Chapter 1 - abdominal sonography Flashcards
Normal echogencity of the abdominal organs from greatest (Brightest) to least (darkest) as follows
renal sinus –> pancreas –> spleen –> liver –> renal core –> renal pyramids –> gallbladder
without echoes
example : gallbladder ; simple renal cyst
anechoic
having both cystic and solid components
ex : hemorrhagic cyst ; hepatic access
complex
structure that produces echoes
ex: fatty liver ; chronic renal disease
echogenic
of differing composition
ex: graves disease ; diffuse liver metastasis
heterogeneous
of uniform composition
ex: normal liver ; normal testicle
homogenous
having many echoes
ex: cavernous hemangioma ; angiomyolipoma
hyperechoic
having few echoes
ex: hepatic adenoma ; thyroid adenoma
hypoechoic
having the same echogeniciy
ex: jocular nodular hyperplasia
isoechoic
demonstrate smooth walls and are round in shape
star criteria
patients who have some form of itis or infection will have an increased
white blood cell count
_____ organs release hormones into the blood stream, where as _____ organs use ducts.
Endocrine
Exocrine
occurs when the sound beam strikes a structure in a no perpendicular manner resulting in a loss of the true echogenicity of the structure
ex ; tendons
Anistrophy
a type of reverberation caused by several small highly reflective interfaces ; ex seen with adenomyomatosis of the GB
Comet tail
caused by air or bowel gas – ex most often seen emanating from bowel may be seen posterior to gas within an abscess – dirty shadow most often emanating from bowel, clean shadow most often emanating from gallstone
Dirty shadowing
reflective or refractive effect seen deep to the margins of a round structure that have a significantly different speed of sound compared to surrounding tissue, may be termed as refractive shadowing – exc often seen arising rom cystic structures and appears as narrow shadow lines originating at the edge of these structures
Edge shadowing
produced by a strong specular reflector and results in a copy of the anatomy being placed deeper than the correct location – ex seen posterior to the liver and diaphragm
Mirror image
produced when the sound beam is barely attenuated through a fluid or fluid filled structure ; ex seen posterior to fluid-filled structures as the GB and renal cysts and ascites
posterior acoustic enhancement or through transmission
– caused by the bending of the ultrasound beam when it passes through an interface between two tissues with vastly dissimilar speeds of sound and the angle of the approach is not perpendicular – ex seen when imaging rectus muscles of abdominal wall
refraction
caused by a large acoustic interface and subsequent production of false echoes – ex seen as an echogenic region in the anterior aspect of the GB or other fluid filled structures
reverberation
artifact that appears as a solid streak or a chain of parallel bands radiating away from a structure ; ex deen emanating from gas bubble within the abdomen ex can help in case of pnuembilia
ring down
caused by attenuation of the sound beam ; ex seen posterior to bone and calculi like gallstones and renal stones
shadowing
caused by sound beams that are peripheral to the main sound beam – ex ; seen as low level echoes with flud, mimicking sludge , debris or pus within a fluid-filled structure like GB
side lobes
caused by compression from 3D to 2D images – ex – can stimulate false echoes that could resemble sludge or debris in the urinary bladder or gallbladder
slice thickness
occurs behind strong granular and irregular surfaces like crystals , calculi or calcifications ex can be seen and useful at identifying a small kidney or biliary stone
twinkle artifact
Supplies the body with oxygen, nutrients, hormones and WBCS and removes waste and toxins by pumping and transferring blood
ex:
arteries. and arterioles
