rest for final Flashcards
(192 cards)
1
Q
how can fluid collections be classified?
A
- body location
- infected
- potentially infected
- intravisceral/extravisceral
2
Q
body locations
A
- neck
- thoracic
- abdominal
- pelvic
- extremity
3
Q
infected
A
asbcess
empyema
4
Q
potentially infected
A
- hematoma
- seroma
- lymphocele
- bile (biloma)
5
Q
what fluid collection drainage is the primary focus today?
A
extravisceral abdominal fluid collection
6
Q
what are fluid collection drainage indications?
A
- urgent drainage fo fluid colletions
- elective drainage of fluid collection
7
Q
what is involved in the pre scan of drainage?
A
look for adjacent organs that can be mistaken for the collection by ultrasaound during the drainage procedure
8
Q
what organs must we look for in the pre scan for drainage?
A
- focally dilated small bowel loop
- gallblader
- urinary bladder
- distended stomach
- ovaries, fallopian tubes, uterus
9
Q
what does the lab value evaluation mostly revolve around for pre drainage procedure?
A
ruling out coagulopathy
10
Q
what is a normal INR range?
A
0.8-1.2
11
Q
what is a normal platelet range?
A
150 000-450 000
12
Q
what is the normal PTT range?
A
25-35 sec
13
Q
what must be mentioned when obtaining informed consent?
A
- explain procedure
- indications
- alnertatives
- procedureal risks
14
Q
what is given to control the pain caused by fluid collection drains?
A
nonarcotic medication. Pain is usually not a problem
15
Q
is pleural/thoracic complications common or not?
A
not common
16
Q
if a person with chest pain or reduced oxygen after a pleural or thoracic fluid drainage, what should be obtained?
A
CXR to rule out pneumothorax or hemothorax
17
Q
is puncture to adjacent structures common in drainages?
A
not common
18
Q
operators should not _________ the fluid collection?
A
over distend
19
Q
what rigors can respond to medication?
A
rigors only without fever
20
Q
what should be done in cases of postoperative fever in drainages?
A
operators should continue with antobiotics and should check for culture and sensitivity of fluid sample obtained
21
Q
what does sepsis require?
A
requires fluid resuscitation and even vasopressors with ICU admission
22
Q
what are the 2 types of drainages?
A
diagnostic
therapeutic
23
Q
Cytopathology/cytology
A
diagnosis malignant vs premalignant/other types of cells in fluid collection on the microscopic level
24
Q
Medical biochemistry/ chemical pathology/ clinical biochemistry
A
concerned with analysis of bodily fluid. Usually check for cell count and different electrolytes, total protein, minerals within the fluid
25
Microbiology - culture
to check if there is infection within the fluid. Fluid samples are tested for presence of pathogens, which is determined by growth in a medium
26
what idoes PUBS stand for?
percutaneous umbilical cord sampling
27
what is another word for PUBS?
cordocentesis
28
what is PUBS?
sampling of blood via the vein in the umilical cord
29
why is PUBS preformed?
a diagnostic test that examines blood from the fetus to detect fetal abnormalities
30
how does a PUBS work?
ultrasound sees where the cord inserts to placenta and a needle goes through abdomen and uterine walls to umbilical cord. A small sample of blood is taken
31
when do results come in from a PUBS?
72 hours
32
how is PUBS different from an amniocentesis?
similar but this but PUBS retrieves blood from the fetus vs amniotic fluid
33
why would a PUBS be preformed?
when diagnostic information can not be obtained through amniocentesis, CVS, ultrasound or the results were inconclusive
34
when is a cordocentesis (PUBS) preformed?
after 17 weeks into pregnancy
35
what is a primary risk for cordocentesis?
miscarriage (between 1-2 times out of every 100 procedures)
36
what are other potential side effects to PUBS?
- blood loss from the puncture site
- cord hematoma
- infection
- drop in fetal heart rate
- premature rupture of membranes
37
what does PUBS detect?
chromosome abnormalities (down syndrome) and blood disorders (fetal hemolytic disease)
38
PUBS may be preformed to diagnose what?
- malformation of the fetus
- fetal infection
- fetal platelet count in the mother
- fetal anemia
- isoimmuninization
39
what does PUBS not diagnose?
neural tube defects (amniocentesis does this)
40
what are reasons for prenatal testing?
