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Final Flashcards

1
Q

Transpyloric plane

A

Level of L1

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2
Q

Subcostal plane

A

Level of L3

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3
Q

Transtubercular plane

A

Level of surface of iliac crest

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4
Q

Midaxillary plane

A

Divides the body into equal anterior and posterior halves

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5
Q

Propagation speed of ultrasound in soft tissue

A

1540 m/s

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6
Q

Propagation speed of ultrasound in air

A

331 m/s

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7
Q

Propagation speed of ultrasound in bone

A

3000-5000 m/s

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8
Q

How do we characterize a structure?

A
  • compare to surrounding structures/tissue
  • evaluate contents
  • shape and borders
  • is it affecting surrounding structures?
  • blood flow?
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9
Q

Low attenuation structures usually represent what echogenicity

A

Anechoic

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10
Q

Anechoic is AKA

A

Echofree, echolucent, sonolucent

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11
Q

High attenuation structures usually appear

A

Echogenic

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12
Q

Complex structure

A

Both anechoic and echogenic areas

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13
Q

Most complex structures are

A

Malignant

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14
Q

Hypoechoic is AKA

A

Echopenic, echopoor

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15
Q

Homogenous

A

Uniform texture, same echoes throughout, same shade of gray

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16
Q

Types of texture

A

Smooth, rough, coarse, cobblestone

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17
Q

Increased through transmission occurs below a structure that is

A

Low attenuation, typically anechoic

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18
Q

Decreased through transmission occurs when sound wave is

A

Attenuated by a solid or calcified structure

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19
Q

Lesion

A

Abnormal change in tissue of an organ, usually caused by disease or trauma

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20
Q

Nodule

A

Abnormal swelling or aggregation of cells in the body

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21
Q

How many lobulations are acceptable

A

3 or less

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22
Q

What are the only two specialty exams that will grant a technologist the credentials of RDMS

A

Ob/Gyn and abdominal

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23
Q

The normal thyroid should appear

A

Homogenous, smooth, Isoechoic

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24
Q

SDMS sets

A

Code of Ethics and Scope of Practice

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25
Q

AIUM creates/regulates

A

scanning protocols

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26
Q

ACR creates/regulates

A

scanning protocols/quality assurance

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27
Q

Assault

A

threat or unsuccessful attempt to injure another causing fear or immediate harm

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28
Q

Battery

A

Unlawful touching of another person directly or with an object

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29
Q

False imprisonment

A

Holding or detaining a patient against his/her will

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30
Q

Negligence

A

Failure to perform in a reasonable manner or to fulfill the expected standard of care

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31
Q

Code of Ethics Principle 1

A

To promote patient well-being:
- provide info about purpose/risks etc of exam
- respect patient autonomy
- promote privacy, dignity, comfort
- protect confidentiality

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32
Q

Code of Ethics Principle II

A

To promote the highest level of competent practice:
- proper education, credentials
- adhere to protocols, practice within scope
- continuing education

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33
Q

Code of Ethics Principle III

A

To promote professional integrity and public trust:
- truthful and appropriate communication
- respect patient, colleague, and your own rights
- promote equitable care

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34
Q

Vascular technology subspecialties

A

Interventional and Diagnostic & Therapeutic

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35
Q

SDMS Scope of Practice

A

“The Diagnostic Ultrasound Professional is an individual qualified by professional credentialing and academic and clinical experience to provide diagnostic patient care services using ultrasound and related diagnostic procedures. The scope of practice of the Diagnostic Professional includes those procedures, acts and processes permitted by law, for which the individual has received education and clinical experience, and in which he/she has demonstrated competency.”

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36
Q

What contributes to patient diagnosis? (4 things)

A
  • lab values
  • imaging
  • patient history
  • symptoms
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37
Q

Borders can be described as

A
  • smooth
  • well-defined
  • irregular
  • ill-defined
  • thick
  • thin
  • angular
  • spiculated
  • lobulated
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38
Q

Cyst appearance

A
  • anechoic
  • well-defined/smooth borders
  • enhancement
  • homogenous
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39
Q

SALT imaging principles

A
  • size
  • shape
  • acoustic characteristics
  • location
  • transmission
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40
Q

What is measured in sagittal

A

length and height

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41
Q

measurement taken in transverse

A

width

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42
Q

When soundwave echoes are uniformly spaced, it results in

A

smooth texture

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43
Q

T or F: Hyperechoic structures usually represent a high density tissue

A

True

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44
Q

Attenuation

A

The process of soundwave absorption

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45
Q

Spiculated masses

A

Always malignant, has center which is origin and pulls surrounding tissue in

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46
Q

Small hyperechoic areas are

A

microcalcifications

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47
Q

Liver metastases appearance

A

hypoechoic spots that look like leopard spots

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48
Q

Which two conditions can be diagnosed using compression technique

A
  1. Murphy’s sign
  2. DVT
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49
Q

What are imaging presets?

