Endoscopic Ultrasound versus Conventional Ultrasonography as A Diagnostic Tool for Patients with Obstructive Jaundice

Background Patient presented with jaundice, initial evaluation should be ultrasonography for evaluation of liver parenchymal changes, cirrhosis and assessment of hepatic vascularity and evaluation of intrahepatic, extrahepatic biliary system. Aim of the Work to compare between the Conventional US and Endoscopic Ultrasound in diagnosis of obstructive jaundice and other diagnostic modality including CT/MRI, ERCP for diagnosis and evaluation of the cause of OJ. Patients and Methods This study was conducted on 60 patients with obstructed jaundice as evident by ultrasonography in the form of dilated CBD with IHBRDs, with visualization of Gall bladder content and pancreas if can be well visualized, all patients had clinically apparent jaundice with disturbance of liver biochemical profile, all patient underwent EUS and compare finding with US including CBD diameter and IHBRDs degree. Results EUS provide better visualization of CBD and IHBRDs with diagnosis of pathological lesion including stones, malignancy. EUS also has better visualization of pancreatic pathology including inflammation and malignancy and extent of the tumor including local extent, lymphatic spread with vascular invasion. Conclusion EUS is better than US and other modality CT&MRI and ERCP in diagnosis of distal CBD stricture including malignant obstruction especially in cases of early malignancy and small tumors, and calculary distal obstruction. CT is insensitive in diagnosis of periampullary cancer, EUS provide early diagnosis of Pancreaticobiliary malignancy and give better advandage for early resectability .

High resolution flow (HR Flow) and Glazing Flow in cases of hepatic flow changes: Comparison to color-coded doppler sonography (CCDS)

AIM: To evaluate the possibilities of flow detection using high resolution flow (HR Flow) and Glazing Flow technique in patients with liver parenchymal changes and flow changes in comparison to colour coded Doppler sonography (CCDS) MATERIAL AND METHODS: All examinations were performed using a multi frequency matrix convex probe with high resolution technique (SC6-1U/Resona7, Mindray, Shenzhen, China) by one experienced examiner to evaluate the venous, portal venous and arterial liver flow with digital documentation of the dynamic flow parameters like peak systolic flow, end-diastolic flow and resistance index. For liver parenchymal stiffness changes shear wave elastography was performed with at least 10 measurements. By independent readers an elevation was performed to evaluate the image quality and the degree of flow artefacts, from 0 = not available to 5 points with excellent image quality without flow artefacts. RESULTS: All 40 patients (24 men, 16 women, age 27–83 years, mean 56±5 years) showed morphology changes from B-Mode of the liver parenchyma to inhomogeneous tissue with higher stiffness evaluated by the shear wave elastography (1.45 m/s up to 2.79 m/s±1.79 m/s, considering F1 up to F4 fibrosis) and in 15 cases histopathologically proven liver cirrhosis. In 9 cases after non-acute thrombosis flow reduction of the portal vein was the reason for the diameter less than 5 mm. Flow parameters for the venous flow were between 8 cm/s up to 29 cm/s, mean 14±4 cm/s, for the hepatic portal vein 5 cm/s up to 57 cm/s, mean 17±5 cm/s, for the hepatic artery systolic flow between 50 cm/s up to 127±33 cm/s, end-diastolic flow from 22 cm/s up to 47 cm/s±8 cm/s. Resistance index for the hepatic artery was between 0.41 up to 0.73, mean 0.67±0.25. The image quality for CCDS over all cases was evaluated for CCDS between 1 up to 4. The mean quality was 2.5±0.5, for HR Flow in combination with Glazing flow 3±0.5, with significant differences for the 2 readers (P < 0.01). CONCLUSION: Combination of HR Flow with Glazing Flow could be helpful to evaluate morphological und hemodynamic changes of liver arterial flow, portal venous flow and venous flow. Reduction of flow artefacts in combination with a higher image quality could be helpful for optimizing the digital measurements also for follow up examinations.

Incidental Traumatic Liver Laceration Diagnosed at Caesarean Section in 37-Year-Old Patient at Kitwe Teaching Hospital in Zambia

Trauma is leading cause of non-obstetric maternal and perinatal mortality and affects 7% of pregnancies worldwide. We present a 37-year-old pregnant woman, who had a World Society of Emergency Surgery (WSES) grade II or American Association for the Surgery of Trauma (AAST) grade III liver injury with hemodynamic instability caused by blunt trauma to the abdomen, resulting in an incidental liver parenchymal laceration discovered only at Caesarian section five days later. Liver laceration was treated with perihepatic packing and definitive surgery was done by direct liver repair. We believe this is the first case to be reported in Zambia.