- Pursue potential medical interventions that may exist
- Begin planning for a child with special needs
- Start addressing anticipated lifestyle changes
- Identify support groups and resources
- Make a decision about carrying the child to term
41
why maybe reasons not to test for prenatal testing?
parents may decline testing
- personal or religous reasons
- outcome has no impact on comfort level
- avoid risk of miscarriage or injury to fetus
42
what is coelocentesis?
sampling of fluid from the exoxoelomic cavity
43
what is the approach for coelocentesis?
endovaginal approach
44
when is prenatal diagnosis for coelocentesis?
7 weeks
45
what are the disadvantages for coelocentesis?
- Coelomic cells difficult to culture
- Nuchal lucency + lab as accurate
- Procedure safety
46
what is culdocentesis?
fluid aspirated from the posterior cul-de-sac
47
what are the findings for culdocentesis?
- blood-intraperitoneal bleeding
- pus-infectious process
- serous-ascitic fluid
48
what are the indications for culdocentesis?
large collection of fluid in the posterior cul-de-sac
49
what are the contraindications for culdocentesis?
- masses
- cysts
- fixed retroverted uterus
- bleeding diathesis
50
what must the patient do before a culdocentesis?
sit or stand upright 10 to 15 minutes prior to procedure
51
is anesthetic given in a culdocentesis?
topical anesthetic applied to the posterior vagina and cervix
52
what is the postion for a culdocentesis?
lithotomy position, head elevated 60 degrees
53
what is the vagina cleansed with in culdocentesis?
iodine
54
how is the culdocentesis preformed?
18G needle attached to 20 mL syringe inserted through the posterior vaginal wall into the posterior cul de sac
55
what are complcations for a culdocentesis?
puncture pelvic nerves
| puncture vessels
56
what is a Hysterosonography &Hysterosonosalpingography?
Procedure used to improve or further evaluate the visualization of the uterus, endometrial canal and tubal patency.
57
when is Hysterosonography &Hysterosonosalpingography preformed?
4 - 10 days into the patients menstrual cycle
58
what are indications dor a Hysterosonography &Hysterosonosalpingography?
- infertility
- recurrent miscarriage
- endometrial polyps, hyperplasia, carcinoma
- AUB / Pre and post menopausal
- submucosal fibroids
- uterine anomalies
59
what are contraindications for a Hysterosonography &Hysterosonosalpingography?
- pregnancy
- pelvic infections
- excessive vaginal bleeding
60
what is done prior to a Hysterosonography &Hysterosonosalpingography?
- NSAID one hour prior (motrin, advil)
- consent obtained
- empty bladder
- pre procedural endovaginal U/S images taken
61
what pre procedure images are taken in a Hysterosonography &Hysterosonosalpingography?
- uterus and cervical postion
- size of uterus
- endometral thickness
- Rt and Lt adnexa
- R/O hydrosalphinx / PID
62
what is injected into the uterine cavity in a Hysterosonography &Hysterosonosalpingography?
saline
63
what is taken simultaneously during a Hysterosonography &Hysterosonosalpingography?
Sag and Trv images as well as cine loops
64
what can a Hysterosonography &Hysterosonosalpingography diagnose?
- endometrial polyps
- submucosal fibroids
- ashermans syndrome
- tubal patency
65
what are the complications for a Hysterosonography &Hysterosonosalpingography?
- pain
- cramping
- spotting/light bleeding
- watery discharge
- nausea
- vasovaginal
- infection
66
what are failed attempts for Hysterosonography &Hysterosonosalpingography?
- severe cervical stenosis
- pelvic pain
- vagal symtoms
- fear of the procedure
67
where does the fetus grow?
within the uterus in a sac called the amniotic sac or cavity
68
what does amniotic fluid contan?
amniocytes and fetal epithelial cells
69
what is amniocentesis?
a prenatal test in which amniotic fluid is removed from the amniotic sac by means of FNA
70
how much fluid is drawn in amniocentesis?
less than one ounce of amniotic fluid is drawn
71
is their harm by extraxting alot of amniotic fluid?
no becuase the body will produce more
72
where is the needle inserted in amniocentesis?
through the abdomen under ultrasound guidance
73
what has amniocentesis been used for?
infusion of dye such as indigo carmine to evaluate for rupture of membranes
74
what has amniocentesis been used for?
in cases of oligohydramnois for therapeutic reasons or to improve visualization
75
what can amniotic fluid help in determining?
- amniocytes for fetal karyotype
- prenatal genetic diagnosis of specific disorder
- evaluation for neural tube defects
- evaluation for infection
- determination of fetal lung indices
- determination of degree of fetal anemai
- therpapeutic amniocentesis for polyhydramnois
76
when is an amniocentesis typically preformed?
15-20 weeks GA
77
genetic testing for amniocentesis?
