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DSM Abd > ABD Final Exam > Flashcards

ABD Final Exam Flashcards

1
Q

Where does the portal vein carry blood from to go to the liver?

A

Intestinal Tract

Pg. 193

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2
Q

What is the arterial supply to the GB?

A

Right Hepatic Artery via the Cystic Artery

Pg. 179

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3
Q

The portal venous system receives blood from what organs?

A

from the intestines and spleen

pg 193

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4
Q

What vessel lies posterior to the neck of the pancreas?

A

SMA

Pg. 180

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5
Q

What blood vessel supplies blood to the stomach and the duodenum?

A

Gastroduodenal Artery and the Right Gastric Artery

Pg. 179

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6
Q

What vessel passes anterior to the uncinate process?

A 
Superior Mesenteric Vein
Pg. 195
OR
Superior Mesenteric Artery
Pg. 180

Both say they run anterior to the uncinate process

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7
Q

What is Budd-Chiari syndrome?

A

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

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8
Q

The distribution of blood flow of the SMA feeds what?

A

The small bowel, the proximal half of the colon and the small intestine
Pg. 181

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9
Q

What vein begins at the splenic hilum and is joined by the gastric and left gastroepiploic veins?

A

Splenic Vein

Pg. 194

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10
Q

Information about the Portal vein (origin, where it travels, etc)

A

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

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11
Q

What is the distribution of blood flow for the IMA?

A

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

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12
Q

Where does the right renal artery pass in reference to IVC?

A

Posterior to the IVC

Pg. 182

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13
Q

What vessel arises from anterior aorta and courses parallel to it?

A

Superior Mesenteric Artery

Pg. 181

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14
Q

What vessel courses between aorta and SMA?

A

Left Renal Vein

Pg. 190

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15
Q

Renal arteries branch from the aorta from what level of the lumbar spine?

A

At the level of and anterior to L1

Pg. 182

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16
Q

What structure does the IVC enter?

A

Lesser sac
Right atrium of the heart
Pg. 184

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17
Q

What vascular structure is a landmark in locating the Celiac trunk?

A

Superior Mesenteric Artery

Pg. 180

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18
Q

What vascular structure is medial and posterior to the borders of the pancreatic body and tail?

A

splenic vein

p.309

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19
Q

The GDA is a branch of what?

A

Common Hepatic Artery

Pg. 179

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20
Q

What is the most common cause for abdominal aneurysms?

A

arteriosclerosis

pg 171

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21
Q

What tumor can fill the IVC?

A

Renal cell carcinoma?

Pg. 189

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22
Q

The liver is suspended from the diaphragm and the anterior abdominal wall by what structure?

A

Falciform ligament

p.208

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23
Q

Fatty infiltration may be observed in patients with what?

A

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

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24
Q

What are the findings of acute hepatitis?

A

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

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25
Q

Eccinococcal cysts come from what?

A

Infections cystic disease common in sheep herding areas. A tapeworm that infects humans and resides in the small intestine of dogs.
p. 255

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26
Q

What is the most common benign tumor of the liver?

A

Cavernous Hemangioma

p. 256

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27
Q

What is the benign liver tumor seen in glycogen storage disease?

A

Liver Cell Adenoma

p. 258

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28
Q

Patients who have hepatocellular carcinoma have had what?

A

Previous history of cirrhosis or hepatitis B or C, a palpable mass, hepatomegaly, appetite disorder and a fever???
p. 259m

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29
Q

What is the most common neoplastic involvement of the liver?

A

Metastatic disease

p. 259

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30
Q

The fossae of the right portal vein and GB are found in what fissure?

A

Main lobar fissure

p. 276

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31
Q

In severe hepatocellular destruction, AST and ALT (increase, decrease, stay the same)?

A

AST: Significantly elevates
ALT: moderate to high increase
p. 217-218

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32
Q

Elevation of Alkaline phosphatase is seen when?

