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Abdominal > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

when stating measurements in your report, what should be stated first?

A

longest measurements first

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2
Q

what would you do with colour doppler?

A

-apply on any abnormal mass
-take an image with the colour box over the area of interest
-

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3
Q

explain power doppler

A
  • more sensitive
  • if colour is not readily apparent, try using power doppler
  • very motion sensitive
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4
Q

lesion

A

-bump or lump on skin or in a solid organ

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5
Q

how can a lesion appear?

A

cystic or solid

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6
Q

nodule

A
  • a small mass of rounded or irregular shape

- benign or cancerous

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7
Q

mass

A

abnormal growth of tissue resulting from multiplication of cells
-may push or displace surrounding tissue or vessels

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8
Q

what is some tumor consistency?

A
  • solid=no enchancment
  • liquid=posterior enhancement
  • mixed=solid and fluid
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9
Q

what is the mass effect?

A

pushing or displacing

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10
Q

what is invading?

A

moving into a vein or other organ

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11
Q

what would a cystic lesion look like?

A
  • anechoic
  • thin walled
  • posterior enhancement
  • may contain thin septations
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12
Q

what is a benign tumor?

A
  • no vascularity
  • peripheral vascularity
  • smooth contour
  • slow growing
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13
Q

what is a malignant tumor

A
  • highly vasculature
  • irregular margins
  • bulls eye or halo
  • rapid growth
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14
Q

what are examples of acute?

A
  • sudden and high pain
  • fever
  • RLQ
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15
Q

what could you have if you have RLQ acute pain?

A

appendicitis

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16
Q

what are examples of chronic pain?

A
  • pain on and off for longer
  • on treatment for other conditions
  • LLQ
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17
Q

what could you have if you have LLQ and chronic pain?

A

constipation

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18
Q

what are some functions of the liver?

A
  • produces proteins
  • breaks down nutrients
  • produces bile
  • more on slide 7 lesson 1
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19
Q

inside the liver, what produces bile?

A

hepatocytes

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20
Q

what does the hepatic artery supply?

A

oxygenated blood

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21
Q

what is the function of the portal vein?

A

supplies WBC and returns flow to the liver from the intestines for cleansing

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22
Q

which structure separates the medial and lateral left lobe?

A

left intersegmental fissure

left hepatic vein

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23
Q

which structures lie within the left intersegmental fissure?

A

cranially-LHV
middle-ascending LPV
caudally-ligamentum teres

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24
Q

The hepatic veins are visualized when scanning which portion of the liver?

A

superior

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25
Q

What does the MHV separate?

A

Anterior RL and medial LL

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26
Q

What is the name of the capsule surrounding the liver?

A

Glisson’s capsule

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27
Q

what is the echogenicity of the liver?

A

compared to kidney, the liver should be slightly hyperechoic

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28
Q

what direction is the portal venous flow?

A

hepatopedal

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29
Q

what kind of flow does hepatic veins have?

A

phasic flow and hepatofugal

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30
Q

what is the flow of the hepatic artery?

A

low resistant hepatopetal flow

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31
Q

Diaphragmatic slip

A

slip-cause of pseudomass on liver sonography

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32
Q

what lab test is a nonspecific marker for malignancy?

A

Alpha-fetoprotein (AFP)

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33
Q

Alpha-fetoprotein (AFP)

A

a protein normally synthesized by the liver, yolk sac, and GI tract of the fetus

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34
Q

what lab test marked elevation is associated with obstructive jaundice?

A

Alkaline Phosphatase(ALP)

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35
Q

Alkaline Phosphatase(ALP)

A

an enzyme produced primarily by liver,bone and placenta

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36
Q

what lab test has an Elevation associated with cirrhosis,hepatitis and biliary obstruction?

A

Alanine aminotransferase-ALT

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37
Q

Alanine aminotransferase-ALT

A

An enzyme found in high concentration in the liver and lower concentrations in the heart,muscle and kidneys
(used to assess jaundice)

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38
Q

what lab test has an elevation that is associated with cirrhosis, hepatitis and mononucleosis?

