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Term 1 > Normal Anatomy (Midterm) > Flashcards

Normal Anatomy (Midterm) Flashcards

1
Q

Intersegmental

A

-definite division between borders (ex. hepatic veins)

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2
Q

Intrasegmental

A

-border between is unclear (ex. portal veins)

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3
Q

What should the liver measure, and where do you measure?

A
  • 13 to 17 cm

- measure posterior/superior to anterior/inferior

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4
Q

What is the shape of the Lt lobe of the liver?

A

-flag shaped

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5
Q

How does the liver appear?

A
  • echogenic
  • homogenous
  • smooth contour
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6
Q

How does the liver look compared to the spleen?

A

-the liver is hypoechoic to the spleen

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7
Q

How does the liver look compared to the kidney?

A

-the liver is hyperechoic or isoechoic to the kidney

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8
Q

What is the difference in appearance of hepatic veins and portal veins and their walls?

A

Hepatic Veins:
-larger and wider as they get closer to IVC

Portal Veins:

  • very parallel
  • look more echogenic
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9
Q

Vasculature of Liver

A
  • hepatic veins
  • portal veins
  • hepatic arteries
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10
Q

What does the falciform ligament separate?

A

-Rt and Lt lobes

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11
Q

What does the ligamentum venousum separate?

A

-Lt lobe from caudate lobe

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12
Q

Which ligament divides the Lt lobe into medial and lateral?

A

-ligamentum teres (round ligament)

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13
Q

Where is the hepatoduodenal ligament?

A

-porta hepatis (enterance to liver)

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14
Q

Where is the gastrohepatic ligament?

A

-connects lesser curvature of stomach to the liver

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15
Q

What do the Rt and Lt triangular ligaments do?

A

-connect the liver to body wall

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16
Q

Bare Area

A
  • posterior, superior aspect of liver
  • direct contact with diaphragm
  • only part of the liver not covered by peritoneum
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17
Q

Main Lobar Fissure

A
  • roughly divides liver into Lt and Rt
  • MHV and MPV run within it
  • echogenic line that runs from GB to RPV
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18
Q

What does the LHV separate?

A

-Lt lateral and Lt medial lobes

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19
Q

What does the RHV separate?

A

-Rt anterior and Rt posterior lobes

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20
Q

What does the MHV separate?

A

-left and right lobes

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21
Q

What are the 3 lobes of the liver?

A

1) left
2) right
3) caudate

4) quadrate (sometimes 4)

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22
Q

What is the most basic way to divide the liver?

A

-Lt and Rt lobes

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23
Q

Portal Triad

A
  • hepatic arteries
  • portal veins
  • bile ducts
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24
Q

Porta Hepatis

A
  • proper hepatic artery
  • main portal vein
  • common bile duct
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25
Q

Gallbladder Layers

A
  • fibrous outer layer (outer layer)
  • smooth muscle layer (mid)
  • mucous membrane (inner)
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26
Q

What is the best imaging modality for the biliary system?

A

-ultrasound

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27
Q

What should the CBD measure?

A

-less than 7mm

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28
Q

Couinaud’s Segments

A
  • universal description for hepatic lesion localization
  • based on portal segments
  • functional and pathological importance
  • each segment has: blood supply, lymphatic and biliary drainage
  • 8 segments
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29
Q

Which segment is the left lateral superior?

A

2

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30
Q

Which segment is the Lt lateral inferior?

A

3

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31
Q

Which segment is the Lt medial superior?

A

4A

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32
Q

Which segment is the Lt medial inferior?

A

4B

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33
Q

Which segment is the Rt anterior superior?

A

8

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34
Q

Which segment is the Rt anterior inferior?

A

5

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35
Q

Which segment is the Rt posterior superior?

A

7

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36
Q

Which segment is the Rt posterior inferior?

A

6

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37
Q

Which segment is the caudate lobe?

A

1

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38
Q

Function of the Liver

A
  • detoxification
  • metabolic break down
  • remove old blood cells
  • recycle iron
  • secrete bile (approx. 1/2 pint per day)
  • stores substances (vitamin A, vitamin B12, vitamin D and iron)
  • production of plasma proteins
  • hematopoiesis (in fetal life)
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39
Q

Which 3 cells is the liver composed of?

