Abdomen Review Final Flashcards
The uncinate process of the pancreas is superior to what?
Duodenum
The splenic vein is joined by what vessels?
The splenic vein joins the SMV to form the portal vein
pg. 194 Hagen Ansert
Begins at hilum of the spleen and joined by the short gastric and left gastroepiptloic vein
The right renal artery passes where in reference to the IVC?
Posterior
pg. 182 Hagen-Ansert
What vessel is parallel to and arises from the aorta?
SMA
pg. 181 Hagen-Ansert
The renal artery passes where in reference to the SMA?
Inferior
pg. 182 Hagen-Ansert
Where does the IVC course to join the heart?
It enters at the right atrium of the heart
pg. 184 Hagen-Ansert
What vessel is posterior and medial to the pancreatic body and tail?
Splenic vein
pg. 194 Hagen-Ansert
What is a common cause for an AAA?
Arteriosclerosis
pg. 172 Hagen-Ansert
What might cause lower trunk edema in a dilated IVC?
Atrioventricular fistula
pg. 179 Hagen-Ansert
The liver is suspended anteriorly by what ligament?
Falciform ligament
P 208
Also, www.webmd.com
What causes fatty infiltration?
Obesity Alcohol intake High cholesterol Diabetes pg. 235 Hagen-Ansert
Except- hepatoportal fistula
What is a benign liver tumor in glycogen 1 storage disease?
Hepatic adenomas
pg. 239 Hagen-Ansert
What fissure does the right portal vein and gallbladder lie in?
Main lobar fissure
pg. 208 Hagen-Ansert
What are the AST and ALT levels in severe liver disease?
AST: significantly elevated
ALT: moderately elevated
pg. 215 Hagen-Ansert
What liver disease will have diminished vascular structures?
Fatty infiltration
P 234
Possibly cirrhosis
What cells are affected by hepatocellular disease?
Hepatocytes
pg. 213 Hagen-Ansert
What direction does normal portal venous flow?
Hepatopetal (toward the liver)
pg. 240 Hagen-Ansert
What is the appearance of the liver in glycogen 1 storage disease?
Hepatomegaly
Increased echogenicity and attenuation
Hepatic adenomas - round, echogenic, homogenous tumors
Focal nodular hyperplasia
What are the features of an extrahepatic mass? (what does it displace)
Located in the area of the porta hepatis causing symptoms seen in biliary obstruction
pg. 249 Hagen-Ansert
What is a common site for echinococcal growth?
Sheep herding countries
pg. 255 Hagen-Ansert
The liver
What is Budd-Chiari syndrome?
Thrombosis of hepatic veins (and IVC?)
pg. 200 Hagen-Ansert
Through which structure would an amebic abscess reach the liver?
Portal vein
pg. 255 Hagen-Ansert
Right and left hepatic ducts unite to form ____.
CHD
pg. 268 Hagen-Ansert
What is a normal measurement of the CHD?
4 mm
pg. 268 Hagen-Ansert
What is a normal measurement of a CBD in a 60 yr old patient?
6 mm
pg. 268 Hagen-Ansert
The cystic duct connects the ___ of the gallbladder with the ___ to form the ___.
Neck; CHD; CBD
pg. 268 Hagen-Ansert
What is the function of the gallbladder?
Reservoir for bile
Concentrates bile
pg. 273 Hagen-Ansert
What is a Hartmann’s pouch?
Gallbladder neck folds back on itself
pg. 273 Hagen-Ansert
A positive Murphy’s sign seen with which gallbladder disease?
Acute cholecystitis
pg. 278 Hagen-Ansert
“Murphy’s Law: whatever can go wrong, will”
What are the symptoms of gallbladder disease?
RUQ pain after eating greasy foods Nausea/vomiting Pain in right shoulder Jaundice pg. 279 Hagen-Ansert
What is the appearance of gallbladder carcinoma?
Heterogenous solid mass
Thickened gallbladder wall
“Shotgun sign” - double barrel appearance of portal veins and dilated ducts
pg. 290 Hagen-Ansert
Irregular echogenic mass projecting from gb wall
The CBD joins the duct of Wirsung going through which structure?
Ampulla of Vater
What is inflammation of the gallbladder called?
Cholecystitis
pg. 281 Hagen-Ansert
What is RUQ pain with polyploid masses arising from the gallbladder?
