ABD Board-Miscellaneous Flashcards by miranda wilcox

appearance of an abscell

variable

typically a complex mass (solid or cystic)

debris

septations

gas can be seen within the abscess (cause reverberation)

poserior enhancement depending on cystic componenet

most reliable:

fever

increased white blood cell count

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in the absence of gas within a collection differentiation of adscess from hematoma is by

percutaneous (made, done, or affected through the skin) aspiration

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extrahepatic collections of extravasated bile

predominantly cystic masses located in the RUQ

associated with ABD trauma, GB disease, or biliary surgery

biloma

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lymphoceles are complications of

renal transplantation

gynecologic surgery

vascular surgery

urological surgery

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lymphoceles are caused by

leakage of lymph from renal allograft or by a surgical distruption of the lymphatic channels

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collection of urine which is located outside of the kidney or bladder

caused by renal trauma, surgery, or from an obstructing lesion

urinoma

appears similar to a lymphocele

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urinoma is most commonly assiciated with

renal transplantation (leak in ureter)

poserior urethral valve obstruction

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a spectrum of disorders affecting the proximal femur and acetabulum that leads to hip subluxation and dislocation

hip dysplasia (developmental dysplasia of the hip, DDH)

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risk factors for hip dysplasia

female

1st born child

frank breech presentation

family history

oligohydramnios

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hip laxity (looseness) is common at birth. sonography is performed after 4 weeks of age. How is the exam performed

3 x more common in the left hip than the right

both hips are evaluated in the coronal and transverse planes

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stress maneuver where dislocation of the hip by adducting and pushing the leg posteriorly

barlow

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stress maneuver where relocation of the dislocated hip by abducting the leg. A palpable and audible clunk is noted as the frmoral head slips back into the socket

ortolani

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two groups of lymphoma

non hodgkin lymphoma (NHL), more common, effects ppl over 60 more often, either B or T cell

hodgkins disease, usually in ppl age 15 to 24

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normal lymph nodes appear as

anechoic/hypoechoic mass containgging a central echogenic foci

no acoustic enhancement

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sign of presence of perivessel lymphoma

typically around linear structure like IVC and SMA

sandwich or mantle sign

found more frequently in non hodgkin lymphoma

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findings associated with non hodgkin lymphoma

nodal masses

fever

night sweats

weight loss

splenomegaly

hepatomegaly

cytopennia (bone marrow involvement)

ABD mass causing bowel ostruction

hydronephrosis due to retroperitoneal nodes

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hodgkins disease and non hodgkins both originate

originates from WBC called lymphocytes

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difference between hodgkins and non hodgkins

hodgkins - presence of reed sternberg cell and all other types are non hodgkins

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excessive accumulation of serous fluid in the peritoneal cavity

ascites

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two mechanisms that produce ascites

low serum osmotic pressure (protein loss)

high portal venous pressure

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causes of ascites

cirrhosis (most common)

renal failure

congestive heart failure

cancer (malignant ascites)

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hypoalbuminemia

low protein

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hypoalbuminemia can be a result of

liver failure

nephrotic syndrome

malnutrition

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successfull treatment for ascites by lowering portal pressure

transjugular intrahepatic portal systemic shunting

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ascites is most commonly found in

inferior aspect of the right love of the liver morisons pouch pelvic cu de sac paracolic gutters GB thickening is frequently seen with ascites

a malignancy characterized by the progressive accumulation of mucus secreting tumor cells within the peritoneum most commonly associated with cancer of the appendix bowel loops are seen matted to the posterior ABD wall

pseudomyxoma peritonei

a procedure to remove ascites from the peritoneal cavity

ABD paracentesis

2 reasons for a paracentesis

diagnostically to perform lab testing on the fluid therapeutically to relieve ABD pressure causing respiratory difficulties or pain

needle typically used for therapeutic (large volume) para

14 gauge cannula with a vacuum aspiration system

an accumulation of fluid within the pleural space

pleural effusions

two classifications of pleural effusions based on lights criteria which is a comparison of pleural fluid and blood chemistries (protein, LDH)

transudates exudates

caused by increased hydrostatic pressure and decreased plasma oncotic pressure which is caused by: heart failure (most common) liver failure (cirrhois) renal failure (nephrotic syndrome)

transudative effusions (pressure infiltration)

caused by increased capillary permeability which is caused by: pneumonia cancer pulmonary embolism

exudative effusions (inflammation)

symptoms of pleural effusions

often asymptomatic dyspnea pleuritic chest pain

lableural effusions analysis typically included for p

total protein LDH cell count and differential gram stain aerobic and anaerobic baterial cultures cytology

identified with the absence of gliding of the parietal and visceral pleura and the presence of a comet tail artifact between these layers with patient in the supine position, air can be located on the anterior medial location of the thorax

pneumothorax

procedure to aspirate fluid from the pleural space of the chect

thoracentesis

reasons for performing a thoracentesis

diagnostic therapeutic (relieve dyspnea)