A

Aspartate aminotransferase-AST

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39
Q

Aspartate aminotransferase-AST

A

An enzyme present in many kinds of tissue that is released when cells are injured or damaged

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40
Q

which lab test has an elevation that is associated with cirrhosis, malignancy, malabsorption of vitamin K and clotting failure

A

Prothrombin time

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41
Q

Prothrombin time

A

Decreases with subacute or acute cholecystitis,internal biliary fistula,carcinoma of the GB,biliary duct injury and prolonged extrahepatic biliary obstruction

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42
Q

Leukocytosis

A

A sign of inflammatory or infection response when white blood cells are above the normal range

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43
Q

serum albumin

A

Decrease suggests a decrease in protein synthesis

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44
Q

Bilirubin

A

A product from the breakdown of hemoglobin in old red blood cells
-balance between production and excretion of bile

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45
Q

Agenesis

A

Of complete liver is incompatible with life

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46
Q

Situs inversus totalis

A

Liver is found in left hypochondrium

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47
Q

Congenital(fetal US) diaphragmatic hernia or omphalocele

A

Liver may herniate into thorax or outside abdominal cavity

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48
Q

Liver granulomas

A
  • Asymptomatic (no symptoms)
  • Appear as calcification within the liver parenchyma
  • May be solitary or multiple
  • may be related to an infection such as hepatitis
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49
Q

Hamartomas

A
  • Small, focal ,solid appearing,hypoechoic
  • Benign malformations
  • Single or multiple
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50
Q

what is the most common benign tumor?

A

cavernoses hemangioma

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51
Q

cavernoses hemangioma

A
  • small, asymptomatic
  • homogenous and hyperechoic (could be hypoechoic)
  • avascular on sonography
  • well circumscribed
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52
Q

what is the second most common tumor?

A

Focal Nodular Hyperplasia-FNH

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53
Q

Focal Nodular Hyperplasia-FNH

A
  • asymptomatic
  • solitary
  • isoechoic
  • well circumscribed
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54
Q

what is more common, FNH or Hepatic Adenoma?

A

Hepatic Adenoma

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55
Q

Hepatic Adenoma

A
  • may be symptomatic (RUQ mass felt if large)
  • hypervascular
  • risk of malignant degeneration
  • resection is recommeded
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56
Q

Hepatic Adenoma-sonographic appearance

A
  • Adenomas appear more heterogeneous than other benign liver tumors
  • multiple feeding hepatic arteries can be seen
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57
Q

what are fatty tumors associated with?

A

renal angiomyolipomas

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58
Q

fatty tumors

A
  • asymptomatic
  • well defined echogenic mass
  • extremely rare
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59
Q

Briefly explain the most common cause of Hydatid disease?

A

a parasite tapeworm are eaten and enter the duodenum and reaches the liver from the portal system
(mainly in animals)

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60
Q

Briefly explain the most common cause of Hydatid disease?

A

a cystic mass with smaller daughter cysts

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61
Q

Briefly describe the classic sonographic appearance of the hemangioma

A

homogenous and hyperechoic;may be singular or multiple;usually <3cm;may be lobulated

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62
Q

What causes the increased echogenicity?

A

A-numerous interfaces between the walls of the cavernous sinuses and blood within them

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63
Q

Is color Doppler helpful in diagnosing Cavernous hemangioma?

A

no, the flow is too slow

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64
Q

What is the differential diagnosis when these lesions are seen?

A

metastases from colon, HCC (hepatocellular carcinoma)

-With mets the LFT’s will be increased and with HCC-Hx of cirrhosis or hepatitis

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65
Q

Describe the lesions sonographic appearance

A

highly complex due to hemorrhage;the sonographic appearance will changes with bleeding- duration and amount of hemorrhage

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66
Q

What are the patients symptoms when a lesion hemorrhages?

A

acute abdominal pain due to the hemorrhage or infarction;palpable mass by physician

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67
Q

Why is resection of adenomas recommended?

A

hemorrhage risks and malignant degeneration

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68
Q

Briefly describe the sonographic appearance of FNH

A

isoechoic,hypoechoic,hyperechoic;stellate vascular pattern or vascular stalk;displaces vascular structures;central scar

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69
Q

What clinical information may lead you to this diagnosis?

A

female, OC use

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70
Q

what is viral hepatitis?

A

inflammation of the liver

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71
Q

how many distinct virus’s are there of hepatitis?