A

Optimized settings for certain type of exam, also have associated measurement packages

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50
Q

During transmission transducer converts energy in what way

A

electrical energy into acoustic energy

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51
Q

During reception, transducer converts energy how

A

Acoustic energy into electrical energy

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52
Q

Imaging preset types

A
  • ABD: ab & renal
  • OB
  • GYN
  • VAS
  • UR (urinary): typically for prostate, sometimes bladder
  • SMP: small parts (thyroid, testicles, breast)
  • PED
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53
Q

Depth

A

adjusted up & down, eliminates excess posterior info to better center and see structure of interest

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54
Q

Curved transducer frequency

A

1-5 mHz

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55
Q

Linear transducer frequency

A

6-15 mHz

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56
Q

Lower frequency is used for

A

Better penetration for deep structures

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57
Q

High frequency used for

A

Better resolution for superficial structures

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58
Q

How can you get better images of the posterior field of view/deeper structures?

A

Increase depth, decrease frequency

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59
Q

What should you do when scanning a larger patient to get better quality images?

A

Use the curved transducer and lower frequency

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60
Q

Gain

A

B
Increases the strength of all electrical signals identically, makes whole image brighter or darker

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61
Q

If vessels are appearing gray in your image how can you improve it

A

Decrease gain so that they appear anechoic

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62
Q

Time Gain Compensation

A
  • creates uniform brightness from top to bottom
  • adjustable from anterior to posterior
  • corrects differences in echo strengths caused by attenuation (posterior tends to be darker)
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63
Q

Focal Zone

A
  • where concentration of soundwave strength is sent
  • position at or below depth of area of interest
  • one focal zone should be used to avoid slowing down system and lowering resolution
  • sometimes more than one is used in superficial structures
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64
Q

Dual Screen

A
  • can look at two images side by side, measure and compare measurements
  • Sag picture (L & H measurements) on left
  • Trans image (width) on right
  • R & L buttons above freeze
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65
Q

What happens if you push down on depth button

A

It will flip the orientation of the image

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66
Q

Trackball

A
  • place measurement calipers
  • change color doppler box size
  • bottom right of screen tells you what the 4 buttons around trackball will do
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67
Q

Sector width

A
  • rotate depth knob
  • narrows field of view & eliminates excess info on sides if you are looking at a small area
  • improves frame rate & resolution
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68
Q

Color Doppler

A
  • shows bi-directional flow: one color is flow towards transducer, one color is flow away from
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69
Q

Color Power Doppler

A
  • sensitive for slow flowing/small vessels
  • non-directional, just evaluates motion and intensity
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70
Q

Pulsed Wave Doppler

A
  • measures velocity of blood flow
  • place gate in middle of vessel
  • displays a waveform
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71
Q

Compression (control)

A
  • eliminates all reflections that are not useful to the image, reducing the difference between smallest and largest signal
  • keeps signals within operating range
  • changes the gray scale
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72
Q

Rejection

A
  • eliminates lowest strength reflections
  • affects low level echoes but not bright ones
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73
Q

What do red and blue represent on color doppler

A
  • red: flow toward transducer
  • blue: flow away from transducer
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74
Q

What controls are adjustable in post-processing?

A
  • annotate, calipers, gain, TGC
  • in more modern machines: zoom and sector width
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75
Q

What is a disadvantage of adjusting zoom and sector width in post-processing?

