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radiographic imaging 4 > Abdominal reading > Flashcards

Abdominal reading Flashcards

1
Q

the routine abdominal x-ray includes but is not limited too……

A

evaluation of the aorta, pancreas, liver, biliary system, kidneys and spleen.

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2
Q

When imaging organs and tissues in the upper abdomen what are the sonographic descriptors (diagnostic elements to be considered to describe appearances).

A
  1. Echogenecity
  2. Sound transmission
  3. outline/border
  4. size
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3
Q

what words do you use to decribe the echogenic level?

A

hyperechoi: Is the liver bright
hypoechoic: Is the liver dark

The common technique is to compare the overall brightness (echogenecity) of liver parenchyma, with that of the kidney cortex.

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4
Q

what words do you use to describe the echo pattern?

A

fine/smooth echotexture= homogenous

coards texture= heterogenous

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5
Q

A heterogenous echotexture in addition to a high-level echogenecity (hyperechoic) can be associated with……………..

A

cirrhosis of the liver

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6
Q

what words do you use to describe the sound transmission through the abdomen?

A

A high attenuation can arise associated with fatty deposits/ infiltration or scarring within the liver.

Equally so, low attenuation (and hence good transmission of sound) will occur with inflammatory conditions. Thiw would be manifested by corresponding low values of power and gain.

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7
Q

what can sound transmisson help detect?

A

a mass. Does the mass shadow thereby attenuate sound, or does it enhance, allowing more sound to pass through than normal surrounding tissue, thus causing the acoustic enhancement phenomenon as seen with fluid-filled structures such as cysts.

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8
Q

when booking abdominal appointments what are some ascpects you should think about?

A

urgency. if it is urgent then consideration of oral preparation may be waived.

allowing 25-30 minutes per patients

if possible try to book the fasting patients early in the morning. Patients are generally less gassy in the morning. This also minimises fasting time to overnight only.

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9
Q

the appearance of a thick walled gallbladder with the presence of pain may indicate?

A

acute cholecytitis

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10
Q

why is fasting before an abdominal ultrasound so important?

A

Because the gallbladder may be contracted from a recent meal, and thus thick walled.

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11
Q

for hepatobiliary and pancrease studies how long must the patient fast for?

A

six hours fasting preceded by a light meal is generally adequate

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12
Q

explain the difficulties in routine preperation?

A

medication, non-fasting, gastric stasis, patient care, exposing the abdomen and using disposable towels and knowing what the examination is about.

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13
Q

Why might someone present with a full stomach?

A

this can be due to a gastric outflow problem. Illeus in the acutley ill is where the peristalsis ceases due to neurogenic obstruction.

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14
Q

what might cause poor or no gastric passage?

A

Thickening of, or a mass associated with the stomach antrum or duodenum will cause poor or no gastric passage.

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15
Q

what other areas of anatomy are closely related with the liver?

A

bile ducts, gall bladder and pancreas

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16
Q

What are some indications for a pancreas examination

A

painless jaundice, palpable central abdominal mass, raised serum amylase and pain consistent with pancreatitis.

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17
Q

what are some indications for a liver examination?

A 
abnormal liver function test 
clinically enlarged liver
pain in the right upper quadrant (RUQ) 
check for metastases
apparent jaundice 
review of lesion seen on CT or other modality.
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18
Q

what are some indications for a biliary examination?

A

investigation of jaundice
abdominal pain
suspicion of gallstones
symptoms of acute cholecytitis

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19
Q

when examining the RUQ and the patient is supine what should you scan first and why?

A

the pancreas because in that position air can rise out of both the duodenum and the stomach which may well obscure visualisation of the pancreas.

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20
Q

where is the head of the pancreas located compared to the body?

A

the head is much more inferior to the body and why the head is often the site for abnormal mass, it is sometimes not well seen due to overlying gas and not being in a recognisable line with the pancreas.

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21
Q

how can visulisation of the pancreas be achieved in the event of gas in the upper abdomen?

A

i. the gall bladder (particularly if it is distended)
ii. The left lobe of the liver; and
iii. Ingestion of water by the patient

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22
Q

what plane should the head, body and tail of the pancreas be scanned in?

A

the transverse plane

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23
Q

Why is the tail of the pancreas often difficult to assess?

A

because you can’t assess it from the anterior approach as the stomach itself can tend to limit visualization of this area. However one approach is using the spleen as a window and viewing the tail of the pancreas adjacent to the hilum of the spleen, this problem can be overcome.

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24
Q

where does the splenic vein run in regards to the pancreas

A

it runs posterior to the body of the pancreas with the ucinate process wrapping around and under the superior mesenteric vein.

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25
Q

if the patient rolls to the left explain the position of the pancreas?

A

the pancreas may slide off the midline to the left of the aorta (no longer maintaining the relationship with the IVC).

26
Q

how many images of the pancreas would be included in a routine examination?

A

5

27
Q

what is the purpose of modification breathing?

A

modified breathing will bring the upper abdominal organs out from behind the costal margin and into view.

28
Q

in most patients deep inspiration will push the diaphragm……

A

down. however in some patients this will draw the diaphragm up.

29
Q

what is the normal measurement for the head of pancreas anteroposteriorly?