A
  • functioning hepatocytes
  • kupffer cells
  • biliary epithelial cells
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40
Q

Functioning Hepatocytes

A
  • detoxification

- form bile (aids in digestion of fats)

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41
Q

Kupffer Cells

A
  • also found in spleen
  • immunity
  • protect hepatocytes
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42
Q

Biliary Epithelial Cells

A

-lines the biliary ducts

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43
Q

Dual Blood Supply of Liver

A
  • portal veins

- hepatic arteries

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44
Q

Portal Veins (Hepatic Circulation)

A
  • supply up to half the oxygen requirements (even though the portal venous system is completely oxygenated)
  • provides 70 to 80% of the blood supply
  • greater flow
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45
Q

Portal System

A
  • transports nutrients from intestines to liver
  • hepatocytes metabolize and store
  • blood is filtered in the liver before it dumps into systemic circulation
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46
Q

Hepatic Arteries

A
  • accompany PV’s
  • very small compared to PV’s
  • not well seen in US
  • 20 to 30% of liver’s blood supply
  • provide oxygen to the liver
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47
Q

Ducts

A
  • carry bile (helps with digestion)
  • very small within the liver (sometimes seen along PV’s)
  • bile is brought by these ducts to the duodenum to help digest food
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48
Q

Location of GB

A
  • intraperitoneal
  • lies within ‘GB fossa’
  • RUQ
  • posterior inferior aspect of liver
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49
Q

Main Lobar Fissure

A
  • separates Rt and Lt lobes
  • extends origin of RPV and the GB fossa
  • fissure seen in approx. 70% of patients
  • landmark for GB fossa
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50
Q

What parts is the GB divided into?

A
  • fundus
  • body
  • neck
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51
Q

How does the GB connect to the biliary system?

A

-cystic duct

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52
Q

Which 2 ducts join to form the CBD?

A
  • cystic duct

- common hepatic duct

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53
Q

Cystic duct

A
  • contains valves of Heister (mucosal folds that prevent it from collapsing)
  • extrahepatic
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54
Q

Bile

A
  • secreted by liver
  • stored and concentrated by GB
  • aids in digestion, especially breaking down fat
  • biliary tree excretes bile into duodenum
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55
Q

What happens to the GB after eating?

A

-contracts and the bile travels via ducts to the duodenum

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56
Q

Which hormones stimulate the biliary tree to contract?

A
  • CCK

- secretin

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57
Q

GB Function

A
  • able to expand
  • acts as a reservoir
  • squeezes out contents on demand
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58
Q

What is the normal size of the GB?

A

-less than 4cm transverse

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59
Q

What is the normal wall thickness of the GB?

A

-less than 3mm

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60
Q

What is the echogenicity of the GB?

A
  • lumen is anechoic

- walls are hyperechoic or echogenic

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61
Q

What is the contour of the GB?

A

-smooth

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62
Q

What is the sonographic appearance of the GB in sagittal?

A
  • anechoic, pear shaped structure
  • echogenic walls
  • in SAG should see whole length (neck, body, fundus)
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63
Q

What is the sonographic appearance of the GB in TRV?

A
  • round/oval anechoic structure
  • echogenic walls
  • appears similar to the AO and IVC
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64
Q

How will a non fasting GB appear?

A
  • non distending
  • anechoic lumen, but can contain echoes
  • thicker walls
  • can be mistaken for bowel or a pathology
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65
Q

What are typical patient positions for the GB?

A
  • supine

- Lt lateral decubitus

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66
Q

Which windows are used for the liver?

A
  • anterior (subcostal approach)

- intercostal

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67
Q

What may cause difficulty while scanning the GB?

A
  • reverberation

- bowel gas

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68
Q

What can affect the size of the CBD?

