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Abd / SS > Module 14 : Abdominal Wall > Flashcards

Module 14 : Abdominal Wall Flashcards

1
Q

indications for abdominal wall ultrasound

A
  • palpable mall
  • surgical wound assessment
  • trauma
  • findings on other modalities
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2
Q

scanning techniques

A
  • high frequency linear transducer
  • minimal pressure (standoff pad needed)
  • no patient prep needed
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3
Q

abdominal wall layers

A
  • epidermis
  • subcutaneous tissue
  • muscle
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4
Q

epidermis

A
  • 1-4mm thick

- highly reflective appears echogenic

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5
Q

subcutaneous layer

A
  • fat
  • variable thickness and echogenicity
  • typically less echogenic than muscle
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6
Q

factors that influence the echogenicty of fat

A
  • water content

- increase water increase echogenicity

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7
Q

muscle layer - anterior and lateral

A
  • rectus abdominus
  • linea alba
  • arcuate line
  • external oblique
  • internal oblique
  • transversus abdominus
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8
Q

rectus abdominus

A
  • paired midline MOST ANTERIOR
  • originates at symphysis pubis and pubic crest and inserts into the diploid process
  • separated by line alba in middle
  • rectus sheath encloses the RA muscle formed by the aponeuroses of internal and external and transverses abdominus
  • contains 3 tendinous insertions that attach rectus sheath anteriorly = localize hemtomas
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9
Q

aponeuroses

A
  • flat sheet of strong fibrous connective tissue that serve as tendons to attach muscle to fixed points
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10
Q

linea alba

A
  • fibrous band that extends from the diploid to symphysis pubis
  • formed by aponeuroses of 3 lateral abdominal muscles
  • wider above umbilicus
  • echogenic
  • creates refractive duplication artifact
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11
Q

arcuate line

A
  • point between umbilicus and symphysis pubis where posterior portion of rectus sheath passes in front of rectus muscle
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12
Q

external oblique

A
  • outer layer
  • origin = outer surface of lower 8 ribs
  • runs diagonally (outer jacket pocket)
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13
Q

internal oblique

A
  • lies deep to external oblique
  • runs in diagonal fashion 90’ to external
  • inner jacket pocket
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14
Q

transversus abdominus

A
  • deep to internal oblique
  • run horizontal
  • innermost
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15
Q

sonographic appearance of muscle

A
  • hypo echoic to sonolucent
  • specular reflectors
  • striated
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16
Q

muscle layer - posterior wall

A
  • psoas major
  • quadratus lumborum
  • iliacus
17
Q

psoas major

A
  • fan shaped
  • origin = sides of vertebral column
  • inserts = lesser trochanters of femur
  • appears hypo echoic and lateral to spine
18
Q

quadratus lumborum

A
  • posterolateral to psoas
  • flat muscle
  • origin = iliac crest
  • inserts = 12th rib and upper 4 lumbar vertebrae
  • directly posterior to kidney
19
Q

iliacus

A
  • origin = iliac fossa sacrum and SI joint

- inserts = psoas major and lesser trochanter

20
Q

inguinal canal

A
  • obliquely oriented tunnel
    + runs inferior and medial
  • slit like passage way
  • opening at each end
    + deep intgional ring / internal
    + superficial inguinal ring / external
  • contains spermatic cord and round ligament
  • anterior wall formed by aponeurosis of external oblique
  • posterior wall formed by transversalis fascia
21
Q

deep inguinal ring / internal

A
  • opening at superior end of canal
  • midway between anterior superior iliac spine ASIS and symphysis pubis
  • defect in transversalis fascia
22
Q

superficial inguinal ring / external

A
  • opening at inferior end of canal

- through external oblique aponeurosis

23
Q

diaphragm

A
  • dome shaped partition separating the thorax from abdominal cavity
  • muscle and tendon
  • major active muscle of respiration
  • originates at periphery of thoracic cage with 3 groupf of muscle fibre
    + lumbar spine (crura)
    - right = broader and longer
    - join in midline to form arcuate ligament
    + lower sternum
    + lower 6 ribds
  • 3 groups coverage radially and insert into central tendon
24
Q

diaphragm on ultrasound

A
  • highly echogenic arc
25
Q

crura on ultrasound

A
  • thin hypo echoic band
  • superior to celiac axis - anterior to aorta
  • at celiac axis lateral to aorta
  • poster to IVC
26
Q

2 scanning approaches to assess pleural space

A
  • abdominal approach (subcostal)

- intercostal

27
Q

2 windows used when scanning inferior aspect of pleural space - abdominal approach

A
  • liver

- spleen

28
Q

normal thickness of diaphragm

A
  • 5 mm
29
Q

mirror image artifact

A
  • evidence of absence of pleural effusion

+ if no reflection then fluid in pleural space

30
Q

distance of pleural space to rib interface - intercostal

A
  • pleural space within 1 cm from rib interface
31
Q

visceral pleura ultrasound

A
  • on the lungs
  • bright linear interface
  • moves with respiration
32
Q

parietal pleura ultrasound

A
  • weak echogenic line or obscured

- hypo echoic separation of parietal and visceral pleural

33
Q

gliding sign

A
  • visceral pleura moving with long during respiration

Abd / SS (14 decks)

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