A

6 distinct viruses (A-E,G)

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72
Q

what is serosurvey?

A

study of blood serum to find antibodies when exposed to hepatitis

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73
Q

what may viral hepatitis lead to?

A
  • portal hypertension
  • cirrhosis
  • hepatocellular carcinoma (HCC)
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74
Q

how is hepatitis A spread?

A

fecal-oral route

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75
Q

where is hepatitis A found?

A

worldwide but usually in developing countries

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76
Q

who does hepatitis A mainly affect?

A

the young

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77
Q

what type of infection is type A?

A

acute infection

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78
Q

where is Hepatitis B found?

A

worldwide but predominate in Asia, Africa, Greenland

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79
Q

How is Hepatitis B spread?

A

parentally (not oral)

  • blood transfusions
  • needle punctures
  • sexual contact
  • birth
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80
Q

where is Hepatitis C found?

A

Italy and Mediterranean

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81
Q

how is Hepatitis C spread?

A

spreads through blood (sharing needles)

presence of antibodies in blood

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82
Q

where is the hepatitis D found?

A

worldwide but predominate in Asia, Africa, Greenland (same as B) uncommon in North america

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83
Q

what is hepatitis D dependant on?

A

hepatitis B for infectivity (must be infected with hep B to be infected with hep D)

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84
Q

how is hepatitis D spread?

A

iv drug users

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85
Q

what are some symptoms of viral hepatitis?

A

-fatigue
-headache
-fever
-nausea
-vomiting
SIGN
-jaundice

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86
Q

how long does recovery take for acute hepatitis?

A

recovery within 4 months

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87
Q

what does acute hepatitis look like on ultrasound?

A

liver parenchyma is more hypoechoic leading to the appearance of bright periportal walls

88
Q

what is acute hepatitis sonographic appearance also known as?

A

starry night sign

89
Q

how long does chronic hepatitis last?

A

Biochemical abnormalities persist beyond 6 months

90
Q

how do you test for chronic hepatitis?

A

antibody and antigen tests can detect different viruses

91
Q

what is the sonographic appearance of chronic hepatitis?

A
  • hepatomegaly and thickening of GB wall

- liver may appear normal in some cases

92
Q

what chemicals can be harmful to the liver?

A
  • alcohol
  • prescription medication
  • poor diet
93
Q

what are some disorders of metabolism?

A
  • steatosis (fatty liver)
  • glycogen storage disease (neonatal)
  • cirrhosis (chronic liver disease)
  • NASH (non-alcoholic steatohepatitis)
94
Q

is steatosis reversible?

A

yes

95
Q

what is the most common cause of steatosis (fatty liver)?

A

obesity

96
Q

what is steatosis?

A

Triglycerides(fat) in the hepatocytes

97
Q

what are some causes of steatosis (fatty liver)?

A
  • excessive alcohol (stimulates lipolysis)
  • severe hepatitis
  • hyperlipidemia (cholesterol)
  • diabetes
  • pregnancy
  • e.t.c
98
Q

steatosis (fatty liver) is a precursor for what?

A

significant chronic disease and could lead to HCC in some patients

99
Q

what does mild steatosis look like?

A

minimal diffuse increase in hepatic echogenicity

100
Q

what does moderate steatosis look like?

A
  • moderate diffuse increase in hepatic echogenicity

- slightly impaired visualization of intrahepatic vessels and diaphragm

101
Q

what does severe steatosis look like?

A
  • marked increase in echogenicity
  • poor penetration of posterior liver
  • poor or no visualization of hepatic vessels and diaphragm
  • Hepatomegaly often present
102
Q

what are other sonographic appearances of fatty liver?

A
  • focal fatty infiltration
  • fatty sparing
  • focal fat
103
Q

what is focal fatty infiltration?

A

Regions of increased echogenicity are present within a background of normal liver
-can mimic a mass

104
Q

what is fatty sparing?

A

Islands of normal liver parenchyma appear as hypoechoic masses within a dense fatty infiltrated liver “no mass effect”

105
Q

does steatosis have a mass effect?

A

no

106
Q

does steatosis have a liver contour abnormality?

A

no

107
Q

in steatosis, where will you find focal fat?