capillaries
heart
veins and venules
Cardiovascular
Provides metabolism, nutrient uptake, energy storage and the extortion of waste
Accessory digestive organs : Liver, GB, Pancreas
Esophagus, mouth, small and large bowel , stomach
Digestive
Secretes hormones or juices through ducts
ex :
breast
pancreas
salivary glands (parotid glands, submandibular glands, and sublingual glands)
liver
EXOCRINE
Secretion of hormones into the blood to control many different body functions. The hypothalamus in the brain controls the pituitary glands secretion of various hormones which in turn controls the secretion of hormones by endocrine organs or glands
ex: ALOPPPPTT
adrenal glands
liver
ovaries
pancreas
parathyroid glands
pineal gland
pituatirary gland (anterior and posterior)
testicles
thyroid gland
ENDOCRINE
Collection and transportation of excess fluid, absorption of fats (which are eventually sent to the liver) and immune response
ex: A BOY LEFT SCHOOL TOGO TOUR
adenoids
bone marrow
lymph node
spleen
thymus gland
tonsils
Lymphatic
provides the structural support system for the body
ex:
cartilage
connective tissue
joints
ligaments
muscles
tendons
MSK
controls almost every organ system and structure in the body
ex: brain
spinal cord
nerves
Nervous
Supplies the body with oxygen and removes carbon dioxide from the blood
ex: bronchus
larynx
lungs
nasal cavity
pharnyx
trachea
Respiratory
Produces new life
ex: Male - epipydmyis, prostate gland, scrotum , testes, vas deferens
Female - Fallopian tubes , ovaries, uterus, vagina
Reproductive
Maintain chemical and water balance, regulate blood pressure and filter waste products from the blood
ex: kidneys
ureters
urethra
urinary bladder
Urinary
Intraperitoneal organs (GLOSS)
Gallblader
Liver
Ovaries
Spleen
stomach
Retroperitoneal organs (AAAADIKPPUUU)
adrenal glands
abdominal lymph nodes
aorta
ascending colon
descending colon
IVC
kidneys
pancreas
prostate gland
ureters
uterus
urinary bladder
Inferior to the diaphgram
divides into Rt & Left
Subherenic spaces
Divides into right anterior & posterior and left.
Right is located between Rt lobe of liver and right kidney
posterior subhepatic space also referred to as Morrisons pouch
Subhepatic spaces
Between pubic bone and urinary bladder also referred to as space of Retzius
Retropubic space
between stomach and pancreas, common location for pancreatic psudeocysts
Lesser sac
extend alongside the ascending and descending colon on both of the abdomen
Paracolic gutters
Male : between urinary bladder and rectum (rectovesical pouch)
Female : between uterus and rectum (Pouch of Douglas, rectouterine pouch)
Posterior-cul-de-sac
Between urinary bladder and uterus, also called vescouterine pouch in females
anterior-cul-de-sac
Pathologies Associated with Ascites
Acute cholecystitis
Cirrhosis
Congestive heart failure
ectopic pregnancy
malignancy
portal hypertension
reputure of abdominal aortic anyersum
tumor of glandular organ
location - most organs
Benign
Adenoma
Tumor containing adrenal tissue
location - testicle
benign
Adrenal rest tumor
Tumor of blood vessels , muscle and fat
Location – kidney
Benign
Angiomyolipoma
abnormal accumulation of cells within a focal region of an organ
Location – liver
Benign
Focular nodular hyperplasia
tumor consisting of a group of inclammtory cells
Location – liver and spleen
benign
Granuloma
Tumor that secretes gastrin
Location – pancreas
benign
Gastrinoma
tumor consisting of an overgrowth of normal cells of an organ
Location – kidney
benign
Hamartoma
tumor consisting of blood vessels
Location – liver, spleen and kidney
benign
Hemangioma
Localized collection of blood
location - a anywhere an organ/tissue is affected by trauma
benign
Hematoma
Tumor that secretes insulin
location - pancreas
benign
Insulinoma
tumor that consists of fat
location - liver spleen kidney and superficial
