Abdomen Comp Flashcards
1
Q
Muscles of the abdomen?
A
- Diaphragm
- Psoas Muscles
2
Q
What does the diaphragm do?
A
- separates abdominal cavity from thoracic cavity
- primary muscle of inspiration
3
Q
Where are the psoas muscles located (vertebral level?)
A
-L1 to lesser trochanters
4
Q
Parts of the digestive system?
A
- oral cavity
- pharynx
- esophagus
- stomach
- small intestine
- large intestine
5
Q
What is the first organ of the digestive system located in the abdominal cavity?
A
Stomach
6
Q
3 parts of the small intestine?
A
- Duodenum
- Jejunum
- Ileum
7
Q
What ligament is at the duodenojejunal junction?
A
Ligament of trietz
8
Q
What increases surface area in the jejunum?
A
Plicae circularis
9
Q
Where is the appendix attached to the colon?
A
Posteromedial colon
10
Q
What is the sphincter at the terminal opening of the large intestine called?
A
Anus
11
Q
How does the spleen sit in relation to the stomach?
A
Posterior and left
12
Q
Can the spleen be seen on plain radiographs?
A
Faintly, especially if enlarged
13
Q
Accessory digestive organs?
A
- pancreas
- liver
- gallbladder
- salivary glands
14
Q
Can the pancreas be seen on plain radiographs?
A
No
15
Q
Where is the spleen located?
A
- posterior to the stomach
- between the duodenum and spleen
- head in C-loop of duodenum “romance of abdomen”
- body and tail extend to upper left abdomen
16
Q
What is the largest solid organ in the body?
A
Liver
17
Q
What percent of gallstones have enough calcium to be visualized?
A
10-15%
18
Q
Parts of the urinary system?
A
- 2 kidneys
- 2 ureters
- bladder
- urethra
19
Q
Vertebral level of kidneys?
A
T11-L3
20
Q
3 constriction points of ureters?
A
- ureteropelvic junction
- pelvis brim
- ureterovesical junction
21
Q
Where do the ureters enter the bladder?
A
Posterolateral aspect
22
Q
Can kidneys been seen on plain radiographs? Why/why not?
A
Yes, because they have a fatty capsule that surrounds them
23
Q
How do the kidneys sit in the body?
A
20 degrees medial (superior more medial)
30 degrees anterior (inferior more anterior)
24
Q
What is the peritoneum? Parts?
A
- serous, double walled membrane
- parietal: adheres to cavity
- visceral: portion that covers organs
- contains serous fluid
- mesentery, omentum (greater/lesser), mesocolon
25
The visceral peritoneum only partially covers what organs?
- ascending and descending colon
- aorta
- IVS
26
What are contained within the fold of the peritoneum?
- blood vessels
- lymph vessels
- nerves
27
What is the mesentery? What does it do?
- double fold of peritoneum that extends anteriorly from the posterior abdominal wall to envelope completely a loop of small bowel
- loosely connects small bowel to abdominal cavity
28
What is the omentum? What does it do?
- double fold of peritoneum that extends from the stomach to another organ
- Lesser omentum: extends superiorly from the lesser curvature to portions of the liver
- Greater omentum: extends inferiorly from the greater curvature to the transverse colon, drapes down over small bowel and back up to form an apron “fatty apron” provides insultation
29
What is the mesocolon? What does it do?
-part of the peritoneum that attaches the colon to the abdominal wall
4 forms:
-ascending, transverse, descending, and sigmoid/pelvic portions (named according to which part of the colon they attach to the abdominal wall)
30
What are the greater and lesser sac?
-divisions of the peritoneal cavity
31
Another name for the lesser sac?
- small upper posterior portion of the peritoneal cavity
| - “omentum bursa”
32
Retroperitoneal organs?
Behind peritoneum
- kidneys
- ureters
- adrenal glands
- pancreas
- C-loop of duodenum
- ascending and descending colon
- upper rectum
- abdominal aorta
- IVC
33
Are retroperitoneal or intraperitoneal organs less mobile (move around less?)
Retroperitoneal because intraperitoneal organs are loosely attached by the mesentery
34
Infraperitoneal organs?
Under/beneath the peritoneum in the true pelvis
- lower rectum
- urinary bladder
- reproductive organs
35
Intraperitoneal organs?
Organs that are partially/completely covered by some type of visceral peritoneum, but are not retro or infra peritoneal
- liver
- gallbladder
- spleen
- stomach
- jejunum
- ileum
- cecum
- transverse colon
- sigmoid colon
36
4 abdominal quadrants?
- RUQ
- LUQ
- RLQ
- LLQ
37
Organs contained in the RUQ?
- liver
- gallbladder
- right hepatic flexure
- duodenum
- head of pancreas
- right kidney
- right suprarenal gland
38
Organs contained in the LUQ?
- spleen
- stomach
- left colic flexure
- tail of pancreas
- left kidney
- left suprarenal gland
39
Organs contained in t-he RLQ?
