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This research was aimed at evaluating the usefulness of ultrasonography in the diagnosis and management of upper abdominal pain. A retrospective study was done atKet Medical Services   and Lifechart 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 sonographicreports 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 0-5years age group was the least affected. Finally, the incidence of upper abdominal pain was greater in female than in male.


Title page    –        –        –        –        –        –        –        –        –        i

Approval Page –   –        –        –        –        –        –        –        –        ii

Certification-        –        –        –        –        –        –        –        –        iii

Dedication  –        –        –        –        –        –        –        –        –        iv

Acknowledgement         –        –        –        –        –        –        –        –        v

Abstract      –        –        –        –        –        –        –        –        –        vi

Table of Contents          –        –        –        –        –        –        –        –        vii


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


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


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


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


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




          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 ultrasound1.

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 advices2.

Upper abdominal ultrasound can reveal many possible conditions including abdominal aortic aneurysm, abscess, cholecystitis, gall stone, hydronephrosis, kidney stones, splenomegaly and pancreatitis3.

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 vomiting5.

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 segments6. The characteristics of the pain, location and timing duration etc are Important in diagnosing its causes7. All these conditions have useful sonographic features which help in their diagnosis except uncomplicated peptic ulcer disease acute myocardial infarction and pneumonitis7.

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.8



  • An increase in the rate of patients presenting with upper abdominal pain for sonographic studies has made it imperative to take a critical look at the different diagnosis.9
  • Many of the predisposition factors may also be related to age and gender.



  • To evaluate the common ultrasound findings in patients with upper abdominal pain.
  • To correlate the sonographic findings in patients with upper abdominal pain with age and gender.



  • The study will help us to know the pertinent role that ultrasound plays in the diagnosis of upper abdominal pain.
  • The documentation of this work may serve as a guide to sonographers during scanning for accurate diagnosis.



          It was carried out atKet medical services and Life chart Scanning Centre  Enugu, Nigeria.  It covered a period of one year (from March 2011– March 2012).



  1. Fatty liver: Accumulation of fat in the liver, an indication of liver disease or benign changes, demonstrated using grey scale ultrasound.
  2. Hepatomegaly: Enlargement of the liver to such an extent that it is can felt below the rib margin. This may be due to congestion as in heart failure, inflammation or tumour.
  3. Hepatitis: Inflammation of the liver caused by viruses, toxic substance or immunological abnormalities.
  4. Schistomosmiasis: A tropical disease caused by blood flukes of the genus schistosoma
  5. Haemangioma: A benign tumour of blood vessels, it often appears on the skin as types of birthmark.
  6. Hydronephrosis:- Distension and dilation of the pelvis of the kidney. This is due to an obstruction to the free flow of urine from the kidney
  7. Pyelonephritis: It is the bacteria infection of the kidney substance. In acute pyelonephritis the patient has pain in the loins, a high temperature and shivering fits. In chronic pyelonephritis the kidney becomes small and scarred and kidney failure ensures.
  8. Glomerulonephritis: It is any of a group of kidney disease involving the glomeruli usually thought to kind disease involving the glomeruli, usually thought to be the results of antibody – antigen reactions that localize in the kidneys because of their filtering function.
  9. Renal stone: It is the calculi in the kidney.
  10. Renal failure: It can be described as acute or chronic acute renal failure occurs when previously healthy kidney suddenly fail because of a variety of problems affecting the kidney and its perfusion with blood. Chronic renal failure occurs when irreversible and progressive pathological destruction of the kidney leads to end-stage renal disease.
  11. Cholelithiasis: This is the formation of stones in the gall bladder
  12. Cholecystitis: It is the inflammation of the gall bladder. It may be acute or chronic.
  13. Splenomegaly: This is the enlargement of the spleen. It is most commonly occurs in malaria, schistosomiasis and other disorders caused by parasites
  14. Pancreatitis: It is the inflammation of the pancreas. It can be acute or chronics.


          According to Jeffery B and Ralls P9. Patients presenting with upper abdominal pain comprise the largest group of people reporting to medical and surgical out-patient department/OPDs9.  Following the history and clinical examination, ultrasonography has become one of the first and most useful methods of investigation9.  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 segment9.  Rare causes include aortic aneurysm and acute myocardial infarction9.  All these conditions have useful sonographic features which help in their diagnosis except uncomplicated peptic ulcer disease, acute myocardial infarction and based pneumonitis.

