Miscellaneous Flashcards
what is the purpose of angling the CR 15-20 cephald on the ap axial c-spine?
to match the intervertebral disc spaces
what is visualized on the ap axial c-spine?
intervertebral disk spaces & spinous processes
on the lateral c-spine which side is visualized the side closer to the IR or farther from the IR?
side closest to the IR
what is visualized on the lateral c-spine?
zyagopophyseal jts, intervertebral disc spaces, vertebral prominens, superior & inferior articular process
on the AP axial oblique c-spine (RPO/LPO)which side is demonstrated?
side that is farthest from the board, intervertebral foramina & pedicles, intervertebral disc spaces
on the PA axial oblique c-spine (RAO/LPO) which side is demonstrated?
side closest to the board, foramina, pedicles, intervertebral disc spaces
ap t spine what is demonstrated?
intervertebral disk spaces & transverse processes
on the lateral t-spine what is visulazied?
intervertebral disc spaces, intervertebral foramina, side down that is demonstrated closest to the board
for ap l-spine what is demonstrated?
intervertebral disc spaces, intervertebral formamen
on the ap l-spine obliques RPO/LPO positions what is demonstrated?
scottie dogs, at a 30-60 rotation, side closest to the IR the down side
on the PA l-spine obliques LAO,RAO positions what is demonstrated?
jts farthest from the IR the upside
for ap si jts ferguson method what is demonstrated?
the upside, side farthest from the IR
what is the CR for si jts?
3.8cm above pubic symphysis to see the lumbosacral jt
what is the angle for males/females for si joints?
30-males, 35-females
what are the characteristics of the male pelvis?
narrow, deep, heavy, round, narrow inlet
what are the characteristics of a female pelvis?
wide, shallow, light, oval, wider inlet, wider sacrum
the brim forms the?
superior aperture “inlet” or true pelvis
inferior aperature is considered?
outlet
outlet extends from?
tip of coccyx to inferior margin of pubic symphysis between tuberosities in horizontal direction
where is the pelvic cavity located?
between the inlet/outlet
in the upright position the brim of the pelvis forms a what degree angle?
60
the highest point of the pelvis is the?
greater trochanter(most prominent too)
most prominent point is the?
pubic symphysis (can be palpated on the msp)
what type of skull has a 40 degree angled petrous ridges and what are the chracteristics?
doliocephalic, bert, pinhead, narrow side to side with a deep vertex
what type of skull is normal and has petrous ridges angles at 47?
mesocephalic, normal, anterior & medial
what type of skull has petrous ridges angled at 54 and what characteristics?
ernie, stewie, short front to back, wide side to side shallow vertex has increased rotation
what is the purpose of acetabulum (judet views)?
see fractures of the acetabulum
on the internal oblique what is seen?
iliopubic colulm with the affected side up
on the external oblique what is seen?
ilioschial column with the affected side down
for the ap oblique si jts which side is visualized?
upside the one farthest from the IR (hip is elevated 20-30)
for the pa oblique si jts which side is visualized?
the down side closest to the IR
which ap oblique elbow do you see the coronoid process?
medial rotation
what is visulalized on the ap oblique elbow with lateral rotation?
radial tuberosity
for the radial head lateral views which ones show the radial tuberosity facing anteriorly?
when the hand is supinated or in lateral rotation
for the radial head lateral views which ones show the radial tuberosisty facing posteriorly?
hand pronated & internally rotated
for axiolateral projection of the elbow coyle method to see the radial head & capitulum where do you angle?
arm at 90 degrees and the CR us 45 degrees twd the shoulder
for axiolateral projection of the elbow method to see the coronoid process and trochlea what should you do?
arm at 80 degrees and the CR is 45 away from the shoulder
which projection is done for dislocations of the shoulder?
scapular Y
for the shoulder when the arm is in external rotation how are condyles positioned and what is visualized?
condyles are parallel and the greater tuberacle is seen
for the ap shoulder neutral how are the condyles and what is visualized?
45 are the condyles and the greater tuberacle is seen
for internal rotation of the shoulder how are the condyles and what is seen?
perpendicular are the condyles and the lesser tuberacle is seen
anterior dislocation of the humeral head results in a wedge shaped defect called?
hills sach defect
in anterior dislocations subcoracoid of the humeral head where is the humeral head located?
beneath the coracoid process
in posterior dislocations subacrominal of the humeral head where is the humeral head located?
beneath the acromion process
on the oblique foot what is visualized in profile?
sinus tarsi & cuboid
on the lateral foot mediolateral what is seen?
the sinus tarsi & sustentaculim tali
fracture of the 5th metarsal is called?
jones fracture
on the ap ankle which jt is closed?
lateral malleoli
on the mortise which jts are open and shut?
all are open on the mortise
on the ap oblique foot which jts is closed?
the medial malleoli
how can you tell when the lateral knee is rotated to much or too little?
by the adductor tuberacle
for the ap oblique knee with lateral rotation what is seen?
fibula superimposed over the tibia
for the ap oblique knee with medial rotation what is seen?
the tibiofibular articulation space open
which projection is done of the knee to look for joint mice?
camp Coventry pa axial projection of the knee intercondylar fossa
for ap pelvis how much rotation is required for the feet?
15-20 to see the lesser trochanters
another name for the pelvis is?
innominate bone
hip bone consists of?
ilium, pubis, ischium
when the islium, pubis and ischium all join together they form the?
acetabulum
ala has how many borders?
3 anterior, posterior, superior
pubis consists of?
superior ramus, inferior ramus and a body
what does the ischium consist of?
body & ischial ramus
what is the name of the line that the surgeons used to measure the neck of the femur
shuntons line
why are 2 ap projections of the pelvis done for congential dislocation of the hip?
to see the relationship of the femoral head to the acetabulum
why is the 1st projection done?
CR directed perpendicular to the pubic symphysis to detect any lateral or superior displacement of femoral head
2nd projection is done to see?
CR directed at the pubic symphysis at a cephalic angle of 45 degrees to cast a shadow of antierorly displaced femoral head above that of the acetabulum and the shadow of posteriorly displaced head below the acetablum
for the judet external oblique if the patient is in trauma what do should you do?
not lie them on their affected side
on inspiration you see which ribs?
1-10
on expiration which ribs do you see?
8-12
which examination would be used to diagnose bilary and or pancreatic pathology in a patient whole biliary ducts are not dilated and there is no known obstruction at the ampulla?
ERCP
which of the following structures is NOT usually demonstrated on a post operative t-tube cholangiogram?
a. right and left hepatic ducts
b. sphincter of oddi
c. pancreatic duct
d. common bile duct
c. pancreatic duct
which of the following views/projections will demonstrate enlargement of the thymus gland in a child?
PA or AP chest
which view with the esophagus opacified with barium will demonstrate enlargement of the LA of the heart?
RAO
into which artery would contrast be injected in order to demonstrate circulation to the anterior portion of the cerebrum?
internal carotid
how long after the injection of contrast media dose optimal visualization of the internal structures of lymph nodes occur?
24hrs
TLD how does it work?
dose measuring device that gives off light when heated
what is inside a TLD?
lithium fluride crystals that absorb xray energy and when heated give off light
OSL what is inside it?
aluminum oxide
how does a OSL work?
uses a laser and it can measure small doses of radiation and is more precise, can be reanalyzed and has excellent long term stability
how is the male shield placed?
midline with its top margin 1” inferior to pubic symphysis
how is the female shield placed?
inferior margin of female shield is placed at or near the top of pubic symphysis, centered midline halfway between the level of ASIS and pubic symphysis
what does 1GY =?
100rad
1Sv = ?
100rem
what is empathy?
sensitivity to others needs that allows you to still meet those needs constructively rather than merely sympathizing or reacting to a patients distress
conversation of a patient must never?
be held in pubic areas, waiting rooms, elevators
how should you interact with a neonatal patient?
influced by face, voice and touch, try to limit the amt of staff, never leave alone and try to involve the patients
how should you interact with toddlers?
their very attached to the parent, give a favorite blanket, make friends and distract
if the patient is hard of hearing what should you do?
speak more slowly, make sure they see your face, watch your lips and facial expressions, simple instructions
if a hospital translator is unavailable what should you do?
draw or act it out
what is aphasia?
defect or loss of language function
what are the five stages that patients experience?
denial, anger, bargaining, depression, acceptance
when sensitive confidential information is to be sent by fax what should you do?
follow up with a phone call
what is never allowed to leave the hospital?
original documents because they can be photocopied
it is usually recommended that films be sent?
directly to the physician rather than allowing the patient to transport them
what is the most common injuries that radiographers complain about?
shoulder strain & rotator cuff tears
what is proper body mechanics?
having a wide stance with a load held close to the body which allows combined line of gravity to bisect the base of support
the body is most stable when the center of gravity is
near the center of the base of support
you must ________ a heavy object
push or roll
when lifting always remember too?
bend your knees and keep your back straight with the load close to your body
what is the fowlers position?
when the head is higher than the feet like sitting up in bed you can also have semi fowlers
what is the trendelnburg position?
when the feet are higher than the head with table tilted 15 degrees
patients who feel nauseated need too?
have their head elevated to prevent aspiration of emesis, fowlers position or lateral recumbent
if the patient is on the table longer than 10minutes what should you do?
use a full sixe radiolucent pad
what may be the result of the use of restraints unauthorized?
false impriosonment
for safety straps or side rails is authorization needed? (restraints)
no
to move patients from one place to another you should?
use a wheelchair transport
infants and small children should not ______?
be carried to the department
use a __________ for patients that can stand and patients who cannot stand should be transported by ——————?
wheelchair, stretcher
heart attack, stroke victims, surgery patients should always be transferred via?
stretcher
bed transfers required how many people?
2
always check with the nursing staff to obtain the patients chart before transferring but you need to remember to have __-identifiers
2- bracelet for name & birthdate, chart
the person transporting the patient is responsible for?
ensuring that the buckles on safety straps are secure
wheels chairs are the most common cause of?
falls not locking the wheels
what is orthostatic hyporetension?
mild, reaction to oxygen supply to the brain from change in body position
how to do a wheel chair transfer?
- position the wheel chair parallel at patients bed with locks on 2. lower bed & rails 3. lift patient into sitting position, pivot while lifting allowing patients legs to clear the edge of the bed 4. allow patient to rest before standing 5. use face to face assist to help raise weak patient to stand 6. provide support as patient eases into chair 7. cover patients lap and legs (if stroke victim postion yourself on the patients weaker side)
how to perform a 2 person lift?
stronger person is the primary lifter. he stands behind the chair extending his arms through the patients armpits and graps her arms from the top. helper kneels on 1 knee taking the thighs and legs and lift togeehter at the same time. patient must cross arms over their chest (if was a 3 person lift the 3rd person takes the butt)
flexible slider boards should not be used in place of?
rigid backboards for spinal immoblizations
what is the cycle of infection?
pathogenic organism, reservoir of infection, portal of exit, mean of transmission, portal of entry, susceptible host
examples of portal of exit?
body fluids, blood, excretions secretions
what is direct contact?
host is touched by an infected person and that organism is placed indirect contact with susceptible tissue
what is airborne contamination?
dust that contains spores or droplets
examples of airborne infections?
tuberculosis, rubeola, varicella (direct too)
examples of direct contact?
HIV, syphilis, strep throat
how is droplet containmination spread?
mucous membranes
examples of droplet contaminations?
cough, sneeze, flu, pneaumonia, meningitis
what is acquired immunity?
immuinity acquired from vaccines, long term
what is passive immuinity?
breast fed infants so is short term
what are nosocominal infections?
staff, MRSA, VRE, c-diffcile
if accidental needle stick injury occurs what should you do?
allow the wound to bleed under cold water and wash it with soap, rinse mucous membranes with water
what else needs to be done?
blood sample drawn and incident report filed
what is the most effective way to get rid of germs from c difficile?
soap & water
in the operating room nails should be kept less than ?
1/4 inch long
what is the aseptic technique to washing hands?
paper towel to control the taps or use a foot dispenser, wet hands keep hands lower than elbows so the water will drain from clean area (forearms) to the most dirty the fingers. add soap, lather well for 20seconds. friction is more effective than soap,rinse allowing the water to run down the hands. use paper towel to dry finger tips to elbows. turn water off with paper towel
tuberculosis & measeles are examples of?
airborne & droplet 5um or smaller, must wear N95 masks
what is the room like for airborne or droplet precautions?
more than 6 air exchanges per hour with negative airflow and doors must always remain closed
examples of droplet precautions are?
diphtheria, pneumonia, influenza
for MRSA & VRE what must you do?
gown & gloves because it spreads by direct contact
airborne diseases are?
chicken pox, SARS, herpes
previously infected workers of chcken pox need not wear?
masks and ppl who had it should avoid the patients
isolation patient rules?
dirty tech positions the patient and the clean tech handles the equipment and anything the patient has not touched
reverse isolation?
trying to protect the patient because their immune system is compromised. equipment cleaned before the patient enters the room, hand hygiene before touching the patient, clean tech only touches the patient,, bed, covered IR and clean sterile iterms, the dirty tech touches only the equipment
what is medical asepsis?
reducing the number of pathogenic microrganisms
what is surgical asepsis?
complete destruction of all organisms
how to prepare for a patient in isolation?
lead apron, don cap making sure hair is all covered, don mask, put on gown, fasten gown securely, don gloves
how to remove isolation attire?
unfasten waist tie, grasp 1st glove from outside and pull off, insert clean fingers inside the cuff of the 2nd glove and remove it, hand hygiene, remove mask by the ties and discard, remove gown folding contaminated surface inward, discard, hand hygiene. clean equipment
pkgs are sterile if?
clean dry, unopened, expiration date is not exceeded, they changed color
always open packages ….
away from you
always read the label?
3x
when the radiographer must manipulate items in a sterile field sterile transfer of forceps are done how?
unwrap, grasp handles without touching the rest. keep forceps above the waist and in sight. after use place the tips in a sterile field with handles protruding so you use them again
never what across a sterile field?
reach
to prepare an area of the skin what should you do?
circle 12” in diameter with the puncture site in the center
you should not scrub or assist with sterile procedures if?
you are not well, upper respiratory infection, wounds or hangnails
extent of the scrub is determined by ?
timing of the steps or counting brush strokes
the number of strokes for nails is?
30
how many strokes to the skin?
