Clinical Details Guidance on scan justification Abdominal US Need to know the duration of abnormality. A single Abnormal/Altered episode of mild moderate elevation does not – LFT’s warrant an abdominal US. Specific LFT results should be included within the referral. For instance ultrasound should be considered for an isolated ALP rise. Need to know whether the patient is symptomatic or asymptomatic. If asymptomatic US is not a first line investigation. Isolated raised ALT US is not justified for a single episode of raised ALT. US is justified if raised ALT is persistent (3-6 months). US is often not required in patients with high risk factors such as DM, Obesity, Statins and other medications which affect liver function. However US can be used to confirm fatty liver in patients with some of the above risk factors. Jaundice All Jaundice requires an US scan and urgent specialist referral. Pain (RUQ/Illiac Generalised or RUQ pain along with abnormal blood Fossa) results would warrant an US scan. Pain along with fatty intolerance and/or dyspepsia Gallbladder disease warrants an US. Gallbladder polyps Less than 5mm require a 12 month US follow up. 6mm 9mm require a 6 month US follow – up. If the patient is symptomatic or with a polyp >10mm then referral to upper GI surgery is advised. A solitary episode of bloating does not warrant a US Bloating/Abdominal scan, if this bloating is persistent/frequent (more than distension 12 times over a month) then an US would be indicated, as in keeping with NICE guidelines. With the presence of a palpable mass US would be indicated.
Clinical Details Guidance on scan justification Abdominal US Abnormal/Altered LFT’s Isolated raised ALT Jaundice Pain (RUQ/Illiac Fossa) Gallbladder disease Bloating/Abdominal distension Need to know the duration of abnormality. A single episode of mild – moderate elevation does not warrant an abdominal US. Specific LFT results should be included within the referral. For instance ultrasound should be considered for an isolated ALP rise. Need to know whether the patient is symptomatic or asymptomatic. If asymptomatic US is not a first line investigation. US is not justified for a single episode of raised ALT. US is justified if raised ALT is persistent (3-6 months). US is often not required in patients with high risk factors such as DM, Obesity, Statins and other medications which affect liver function. However US can be used to confirm fatty liver in patients with some of the above risk factors. All Jaundice requires an US scan and urgent specialist referral. Generalised or RUQ pain along with abnormal blood results would warrant an US scan. Pain along with fatty intolerance and/or dyspepsia warrants an US. Gallbladder polyps Less than 5mm require a 12 month US follow up. 6mm – 9mm require a 6 month US follow up. If the patient is symptomatic or with a polyp >10mm then referral to upper GI surgery is advised. A solitary episode of bloating does not warrant a US scan, if this bloating is persistent/frequent (more than 12 times over a month) then an US would be indicated, as in keeping with NICE guidelines. With the presence of a palpable mass US would be indicated.