A
  • age

- surgery

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69
Q

Normal Embryology of GB

A
  • first is intrahepatic and migrates to liver surface

- 50 to 70% covered with adventitial tissue (common area to see edema)

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70
Q

Intrahepatic GB

A
  • anomaly
  • if GB does not migrate
  • very rare
  • may pose problems for laparoscopic surgery
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71
Q

Torsion of GB

A
  • anomaly
  • GB fully enveloped in visceral peritoneum
  • hanging from mesentery
  • increased mobility
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72
Q

Agenisis GB

A
  • anomaly

- rare

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73
Q

Ectopic Positions GB

A
  • anomaly

- suprahepatic, suprarenal, within abdominal wall, in falciform ligament

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74
Q

Septate GB

A
  • normal variant

- 2 or more intercommunicating compartments divided by thin septa

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75
Q

GB Duplication

A
  • usually occurs with duplication of cystic duct
  • normal variant
  • 2 non communicating anechoic structures
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76
Q

Phrygian Cap

A
  • normal variant in GB
  • kink in fundus
  • looks like smurfs hat
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77
Q

What is a normal variation of ducts in the GB?

A

-CHD/CBD is seen inferior to the HA

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78
Q

Are the kidneys intraperitoneal or retroperitoneal?

A

-retroperitoneal

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79
Q

Which quadrant are the kidneys located in?

A

-RUQ

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80
Q

Where does the spleen lie in relation to the Lt kidney?

A

-superior

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81
Q

Where does the liver lie in relation to the Rt kidney?

A

-superior and anterior

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82
Q

External Layers of Kidney’s

A

1) renal capsule (aka true capsule, fibrous capsule)
- tough fibrous capsule

2) perirenal fat (aka perinephric fat, adipose capsule, packing fat of zuckerkandl)
- surrounds capsule

3) gerota’s fascia (aka perirenal fascia, perinephric fascia)
- anchor’s the kidney’s

4) pararenal fat/body

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83
Q

Anterior Pararenal Space (retroperitoneum)

A

-fat area between the posterior peritoneum and Gerota’s fascia

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84
Q

What organs and vessels are in the anterior pararenal space (retroperitoneum)?

A
  • pancreas
  • descending duodenum
  • ascending and descending colon
  • superior mesenteric vessels
  • inferior portion of CBD
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85
Q

Posterior Pararenal Space

A

-between gerota’s fascia and the posterior abdominal wall muscles

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86
Q

What is the the posterior pararenal space?

A
  • iliopsoas
  • QL
  • posterior abdominal wall
  • fat
  • nerves
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87
Q

Perirenal Space

A

-separated from the pararenal space by gerota’s fascia

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88
Q

What is in the perirenal space?

A
  • kidneys
  • adrenal glands
  • perinephric fat
  • ureters
  • renal vessels
  • aorta and IVC
  • lymph nodes
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89
Q

What do the pararenal and perirenal fat accommodate for?

A

-movement during respiration

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90
Q

What 2 areas is the kidney divided into?

A
  • renal parenchyma

- central sinus

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91
Q

Renal Parenchyma

A
  • cortex

- medulla

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92
Q

Central Sinus

A
  • renal sinus
  • renal hilum
  • inner aspect
  • blood vessels
  • renal pelvis
  • nerves
  • fat
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93
Q

Renal Cortex

A
  • outer portion

- superficial layer of parenchyma

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94
Q

Medulla

A
  • deep layer of parenchyma
  • folds into projections (renal pyramid)
  • renal pyramids
  • renal columns
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95
Q

Renal Pyramids

A
  • cone shaped (triangular) sections in medulla parenchyma
  • 8 to 18
  • base of pyramids is toward the outer kidney
  • apices (tip) converge toward sinus
  • renal papilla at the apices
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96
Q

Where are the renal columns?

A

-between the renal pyramids

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97
Q

Renal Hilum

A
  • where the ureter, renal artery and renal vein leave the kidneys
  • renal sinus is continous with the hilum
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98
Q

Are kidneys vascular?

A

-highly

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99
Q

What is the collecting system of the kidney?

A

-where urine flows out and makes it’s way to the bladder, then out of the body

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100
Q

Parts of the Collecting System Within the Kidney

A
  • minor calyces
  • major calyces
  • renal pelvis
  • ureter
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101
Q

Kidney Contour

A

-smooth borders

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102
Q

Kidney Shape

A
  • bean shape
  • convex laterally
  • concave medially
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103
Q

Kidney Size

A
  • 11 cm in length

- varies with size of person and age

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104
Q

Parenchymal Reduction

A
  • cortex of kidney (outer layer) decreases with age

- measure of AP thickness

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105
Q

Echogenicity of Kidney

A
  • hypoechoic or isoechoic to the liver

- hypoechoic to spleen

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106
Q

How would you determine if you are backwards in sagittal and transverse when scanning the kidney?