A retrospective study done by Okike I. F10, in the ultrasound unit of Radiation Medicine Department in University of Nigeria Teaching Hospital, Ituku-Ozalla in Enugu.  588 patients were scanned for abdominal pain in 2009. The sonographic report showed that 171 (29.08%) had kidney pathologies, 154(26-19) had liver disease, 73(12.41%) had normal scan, 72(12.24%) had obstetrics and gynecological problems, 49(8.33%) had gastrointestinal tract problems, 37(6.29%) had spleen pathologies, 5(0.85%) had pancreatic disease and 2(0.34%) had aortic and Para-aortic diseases. It was also found that 61-70years age group was mostly affected with abdominal pain and 81-90years age group was the least affected.  And generally the incidence of abdominal pain was greater in females than in males.

A research done by Cyoyal M11 showed that 82 cases for upper abdominal ultrasound were scanned.  It reveal that 18 have gallstone, 4 have fatty liver, 4 have dilated common duct, 2 have thick walled gallbladder, 2 have hepatic cyst and one patient each for the following has splenomegaly, focal liver abnormalities, renal cyst, partial nephrectomy, gallbladder poly and abnormal liver texture.

The  research done by Mir Ali et al12,   on upper abdominal ultrasound, ultrasound findings expressed as percentage of all patients were Fatty liver (90.58%), auto-splenoectomy (55.4%) markedly reduced splenic size (31.0%) reduced renal size (27.1%), cholelithiasis (25.7%) splenomagely (4.1%) and renal enlargement (2.78%).

The prospective study by B.Wibulpolprasert and T .D Hiensiri13  involved 251 patients ranged 2-77 years who were hospitalized with brucellosis during a 4-years period. Patient were classified as having acute (<3 months) sub acute (3-12) months, or chronic (> 12 months) disease.  Physical, laboratory and abdominal sonographic findings were analyzed.  The disease was acute in 92 cases (36.7%), subacute in 48(19.1%) and chronic in 111 (44.2%). Sonographic examination of the abdomen showed enlarged periportal lymph nodes in 23 patients (9.2%) splenomegaly in 21(8.4%), hepatomegaly in 15(6%), pleural effusion in 7(2.8%), splenic abscesses in 4(1.6%), splenic cysts in 2(0.8%), acute appendicitis in 2(0.8%) and acute calculus cholecystitis in 1 patient (0.4%).

According to the work done by Bakhieta   I. A14., his sonograms and records of 80 patients with melioidosis were retrospectively reviewed.  The number, size, sonographic appearances and distribution of abscesses in the abdominal visceral organs were analysed. There most common suspected diagnosis upon hospital admission was septicemia and pyrexia of unknown origin (39%). Abdominal visceral organ abscess was suspected in only 28% of patients. Fifty-seven patients (71%) had single organ involvement and 23 (29%) had multiple organ involvement. There were lessons in the spleen in 59 patients (74%), liver in 37(46%), and kidney in 10(12%) multiple abscesses were much more common than a solitary abscess in each organ and were demonstrated in 83%, 68% and 78% of patients with spleen, liver and kidney involvement respectively.

In a work done by Thulkar O.S15, abdominal sonographic imaging of patients with sickle cell anemia revealed a high prevalence of abnormalities in the liver, gallbladder and spleen but a low prevalence in the kidney.

In a research done by Roman al16, sonographic findings in 40 patients with dengue hemorrhagie fever, including pleural effusion, ascites and gallbladder wall thickening, splenomegaly was not mentioned.  In our series, we found that splenomegaly was a frequently, sonographic finding.  Liver size was not measured in our study, therefore hepatomegaly was not considered.

In work done by Speets A. M17,abdominal ultrasound is a valuable investigation in patients with suspected of biliary pathology and in evaluating abdominal masses. Patients with localized pain and tenderness are more likely to have a positive findings on ultrasound examination than are those with defuse abdominal pain and tenderness pain ultrasound is less useful in patients who are less than 25 years of age especially when there symptoms and signs are non specific and the laboratory results are normal.

Another study done by Raman S. I18, showed that the mean age of the patient at the time of the abdominal ultrasound was 54 years and were 35% male.  10% of the patients had a prior diagnosis of choleliathiasis and 7% had a prior cholecystectomy. Almost 80% of the patients had complaints of abdominal pain. Abnormalities with physical examination were found in 44% of the patients. The most common suspected diagnosis was cholelithiasis (47%) and nephrolithiasis (13%).


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