ABD Final Exam Flashcards
Where does the portal vein carry blood from to go to the liver?
Intestinal Tract
Pg. 193
What is the arterial supply to the GB?
Right Hepatic Artery via the Cystic Artery
Pg. 179
The portal venous system receives blood from what organs?
from the intestines and spleen
pg 193
What vessel lies posterior to the neck of the pancreas?
SMA
Pg. 180
What blood vessel supplies blood to the stomach and the duodenum?
Gastroduodenal Artery and the Right Gastric Artery
Pg. 179
What vessel passes anterior to the uncinate process?
Superior Mesenteric Vein Pg. 195 OR Superior Mesenteric Artery Pg. 180
Both say they run anterior to the uncinate process
What is Budd-Chiari syndrome?
Uncommon thrombosis of the hepatic veins or IVC. Carries a poor prognosis and presents abdominal pain, massige ascites and hepatomegaly. Hepatic vein occlusion is fatal within weeks or months.
p. 246
The distribution of blood flow of the SMA feeds what?
The small bowel, the proximal half of the colon and the small intestine
Pg. 181
What vein begins at the splenic hilum and is joined by the gastric and left gastroepiploic veins?
Splenic Vein
Pg. 194
Information about the Portal vein (origin, where it travels, etc)
Formed posterior to the pancreas by the SMV and SV at the level of L2. Courses posterior to the first portion of the duodenum and then between the layers of the lesser omentum to the porta hepatis where it bifurcates into its hepatic branches.
Pg. 193
What is the distribution of blood flow for the IMA?
Arises from the anterior abdominal aorta and proceeds to the left to distribute blood to the descending colon, sigmoid colon, transverse colon and rectum.
Pg. 182
Where does the right renal artery pass in reference to IVC?
Posterior to the IVC
Pg. 182
What vessel arises from anterior aorta and courses parallel to it?
Superior Mesenteric Artery
Pg. 181
What vessel courses between aorta and SMA?
Left Renal Vein
Pg. 190
Renal arteries branch from the aorta from what level of the lumbar spine?
At the level of and anterior to L1
Pg. 182
What structure does the IVC enter?
Lesser sac
Right atrium of the heart
Pg. 184
What vascular structure is a landmark in locating the Celiac trunk?
Superior Mesenteric Artery
Pg. 180
What vascular structure is medial and posterior to the borders of the pancreatic body and tail?
splenic vein
p.309
The GDA is a branch of what?
Common Hepatic Artery
Pg. 179
What is the most common cause for abdominal aneurysms?
arteriosclerosis
pg 171
What tumor can fill the IVC?
Renal cell carcinoma?
Pg. 189
The liver is suspended from the diaphragm and the anterior abdominal wall by what structure?
Falciform ligament
p.208
Fatty infiltration may be observed in patients with what?
Obesity, excessive alcohol intake, poorly controlled hyperipidemia, diabetes, excess corticosteroids, pregnancy, total parenteral hyperalimentation, severe hepatitis, glycogen storage disease, cystic fibrosis, pharmaceutical, or chronic illness
Pg. 235
What are the findings of acute hepatitis?
Clinical: increase in AST and ALT, increased bilirubin, and leukopenia
Sonographic: nonspecific and variable, normal to slightly increased echogenicity, increased brightness of portal vein borders, hepatosplenomegaly, and increased thickness of GB wall
Differentials: Fatty liver
p.234
Eccinococcal cysts come from what?
Infections cystic disease common in sheep herding areas. A tapeworm that infects humans and resides in the small intestine of dogs.
p. 255
What is the most common benign tumor of the liver?
Cavernous Hemangioma
p. 256
What is the benign liver tumor seen in glycogen storage disease?
Liver Cell Adenoma
p. 258
Patients who have hepatocellular carcinoma have had what?
Previous history of cirrhosis or hepatitis B or C, a palpable mass, hepatomegaly, appetite disorder and a fever???
p. 259m
What is the most common neoplastic involvement of the liver?
Metastatic disease
p. 259
The fossae of the right portal vein and GB are found in what fissure?
Main lobar fissure
p. 276
In severe hepatocellular destruction, AST and ALT (increase, decrease, stay the same)?
AST: Significantly elevates
ALT: moderate to high increase
p. 217-218
Elevation of Alkaline phosphatase is seen when?
Hepatitis and cirrhosis p. 218 Fatty Infiltration Pg. 234 Proximal biliary obstruction, distal biliary obstruction, Extrahepatic Mass, and Common Duct Stricture Pg. 250
Diminished vascular structures in the liver happens because of this?
fatty infiltration
p.234
Could also be Cirrhosis
Pg. 234
The falciform ligament extends from the umbilicus to the diaphragm and contains what?