A

anterior to portal vein at porta hepatis

108
Q

in steatosis, where will you find focal fatty sparing or infiltration?

A

anterior to portal vein at porta hepatis,gallbladder fossa,

and liver margins

109
Q

what is glycogen storage disease?

A

large amounts of glycogen are deposited in liver and kidneys

110
Q

when does glycogen storage disease occur?

A

neonatal-Patients survive to childhood or young adulthood with enzyme therapy

111
Q

what may develop with glycogen storage disease?

A

benign adenomas or Hepatocellular carcinoma

112
Q

how does glycogen storage disease appear to fatty infiltration?

A

indistinguishable

113
Q

what 3 major pathological mechanisms combine to create cirrhosis?

A
  • cell death
  • fibrosis
  • regeneration
114
Q

what is the most common cause of micronodular form?

A

alcohol consumption

115
Q

what is the most common cause of macronodular form?

A

chronic viral hepatitis

116
Q

what could be clinical presentation of cirrhosis?

A
  • hepatomegaly
  • jaundice
  • ascites
117
Q

what is the sonographic appearance of early stages of cirrhosis?

A
  • liver may be enlarged
  • may be difficult to distinguish from fatty liver
  • look for irregular contour
118
Q

what is the sonographic appearance of advanced stages of cirrhosis?

A

liver is often small-shrinking, ascites

119
Q

what are the overall sonographic appearances of cirrhosis?

A
  • volume redistribution
  • coarse echotexture
  • nodular surface
  • nodules
  • portal hypertension
120
Q

what is NASH?

A

it resembles alcoholic liver disease but occurs in people who drink little or no alcohol

121
Q

what can NASH lead to?

A

cirrhosis

122
Q

what are the signs and symptoms of NASH?

A
  • fatigue
  • weight loss
  • weakness
  • increased LFT’s
123
Q

what is the treatment of NASH?

A
  • balanced diet
  • physical activity
  • avoid alcohol
124
Q

what does NASH look like sonographically?

A

dense fatty infiltration or cirrhosis

125
Q

what are the 2 forms of hepatic failure?

A

acute and chronic

126
Q

define acute liver failure

A

the rapid development pf hepatocellular dysfunction, specifically coagulopathy and mental status changes (encephalopathy) in a patient without known prior liver disease”

127
Q

what can cause liver failure?

A
  • excessive alcohol intake
  • hep B or C
  • autoimmune, hereditary and metabolic causes
  • Steatohepatitis or non-alcoholic fatty liver disease
128
Q

ascites usually occurs secondary to __________

A

liver cell failure

129
Q

coagulopathy

A

bloods ability to clot is impaired

130
Q

hepatic encephalopathy

A

Patient exhibits confusion,altered level of consciousness and coma as a result of liver failure

131
Q

Why is it important to image the right kidney and liver interface?

A

to compare echogenicity

132
Q

What is the classic clinical presentation of cirrhosis?

A
  • hepatomegaly
  • jaundice
  • ascites
133
Q

What is the most common malignant tumor of the liver?

A

HCC

134
Q

What are 2 of the most common predisposing causes of HCC?

A

alcoholism and hepatitis

135
Q

Hepatocellular carcinoma may invade which other structures? What is useful in the diagnosis?

A
  • portal vein (30-60% of cases)
  • hepatic veins
  • colour doppler
136
Q

List the most common primary tumors that result in liver meastastases?

A
  • GB
  • colon
  • stomach
  • pancreas
  • breast
  • lung
137
Q

what structures aid in the spread of primary tumors?

A

Blood borne route-hepatic artery or portal vein

Lymphatics route- –stomach,pancreas,ovary or uterus

138
Q

What is the differential diagnosis for hyperechoic lesions in the liver other than mets?

A

hemangiomas

139
Q

Describe briefly the 3 stages of hematoma sonographic appearance

A

1-<24 hours-echogenic-fresh hemorrhage
2-within 1st week-becomes more hypoechoic-resorption of tissues and fluid
3-2-3 weeks-increasingly indistinct-fluid resorption and tissue granulation

140
Q

do we see hepatoma’s mainly in men or women?

A

men (5:1)

141
Q

what are the causes of hepatoma?