A

2-3cm

30
Q

What is the normal measurement for the neck of pancreas anteroposterioly?

A

1-2cm

31
Q

what is the normal measurement for the tail of pancreas?

A

1.2-2.8cm

32
Q

what are the 3 forms of pancreatitis

A

acute. chronic and acute/chronic

33
Q

describe the appearance of acute pancreatitis?

A

the organ usually becomes enlarged and hypoechoic

34
Q

why and how should the liver be compared to the pancreas?

A

the pancreas usually becomes enlarged and hypoechoic. Evaluating the pancreas, the ecogenecity of the liver, at the same depth, is compared to that of the pancrease.

This is performed in the sagittal section where liver can be seen at the same depth in the same scan frame

35
Q

the echogenicity of the normal pancreas should be ……… to the liver

A

equal to or greater then that of the liver.

36
Q

what is pancreatic pseudocysts?

A

collections of leaked pancreatic fluid that may form next to the pancreas during pancreatitis

usually complex masses with internal debris and septae.

37
Q

when there is irregularity in the outline and a non-uniform highly chogenic echo pattern of the pancreas, then what might be suspected?

A

chronic pancreatitis

also the presence of calculi may be seen in severe chronic pancreatitis

38
Q

what are the main features of acute/chronic pancreatitis?

A

findings include an enlarged heterogenous pancreas with or without calcification.

39
Q

state the measurements that are classified as “normal” for the pancreatic duct?

A

many consider that 2mm or less is normal with 3mm the grey area and 3mm dilated.

40
Q

what are some reasons for pancreatic duct dilation?

A

Biliary calculus in the ampulla of vater
pancreatolithiasis
intrinsic invasion via cholangiocarcinoma and extrinsic compression from tumour

41
Q

what are pancreatic tumours that are benign?

A

adenoma

cystadenoma

42
Q

what are the pancreatic tumours that are malignant?

A

Adenocarcinoma
Squamous carcinoma
Cystadenocarcinoma
anaplastic carcinoma and insulinoma.

43
Q

how likely are pancreatic carcinomas seen in the head, body and tail?

A

head- 75%
body- 20%
tail- 5%

44
Q

explain the shape, size texture of pancreatic carcinomas

A

Typically they are irregular, focal complex and predominantly hypoechoic mass with associated ductual dilation.

45
Q

What is Courvoisier’s sign?

A

a distended gallbladder in pancreatic carcinomas

46
Q

When the colon or gastric antrum overlays the pancreatic head how might you be able to see it?

A

Angling down in an oblique fashion through the liver, using the gallbladder for a window or a coronal approach.

A water filled stomach or a left coronal approach through the kidney and spleen are sometimes helpful.

47
Q

what is one technique to scanning the entire volume of the liver?

A

Begin supine position to evaluate the left liver segments. The left liver is scanned in sagittal and transverse planes. The right liver segments are then scanned with the patients right side raised approx 30 degrees.

48
Q

What might be the liver infiltration indications of hepatomegaly be?

A

hepatomegaly is a large liver.
CAUSE
Liver infiltration- primary (hepatoma), metastatic disease, cirrhosis (early stages), lymphoma, amyloidosis and hepatitis.

49
Q

What might be the extra hepatic influences indications of hepatomegaly be?

A

venous congestion of the liver (CCF)

50
Q

how can you tell if the liver is enlarged or not?

A

viewing the lower border of the liver. If the liver is in normal limits it is pointed and if enlargement is present it will be rounded

51
Q

if the liver extends below the right kidney then it is considered…..

A

enlarged

52
Q

what is Riedels lobe and how do you identify it?

A

an accessory extension of the right lobe of liver inferiorly.

can identify it using the anterior branch of the portal vein (ARPV) i.e lying in and extending with the extension of the lower right lobe of the liver should be the ARPV. Riedels lobe often has a waist at its superior margin (anterior to the lower right kidney)

53
Q

what causes an increase in the echogenicity of a fatty liver

A

accumulation of triglycerides within hepatocytes. The increase of echogenicity is also associated with increased attenuation and loss of the reflectivity of the portal triads

54
Q

describe the appearance of the fatty liver in the early stages?

A

the echogenecity of the liver can be seen to be increased but the attenuation is normal with a slight loss of portal vein differentiation.

55
Q

describe the appearances of the fatty liver in moderate cases?

A

the brightness of the liver increases further from that of the early stages. portal vein differentiation decreases further.

56
Q

describe the appearances of the fatty liver in severe cases?

A

the echogenicity of the liver remains high but no portal vessels, other then the main branches, can be seen.

57
Q

what are some conditions that are associated with fatty liver?

A

excessive alchol intake, poorly controlled hyperlipidaemia and diabetes are some conditions associated with fatty liver

58
Q

explain the echogenicity in acute and chronic heaptitis?

A 
acute= increased echogenecity 
chronic= decreased echogenecity
59
Q

what does heaptitis mean?

A

inflammation of the liver.

60
Q

name the types of lymphoma (malignant)

A 
Hodgkins lymphoma (affecrts lymphatic system)
non-hodgkins lymphoma 
lymphosarcoma
reticulum cell sarcoma 
leukosarcoma 
lymphocytic leukemia

radiographic imaging 4 (3 decks)

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