A

-hilum would be facing laterally, instead of medially

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107
Q

How do I know if I am sagittal medial, lateral or longest length?

A

medial- can see hilum

lateral- no hilum

-sweep back and forth to find longest axis

108
Q

What should a TRV kidney look like?

A

upper pole- cortex and sinus

mid- at hilum

lower pole- cortex and sinus

109
Q

Where do the adrenal glands sit?

A

-medial aspect of kidneys

110
Q

Where is the Rt adrenal gland located?

A
  • between IVC and UP of kidney

- near liver

111
Q

Where is the Lt adrenal gland located?

A
  • near diaphragm

- superioposterior border of spleen

112
Q

What is another name for the adrenal glands?

A

-suprarenal

113
Q

2 Main Parts of Adrenal Glands

A

Cortex

  • 3 layers
  • endocrine tissue
  • coricosteroids

Medulla

  • neurosecretory tissue
  • catecholamines
114
Q

Function of Adrenal Glands

A
  • regulate homeostasis
  • sodium and water balance
  • fight or flight response
115
Q

Adrenal Gland Lab Tests

A
  • aldosterone

- cortisol

116
Q

Why don’t we routinely image the adrenal glands in adults?

A

-difficult to visualize (small)

117
Q

Why is it important to know the location of the adrenal glands?

A

-abnormalities can be detected with US

118
Q

What do the adrenal glands look like on US in adults?

A

-thin hypoechoic layers, separated by hyperechoic layers

119
Q

What do adrenal glands look like on paediatric patients?

A
  • larger
  • well visualized
  • pyramid shape
120
Q

Renal Functions

A

1) urine formation
- #1 function
- excrete metabolic waste from blood in the form of urine
2) homeostasis
- regulates water/salt and acid/base balance
3) endocrine gland
- secretes hormones

121
Q

Basic Functional Unit of the Kidney’s

A
  • nephron
  • approx. 1 million (microscopic)
  • filter blood
  • in the cortex and medulla
122
Q

Cortical Nephron

A
  • in cortex

- shorter loop of henle

123
Q

Juxtamedullary Nephrons

A
  • in medulla

- longer loops of henle

124
Q

What is the renal corpuscle also known as?

A
  • glomerulus

- bowman’s capsule

125
Q

Where is the loop of henle located?

A

-medulla

126
Q

What happens in the nephron?

A

Filtration: filters blood, produces urine

Tubular Reabsorption: substances needed by the body are reabsorbed into the blood

Tubular Secretion: waste products and excess water pass into collecting ducts as urine

127
Q

What percentage of renal function may be lost before blood levels will be elevated on tests?

A

50%

128
Q

Serum Creatinine

A
  • formed in muscle in small amounts, passed into blood and excreted in urine
  • increased creatinine causes a disturbance in function
129
Q

BUN (blood urea nitrogen)

A

Urea- end product of protein metabolism (normally low)

BUN level increase = function or perfusion impared

  • dehydration
  • urinary tract obstructions
  • mental confusion, disorientation or coma
130
Q

Transient Pyelectasis

A
  • normal
  • when patient drinks a lot of water (well hydrated)
  • calyces and pyramids are more anechoic and prominent
  • resolve’s after patient pees
  • not normal if the whole collecting system is anechoic
131
Q

3 Sets of Kidney’s in Embryo

A

1) pronephros
2) mesonephros
3) metanephros

132
Q

Pronephroi

A
  • early in 4th week gestation

- rudimentary and nonfunctioning

133
Q

Mesonephroi

A
  • late in 4th week

- function as interim kidney’s

134
Q

Metanephroi

A

-permanent kidneys

135
Q

What do the metanephroi (permanent kidney’s develop from)?