Cholesterlosis
P 288
Adenomyomatosis
What is a porcelain gallbladder?
Calcium incrustation of the gallbladder wall
Appears echogenic with posterior shadowing
Can develop into cancer
pg. 288 Hagen-Ansert
What is the appearance of sludge?
Thickened bile, low level internal echoes, non shadowing
P 279
Where are the valves of Heister?
Valves located in the neck of the gallbladder to help the duct from kinking
pg. 273 Hagen-Ansert
Cystic duct
The pancreas lies in what area?
Retroperitoneal Cavity
P 302
Also the epigastrium and a portion lies in the left hypochondriac behind the lesser sac
What sac is the pancreas located behind?
Lesser sac
Where does the head of the pancreas lie? (In reference to the duodemum)
Anterior to the IVC Right of the Portal Confluence Inferior to the main portal vein and caudate Medial to the duodenum Lies in c loop of duodenum
What structure passes through the groove posterior to the pancreatic head?
“The common bile duct passes through the first part of the duodenum and courses through a groove posterior to the pancreatic head.”
pg. 302 Hagen-Ansert
Where is the tail of the pancreas located?
Anterior to the left kidney
Posterior to the left colic flexure and transverse colon
The tail begins to the left of the lateral border of the aorta and extends toward the splenic hilum
What is the duct of Santorini?
Accessory duct located in the head of the pancreas
What are the normal dimensions of the pancreatic head?
2-3cm AP….
Not to be confused with pancreatic duct which is less than or equal to 3mm.
What are the cells of the pancreas called?
Acini Cells
Islets of Langerhans
How would you angle your probe to locate the celiac axis?
Superiorly
The original question based on previous test was in reference to seeing the pancreas if you’re looking at the celiac access.
Inferiorly
What is a common cause for pancreatitis?
Biliary tract disease pg 317
Why is the pancreas reflective?
Fat between the lobules
Quizlet
SMV courses where?
Begins at the ileocolic junction and runs cephalad song the posterior abdominal wall. Anterior to the 3rd part of the duodenum and posterior to the neck of the pancreas.
What is an annular pancreas?
Rare anomaly in which the the head of the pancreas surrounds the second portion of the duodenum
Pg 309
What is cystic fibrosis?
Heredity disease that causes excessive production of thick mucus by the endocrine glands. Pancreas is replaced with fatty tissue and sometimes calcifications
P327
40-60% of gallstones are seen with which disease?
Acute pancreatitis
Quizlet
What is the appearance of the pancreas with acute pancreatitis?
Enlarged, hypo-echoic indistinct but smooth borders. IVC may be compressed. Peripancreatic fluid collections
What is gastric carcinoma ranked as in causing death?
4th
What does lymphoma of the stomach appear as?
Multi focal lesions in the GI tract, the stomach has enlarged and thickened mucosal folds, multiple submucosal nodules, and ulcerations and a large extraluminal mass.
Symptoms: nausea, vomiting and weight loss.
Sono appearance: large poorly echogenic mass, thickened wall, spoke-wheel pattern.
Can occur as a primary tumor of the GI tract (37% of stomach tumors).
What is the appearance of small bowel obstruction?
Dilated hoops have a tubular or round echo-free appearance
Where is the appendix located?
On the abdominal wall under McBurney’s point.
What might be an embryological mistake that forms a cyst?
A Duplication cyst
Well developed muscular walls.
Continuous with the stomach.
Lined with alimatary tract
What is the normal diameter of the appendix?
1-9 inches long….
Averages 3 inches.
Thickness should not exceed 6mm.
What is Crohn’s disease?
A regional enteritis, a recurrent granulomatory inflammatory disease that effects the terminal ileum, colon or both at any level.
Symptoms: diarrhea, fever, RLQ pain.
What are the colon segments called?
Cecum/Ascending Colon Transverse Colon Descending Sigmoid Colon Rectum
What part of the duodenum courses to the level of the gallbladder neck?
The superior portion courses anteroposteriorly from the pyloris to the level of the GB neck.
What ligaments support the curvature of the stomach?
Greater curvature: greater omentum, gastrophrenic ligament….
Lesser curvature: gastrohepatic ligament of the lesser omentum.
A pseudokidney sign may be seen in what?
Pseudokieney sign is a section of bowel that looks like a kidney. It is an indicator of bowel disease. It can be seen in intussusception and other bowel disease.