A

You do not get the same benefits as using them during live scanning such as better image resolution

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76
Q

Abdominal region of the liver

A

Right hypochondrium and epigastrium

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77
Q

Abdominal region of the gallbladder

A

right hypochondrium

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78
Q

Abdominal region of the pancreas

A

Epigastrium

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79
Q

Abdominal region of the spleen

A

Left hypochondrium

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80
Q

Abdominal region of the stomach

A

Mainly in transpyloric plane

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81
Q

Abdominal region of kidneys

A
  • Right kidney more posterior to left
  • Hilus mainly in transpyloric plane
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82
Q

Abdominal region of great vessels

A
  • midline of body
  • aorta to left of midline
  • IVC right of midline
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83
Q

Abdominal region of small intestine

A

Central portion of abdomen

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84
Q

Abdominal region of large intestine

A

Periphery of abdomen

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85
Q

Abdominal region of appendix

A

Right iliac

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86
Q

Abdominal region of bladder, prostate, uterus

A

Hypogastrium

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87
Q

What is the goal of ergonomics

A

To increase efficiency and productivity and reduce discomfort and injury

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88
Q

Methods to create a more ergonomic environment

A
  • modifying equipment
  • reevaluating tasks
  • changing the environment for optimal health & safety
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89
Q

What year did sonography related pain and discomfort surface?

A

1980

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90
Q

Who conducted a research survey in 1985? Who did it survey and what did it find?

A
  • Marveen Craig
  • 100 sonographers with 5-20 years experience
    Complaints:
  • stress/burnout
  • visual problems
  • infections
  • allergies
  • electric shock
  • muscle strains
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91
Q

What was the most common complaint by sonographers?

A

Sonographer’s shoulder

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92
Q

What is sonographer’s shoulder?

A
  • includes shoulder, elbow, wrist, thumb
  • pain, strain, stiffness, carpal tunnel
  • worsened by heavy transducers and cables
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93
Q

What were ultrasound machines like before 1980?

A

Articulated arm scanner, b-mode machines (images made of dots of different brightness)

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94
Q

How did ultrasound change after 1980?

A
  • real time 2D scanners were introduced
  • sonographer’s shoulder declined but only for a decade
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95
Q

When was the Occupational Safety and Health Act passed?

A

1970

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96
Q

What is a work-related musculoskeletal disorder?

A

Defined by injuries that result in:
- restricted work
- days away from work
- symptoms for > 7 days
- require medical treatment

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97
Q

What are ultrasound WRMSD caused by? What do they cause?

A
  • Aggravated workplace activities (repeated motions)
  • Cause inflammation, swelling, deterioration, degeneration
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98
Q

What percent of workplace injuries are WRMSD?

A

60%

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99
Q

How many sonographers have a WRMSD?

A

> 80%

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100
Q

What does awkward posture cause?

A

Imbalances between moving and stabilizing muscles

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101
Q

Consequence of prolonged, static posture

A

Compression on spine and soft tissues

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102
Q

Consequence of repetitive head and neck rotation

A

One set of muscles become stronger and shorter and opposite muscles become weaker and elongated

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103
Q

Asymmetric forces cause

A

Spinal misalignment

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104
Q

Increased pressure on nerves adjacent to affected muscles can cause

A

Nerve entrapment syndromes

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105
Q

Tendonitis/tenosynovitis

A

inflammation of tendon/tendon sheath, typically occur together

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106
Q

Carpal tunnel

A

entrapment of the median nerve through the carpal bones, caused by repeated flexion/extension of the wrist

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107
Q

Thoracic outlet syndrome

A

Nerve entrapment occurring at different levels of the thoracic cage, from collarbone to border of ribs

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108
Q

Trigger finger

A

Inflammation and swelling of the tendon sheath, entraps the tendon & restricts finger motion

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109
Q

Bursitis

A

Inflammation of shoulder bursa from repetitive motioin

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110
Q

Rotator cuff injury

A

Repetitive motion causes fraying of rotator cuff muscle tendons, caused by increasing age and repetitive abduction of the arm

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111
Q

Spinal degeneration

A

Vertebral disc degeneration, caused by bending, twisting, and improper seated posture

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112
Q

Features of modern machines that can help reduce WRMSD

A
  • brakes
  • adjustable height control panel
  • adjustable height, swivel, tilt monitor
  • easily accessible controls
  • transducer are not too wide or narrow
  • lightweight, thin, flexible transducer cords
  • cord hooks
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113
Q

Features of exam tables and chairs that improve ergonomics

A

Tables:
- adjustable height
- brakes
- stirrups
- drop down compartments for gyn exams
Chairs:
- adjustable height & flexion/extension
- wheels
- narrow (less distance from pt)

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114
Q

Proper transducer grip

A
  • Mild pressure
  • Limit excess gel
  • Use more of hand and less of fingers (no pinch grip)
  • Neutral wrist
  • Forearm support (table, patient, etc)
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115
Q

What is the main reason for shoulder pain?