A
  • ureteric bud

- metanephrogenic blastema

136
Q

Ureteric Bud

A
  • ureter
  • renal pelvis
  • calices
  • collecting ducts

-ureteric bud interacts with and penetrates the metanephrogenic blastema

137
Q

Hypertrophied Column of Bertin (HCB)

A
  • normal variant
  • usually on upper and middle thirds of kidney
  • renal cortex is continuous with adjacent cortex
  • contain pyramids
138
Q

Junctional Cortical (parenchymal) Defect

A
  • normal variant
  • located anteriorly and superiorly
  • traced medially to inferiorly into renal sinus
139
Q

Extrarenal Pelvis

A
  • normal variant

- mildly dilated UPJ medial to hilum

140
Q

Dromedary Hump

A
  • normal variant
  • bulge on lateral aspect of kidney
  • not clinically significant
141
Q

Lower Urinary System

A
  • ureters and urethra function as a conduit’s

- bladder functions as a reservoir for urine

142
Q

How long are the ureters?

A

-approx 25 to 30 cm

143
Q

Where do the ureters course?

A
  • inferiorly behind the parietal peritoneum
  • anterior to the psoas
  • crosses iliac vessels anterior to the SI joint
  • enters inferior bladder
144
Q

What are the layers of the ureters?

A
  • inner mucosal layer
  • medial layer of longitudinal and circular smooth muscle
  • outer fibrous layer
145
Q

Function of Ureters

A

-transorts urine to bladder by urethral peristalsis

146
Q

Proximal Ureter

A
  • leaves kidney

- UPJ (ureteropelvic junction)

147
Q

Distal Ureter

A
  • enters bladder

- UVJ (ureterovesicle junction)

148
Q

Where is the bladder located?

A
  • pelvic cavity
  • retroperitoneal
  • female: anterior to vagina, superior to uterus
  • male: superior to prostate
149
Q

Bladder Wall

A
  • smooth muscle

- inner layer forms folds (rugae)

150
Q

Trigone

A
  • ureters (corners)

- urethral opening (anterior, lower corner)

151
Q

Function of the Bladder

A
  • reservoir for urine

- expels urine from the body (aided by urehra)

152
Q

Bladder Volume (cc) =

A

(L x W x H) x 0.523

153
Q

How is the bladder measured?

A

SAG: long axis, diagonally
TRV: measure AP (height) and Rt to Lt (width)
-prevoid and postvoid volume

154
Q

What does colour doppler help with when scanning the bladder?

A
  • shows ureter jets at the UVJ

- aids in proving no obstruction

155
Q

What happens when the bladder grows?

A
  • distal mesonephric ducts become part of the CT in trigone

- ureters open into bladder

156
Q

Anomalies Related to Growth of the Urinary Tract

A
  • hypoplasia
  • fetal lobulation
  • compensatory hypertrophy
157
Q

Hypoplasia

A
  • under development
  • small kidneys
  • reduced nephrons
158
Q

Persistant Fetal Lobulation

A
  • normally present in children until 4 to 5 years of age
  • persists in some adults (51%)
  • smooth indentations
159
Q

Compensatory Hypertrophy

A
  • diffuse or focal
  • diffuse: contralateral nephrectomy, renal agenesis, renal hypoplasia, renal atrophy, renal displasia
  • focal: area of normal tissue enlarged in diseased kidney (looks like a mass)
160
Q

Anomalies Related to Ascent of Kidney

A
  • ectopia
  • crossed renal ectopia
  • horseshoe kidney
161
Q

Renal Ectopia

A
  • not in normal location
  • pelvis or thorax
  • no symptoms
  • 50% of ectopic kidneys have reduced function
162
Q

Possible Complications of Renal Ectopia

A
  • infection
  • stones
  • blunt trauma
163
Q

Renal Ectopia US

A

-not within renal fossae

164
Q

Crossed Renal Ectopia

A
  • displacement of 1 kidney to the opposite side
  • 2 forms: fused (85% to 90%) OR lying on 1 side without fusion
  • Lt kidney going to Rt is more common
165
Q

Horseshoe Kidney

A
  • fused lower poles at midline
  • cancerous tumours are more likely to appear
  • no treatment necessary if no symptoms
  • may need surgery if symptoms
166
Q