What is the most common kidney obstruction? It is also seen in utero
UPJ
Where are paraplegic cysts located on the kidney?
renal sinus or pelvis
What is the appearance of tuberous sclerosis?
Multiple renal cysts Angiomyolipomas Harmartomas Similar in appearance to adult polycystic kidney disease pg. 382 Hagen-Ansert
What is the most echogenic portion of the kidney?
Renal sinus
What is a ureterocele?
Cyst like enlargement of the lower end of the ureter
What is the sonographic appearance of chronic pyelonephritis?
Inability to distinguish the cortex from the medullary regions
What disease would be expected if a renal artery Doppler is ordered?
Hypertension
After how many hours after a renal transplant does a baseline renal transplant Doppler need to be performed?
48-72 hours
What is common to find on the kidney in those over 50 yrs old?
Simple renal cyst
What would a dilated renal pelvis be?
UPJ? Hydro?
What is the process of disposing metabolic waste?
Excretion
What is the right kidney in contact with?
Adrenal gland Liver Duodenum Right colic flexure Small intestine P 356
Where does the left renal vein course?
Anterior to the aorta
Quizlet
What is the potential space between the right kidney and liver?
Morrisons pouch
Quizlet
What might be seen with pyonephrosis?
Pus found within the collecting system. Often associated with urosepsis and I secondary to long standing ureteral obstruction
What is lipomatosis?
Condition characterized by deposition of a moderate amount of fat in the renal sinus with parenchyma atrophy.
May cause enlargement of sinus region with increased echogenicity and regression toward center of parenchyma.
What does hydronephrosis look like sonographically?
Fluid filled pelvocaliceal collecting system (Per Beth)
Pg 397
What are the characteristics of autosomal dominant polycystic kidney disease
Bilateral disease that is characterized by enlarged kidneys with multiple asymmetrical cysts varying in size and location in the renal cortex and medulla.
Clinical symptoms: pain, hypertension, palpable mass, hematuria, headache, UTI, and renal insufficiency.
Pg 382 Hagen-Ansert
What is a common location of renal ectopia?
The pelvis
What is bladder diverticulum?
Herniation of the bladder wall. Out pouchings may be singular or multiple and are thinner than the normal bladder wall.
Acquired: outpouching of bladder mucosa between muscle bundle caused by increased intravascular pressure
Congenital: rare; originate at the posterior angle of the bladder trigone and contains all components of the bladder wall.
What are the functions of the spleen?
-Production of lymphocytes and plasma cells
- production of antibodies
- storage of iron
-storage of metabolites
-maturation of the surface of erythrocytes
-Reservior
-culling
-pitting
-disposal of senescent or abnormal erythrocytes
Functions related to platelet and leukocyte life span
Fights Infections Produces lymphocytes & plasma cells Produces RBC's and antibodies Stores iron and metabolites Hematopoiesis p.427
Major function: To filter the peripheral blood, active in the body’s defense against disease
What is splenic infarction most commonly caused by?
Emboli that arises from the heart produces from mural thrombi or vegetation on the valves on the left side of the heart
What might cause a splenic rupture?
Cavernous hemangioma
Trauma
The spleen is variable in size and is considered all of the following…
Orange segment
Tetrahedral
Triangular
Generally ovoid with smooth, even borders and convex superiority and concave inferior surface
What is the best position to evaluate the spleen?
Steep right decubitus
What are the sonographic signs of histoplasmosis?
Calcifications
P 433
What is the measurement of splenomegaly?
13cm +
What is the chronic disease the involves all bone marrow elements?
Polycythemia vera
What is the result of massive splenomegaly?
Myelofibrosis
The adrenal glands and kidneys are contained in ____.
Perirenal fat and gerota’s fascia
Quizlet
What is the length of a normal adrenal gland?
Less than 3cm
What is the most common adrenal tumor in infancy?
Neuroblastoma
Hagen p 457
What is the most common primary retroperitoneal tumor?
Liposarcoma, malignant.
(google)
Lymphoma
Hagen pg 457
Which muscles lie posterior to kidneys?
Psaos, quadratus lumborum, and transversus abdominis muscles.
Pg 356 Hagen-Ansert
What is the space between the bladder and rectum?
Rectovesicular space , in males
The Vagina lies between the bladder and the rectum in females.
Pouch of Douglas/rectouterine/posterior cul-de-sac = located between uterus and bladder.
What is the adrenal medulla?