A
  • alcoholic cirrhosis (west)
  • Viral Hep B&C (worldwide)
  • fatty liver (western world)
  • toxins in food (developing countries)
142
Q

what are symptoms of HCC?

A
  • RUQ pain
  • Weight loss
  • Abdominal swelling-ascites is present
143
Q

Budd-Chiari Syndrome???

A

????

144
Q

what is the sonographic appearance of HCC?

A
  • hypoechoic, complex, or echogenic
  • may have a thin peripheral hypoechoic halo (fibrous capsule)
  • calcification is uncommon
145
Q

where do you find fibrolamellar carcinoma?

A

adolescents and young adults

146
Q

is calcification present in fibrolamellar carcinoma?

A

central echogenic scar distinguishes it from hepatomas of HCC

147
Q

Hemangiosarcoma

A
  • extremely rare malignant tumor

- on US there is a large mass of mixed echogenicity

148
Q

Hepatic epitheliod

A

-rare malignant tumor of vascular origin

149
Q

what does Hemangiosarcoma look on US?

A

Large mass of mixed echogenicity on US

150
Q

what does Hepatic epitheliod look like on US?

A

Multiple hypoechoic nodules-large masses

151
Q

who is seen to have Hemangiosarcoma?

A

adults 60-70 years of age

152
Q

who is seen to have Hepatic epitheliod?

A

occurs in adults

153
Q

what is affected in Hepatic epitheliod?

A

soft tissues, lung, and liver

154
Q

Study sonographic patterns of metastatic disease

A

Part 3 liver-slide 15/16

155
Q

when do we commonly see the bulls eye or target?

A

lung cancer

156
Q

shadowing in the liver is most often due to ______________

A

calcifications, air, stones and fat containing lesions

157
Q

a clean shadow is caused by _____, while a dirty shadow is caused by _____

A

calcifications, air

158
Q

what is the most common cause of a calcified liver tumor?

A

metastases

159
Q

does FNH have calcifications?

A

rarely

160
Q

what is the sonographic appearance of cystic metastases?

A
  • mural nodules
  • thick walls
  • fluid-filled levels
  • internal septations
  • extensive necrosis
161
Q

what is the sonographic appearance of Infiltrative metastatic disease?

A

-hard to distinguish

162
Q

what is contrast enhanced ultrasound?

A

involves the use of microbubble contrast agents and specialized imaging techniques

163
Q

what is one of the most common causes of hepatomegaly?

A

alcohol abuse

164
Q

what are symptoms of hepatomegaly?

A
  • abdominal pain
  • swelling
  • feeling of fullness
  • jaundice
165
Q

what is the aurora sign?

A

ringdown artifact

166
Q

what are the ways that pyogenic bacteria can reach the liver?

A

1) biliary tract in patients with suppurative (pus)
2) travels through porta venous system
3) travels through hepatic artery
4) result of a blunt or penetrating trauma to liver

167
Q

cholangitis

A

inflammation of entire biliary system

168
Q

cholecystitis

A

inflammation of gallbladder

169
Q

diverticulitis

A

infection of an out pouch of a bowel

170
Q

pyogenic bacteria traveling from biliary tract

A

cholangitis and cholescystitis

171
Q

pyogenic bacteria travels through portal venous system

A

diverticulitis and appendicitis

172
Q

pyogenic bacteria travels through hepatic artery

A

osteomyelitis and bacterial endocarditis

173
Q

what can blunt trauma to the liver result in?

A

hepatic abscess

174
Q

osteomyelitis

A

infection of bone

175
Q

bacterial endocarditis

A

infection of lining of the heart

176
Q

what is hepatic abscess mainly caused by?

A

anaeurobic (bacterial) infection

177
Q

what are presenting features of pyogenic liver abcess?

A
  • fever, malaise, anorexia, RUQ pain, jaundice

- leukocytosis

178
Q

is sonography helpful for hepatic abscesses?

A

yes

179
Q

what are some varied sonographic signs of liver abscess?

A
  • frankly purulent
  • early suppuration
  • GAS PRODUCING ORGANISMS give rise to echogenic foci
  • fluid/fluid interfaces, internal septations and debris
  • walls can be thick, irregular, or well defined
180
Q

what are the differential diagnosis for liver abscess?