Ligamentum Teres
p. 208
Elevation in bilirubin results in what?
Jaundice
p. 218
Symptoms in a patient with abscess formation would be?
fever of unknown origin, tenderness, swelling post operation, chills, weakness, malaise, and pain at the site.
pg 466
A tumor that consists of large blood-filled spaces is called?
Hemangioma
p. 256
Dilated intrahepatic ducts may be seen with all of the following except:
May be seen in: Proximal/distal biliary obstruction, Extrahepatic mass, Common duct stricture
Pg. 250 er
What is normal portal venous flow called?
Hepatopetal flow
p. 196
What is the most common site for an echinococcal virus to grow?
The liver
p. 255
An amebic abscess may reach the liver through what structure?
The portal vein
p. 255
What is the benign liver tumor that is solitary, well- circumscribed, non-encapsulated, has a multi-nodular mass?
Focal nodular hyperplasia
p. 258
What are common malignancies that affect the pediatric population?
The most common are Hepatoblastoma and hepatocellular carcinoma
Mets to liver are Wilm’s tumor Neuroblastoma, Leukemia, and Lymphoma
p.697 ????
In cases of choledocholithiasis, stones tend to lodge in what structure?
Ampulla of Vater
The right and left hepatic ducts unite to form what structure?
Common hepatic duct
p. 268
What is the diameter of the common hepatic duct?
4mm
p. 268
The hepatic duct is joined by _____ to form _______?
cystic duct; common bile duct
p. 268
What is the normal size of a common bile duct in a 60-year old patient?
6mm
p.268
The cystic duct connects the ______to form the _____?
neck of GB and the common hepatic duct; common bile duct
p. 268
What is a Phryigian cap on the gallbladder?
Part of the fundus is bent back on itself
p. 273
What are the functions of the gallbladder?
Stores bile and concentrates bile when the body is in a fasting state
PP DMSO Gallbladder and Biliary 1, Slide 6
p.273
What is the fold at the area of the neck of the gallbladder called?
Hartmann’s Pouch
p. 273
Gas forming bacteria in the gallbladder appear as what on ultrasound?
Emphysematous Cholecystitis appears differently varying on the amount of gas present. if gas is intraluminal; brighe echo along the anterior wall with ring down or comet tail artifact posterior to the echogenic structure. If a large amount of gas is present; appearance may simulate a packed bag or WES sign with curvilinear echogenic area with complete posterior fuzzy shadows.
Pg. 284
A positive Murphy’s sign is associated with what?
Acute Cholecystitis, Acalculous Cholecystitis
Pg. 278
I believe Cholelithiasis is also an answer but it doesn’t say so in the book.
What are the classic symptoms of gallbladder disease?
1) RUQ Pain after ingestion of greasy foods sometimes with nausea and vomiting.
2) Jaundice when gallstones block the bile ducts.
3) Sludge frequently due to bile stasis
Pg. 278
What is the most common appearance of gallbladder carcinoma?
It is associated with cholelithiasis 80-90% of the time. The gallbladder tumor is usually columnar cell adenocarcinoma and arises in the body, infiltrating the gallbladder causing thickening and rigidity of the wall. The liver is also often invaded and the tumor obstructs the cystic duct as well.
Sonographically, the mass is heterogeneous with abnormal wall thickening, the liver is often heterogenous and dilated biliary ducts causing the “Shotgun Sign”
Pg. 289
Sorry, i’m not really sure if she means sonographic findings or not?
The common bile duct is joined by the main pancreatic duct and together they open as what into the duodenal wall?
Ampulla of Vater
Pg. 268
What is inflammation of the gallbladder referred to as?
Cholecystitis
Pg. 281
What condition does someone have if polypoid masses arise from the gallbladder wall?
Cholesterolosis
Pg. 288
What is the sonographic appearance of cholelithiasis?
Increased size, increased wall thickness, presence of internal reflections within the lumen, posterior acoustic shadowing, dilated gallbladder lumen, WES sign. All stones greater than 3 mm cast an acoustic shadow regardless of specific properties. Some stones float.
Pg. 284
What is the most common cause of biliary ductal obstruction?
Presence of a tumor or thrombus within the ductal system.
Pg. 292
What is the WES sign?
Wall Echo Shadow, when the gallbladder is compleatly packed full of stones, the sonographer will only be able to image the anterior border of the gallbladder with the stones casing a distinct acoustic shadow.