A 
Hepatitis and cirrhosis
p. 218
Fatty Infiltration
Pg. 234
Proximal biliary obstruction, distal biliary obstruction, Extrahepatic Mass, and Common Duct Stricture
Pg. 250
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33
Q

Diminished vascular structures in the liver happens because of this?

A

fatty infiltration
p.234
Could also be Cirrhosis
Pg. 234

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34
Q

The falciform ligament extends from the umbilicus to the diaphragm and contains what?

A

Ligamentum Teres

p. 208

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35
Q

Elevation in bilirubin results in what?

A

Jaundice

p. 218

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36
Q

Symptoms in a patient with abscess formation would be?

A

fever of unknown origin, tenderness, swelling post operation, chills, weakness, malaise, and pain at the site.
pg 466

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37
Q

A tumor that consists of large blood-filled spaces is called?

A

Hemangioma

p. 256

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38
Q

Dilated intrahepatic ducts may be seen with all of the following except:

A

May be seen in: Proximal/distal biliary obstruction, Extrahepatic mass, Common duct stricture
Pg. 250 er

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39
Q

What is normal portal venous flow called?

A

Hepatopetal flow

p. 196

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40
Q

What is the most common site for an echinococcal virus to grow?

A

The liver

p. 255

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41
Q

An amebic abscess may reach the liver through what structure?

A

The portal vein

p. 255

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42
Q

What is the benign liver tumor that is solitary, well- circumscribed, non-encapsulated, has a multi-nodular mass?

A

Focal nodular hyperplasia

p. 258

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43
Q

What are common malignancies that affect the pediatric population?

A

The most common are Hepatoblastoma and hepatocellular carcinoma
Mets to liver are Wilm’s tumor Neuroblastoma, Leukemia, and Lymphoma
p.697 ????

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44
Q

In cases of choledocholithiasis, stones tend to lodge in what structure?

A

Ampulla of Vater

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45
Q

The right and left hepatic ducts unite to form what structure?

A

Common hepatic duct

p. 268

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46
Q

What is the diameter of the common hepatic duct?

A

4mm

p. 268

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47
Q

The hepatic duct is joined by _____ to form _______?

A

cystic duct; common bile duct

p. 268

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48
Q

What is the normal size of a common bile duct in a 60-year old patient?

A

6mm

p.268

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49
Q

The cystic duct connects the ______to form the _____?

A

neck of GB and the common hepatic duct; common bile duct

p. 268

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50
Q

What is a Phryigian cap on the gallbladder?

A

Part of the fundus is bent back on itself

p. 273

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51
Q

What are the functions of the gallbladder?

A

Stores bile and concentrates bile when the body is in a fasting state
PP DMSO Gallbladder and Biliary 1, Slide 6
p.273

52
Q

What is the fold at the area of the neck of the gallbladder called?

A

Hartmann’s Pouch

p. 273

53
Q

Gas forming bacteria in the gallbladder appear as what on ultrasound?

A

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

54
Q

A positive Murphy’s sign is associated with what?

A

Acute Cholecystitis, Acalculous Cholecystitis
Pg. 278
I believe Cholelithiasis is also an answer but it doesn’t say so in the book.

55
Q

What are the classic symptoms of gallbladder disease?

A

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

56
Q

What is the most common appearance of gallbladder carcinoma?

A

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?

57
Q

The common bile duct is joined by the main pancreatic duct and together they open as what into the duodenal wall?

A

Ampulla of Vater

Pg. 268

58
Q

What is inflammation of the gallbladder referred to as?

A

Cholecystitis

Pg. 281

59
Q

What condition does someone have if polypoid masses arise from the gallbladder wall?

A

Cholesterolosis

Pg. 288

60
Q

What is the sonographic appearance of cholelithiasis?

A

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

61
Q

What is the most common cause of biliary ductal obstruction?

A

Presence of a tumor or thrombus within the ductal system.

Pg. 292

62
Q

What is the WES sign?