A

Scanning arm abduction

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116
Q

How to improve scanning arm abduction

A
  • Should be < 30 degrees
  • Lower table and raise chair
  • As close to pt as possible
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117
Q

When you are not using controls you should

A

Bring your arm back to your lap

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118
Q

Issues with portable scanning

A
  • lack of space
  • tubes, lines, cords, catheters
  • patient’s can’t move themselves or are positioned in a particular way
  • oversized beds
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119
Q

Solutions to help with portable scanning

A
  • inform main desk before entering room
  • ask for help
  • rotate sonographers
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120
Q

Liver size

A

~ 15-17 cm long, 3.5 lbs

121
Q

What 3 areas of the liver are not covered by peritoneum?

A
  • Bare area
  • Fossa for IVC
  • Fossa for gallbladder
122
Q

What is the bare area?

A

To the right of the IVC, in direct contact with the diaphragm

123
Q

What is the entire liver enclosed by

A

Glisson’s capsule (fibrous capsule)

124
Q

Right lobe of the liver is how much larger than the left

A

6 times larger

125
Q

What divides right and left lobes?

A
  • Middle hepatic vein: divides lobes cranially
  • Main lobar fissure: divides lobes caudally, gallbladder located within
  • Falciform ligament: extrahepatic portion of ligamentum teres, separates right and left lobes at surface of diaphragm
126
Q

Margins of the caudate lobe

A
  • Ligamentum venosum fissure: divides left lobe anteriorly from caudate lobe posteriorly
  • Left portal vein: same as above
  • IVC: margin to right lateral of caudate lobe
  • Left margin forms the hepatic boundary of the superior region of the lesser sac
  • Right margin extends as projection between IVC and portal vein
127
Q

The right lobe of the liver is divided into anterior and posterior segments by

A

right intersegmental fissure

128
Q

Where does the right intersegmental fissure run

A

from porta hepatis to right hepatic vein

129
Q

The left lobe is divided cranially to caudally by what 3 things

A

left hepatic vein, left portal vein, ligamentum teres

130
Q

Couinaud intersegmental anatomy divides the liver into _______ based on what

A

8 segments based on blood supply (each segment has its own blood supply)

131
Q

The ligamentum teres is AKA

A

round ligament

132
Q

The ligamentum teres is the remnant of what

A

fetal umbilical vein which closes after birth

133
Q

What is patent umbilical vein

A

When the umbilical vein becomes recanalized due to cirrhosis or portal hypertension

134
Q

The ligamentum teres is an extension of what

A

left portal vein

135
Q

What is the sonographic appearance of ligamentum teres in transverse

A

an echogenic triangle

136
Q

What is the falciform ligament? What does it do?

A

intrahepatic part of ligamentum teres, connects liver to abdominal wall

137
Q

When is the falciform ligament seen on ultrasound?

A

When the patient has ascites

138
Q

What is the ligamentum venosum remnant of?

A

The fetal ductal venosum

139
Q

The ligamentum venosum separates what lobes?

A

left and caudate

140
Q

The ligamentum venosum communicates with the _____ at the region of the portal vein

A

ligamentum teres

141
Q

Main lobar fissure is AKA

A

interlobar fissure

142
Q

The main lobar fissure divides

A

right and left lobes

143
Q

Main lobar fissure sonographic appearance

A

Sag: thin, echogenic line from right portal vein to gallbladder fossa
Trans: from gallbladder to IVC

144
Q

The right intersegmental fissure divides the right lobe into

A

anterior and posterior segments

145
Q

The left intersegmental fissure divides the left lobe into

A

medial and lateral segments

146
Q

Vascular supply to the liver: how much via portal vein/hepatic artery

A

portal vein: 80%, nutrient rich
hepatic artery: 20%, oxygen rich

147
Q

What drains the liver?

A

hepatic veins, join together and drain into IVC

148
Q

What enters and exits at the porta hepatis?

A

Portal vein and hepatic artery enter
CBD exits

149
Q

The porta hepatis is located on what surface of the liver?