benign
lipoma
tumor consisting of onocytes
location - kidney
benign
Oncocytoma
tumro consisting of chromaffin cells of adrenal gland
location - adrenal gland
benign
phecromocytoma
tumors that consist of three germ cell layers
location - testicle/ovary
benign
teratoma
localized collection of urine
location - adjacent to kidney transplant
benign
urinoma
cancer of glandular origin
location - pancreas and GI tract
malignant
adenocarcinoma
cancer in the lining of vessels (lymphatic or vascular)
location - spleen
malignant
angiosarcoma
cancer that consists of trophoblastic cells
location - testicle
malignant
choriocarcinoma
cancer of the bile ducts
Location : biliary Tree
malignant
cholangiocarcinoma
cancer that is fundamentally adenocarcinoma with cystic components
Location : Pancreas
malignant
cystadenocarcinoma
cancer that is germ cell origin
Location : Testicle
malignant
embryonal cell carcinoma
cancer of aggressive abnormal epithelial cells
Location : thyroid
malignant
follicular carcinoma
cancer that originates the hepatocytes
Location : liver
malignant
hepatocellular carcinoma (hepatoma)
cancer that originates in the tubules of the kidney
Location : Kidney
malignant
hypernephroma (renal cell carcinoma)
cancer of the blood cells
Location : spleen, liver and testicle
MALIGNANT
LEUKEMIA
cancer of the lympathic system
Location: spleen kidney and testicle
malignant
lymphoma
cancer originating from the parafollicular cells of the thyroid
Location : thyroid
malignant
medullary carcinoma
cancer that has formation of many irregular fingerlike projection
Location : thyroid
malignant
papillary carcinoma
cancer that originates in the seminiferous tubules
Location : Testicle
malignant
seminoma
– cancer that orginates in the transitional epeitehilum of an organ or struct
Location : bladder, urerter ; kidney
malignant
transitional cell carcinoma
cancer that is of germ cell orgin
Location : testicle
malignant
yolk sac tumor
pediatric malignant liver tumor
hepatoblastoma
pediatric malignant kidney tumor
nephroblastoma (WILMS TUMOR)
pediatric adrenal gland malignant tumor
neuroblastoma
tumor marker for
liver
ovarian and testicular cancers
AFP
breast tumor marker
CA 15-3
tumor marker for
pancreatic
billiary tract
stomach
colon
CA 19-9
ovarian tumor marker
Ca-125
medullary thyroid cancer tumor marker
calcitonin
testicular cancer and germ cell tumor marker
Beta- HCG
testicular ovarian and other germ cell tumors
LDH
inherited condition that causes cysts in multiple organs usually seen in adults later in life.
Location : kidneys, liver, spleen and pancreas
ADPKD
inherited condition that causes cysts in the kidneys, renal failure and hepatic fibrosis, usually discovered in utero or in new borns
Location : kidneys and liver
ARPKD
virus that attacks the immune system
Location : liver, spleen, lymph nodes and skin tumors (karposi sarcoma)
HIV & AIDS
growth disorder that causes enlargement of many organs and structures ; increased risk for kidney and cancer in children
Location : skull, abdominal visceromegaly, and tongue (macroglossia
Beckwidth Weidemann syndrome
narrowing or occlusion of the hepatic veins and IVC
Location : liver and IVC
Budd-Chiari
results from high levels of aldosterone can be caused by adrenal adenoma
Location : adrenal glands
Conn syndrome
autoimmune disease that causes chronic inflammation of the GI
Location : GI tract
Chrohns disease
results from high levels of vortisol can be caused ny adrenal adenoma
Location : adrenal glands
Cushing syndrome
caused by hyposecretion or hypoactivity of insulin
Type 1 – early onset (juvenile or young adult)
Type 2 – Adult onset
Location : multiple organs include ; eyes extremities, kidneys nerves and vasculature
Diabetes
rare complication of PID causing inflammation around tissue of liver
Location : liver
Fitz Hugh Curtis syndrome