Pg. 284
Non-shadowing, low amplitude echoes in the gallbladder are?
Sludge
Pg. 279
Where are the valves of Heister located?
Neck of the gallbladder in the cystic duct
Pg. 273
The physiological effect of a fatty meal is?
As the stomach empties the food into the duodenum the intestines secrete enzymes and bile salts that stimulate the gallbladder to contract, resulting in an outpouring of bile into the duodenum.
Pg. 273
PP DMSO 101 Gallbladder and Biliary 1, Slide 6
Air within the biliary tree secondary to a duct stent?
Pneumobilia
Pg. 296
The most common tumor sites that can spread carcinoma to the biliary tree are?
Breast, colon and melanoma.
Pg. 299
The majority of the pancreas lies in what abdominal cavity?
Retroperitoneal Cavity.
A small portion of the head is surrounded by the peritoneum.
PP. Chapter_012 Pancreas, Slide 6
p.302
`The pancreas is found behind the ____ sac?
Lesser Omental Sac
PP. Chapter_012 Pancreas, Slide 6
p.301
The head of the pancreas lies where?
Anterior to the IVC, Right of the portal-splenic confluence, Inferior to the main portal vein and caudate lobe, medial to the duodenum. Lies in the lap of the C-loop of the duodenum.
PP. Chapter _012 Pancreas, Slide 20
po.302
The head of the pancreas is inferior to this structure of the liver?
Main Portal Vein and Caudate Lobe
PP. Chapter_012 Pancreas, Slide 20
p.302
This structure passes through a groove posterior to the head of the pancreas
Common Bile Duct
Pg. 302
What structure is on the anterolateral border of the pancreas?
Gastroduodenal Artery
Pg. 302
Where is the tail of the pancreas located?
Anterior to the left kidney, posterior to the left colic flexure and transverse colon. The tail beings to the left of the lateral border of the aorta and extends toward the splenic hilum.
Pg. 302
What is the primary pancreatic duct called?
duct of Wirsung
p.308
An older man with a history of alcoholism was recently diagnosed with acute pancreatitis. His hematocrit is low and he is hypotensive. What would your differential diagnoses include? (Cholecystitis, psuedocyst, chronic pancreatitis or hemorrhagic pancreatitis)
Hemorrhagic pancreatitis
p.318
A patient has painless jaundice, weight loss and a decrease in appetite may have?
Adenocarcinoma of the pancreas
p.328
What is the duct of Santorini?
small accessory duct of the pancreas found in the head of the gland
p.308
What is the normal dimension of the pancreatic head?
2-3 cm, anterior to posterior.
Pg. 308
What is the normal size of the pancreatic duct?
less than 2 mm
p.308
Which level is going to be twice normal with acute pancreatitis?
Amylase
Pg. 311
Microscopic cells of the pancreas are called what?
Acini Cells
Pg. 310
Where is the splenic vein located in reference to the pancreas?
runs along the posterior aspect of the tail of the pancreas
p.309
If you can see the Celiac axis, which way should you angle/move the transducer to see the pancreas?
Inferiorly from the Celiac axis
Pg. 313
The splenic artery is located where in reference to the pancreas?
Along the superior border of the pancreas body and tail as it crosses horizontally toward the splenic hilum
p.309
The main pancreatic duct joins this structure before entering the duodenum
Common bile duct.
Joins to form the common trunk, enters at the ampulla of Vater.
Pg. 308
What are the signs and symptoms of acute pancreatitis?
Sudden onset of moderate to severe abdominal pain with radiation to back usually after a large meal or alcohol binge, Nausea and vomiting, History of gallstones or alcoholism, Mild fever, Increased pancreatic enzymes in blood (Amylase, Lipase), Increased leukocytosis, and Abdominal distention.
Pg. 318
The most common cause for acute pancreatitis in our country is?
Biliary Tract Disease
Pg. 317
What vessel is posterior to the lower neck of the pancreas and anterior to the uncinate process?
SMV
What is the condition that causes increased secretion of mucus?
Cystic fibrosis
p.327
Gallstones are present in patients 40-60% of the time with this condition?
Acute Pancreatitis
Pg. 317
In acute pancreatitis, what does the pancreas look like sonographically?
Size ranges from normal to focal/diffuse enlargement, Hypoechoic to anechoic texture (Edema) and less echogenic than the liver, Borders distinct but irregular, Enlargement of head causes depression on IVC, 40-60% have gallstones, Enlarged Pancreatic Duct, Parapancreatic fluid collections.
