Flashcards Davies Abdomen 8
Baker’s cysts may be caused by ____ or _____
trauma
rheumatoid arthritis
The ______ in a Baker’s cyst is very inflammatory and can cause a great deal of pain
synovial fluid
Complications of Baker’s cysts
infection
venous thrombosis
compression of venous structures causing calf swelling
What is pseudomyxoma peritonei?
relatively rare condition described at the filling of the peritoneal cavity with mucinous material and gelatinous ascites. Result of rupture of a mucinous cystadenocarcinoma of the ovary, appendix, or other sources. Adhesions are present, producing matting and bowel posteriorly in the abdominal cavity.
relatively rare condition described at the filling of the peritoneal cavity with mucinous material and gelatinous ascites. Result of rupture of a mucinous cystadenocarcinoma of the ovary, appendix, or other sources. Adhesions are present, producing matting and bowel posteriorly in the abdominal cavity.
pseudomyxoma peritonei
Most common causes of pseudomyxoma peritonei
rupture of a mucinous cystadenocarcinoma of the appendix
rupture of a mucinous cystadenocarcinoma of the ovary
What is the most common cause of a neonatal adrenal mass?
adrenal hemorrhage
Neonatal adrenal mass that generally occurs during the first week of life, either as an asymptomatic abdominal mass or as a mass in the presence of jaundice and/or anemia
adrenal hemorrhage
Sonographic appearance of adrenal hemorrhage
variable depending on age of hematoma
What does the presence of portal venous gas indicate?
bowel infarction, as seen in ulcerative colitis or necrotizing enterocolitis
What is the sonographic appearance of portal venous gas?
liner echogenic branches in the periphery of the liver. Echogenic foci within the lumen of the portal vein.
Does the sonographic portal venous gas differ from that of biliary gas?
Yes. Portal venous gas is seen within the periphery of the liver, whereas biliary gas is located closer to the liver hilum.
Portal venous gas is seen:
within the periphery of the liver
Biliary gas is seen:
closer to the liver hilum
What is nutcracker syndrome?
compression of the left renal vein between the superior mesenteric artery and the aorta.
compression of the left renal vein between the superior mesenteric artery and the aorta
nutcracker syndrome
Nutcracker syndrome is compression of the _____ between the superior mesenteric artery and the aorta
left renal vein
Nutcracker syndrome is compression of the left renal vein between the _____ and the aorta
superior mesenteric artery
Nutcracker syndrome is compression of the left renal vein between the superior mesenteric artery and the _____
aorta
_____ is evident by the markedly dilated left renal vein as compared to the right renal vein
nutcracker syndrome
Associated symptoms of Nutcracker syndrome
left-sided hematuria
abdominal pain
varicocele formation
possibly infertility
What pathology is described by the terms mantle sign and sandwich sign?
Diffuse lymphadenopathy
_____ of the abdomen will create a layered or mantle appearance around vessels of the abdomen
diffuse lymphadenopathy
Diffuse lymphadenopathy of the abdomen will created a layered or ____ appearance around vessels of the abdomen
mantle
____ is visualized anterior and posterior to vessels of the abdomen, thus creating a sandwich sign
lymphadenopathy
Lymphadenopathy is visualized anterior and posterior to vessels of the abdomen, thus creating a _____ sign
sandwich
What are the symptoms of Grave’s disease?
exophthalmos
palpable lymph nodes
muscle atrophy
localized myxedema
weight loss
tremors
nervousness
characterized as thyroid hyperfunctioning, causing diffuse glandular hyperplasia
Graves’ disease
What is Graves’ disease?
characterized as thyroid hyperfunctioning, causing diffuse glandular hyperplasia
hyperfunctioning thyroid
Graves’ disease
Describe the sonographic features of Graves’ disease
diffusely enlarged and appears identical to multinodular goiter. Color Doppler will show increased vascularity due to hyperfunctioning of the gland.