associatd with hyperthyroidism
Location thyroid
Graves disease
associated with hypothyroidism
Location: thyroid
Hashimoto disease
genetic condition in which a male has an extra X chromosome
Location : testicle and male breast
Klinefelter syndrome
disorder of the connective tissue
Location : heart, vasculature structures and skeleton
Marfan syndrome
jaundice pain, and fever associated with a stone lodged in the cystic duct
Location : liver, GB and biliary tract
Mirizzi syndrome
– damaged filtration of kidney causes excessive protein in the urine (proteinuria)
Location : kidneys, swlling of feet and ankles
Nephrotic syndrome
infllammtory disease that results in scar tissue development in multiple organs
Location : liver, spleen, kidneys, testicles , lymphatics and lungs
Sarcoidosiss
rare genetic disorder that leads to development of tumros within various organs
Location : lungs, lymphatics and testicles
Tuberculosis
rare genetic disorder that leads to development of tumors within various organs
Location – brain, heart and kidneys (angiomyolipoma)
Tuberous sclerosis
rare genetic disorder characterized by cysts and tumors in various organs
Location : pancreas, kidneys and adrenal glands
Von-hippel-lindau disease
tumor (gatsrinoma_ in the pancreas of intestine that causes an increase in the roduction of gastrin
Location : prancreas and stomach ( produces excessive
Zollinger - Ellison syndrome
- Transitional cell carcinoma is commonly found in all of the following locations except
a. Liver
b. Renal pelvis
c. Urinary bladder
d. Ureter
A
- A patient with cholecystis most likely has an elevation in which of the following labs
a. Afp
b. Wbc count
c. Lactate dehydrogenase
d. Chromaffin
B
- The neuroblastoma is a malignant pediatric mass commonly found in the
a. Kidney
b. Liver
c. Testicle
d. Adrenal gland
d
- What is a substance produced by a cancerous tumor or an organ or structure in response to cancer
a. Onocyte
b. Tumor marker
c. Lymphadenopathy
d. Homestatin
B
- The pheochromocytoma is a benign mass commonly located in the
a. Testicle
b. Thyroid gland
c. Adrenal gland
d. Liver
C
- A tumor that is of similar echotexture to normal liver tissue is discovered in the liver of an aysymptomatic patient. What is the echogenicity of the tumor
a. Echogenic
b. Hypoechoic
c. Isoechoic
d. Hypodense
c
- Which of the following is not considered to be an intraperitoneal organ
a. Liver
b. Pancreas
c. Gallbladder
d. Spleen
B
- Which of the following are not considered retroperitoneal organs
a. Abdominal lymph nodes
b. Adrenal glands
c. Kidneys
d. Ovaries
D
- What is another name for Morrison pouch
A. posterior right subhepatic space
B. Posterior cul-de-sac
C. Anterior subhepatic space
D. Anterior cul de sac
A
- The hypernephroma may also be referred to as the
A. Nephroblastoma
B. Neuroblastoma
C. Hepatocellular carcinoma
D. Renal cell carcinoma
D
- A type of reverberation artifact caused by several small, highly reflective interfaces such as gas bubble describes
a. Mirror image
b. Posterior shadowing
c. Comet tail artifact
d. Ring-down artifact
C
- The term choloangiocarcinoma denotes
a. Bile duct carcinoma
b. Hepatic carcinoma
c. Pancreatic carcinoma
d. Splenic carcinoma
A
- Which of the following occurs when the doppler sampling rate (PRF) is not high enough to display the doppler frequency shift
a. Doppler noise
b. Aliasing
c. Mirror image
d. Twinkle artifact
B
- The hepatoma is a
a. Benign tumor of the spleen
b. Benign tumor of the liver
c. Malignant tumor of the panvrea
d. Malignat tumor of the liver
D
- The hepatoblastoma is a
A. Benign tumor of the pediatric liver
B. Malignant tumor of the adult liver
C. Malignant tumor of the pediatric liver
D. Malignant tumor of the pediatric adrenal gland
C
- Which of the fllowing is the space located between the pancreas and the stomach