20
use ————-friction and it takes ———–minutes
light, 5
keep your hand above ?
elbows while scrubbing
what are the 2 methods of gloving?
open / closed
how do you open a sterile package?
check expiration date first
how to establish a sterile field?
open the 1st corner away from you, open 1 side by grasping the corner tip, open the 2nd in the same way, pull the remaining corner toward you, do the inner 1 the same way
how do you avoid contaimination in a sterile field?
holding the corners of the outer wrap while dropping items onto the tray
peel down wrapper items are————to a sterile field?
added
how do you add liquid to a sterile field?
check the label, cleanse the lip of the container with a small amt of liquid in to the waster container, pour the required amt in taking care not to contaminate the sterile field
what are some rules to remember when in a sterile field?
any object touched by someone unsterile is not sterile anymore, throw it out if you suspect its contaiminated, do not pass between the physician and the sterile field, never leave a sterile field unattended, there is a 1” border at the perimeter of the sterile field considered the buffer zone and is treated like it is contaiminated
explain the sterile scrub procedure
don cap, mask & goggles, use foot lever to adjust water and wash hands above the elbows , wet the hands and forearms avoid splashing clothes. add soap and water to lather. wash. use brush to scrub nails and hands 1minute each and discard the brush. under the running water clean under fingernails with fingernail cleaner. rinse hands & forearms. with the second brush and soap scrub finger nails for 30 strokes, 20 strokes for each skin area, and all sides of the fingers webs etc and add water lather. use circular motion with brush to scrub all sides of forearms and elbows. 20 strokes for each area. keep hands above the elbows. dry with a towel starting with the fingers
how to sterile gown with a closed gloving technique
lift folded gown, step back from the table, allow the gown to unfold with the inside toward you. insert arms into the sleeves. do not allow hands to protrude through the cuffs. with dominant hand inside the sleeve pick up the glove for the non dominant hand. insert non dominant hand into glove,stretch the cuff of the glove over the gown, with non dominant hand pick up 2nd glove insert fingers of dominant hand into open glove. stretch the cuff over the glove separate waist tie from the gown, pass protective tab to assistant then turn in a circle to wrap the tie around your waist. sharp tug on tie will separate it from the contaiminated tab so you can tie it
how to do a open gloving technique?
hand hygiene, check size of gloves, open outer wrap to expose the inner wrap, expose gloves will open ends facing toward you, put on 1st glove only touching the inner surface of the folded cuff, using the gloved hand grasp the second glove under the cuff and put on the second glove and unfold the cuff. insert finger under cuff of 1st glove and unfold the cuff. keep hands infront of the body at a safe distance to avoid contaimination
of the 2 gloving techniques which is the one radiographers would use more often?
open gloved technique
when a female patient is placed on the bed pan what needs to be done?
the upper torso needs to be slightly elevated to prevent urine from running up her back
the most common type of catheter is?
foley
how should you hold urine bags?
below the level of the patients bladder to prevent urine in the tube from being siphoned back into the bladder causing bacteria to enter the bladder
when you add history to a requisition what should you do?
sign and date the addition unless your identification and the are added automatically when the document is scanned into the computer
you must report a complete hx of what to the radioliogist before contrast media is given
allergies
what is a diaphoretic patient?
cold sweat
cyanotic means?
bluish color lack of oxygen
what is a petit mal?
seizure disorder without convulsions that can cause a brief loss of consciousness without warning
what are the 4 levels of consciousness?
alert & conscious, drowsy but responsive, unconscious but reactive to pain, comatose
what does orthopnea mean?
inability to breathe while recumebent may be relieved in a fowlers position and if not there is a change in the patients status
what are vital signs?
temperature, pulse rate, respiratory rate and blood pressure
what is a normal body temperature?
36-38C
what is another word for fever?
pyrexia
temperatures can be taken where?
oral, rectal, axiallary, tympanic, temporal artery
the oral temp route provides?
accurate measure of changes in body core temerpurature but not appropiriate if the pt just had something cold or hot or cardiac condictions because it stimulates the vagus nerve
rectal temperature is?
accurate and faster
axiallry temperature is?
slower and less accurate but is more preferred
for children how should you get their temperature?
tympanic or termporal artery
hospitals prefer which way for children under 6?
axiallary, tympanic or temporal artery
never leave a patient alone when”?
taking a rectal temperature
disposable thermoeters are primary used for?
children
what is a pulse?
advancing pressure wave in an artery caused by expulsion of blood when the LV of the heart contracts
patient comes into the ER with a heart rate greater than 100BPM what is this?
tachycardia
what is a thread pulse?
weak the heart is not pumping enough blood
where is the most common site for palpation of the pulse?
radial artery at the base of the thumb
if the radial pulse is weak are hard to find what should you use?
carotid pulse
if the pulse is slow or irregular you may want to take a ?
apical pulse
what are the normal respirations for an adult?
12-20 breathes per min
what is braypnea?
slow breathing with fewer than 12 breathes per min
rapid breathing in excess of 20 breathes per min called?
tachypnea
patients who are in shock with significant blood loss are?
increased pulse rate and rapid with shallow breathes
hypertension is more common in?
men before the age of 50 and women after 50
what is hypertension?
abnomally high blood pressure that accounts for kidney disease
what is hypotension?
ABNORMALLY LOW BLOOD PRESSURE (shock) diastolic pressure of 50 and systolic pressure of 90
the top number of blood pressure is?
systolic that measures the pumping action of the heart muscle
what is the bottom number?
diastolic that indicates the arterial system of blood forced into the heart
what is a normal blood pressure?
120/80
normal systolic pressure is?
95-119mm
normal diastolic pressure is?
60-79mm HG
what does 119/79 blood pressure indicate?
prehypertension increased risk for a heart attack or stroke
hypotension is confirmed when?
20% below the patients normal baseline
what is a abnormally high BUN called?
azotemia which indicates impaired renal function
what is a pulse oximeter?
measures pulse rate and oxygen levels (placed on toe, finger or earlobe)
what is the purpose of it? (pulse oximeter)
to observe patients on sedatives that have suppress respirations or measure and record oxygen saturation levels in conjuction with vital signs
normal pulse oximeter levels are?
95-100% below below means tissues are not receiving enough oxygen
what is a heart rate below 60BPM called?
bradycardia (seen in athethles with large cardiac output)
ventricular fibrillation is the most common cause of?
sudden death
if the patient has no pulse CPR is started with a shock of he defribllator and then what is given?
1ml epinephrine to allow more oxygenated blood to reach the heart
ventricular tachycardia heart rate can be high as?
150-250BPM but the cardiac output is slow, patient can become unresponsive, lose consciousness and become hypotensive and need to be defribllated
what is atrial fribrillation?
continuous irregular heart reentry of electrical impulses back into the atria
atrial fibrillation in a young patient is caused by?
rhematic mitral valve disease but more common in older patients
if patient sufferes from mitral stenosis or left ventricular disease what results?
cardiogenic shock, acute pulmonary edema (need to slow ventricular contraction and increase cardiac output
IV infusions are delivered?
at regular intervals, into the vein slow at a constant rate
any verbal orders given need to be?
signed by the physician before leaving
what is a standing order?
written directions on a specific medication or procedure signed by the physician under specific condictions. the name and amt of drub, time given and patient condictions on there too
what is a cathartic?
strong laxative
a drugs proprietary name is
how it is first developed and marketed
what is pharmacokinetics?
the way a drug is absorbed
metablized?
how it is physically and chemically changed and the drug becomes chemically inactve
what are the 4 ways a drug goes thru the body?
absorption, distribution, metabolism & excretion
what is pharmacodymanics?
study of the drug on normal physiological functions most common mechanism of drug action
what is the therapeutic effect
action of drug on specific receptor cells
what is an antagonist?
drug that attaches itself to the receptor preventing the agonist from acting
what is an antidote?
a specific drug that treats toxic effect
what is a idiosyncractic reaction?
when a patient over reacts or under reacts to a drug
what is phenobarbital used for?
to sedate a patient
opiates may?
slow respiratory rate
what do vasodilators do?
cause blood pressure to drop
adverse side effects are?
not normal (mild nausea, flushing, diarrehea) severe would be cardiac arrest, hives, respiratory distress
what is a synergistic affect?
effect that goes far beyond the desired outcome
diphenhydramine (Benadryl) is given for?
antihistamine with sedative effects
how much should an adult receive?
20-50mg orally
how much for children weighing more than 20pds?
12.5-25mg orally
if the patient has a allergic reaction how should Benadryl be given
intramuscular or intravenous adult 10-50mg and increased to 100mg is the max dose in 24hrs
for patients with acute allergic reactions what should be given?
epinephrine (adrelaine) subcutaneously, IM or IV because it stimulates the heart and nevous system
give epinephrine for?
angioedema shock or respiratory distaress 0.2-1 ml for 1:1000
if patient does not respoind then give
methyprednisolone
if a seizure is prolonged admister?
IV diazepam (valium) 5-10mg and repeat every 15-30min up to 30mg
ventricular and atrial arrhythmias are treated with?
lidocaine, amiodarone, quinidine IV infusion
analgesics do what?
relieve pain without causing loss of consciousness ex” codeine, demoral, morphine,
fentanyl a high potent opioid is given to patients with?
sensitive to other analgesics and not resoponding to other pain meds
what are some sedatives / tranquilizers?
lorazepam, valium, diazepam, phenobarbital (seizures too)
valium you need to avoid?
small veins of hand wrist because it can irate and damage causing phlebitis
what is a local anesthetics?
xylocaine, lithocaine
hypoglycemic agents control?
level of glucose in the blood like glucopahge, metformin. type 1 treated with insulin and type 2 treated orally with one of those
what are the 6 rights of medication administration?
dose, medication, patient, time, route, documentation
to convert a child weight fro pounds to kilograms how to you do it?
divide the pds by 2.2 ex: lbs / kg = answer
1ml is equal too?
1cc
1 oz is equal to?
30ml
liquid agents are often?
diluted 1st
enteral route is?
oral or rectal
rectal route can expel premature making the dose unreliable
nasogatric tube is most effective because
most reliable dose is easily controlled
what is first pass effect?
dimishes the drugs therapeutic effect
when the patient has angina pectoris what should you give?
nitroglycerin
drugs under the tongue are?
sublingual
drugs inside the cheek are ?
buccal and absorbed in the blood
parenteral route drugs are given?
firectly into the body and by pass the GI tract
intrathecal is?
in the spinal canal
gauge of the needle indicates?
diameter
gauge increases as the diameter?
decreases
usual gauge range for adults is
18-22
intramuscular, subcutaneous and intradermal are given at what angles?
90, 45, 15
glass syringes are not?
disposable and are sterilized before each use
IV administration is done by?
IV route because gives immediate effects
subcutenous injections are given
under the skin with a 23-25 gauge needle in large quantity under the skin
intramuscular is given into
the muscle in larger amts up to 5ml with a 22 gauge needle
read the label of a drug 3x before
administration, when selecting and while preparing the dose and just before the injection
what is an ampule?
glass containers with narrow neck that neck to be broken before admistered
what must you keep in mind for a vial?
inject volume of air equal to the amount of fluid that you wish to remove
the IV route in the most common route for?
rapid medication administration (ER patients)
venipuncture is done with?
hypodermic needle, butterfly set, or IV catheter
always fill the tubing with liquid from the needle to avoid?
injecting air into the vein
iv catheters are frequently used instead of butterfly sets when
iv injections are repeated or continuous infusions are administered
what is a intermittent injection port?
saline lock
what is infiltration?
leakage around surrounding tissue in the the antecubital vein rupturing the vein
to start an iv the vein most often used is found in
anterior forearm, posterior hand, radial aspect of wrist andtecubital space
antecubital veins are
a last resort
you need a good size vein for a
bolus injection (rapid) children need a antecubital site
for patients that have had a mastectomy you should select a vein
on the opposite side of the mastectomy because they often suffer from lymphedema causing boggy tissue and obstruct the vein
obese patient have veins that are
deep
elderly patient have veins that are
easy to see but roll or are crooked
what is extravastion
rupture of the vein or passage of fluid through intact vessel walls aka infiltration
when infiltration occurs what should you do
pressure till the vein stops bleeding, use a cold pack to cause constriction of the blood vessels , only use hot packs to increase the viscosity
most patient tolerate how many drops per minute with iv?
15-20, 60ml per hour
if to fast patients with COPD or CHF will
get more fluid causing fluid to accumulate in the lungs (pulmonary edema)
iv bottle and bag should be hung at
18-20 above the level of the vein
if the iv solution is too high it causes
hydrostatic pressure because of increased infiltration
what images should be taken on trauma patients?
chest, pelvis, lateral cspine
if 2 patients need to be done at the same time in an emergency what should you do?
determine which patients status is more urgent
when patients are of equal urgency what should you do?
do the patient that has the shortest amt of time
if a patient is experiencing shortness of breathe, rapid heart rate and acute anxiety should be given
low flow rate of oxygen
what is a nasal cannula?
the simplest most frequent form for longer term oxygen
nasal cannula oxygen is delivered at
1-6L and 24-45% warmed and humified
oxygen mask
short term 6-10l/min 40-60% oxygen
non rebreathing mask
valve to prevent exhaled gas from being inhaled again 100% o2 reservoir bag attached
partial rebreathing mask
some air can enter the reservoir abg 40-70% concentrations
venture mask delivers
controlled rate24-60% for patients with COPD
what is the normal oxygen flow rate for normal patients
2-5L/min
severely compromised patients the oxygen flow rate is
10l/min
patient with COPD should have
venture mask and giver oxygen at a slower rate less than 3L/min
if a cough does not clear the airway then
suction is needed
never insert your fingers
into the mouth of conscious patient
for an asthma attack you should
given o2 saturation at 92% with a nebulizer and subcutaneneous injections of epinephrine
patient that has had an MI
admister oxygen at 2-4l/min for shortness of breathe and raise the ehead
brain damage that is irrepairable happens in
3-5min
treatment of hemothroax or pneumothorax is
surgical opening a thoracotomy into the visceral pleura
thoracenteiss
removes fluid
multiple rib fracture may cause
flail chest
what is a cardiac tamponade
blow to the chest causing brusing and bleeding
never remove a splint unless
physican approves it
what is evisceration
loss of organs from the body
dehiscence
when a surgical line parts (place patient in recumbent or semirecumbent)
burns are associated with
respiratory complications pleural effusion or pneaumonia
when a burn victim requires a xray be sure to give pain meds
30min before
what is shock
failure of circulation in which blood pressure is adequate to tissue
what are early signs of shock
pallor, increased heart rate, repsirations and restlessness with confusions
what is hypovolemic shock
large amt of blood is lost from burns, laceations dehydration, vomiting
how to treatment hypovolemic shock
fluid replacement oxygen and meds for vasocontristion
what is septic shock
massive infection and blood pressure drops suddenly
what is neurogenic shock
failure of arterial resistance causing pooling of blood in peripheral vessels monitor head and spinal patients for this
what is cardiogenic failure
interference with heart function can be initated by PE or reaction from anesthesia
what is allergic shock or anaphylaxis
exposed to a foreign substance , server dyspnea, edema
if a patient is expericeing shock what position should they be put in
dorsal recumbent, trendelburg
syncope is a
mild form of shock , place patient in dorsal recumbent elevating the feet
patient who feels faint should
sit or be in recumbent position
there is a greater risk of reaction to a iv admistration than a
arterial injection
people with asthma are 3x more likely
to suffer from adverse reactions
serious allergic reactions happen within
the first 30 min
if the patient has a vasovagal reaciton
palce with feet elevated 20 degrees and head elevated 10
severe allergic reaction is called
anaphylaxis give epinephrine
diabetic coma is likely to occur
with type 1 diabetes
if a patient is having symptoms of stroke
recumbent position with head elevated
if patient has a seizure assist to
supine position treat with diazepam or lorazepam
as the seizure passes turn patient to
lateral recumbent positon
anoxia is
lack of oxygen
how to treat epistaxis
breathe through mouth, squeeze firmly against nasal septum for 10min and patient should not lie down blow nose or talk
if patient is nauseous
lateral recumbent position to avoid aspiration
barium studies are always scheduled?