A

Inferior

150
Q

The common hepatic artery branches off the _____

A

celiac axis

151
Q

The common hepatic artery gives rise to

A

gastroduodenal artery, supraduodenal artery, right gastric artery

152
Q

The common hepatic artery divides into what

A

Right and left branches to supply the right and left lobes

153
Q

The portal veins bring ______ blood to the liver from

A

nutrient rich blood from the intestines

154
Q

The main portal vein originates at the union of what two veins

A

splenic and superior mesenteric
portal splenic confluence

155
Q

At the porta hepatis the main portal vein divides into

A

right and left portal veins

156
Q

The left portal veins travel ______ into the left lobe

A

vertically

157
Q

The right portal veins travel _______ into the right lobe

A

transversely

158
Q

Bile ducts and portal veins normally travel

A

parallel to each other

159
Q

What is the collagen content of the hepatic vs portal veins

A

hepatic: less collagen, not as bright
portal: more collagen, brighter

160
Q

Branching pattern of hepatic vs portal veins

A

Hepatic: longitudinally
Portal: transversely

161
Q

Change in diameter of hepatic vs portal veins

A

Hepatic: increase in diameter closer to IVC
Portal: no change

162
Q

Segmental location of hepatic vs portal veins

A

Hepatic: intersegmental (between)
Portal: intrasegmental (within)

163
Q

Doppler of hepatic vs portal veins

A

Hepatic: pulsatile
Portal: continuous

164
Q

Primary functions of the liver

A
  • Bile production/excretion
  • Excretion of hormones/drugs
  • Metabolism of fats, proteins, carbs
  • Enzyme activation
  • Storage of glycogen, vitamins, minerals
  • Synthesis of plasma proteins
  • Blood detox and purification
  • Kupffer cells: defense against invading organisms
165
Q

What is the papillary process?

A
  • anteromedial extension of the caudate lobe
  • may appear separate from liver
  • may mimic lymphadenopathy
166
Q

What is Reidel’s lobe?

A
  • the inferior aspect of the right lobe extends as far as the iliac crest
  • tongue-like extension
  • more common in females
167
Q

What is the main difference between endocrine functions and exocrine functions?

A

Endo: direct release into bloodstream
Exo: need a pathway

168
Q

What term is given to the condition of low white blood cells?

A

leukopenia

169
Q

Where does the common bile duct terminate? Which two structures are located at the region of termination and determine if the bile passes through?

A

CBD terminates at the duodenum, sphincter of Oddi and Ampulla of Vater determine if bile passes through

170
Q

The biliary system is made up of

A

liver, gallbladder, bile ducts

171
Q

What are the functions of the biliary system?

A
  • Drain waste products from liver into duodenum
  • Aid in digestion with controlled release of bile
172
Q

What does bile consist of?

A

Waste, cholesterol, bile salts

173
Q

What are the two primary functions of bile?

A
  1. carry away waste
  2. break down fats
174
Q

Where is the gallbladder located? What is its size and wall thickness?

A
  • intraperitoneal, located within main lobar fissure
  • 8-10 cm long, 3-5 cm wide
  • wall: <3 mm
175
Q

What are the parts of the gallbladder?

A

Neck, body, fundus

176
Q

What are the wall layers of the gallbladder?

A
  1. mucosa
  2. muscularis
  3. serosa
177
Q

What are the Rokitansky-Aschoff sinuses?

A

Pocket-like invasions of the mucosal epithelium into the muscularis layer that allow for bile accumulation without overextending and weakening the GB wall

178
Q

What is the cystic duct?

A

A tortuous structure formed by GB neck tapering, it connects the neck of the GB with the CHD to form the CBD

179
Q

What are the mucosal folds within the cystic duct called?

A

Spiral valves of Heister

180
Q

What is bile produced by in the liver?

A

hepatocytes

181
Q

What is cholecystokinin?

A

the hormone released by the duodenum in response to food, triggers GB to contract and release bile

182
Q

Which artery supplies the GB?

A

cystic artery

183
Q

What drains the GB?

A

a complicated venous plexus, it empties into the liver or portal vein

184
Q

How is the CBD measured?

A

inner wall to inner wall distally (close to pancreatic head)

185
Q

What is a phrygian cap?

A

the fundus folds over the body

186
Q

What is a junctional fold?

A

a fold within the body of the GB

187
Q

What is a Hartman’s pouch?

A

a fold between the neck and body of the GB, sacculation of the neck

188
Q

What are the endocrine functions of the pancreas?

A
  • secretion of hormones (insulin and glucagon)
  • necessary for metabolism of carbs and glucose
189
Q

What produces hormones in the pancreas?