A 6 year old patient presents with a lateral neck mass. The mass is anterior to the sternocleidomastoid muscle and lateral to the thyroid near the angle of the mandible. The mass is predominantly cystic, with enhanced through-transmission. What is the most likely diagnosis for this mass?
branchial cleft cyst
A ______ arises in the lateral aspect of the neck, common from epithelial remnants of the second branchial cleft.
branchial cleft cyst
A branchial cleft cyst arises in the ____ aspect of the neck, common from epithelial remnants of the second branchial cleft.
lateral
Most common explanation for a cyst in the lateral aspect of the neck.
branchial cleft cyst
A patient presents with hypoglycemia and a hypoechoic mass in the tail of the pancreas. What is the mass in the pancreas?
islet cell tumor/ insulinoma
This tumor, which is usually seen in the body or tail of the pancreas, causes hypersecretions of insulin, which causes hypoglycemia.
islet cell tumor/ insulinoma
Name and describe two cystic masses associated with the pancreas in patients without a history of autosomal dominant (adult) polycystic kidney disease.
pseudocysts
cystadenomas
formed in association with acute or chronic pancreatitis. Encapsulated collections of pancreatic enzymes. predominantly anechoic masses that may or may not contain dependent debris. Commonly displace or invade adjacent structures such as the liver, lesser sac, stomach, left kidney, or spleen
pseudocysts
What is a pseudocyst?
formed in association with acute or chronic pancreatitis. Encapsulated collections of pancreatic enzymes. predominantly anechoic masses that may or may not contain dependent debris. Commonly displace or invade adjacent structures such as the liver, lesser sac, stomach, left kidney, or spleen
rare fluid collections that arise from the epithelium of the pancreatic duct. Primarily cystic, with septations and thick walls.
cystadenomas
Both pseudocysts and cystadenomas are associated with increased levels of _____
serum amylase
Describe the sonographic characteristics of emphysematous cholecystitis.
thickened gallbladder wall. Gas within the wall will produce comet-tail or reverberation artifacts. This may be described as a “ring of air”
thickened gallbladder wall. Gas within the wall will produce comet-tail or reverberation artifacts. This may be described as a “ring of air”
emphysematous cholecystitis
an acute infection of the gallbladder wall. Due to vascular compromise, bacteria produces gas within the wall of the gallbladder
emphysematous cholecystitis
What is emphysematous cholecystitis?
an acute infection of the gallbladder wall. Due to vascular compromise, bacteria produces gas within the wall of the gallbladder
A large percentage of patients with emphysematous cholecystitis are _____
diabetics
Symptoms of emphysematous cholecystitis
right upper quadrant pain
fever
leukocytosis
What two vessels form the main portal vein?
splenic vein
superior mesenteric vein
The ____ and the _____ join at the confluence adjacent to the head of the pancreas to form the main portal vein.
splenic vein
superior mesenteric vein
The splenic vein and superior mesenteric vein join at the confluence adjacent to the _______ to form the main portal vein
head of the pancreas
The splenic vein and superior mesenteric vein join at the confluence adjacent to the head of the pancreas to form the _____
main portal vein
What are two methods of renal artery evaluation?
Direct evaluation- renal artery velocity evaluation
Indirect evaluation- intrarenal waveform evaluation
Name five techniques to access a renal artery stenosis
Main renal artery peak systolic velocity
Renal artery/ aorta velocity ratio (RAR)
Pulsus parvus et tardus
absent early systolic peak
acceleration (intrarenal waveform)
Describe the use of the renal artery to aortic ratio in determining renal artery stenosis
To determine the degree of stenosis in the renal arteries, peak systolic velocities of the main renal arteries are compared with the peak systolic velocity of the aorta
The ratio is computed by dividing the peak systolic velocity of the renal artery by the peak systolic velocity of the aorta
Renal artery to aortic ratios greater than or equal to ____ indicate a hemodynamically significant stenosis
3.5
Define acceleration time
the interval of time from the beginning of systole to the inital peak velocity
the interval of time from the beginning of systole to the initial peak velocity
acceleration time
Define acceleration index
derived by dividing the acceleration slope by the transmitted frequency (MHZ)
derived by dividing the acceleration slope by the transmitted frequency (MHZ)
acceleration index
Describe the use of the acceleration time and acceleration index in determining renal artery stenosis
Changes in the waveform of a segmental artery can be assessed by measuring the acceleration index and acceleration time
Normal segmental artery waveforms have ____ systolic upstrokes
steep
Waveforms ____ to a hemodynamically significant stenosis have a more gradual upstroke and dampened systolic peak
distal
An acceleration time of >___ sec indicates a hemodynamically significant stenosis of 50% or greater
0.1
An acceleration index of <____ kHz/sec/MHZ indicate a hemodynamically significant stenosis of 50% or greater
3.75
Define the term tardus
a prolonged or delayed early systolic acceleration
a prolonged or delayed early systolic acceleration
tardus
Define the term parvus
a decreased amplitude and rounding of the systolic peak
a decreased amplitude and rounding of the systolic peak
parvus
What is the association of the tardus-parvus waveform with renal artery stenosis?