last
barium as a contrast media are always done
first
patients has gastroscopy should have
NPO 12hrs preceding exam
oral administration to a patient that is sedated increases risk of
that a patient may aspirate barium
when sequencing diagnostic procedures
thyroid scan are done before iodine contrast because contrast can cause inaccurate thyroid tests for 3wks
emergency patients always have
priority, then pediatric, geriatric. but diabetic have priority
need to clease the bowel for
barium enema or lower GI studies
low residue diet for
several days preceeding exam
need to be on a clear liquid diet of
consumme, apple juice, tea avoid milk
NPO 8-12hrs
before the exam
examples of cathratics are
bulk, lubricant, emollient, saline (ducolax)
drink at least 8oz of water or clear liquid 2 hours between noon and midnight
the day preceeding the exam
suspository is placed in
2-3” into the rectum superior and anterior need to retain 30min before evacuation
liquid used for cleaning enema is
tap water, or soapsuds,saline solution or olive oil, glycerin in water
fill tap water up to
1000ml of tepid water add 30ml of castile soap
place the patient in the
sim positions left anterior oblqiue
hang the enema bag
18” above the level of anus
if the bag is hung to high they get
abd cramping and cause harm like diverticulitis or ulcerative colitis
tip is inserted
superior and anterior into rectum at 2-4”
it takes 200ml to fill the
sigmoid colon
black tarry blood indicates
upper GI tract
fresh red blood indicates
hemmorhoids
sodium phosphate enema (fleet) is
disposable enema that has salt and is highly efficient at evacualte
barium sulfate is
inert, thick suspension
esophagus requires a
thick mixture of barium abd barium enemas need a thin one
hydroscopic means
barium tends to absorb water
air absorbs
less radaition
barium coats the lining while the air
fills the lumen to see
glucagon prevents
cramping and is also given to treat hypoglycemia
most common side effects of glucopahge are
nausea and vominting from 2mg
enema bag for barium enema is hung
60cm above level of anus
hypervolemia is
excessive fluid absorption during a BE
for a ESND prep
NPO 8hrs before no smoking, gun
when the barium in the stomach does not empty then
place the patient in the RAO
small bowel series
drink barium and take pic after 15min, then after 30min, ice water, coffee or tea help move it down faster
for a enteroclysis once contrast has reached the cecum
air is instilled or methlycellulose
iodine components absorb radiation in
a greater degree than blood or soft tissue
most iodinated contrast agetns are
aqueous and only suitable for intravascular injections
molecules that dissociate
ionic
molecules that remain in whole for the solution are
non ionic
viscosity is reduced by
warming to body temp before injection
nonionic cm is
equal to blood & less toxic
visipaque is often the contrast of choice when
patients are experiencing mild to moderate renal sufficiency because less toxic to kidneys
normal BUN levels
6-20mg (no lower)
creatine levels
0.6-1.5 and no higher (2.0)
for diabetic patients metformin must be withheld
day of exam and 48hrs after
can have a serious allergic reaction to just
1ml of contrast media
IVU, IVP are done to
see the urinary system
when a cystogram is ordered
patient is usually sent to radiology with a rentention catheter in place
cystogram is a
sterile procedure
cystogram is done to
see the bladder, done by filling retrogradepre
prep for oral cholecystogram is
fat in diet day before and withheld day of
pictures are taken
20-30min after a fatty meal
PTC uses
a thin needle and placing the tip of a neddle in the patients right side through the liver directly into the common bile duct
complications of PTC
leakage of bile into peritoneal cavity, hemmorahgae, pneumothorax or sepis
cholecystomy is
removal of gallbladder
crossbars of T extend into
hepatic and common bile ducts
base of the t bar in
cystic duct
purpose of T-tube to detect
calculi, patency of ducts
ERCP done to
examine common bile duct, tube into throat into duodenum
stone basket can remove
bilary calcuili
PACU is referred to as
postanesthesia recovery
patient with head injured is in what position
semi erect to minimize intracranial pressure
new trachesotomies are monitored in ICU and require
frequent suctioning to keep free of secretions
tape is used to
hold trachesotmy in placre
nasogastric tubes placed into the stomach have several purposed
feeding, decompression and
most common NG for decompression
Levin (single)and salem sump (double)
common NG feeding tube is
dobbhoff
some types of NE tubes are
miller (double lumen)abbott, harris, cantor
naso enerteric tubes are placed
in the stomach and peristalisis advances them into the SI
types of CVC
hickman, groshong, raaf, port a cath, picc
swan ganz measure
cardiac output, right heart pressure and indirect left pressure
swan ganz is inserted into
subclavian, internal or external jugular, femoral vein and advanced into RA, inflate ballon and it floats In the pulomonary artery
purpose of CVC
chem, long term therapy, total parenteral nutrition, dialysis, blood transfusions
cvc the distal tip rests in
the vena cava in the RA
CVC are classified as
short/long term non tunnedled, short/long term external catheters
short term non tunneled are in the
neck, shoulder, groin or antecubital fossa with the tip in the SVC
picc
used for short term or long
CVC
inserted into a vein in patients arm neck, shoulder or groin to the vena cava and are short term
long term tunneled are external catheters placed
directly beneath the skin
examples of tunneled CVC
hickman, groshong, raaf to the SVC
hickman is used for
long term parenteral nutrition
groshong is used for
medication adjusted with 2 lumens
raaf is used for
dialysis with a double lumen
non sterile clothes are
mask, shirt and pants, hat, shoe covers
sterile members
surgeon, assistant to surgeon, scrub person (nurse)
non sterile members
anesthesiologist, circulating nurse, radiographer
if you need to walk near the surgeon dressed in sterile attire
pass behind them rather than infront to prevent contamination
for abd surgery and open reduction lower extremities
head end of the table is not sterile
how to treat angioplasty
by athersclerosisal
what are inflammatory disorders
croup & epiglottis
croup is
viral infection of young children, inflammation of subglottic potion, bark cough, stridor, smooth tapered hour glass seen
inflammation of epiglottic pharyngeal structures caused by haemophilus influenza that is life threating is
epiglottis need a soft tissue lateral neck to see, these children tripod
air in the pleural cavity that results in small partial or complete collapse of lung is
pneumothroax
what causes a pnemothroax
traumatic rupture of subpleaural bulla which can be spontenous or secondary from a lung disease, istrogenic from chest tube, hyaline membrane disease or prolonged ventilation
what does it look like
hyperlucent area of lungs, no lung markings and visceral line can be seen
what happens with a tension pneumothorax
deviation of the trachea away from the side of tension, shift of mediastinum and depressed hemi diaphargm
fluid collection in the pleural cavity is
pleural effusion
causes of pleural effusion
secondary to primary disease, or abdominal diseases, CHF, neoplasms, PE, ascites, surgery, pancreatitis
what does a pleural effusion look like
blunt costophrenic angles, homogenous upward concave border of fluid
what do you need to do for a pleural effusion
upright chest or good decubitis with the patient lying on the affected side besure to treat the underlying cause
what is a hemothroax
blood in the pleural space from trauma
infected pleural fluid is the result of bacterial pneumonia, lung absess or trauma surgery is
empyema need lab work to tell the difference
abnormal accumulation of fluid in the extravascular tissues is
pulmonary edema
what is the most common cause of pulmonary edema
pulmonary venous pressure from left sided heart failure
what are other causes of pulmonary edema
cardiac & non cardiac
what does it look like
transudation of fluid in interstitial space of lungs, peripheral haze from fluid loss, thin horizontal lines of increased density, cardiomegaly can be sign but if not cardiac heart size is normal
what is a benign granuloma or neoplasm that can be anywhere in the lungs
pulmonary nodule
what is the appearance if malignant
irregular and smooth if benign
RA of pulmonary nodule
popcorn calcification seen best on CT
who is at risk for these
patients age older than 30
a neoplasm arising from the mucous glands & ducts that is a low grade malignancy that grows and spreads slower than lung cancer
bronchial adenoma
where do bronchial adenoma occur
80% in the major/segmental bronchi and obstruction, can cause atelectasis, 20% are peripheral
what is the most common primary carcinoma of the lung
bronchogenic carcinoma (looks like ill defined solitary mass in chest
where does bronchogenic carcinoma arise
in the muscosal lining of bronchi could be caused from smoking, pollution, fumes
80% of cancers are
small cell lung cancers fast growing
3 type of small cell lung cancers are
squamous, adenocarcinoma, bronchiolar
20% of lung cancers are
small cell oat cell
secondary tumors caused from seeding, heamtogenous or lymphatic spread
pulmonary metastases
what does pulmonary metastases look like
multiple well circumscribed through out lungs
what are some types of mediastinal masses?
thymomas, lymphoma, thyroid mass, lipomas
mediastinal masses are usually
asymptomatic are detected on chest zrays . if large patient will have cough, dyspnea and pain
what are the 3 most common pneumoconiosis?
silicosis, asbestosis, anthracosis
inhalation of silicon dioxide, common in minors or sandblasters is
silicosis
what happens in silicosis?
fibrotic lung tissue with multiple well defined nodules scattered
occurs in manufactors that work with asbestos
asbestosis
what happens with asbestosis
extensive fibrotic reaction in lungs, with the pleural lining and thick linear plaques , shaggy heart
what is a complication of asbestosis
mesothelioma a tumor in the pleural lining
what is coal workers black lung?
anthracosis
what causes it
inhalation of coal dust that causes multiple well defined nodules and when advanced shows progressive fibrosis
what is elevation of 1 or both hemi diapharms caused by interference of the phrenic nerve?
diaphragmatic paralysis
what does diaphragmatic paralysis look like
paradoxical movement seen on fluro. on expiration normal hemi diapharm rises and the paralyzed one descends due to abdomen pressure
a congential abnormalitiy where there is complete muscularization of a hemidiapharm
eventration
what does it look like
localized buldging or elevation of that portion of diapharm with little movement
what are the 4 COPD diseases
chronic bronchitis, emphysema, asthma, bronchiectasis
chronic inflammation of the bronchi leading to excessive mucus with productive cough
chronic bronchitis
what causes chronic bronchitis
smoking 90%, infection or pollutants
what does it look like?
