Abdomen Flashcards
What system is the spleen a part of?
Lymphatic system
Where is the spleen located?
Posterior and to the left of the stomach in LUQ.
Can the spleen be visualized on a radiograph?
Faintly, particularly if enlarged (splenomegaly).
What can be lacerated during trauma to left lower rib cage?
The spleen.
What are the accessory organs of digestion?
Pancreas, liver, gallbladder.
Where is the pancreas located?
Posterior to the stomach, between the stomach & the spleen.
Is the pancreas an endocrine or exocrine gland?
Both. It secretes hormones that it produces, into the blood stream, making it endocrine. It also secretes digestive juices into the digestive tract (considered “outside” of the body) making it exocrine.
Where does the body and tail of the pancreas extend towards?
The upper left abdomen.
Where is the liver located?
The liver occupies most of the right upper quadrant and is inferior to the right hemidiaphragm.
What is the function of the liver?
It produces bile.
How does the liver show up on a radiograph?
As decreased optical density (whiter).
Where is the pear shaped gall bladder located?
In the inferior aspect of the liver.
What does the gall bladder do?
Stores and concentrates bile.
Can a normal gall bladder be seen on plain films?
No.
What percentage of gall stones can be seen on plain film radiographs?
10-15% (due to calcium.).
What is the urinary system composed of?
Kidneys, ureters, bladder, urethra.
Are the kidneys retroperitoneal, intraperitoneal, or infraperitoneal?
Retroperitoneal.
What is the function of the kidneys?
To remove liquid waste products from the blood.
Which kidney is lower than the other and why?
The right kidney is lower due to the liver taking up so much room on the right side.
What level of the spine are the kidneys located?
T12 to the level of transverse processes of L3.
What do the ureters do?
They connect the kidneys to the bladder.
How large are the ureters?
About 10-12 inches long.
Are the ureters retroperitoneal, intraperitoneal or infraperitoneal?
Retroperitoneal.
What is the name of the tube that leads from the floor of the urinary bladder to the outside?
Urethra.
What system are the adrenal glands a part of?
The endocrine system.
Where are the adrenal glands located?
Superior and medial to each kidney.
Are the adrenal glands visible on a radiograph?
Not usually.
Why are the kidneys visible on a radiograph?
Because of a fatty capsule that surrounds the kidneys.
How are the organs of the urinary system made visible on a radiograph?
With contrast media injected intravenously. (Excratory Urography or Intravenous Urography.)
What are the two main cavities of the body?
The dorsal cavity and the ventral cavity.
The organs of any cavity are referred to as:
the viscera.
What is the dorsal cavity made up of?
The cranial cavity and the spinal cavity.
What is the ventral cavity made up of?
The thoracic cavity and the abdominopelvic cavity.
What does “Parietal peritoneum” refer to?
the covering of walls of the cavity.
What does “Visceral peritoneum” refer to?
The covering on an organ.
Four terms describing the anatomy of the abdominal cavity.
Peritoneum, mesentery, mesocolon, omentum.
What is the peritoneum?
A double-walled seromembranous sac that encloses the abdominopelvic cavity.
What is the parietal peritoneum?
The outer portion of the peritoneum that adheres to the cavity wall.
What is the visceral peritoneum?
The inner portion of the peritoneum.
What is the peritoneal cavity?
The space or cavity between the parietal peritoneum and visceral peritoneum which contains serous fluid.
What is the purpose of the serous fluid in the peritoneal cavity?
Allows organs to move against each other without friction.
What is ascites?
Abnormal accumulation of fluid in the peritoneal cavity.
What is the definition of retroperitoneal?
“Behind” the peritoneum. Organs that lie on the posterior abdominal wall and are covered by peritoneum on their anterior surfaces only are retroperitoneal.
Describe the purpose of the folds of the peritoneum.
The folds bind the organs to each other and to the walls of the abdominal cavity and contain blood and lymphatic vessels and nerves that supply the abdominal organs.
What is the name of the folds in the peritoneum that hold the small intestine in place and attaches the small intestine to the abdominal wall?
The mesentary.
What does the mesentary hold?
The small intestine and various nerves and arteries of the abdomen.
Which fold of the peritoneum attaches the large intestine to the posterior abdominal wall?
The mesocolon.
What does the mesocolon do?
Carries blood and lymphatic vessels to the intestines.
What is something the mesentery and mesocolon have in common?
They both hold intestines loosely in place to allow for peristalsis.
Which double fold of the peritoneum extends from the lesser curvature of the stomach to portions of the liver?
The lesser omentum.
Which double fold of the peritoneum is the largest peritoneal fold and is the “fatty apron” that hangs over the transverse cold on and small intestine?
The greater omentum.
What is a pneumoperitoneum?
Free air or gas in the peritomeal cavity.
What can a pneumoperitoneum be caused by?
A perforation of a gas containing viscus. Ex: perforating ulcer or some penetrating trauma.
How is a pneumoperitoneum best demonstrated?
With a horizontal beam, erect abdomen, or chest xray.
What does the X-ray of a pneumoperitoneum look like?
Small amounts of free air seen as it rises to the highest position under the diaphragm.
What is peritonitis?
And acute inflammation of the peritoneum.
What is peritonitis caused by?
The common cause is contamination of the peritoneum by infectious microbe. Bacteria can gain access to the peritoneal activity through rupture of appendix.
What does retroperitoneal organs mean?
Refers to organs that lie behind the peritoneum.
What does infraperitoneal organs mean?
refers to organs located under or beneath the peritoneum.
What does intraperitoneal organs mean?