- postive results from prenatal screening
- chromosomal or neural tube defect in prev, pregnanacy
- you are over 35 age
- family history of specific genetic condition
78
maturity testing for amniocentesis?
determine if lungs matured enough for birth
- only done if delivery or Csection is early
- between 32 and 39 weeks
79
what are other reasons for amniocentesis?
- infection or illness
- decrease amniotic fluifd amount
- evaluate severity of anemia in babies with Rh sensitization
80
why may you might not have an amniocentesis?
- you may have placental problems (low lying)
- history of pre term labour
- incompetent cervix
81
what are the risks/complications for amniocentesis?
- miscarriage
- leaking amniotic fluid
- bleeding
- rupture of membranes
- preterm labour
- Rh sensitization
- needle injury
- infection and infectious transmissions
82
what are the factors that affect the risk of miscarriage in amniocentesis?
bloody or discolored fluid withdrawl and vaginal bleeding
83
where is an amniocentesis preformed?
done in an out-patient facility or healthcare providers clinic
84
when do you need a full bladder for an amniocentesis?
under 20 weeks, after 20 weeks you do not need a full bladder
85
how long does an amniocentesis take?
20-30 minutes
86
what antiseptic is the abdomen prepared with for an amniocentesis?
povidone-iodine (betadine) or chlorhexidine
87
what type of needle is used for a amniocentesis?
22 guage
| 3.5 inch long spinal needle is used
88
what other types of needles may be used for an amniocentesis?
20 guage for therapeutic
| 2 or 7 inch for obese
89
what is documented before the patient leaves from an amniocentesis?
fetal cardac activity
90
what should be given to Rh-negative mother after amniocentesis is complete?
Rh (D) immune globulin (RhoGAM)
91
what may be felt after an amniocentesis?
a stinging sensation and a cramping feeling
92
what may happen following an amniocentesis?
vagial bleeding
93
what should the patient not do after an amniocentesis?
no strenuous physical activity 2-3 days afterwards
94
if you experience what symtoms, you should contact your doctor from an amniocentesis?
- Persistent fluid leaking from vagina
- Heavy vaginal bleeding
- Abdominal pain uterine cramping that lasts more than a few hours
- Fever
- Redness and inflammation where the needle was inserted
- Unusual fetal activity or a lack of fetal movement
95
how are the cells from amniotic fluid examined?
can be tested directly or grown in cultures
96
when are the results ready after an amniocentesis?
10-14 days following the procedure
97
when can information be gathered sooner after an anmiocentesis?
trisomy 21, 18, or 13-information can be gathered sooner using florescence in situ hybridization (FISH)
98
what is chorionic vilus sampling?
prenatal test that involves taking a sample of fetal cells from the tissue of the placenta under the guidance of an ultrasound scan
99
where is the sample taken in chorionic vilus sampling?
tiny-finger like projections on the placental called chorionic villi
100
what is the purpose of chorionic vilus sampling?
- assess the fetal karyotype
- biochemical test of fetal cells for evaluation of disease status
- detects more than 200 genetic disorders
101
what genetic disorders can chorionic vilus sampling detect?
trisomt 13, 18, 21
| tay-sachs disease
102
when is chorionic vilus sampling preformed?
between 10-13 weeks
103
successful genetic diagnosis is obtained in _____ of cases
99.7%
104
what are the indications of a CVS?
- US showed baby had structural defects with a chromosomal anomaly
- your a carrrier of a recessive genetic disorder (cystic fibrosis or sickle cell)
- previously been pregnant with a child with genetic abnormality
- family history
- over 35
105
what are the 2 techniques for a CVS?
- transcervical
| - transabdominal
106
when is a transcervical approach CVS preformed?
posterior and low placentas
107
when is a transabdominal CVS preformed?
fundal and anterior placentas
108
what is done in the pre scan for CVS?
- measure size of baby
- document location of placenta
- obatin heart rate
109
what cleans the cervix in an CVS?
betadine or chlorohexidine
110
what is used in a CVS?
a 5.7 Fr flexible CVS cannula with a rigid metal introducer
111
what size of syringe is used for a CVS?
20 cc
112
how much of a CVS sample is required?
atleast 15 mg
113
what is prepared on the abdomen with a CVS?
betadine or chlorhexidine
114
what anesthetic will you recieve for a CVS?
anesthetic of 1% lidocaine
115
what type of needle is used for an CVS?
18 or 20 guage needle
116
what type of syringe is used for CVS?