increase in bronchial markings, dirty chest, peribronchial inflammation, tram lines of thickened bronchi which can lead to emphysema
destruction of the alveoli leading to increase volume of air trapped in the lungs
emphysema
what does it look like
hyperinflation of the lungs leading to depressed diapharms, hypoemia, CHF,bullae leading to a pneumothorax or atelectasis. barrel chest
narrowing of the airways from inflammation of allergic response (extrinsic) or other irritants heat, cold, exercise (intrinsic)
asthma
what are complications from asthma
increase mucus , patient may wheeze, you see hyperlucent lungs with depressed diapharms or a dirty chest
weaking of the walls of bronchus from chronic inflammation of bacterial or viral infections permeanently dilating the walls
bronchiectasis
what is a common complication of bronchiectasis
bronchitis
what does it look like/complications
dilated bronchi, fibrosis, reoccurring pneumonia leading to honey comb pattern, need to remove secretions
hereditary disorder with excdessive secretions which blocks the lungs leading to infection of atelectasis
cystic fibrosis
chronic cystic fibrosis leads to what by age 10
bronchiectaisis
what is seen on cystic fibrosis
thickening of lung parenchyma, hyperinflation
idiopathic respiratory distress syndrome in premature infants from diabetic mothers or c sections
hyaline membrane disease
what are complications of hyaline membrane disease
lack surfactant that keeps the alveoli open, underaeriated lungs, decrease gas exchange see air bronchograms, atelectasis
inflammation of the lungs from bacterial, viral or fungal infection
pneumonia
3 patterns of pneumonia
alveolar, bronchopneumonia, interstitial
what is alveolar pneumonia
homogenous consolidation of fluid that replaces normall filled air alveoli, can see air bronchograms
what is bronchopneumonia
staphylococcal infection, in the bronchi that spreads to alveoli, small patches of consolidation no air bronchograms, can lead to atelectasis
what is interstitial pneumonia
viral, mycoplasmal infection that produces inflammation in walls and lining of alveoli produces mesh like shadows in linear or recticular opacities can lead to honey comb lung, shaggy heart
necrotic area of tissue containing pus from secondary conditions
lung abscess patients get fever, cough, smelly sputum, encapsulated mass with air fluid level
most common cause of lung abscess is
aspiration
spread of droplets in air from infected patient caused by mucobactrium tuberculosis
tuberculosis
primary lung tissue and can spread to
gi, urinary, skeletal
4 patterns of tuberculosis
lobar- well defined apical, enlarged hilar nodes, ghon lesion, pleural effusion
large numbers of bacteria spread through out blood stream displays discrete nodules in the lungs with a dry cough
military tiberculosis
affects children under 2 and is a viral infection that causes necrosis of respiratory epithelium and leads to bronchiolitis
RSV
complications of RSV
necrotic tissue and edema cause obstruction, flu cold symptoms hyperinflation with increase in interstitial markings
spread by direct droplet contact,non productive cough , fever, chills, hypoxia aka coronavirus
SARS
what is seen on SARS
infiltrates with areas consoldiation
pulmonary infections, attachs of jiroveci pneumonia
AIDS
what does it look like
hazy granular peripheral infiltratesd, air bronchograms
a clot from lower limbs from venous stasis (thrombus)
pulmonary embolism
complications from this
partial or complete obstruction of circulation, clot in lower lobes of lungs,
what does it look like
filling defect , enlarged vessels, treat with IVC filter or thrombolitics
abnormal communication between the pulmonary artery and vein
pulmonary arteriovenous fistula
what is it
when blood cannot be oxygenated enough and results in hypoxemia & cyanosis round soft tissue mass in lower lobes
a partial or complete collapse of lung from dimished air
atelectasis
what is it caused from
FB, secondary condiction, trauma, neoplasm, excessive mucous
what does it look like
localized increase in density from decreased aeration looks like streaks or plates, displacement of lobar fissuers
lung completely breaking down leading to a massive leak of cells into the interstitial space (Pulmonary edema), unexpected and is life threating
adults respiratory distress
causes of ARDS
trauma, shock, aspiration, infection
what does ARDS look like
patchy consolidation of air spaces throughout lungs but the heart remains normal need diuretics to treat
causes of non cardiogenic pulmonary edema
ARDS, aspiration, burns, drugs, drowning, trauma, pancreatitis, sepis, hypotension
aspiration of solid FB into bronchial tree usually the right
intrabronchial FB
partial obstruction causes
HYPERAEORATION and shift of heart and mediastiunum
complete obstruction causes
no air can get beyond obstruction causing the lobe to collapse with shift of heart and mediastinum to the affected side with elevation of ipsilateral hemidiapharm
what is pneumomediastinum
air in mediastinum from coughing vomiting or straining, chest trauma or perforation of esophagus
what does it look like
air displaced the mediastinal pleura making a linear opaque line along heart border
air into the tissues under the skin in the chest wall or neck
subcutaneous emphysema
how is it seen as
smooth bulging of skin when it is palpated which is the gas pushing up
what causes it
pneumothorax from rib fracture, ruptured esophagus or bronchial tube, trauma vomiting, gun shot, stabbing
type of stap bacteria that does not respond to the antibiotics that are commonly used to treat staph infections
MRSA
congential closure of the esophagus
esophageal atresia
what does it look like
ends in a blind pouch
symptoms of it
excessive salivation, choking, gagging, cyanosis
what does esophageal atresia look like
absence of air below the diapharm need immediate surgury
what can show it
NG tube on chest xray
a congential failure of esophageal lumen to develop separate from trachea
tracheoesophageal fistula
type 1 looks like
upper & lower parts are blind pouches with no air below the diapharm
type 2 looks like
upper esophagus communicates with trachea & lower part of esophagus ends in blind pouch see no gas in the abdomen, contrast outline bronchial tree
type 3 looks like
upper parts end in blind pouch and lower part is attached to trachea, 85%, air in bowel
type 4 2 types, the first one looks like
upper part end in blind pouch and is connected to bronchial tree and you see gas in stomach
type 4 second type looks like
trachea and esophagus are intact but are connected with a single fistulous tract H fistula need surgery asap so don’t get aspiration pneaumonia
50% are from cancer in mediastinum or infectious processes or trauma and can be a later complication of esophageal cancer
acquired trachesophageal fistula
what does acquired TE Fistula look like
air dissecting in mediastinum with a pleural effusion
symptomatic reflux of stomach contents into the esophagus from reflux or infectious disorfers, injury or medications
esophagitis (GERD)
produces burning in the chest
acute esophagitis (can get superifical ulcers)
esophagitis is best seen with
oral double contrast
esophageal ulcers are in patients with GERD as
streaks or dots of barium superimposed, flat mucosa in distal esophagus, fibrotic healing, narrowing of distal esophagus, smooth strictures and tapering
dysphagia
difficulty swallowing
strong correlation with alcohol, smokling, poor prognosis, found at esophagogastric junction with squamous cell types
esophageal cancer
what types of modalities to see it
ct for staging (wall thicker than 3-5mm) and double contrast ba swallow
what does esophageal carcinoma look like
flat plaque like lesion wall , advanced lesions encircle lumen irregular narrowing leading to obstructions
outpouching of esophageal wall
esophageal diverticula
what are the 2types of esophageal diverticula?
traction or true, pulsion or false
which one involves all layers of the wall
traction true diverticula
which one involves only the mucosa and submoucosa heriniating through muscular layer
pulsion, false diverticula (if fill with food can call aspiration pneumonia)
arises from the posterior wall of upper esophagus at pharyngogeal junction, sm or large
zenkers diverticula (pulsion), ba swallow to see, ct to see location
found opposite bificuation of trachea can result in motor function problems or infection in lymph nodes
traction diverticular
in the distal 10cm of esophagus result in resophageal peristalisis & spincter relaxation that increase intraluminal pressure
epiphrenic diverticula pulsion
dilated veins in the distal esophagus from portal hypertension caused by cirrohis of liver that may hemorrhage
esophageal varices
esophageal varcies is best seen with
double contrast ba swallow
what does it appear as esophageal varcies
round filling defects or rosary beads, worms need to treat with tips procedure
protrusion of portion of stomach into thoracic through esophageal hiatus in diapharm from GERD
hiatial hernia ( seen on xray or ba study)
hiatial hernias can be….
sliding or rolling
portion of the stomach and gastroesophageal junction are both above diapharm and schatzkis ring is seen (mucosal ring sticking into lumen)
sliding or direct 99%
part of stomach herniates above diapharm and gastroesophageal junction is below diapharm if the stomach is above diapharm then intrathrocic stomach happens
rolling or paraesophageal 1%, risk of volvulus of life threating, looks like a snowman on xrays
neuromuscular abnormality with functional obstruction in distal esophagus with proximal dilation
achalasia
what causes achalasia
incomplete relation of lower esophageal spincter rom absence of ganglio cells , get slow dysphagia, regurgitation , chest pain and weight loss
what does achalasia look like
seen on ba studies as tapered smooth, 1-3cm narrowing of distal esophageal, rat tail, small spurts of ba in distal segement entering stomach, dilated esophagus, widened mediastinum, aid fluid level on right side
dysphasia
difficulty speaking
dysphagia
difficulty swallowing
perforation of esophagus due to
esophagitis, trauma, neoplasm, vomiting, instrumentation, patient with GERD
where does perforation of esophagus happen
pharnygoesophageal junction,air & fluid in mediastinum contrast leaking through perforation
a congential stomach anaomaly in the pyloric canal that causes narrowing and hypertrophy of pyloric sphincter. infants vomit at 2-6wks of age and become dehydratyed
IHPS (can palpate an olive and us shows it
what does IHPS look like
stomach is distended lack of ba in pyloric sphincter, string sign, ba trickles through narrowed elongated pyloric canal
inflammatory process involving stomach (gastic ulcer) and duodenum (duodenal ulcer) with mucosal destruction from NSAIDS, alcohol or stress
pepic ulcer disease that can hemorrhage, gastric outlet obstruction or perforation
where is the most common location of peptic ulcer disease?
lesser curvature of stomach and duodenal bulb
PUD is the most common cause of
acute upper GI bleeding
most common cause of perforation of a peptic ulcer is
pneumoperitoneum (pain only when stomach is empty)
most common peptic ulcer
duodenal ulcer 95% in the duodenal bulb
what does a duodenal ulcer look like
crater small collection of ba in the lumen, face on rounded ba in lucent folds, cloverleaf, outpunching of duodenal wall with lucent edema
which ulcer occurs in the lesser curvature of the stomach
5% gastric ulcers that are malignant
what does a gastric ulcer look like
barium filled erosion of stomach, halo of edema, ulcer collar, crater suggest cancer, if found in the stomach fundus its malignant (looks like a flower)
diagnosed later in patients with atrophic gastric mucosa or patients with partial gastrectoy from peptic ulcers 10-20yrs later
carcinoma of stomach
what does carcinoma of the stomach look like
thickening gastric wall, with narrowing and fixation of stomach wall with a tubular structure like a tornado, irregular polypoid masses in mucosal wall
bowel loop protruding in the inguinal canal of anterior abd wall that descends down into scrotum
inguinal hernia, from heavy lifting straining
traumatic diapharagmatic hernias look like
happen when sudden rise in abd pressure causes tear in diapharm and contents herniate into chest
congential diaphragmatic hernia look like
incomplete formation of diapharm with herniation of abd contents into chest cavity
how do diaphargamatic hernias happen
sudden trauma, on left side 90%, tears are at periphery of diapharm, doesn’t always happen right away, see bowel loops above the hemidiapharm
chronic inflammatory bowel disease anywhere in the sm or large bowel mostly in the terminal ilium in young adults
crohns disease
where does crohns start
mucosal layer leads to inflammation and edema all layers of wall with RLQ pain, diarrhea, blood, weight loss, can be from stress
what does crohns look like
skip areas, thickened mucosal folds, cobblestone, string sign seen with ente3roclysis or double contrast BE
what is a mechanical bowel obstruction aka small bowel obstruciton
blockage of bowel lumen
what is a adynamic ileus
failure of peristalis
what does a mechanical bowel obstruction look like
fibrous adhesions 2nd common cause of externall hernias or from intrinsic lesions of bowel wall and lumical occulsions. get vominitng and bowel sounds are present need to decompress with NG, dialtde loops of small bowel, air fluid , step ladder
adynamic ileus happens in sm or lg bowel from
failure of peristalsis from surgery or peritonitis, medications, metabolic disorders or trauma and no bowel sounds are heard appers uniformly dialted with no point of obstruction
what are the 2 types of adynamic ileus
localized ileus isolated distened loop of sm or lg bowel .
colonic ileus a gaseous distention of lg bowel without obstruction with a massive cecum
bowel obstruction in children that has telescoping on part of bowel into another
intussusception
what can intussception lead to
ischemic necrosis from cut off of vascular supply
what is the most common site of intussusception
ileoceceal valve
what are the symtoms of intussception
severe abd pain, blood, palpable right side mass in adults from tumor. coiled spring appearance , 3 concentric rings like a doughnut
congential diverticulum of distal ileum with a sac like anaomly 6feet within ileocecal valve
meckels diverticulum
classic sign in children of meckels diverticulum
painless rectal bleeding, ulcer, cramping or vomiting need nuc med to diagnose
hereditary disorder, celiac sprue sensitive to gluten that interferes with digestion with increase in k lymphocytes
celiac disease
what does celiac disease look like
dilated bowel, mucosal fold atrophy and peristalsis slows or stops, fart, on off fiarrehea. see stacked coinds of turfts of cotton
neck of appendix becomes blocked and creates a loop obstruction with fluid accumulation that causes bacteria that causes gangrene or perforation
appendictitis
symptoms of appendicitis are
RLQ pain, fever, nausea vomiting
if the appendix ruptures it causes
PERITONITUS
what does appendicitis look like
round oval appendicolith and need to avoid a BE in acute causes
what does appendicitis look like
round oval appendicolith and need to avoid a BE in acute causes
acquired herniation outpouching of mucosa & submuscosa through bowel without inflammation is
diverticulosis
most common spot for diverticulosis
sigmoid colon
what is diverticulosis caused from
straining to pass a stool , get low back pain alternating bouts of constipation and diarrehea, see round oval outpouchings in lumen in clusters or deep crisscrossing sawtooth apperance
complication of diverticulosis of large bowel in sigmoid area with inflammation is
diverticulitis
what causes diverticulitis
fecal that is trapped in the narrow neck of diverticulum with bleeding and erosion , lower left quadrant pain, fever increase wbc
the leading cause of lower GI bleeding in adults is
diverticular disease
complications from diverticulitis are
fistulas, strictures, abscesses or perforations that can lead to peritonitis, fistulas can develop between adjacent organs
diverticulitis has what type of apperance
dirty
1 of the major inflammatory bowel diseases that affects young adults and is auto immune is
ulcerative colitis
symptoms of ulcerative colitis
bloody diarrehea, abd pain, fever, weight loss
ulcerative colitis only affects the
large bowel, starts in distal colon and rectosigmoid you see nodular protrosions of hyperplastic mucosa, ulcers with intraluminal gas and loss of haustral markings
major complication of Ulcerative colitis is
toxic megacolon
the appearance of ulcerative colitis is
stippled, deep ulceration collar button appearance. haustra are absent, tubular lead pipe appearance,
carcinoma of the colon is 10x more frequent in people with
ulcerative colitis
absence of neurons in bowel wall in the sigmoid area is
congential megacolon aka hirschsprungs disease
what does it look like/cause?