A

Islets of Langerhans

190
Q

What are the exocrine functions of the pancreas?

A
  • production of digestive enzymes from acinar cells
191
Q

What digestive enzymes do acinar cells produce?

A

Trypsin (protein), lipase (fats), amylase (starches)

192
Q

Where is the pancreas located? What position is it in?

A

Retroperitoneal, usually oblique, may assume transverse or horseshoe position

193
Q

What is the shape of the pancreas?

A

can be comma, tadpole, sausage, dumbbell

194
Q

What is the size of the pancreas?

A
  • about 12-15 cm long
  • extends from duodenum to hilum of spleen
  • AP diameter of head 2.5 to 3.5 cm
195
Q

What plane do we look at pancreas in?

A

transverse because it allows you to view it in its elongated position

196
Q

The head of the pancreas is _____ to the IVC

A

anterior

197
Q

The gastroduodenal artery lies ______ to pancreas head, the CBD lies ______

A

anterolateral, posterolateral

198
Q

What is the uncinate process of the pancreas?

A

the neck, connects head and body

199
Q

The uncinate process is ______ to the IVC and _______ to the SMV

A

anterior, posterior

200
Q

The body of the pancreas lies ______ and _______ to the head

A

superior and ventral

201
Q

The pancreas body is _______ to the aorta, SMV, SMA, splenic vein

A

anterior

202
Q

The pancreas body is located between which two vessels

A

splenic artery in front and splenic vein behind

203
Q

The pancreas tail lies within the _____

A

splenic hilum

204
Q

What is the Duct of Wirsung?

A

It is the main pancreatic duct, arises in the pancreas tail and travels through pancreas to open at the Ampulla of Vater

205
Q

What is the Duct of Santorini?

A

It is the accessory duct and only functions when absolutely necessary for ex. blockage in Duct of Wirsung or distal CBD

206
Q

What supplies the pancreas?

A

Branches of the splenic artery, hepatic artery, gastroduodenal artery and superior mesenteric artery

207
Q

What drains the pancreas?

A

The portal splenic confluence:
The splenic vein travels through the pancreas posteriorly, meets with SMV and forms the portal vein

208
Q

In adults, how does the pancreas appear in comparison to the liver?

A

slightly hyperechoic or isoechoic

209
Q

In pediatrics, how does the pancreas appear in comparison to the liver?

A

slightly hypoechoic

210
Q

How does the pancreas appear with increased age?

A
  • decreased size
  • increased echogenicity
211
Q

How does the Duct of Wirsung appear on US?

A

seen in panc body as an echogenic line or anechoic, tubular structure

212
Q

The Duct of Wirsung AP diameter should be

A

< 2 mm, if larger it indicates blockage

213
Q

What is ectopic pancreatic tissue?

A

pancreatic tissue with no vascular or structural connection to true pancreas

214
Q

What is partial duplication of the pancreas tail?

A

Rare, tail may appear enlarged, tail is split so there are two tails right next to each other

215
Q

What kind of organ is the spleen?

A

Lymphatic, largest organ in lymphatic system

216
Q

What part of the spleen is not covered by peritoneum?

A

a small portion near the hilum

217
Q

Where is the spleen located?

A

posterior, left hypochondrium between the stomach fundus and the diaphragm

218
Q

What is the size of the spleen?

A

L: 8-13 cm
H: 3-4 cm
W: 7 cm
150-200 g

219
Q

What is the main function of the spleen?

A

It synthesizes blood proteins
- destroys RBC
- destroys microorganisms

220
Q

How does the spleen contribute to fetal development?

A
  • hematopoiesis
  • erythropoiesis
221
Q

How does the spleen aid in the body’s defense?

A
  • production of lymphocytes
  • production of plasma cells (WBC & antibodies)
222
Q

What are lab indications for spleen US?

A

WBC count
- leukopenia
- leukocytosis
RBC count
- increased/decreased
Hematocrit
- increased/decreased blood oxygenation
Platelet count
- thrombocytosis
- thrombocytopenia

223
Q

What supplies the spleen?

A

The splenic artery enters the hilum of the spleen and divides into 6 smaller arteries

224
Q

What drains the spleen?

A

Splenic vein which is formed by smaller veins within the spleen that merge

225
Q

When the splenic vein exits the hilum it joins with what?

A

The superior mesenteric vein, becoming the portal vein

226
Q

What is the sonographic appearance of the spleen?