Symptoms of Horseshoe Kidney

A
  • abd pain
  • nausea
  • stones
  • UTI
167
Q

Horseshoe Kidney US

A
  • lower level than normal

- bridge of renal tissue (isthmus) connecting 2 kidneys

168
Q

Renal Agenesis

A
  • failure of formation

- unilateral or bilateral

169
Q

Causes of Renal Agenesis

A
  • anomaly of urethral bud
  • absense of metanephrogenic blastema
  • absense of urethral bud development
  • absense of interaction and penetration of the urethral buds with metanephrogenic blastema
170
Q

Supernumery Kidney

A
  • anomaly of urethral bud
  • rare
  • extra kidney (smaller)
  • location above, below or in front of normal kidney
  • can be functioning
171
Q

Symptoms of Supernumery Kidney

A
  • pain
  • fever
  • hypertension
  • palpable abd mass
172
Q

Duplex Ureter System and Uretrocele

A
  • complete or incomplete
  • unilateral or bilateral
  • congenital abnormality in distal ureter
  • distal ureter balloons at UVJ forming a sac like pouch
  • associated with duplication of collection system
173
Q

Duplex Collecting System Complications

A
  • uretral obstruction

- reccurent UTI’s

174
Q

Treatment for Duplex Collecting System

A

-surgery

175
Q

Congenital Megaureter

A
  • more common in males
  • results in functional ureteric obstruction
  • Lt ureter is more common
176
Q

Retrocaval Ureter

A
  • abnormal embryogenesis of IVC
  • ureter passes behind IVC before entering the pelvis
  • usually Rt
  • more common in males
  • symptoms: Rt flank pain and UTI
177
Q

Bladder Agenesis

A
  • very rare anomaly

- stillborn

178
Q

Bladder Duplicaion

A

3 Types:

1) peritoneal fold
2) internal septum
3) transverse band: band of muscle that divides bladder into 2 cavities

179
Q

Bladder Extrophy

A
  • part of the bladder is present outside the body
  • often inside out
  • more common in males
  • failure of abd wall to close during fetal development
180
Q

Urachus

A

-remnant of the channel between the bladder and umbilicus

181
Q

Uretral Diverticulum

A

-pocket/outpouching forms next to the urethra and connects with urethra

182
Q

Renal Duplication Artifact

A
  • result of sound beam refraction between lower portion of spleen or liver and adjacent fat
  • Lt kidney of obese patients
183
Q

What does renal duplication artifact sometimes look like?

A
  • duplex collecting system
  • suprarenal mass
  • upper pole thickening
184
Q

How can we resolve renal duplication artifact?

A
  • change transducer position

- using deep inspiration (liver and spleen as window)

185
Q

What imaging modalities are used for the urinary system?

A
  • IVP
  • nuclear medicine
  • CT
  • US
186
Q

IVP (intravenous pyelography)

A
  • radiographic exam
  • IV admin of contrast medium
  • functional and anatomical info
  • shows whole urinary tract on a few films
  • ideal imaging calculi
187
Q

Nucelar Medicine

A
  • admin of IV radionuclide filtered through kidneys at a specific rate and concentration
  • series of films demonstrate renal perfusion and function
  • disadvantage: rely on renal function, demonstrates only gross anatomy
188
Q

CT of Urinary Tract

A
  • best detail
  • can differentiate between different masses
  • disadvantages: expensive, limited, ionizing radiation
189
Q

Location of Spleen

A
  • LUQ
  • left hypochondriac
  • intraperitoneal
190
Q

What is the spleen in contact with superiorly, laterally and posteriorly?

A

-diaphragm

191
Q

What is the inferiomedial aspect of the spleen in contact with?

A

-stomach, Lt kidney, pancreas and splenic flexure

192
Q

Where is the spleen in relation to the stomach?

A

-posterior

193
Q

Where is the spleen in relation to the pancreas tail?

A

-superior and lateral

194
Q

What is the spleen surrounded by?

A

-fibrous capsule

195
Q

What is the shape of the spleen?

A
  • ovoid

- convex superolaterally and concave inferomedially

196
Q

Border’s of the Spleen

A
  • smooth: posterior, superior and lateral

- gental indentations: medial

197
Q

Hilum of Spleen

A
  • splenic artery and vein enter and exit

- highly vascular organ

198
Q

What is the spleen composed of?