A
  • amebic or echinococcal infection
  • simple cyst with hemorrhage
  • necrotic or cystic neoplasm (non identified mass)
  • hematoma
181
Q

what confirms diagnosis for liver abscess?

A

ultrasound guided needle aspiration

182
Q

for fungal disease: candidiasis patients are generally ___________

A

immunocomprimised

183
Q

when can fungal disease: candidiasis occur?

A
  • pregnancy

- hyperalimentation (artificial nutrients like getting blood)

184
Q

what does fungal disease: candidiasis present as?

A

persistent fever in a neutropenic patient (low white blood cell count) whose leukocyte count is returning to normal

185
Q

which patients are immunosuppressed?

A

weakened immune system

  • pre and post transplant
  • cancer
  • poor nutrition
  • pregnant
186
Q

what are some ultrasound features of candidiasis?

A
  • wheel within a wheel
  • central nidus (where bacteria form and grow)
  • hyperechoic foci
  • bulls eye
  • uniformly hypoechoic
  • echogenic
187
Q

wheel within a wheel

A

Peripheral hypoechoic zone with inner echogenic wheel & central hypoechoic nidus (where bacteria form and grow)

188
Q

central nidus

A

Focal necrosis where fungal elements are found

189
Q

hyperechoic foci

A

multiple small abscesses with air

190
Q

bulls eye

A
  • 1-4 cm lesion with hyperechoic center and hypoechoic rim

- echogenic center contains inflammatory cells

191
Q

uniformly hypoechoic

A

-due to progressive fibrosis

192
Q

what is the most common ultrasound feature for candidiasis?

A

uniformly hypoechoic

193
Q

what is amebiasis?

A

hepatic infection

194
Q

what is amebiasis caused by?

A

parasite-entamoeba histolytica

195
Q

how is amebiasis transmitted?

A

fecal-oral route

-penetrates through the colon, via mesenteric venules, then to the portal vein, liver

196
Q

what is the most common presenting symptom for amebiasis?

A

pain

15% of patients have diarrhea

197
Q

what is the sonographic features of the amebiasis?

A
  • round or oval shaped lesion
  • absence of prominent wall
  • hypo echogenicity
  • low level echoes, distal enhancement
198
Q

what is another name for hydatid disease?

A

echinococcal disease

199
Q

what is the most common cause of hydatid disease?

A

parasite echinococcus granulosis

200
Q

how is hydatid disease transmitted?

A

embryos are freed in duodenum-reach the liver via portal veins

201
Q

which liver disease involves a tapeworm?

A

hydatid disease

202
Q

what other organs may hydatid disease involve?

A

lungs, kidneys, spleen, CNS

203
Q

what are the sonographic features of hydatid disease?

A
  • cysts with daughter cysts

- simple cysts

204
Q

how is hydatid disease treated?

A

surgury

205
Q

what disease is referred to the waterlily sign on an ultrasound?

A

hydatid disease

206
Q

what is the most common parasitic infection in humans?

A

schistosomiasis

207
Q

how many different parasites are involved in schistosomiasis?

A

4

208
Q

how does the ova in Schistosomiasis reach the liver?

A

portal vein

209
Q

what does Schistosomiasis lead to?

A
  • portal hypertension
  • splenomegaly
  • varices
  • ascites ensues
210
Q

what are the sonographic features of Schistosomiasis?

A
  • widened echogenic portal tracts

- dilated biliary ducts

211
Q

what is the region affected in Schistosomiasis?

A

porta hepatis

212
Q

what is the process of the infection of Schistosomiasis?

A
  • initially it is hepatomegaly
  • then periportal fibrosis occurs
  • liver then shrinks
  • portal hypertension prevails
213
Q

what is the most common organism causing opportunistic infection in patients with AIDS?

A

pneumocystis carinii

214
Q

what is the most common cause of life threatening infection?

A

pneumonia

215
Q

who is at risk for Pneumocystis carinii?

A

patients undergoing bone marrow and organ transplants

216
Q

what is the sonographic appearance of Pneumocystis carinii?

A
  • tiny, diffuse non shadowing echogenic foci

- replacement of normal hepatic parenchyma by echogenic clumps of dense calcification

Abdominal (11 decks)

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