A
  • moon shaped
  • homogenous, smooth
  • isoechoic or slightly hyperechoic to liver
  • superior surface: convex, inferior: concave
227
Q

What is it called when the spleen never developed?

A

aplasia

228
Q

What is it called when the spleen is abnormally small?

A

hypoplasia

229
Q

What is wandering spleen?

A

The spleen stops during development and doesn’t move up into left hypochondrium

230
Q

What is accessory spleen? What else is this called?

A
  • Pockets of ectopic splenic tissue that sit under the hilum and near the superior tip of the spleen
  • also called splenules
231
Q

What is the peritoneal cavity made up of?

A
  • ligaments and folds that connect organs to each other and abdominal walls
  • lesser and greater omentum
  • mesenteries
  • ligaments
  • fluid spaces
232
Q

What is peritoneum?

A

Smooth membrane that lines the entire abdominal cavity and the organs contained within the cavity

233
Q

What does parietal peritoneum line?

A

The walls of the cavity

234
Q

What does visceral peritoneum line?

A

The abdominal organs

235
Q

What is the greater sac?

A

The general peritoneal cavity

236
Q

What is the lesser sac?

A

Smaller area formed by spleen and posterior stomach

237
Q

How do the greater and lesser sacs communicate?

A

Through the epiploic foramen, an opening inferior to the liver and duodenum

238
Q

What is the lesser omentum?

A

Double layer of peritoneum extending from the liver to the lesser curvature of the stomach

239
Q

The lesser omentum does what for the stomach?

A

Acts like a sling

240
Q

What is the greater omentum?

A

Apron-like fold of peritoneum that hangs from the greater curvature of the stomach

241
Q

How does the greater omentum lie?

A

Freely over intestines except for the superior portion which is fused with the transverse colon

242
Q

The greater omentum can be compared to

A

A skirt for the intestines, covers small intestines

243
Q

What does the lesser omentum attach?

A

The stomach to the liver

244
Q

What is mesentery?

A

2 layered peritoneal folds which suspend the small bowel and colon to the posterior abdominal and pelvic wall

245
Q

Mesentery is best visualized on ultrasounds when there is

A

the presence of ascites

246
Q

Anterior abdominal wall layers (superficial to deep)

A

skin
fascia
muscle
fascia transversalis
peritoneum

247
Q

What is Camper’s fascia?

A

Fatty superficial layer

248
Q

What is Scarpa’s fascia?

A

Deep fibrous layer

249
Q

Anterior abdominal wall muscles

A
  • rectus abdominus
  • external oblique
  • internal oblique
  • transverse abdominal
250
Q

What are the rectus abdominus muscles? Location, size etc

A
  • extend from xiphoid process to pubic bone
  • midline
  • encased in a sheath that attaches musculature to abdominal cavity
251
Q

Sonographic evaluation of abdominal wall

A

Fatty composition layers: hypoechoic (depending on content)
Musculature: linear striations, hyperechoic (high density structures)

252
Q

Aorta

A

Main vessel that carries blood from heart to rest of body

253
Q

Abdominal aorta

A

Portion of descending aorta that supplies blood to abdomen, pelvis, and lower extremities

254
Q

What are the layers of the aorta?

A

Tunica intima (inner)
Tunica media (mid)
Tunica adventitia (outer)

255
Q

Where is the aorta positioned?

A

Posterior to:
- left lobe
- body of pancreas
- pylorus of stomach
- splenic vein

256
Q

What are the main branches of the aorta?

A

celiac
SMA
renal arteries
IMA

257
Q

Celiac axis

A

First branch off aorta
Sub-branches: left gastric artery, common hepatic artery, splenic artery
Supplies stomach, liver, spleen

258
Q

What does the SMA supply?

A

Duodenum, small intestines, and transverse colon

259
Q

Which renal artery branches off first?

A

Left renal artery branches off aorta first

260
Q

What does the IMA supply?

A

large intestines

261
Q

Where does the aorta bifurcate?

A

at L4

262
Q

What does the aorta bifurcate into?

A

The right and left common iliac arteries which supply the respective legs

263
Q

What does the aorta look like on US? Where is it?

A

blood filled lumen: anechoic
walls: echogenic
long, pulsatile, tubular structure
located anterior and left of the spine
- can use left lobe of liver as landmark

264
Q

What is the normal proximal AP diameter of the aorta?

