Abdomen

• Biliary colic/RUQ pain
  • routine USS unless features of acute cholecystitis warranting acute surgical admission
     
• Abnormal LFT’s   
  • Elevated liver enzymes -> routine liver USS as part of NILS
  • High-risk alcohol intake -> direct access fibroscan, USS not required
  • Gilbert’s syndrome does not require USS investigation
  • Conditions that do not require USS prior to referral:
    • Suspected haemochromatosis meeting criteria on iron studies
    • HCV PCR positive
    • HBV serology positive
    • Anti-mitochondrial Ab positive (PBC) or anti-smooth muscle Ab positive (AIH/PBC)
    • Anti-nuclear Ab positive with elevated IgG
      
      See guidance and fibroscan request form here

• Abdominal mass
  •   consider 2ww colorectal/gynaecology without need for prior imaging if criteria met
  •   suspected fibroid uterus -> routine USS

• Painless Jaundice
  • does not require USS prior to referral to jaundice rapid access clinic

• Ascites
  • depending on suspected source, consider 2ww gynaecology or hepatology A&G

• Change in bowel habit
  • no role for USS in diagnosis of IBS or diverticulosis, consider 2ww colorectal if malignancy suspected

• Herniae
  • inguinal, incisional, periumbilical or spigelian herniae in the absence of red flags only require USS if the diagnosis is in doubt. Irreducible, acutely tender herniae raising the suspicion of obstruction warrant urgent surgical admission. Further guidance is available here

• Suspected retroperitoneal pathology
  • poor yield on USS, consider CT or Radiology A&G

• USS requests for bloating in isolation and non-specific pain rarely yield positive findings however these symptoms should prompt further investigation that may lead to USS request - eg elevated CA125

• Incidental findings such as hepatic cysts where need for surveillance is unclear – consider Hepatology or Radiology A&G

• AAA screening is managed by the national screening program. Incidental findings of asymptomatic AAA should be referred to vascular surgery at detection. Guidance is available here

 

Date reviewed                     18/02/2022

Next review due                  18/02/2023

Sifter name                          Dr Rebecca Hopkins