A
  • white pulp

- red pulp

199
Q

Splenic Ligaments

A
  • splenorenal ligament
  • phrenicocolic ligament
  • gastrosplenic ligament

**not usually seen, unless patient has ascites

200
Q

Functions of Spleen

A
  • defense (immunity)
  • tissue repair
  • hematopoeisis: monocytes and lymphocytes develop
  • RBC and platelet destruction
  • blood reservoir: pulp and sinus store blood
201
Q

Can the spleen be congenitally absent?

A

Yes.

202
Q

Can the spleen be surgically removed?

A

Yes.

203
Q

What should you ask your patient before scanning the spleen?

A
  • surgery
  • trauma
  • sickness
204
Q

Size of Spleen

A
  • eyeball
  • compare to Lt kidney
  • 11cm to 12cm long (8 to 13 is normal)
  • 5 cm to 7cm AP
  • dependant on centre and body height
205
Q

Volume of Spleen

A

-60 to 200mL

206
Q

Weight of Spleen

A
  • less than 150 grams (80 to 300g is normal)
  • decreases as we age
  • smaller in women
207
Q

Shape of Spleen

A
  • convex superolaterally

- concave inferomedially

208
Q

Contour of Spleen

A

-smooth

209
Q

Echogenicity of Spleen

A

-hyperechoic to liver and Lt kidney

210
Q

Echotexture of Spleen

A

-parenchyma is homogenous

211
Q

Is it normal to see calcified arteries in the spleen?

A
  • yes

- as the patient ages

212
Q

What other imaging modalities can be useful for the spleen?

A
  • CT

- MRI

213
Q

Accessory Spleen

A
  • aka splenule
  • normal variant/congenital anomaly
  • most common
  • homogenous, isoechoic mass, similar to the spleen
  • found at hilum or inferior border
214
Q

Asplenia

A
  • complete absense
  • rare
  • congenital abnormality
215
Q

Polysplenia

A

-multiple sm accessory spleens

216
Q

Wandering Spleen

A
  • migrated from it’s normal location in the LUQ
  • dorsal mesentery fails to fuse properly with posterior peritoneum
  • lack of support ligaments
217
Q

Ectopic Spleen

A

-out of position

218
Q

How many lymph nodes do we have?

A

-500 to 600

219
Q

Lympatics refers to…

A
  • lymph
  • lymphatic vessels
  • lacteals
  • lymph nodes
  • spleen
  • bone marrow
  • thymus gland
220
Q

Function of Lymphatic System

A
  • collects and transports excess fluids and lymph from interstitial spaces back into the venous system
  • absorbs fats from sm intestine and transports to liver
  • stimulates lymphoid tissue and organs to produce cells that fight and dispose of foreign material (immune system)
221
Q

Common Sites for Lymph Nodes

A
  • paraaortic and paracaval (near great vessels)
  • peripancreatic area
  • portahepatic area
  • renal hilar area
  • mesenteric region
222
Q

Lymph Node Appearance

A
  • less than 1 cm
  • ovoid
  • cortex: hypoechoic
  • hilum: hyperechoic, fatty
  • AP is smaller that width or length
223
Q

The prostate is posterior to…

A

-symphysis pubis

224
Q

The prostate is anterior to…

A

-rectum

225
Q

The prostate is inferior to…

A
  • seminal vesicles

- bladder

226
Q

How is semen transported outside?

A
  • epididymis
  • vas deferens
  • join seminal vesicles
  • ejaculatory ducts
  • urethra
227
Q

Seminal Vesicles

A
  • 2 hollow structures
  • base of bladder
  • superior to prostate
  • inferior to vas deferens and ureters
228
Q

Prostate

A
  • small, chestnut shaped
  • base: superior part
  • apex: inferior part
229
Q

