Rama Final Flashcards
What is a hernia?
Protrusion of abdominal cavity (bowel or fat) through abdominal wall
Name 3 types of hernia
inguinal femoral umbilical epigastric semilunar incisional
What maneuver do you use to visualize hernias?
Valsalva maneuver
Where does inguinal hernia appear?
in spermatic cord or round ligament
Ultrasound appearance of hernia
interaction of peritoneal line outline contents of mass peristalsis (absent with incarceration) valsalva reducibility with pressure
signs and symptoms of appendicitis
nausea vomiting RLQ or periumbilical pain fever elevated WBC
Differential diagnosis for appendicitis
Crohn’s disease
ovarian pathology
lymphoma
neoplasm
Evaluation/Protocol for appendix
compression at RLQ longitudinal transverse peri-appendiceal fluid measurements
Landmark for appendix
Cecum
Sonographic appearance of normal appendix
not visualized
Transducer of choice for appendix
Linear 7.5-12.0 MHz
Sonographic appearance of abnormal appendix
no peristalsis bulbous tip thickened wall not compressible >6mm diameter with compression peri-appendiceal fluid hyperemia
What are the most important measurements in the carotid?
peak systolic and end diastolic
What are random biopsies?
no mass, but you want a tissue sample. Usually due to abnormal blood/urine tests
Where should the needle be places in relationship to the transducer
parallel to the transducer so you can see the entire length of the needle
What should always be done prior to a biopsy
Blood work to check coagulation time
What two tests are done/calculated to check for coagulation?
Prothrombin time (PT) and International Normalized Ration (INR)
What are the reasons for liver biopsy?
To confirm malignancy
to determine whether lesion is primary or mets
to determine cause of transplant rejection
Contraindication for US-guided procedures
uncorrectable bleeding disorder
lack of safe needle path
uncooperative patient
What are biopsied used for
to determine whether mass is benign, malignant or infectious
How much fluid do you need to drain for diagnosis
60cc
Where is paracenthesis done?
LLQ or RLQ
paracolic gutters
Benefits of using needle guides
faster learning curve
faster placement of needle
ability to keep needle going through anesthetized area for multiple passes
Key roles of ultrasound testicular exam
rule out intra-testicular mass/pathology
elevate blood flow
name for undescended testicles
chryptorchidism
most common location of undescended testicle
inguinal/groin region
surgery to free undescended testicle
orchiopexy
Most common cause of acute pain in adolescence
testicular torsion
Sonographic appearance of torsion
focal or diffusely hypoechoic decrease in size Ischemia (decrease in blood flow) spectral wall thickening associated hydrocele
inflammation of epididymis
epididymitis
presentation of epididymitis
fever and painful urination swelling asymmetry hypoechoic testicle increased vascularity associated hydrocele
infection/inflammation of the testicle
orchitis
presentation of orchitis
fever elevated WBC enlarged testicle hypoechoic increased vascularity
Location and cause of epididymal cysts
head of epididymis
caused by obstructed ducts
Spermatocele
cysts filled with non-viable sperm
common in the head
hydrocele
collection of fluid between layers of tunic vaginalis
most common cause of painless swelling
hematocele
collection of blood
pyocele
pus containing collection
Where does a varicocele occur?
pampiniform plexus
What causes vericoceles?
incompetent valves in the spermatic vein
Which side are varicoceles more common on?
left
Appearance of a vericocele
tortuous tubular structures
increased size during valsalva
greater than 2mm
True/False
intra-testicular masses are usually malignant and extra-testicular masses are usually benign
True
What is the size of a normal testicle
3-5cm length
2-4cm width
3cm AP
Where do hydroceles occur?
between visceral and parietal layers of tunica vaginalis
location of epididymis
superior and posteriolateral to tesis
Size of epididymal head
6-15mm
What is acute appendicitis
result of laminal obstruction and inflammation leading to ischemia of the vermiform appendix
symptoms of cute appendicitis
pain, rebound tenderness at McBurney's point nausia diarrhea elevated WBC fever
Where do spermatoceles occur?
rete testis or epididymis