gross dilation beyond narrowing that is found after birth with little or no meconium that leads to toxic megacolon. you see no air in the rectum beyond the narrowing
small masses of tissue in the bowel wall that project inward into lumen in the rectosigmoid
colonic polyps, seen as round filling defects, remove so don’t become cancerous
malignant polyps have
irregular surface without stalks and are larger than 2cm. beign are smooth with a stalk
adenomatous polyp is
benign tumor that can become malignant,
3rd leading cause of death from canceri the rectum and sigmoid is
colon colorectal cancer
apple core lesion or napkin ring carcinoma with flat plaques of tumor only in part of the circumference of the wall that infiltrate the bowel wall as it grows
annular colon cancer most common in sigmoid
70% of large bowel obstructions result from primary
colonic carcinoma- diverticulitis & volvulus are other cases
large bowel obstructions develop
slowly and are less acute than small ones there is danger of perforation of ileocecal valve is comptetent (working)it will perforate if ceceum is more than 10cm very dilated, caused from apple core lesion in the sigmoid
do a —————-to fix large bowel obstruction
low pressure barium enema
twisting of bowel on itself that may cause obstruction
volvulus
most often occurs where the volvulus
cecum and sigmoid because of moveable mesentery, ppl with low fiber diet
cecum volvulus looks like
distended cecum displaced upward and to left with a kidney shaped mass twisted, need ba enema to diagnosis
sigmoid volvulus looks like
long loop twisted on its mesenteric axis in a closed loop as an inverted u without haustral markings looks like a birds beak appearance at the stenosis
congential disorder with no opening to the exterior with a fistula present
imperforate anus
how is imperforated anus shown
X TABLE LATERAL RECTUM OR FISTULOGRAM
choleithiasis is aka
gallstones
2 types of gallstones are
cholesterol (most common ) pigment
what is the predispositions for gallstones
Four F’s fat fourty, female, family history
why do gallstones happen
not enough bile salts you get bloating, nausea, RUQ pain seen well on US
gallstones are
radiolucent
cecum volvulus looks like
distended cecum displaced upward and to left with a kidney shaped mass twisted, need ba enema to diagnosis
sigmoid volvulus looks like
long loop twisted on its mesenteric axis in a closed loop as an inverted u without haustral markings looks like a birds beak appearance at the stenosis
congential disorder with no opening to the exterior with a fistula present
imperforate anus
how is imperforated anus shown
X TABLE LATERAL RECTUM OR FISTULOGRAM
choleithiasis is aka
gallstones
2 types of gallstones are
cholesterol (most common ) pigment
what is the predispositions for gallstones
Four F’s fat fourty, female, family history
why do gallstones happen
not enough bile salts you get bloating, nausea, RUQ pain seen well on US
gallstones are
radiolucent
inflammation of the gallbladder with 95% of cases occurring after an obstruction of the cystic duct. patient has pain. fever, nausea, vomiting. best seen on us
acute cholecystitis
calcification of the gallbladder from chronic cholecystitis, this increases your risk of carcinoma
porcelain gallbladder
group of diseases of the liver from consuming contaiminated water, food dirty needles, unsafe sex
viral hepatitis
acute inflammation of the liver that interferes with its ability to excrete bilirubin, see a fatty liver with multiple fibrotic nodules oon US, CT, MRI
hepatitis
spread by contact with infected person through ingestion of contaminated water or food. highly contangious so hand washing is best to prevent. mild form
hepatitis A
spread through infected serum or blood, result is asymptomatic carrier, cirrohis, heapatocelluar cancer or hepatitis. vaccine to prevent
hepatitis B
80% of heapatitis cases after blood transfusions or sexual contact. can be chronic or acute some with get cirrhosis of the liver. immunizations will decrease risk
hepatitis C
happens with acute or chronic HBV, cant happen alone
hepatitis D
from waterborne outbreaks of hepatitis in developing countries can be severe but not chronic
hepatitis E
transmitted thru blood results in chronic hepatitis
hepatitis G
chronic destruction of liver cells & structure with nodular regeneration of parenchyma & fibrosis. end stage liver disease. caused from alcoholism, drugs, disease of bile ducts, hepatitis or hemochromatosis
cirrhosis of the liver
secondary liver cancer from metastases from else where in the body, the most common malignant tumor of the liver that is pallative
hepatic metastases
what is the most common chractertistic of cirrhosis of the liver
ascites- patients abdomen is tight hard and distended
what does cirrohosis of the liver look like
ground glass appearance, increased fat in the liver, low density with multiple nodules
interference of portal blood flow through liver due to cirrohosis with nodular regeneration that causes fibrosis and obstructs the portal vein that drains the blood form the GI tract from liver before its emptied into IVC
portal hypertension
complication of portal hypertension from increased pressure in portal vein
splenomegaly and collateral venous connections, esophageal varcies
palliative treatment for portal hypertension
TIPS stent used to decrease hypertension allowing portal venous circulation to by pass through liver, low pressure between portal and hepatic veins
accumulation of fluid in the peritoneal cavity that develops from albumlin deficiency that allows increase pressure in obstructed veins to leak fluid into the abdomen, weeping from the liver
ascites
ascites is a major symptom and cause of death in
cirrohosis of the liver
primary liver cancer in patients with underling liver disease like alcohlics or cirrohis of the liver/ patient has RUQ pain, wt loss and jaundice from intraperitoneal bleeding
hepatocellular cancer of the liver best seen on Ct
inflammatory process where protein and lipid digestion become activated within the pancreas and begin to digest the organ itself caused from excessive alcohol consumption
acute pancreatitis
acute pancreatitis can also be caused form
gallstones obstructing the ampulla of vater
symptoms of acute pancreatitis
severe back pain, nausea vomiting, enlarged pancreas with edema
chronic injury to pancreas causes damage and leaves scar tissue wit recurring episodes from chronic alcohol abuse
chronic pancreatitis
3 main symptoms of chronic pancreatits
pain, malabsorption causing weight loss, diabetes, see patchy inhomogenous calcifications
locualted fluid filled collection from inflammation, necrosis, hemorrhage associated with pancreatitis or trauma, form from infected pancreas and continue to produce enzymes
pancreatic pseudocyst
what does a pancreatic pseudocyst look like
shaggy lining with dense white scar tissue
inflammatory process where protein and lipid digestion become activated within the pancreas and begin to digest the organ itself caused from excessive alcohol consumption
acute pancreatitis
acute pancreatitis can also be caused form
gallstones obstructing the ampulla of vater
symptoms of acute pancreatitis
severe back pain, nausea vomiting, enlarged pancreas with edema
chronic injury to pancreas causes damage and leaves scar tissue wit recurring episodes from chronic alcohol abuse
chronic pancreatitis
3 main symptoms of chronic pancreatits
pain, malabsorption causing weight loss, diabetes, see patchy inhomogenous calcifications
locualted fluid filled collection from inflammation, necrosis, hemorrhage associated with pancreatitis or trauma, form from infected pancreas and continue to produce enzymes
pancreatic pseudocyst
what does a pancreatic pseudocyst look like
shaggy lining with dense white scar tissue
happens when the intestines are not in there normal place
malrotation
most of pancreatic tumors arise in the
pancreatic ducts
what causes pancreatic cancer
high protein & high fats, smoking, diabetes and carcinogens
what is the best modality for detecting pancreatic cancer
ct
what happens if the tumor is in the head of the pancreas
percutaneous transhepatic cholangiogram or an ERCP to show the narrowing of the distal common bile duct, upper ba study will also show distoration
common endrocine disorder that can affect the heart, kidney and cause stroke or blindness that can lead to amputation
diabetes mellitus
blood glucose levels are high
hyperglycemia
type 1 diabetes
insulin dependent or jevenile
type 2 diabetes
non insulin dependent or adult onset
gestational diabetes
during pregancy
occurs at any age but develops in childhood , produce little or no insulin because of autoimmune destruction of pancreatic b cells and are insulin dependent , weight loss, increase in urination, excessive thrist and glucose in the urine
type 1 diabetes
pancreas still forms insulin but the body does not produce enough or is not able to use it effectively from altered cellular metabolism. risk of developing over 40, accounts for 90%, obesity and acitivity
type 2 diabetes
major complication of diabetes
atherosclerosis
complications of diabetes
decrease in sugar in the blood
hypoglycemic shock results from
too much insulin, not enough food or excessive exercise, fill light headed , trembles, perspire, need to give sugar or juice
happens when the intestines are not in there normal place
malrotation
different degrees of malrotation are
failure of fixation of cecum in the RLQ & complete transposition of bowel where the small bowel is on the right hand side and colon is on the left hand side
complete reversal of all abdominal organs
situs inversus
free air in the peritoneal cavity
pneumoperitoneum
what causes pneumoperitoneum
performation of gas containing viscus, abdominal surgury
what does pneomoperitoneum look like
free air seen below the dome of the diapharm when patient is upright, easiest to see on the right side and on the supine you see a double wall sign
enterococci bacteria found in healthy people stomach that has no illness unless it gets into open wounds and can become resistant to medicine. spread directly on infected surfaces from people
VRE
the ureters of the bladder are found
inferior/posterior in the bladder
trigone is
triangular area posterior bladder between openings for ureters and urethra
what does a ureterocele look like
round or oval density surrounded by a radiolucent halo from the prolapsed cobra head. when it does not fill with contrast it shows a radiolucent mass
what are abdominal retroperitoneal viscera
suprarenal glands, aorta, IVC, duodenum, pancreas(not tail), colon (ascending and descending), kidneys, esophagus(part), rectum (sad pucker)
congential, solitary, rare kidney, absence on one side and the other kidney is larger to compensate, happens inutero
renal agenesis
in true renal agenesis what happens
half of the trigone is missing too
congential, 3rd kidney, small, rudimentary with its own pelvis and blood supply but functions normally. more susceptiable to infections and may need to be removed
supernumerary kidney
congential, smaller replica of a normal kidney, good function, normal tissue but the other kidney may enlarge to compensate
hypoplastic kidney
congential, abnormally positioned kidneys found anywhere in the pelvic/abdominal thoracic cavity , function well, increases obstructions at the ureteropelvic junciton
ectopic kidney
congential, ectopic kidney on the same side as the normall kidney that is sometimes joined to it
crossed ectopia
congential, most common fusion, both kidneys are malrotated and lower poles are connected. ureters arise from kidneys anterior instead of medial and lower poles are medial instead of lateral. obstrucitons are urteropelivc junction happen , more infections
horse shoe kidney
different degrees of malrotation are
failure of fixation of cecum in the RLQ & complete transposition of bowel where the small bowel is on the right hand side and colon is on the left hand side
complete reversal of all abdominal organs
situs inversus
free air in the peritoneal cavity
pneumoperitoneum
what causes pneumoperitoneum
performation of gas containing viscus, abdominal surgury
what does pneomoperitoneum look like
free air seen below the dome of the diapharm when patient is upright, easiest to see on the right side and on the supine you see a double wall sign
enterococci bacteria found in healthy people stomach that has no illness unless it gets into open wounds and can become resistant to medicine. spread directly on infected surfaces from people
VRE
the ureters of the bladder are found
inferior/posterior in the bladder
trigone is
triangular area posterior bladder between openings for ureters and urethra
kidneys are —————- structures
retroperitoneal
what are abdominal retroperitoneal viscera
suprarenal glands, aorta, IVC, duodenum, pancreas(not tail), colon (ascending and descending), kidneys, esophagus(part), rectum (sad pucker)
congential, solitary, rare kidney, absence on one side and the other kidney is larger to compensate, happens inutero
renal agenesis
in true renal agenesis what happens
half of the trigone is missing too
congential, 3rd kidney, small, rudimentary with its own pelvis and blood supply but functions normally. more susceptiable to infections and may need to be removed
supernumerary kidney
congential, smaller replica of a normal kidney, good function, normal tissue but the other kidney may enlarge to compensate
hypoplastic kidney
congential, abnormally positioned kidneys found anywhere in the pelvic/abdominal thoracic cavity , function well, increases obstructions at the ureteropelvic junciton
ectopic kidney
congential, ectopic kidney on the same side as the normall kidney that is sometimes joined to it
crossed ectopia
congential, most common fusion, both kidneys are malrotated and lower poles are connected. ureters arise from kidneys anterior instead of medial and lower poles are medial instead of lateral. obstrucitons are urteropelivc junction happen , more infections
horse shoe kidney
congential, duplication of renal pelvis and ureters in the same kidney. varies from bifid pelvis, double pelvis, ureter or uterovesical orfice
duplication kidney
what is a complete duplication of a kidney
obstruction at vesicoureteral reflux = infection with lower ureter and renal pelvis, the obstruction affects the upper pole
cyst like dilatation of distal ureter near insertion into bladder
ureterocele
what results from the congential stenosis of a ureteral orifice in uterocele
degrees of dilation in the proximal ureter, the stenosis leads to prolapse of the distal ureter in the bladder causing dilation of the lumen of the prolapsed segement
2 types of urteroceles are
simple, ectopic(mostly in infants)
most ectopic ureteroceles are associated with
ureteral duplication 80%
what does a ureterocele look like
round or oval density surrounded by a radiolucent halo from the prolapsed cobra head. when it does not fill with contrast it shows a radiolucent mass
thin transverse membrane that has a reverse valve(prevent antegrade flow) in males that leads to hydronephrosis, hydroureter, renal damage and is best seen on a VCUG
posterior urethral valves
what does posterior urethral valves look likes?
proximal urethra dilated and a thin lucent transverse membrane valve
congential outpouchings on the ureters best seen on retrograde urography
ureteral diverticula
congential or from chronic bladder obstructions and infections in middle aged men seen on cystography or cystoscopy
bladder diverticula
bilateral non suppurative inflammatory process of glomeruli and tubules within kidneys tissue
glomerulonephritis
what do the glomeruli do
filter blood in the kidneys
what happens in glomerulenephritis
inflammatory process causes glomeruli to be permeable allowing RBC into urine (hematuria or proteinuria), get a decrease in glomerular filtration and decrease of urine (oliguria) smoky coffee urine
what causes glomerulonephritis
strep throat, chronic autoimmune disorders
in acute glomerulonephritis what does it look like
kidneys are normal but increased in size with smooth contours and normal calcyes
in chronic glomerulonephritis what does it look like
loss of renal substance, bilateral small kidneys renal outline is smooth with a normal collecting system see on IVU or US
suppurative inflammation of renal pelvis with pyogenic bacteria that affects the intersitisal tissue between the tubules. infection has a patchy distribution and affects one kidney
pyelonephritis
where does the infection originate for pyelonephritis?
