IMAGE INTERPRETATION

1. INTERPRETATION OF FINDINGS


  • Defining the type of content (empty, clear fluid or thick fluid/solid) is the first step. An empty stomach is suggestive of low aspiration risk. Solid content is suggestive of a high aspiration risk. 
  • The risk implications of an empty stomach (low risk) and solid content (high risk) as self-evident.
  • When clear fluid is present, a volume assessment can discriminate between a low volume compatible with a fasting state (Grade 1 antrum and ≤1.5 mL/Kg), vs. a high volume suggestive of a non-fasting state (Grade 2 antrum and >1.5 mL/Kg).


2. Medical Decision Making


Your findings will help you decide if you should:

  • Delay
  • Cancel
  • Proceed ± aspiration profylaxis
  • Insert nasogastric tube: pre-, per- or post-operatively
  • Use a laryngeal mask or endotracheal tube
  • Do standard intubation or rapid sequence

 

Some examples:

  1. Ultrasound findings can help decide if it is safe to proceed with an elective procedure when there is questionable fasting status.

  2. In case of urgent or emergency surgery that needs to proceed, gastric ultrasound findings can help decide:

    • Adult for laparotomy
    • Adult with non-reassuring airway where one may require bag-ventilation for emergency
    • Infants with pyloric stenosis
    • Prior to extubation in at risk patients
    • Obstetric with epidural for C-section with high risk of conversion to GA
    • If a nasogastric tube should be considered prior to induction of anesthesia

 


3. LIMITATIONS OF GASTRIC ULTRASOUND


Gastric ultrasound findings may be inaccurate in subjects with abnormal underlying gastric anatomy. For example:
  • Previous gastric resection or bypass
  • Gastric band in situ
  • Previous fundoplication
  • Large hiatus hernia


4. Cut-off-values


Defining a full stomach based on ultrasound findings:

Empty Stomach (any of the following)
  • No content visible in any patient position (Grade 0 antrum) 
  • Clear fluid in the right lateral decubitus but appears empty when supine (Grade 1 antrum) 
  • Clear fluid with a cross-sectional area of < 10 cm2 in the RLD for an average adult
  • Clear fluid with estimated Gastric volume < 1.5 mL/Kg 

Full Stomach (any of the following) 
  • Thick fluid or Solid content in any patient position
  • Antrum distended with clear fluid evident in both supine and right lateral decubitus (Grade 2 antrum)
  • Clear fluid with cross-sectional area > 10 cm2 in the RLD for an average adult
  • Clear fluid with estimated Gastric volume > 1.5 mL/Kg 


Share Your Cases

  • Have an interesting case to share where gastric ultrasound made a difference to you or your patient?
  • Selected cases will be posted
  • Sources will be acknowledged
  • Please, mail your cases to edu@gastricultrasound.org