it.

[00:05:08]Usually we work with the curved probe to see the uh organs of the bowel.

[00:05:17]But this probe has uh deep penetration. It's good for the organs, but when we are specifically looking at the layers of the bowel, we would like to use the other one which a high a high frequency probe. That's the way we are going to use it.

[00:05:36]The bowel wall in ultrasonography is five layers and they are not exactly what you see in histopathology. However, these five layers from which the three middle layers are very important to us. The one in the middle is the submucosa and this is a very obvious layer when you examine the bowel. On either side you find black and the black stripes.

[00:06:02]The black stripe up to the wall is the deep mucosa, the one down is the muscularis propria and on either side here to the wall we have the superficial mucosa and we have deep the serosa. As you can see five stripes, white, black, white, black and white.

[00:06:23]And these layers can be easily seen in ultrasonography particularly with the high resolution uh linear probe.

[00:06:36]The changes which occur in the bowel wall are very few.

[00:06:40]The most important ones are increasing the thickness. The golden number here is 3 mm. Everything above 3 mm is abnormal.

[00:06:48]The other thing is increasing the vascularity.

[00:06:51]As you can see in this picture, you know the Oreo?

[00:06:55]That's what we see in the bowel.

[00:06:58]That's the wall of the stomach. This is the stomach with five walls in the anterior and five walls in the posterior wall. They are very clear, the three layers in the middle. You can easily see them.

[00:07:09]Uh the uh muscularis propria, the one I'm referring to it, the submucosa and the uh uh deep mucosa and on either side the serosa and the inter uh position between the lumen and the mucosa. These are the five layers.

[00:07:29]Most of the time you will see at least three layers of this.

[00:07:35]Again, every time you see these striations, black, white, black, white, that's what we call the signature of the bowel, the signature of the bowel.

[00:07:45]There has been a surge in the publications dedicated for intestinal ultrasonography, particularly in the field of inflammatory bowel disease, and that's what made intestinal ultrasonography these days very popular.

[00:08:00]What I mean by this, if you look at the graphs showing the ultrasonography, there is exponential increase in the studies. And now, lastly, in the last year, we have intestinal ultrasonography formulated with the follow-up and monitoring of patients with Crohn's disease and ulcerative colitis as an integral part of the way we see these patients and we follow them up.

[00:08:27]As I told you, there is increase in the literature in this field, particularly in inflammatory bowel disease, whether you are referring to the Crohn's disease or you are referring to ulcerative colitis.

[00:08:41]Where we can use them? In every part of the inflammatory bowel disease, you can use intestinal ultrasonography.

[00:08:48]It has been used to monitor Crohn's disease and to diagnose monitor disease.

[00:08:52]It has been used to monitor the response of treatment in ulcerative colitis, and actually, in that part, the response is very rapid.

[00:09:01]I may I may see that it's in days, not weeks.

[00:09:05]Again, in emergencies of the intestinal tract, the ultrasonography is a very good way to examine this.

[00:09:13]And now we are talking about why they are not using it in the Asia Pacific, why you are not using it in the America the same way they are using it in Europe, which really led the way in this part of examining the small bowel by ultrasonography.

[00:09:31]I have a dream long time ago, 4 years.

[00:09:37]My dream is that a gastroenterologist, particularly those working with inflammatory bowel disease, should use ultrasonography.

[00:09:46]Use the ultrasonography to listen to the bowel the same way you was using your your stethoscope to listen to the heart of the patient.

[00:09:59]I'd like to say to you that ultrasonography, the way I'm going to give to you with your excellent professors here, is going to give you the way to examine the bowel, but it's up to you to improve your talent and improve your skill in this way.

[00:10:20]As I say, usually ultrasonography scanning is more of an art than a science, and that's why I'm going to say to listen from time to time that it's operator-dependent. So, let us together with your excellent experts in this group pave the way, and you are going to be a part of this in the future presentations in this uh group. I hope that over the with uh the time, you will be expert in ultrasonography, and you will reach what you dreamed of and beyond.

[00:10:57]Thank you, and I hear from you you next time. Thank you.