bladder common in women and children can be caused from a obstruction in urinary track enlarged prostate, kidney stone or congential defect
what can cause pyelonephritis
stagnation of urine, catheterization giving you fever, chills, back pain, dysuria and pus in the urine. seen on IVU get delayed opacification and striation in renal pelivs
what does pyelonephritis look like
calcyes clubbing with atrophy of renal parenchyma
severe parenchymal perirenal infection with gas forming bacteria, in diabetic patients it causes acute necrosis of the kidney seen best on CT
emphysematous pyelonephritis
what does emphysematous pyelonephritis look like
radiolucent gas in and around the kindey
what is autosomal dominant polycystic kidney disease
asymptomatic symptoms only show later in life,. cysts enlarge as patient ages destroying normal tissue, lower back pain, UTI and kidney stones, some have liver cysts, 10% have saccular aneurysms and 50% hypertension
what causes cystitis
instrumentation, catherization, retrograde urine flow, sex. symptoms include burning urine frequencey
in chronic cystitis what do you see
decrease in bladder irregularity with irregular bladder wall that is thickned
urinary calculi or kidney stones that develop from calcium and salts in the urine in women after 30
renal calculi
what causes stone formation of kidneys
metabolic disorders(hyperparathryroidism) excessive calcium, high urine concentration and chronic UTI)
5% of stones do not calcify are made of
urice acid and oxalates
STONES LESSS THAN ————PASS ON THEIR OWN
3MM
most stones form in the
calyces or renal pelvis
a large shaped stone in the pelvicalyceal junction
staghorn calculus
stones are always————–till they ————–
asymptomatic, move
common sites of kidney stones are
ureterovesical junction, ureteropelivc junction and pelvic brim
renal colic is
movement of stones or acute obstruction with severe intermittent pain
in IVU non opaque stones appear as
filling defects
percutaneous catheter introduces medicine into upper urinary to dissolve stones
chemolysis
shock waves to break up stones less than 2cm in the upper urinary tract
lithotripsy
basket or laser destruction of stones in the lower urinary tract
cystoscopic retreieval
internal or external pressure that prevents normal urine flow
urinary tract obstruction
causes of urinary tract obstructions
calculi, tumors, urethral strictures, enlarged prostates in children its from congential malformations
normal points of narrowing in the urinary system are
ureteropelivc & uretoervesical junctions, bladder neck, urethral meatus,
blockage of the bladder with unilateral dilatation is
hydroureter
blockage of renal pelivicalceal system is
hydronephrosis
what does a urinary tract obstruction look like
delayed pelivicalyceal filling in chronic its calcyceal clubbing and US shows it best
what does hydroureter look like
dilated ureter from obstruction
increase in blood pressure from occlusion of 1 or both renal arteries that releases renin and makes the body hold on to salt and blood pressure rise
renal hypertension
how to treat hydronephrosis
decompress by draining the urine by percutaneous nephrostomy to show the obstruction
most common masses in kidney that are fluid filled and unilocular in 1 or both kidneys that cause focal displacement of adjacent pelvicalcalyceal systems
renal cysts
ultrasound is used for renal cysts to determine
if its fluid filled or a solid mass lesion
ivu shows renal cysts as
smooth walled fluid filled mass with a birds beak apperance
ct shows renal cysts as
thin walled non enhanced kidneys
how to treat a renal cyst
percutaneous drainage of cyst or injection of iodine or alcohol to decrease the cyst size
congential inherited kidney disorder with innumerable tiny cysts inside the nephron at birth that can be autosomal recessive or autosomal dominant
polycystic kidney disease
what is autosomal recessive polycystic kidney disease
rare, childhood from childhood renal failure, serious and gets worse quiclkly, causes serious lung and liver disease and death. us used to diagnose kidneys appear smooth
us shows autosomal dominant PK as
enlarged kidneys with multiple cysts, poor outline calyceal stretching
most common neoplasm over 40 with painless hematuria that starts in the tubular epithelium of the renal cortex and 90% of the tumors are calcium in non peripheral that are malignant
renal cell carcinoma (hypernephroma)
what are the classic triad symptoms of renal cell carcinoma
hematuria, flank pain and palpable abdominal mass that causes elongation of adjacent calyces and infiltration that leads to distroation and narrowing of the collecting system. large tumors obstruct upper ureter and you get a loss of renal function has the tumor invades the renal vein
how is renal cell carcinoma best seen
nephrotomogram to show the cystic type mass and thick irregualar walls
adrenergic drugs
constrict blood vessels, stimulate heart, used for cardio vascular, respiratory and allergic responses
malignant renal wilms tumors are
found before age 5 as mass that is palpable with no symptoms
wilms tumor looks like
enlarged displacement of the kidney, solid fluid filled mass
starts in the epithelium of bladder and is called urothelial carcinoma of men over 50 with tumors that are small in the trigone area
carcinoma of the bladder
what causes carcinoma of the bladder
cigarette smoke chemicals. you get painless hemturia
what does carcinoma of the bladder look like
on kub finger like projections into the bladder lumen . ivu shows polypoid defect with wall thickening, filling defect
what are the 2 types of renal faliure
acute and chronic
what is renal failure
end result of a chronic process in lost of kidney function kidneys become impaired from loss of glomular fitration and renal tissue shrinks
what do the kidneys do
remove waste and excess water from body
uremia
rentention of urea in blood from renal failure
sudden loss of ability for kidneys to remove waste and concentrate urine
acute renal failure
prerenal failure is
decrease in blood flow to the kidneys from hemorrhage, dehydration, surgical shock, burns or injury from cardiac failure , obstruction of both renal arteries, or neprhoteixc agents or diseases
what is postrenal failure
obstruction of urine from both kidneys
symptoms of acute renal failure
breathe odour, bruise easily and have decreased urine output with change in mental status
slow loss of kidney function from underlying causes
chornic renal failure
2 most common causes of chronic renal failure
diabetes and high blood pressure
complications of chronic renal failure
damage to small blood vessels in body from diabestes or high blood pressure, there is increased levels of creatine in blood (uremia) with nausea, vomiting, diarrhea and convulsions, itching
chronic renal failure causes
retention of sodium that increases water rentenion and edema that lead to CHF
most common cause of renal hypertension
atherosclerosis
what does renal hypertension look like
diminished size of right kidney and renal artery stenosis
aka prostatic hyperplasia that is a benign enlargement of the prostate gland due to nodules on the prostate from horomonal change in older men over 60 that is detected on a digital rectal exam
benign prostatic hyperplasia
symptoms of benign prostatic hyperplasia
hard to stop or maintain urine flow and cant empty the bladder that can lead to hydronephrosis or pyeloneprhitis
what does benign prostatic hyperplasia look like
ivu- enlarged prostate with smooth filling defect at base of bladder that looks like a j shpe or fish hook in the distal ureter
bladder dysfunction from interference of nerve impulses with urination from spinal cord injury, cerebral disorders, diabetes or meteabolic disorders
neurogenic bladder
complications from neurogenic bladder
incontinenece, residual urine, UTI, calculus formation or renal failure
what does neurogenic bladder look like
cystography you see reflux and a rough bladder wall that should be smooth
abnormal back flow of urine from the bladder into the ureters and is the most common urologic childhood condition with increase risk of UIT that leads to damaged kidneys
vesicourecteral reflux
what does vesicourecteral reflux look like
defect in valve that prevents urine from leaving the bladder and going to ureters so het urinary blockage
fistulous tract between the bladder and vagina that allows continuous discharge of urine
vesicovaginal fistula
causes of vesicovaginal fistula
childbirth, prolonged labour, sexual assault, cancer
adrenergic drug that treats shock, MI, renal failure, chronic cardiac decompensation
dopamine (intropin)
adrenergic drug that treats cardiac arrest, acute asthma and hay fever
epinephrine (adrenaline)
what adrenergic drug treats shock, and acute renal failure
isoproterenol (isuprel)
adrenergic blocking agents
cause increase peripheral circulation and decreased blood pressure
adrenergic blocking agent that treats hypertension and angina
atenolol
adrenergic blocking agent that treats cardiac arrhymias, MI and hypertension
propranolol, (Inderal)
antimuscarinic drugs
increase cardiac output, constrict blood vessels and decrease bronchial secretions
antimuscarinic drug that treats braydcardia, bradyarrthmia and prevents bronchial secretions before surgury
atropine sulfate (atropine)
calcium channel blockers
reduce calcium to the heart and relax smooth muscle and reduce spasms
calcium channel blocker that treats angina and hypertension
ditizem (Cardizem)
calcium channel blocker that treats angina, cardiac arrhymias and hypertension
verapamil (calen)
cardiotonics
increase the force of contraction to the heart to reverse cardiac symptoms
antiarrhythmics are used
correct arrhythmias of heart due to electrical abnormalties
antiarrhymics that maintains normal cardiac rhythm
quinidine (quinaglute)
antiarrhythmic that treats serious ventricular arrhythmias and is used a local anestheic
lidocaine (xylocaine)
antiarrhymic that treats life threating ventricular fibrillation
amiodarone (cordarone)
organic nitrates
relax smooth muscles of arteries and veins can be short or long acting
organic nirtrate that treats sudden onset of angina
nitroglycerin (short)
organic nitrate that treats or minimizes angina
nitroglycerine patch (long acting)
directics
reduce blood volume by urine excretion of water to treat hypertension
a diuretic that treats hypertension, edema and CHF
furosemide,(Lasix)
analgesics, antipyretics and anti-inflammatory drugs
reduce pain and fever from inflammation
a analgesics anti-inflammatory drug that treats moderate pain
ibroprofen (motrin, advil) NSAID, tyelonol, acetaminophen
analgesics anti-inflammatory drug that treats mild pain or fever, arthritic inflammatorycondictions and prevent thrombosis
aspirin, acetylsalicylic acid
opioid analgesics narcotics
control intense pain and anxiety
opioid analgesic that treats severe pain and can become dependent on
morphine sulfate, Demerol)meperidine hydrochloride), fentanyl
opioid analgesics
treat middle to moderate pain
opioid analgesics that treat milder pain
codeine, oxycodone
antianxiety drugs
treat anxiety and behavior disorders
antiaxiety drug that treats anxiety or seizures
lorazepan (ativan)or diazepam (valium)
drugs that affect blood
prevent thrombus from MI, strokes, PE or venous thrombiss
drug that affects blood that inhibits clot formation and maintain patency of venous catheters
heparin sodium
drug that affects blood that prevents emboli in chronic atrial fibrillation, deep vein thrombosis and heart valve damage
warfarin sodium
drugs that affect respiratory system to treat bronchospasm, asthma attacks and anaphylazis
epinephrine (adrenaline)
antihistamines are used to
treat anaphylactic shock, acute urticarial, edema, hypersensitivity, nausea and motion sickness
antihistamine to treat anaphylaxis
benadry (diphenhydramine) do not administer antihistamines to patients with asthma or who operate motor vehicnles
antacids
treat heart burn and indigestion by decreasing acidity and rate of GI emptying
antacid to treat cardiac arrest and reduce acidosis
sodium bicarbonate (aluminum hydroaxide)
glucocorticoids (hydrocortisone) cortef
replacement therapy of disease for adrenal glands or relief of inflammatory symptoms from allergic reactions that are severe and relief of stress from trauma
ionic hypaque cystoconrayll used for retrograde and VCUG has
high osmality
non ionic optiray isovue omipaque used for angio, ct, mye, arthro, retreogrades, cholang, ercp, ivp has
low osmality
what is a vasovagal reaction
pallor, cold sweats, rapid pulse, syncope, braydcardia, hypotension
what is expected side effects
flushed, warm, nausea, vomiting, headache, pain at injection side, metallic taste
what are mild adverse reactions
nausea, vomitning, cough, dizzy, warm, headache, shaking, pallor, itching
what are moderate adverse reactions
tachy,bradycardia, hyper.hypotension, dyspnea, bronchospasm, wheezing
what are severe allergic reactions
edema, seizures, cardiac arrthymia, cardiac arrest
closed fracture
simple fracture broken bone does not penetrate the skin
open fracture
compound fracture broken through the skin, longer to heal, surgery, high infection and non union
communited fracture
more than 2 fragements starburst, butterflu, segemntal
butterfly fracture
elongated trigular fragement detached from 2 other fragements
segemental fracture
segement of sharft is isolated by proximal distal lines of fracture
complete fracture
entire cross section discontinuity of 2 or more fragments (transverse, oblique, spiral, avulsion)
incomplete fracture
bone is cracked but not completely transverse width of the affected bone (green stick or torus)
longitudinal fracture
extends across long bone
linear fracture
parallel to long axis of bone no displaced tissue (hairline)
compression fracture
decrease in length and width wedge shaped , osteoporosis, collapse of vertebral body
impacted fracture
like compression, closed pressure at both ends into 2 fragements
depressed fracture
portions of fracture driven inwards
undisplaced fracture
bone break cracks bone and radiates into different directions but does not separate (linear, hairline)
displaced fracture
2 ends of long bone are separate from one another
dislocation
displacement, posterior for hips and anterior for shoulder most common
subluxation
incomplete or partial dislocation of bone or jt
bimalleolar fracture
aka potts transverse fracture of medial malleolus with low oblique fracture of distal fibula
trimalleolar fracture
fracture of ankle, medial malleolus, distal posterior tib the posterior malleous
blow out fracture
traumatic, medial orbital wall into max sinus
boxer fracture
transverse break at 5th metacarpal with palmer angulation
bennetts fracture
base of 1st metacarpal thumb
colles fracture
most common transverse fracture though distal radius with avulsion fracture of ulnar styloid displaced posterior (FOOSH)
jones fracture
transverse fracture of bases of 5th metartarsal
Jefferson fracture
communited fracture of ring of atlas of posterior and anterior arches
navicular fracture
scaphoid, most common, transverse at waist, sometimes seen 7-10 days later
smiths fracture
fracture f wrist with distal fragement radius displaced anteriorly falling backward on outstretched hand
intertrochanteric fracture
between greater and lesser trochanter
contra coup fracture
distant from side opposite side of the impact
stress fracture
aka march from repeated stress 2-3 metatarsals
epiphyseal fractures
easiest fracture salter harris to classify
monteggia fracture
fracture of proximal 1/2 of ulna wit dislocation of radial head, anterior dislocation of radius and elbow
galeazzi fracture
fracture of shaft of radius and dorsal posterior dislocation of ulna at the wrist
supracondylar fracture
fracture of humerus elbow in children
hangmans fracture
though pedicles of axia without displacement of c2-c3 from acute hyperextension
clay sholvers fracture
alvulsion fracture of spinous process in lower cervical and upper tspine
seat belt fracture
transverse fracture of lspine with visceral injuries
compound fracture
skin is disrupted and open
complete fracture
disconuityof 2 or more fragements
incomplete fracture
partial disconitnuty with portion cortex remaining in tact
avulsion fracture
small fragement from bony prominences result from indirect tension with attached ligaments
pathologic fracture
bone weakness from pathology
greenstick fracture
incomplete fracture with opposite cortex intact children
torus buckle fracture
one cortex intact with buckling or compaction of opposite cortex
bowing fracture
plastic deformation from stress
undisplaced fracture
plain of bone with angulation of seperation
displacement