Pg. 318
Information on the spleen (location, etc)
region of spleen is left hypochondrium. It is located posterior to left hypochondrium and between fundus of stomach and the diaphragm. Width is 7cm. Length is 8-13cm. Thickness is 3-4 cm.
pg 423-424
What are the reasons for someone to have splenomegaly?
Mild to moderate: Infection, portal hypertension and AIDS
Moderate: Leukemia, lymphoma, infectious mononucleosis
Massive: Myelofibrosis
Focal Lesions: Lymphomatous involvement, metastatic disorder, hematomas
p. 431
An abnormal decrease in platelets is?
Thrombocytopenia
Pg. 427
In the early stages of sickle cell anemia, how does the spleen appear?
The spleen is enlarged with marked congestion of the red pulp
p. 432
Know the location of the spleen in reference to its adjacent structures
Lies between the left hemidiaphragm and the stomach. Posteriorly, the diaphragm, left pleura, left lung and rigs are in contact with the spleen. Medial surface is related to the stomach and lesser sac. The tail of the pancreas lies posteriorly to the stomach and lesser sac as it approaches the hilum of the spleen. The left kidney lies inferior and medial to the spleen.
Pg. 425
What are the functions of the spleen?
Production of lymphocytes & plasma cells
Production of antibodies
Storage of iron
Storage of other metabolites
Maturation of the surface of erythrocytes
Reservoir
Culling
Pitting function
Disposal of senescent or abnormal erythrocytes
Functions related to platelet & leukocyte life span
p.427
What is the most common reason for splenic infarction?
Emboli that arises form the heart, produced from mural thrombi or vegetation on the valves of the left side of the heart.
Pg. 435
What are the different shapes of the spleen?
Orange segment, tetrahedral, triangular, but is generally ovoid with smooth, even borders, and a convex superior and concave inferior surface
p. 424
Where is an accessory spleen usually located?
Near the hilum or inferior border of the spleen
p. 425
The splenic vein courses posterior to what structure?
Posteromedial border of the pancreas
Pg.424
What may cause a splenic rupture?
causes for splenic rupture other than trauma are enlarged spleen, hemolytic anemia,lymphoma,infectious mononucleosis.
cavernous hemangioma*
(from last test)
What are the primary tumors that metastasize to the spleen called?
Breast, lung, ovary, stomach, colon, kidney, prostate
Pg.439
What other areas should be evaluated when splenic rupture has occurred?
4 quadrants: Morison's pouch Subdiaphragmatic areas Liver and splenic capsule Bladder and anterior rectal area Pg.436
What is the sonographic appearance of histoplasmosis?
Calcifications
Pg.433
Spleen migration from its normal location is called?
Wandering spleen
p. 425
What is splenomegaly?
Splenic Englargement. Greater or equal to 13cm.
Pg. 430
A chronic disease that involves all bone marrow elements is?
Polycythemia vera
p. 433
Massive splenomegaly is most likely the result of?
Myelofibrosis
p. 431
What structure is found on the right side of the liver to form the subphrenic and subhepatic spaces?
Morison’s pouch
pg 129
Where is the lesser sac located?
behind the lesser omentum and stomach
p.128
A lesion that may mimic a gas containing abscess is called?
Teratoma/ solid lesion?
p. 466
What is inflammatory or malignant ascites?
Fine or coarse internal echoes
Loculation
Unusual distribution, matting or clumping of bowel loops Thickening of interfaces between the fluid & neighboring structures
Pg. 466
What are the most common sites for abscess formation?
Hepatic recesses and perihepatic spaces
Pg. 470
What are the most common primary lesions to develop peritoneal metastasi?
Ovaries, stomach and colon
Pg. 472
What is the most common pathological process that requires immediate surgery?
Acute appendicitis
Pg. 470
A cystic mass between the umbilicus and the bladder is referred to as?
Urachal Cyst
Pg.471
This structure lies freely over the intestines and looks like an apron
Greater omentum
p. 462
Fluid collects in the most _____areas of the body?
Dependent
Pg.463
What is the double layer of peritoneum called that extends from the liver to the stomach?
Lesser omentum
p. 462
What are the clinical signs and symptoms of infection?
fever, swelling, pain, redness, elevated WBC
What is a lymphocele?
Collection of fluid that occurs after surgery in the pelvis, retroperitoneum or recess cavities
Pg. 472
A hernia location that typically contains fat is?
Epigastric hernias
Pg. 473
The superior portion of the subhepatic space is called what?
Morisons Pouch
Pg. 464
This structure adheres to diseased organs
Greater Omentum
Pg. 462