- ascending colon
- vermiform appendix
- cecum
- 2/3 of ileum
- ileocecal valce
40
Organs contained in the LLQ?
- descending colon
- sigmoid colon
- 2/3 jejunum
41
9 abdominal regions
- R/L hypochondriac
- R/L lumbar (lateral)
- R/L inguinal (iliac)
- epigastric
- umbilical
- hypogastric (pubic)
42
2 transverse planes separating the 9 abdominal regions?
- Transpyloric plane (lower L1)
| - Transtubercular plane (L5)
43
7 landmarks of the abdomen?
1. Xiphoid process (T9/T10): superior margin of abdomen
2. Lower Costal Margin (L2/L3): used to locate upper abdo organs
3. Iliac Crests (L4/L5): corresponds to mid abdomen
4. ASIS: secondary landmark for general abdo positioning
5. Greater Trochanter: superior border of symp
6. Symphysis Pubis: inferior margin of abdomen
7. Ischial tuberosity: lower margin on PA abdomen, 1-4cm below symph
44
What is the most commonly used landmark?
Iliac crests
45
Exposure factors for abdomen?
70-80kVp at 10mAs
46
Ascites?
Fluid in the peritoneal cavity
- caused by cirrhosis of the liver or metastatic disease to the peritoneal cavity
- general abdominal haziness (increase technique)
47
Pneomoperitoneum?
Free air in the peritoneal cavity
- caused by perforation (ulcer) or trauma
- small amounts of air can be visualized 2-3weeks post abdominal surgery-best demonstrated with horizontal beam upright abdomen or chest
- decrease technique because of air
48
Dynamic or mechanical bowel obstruction? Causes?
Complete/nearly complete blockage of flow to the intestinal contents caused by:
- Fibrous adhesion
- Crohn’s disease
- Intussusception
- Volvulus
49
What is a fibrous adhesion?
Most common mechanical obstruction
| -fibrous band of tissue interrelates with the intestine causing a blockage
50
What is Crohn’s disease?
“Regional enteritis”: chronic inflammation of (all layers) of the intestinal wall
- common in young adults
- fistulas form
- common in terminal ileum and proximal colon
51
What is intussusception?
Telescoping of one section of bowel into another
- common in terminal ileum
- common in children
52
What is a volvulus?
Twisting of a loop of intestine
53
Ileus (non mechanical) bowel obstruction?
- adynamic (without power/force)
- caused by peritonitis or paralysis ileus (lack of intestinal mobility)
- abdominal surgery can cause
- large air fluid levels and no obvious obstruction
- decrease technique because of air
54
What is ulcerative colitis?
- chronic inflammation of the colon in young adults primarily
- common in the rectosigmoid region
- can cause toxic megacolon with potential perforation
- decrease technique because of air
55
What is done to demonstrate free air below the diaphragm better?
PA chest: exposure technique for chest better demonstrates air
56
When the kidneys are of primary interest, is a PA or AP less desirable?
PA because increased OID
57
What can a dorsal decubitus abdomen demonstrate?
- calcification of the aorta or other vessels
- umbilical hernia
- aneurysms
58
What does a true lateral demonstrate?
Foreign bodies
59
Indications for a 3 view abdomen?
- ileus
- ascites
- performed bowel viscus
- intra-abdominal mass
- post-operative
60
What can happen if you don’t decrease your technique when theres air in the abdomen?
Picture may be overexposed
61
How much do you decrease your technique for air in the abdomen?
- decrease mAs 30-50%
| - decrease kVp 5-8%
62
What is a spinal stimulator implant?
- placed under the skin in the abdomen, leads go to spinal canal
- to treat chronic pain
63
Widest part of the abdomen on different body habitus?
- Hypersthenic: short and wide abdo, upper abdomen widest
| - Asthenic: long and narrow abdo, lower abdomen widest
64
How much does the diaphragm move from inspiration to expiration? Vertebral levels?
4”
- inspiration: as low as T12
- expirationL T8/T9
65
What happens if 3 AEC cells are selected on inspiration?
-underexposed because side cells are over lung
66
Rotation on an abdomen decreases visualization of what?
Fat lines
67
What does enlargement of the fat strips indicate?
Ascites
68
Including what vertebral level will include both diaphragms?
T8
69
If the MSP is not parallel to the IR, what happens?
- decreases visualization of fat lines
| - when rotated fat shifts anterior or posterior to muscle and eliminates subject contrast
70
Why do we do a LLD?
So the air rises away from the stomach bubble
71
How long should a patient lie on their side or be upright before we take the respective upright or decubitus picture?
5 mins
-10-20 preferred
To allow air to rise and fluid to settle
72
What do we do for patients with wide hips on a LLD?
-include right hemidiaphragm to iliac wing
73
What kind of filter do we use for a LLD? Why?
Wedge compensating filter because the belly drops to the lower side and makes it thicker