Refers to organs located within the abdominal cavity that are either partially or completely covered by some type of visceral peritoneum but are not retro- or infraperitoneal.
Describe the peritoneal enclosure in men.
In men, the lower aspect of the peritoneum is a closed sac. The peritoneum lies above the urinary bladder totally separating reproductive organs from those within the peritoneum.
Describe the peritoneal enclosure in women.
In women, the lower aspect of the peritoneum is not a closed sac. The uterus, uterine tubes and ovaries pass directly into the peritoneum.
Name the retroperitoneal organs.
Kidneys, ureters, adrenal glands, pancreas c-loop of the duodenum, ascending and descending colon, upper rectum, and major abdominal blood vessels (aorta and inferior vena cava.).
Name the intraperitoneal organs.
Liver, gallbladder, spleen, stomach, jejunum, ileum, cecum, transverse colon, sigmoid colon.
Name the infraperitoneal organs.
Lower rectum, urinary bladder, reproductie organs (men having a closed peritoneal sac and women having an open sac with their reproductive organs extending into the peritoneal cavity.
The two methods to describe the location of organs or other structures within the abdominopelvic cavity are:
Four abdominal quadrants and nine abdominal regions.
The name of the four abdominal quadrants are:
RUQ = right upper quadrant LUQ = left upper quadrant RLQ = Right lower quadrant LLQ = Left lower quadrant.
A transverse plane and a midsaggital plane pass through the umbilicus forming the:
Four abdominal quadrants.
The nine abdominal regions are formed by:
two horizontal (transverse) planes (L1 and L5) and two vertical (lateral) planes (located parallel to and midway between the MSP and each ASIS on both sides.
The names of the nine abdominal regions are:
Right hypochondriac epigastric left hypochondriac, right lateral (lumbar) umbilical left lateral (lumbar) right inguinal (iliac) Pubic (hypogastric) left inuinal (iliac)
Topographic landmarks
Palpable bony landmarks that are used to aid in radiographic positioning. Inform patient before palpating gently.
The seven bony landmarks of the abdomen are:
Xiphoid process (T9 - T10) inferior costal margin (L2 - L3) Iliac crest (L4 - L5) Anterior superior iliac spine (ASIS) Greater trochanter Pubic symphysis Ischial tuberosity
Which bony landmark is the superior margin of the abdomen and not a primary landmark due to variations in body habitus?
Xiphoid process
Which bony landmark is used to locate upper abdominal organs such as the gallbladder and stomach and what level of the spine is it associated with?
Inferior costal margin (L2 - L3).
What is the most commonly used abdominal landmark and what level of the spine is it associated with?
Iliac crest (L4 - L5).
What is the bump that is inferior and anterior to the iliac crest and used for positioning for the pelvis and lumbar spine?
Anterior Superior Iliac Spine (ASIS).
Where is the uppermost margin of the greater trochanter?
About the same level of the pubic symphysis.
What is the anterior junction of the 2 pelvic bones and corresponds to the inferior margin of the abdomen?
Pubic symphysis.
What can be palpated (or used) instead of the pubic symphysis?
The greater trochanter or inguinal fold.
What is the lower margin of the abdomen when the patient is prone?
The ischial tuberosity.
What bony landmark bears most of one’s weight of the trunk when one is sitting?
Ischial tuberosity.
Where are the lower margins of the ischial tuberosity?
1 to 1 and a half inches distal to the pubic symphysis.
What are the basic steps for patient preparation?
All clothing removed Opaque objects removed. hospital gown worn pillow for head, clean linen on table. cover patient for warmth and modesty.
What is the single greatest deterrent to image sharpness as related to positioning?
Motion. Voluntary and involuntary.
What are ways to prevent motion in abdominal radiography?
Shortest exposure time possible
Careful breathing instructions.
When are abdominal radiographs exposed? Upon inspiration or expiration and why?
Expiration, in order to have the diaphragm in a superior position to better visualize abdominal structures.
What are two ways to reduce voluntary motion?
Through explanation of procedure and precise breathing instructions as well as use of sponges and sandbags as immobilization devices.
What does voluntary motion look like on a radiograph compared to involuntary motion?
Voluntary motion involves a blurring of the entire area, while involuntary motion involves localized blurring.
Correctly placed markers need to be ______ and cannot _______.
Visible, obscure essential anatomy.
True or false: If one forgets to place their image marker on the IR before exposure, they can add it digitally in post processing.
False.
Why is radiation protection especially essential in abdomen radiography?
Because of the proximity of the gonads.
How is gonadal shielding placed on males?
With the upper edge of the shield placed at the pubic symphysis.
When can gonadal shielding be used on females during abdominal radiography?
Only when shields do not obscure essential anatomy.
Where should gonadal shielding be placed on females?
Top of ovarian shield should be placed slightly above or at the level of ASIS and the lower border at the pubic symphysis.
True or false: All women of childbearing age should be screened for possibility of pregnancy.
True. If patient indicates a chance that she is pregnant, the radiologist must be consulted.
What kVp range should be used in an abdominal radiograph?
70-80 kVp. (Moderate contrast required with medium kV to allow for visualization of various abdominal structures, including possible semiopaque stones in gallbladder or kidneys.)
Should a short or long exposure time be used in abdominal radiography and why?
Short…to minimize the effect of involuntary motion of peristalsis of the bowels.
A correctly exposed abdominal radiograph will show what?
Psoas muscles Lower liver margin Kidney outlines Lumbar vertebrae Transverse processes.
Pediatric applications for abdominal radiographs
Supine and horizontal beam
pigg-o-stat
control motion and use short exposure time
reduction in mAs and kV (under 12 or 13 y.o.)
minimize repeats