serpation from bone
transitional vertebrae
at l-s spot, expanded transverse process, L1 vertebrae may have a rudimentary rib or transverse processo fC7
spina bifida
posterior defect of lamina, failure of posterior element to fuse properly, dimple of hair over lesions, no lamina with increased intrapedicular distance
herinieation of just meninges, have a club foot and bladder incontinence
meningocele
meniges and spinal cord protrude thru, chiari II malformation
myelomeningcele
marble bones, rare hereditary, failure of reabsorption of calcified cartilage interrupts normal replacement of bone , brittle bones, anemic, increase in bone density, increase atteuation
osteopetrosis
disseminated malignancy of plasma cells associated with bone destruction, bone marrow failure, hypercalcemia, renal failure and reoccurring infections, 40-70yrs, tumors attack the intramedullary canal of the diaphysis, bence jones protein in urine, punched out osteolytic lesions on lateral skull views, affects axial skeleton
multiple myeloma
most common dwarfism, dimished cartilage growth plate, autosomal dominant affecting membraneous bone formation shorts limbs, saddle nose, prominent buttocks, jutting jaw, frontal bulging, widened metaphysis Erlenmeyer flask
achondroplasia
developemental hip dysplasia, incomplete acetabulum formation. in females, hip click and pop, legs are displaced anteriorly or posteriorly children waddle like a duck
congential hip dysplasia
chronic systemic disease, non suppurative inflammatory of the jts in the hands and feet, females over 40, symmetric, erosion of articular cartialage, poor defined margins, narrowing of joint spaces, subluxation and constrictures
rheumatoid arthritis
starts in si jts, bilateral, symmetric, blurred articular margins, patchy sclerosis, narrowing jt spaces, poker spine, bamboo spine, skeletal osteoporosis
ankylosing spondylitis
recative arthritis, young men with gi infections, bilateral, asymmetric, si jts, heels, feet
reiters syndrome
degenerative jt disease, loss of jt cartialage, new bone formation, wear and tear narrowing jt spaces, bone spurs and osteophytes in medial femorotibial compartment
osteoarthritis
inflammation of the bone marrow(myelitis), infectious, hematogenous spread from direct surgery, affects metaphysis, long bones rich in marrow, vertebrae, femur with swelling and fever, moth eaten appearance leading to necrosis, raises periosteum
bacterial osteomyletits
mass of bone decreases, bone removal and replacement, bones become lucent, need low kvp and short scale contrast, picture frame pattern
osteoporosis
osteoclastic
bone removal
osteoblastic
bone replacement
insufficient mineralization of skeleton failure of calcium and phosphorus deposition in bone matric from chronic kidney failure bones soften and bend bowing deformities
OSTEOMALACIA
childrens bones soften, not enough vit D, premature enfants ribs, tib, humerus, radius, ulna, metaphyseal ends become cup shaped and frayed with bowing
rickets
metabolism diease with increase in uric acid deposition in jts attacks the 1st metatarsal jt (big toe) first, punched out lesions , rat bite
gout
osteo deformans most common metabolic disorder destruction and repair, weakend thickened fracture easily, men, pelvis, femur, skull, clavicles, ribs , cotton wool appearance , ivory veretebrae picture frame, can develop osteosarcoma
pagets disease
most common place for pagets is
pelvis
hot spot
reparative
cold spot
destructive
loss of blood supply, repeated trauma, fracture, alcohol steroids, femoral head is the most common spot see a cresent sign a radiolucent band
ischemic necrosis of bone
exocytosis, benign projection of bone with a cartilaginous cap, teens, epiphyseal plate and grows laterally, can be malignant
osteochondromas
slow growing benign cartiliganous tumor in the medullary cavity, tumor destroys bone in the cartilage, hands and feet, thinning and scalloping the cortext leading to pathogical fractures, stippled speckled ring calcification with lucent matrx
enchondroma
osteoclastoma, in the distal femur or proximal tibia, young adults, lucent lesion in metaphysis extending to cortex but not jt, multiple large bubbles as it expands toward the shaft
giant cell tumor
osteomas
in outer table of skull, sinuses, well circumscbired dense round lesions no more than 2cm in diameter local pain that is worse at night
unicameral fluid filled wall o fibrous tissue in proximal humerus or femur in metaphysis, asymoptomatic, expanded lucent lesion, thin rim of sclerosis
simple bone cysts
numerous blood filled communications, cyst like lesion, prounounced ballooning of thinned cortex
aneurysmal bone cyst
solitary sharp areas of dense compact bone in pelvic or upper femora asymptomatic
bone islands
end of long bone in metaphysis (knee), spicules of calcified bone, 10-25yrs, pain, swelling, wt loss, anemia, pulomonary mets, sunburst pattern, elevated periosteum at periphery codmans triangle
osteogenic sarcoma
malignant tumor of cartilaginous origin, long bones orginate in ribs, scapula, vertebrae, slow growing has punched out calcification, scalloping and cortical destruction
chondrosacroma
primary malignant tumor in the bone marrow of long bones tumor in children and young adults, onion skin appearance, local pain, ill defined bone destruction in the central part of long bone
ewings sarcoma
disseminated malignancy of plasma cells associated with bone destruction, bone marrow failure, hypercalcemia, renal failure and reoccurring infections, 40-70yrs, tumors attack the intramedullary canal of the diaphysis, bece jones protein in urine, punched out osteolytic lesions on lateral skull views, affects axial skeleton
multiple myeloma
adrenergic drug that treats shock, MI, renal failure, chronic cardiac decompensation
dopamine (intropin)
adrenergic drug that treats cardiac arrest, acute asthma and hay fever
epinephrine (adrenaline)
what adrenergic drug treats shock, and acute renal failure
isoproterenol (isuprel)
adrenergic blocking agents
cause increase peripheral circulation and decreased blood pressure
adrenergic blocking agent that treats hypertension and angina
atenolol
adrenergic blocking agent that treats cardiac arrhymias, MI and hypertension
propranolol, (Inderal)
antimuscarinic drugs
increase cardiac output, constrict blood vessels and decrease bronchial secretions
antimuscarinic drug that treats braydcardia, bradyarrthmia and prevents bronchial secretions before surgury
atropine sulfate (atropine)
calcium channel blockers
reduce calcium to the heart and relax smooth muscle and reduce spasms
calcium channel blocker that treats angina and hypertension
ditizem (Cardizem)
calcium channel blocker that treats angina, cardiac arrhymias and hypertension
verapamil (calen)
cardiotonics
increase the force of contraction to the heart to reverse cardiac symptoms
antiarrhythmics are used
correct arrhythmias of heart due to electrical abnormalties
antiarrhymics that maintains normal cardiac rhythm
quinidine (quinaglute)
antiarrhythmic that treats serious ventricular arrhythmias and is used a local anestheic
lidocaine (xylocaine)
antiarrhymic that treats life threating ventricular fibrillation
amiodarone (cordarone)
organic nitrates
relax smooth muscles of arteries and veins can be short or long acting
organic nirtrate that treats sudden onset of angina
nitroglycerin (short)
organic nitrate that treats or minimizes angina
nitroglycerine patch (long acting)
directics
reduce blood volume by urine excretion of water to treat hypertension
a diuretic that treats hypertension, edema and CHF
furosemide,(Lasix)
analgesics, antipyretics and anti-inflammatory drugs
reduce pain and fever from inflammation
a analgesics anti-inflammatory drug that treats moderate pain
ibroprofen (motrin, advil) NSAID, tyelonol, acetaminophen
analgesics anti-inflammatory drug that treats mild pain or fever, arthritic inflammatorycondictions and prevent thrombosis
aspirin, acetylsalicylic acid
opioid analgesics narcotics
control intense pain and anxiety
opioid analgesic that treats severe pain and can become dependent on
morphine sulfate, Demerol)meperidine hydrochloride), fentanyl
opioid analgesics
treat middle to moderate pain
opioid analgesics that treat milder pain
codeine, oxycodone
antianxiety drugs
treat anxiety and behavior disorders
antiaxiety drug that treats anxiety or seizures
lorazepan (ativan)or diazepam (valium)
drugs that affect blood
prevent thrombus from MI, strokes, PE or venous thrombiss
drug that affects blood that inhibits clot formation and maintain patency of venous catheters
heparin sodium
drug that affects blood that prevents emboli in chronic atrial fibrillation, deep vein thrombosis and heart valve damage
warfarin sodium
drugs that affect respiratory system to treat bronchospasm, asthma attacks and anaphylazis
epinephrine (adrenaline)
antihistamines are used to
treat anaphylactic shock, acute urticarial, edema, hypersensitivity, nausea and motion sickness
antihistamine to treat anaphylaxis
benadry (diphenhydramine) do not administer antihistamines to patients with asthma or who operate motor vehicnles
antacids
treat heart burn and indigestion by decreasing acidity and rate of GI emptying
antacid to treat cardiac arrest and reduce acidosis
sodium bicarbonate (aluminum hydroaxide)
glucocorticoids (hydrocortisone) cortef
replacement therapy of disease for adrenal glands or relief of inflammatory symptoms from allergic reactions that are severe and relief of stress from trauma
ionic hypaque cystoconrayll used for retrograde and VCUG has
high osmality
non ionic optiray isovue omipaque used for angio, ct, mye, arthro, retreogrades, cholang, ercp, ivp has
low osmality
what is a vasovagal reaction
pallor, cold sweats, rapid pulse, syncope, braydcardia, hypotension
what is expected side effects
flushed, warm, nausea, vomiting, headache, pain at injection side, metallic taste
what are mild adverse reactions
nausea, vomitning, cough, dizzy, warm, headache, shaking, pallor, itching
what are moderate adverse reactions
tachy,bradycardia, hyper.hypotension, dyspnea, bronchospasm, wheezing
what are severe allergic reactions
edema, seizures, cardiac arrthymia, cardiac arrest
closed fracture
simple fracture broken bone does not penetrate the skin
open fracture
compound fracture broken through the skin, longer to heal, surgery, high infection and non union
communited fracture
more than 2 fragements starburst, butterflu, segemntal
butterfly fracture
elongated trigular fragement detached from 2 other fragements
segemental fracture
segement of sharft is isolated by proximal distal lines of fracture
complete fracture
entire cross section discontinuity of 2 or more fragments (transverse, oblique, spiral, avulsion)
incomplete fracture
bone is cracked but not completely transverse width of the affected bone (green stick or torus)
longitudinal fracture
extends across long bone
linear fracture
parallel to long axis of bone no displaced tissue (hairline)
compression fracture
decrease in length and width wedge shaped , osteoporosis, collapse of vertebral body
impacted fracture
like compression, closed pressure at both ends into 2 fragements
depressed fracture
portions of fracture driven inwards
undisplaced fracture
bone break cracks bone and radiates into different directions but does not separate (linear, hairline)
displaced fracture
2 ends of long bone are separate from one another
dislocation
displacement, posterior for hips and anterior for shoulder most common
subluxation
incomplete or partial dislocation of bone or jt
bimalleolar fracture
aka potts transverse fracture of medial malleolus with low oblique fracture of distal fibula
trimalleolar fracture
fracture of ankle, medial malleolus, distal posterior tib the posterior malleous
blow out fracture
traumatic, medial orbital wall into max sinus
boxer fracture
transverse break at 5th metacarpal with palmer angulation
bennetts fracture
base of 1st metacarpal thumb
colles fracture
most common transverse fracture though distal radius with avulsion fracture of ulnar styloid displaced posterior (FOOSH)
jones fracture
transverse fracture of bases of 5th metartarsal
Jefferson fracture
communited fracture of ring of atlas of posterior and anterior arches
navicular fracture
scaphoid, most common, transverse at waist, sometimes seen 7-10 days later
smiths fracture
fracture f wrist with distal fragement radius displaced anteriorly falling backward on outstretched hand
intertrochanteric fracture
between greater and lesser trochanter
contra coup fracture
distant from side opposite side of the impact
stress fracture
aka march from repeated stress 2-3 metatarsals
epiphyseal fractures
easiest fracture salter harris to classify
monteggia fracture
fracture of proximal 1/2 of ulna wit dislocation of radial head, anterior dislocation of radius and elbow
galeazzi fracture
fracture of shaft of radius and dorsal posterior dislocation of ulna at the wrist
supracondylar fracture
fracture of humerus elbow in children
hangmans fracture
though pedicles of axia without displacement of c2-c3 from acute hyperextension
clay sholvers fracture
alvulsion fracture of spinous process in lower cervical and upper tspine
seat belt fracture
transverse fracture of lspine with visceral injuries
compound fracture
skin is disrupted and open
complete fracture
disconuityof 2 or more fragements
incomplete fracture
partial disconitnuty with portion cortex remaining in tact
avulsion fracture
small fragement from bony prominences result from indirect tension with attached ligaments
pathologic fracture
bone weakness from pathology
greenstick fracture
incomplete fracture with opposite cortex intact children
torus buckle fracture
one cortex intact with buckling or compaction of opposite cortex
bowing fracture
plastic deformation from stress
undisplaced fracture
plain of bone with angulation of seperation
displacement
serpation from bone
transitional vertebrae
at l-s spot, expanded transverse process, L1 vertebrae may have a rudimentary rib or transverse processo fC7
spina bifida
posterior defect of lamina, failure of posterior element to fuse properly, dimple of hair over lesions, no lamina with increased intrapedicular distance
herinieation of just meninges, have a club foot and bladder incontinence
meningocele
meniges and spinal cord protrude thru, chiari II malformation
myelomeningcele
marble bones, rare hereditary, failure of reabsorption of calcified cartilage interrupts normal replacement of bone , brittle bones, anemic, increase in bone density, increase atteuation
osteopetrosis
brittle bone disease, inherited, multiple fractures, blue sclera eye, thin cortices seen in different stages of healing mistaken for child abuse, bowing of the bones, lower factors, wide sutures
osteogenesis imperfecta
most common dwarfism, dimished cartilage growth plate, autosomal dominant affecting membraneous bone formation shorts limbs, saddle nose, prominent buttocks, jutting jaw, frontal bulging, widened metaphysis Erlenmeyer flask
achondroplasia
developemental hip dysplasia, incomplete acetabulum formation. in females, hip click and pop, legs are displaced anteriorly or posteriorly children waddle like a duck
congential hip dysplasia
chronic systemic disease, non suppurative inflammatory of the jts in the hands and feet, females over 40, symmetric, erosion of articular cartialage, poor defined margins, narrowing of joint spaces, subluxation and constrictures
rheumatoid arthritis
starts in si jts, bilateral, symmetric, blurred articular margins, patchy sclerosis, narrowing jt spaces, poker spine, bamboo spine, skeletal osteoporosis
ankylosing spondylitis
recative arthritis, young men with gi infections, bilateral, asymmetric, si jts, heels, feet
reiters syndrome
degenerative jt disease, loss of jt cartialage, new bone formation, wear and tear narrowing jt spaces, bone spurs and osteophytes in medial femorotibial compartment
osteoarthritis
inflammation of the bone marrow(myelitis), infectious, hematogenous spread from direct surgery, affects metaphysis, long bones rich in marrow, vertebrae, femur with swelling and fever, moth eaten appearance leading to necrosis, raises periosteum
bacterial osteomyletits
mass of bone decreases, bone removal and replacement, bones become lucent, need low kvp and short scale contrast, picture frame pattern
osteoporosis
osteoclastic
bone removal
osteoblastic
bone replacement
insufficient mineralization of skeleton failure of calcium and phosphorus deposition in bone matric from chronic kidney failure bones soften and bend bowing deformities
OSTEOMALACIA
childrens bones soften, not enough vit D, premature enfants ribs, tib, humerus, radius, ulna, metaphyseal ends become cup shaped and frayed with bowing