A

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

63
Q

Non-shadowing, low amplitude echoes in the gallbladder are?

A

Sludge

Pg. 279

64
Q

Where are the valves of Heister located?

A

Neck of the gallbladder in the cystic duct

Pg. 273

65
Q

The physiological effect of a fatty meal is?

A

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

66
Q

Air within the biliary tree secondary to a duct stent?

A

Pneumobilia

Pg. 296

67
Q

The most common tumor sites that can spread carcinoma to the biliary tree are?

A

Breast, colon and melanoma.

Pg. 299

68
Q

The majority of the pancreas lies in what abdominal cavity?

A

Retroperitoneal Cavity.
A small portion of the head is surrounded by the peritoneum.
PP. Chapter_012 Pancreas, Slide 6
p.302

69
Q

`The pancreas is found behind the ____ sac?

A

Lesser Omental Sac
PP. Chapter_012 Pancreas, Slide 6
p.301

70
Q

The head of the pancreas lies where?

A

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

71
Q

The head of the pancreas is inferior to this structure of the liver?

A

Main Portal Vein and Caudate Lobe
PP. Chapter_012 Pancreas, Slide 20
p.302

72
Q

This structure passes through a groove posterior to the head of the pancreas

A

Common Bile Duct

Pg. 302

73
Q

What structure is on the anterolateral border of the pancreas?

A

Gastroduodenal Artery

Pg. 302

74
Q

Where is the tail of the pancreas located?

A

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

75
Q

What is the primary pancreatic duct called?

A

duct of Wirsung

p.308

76
Q

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)

A

Hemorrhagic pancreatitis

p.318

77
Q

A patient has painless jaundice, weight loss and a decrease in appetite may have?

A

Adenocarcinoma of the pancreas

p.328

78
Q

What is the duct of Santorini?

A

small accessory duct of the pancreas found in the head of the gland
p.308

79
Q

What is the normal dimension of the pancreatic head?

A

2-3 cm, anterior to posterior.

Pg. 308

80
Q

What is the normal size of the pancreatic duct?

A

less than 2 mm

p.308

81
Q

Which level is going to be twice normal with acute pancreatitis?

A

Amylase

Pg. 311

82
Q

Microscopic cells of the pancreas are called what?

A

Acini Cells

Pg. 310

83
Q

Where is the splenic vein located in reference to the pancreas?

A

runs along the posterior aspect of the tail of the pancreas

p.309

84
Q

If you can see the Celiac axis, which way should you angle/move the transducer to see the pancreas?

A

Inferiorly from the Celiac axis

Pg. 313

85
Q

The splenic artery is located where in reference to the pancreas?

A

Along the superior border of the pancreas body and tail as it crosses horizontally toward the splenic hilum
p.309

86
Q

The main pancreatic duct joins this structure before entering the duodenum

A

Common bile duct.
Joins to form the common trunk, enters at the ampulla of Vater.
Pg. 308

87
Q

What are the signs and symptoms of acute pancreatitis?

A

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

88
Q

The most common cause for acute pancreatitis in our country is?

A

Biliary Tract Disease

Pg. 317

89
Q

What vessel is posterior to the lower neck of the pancreas and anterior to the uncinate process?

A

SMV

90
Q

What is the condition that causes increased secretion of mucus?

A

Cystic fibrosis

p.327

91
Q

Gallstones are present in patients 40-60% of the time with this condition?

A

Acute Pancreatitis

Pg. 317

92
Q

In acute pancreatitis, what does the pancreas look like sonographically?

A

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

93
Q

Information on the spleen (location, etc)

A

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

94
Q

What are the reasons for someone to have splenomegaly?

A

Mild to moderate: Infection, portal hypertension and AIDS
Moderate: Leukemia, lymphoma, infectious mononucleosis
Massive: Myelofibrosis
Focal Lesions: Lymphomatous involvement, metastatic disorder, hematomas
p. 431

95
Q

An abnormal decrease in platelets is?

