POCUS Learning Modules

MODULE 4:  Kidneys, Bladder, & FAST Scan

Curriculum Location: Surgery / Total Time: 2 hours

For this and all other modules, you are welcome and encouraged to take notes as helpful to you in your Ultrasound/POCUS for Family MedicineEvernote Notebook, found here. 

Learning Module Objectives:

  1. Assess the kidneys for hydronephrosis

  2. Assess the bladder for urinary retention present as measured by increased post-void residual (PVR) volume

  3. Recognize renal or bladder stones if present

  4. Assess the prostate for enlargement with transverse measurement

  5. Assess the kidneys for CKD using size and echogenicity

  6. Understand the rationale and 4-views of the FAST Exam

Renal US (Time: 20 minutes)

  1. Background Case: Hematuria and elevated creatinine

    1. Introduction: Read this Case Summary and accompanying Case Questions for a brief example of how POCUS applies to family medicine regarding renal ultrasound.

    2. Case description: A 55 year old woman complains of lower abdominal pain, and brief gross hematuria, now resolved, and is found in your office to have hematuria on her POC Urinalysis. You decide to order a creatinine, which is elevated 1.7 times over her baseline (Stage 1 AKI). You suspect post-renal obstruction, possibly due to stones, as the cause of her AKI. You augment your physical exam with POCUS to assess for hydronephrosis.

    3. Case Question: How do you assess the kidneys for obstruction/hydronephrosis?

  2. Assignments:

    1. Watch the following SUSME introductory video: Renal Ultrasound. (You may want to take notes in your Ultrasound/POCUS for Family Medicine Notebook note: "2 Application: KUB - Renal Ultrasound"; link to the notebook is above.)

    2. Visit Ultrasoundpaedia’s page on the normal kidneys. Hover over the normal kidney images at the top to review the anatomy (the section on renal anomalies can be skipped).

    3. Review the following abnormal findings of renal ultrasound:

      1. Sonoworld: Renal & Perinephric abscess

      2. Soundbytes: Hydronephrosis (Watch 3:00-7:35 segment only)

Bladder & Prostate US (Time: 20 minutes)

  1. Background Case: Nocturia

    1. Introduction: Read this Case Summary and accompanying Case Questions for a brief example of how POCUS applies to family medicine regarding bladder & prostate ultrasound.

    2. Case Summary: A 60 year old man sees you in the FMC with complaint of increasing nocturia. He last urinated 2 hours ago. You decide to use POCUS to scan his prostate for BPH through his filled bladder, then have him urinate and measure a post-void residual volume, before proceeding to a digital rectal exam.

    3. Case Questions: How do you perform a bedside RUQ Ultrasound scan of the bladder to measure and interpret a post-void residual volume? How can POCUS assist in evaluate for BPH.

  2. Assignments:

    1. Watch the following SUSME introductory video: Urinary Bladder and Ureter Ultrasound. (OPTIONAL: You may also want to watch this brief summary of bladder from the SUSME material.

    2. Briefly review UP’s page on the normal bladder. Note the comments on calculating a PVR: http://www.ultrasoundpaedia.com/normal-bladder/

    3. Briefly review the anatomy of the prostate and note the appearance of the prostate below the bladder in transverse orientation: http://www.ultrasoundpaedia.com/normal-prostate/

    4. Review this Evernote for a summary of BPH assessment with POCUS: https://www.evernote.com/l/AM_ozK5BYaBO6YdNFUN6sytzlAnSFR8itt8

FAST/E-FAST Scan (Time: 30 minutes)

  1. FAST Scan and E-FAST Scan is an emergency/trauma protocol you have likely heard of, and possibly seen. FAST Scan (Focused Abdominal Sonography for Trauma) is a 3-minute protocol utilized in the U.S. since the 1980s to quickly diagnose intraabdominal bleeding. It is an integral part of ATLS protocol in trauma surgery, and is often extended (the "E" in "E-FAST") to include a pulmonary application to rule out pneumothorax. Now that you have been introduced to liver, kidney, and bladder US, it's time to familiarize yourself with and understand the rationale and approach to the FAST Scan.

  2. Review how to do a FAST Scan (choose one option only):

    1. For Apple device use only (preferred, if accessible): Read Volume 1, Chapter 1 “FAST/EFAST” of the excellent, free iBook resource “Introduction to Bedside Ultrasound” by Dawson/Mallin, linked HERE (app store) and in the resource section of your Ultrasound/POCUS Webpage. Read Sections 1 and 2 only; you do NOT need to read Section 3 on "E-FAST". Also, as you read about the subxiphoid view portion of FAST "don't sweat it if you don't get it", since you have not yet been introduced to echocardiography applications of POCUS. That'll come in a later module.) Be sure to click on the Videos and Images embedded in the chapter, and be sure not to miss “Movie 1.1,” an excellent brief overview of FAST Scan.

    2. If you do not have an Apple device and cannot access iBook, please read the summary found in your Evernote notebook, found HERE, and then review this FAST Scan Overview from ACEP's Sonoguide.

  3. Last, please view the 5 minute video of a case of an intraperitoneal bleed found with FAST Scan from the MGH Emergency Medicine's Educational Case Series linked HERE.

Module QUIZ (Suh-weet!) (Time: 10 minutes)

Congratulations on completing the module.  Please click HERE to take your Module Quiz and provide Module feedback.