An intrarenal tardus parvus waveform suggests a certain degree of main renal artery stenosis. Also the loss of the normal early systolic peak of the intrarenal waveform is an indication of a hemodynamically significant stenosis of the main renal artery.
Name two clinical symptoms associated with mesenteric ischemia
postprandial intestinal angina
weight loss
What three sonographic factors define mesenteric ischemia?
A peak systolic velocity of the superior mesenteric artery >275 cm/sec correlates with a hemodynamically significant (70%) stenosis
A peak systolic velocity of the celiac axis >200 cm/sec correlates with a hemodynamically significant (70%) stenosis
Patients with intestinal angina are diagnosed with mesenteric ischemia when two of the three arteries that supply the mesentary are occluded or significantly stenosed. These three arteries are the superior mesenteric artery, celiac axis, and inferior mesenteric artery.
Patients with intestinal angina are diagnosed with mesenteric ischemia when two of the three arteries that supply the mesentery are occluded or significantly stenosed. The three arteries are the:
superior mesenteric artery
celiac axis
inferior mesenteric artery
Six causes of gallbladder wall thickening
ascites
cholecystitis
adenomyomatosis
hypoalbuminemia
congestive heart failure
acute hepatitis
Five reasons for an enlarged gallbladder
prolonged fasting
hydrops of the gallbladder (cystic duct obstruction)
choledocholithiasis (CBD obstruction)
Courvoisier gallbladder (pancreatic carcinoma)
Diabetes
Name three causes of jaundice
hepatocellular disease
hemolytic disease
surgical jaundice
What is hepatocellular disease?
destruction of hepatocytes that interfere with the excretion of bilirubin
destruction of hepatocytes that interfere with the excretion of bilirubin
hepatocellular disease
What is hemolytic disease?
occurs when the hepatocytes can not conjugate bilirubin fast enough to keep up with an increase in red blood cell destruction. This creates in indirect or unconjugated bilirubin
occurs when the hepatocytes can not conjugate bilirubin fast enough to keep up with an increase in red blood cell destruction. This creates an increase in indirect or unconjugated bilirubin p
hemolytic disease
What is surgical jaundice?
the mechanical obstruction of the biliary tree causing increases in direct or conjugated bilirubin
the mechanical obstruction of the biliary tree causing increases in direct or conjugated bilirubin
surgical jaundice
areas of further evaluation with a solid testicular mass
periaortic region for lymphadenopathy
areas of further evaluation with a solid renal mass
the inferior vena cava and the renal veins for tumor extension
areas of further evaluation for solid mass filling the gallbladder
the liver for metastatic disease to verify malignant nature of the gallbladder mass
areas of further evaluation for solid pancreatic mass
liver for metastatic disease, biliary tree and pancreatic duct for dilatation, regional lymphadenopathy, and the portal vein and splenic vein for thrombosis
The pancreas is divided into ____ and ____ functions
endocrine
exocrine
What is the endocrine function of the pancreas?
produce insulin
The cells that produce insulin are the _____
islets of Langerhans
The exocrine function of the pancreas is:
produce amylase, lipase, carboxypeptidase, trypsin, and chymotripsin
The cells that produce amylase, lipase, carboxypeptidase, trypsin, and chymotripsin are called:
acinar cells
What is the typical location of a transplanted kidney?
in the right pelvis within the retroperitoneum
Name four fluid collections that may be seen around a transplant kidney
urinoma
lymphocele
hematoma
abscess
What five sonographic findings are indicated of acute renal vein thrombosis?
dilated and echo-filled renal vein
absence of intrarenal venous flow
an enlarged kidney
hypoechoic renal parenchyma
highly resistive renal artery waveform
The _____ is the “C-shaped” portion of bowel that is divided into four part.
duodenum
The ______ is a transversely oriented segment which originates from the pylorus.
first portion of the duodenum
The first portion of the duodenum is a transversely oriented segment which originates from the _____
pylorus
The _____ and the _____ run posterior to the first part of the duodenum.
common bile duct
gastroduodenal artery
The common bile duct and the gastroduodenal artery run _____ to the first part of the duodenum.
posterior
The common bile duct and the gastroduodenal artery run posterior to the ______
first part of the duodenum
