Marcus Bastos, Fabio Pace, Natalia Fernandes, Aline Schreider, Gustavo Camilo, Gabriela Cumani

OBJECTIVE

To assess whether ultrasound augments medical students ability in identifying intra-abdominal free fluid.

INTRODUCTION

Intra-abdominal free fluid (IAFF) describes an accumulation of fluid in the peritoneal cavity. It has different etiology, but always constitutes an important clinical sign.

AIM

In this study, the authors interrogate whether ultrasound (US) augments medical students ability in identifying IAFF.

METHODS

Twelve medical students were subjected to a multiple choice test before and after receiving a four hours of theoretical and hands-on sessions about physical examination (PE) and abdominal ultrasound in the diagnosis of IAFF.

The hands-on sessions were done in human models (one medical student and a CAPD patient with two litter of peritoneal dialysis solution in his cavity) to document the absence or presence of IAFF, respectively.

The abdominal ultrasound were done at upper right quadrant (RUQ), left upper quadrant (LUQ) and pelvic cavity (PC) in supine position.

For the assessment of IAFF, three other CAPD patients with no liquid or one litter or 2 litters of peritoneal solution were used, with infusion controlled by a specialized nurse.

RESULTS

The cognitive assessment (total of 15 points) before and after the theoretical and hands-on training increased from 6.83±3.07 to 11.91±1.31 points (p <0.05).

It was noticed by one of the researchers (GC) that IAFF was detected by the US even in the patient with drained peritoneal cavity. The performance of the students using US was superior to their PE mainly when imaging the RUQ associated with LUQ and/or PC (p <0.05).

When the three situations of liquid in the peritoneal cavity (“empty”, one litter and 2 litters) are analyzed, the IAFF was misdiagnosed as negative or dubious using US in 44%, mainly due to the negative findings in the PC (88%).

The students were able to detect IAFF in all patients in whom the assessment were negative by PE.

CONCLUSION

These results demonstrate that medical students’ ability to diagnose IAFF using abdominal US is superior when compared to PE only.

The PC is the region where the student found more difficulties in identifying IAFF by US.