Flashcards Davies Abdomen 8 Flashcards by Billie Harney

Baker’s cysts may be caused by ____ or _____

trauma
rheumatoid arthritis

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The ______ in a Baker’s cyst is very inflammatory and can cause a great deal of pain

synovial fluid

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Complications of Baker’s cysts

infection
venous thrombosis
compression of venous structures causing calf swelling

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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.

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pseudomyxoma peritonei

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Most common causes of pseudomyxoma peritonei

rupture of a mucinous cystadenocarcinoma of the appendix

rupture of a mucinous cystadenocarcinoma of the ovary

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What is the most common cause of a neonatal adrenal mass?

adrenal hemorrhage

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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

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Sonographic appearance of adrenal hemorrhage

variable depending on age of hematoma

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What does the presence of portal venous gas indicate?

bowel infarction, as seen in ulcerative colitis or necrotizing enterocolitis

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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.

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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.

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Portal venous gas is seen:

within the periphery of the liver

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Biliary gas is seen:

closer to the liver hilum

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What is nutcracker syndrome?

compression of the left renal vein between the superior mesenteric artery and the aorta.

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compression of the left renal vein between the superior mesenteric artery and the aorta

nutcracker syndrome

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Nutcracker syndrome is compression of the _____ between the superior mesenteric artery and the aorta

left renal vein

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Nutcracker syndrome is compression of the left renal vein between the _____ and the aorta

superior mesenteric artery

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Nutcracker syndrome is compression of the left renal vein between the superior mesenteric artery and the _____

aorta

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_____ is evident by the markedly dilated left renal vein as compared to the right renal vein

nutcracker syndrome

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Associated symptoms of Nutcracker syndrome

left-sided hematuria
abdominal pain
varicocele formation
possibly infertility

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What pathology is described by the terms mantle sign and sandwich sign?

Diffuse lymphadenopathy

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_____ of the abdomen will create a layered or mantle appearance around vessels of the abdomen

diffuse lymphadenopathy

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Diffuse lymphadenopathy of the abdomen will created a layered or ____ appearance around vessels of the abdomen

mantle

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____ 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?

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"

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)

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

tardus

Define the term parvus

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

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

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