A

Thrombocytopenia

Pg. 427

96
Q

In the early stages of sickle cell anemia, how does the spleen appear?

A

The spleen is enlarged with marked congestion of the red pulp
p. 432

97
Q

Know the location of the spleen in reference to its adjacent structures

A

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

98
Q

What are the functions of the spleen?

A

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

99
Q

What is the most common reason for splenic infarction?

A

Emboli that arises form the heart, produced from mural thrombi or vegetation on the valves of the left side of the heart.
Pg. 435

100
Q

What are the different shapes of the spleen?

A

Orange segment, tetrahedral, triangular, but is generally ovoid with smooth, even borders, and a convex superior and concave inferior surface
p. 424

101
Q

Where is an accessory spleen usually located?

A

Near the hilum or inferior border of the spleen

p. 425

102
Q

The splenic vein courses posterior to what structure?

A

Posteromedial border of the pancreas

Pg.424

103
Q

What may cause a splenic rupture?

A

causes for splenic rupture other than trauma are enlarged spleen, hemolytic anemia,lymphoma,infectious mononucleosis.
cavernous hemangioma*
(from last test)

104
Q

What are the primary tumors that metastasize to the spleen called?

A

Breast, lung, ovary, stomach, colon, kidney, prostate

Pg.439

105
Q

What other areas should be evaluated when splenic rupture has occurred?

A 
4 quadrants:
Morison's pouch
Subdiaphragmatic areas
Liver and splenic capsule
Bladder and anterior rectal area
Pg.436
106
Q

What is the sonographic appearance of histoplasmosis?

A

Calcifications

Pg.433

107
Q

Spleen migration from its normal location is called?

A

Wandering spleen

p. 425

108
Q

What is splenomegaly?

A

Splenic Englargement. Greater or equal to 13cm.

Pg. 430

109
Q

A chronic disease that involves all bone marrow elements is?

A

Polycythemia vera

p. 433

110
Q

Massive splenomegaly is most likely the result of?

A

Myelofibrosis

p. 431

111
Q

What structure is found on the right side of the liver to form the subphrenic and subhepatic spaces?

A

Morison’s pouch

pg 129

112
Q

Where is the lesser sac located?

A

behind the lesser omentum and stomach

p.128

113
Q

A lesion that may mimic a gas containing abscess is called?

A

Teratoma/ solid lesion?

p. 466

114
Q

What is inflammatory or malignant ascites?

A

Fine or coarse internal echoes
Loculation
Unusual distribution, matting or clumping of bowel loops Thickening of interfaces between the fluid & neighboring structures
Pg. 466

115
Q

What are the most common sites for abscess formation?

A

Hepatic recesses and perihepatic spaces

Pg. 470

116
Q

What are the most common primary lesions to develop peritoneal metastasi?

A

Ovaries, stomach and colon

Pg. 472

117
Q

What is the most common pathological process that requires immediate surgery?

A

Acute appendicitis

Pg. 470

118
Q

A cystic mass between the umbilicus and the bladder is referred to as?

A

Urachal Cyst

Pg.471

119
Q

This structure lies freely over the intestines and looks like an apron

A

Greater omentum

p. 462

120
Q

Fluid collects in the most _____areas of the body?

A

Dependent

Pg.463

121
Q

What is the double layer of peritoneum called that extends from the liver to the stomach?

A

Lesser omentum

p. 462

122
Q

What are the clinical signs and symptoms of infection?

A

fever, swelling, pain, redness, elevated WBC

123
Q

What is a lymphocele?

A

Collection of fluid that occurs after surgery in the pelvis, retroperitoneum or recess cavities
Pg. 472

124
Q

A hernia location that typically contains fat is?

A

Epigastric hernias

Pg. 473

125
Q

The superior portion of the subhepatic space is called what?

A

Morisons Pouch

Pg. 464

126
Q

This structure adheres to diseased organs

A

Greater Omentum

Pg. 462

DSM Abd (9 decks)

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