Ejaculatory Ducts

A

-join urethra approx. mid way through prostate

230
Q

Prostatic Urethra is Divided into…

A
  • proximal

- distal

231
Q

Male Pelvic Ducts

A

-transport seminal fluid

232
Q

Seminal Vesicles

A

-add secretions to seminal fluid

233
Q

Prostate

A

-adds secretions to seminal fluid

234
Q

Male Urethra

A

-conduit for semen and urine

235
Q

Prostaticovesical Arteries

A
  • from internal iliac arteries

- prostatic and inferior vesicle artery

236
Q

Inferior Vesicle Artery

A

-supplies the base of the bladder, seminal vesicles and ureter

237
Q

Prostatic Artery

A
  • branches to capsular and urethral arteries

- supply prostate

238
Q

Venous Supply of Male Pelvis

A
  • network around sides and base of prostate

- deep dorsal penile vein draining into the internal iliac veins

239
Q

2 Regions of Prostate Gland

A
  • fibromuscular region/stroma: smaller, anterior

- glandular region: posterior

240
Q

4 Zones of Prostate

A
  • peripheral
  • central
  • transitional
  • periurethral glandular
241
Q

Peripheral Zone of Prostate

A
  • largest
  • 70% of glandular tissue
  • 70% of cancers found here
  • posterior, lateral and apical regions of the prostate
  • resembles ‘egg cup’
242
Q

Central Zone of Prostate

A
  • 25% of prostatic glandular tissue
  • 5% of cancer located in central zone
  • where the vas deferens and seminal vesicles enter
243
Q

Transitional Zone of Prostate

A
  • lateral aspects of proximal urethra
  • 5% of glandular tissue
  • 20% of cancers
244
Q

Periurethral Glandular Zone of Prostate

A

-tissue that lines proximal prostatic urethra

245
Q

Verumontanum

A

-divides prostatic urethra into proximal and distal where the ejaculatory ducts meet the urethra

246
Q

Clinical Indications for Scanning Male Pelvis

A
  • problem suspected: size, cancer, feel lump during rectal exam
  • increased lab values: PSA
  • urinary problems: nocturne, frequency, weak stream
247
Q

DRE

A

-digital rectal exam

248
Q

PSA

A
  • prostate specific antigen
  • blood test
  • glycoprotein produced exclusively by the prostate
  • increase: possible prostate cancer
  • higher the elevation, the more likely it’s cancer
249
Q

Why is PSA not ideal?

A
  • normal does not excuse cancer
  • 20% to 40% have cancer with normal
  • elevated does not definitely mean cancer
  • prostate size increases, so does PSA
250
Q

Serial PSA Tests

A

-check if levels change over time

251
Q

What anatomy is assessed for a male pelvis US?

A
  • prostate
  • seminal vesicles
  • bladder
252
Q

What kind of US is used to better visualize the prostate?

A

TRUS

253
Q

Why is an abd US not the best for prostate?

A
  • limited to size, shape, weight

- not detailed

254
Q

Normal Prostate Size

A

weight = 20g

4cm (wide) x 3cm (AP) x 3.8cm (length)

volume x 0.523 = 23.8cc

255
Q

Main Reasons for a TRUS

A
  • prostate cancer evaluation
  • biopsy
  • guidance of procedures
256
Q

Positioning for TRUS

A
  • Lt lateral decub
  • legs together and bent up
  • DRE performed prior
257
Q

Frequency of TRUS probe?

A

-7 to 11 MHz

258
Q

Inner Prostate Gland (central)

A
  • transitional
  • anterior fibromuscular stroma
  • glandular tissue
  • internal urethral sphincter
  • hypoechoic, heterogenous
259
Q

Outer Prostate Gland (peripheral)

A
  • peripheral zone
  • central zone
  • uniform, homogenous texture
  • hyperechoic to inner gland
260
Q

Surgical Capsule

A
  • separates inner and outer prostate glands
  • not a true capsule
  • not always seen in young males
261
Q

Sonographic Appearance of Seminal Vesicles

A
  • multiseptated

- hypoechoic

262
Q

Sonographic Appearance of Vas Deferens

A

-adjacent to seminal vesicles

263
Q

Benign Ductal Ectasia

A
  • normal prostatic variant
  • older men
  • caused by atrophy and dilation of prostatic ducts
  • single or grouped structures in peripheral zone
  • 1 to 2mm diameter
264
Q

Prostatic Calcifications and Corpora Amylacea

A

-normal variant
-older men
bright echogenic foci/clumps in prostate

265
Q

Corpora Amylacea

A
  • proteinaceous debris

- sound attenuating preventing TRUS

Term 1 (17 decks)

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