Jitesh Parekh

AIM

The general primary care physician in the U.K receives no formal PoCUS under or post-graduate training.

At [name of institution], we aim to train general primary care physicians in how to use PoCUS to aid diagnosis.

With new pocket sized, affordably priced ultrasound machines, this revolutionary technology can now be used to identify those patient’s needing emergency medical care or, those stable enough to have a formal scan at a later date.

CASE REPORT

A 71-year-old female presented with a five-day history of lower abdominal pain, poor appetite and one single episode of vomiting.

She had been opening her bowels regularly, with no change in bowel habit, constipation or diarrhoea. There was no history of fever, weight loss or rectal bleeding. She had a past medical history of atrial fibrillation for which she was taking warfarin.

On examination, her observations were all normal. The abdomen was mildly distended with tenderness over the umbilicus, there were no signs of rebound tenderness or peritonism. She was rovsing’s and murphy’s negative, with normal bowel sounds.

The general primary care physician performed a focused PoCUS. Although she was sonographically murphy’s negative, it showed a thickened wall gallbladder with multiple gallstones, confirming a diagnosis of acute cholecystitis.

The patient was admitted to hospital, computed tomography (CT) confirmed the diagnosis, and she was treated with intravenous antibiotics with view to undergo a laparoscopic cholecystectomy.

DISCUSSION

The case illustrated how PoCUS can be used in primary care, where sameday investigations are not readily available, such as blood tests, to rule in life threating conditions such as acute cholecystitis.

This is especially helpful in patient’s presenting with normal observations and non-specific abdominal pain. It can also be used to diagnose ruptured abdominal aortic aneurysms, kidney stones and free fluid in the pelvis.

We understand performing PoCUS may require more time than the current ten minute’s allocated for appointments in U.K primary care and is also user dependent. However, we hope a national campaign by the [name of organisation] to increase appointment times and a structured PoCUS general practice training programme, will help tackle these issues.

CONCLUSION

PoCUS in primary care can be a valuable non-invasive tool in the hands of a trained primary care physician in diagnosing acute causes of abdominal pain, especially in those presenting with non-specific symptoms with normal observations.