A

Men: 2.5-2.7 cm
Women: 2.1-2.3 cm

265
Q

What is calcification of a vessel?

A

Accumulation of plaque products along the walls of the artery, resulting from disease, old age, poor dietary habits

266
Q

What is aortic wall dissection?

A

Inner layer of aortic wall tears, caused inner and middle layer to separate

267
Q

What is the IVC?

A

Main vessel that carries blood from the extremities and abdominal/pelvic cavity back to the heart

268
Q

What is the IVC formed by?

A

Union of the common iliac veins

269
Q

What does the IVC look like on US?

A

blood filled lumen: anechoic
walls: thin, collapsible, not as echogenic as aorta walls
phasic: diameter changes, color doppler evaluation

270
Q

When do the kidneys ascend to their abdominal position?

A

12-15 weeks gestation

271
Q

When does urine production begin?

A

When the kidneys ascend to their abdominal position

272
Q

Where are the kidneys located?

A

Retroperitoneal, between L1 and L3, right slightly lower

273
Q

How many nephrons are contained in the renal parenchyma?

A

Over 1 million

274
Q

What does the cortex contain?

A

Convoluted tubules and glomerular capsules

275
Q

What does the medulla contain?

A

renal pyramids containing collecting tubules and loops of Henle

276
Q

What does the renal sinus contain?

A

Calyces, arteries, veins, lymphatics, peripelvis fat and fibrous tissue

277
Q

What is the hilum of the kidney?

A

The concave medial border where vessels and lymphatics enter and exit

278
Q

What are the 3 protective layers of the kidney?

A
  1. true capsule (inner)
  2. perirenal fat
  3. Gerota’s capsule (outer)
279
Q

What is the size of a kidney?

A

L: 9-12 cm
W: 4-5 cm
AP diam: 2.5-3 cm

280
Q

What is the formula for calculating a child’s renal length?

A

6.7 + (0.22 x age in years) = renal length in cm

281
Q

What supplies the kidneys?

A

The renal artery that branches off aorta

282
Q

How do the renal arteries divide?

A
  1. Divid into 4-5 segmental arteries at the hilum
  2. Segmental arteries divide into interlobar arteries
  3. Interlobar arteries travel into cortex and divide into arcuate arteries
  4. Arcuate arteries become interlobular arteries and supply arterioles
283
Q

What drains the kidneys?

A
  • Arterioles communicate with capillaries and transfer blood to venules
  • venules travel via interlobular veins to arcuate veins to interlobar veins
  • interlobar veins join to form main renal vein
  • main renal vein drains into IVC
284
Q

What enters and exits at the hilum?

A
  • Renal vein exits anteriorly
  • Ureter exits posteriorly
  • Renal artery enters between them
285
Q

What are the kidney functions?

A
  • Excretion of metabolic waste
  • Urine production
  • Regulation of acid-base balance
  • Regulation of serum electrolytes
  • Production of erythropoietin
  • Renin-angiotensin system (blood pressure, blood volume, etc)
286
Q

What are indications for renal US?

A
  • flank pain
  • hematuria
  • follow up
  • classification of a mass
  • post-surgical complications
  • interventional guidance
  • post-traumatic injury
287
Q

What is the sonographic appearance of the cortex?

A

homogenous, hypoechoic to liver, hyperechoic to medulla

288
Q

How does the sinus appear on US?

A

most echogenic due to fat content

289
Q

How does the medulla appear on US?

A

anechoic

290
Q

What is the only layer of covering seen on US?

A

True capsule, seen as thin echogenic line

291
Q

How thick should the cortex be?

A

Greater than 1 cm

292
Q

In males the bladder is located _______.
In females, ______

A

Males: superior to prostate
Females: inferior to uterus

293
Q

What is the maximum capacity of the bladder?

A

500 ml

294
Q

What is the typical capacity of the bladder?

A

300-350 ml

295
Q

What is the detrusor muscle?

A

The bladder wall muscle that contracts to expel urine through the urethra

296
Q

What does bladder wall thickening indicate?

A

inflammation, infection, or tumor

297
Q

What is trabeculation of the bladder wall?

A

Hypertrophy of bladder wall muscle due to recurrent urethra obstruction

298
Q

How thick should the bladder wall be if full? If empty?

A

Full: < 3 mm
Empty: < 5 mm

299
Q

What is a normal post-void residual measurement?

A

Less than 50 ml

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