rickets
metabolism diease with increase in uric acid deposition in jts attacks the 1st metatarsal jt (big toe) first, punched out lesions , rat bite
gout
osteo deformans most common metabolic disorder destruction and repair, weakend thickened fracture easily, men, pelvis, femur, skull, clavicles, ribs , cotton wool appearance , ivory veretebrae picture frame, can develop osteosarcoma
pagets disease
most common place for pagets is
pelvis
hot spot
reparative
cold spot
destructive
loss of blood supply, repeated trauma, fracture, alcohol steroids, femoral head is the most common spot see a cresent sign a radiolucent band
ischemic necrosis of bone
exocytosis, benign projection of bone with a cartilaginous cap, teens, epiphyseal plate and grows laterally, can be malignant
osteochondromas
slow growing benign cartiliganous tumor in the medullary cavity, tumor destroys bone in the cartilage, hands and feet, thinning and scalloping the cortext leading to pathogical fractures, stippled speckled ring calcification with lucent matrx
enchondroma
osteoclastoma, in the distal femur or proximal tibia, young adults, lucent lesion in metaphysis extending to cortex but not jt, multiple large bubbles as it expands toward the shaft
giant cell tumor
osteomas
in outer table of skull, sinuses, well circumscbired dense round lesions no more than 2cm in diameter local pain that is worse at night
unicameral fluid filled wall o fibrous tissue in proximal humerus or femur in metaphysis, asymoptomatic, expanded lucent lesion, thin rim of sclerosis
simple bone cysts
numerous blood filled communications, cyst like lesion, prounounced ballooning of thinned cortex
aneurysmal bone cyst
solitary sharp areas of dense compact bone in pelvic or upper femora asymptomatic
bone islands
end of long bone in metaphysis (knee), spicules of calcified bone, 10-25yrs, pain, swelling, wt loss, anemia, pulomonary mets, sunburst pattern, elevated periosteum at periphery codmans triangle
osteogenic sarcoma
malignant tumor of cartilaginous origin, long bones orginate in ribs, scapula, vertebrae, slow growing has punched out calcification, scalloping and cortical destruction
chondrosacroma
primary malignant tumor in the bone marrow of long bones tumor in children and young adults, onion skin appearance, local pain, ill defined bone destruction in the central part of long bone
ewings sarcoma
disseminated malignancy of plasma cells associated with bone destruction, bone marrow failure, hypercalcemia, renal failure and reoccurring infections, 40-70yrs, tumors attack the intramedullary canal of the diaphysis, bence jones protein in urine, punched out osteolytic lesions on lateral skull views, affects axial skeleton
multiple myeloma
most common malignant tumor spread through blood and lymph or direct extension, breast, lung, kidney and thyroid, spread in red marrow, lucent lesions and poor defined margins, men its prostate and women its breast
bone mets
healing of fracture fragements in a faulty position leading to impairment of normal function
malunion
ill defined fracture that takes longer to heal from infection or not proper immbolization limited blood supply, loss of bone at fracture site
delayed union
healing stopped and fracture remains ununited, smooth well defined sclerosis at fracture margins will occultion of medullary canal
non union
most common dislocation
shoulder in anterior where it rests beneath the coracoid process
most common malignant tumor spread through blood and lymph or direct extension, breast, lung, kidney and thyroid, spread in red marrow, lucent lesions and poor defined margins, men its prostate and women its breast
bone mets
healing of fracture fragements in a faulty position leading to impairment of normal function
malunion
ill defined fracture that takes longer to heal from infection or not proper immbolization limited blood supply, loss of bone at fracture site
delayed union
healing stopped and fracture remains ununited, smooth well defined sclerosis at fracture margins will occultion of medullary canal
non union
most common dislocation
shoulder in anterior where it rests beneath the coracoid process
bones are joined together by
fibrous ligaments
there are 3 main types of fibrous joints
suture, gomphosis, syndemosis
suture
between the bones of the skull
gomphosis
peg and socket joint found between the teeth and jaw
syndesmosis
bones joined by a fibrous interosseous membrane, sm amt of movement found at tib fib jt
what is a joint or articulation
union or junction between 2 or more bones with or without movement
what are the 3 main joints
fibrous, cartilaginous, synnoviral
what is a cartilaginous joint
joints joined by layer of cartilage and bound by ligaments with no joint cavity with little or no movement
2 main types of cartilaginous jt
synchondrosis or primary
symphysis or secondary
what is a synchodrosis jt
bones joined by hyaline cartilage which is replaced by bone ex: jt between diaphysis or epiphysis
what is a symphysis or secondary cartilaginous jt
ends of long bone slightly moveable ex: pubis symphysis or intervertebral discs
diarthroses is
a synvovial freely moveable jt ex: knee
6 main synovial jts
hinge, pivot, saddle, ellipsoid, ball & socket, hindge
gliding jt
one bone over another small, carpals
hinge only 1 movement uniaxial
flexion & extension like elbow
pivot is
uniaxial rotation around the axis like c1-c2
saddle is
bi axial all movement like carpometacarpal
ellipsoid is
biaxial like the wrist joint
ball and socket is
multiaxial like the hip or shoulder
a fracture is seen as a
radiolucent line cross the bone
fractures in where the bone fragments overlap produce a
radiopaque line
what are the 2 major causes of fractures
traumatic or pathological
compression fracture is
associated with osteoporosis or compression with trauma.
what does a compression fracture look like
collapse of a vertebral body resulting in decrease in length or width in bone like a wedge
what is a depressed fracture
in the skull or tibial plateus
what is a impacted fracture
compression, where it is closed from pressure that was applied causes it to split in 2 pieces like a car accident or fall
dislocation of the the hips 85-90% are
posterior dislocations
;the most common dislocation of the shoulder is 95%
anterior
what is another name for a bimalleor fracture
potts fracture
what is a bimalleoar fracture
transverse fracture of medial malleolus
oblique fracture of distal fibular
what is a trimalleolar fracture
fracture of the ankle with lateral & medial malleolus and the distal posterior tibia (posterior malleolus)
what is a blow out fracture
from traumatic force in the orbital rim blowing out the floor of the maxillary sinus
what is a boxers fracture
transverse break in the neck of the 5th metacarpal with palmar angulation
strike with the clenched fist
what is a contracoup fracture
occurs distant from the site of injury ex: car accident
what is another name for the epiphyseal fractures
salter harris
what is a epiphyseal fracture
fracture throught the epiphyseal plate in 5 ways
type 1 salter harris fracture is
complete epiphyseal fracture with or without displacement
type 2 salter harris fracture
epiphyseal fracture extends thru metaphysis producing a chip
type 3 salter harris fracture
epiphyseal fracture extending thru epiphysis
type 4 salter harris fracture
ephiphyseal fracture plus epiphyseal &* metaphyseal fractures
type 5 salter harris fracture
compression fracture in the growth plate
what is a monteggia fracture
fracture of proximal 1/2 ulna, dislocation of the radial head
what is the most common fracture in children of the elbow
supracondylar fracture
what is a bennetts fracture
fracture at the base of the metacarpal bone into the carpometacarpal jt
colles fracture
foosh, transverse fracture of distal radius with lower fragment being displaced backwards
smiths fracture
reverse of a colles fracture
fracture of wrist with distal fragment of the radius displaced anteriorly from falling backwards on a outstretched hand
intertrochanteric fracture
fracture in 1 where the fracture line lies between the greater and lesser trochanter. has a good blood supply to cancellous bone
hangmans fracture
occurs through the pedicle of the axis of c2 with or without displacement of c2 or c3
pathological fracture happens because of
weakned diseased bone
what is malunion
poor positioning of fracture result in decrease in function or loss of use
what is transitional vertebrae
vertebrae that has characteristics of vertebra above and below it (congential)
where is transitional vertebrae found
T or Lspine or lumbosacral jt
what are chracteristics of transitional vertebrae
1st lumbar vertebrae may have rudimentary ribs or C7
what is spina bifida
defect in the posterior lamina of spinal canal form incomplete closure of the vertebral canal
what is the mildest form of spina bifida
occulta at L5/S1
what happens with larger defects of spina bifida
absence of lamina may have meningocele or myelomenigocele with a slight dimple or tuft of hair over the lesion
what are the characteristics of spina bifida
absence of lamina with increased interpedicular distance
what is another name for osteopetrosis
marbal bones
what is osteopetrosis
hereditary, increase in bone density
bones are heavy with no absorption, brittle with stress fractures
what does osteopetrosis look like
increased density and thickness of the bony cortex need to increase kvp
what is osteogenesis imperfecta
inherited connective tissue disorder from not enough collagen with multiple fractures
what is another name for osteogenesis imperfecta
brittle bone disease
what are some characteristics of OI?
flattening of the vertebral bodies, ribs and long bones wormian bones of the skull, fractures in varies stages of healing need to decrease kvp
what is achondroplasia?
most common inherited disorder of the skeletal system, dwarfism
what happens in achondroplasia
no growth plate or minimal, impaired longitudinal growth
what are the characteristics of achondroplasia
short limbs, large forehead, bowed legs, prominent buttocks and normal size trunk
what does achondroplasia look like
narrowing of interpedicular distance, scalloping of posterior vertebral bodies, wide metaphysis
what is congential hip dysplasia
incomplete formation of the acetabulum in utero the head of the femur is displaced superiorly or posteriorly
what is another name for CHD
DDH developmental dysplasia of hip
what are the chracteristics of CHD
when the hip is moved it clicks or pops
what is polydactyly
more than normal number of digits on hand or feet
what is syndactyly
webbed toes or fingers
what is rheumatoid arthritis
chronic, systemic disease, autoimmune, non suppurative arthritis
what does rheumatoid arthritis include
hands, feet first then all joints
what does RA look like
inflammation, overgrowth of synovial tissue more common in women, symmetric joint destruction erosion with narrow joint spaces or subluxation or dislocation
what is juvenile RA
children under 16
aka stills disease
what is another name for ankyosing spondylitis
marie strumples disease
what is ankylosing spondylitis
arthritis that is progressive in the spine like the SI jts
with lower back pain, fever weight loss and fatigue in men
what does ankyolosing spondylitis look like
bamboo spine between the vertebral bodies, narrowing of the articular margins, fibrous adhesions
what is osteoarthritis
aka degenerative jt disease broken into primary or secondary
what is primary OA
jt cartilage destruction that occurs with normal wear and tear
what is secondary OA
from bone stress or trauma, arthritis ,
what does OA affect
large weight bearing jts like, hips, knees and ankles . fingers develop knobs, narrowing of the jt space small bony spurs, osteophytes, loss of articular cartialge
what is osteomyelitis
bacterial infection of the bone marrow caused from pathogenic microorganism spread by blood. get fever. swelling, tenderness
what does osteomyelitis look like
localized edema, bone erosion, moth eaten appearance that elevates the periosteum, necrotic bone “sequestra”
what is osteoporosis
loss of bones mass from accelerated resorption of bone from reduction in bone formation greater risk for fractures
what does osteoporosis look like
bone is more lucent (osteopenic) with cortical thinning from resorption of inner surface, picture frame pattern , compression fractures are common
what is osteomalacia
adult rickets from decrease in amt of calcium in the body failure to absorb calcium , get bowing of the bones
what does osteomalcia look like
decrease in bone calcification, increased trabeculation of spongy bone
what are rickets/ scurvy
child form disappearance of trabecular marking and thin cortexs around the knees and wrist
most common fracture in kids from rickets
GREEN STICK
what is gout
protein metabolism where excessive amts of uric acid are produced and deposited in the jts, kidneys, cartilage affetcs the 1st metatarsophalangeal jt
what does gout look like
joint effusion, crystal deposits, eroding underlying bone rat bites
what is pagets disease
aka osteitis deformans
metabolic disorder in 40+
chornic destruction and repair of bone
what bones does pagets affect
pelvis, spine, skull, femur, tibs, clavicles
what does pagets look like
cottong wool appearance, areas of lucency, matric is thicker but softer, nuc med to diagnose
what is acromegaly
endocrine disorder hyperpituatarism, excessive production of growth hormone results in pituitary adenoma
hyperpitutarism is
before bone growth has stopped called gigantism,
what does acromegaly look like
thick bones of skull enlarged sinuses & occipital proturbance, mandible, enlarged sella turica, MRI to diagnose the tumor
what is ischemic necrosis of bone
aka aseptic necrosis, avascular necrosis
what causes ischemic necrosis
bone death from poor blood supply to area most common in hip and shoulder can affect wrist, elbow or ankle
from trauma, steroids, sickle cell disease, alcohol, radiation therapy thrombosis
what does ischemic necrosis look like
creasent sign multiple lytic and sclerotic areas with flat femoral heads
what is legge calve perthe’s disease
avascular necrosis of the femoral head of 3-10years
ball of hip jt dies and becomes flat from lack of blood supply
what is osteochondritis dissecans
joint condiction where a piece of cartilage with a thin layer of bone beneath it becomes loose from end of the bone affects the knee from lack of blood supply. jet joint locking or popping
what is Osgood schlatters disease
overuse of injury to the knee in growing teens
tibial tuberosity becomes inflamed pain with swelling
boy 10-15
what does Osgood schlatters disease look like
elevation of the tibial tuberosity, with swelling
what is osteochondroma
most common benign tumor in the growth plate of dital femur and prox tibia
what does osteochondroma look like
bone growth parallel to main bone and points away from the nearest joint (exostosis)
what is enchondromas
slow growing cartilage tumor in the medullary cavity affects hands and feet leads to fractures
what does enchondroma look like
cortica thinning and calcifications with in the lesions , stippled apperance
what is a giant cell tumor
aka osteoclastomas
distal femur and prozimal tibia lucent lesion sin the metaphysis
multiple large bubbles
what is a osteoma
in the outer skull and sinueses of mandible a dense round lesion
what is osteoid osteoma
teens, pain that gets worse at night but relieved with aspiring found in ttib and femur
small lucent centers
what is a simple bone cyst
fluid filled at metaphyses of femur and humerus
radiolucent with well defined margin
what is a aneurysmal bone cyst
pain and swelling with cortical thinning with ballooning
what is osteogenic sarcoma
in metaphyses osteoblasts produce spicules
ages 10-25
malignant with pain and swelling
sunburst appearance, codmans triangle with raised periosteum
what is chondrosarcoma
cartilaginous origin numerous calcification within the matrix
what is ewings sarcoma
in the bone marrow
teens to 30
local pain ill defined bone
onion skin appearance
what is multiple myeloma
widespread maglinancies of the bone 40-70
in the diaphysis
osteolytic lesions through out the skeleton
red marrow is affected
what is bone metastases
most common malignant bone tumors
spread from a primary tumor b yblood, lymph or seeding
common in breast, lung, prostate, kidney or thyroid
get sclerotic lesions with ivory vertebra
what is spondylolysis
cleft or erosion in para interarticularis bilateral at L5 no displacement
what is spondylolisthesis
anterior subluzation of vertebral body
fwd displacement with par interarticularis defect
seen on oblique views