thoracentesis procedure

supine but can also be done with patient in LLD needle insertion is on superior aspect of the rib as vessels are located inferior aspirated slowly not to exceed 1.5 liters per day to avoid hypotension and pulmonary edema post procedure chest x ray is performed to rule out pneumothorax and compare with pre thoracentesis chest x ray coughing occurs as the lung re expands, with inflammation of the pleura, as the fluid is removed visceral and parietal pleura rub together resulting in pain

a collection of synovial fluid in the popliteal fossa

bakers cyst commonly located in the medial aspect of the popliteal fossa but may also extend downward into the calf muscles

causes of bakers cyst

rheumatoid arthritis osteoarthiritis overuse of the knees symptoms may be mistaken for DVT due to pain and swelling behind the knee and in the upper calf

second most common tumor of the hand and wrist

giant cell tumor

most common tomor of the hand and wrist

ganglion cysts simple cyst with sound enhancement

solid masses that may have varying appearances of the hand and wrist

giant cell tumor may appear cystic but with no acoustic enhancement

two longitudinally oriented muscles extending from the zyphoid process to the pubic bone encased in a sheath anteriorly and posteriorly these sheaths join at the midline to form the lineal alba, which is a complete partition of this compartment

rectus abdominus muscles

result of bleeding from the superior or inferior epigastic vessels (superior and inferior to umbilicu) or from a tear of the rectus muscle

rectus sheath hematoma

located midway between the umbilicus and the symphysis pubis where the posterior wall of the sheath ends

arcuate line

hematomas superior to the arcuate line superficially located are

confined between the anterior and posterior sheaths and should not move across the midline dur to the linea alba

hematomas inferior to the arcuate line

will extend into the space of retzius (retropubic space) within the pelvis causing external compression and irritation of the urinary bladder without the posterior sheath the bleed does not tamponade as is does above the arcuate line extensive bleeding can result in a decrease in hematocrit and hypovolemic shock but most rectus sheath hematomas are self limiting

resctus sheath hematomas occur due to

external trauma trauma from surgery vigorus muscle contraction valsalva with severe caughing/vomiting pregnancy

rectus sheath hematoma is a recognized complication of

anticoagualtion therapy

types of hernias

epigastric hernia incisional hernia umbilical herniafemoral hernia obturator hernia inguinal hernia indirect inguinal hernia (scrotal) direct inguinal hernia (down groin) spigelian hernia (not on mid line)

occurs due to a weakness on the midline of the upper ABD wall, on a line between the breast bone and the umbilicus

epigastric hernia

a result of a post operative weakening of the ABD wall

incisional hernia

occurs near the umbilicus due to the natural wakness of the ABD wall from the umbilical cord

umbilical hernia

occurs within the femoral canal adjacent to the femoral vein just below the groin crease and is usually associated with pregnancy

femoral hernia

protrudes from the pelvic vcavity through an opening in the pelvic bone (obturator foramen). Because of the lack of visible bulfing, this hernia is very difficult to diagnose

obturator hernia

most common ABDwall hernia occuring more often in men than women

inguinal hernia

follows the inguinal canal descending from the ABD into the scrotum. This pathway normally closes before birth but may remain a possible site for a hernia inlater life. Sometimes the hernia sac may protrude into the scrotum.

indirect inguinal hernia

occurs slightly to the inside of the site of the indirect hernia, in an area where the ABD wall is naturally slightly thinner. It rarely will protrude into the scrotum.

direct inguinal hernia

occurs along the edge of the rectus abdoninus muscle through the spigelian fascia, which is several inches lateral to the middle of the ABD

spigelian hernia

four patterns of muscle fiber organization (skeletal muscle)

parallell (fusiform) convergent (triangular) pennate circular

long axis of muscle fibers runs with longitudinal axis of muscle (examples are biceps, sartorius)

parallell (fusiform)

muscle fibers converge toward a single tendon (examples are pectoralis major)

convergent (triangular)

muscle fibers branch from central tendon diagonally (feather like) (examples are rectus femoris and deltoid)

pennate***

muscle fibers are arranged in concentric rings (examples are obicularis oris)

circular

OSHA

occupational safety and health adimnistation

because of significant health risk associated with exposure to viruses and other micro organisms that cause blood borne diseases OSHA made

occupational exposure to bloodborne pathogens standard in 1991

primary concern for blood born pathogens

human immunodeficiency virus (HIV) hepatitis B and C

infectious microorganisms present in blood that can cause disease in humans

bloodborne pathogens

an approach to infection control to treat all human blood and body fluids as if they were known to be infectious

universal precautions

healthcare associated (acquired) infections (HAI's)

central line associated bloodstream infections (91% of patients) catheter associated urinary tract infections (77% of patients) ventilator associated pneumonia (95% of patients) surgical site infections