The adrenal medulla, the inner part of an adrenal gland, controls hormones that help you cope with physical and emotional stress. The main hormones secreted by the adrenal medulla include epinephrine (adrenaline) and norepinephrine (noradrenaline), which have similar functions.
What lesion may mimic a gas containing abscess?
Teratoma
Solid lesion ?
P 466
The most common primary lesion to develop primary metastasis originates from ___.
Ovaries, stomach, colon
What is the most common abdominal immediate surgery?
Acute appendicitis
What is a cystic mass between the umbilicus and bladder?
Urachal cyst
What apron lies over the intestines?
Greater omentum
Fluid collects in the most ___ areas.
Dependent
What is the double layer of peritoneum extending from the liver to the lesser curvature of the stomach?
Lesser omentum
How do we classify kidney abscesses?
Bosniak system
class I - simple cyst class II- probable benign cyst class III- indeterminate cyst lesion classIIII-presumed malignant cyst mass
What is the superior portion of the subhepatic space called?
Morrisons Pouch
What is the hernia location that typically contains fat?
Epigastric hernia
How would you define a lymphocele?
Collection of fluid that occurs after surgery on the pelvis, retroperitoneum or recess cavities.
What gauge needle would you use in a FNA?
1) 25 gauge for thyroid
2) 16-18 gauge for thicker more viscous fluid drainages
What type of biopsy would you use a spring loaded device?
Liver Biopsy?
Core Biopsy
Per Previous Reviews, Pg. 498
What is the most common organ biopsied?
liver
Renal parenchyma biopsies are requested for patients with what disease?
Requested on patients with proteinuria, nephrotic syndrome, or in renal failure.
Pg 518 Hagen-Ansert
In a renal parenchyma biopsy, which portion of the kidney is typically biopsied?
Cortical tissue (cortex) Pg 518 Hagen-Ansert
What are specific complications of a renal biopsy?
Perinephric hematoma and hematuria.
What is the patient position for a thoracentesis?
Patient sits on side of the bed and leans on a beside table with a pillow for comfort.
What is the best position for a prostate biopsy?
LLD.
What lab test should indicate a liver lesion?
AFP
What are the dimensions of the thyroid?
Length: 40-60mm
Height: 20-30mm
Width: 13-18mm
What are the neighboring structures of the thyroid?
Anterior: sternothyroid, omohyoid, sternohyoid, sternocliedomastoid
Posterior: longus Colli muscle (posteriolateral)
Where is the pyramidal lobe on thyroid?
Arises from isthmus, tapers anteriorly.
Parathyroid glands produce a hormone that affects ____.
PTH: acts on one, kidney and intestines to enhance calcium absorption.
How many parathyroid glands do we have?
4
What could a cystic formation lateral to the thyroid be?
Branchial cleft cysts.
What are the normal measurements of the testicle?
Length: 3-5cm
Width: 2-4cm
Height: 3cm
What is the fibrous capsule over the testicles?
Tunica Albuginea.
What is the sonographic appearance of the testicles?
Smooth, medium gray, fine echo texture.
Where is the epididymis located in reference to the testicles?
Begins superior then courses posteriolateral to the testes.
What are the common reasons to develop hydroceles?
Idiopathic.
Epididymo-orchitis and torsion.
Trauma.
What is the common cause for acute scrotal pain in adults?
Epididymo-orchitis.
Tubular ectasia of the rete testes is associated with ___.
Spermatocele, epididymal or testicular cysts or other epididymal obstruction.
What does epididymoorchitis most commonly result from?
Spread of a lower UTI via the spermatic cord.
Intratesticular cysts are associated with ___.
Extratesticular spermatoceles.
Clinical history of a vasectomy is associated with ___.
Sperm granuloma
Pg 621 Hagen-Anserr
Microlithiasis of the teste is associated with ___.
Testicular malignancy , cryptoorchidism, klienfelter’s, infertility, varicoceles, testicular atrophy and male psudohermaphorditism
What structure is attached superiorly between the testicle and epididymis?
Appendix testis.
Between which layers does a hydrocele form?
Visceral and parietal layers of the tunica vaginalis
What is the sonographic appearance of the epididymis in reference to the teste?
The epididymis appears isoechoic or hyperechoic compared with the testis, although the echo texture is coarser. Pg. 605
Which vessel passed anterior to the uncinate process of the pancreas?
SMV
