Renal/Gallbladder US Flashcards
objectives of renal US
- detect hydronephrosis in context of obstructive uropathy
- cysts/masses
- directly visualize large obstructive calculi.
useful in pt presentations with hematuria, renal colic symptoms, urinary retention.
Anatomical effects of hydronephrosis
mild: enlarged calyces, preserved pyramids.
mod: dilated calyces, blunted pyramids
severe: calcyeal ballooning, obliterated pyramids, cortical thinning.
Sites where a stone gets stick
renal parenchyma
UPJ proximally
UVJ distally.
Visualizing renal calculi has low sensitivity on US.
purpose of US
free fluid
estimation of bladder volume
confirmation of proper foley placement
detection of stone
ureteral jets
assessment of bladder volume
(0.75x widthx length x height0 at the bladder dome.
what is considered an enlarged prostate
enlarged is >5cm.
portal triad
hepatic artery, portal vein and common bile duct
US definition of cholecystitis
anterior wall >3mm
stones/cholelithiasis/sludge
perocholecystic fluid
sonographic murphies
+/- 4. Gall bladder distension: normally the GB is 10cm or less in length, and 5cm or less in diameter. When dilated from a stone, the GB can develop a balloon shape and loose its tapered pear appearance.
false positives for GB wall thickening
CHF, hepatitis, pancreatitis, nonfasted state (GB contracts), hypoalbuminemia.
What is the exclamation point sign of the GB
the GB connects with the main lobar fissure of the liver which connects with the right portal vein, which produces the exclamation point sign.
How can you tell its a GB stone vs polyp
stone is dependent: moves with position as it is affected by gravity.
Also will cause an acoustic shadow artifact.
What is the wall echo shadow sign
WES Sign: all, echo, shadow sign: occurs when the GB lumen is almost completely filled with echogenic stones. It is often mistaken for bowel gas adjacent to the liver. Use the exclamation point to help positively identify the GB.
trouble shooting for finding the GB
usually GB is anterior and around the midclavicular line, but you can trouble shoot imaging by:
1. asking to take deep breath
2. distending the abdomen
3. left lateral decubitus
4. intercostal approach
5. lateral approach
differentiate IVC vs GB
GB has characteristic pear sign with tapering
GB does not vary in thickness with respiration (it does vary in position)
GB will not have flow on doppler.
GB is not pulsatile.