A. Morrison’s pouch
B. Lesser sac
C. Space of retzius
D. Pouch of douglas
B
- Which of the following is another name for the wilms tumor
a. Nephroblastoma
b. Hepatoblastoma
c. Neuroblastoma
d. Hepatoma
A
- An angiosarcoma would most likely be discovered in the
a. Rectum
b. Gallbladder
c. Spleen
d. Pancreas
C
- Which of the following is not an endocrine organ or structure
a. Thymus
b. Pancreas
c. Thyroid
d. Spleen
D
- Which of the following is an artifact that alters the echogenicity of a tendon
a. Acoustic enhancement
b. Anistrophy
c. Ring down artifact
d. Mirror image artifact
B
- The gastrinoma would most likely be discovered in the
a. Pancreas
b. Adrenal gland
c. Stomach
d. Spleen
A
- Of the list below which is considered to be an intraperitoneal organ
a. Left kidney
b. Aorta
c. IVC
d. Liver
D
- Which of the following is considered to be a malignant testicular neoplasm
a. Neuroblastoma
b. Hepatoma
c. Yolk sac tumor
d. Hamartoma
C
- Which of the following is caused by the bending of the ultrasound beam when it passes through an interface between two tissues with vastly dissimilar speeds of sound and the angle of the approach is not perpedincular
a. Comet tail
b. Refraction
c. Reverberation
d. Acoustic enhancement
B
- These potential spaces extend alongside the ascending and descending colon on both sides of the abdomen
a. Parcolic gutters
b. Periumbilical gutters
c. Greater gutters
d. Pericentric gutters
A
- This common tumor of the kidney , contains blood. Vessels , muscle and fat
a. Hemangioma
b. Angiomyolipoma
c. Oncocytoma
d. Lipoma
B
- Which of the following is not a salivary gland
a. Thyroid gland
b. Parotid gland
c. Submandibular glanf
d. Sublingual land
A
- Which of the following is not a pediatric malignant tumor
a. Hepatoblastoma
b. Neuroblastoma
c. Pheochromocytoma
d. Nephroblastoma
C
- A tumor that consists of tissue from all three germ cell layers is the
a. Pheochromocytoma
b. Hamartoma
c. Adrenal rest tumor
d. Teratoma
D
- Which of the following lab values would be most hekpful in evaluating a patient who had suffered from recent trauma
a. Wbc count
b. Afp
c. BUN
d. Hematocrit
D
- The insulinoma is a
a. Malignant pediatric adrenal tumor
b. Benign pancreatic tumor
c. Malignant pancreatic tumor
d. Benign liver tumor
B
- A tumor that consists of a group of inflammatory cells best describes the
a. Hematoma
b. Hepatoma
c. Lymphoma
d. Granuloma
D
- A tumor that. Consist of a focal collection of blood best describes the
a. Hematoma
b. Hamartoma
c. Lipoma
d. Angiomyolipoma
A
- Which of the following is a tumor marker that may be used in cases of suspected testicular malignancy
a. Bun
b. Creatnening
c. Hcg
d. Calcitonin
C
- The malignant testicular tumor that consists of trophoblastic cells is the
a. Choriocarcinoma
b. Yolk sac tumor
c. Teratoma
d. Insulinoma
A
- What is the artifact likely encountered posterior to a gallstone
a. Acoustic enhacment
b. Shadowing
c. Ring down
d. Reverberation
B
- A collection of abdominal fluid within the peritoneal cavity often associated with c ancer is termed
a. Transudate ascites
b. Chromaffin ascites
c. Peritoneal
d. Exudate ascites
D
- Which of the following is not a rule of surgical asepsis
a. If you recognoxe that an item has become nonsterile act immediately
b. If one sterile person must pass another, they must pass face to face
c. A sterile field must never be left unmonitored. If a sterile field is left unattended it is considered non sterile
d. A sterile person does not lean a across a sterile field
B
- Which of the following occurs behind a strong granular and irregular surfaces like cyrstals, calculi or calcifactions such as a kidney stone
a. Twinkle artifact
b. Refraction
c. Anistrophy
d. Side lobes
A
- Which of the following has both endcrine and an exocrine function
a. Adrenal gland
b. Spleen
c. Pancreas
d. Duodenum
C