What do the doctors find in the abdominal ultrasound, which many Romanians delay too much. “It should be done every year, regardless of age”

Vague abdominal pain, bloating and nausea are often ignored or treated symptomatically. Many patients come to the doctor only when the manifestations become persistent or worrisome. But in the office Dr. Luminița Nițăan internist specializing in 4D ultrasound, things look different: a simple investigation, such as an abdominal ultrasound, frequently reveals problems that have been developing silently for years. “Abdominal ultrasound should be done every year, regardless of age, even in the absence of symptoms. It is a basic, preventive investigation,” explains the specialist from Hyperclinic MedLife Berceni. The recommendation exists, but in practice, most patients go to ultrasound only when problems arise or on the indication of other specialists. Prevention remains an exception.

The most common problem that doctors identify on abdominal ultrasound is hepatic steatosis, popularly known as “fatty liver”. It is an increasingly widespread condition linked to diet and lifestyle. “Most frequently we detect hepatic steatosis. Fats are stored in the liver and this is very clearly visible on ultrasound,” says the doctor.

Along with fatty liver, another common finding is gallstones – gallstones formed in the gallbladder. Depending on the size and symptoms, they may require only monitoring or surgery. “If they are small, they can migrate and lead to complications, such as pancreatitis, in which case surgery is recommended. If they are larger and do not cause symptoms, the intervention can be delayed and a diet is recommended”, explains Dr. Luminița Niță.

The kidneys are also evaluated during the abdominal ultrasound, and renal microlithiasis – “sand in the kidneys” – is another common problem in patients who present with lower back pain, burning when urinating, repeated urinary infections or episodes of renal colic. Depending on the size of the stones, treatment can vary from conservative measures to urological interventions.

Bloating, one of the most common symptoms that bring patients to ultrasound

Although the investigation is recommended annually, most patients arrive at an abdominal ultrasound only after the onset of symptoms. The most common are upper abdominal pain and bloating. “Upper abdominal pain and bloating are the most common reasons for presentation. Then comes nausea, vomiting, or unintentional weight loss,” says the doctor.

Bloating is one of the most common symptoms, but also one of the most deceiving. From Helicobacter pylori infection and irritable bowel syndrome to gastritis, gallstones or liver problems, the causes are multiple.

“In the spring, for example, bloating is accentuated by the consumption of raw vegetables – green vegetables, radishes, salads. In patients with gastritis, these foods can aggravate the symptoms”, explains the doctor. There are also situations where bloating has a hormonal component, especially in women, during perimenopause or menopause.

More and more abdominal tumors in recent years

Beyond common problems, serious conditions can also be identified during an abdominal ultrasound, sometimes unexpectedly. In recent years, doctors say they are noticing tumor formations more and more often. “We discover primary liver tumors or metastases, liquid in the abdominal cavity, which must be investigated further. These are problems that do not always give symptoms at the beginning”, explains Dr. Luminița Niță.

One of the cases that made a strong impression on her was that of a young patient who had regular medical check-ups. Tests indicated elevated liver enzymes, and ultrasound was the next step. Further investigations led to the diagnosis of cholangiocarcinoma, an aggressive tumor of the bile ducts.

Another case was that of a 21-year-old man who came to the ultrasound for seemingly trivial but persistent nausea. Ultrasound showed fluid in the abdomen, and further investigations showed peritoneal carcinomatosis, an advanced form of cancer. “That's why ultrasound is important for preventive purposes: it can indicate the first changes that raise an alarm,” says the doctor.

There are also situations where early detection during an abdominal ultrasound leads to effective therapeutic management. Renal tumor formations detected by chance could be treated surgically, without the need for complex oncological treatments, exemplifies Dr. Luminița Niță.

When is 4D ultrasound useful?

Advanced technology offers a clear advantage for early identification of potentially dangerous changes, and 4D ultrasound creates a clearer and more detailed image compared to classical methods. “4D ultrasound is more accurate and is especially useful in patients with obesity or bloating, where visualization is more difficult,” explains Dr. Luminița Niță.

However, an ultrasound with “good” results should be supplemented with other investigations to assess the health of all organs in the abdominal area. Ultrasound cannot replace, for example, an endoscopy or a colonoscopy, the doctor points out. The colon and stomach cannot be evaluated sonographically in detail. That's why the recommendation is that the upper digestive endoscopy be done on the doctor's recommendation and the colonoscopy – as a screening method after the age of 40-45 or earlier if there is a family history of cancer, says Dr. Niță.

Preparing for the ultrasound can help with clearer results

In order for the results to be as accurate as possible, the abdominal ultrasound requires minimal preparation. For 24 hours before, patients should avoid foods that cause bloating, such as legumes or raw vegetables. “Treatment to reduce gas is also recommended, and before the investigation the patient must be well hydrated and not empty the bladder”, explains the doctor.

Abdominal ultrasound does not always make the final diagnosis, but it is an important step for prevention. “If we detect something suspicious, we continue with more complex investigations, depending on each individual case”, concludes Dr. Luminița Niță.

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