Abdominal ultrasound yield in critical care patients with liver function tests abnormalities

• Autor(a) principal: Rosa Carolina Gonçalves Pereira
• Data de Publicação: 2018
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://hdl.handle.net/10216/114278
• topic: Medicina clínica; Clinical medicine

Introduction: The term Liver Function Tests is commonly used to refer a combination of liver biochemical tests - ALT; AST; GGT; ALP; Bilirubin. Abnormalities in these five assays are a significant entity in critical illness, increasing the demand and burden of diagnostic imaging tests. Purpose: We intend to evaluate the abdominal ultrasound yield as diagnostic evaluation of Liver Function Tests abnormalities in critical care patients. Material and Methods: Single-center retrospective analysis of all abdominal ultrasound requests of Intensive Care Service over a 2-year period. We matched the ultrasounds done with the indication Liver Function Tests abnormalities to both ultrasound report and laboratory results. Reports were reviewed and coded using a fixed coding scheme by two radiologists as "positive" (abnormal findings explain the laboratory results) or "negative". We also recorded ultrasonographic diagnoses and abnormalities. Results: Of 573 abdominal ultrasounds requests, 122 (21.3%) were due to Liver Function Tests abnormalities. Among these, 6 were coded as "positive" and were diagnosed as Cholecystitis (n=4), Portal Vein Thrombosis (n=1) and Sludge or Malignancy causing Biliary Tract Distension (n=1). Frequent described abnormalities include: Hepatomegaly (n=60), Steatosis (n=49), Gallbladder sludge (n=44) and Gallstones (n=24). Discussion: Abdominal ultrasound rarely found a cause for Liver Function Tests abnormalities. No statistically significant correlation was found between laboratory parameters and "positive" ultrasounds, so we aren't yet able to know the subgroup of patients that would most likely benefit from ultrasound scan. Conclusion: The clinical indication of abdominal ultrasound as diagnostic evaluation of Liver Function Tests in critical care patients is questionable.