20 cc with 2mL transport
117
why is RhoGam given if mothers blood is Rh-negative?
becuase your baby's blood may have mixed with your during procedure
118
how long should recovery with CVS take?
about a day
119
what may you experience after your CVS procedure?
light bleeding or cramps after the procedure
120
when should you contatc your doctor after a CVS?
- a high temperature of 38 C (100.4F) or over
- excess bleeding
- excess vaginal discharge
121
what is the role of the sonographer during an CVS?
assist the radiologist and making sure the patient is at ease
122
what are the duties of the sonographer during an CVS?
- preform prescan and confirm placenta location
- prepare the trays and equipment
- ensure and maintain a sterile field
- directly visualise the needle of the cathedar entering the placenta for a precise diagnosis and limit the risks
- watch the patient for signs of discomfort or vasovagal reaction
123
what is the possibly of miscarriage for a CVS?
1%
124
does CVS or amniocentesis have a higher miscarriage rate?
CVS
125
when is risk of miscarriage considered to be higher for CVS?
when its thorugh the cervix
126
what are complications of CVS?
- bleeding
- infection
- Rh incompatibility in the mother
- rupture of the membranes
127
when should you have your results after a CVS?
2 weeks
128
what is done in the lab for a CVS?
lab techs isolate the tissue cells and allow them to reproduce, they then analyze the cells for chromosomal abnormalities
129
what is FISH?
will give you CVS findings in a few days
130
can else can FISH tell you?
tell you the baby's gender
131
what is the negative result for CVS?
this means you are negative for signs of any genetic defects in the developing baby
132
what is the postive result for CVS?
the baby has the disorder that was tested
133
when is a CVS preformed?
10-13 weeks
134
what is your only option for testin after 15 weeks?
amniocentesis
135
what locks into place when we stand?
valves
136
when is pressure created in the legs?
valves become faulty and remain open, causing blood to flow backwards and pool in legs
137
what is backwards flow known as?
venous disease, venous insufficiency or venous reflux
138
what are signs and symtoms of venous reflux?
- heaviness
- aching
- pain
- swelling
- varcose veins
- spider veins
- skin color changes
- ulcers
139
whata are the risk factors for venous reflux?
- family history
- obesity
- pregnancy
- standing or sitting for long periods of time
- previous DVT
- Injury
- surgery
140
what are the 3 components of US used for diagnosis of venous reflux?
- greyscale
- color flow doppler
- spectral doppler
141
what can greyscale detect?
- thickened walls
- webbing
- diameter
- presence of tributaries
142
what can color doppler detect?
- presence or absence of flow
- direction of flow
- color fill
143
what can spectral doppler detect?
- measurment of the duration of reflux
| - velocity
144
what are the forms of treatment for deep veins?
- compression stockings
| - leg elevation
145
what are the forms of treatment for superficial veins?
- endovenous laser treatment / radiofrequency ablation
- VenaSeal
- sclerotherapy
- ambulatory phlebectomy
146
what is US guided endovenous laser / radiofrequency ablation?
uses heat to close the vein under US
147
what are the steps for US guided endovenous laser / radiofrequency ablation?
- identifies the refluxing vein
- confirms access into the vessel
- navigates the ablation fiber through the correct vessel
- aides in the placement of tumescent anesthetic around the vein
- determines a safe distance from the deep veins
148
what is VenaSeal?
uses a medical adhesive to close the vein under US guidance
149
what are the steps for a venaseal?
- identifies the vessel
- confirms access into the vessel
- determines a safe distance from deep veins
- provides guidance and compression as the adhesive is administered
150
what is sclerotherapy?
under US guidance a medical grade solution is injected into the vein causing the vein to spasm and close over time
151
what is the post procedure US for therapy for reflux?
- determine the success of the closure
- thrombus extension into the deep veins
- locate the presence of open tributaries
- neovascularity
- monitors mild cases of reflux in other vessels
152
what are US contrast agents?
gas liquid suspensions of biocompatible gas-filled microspheres
153
what does the contrast agents do once injected into the arms?
the flow unimpeded through the patients circulatory system, miminking the flow patterns of red blood cells while producing enhanced ultrasond reflectivity
154
do US contrast agents contain dye?
no and does not expose to radiation
155
what is the structure of contrast agents?
gas filled microbubbles surrounded by an outershell composed of phospholipids or synthetic polymers
156
are RBC's or microbubbles smaller?
microbubbles are smaller
157
how do contrast agents leave the body?
remiain in vessles, not excreted. Must last several minutes in blood streaming before dissolving
158
how do the microbubbles oscillate within the circulation system?
in responce to changes with the US beam, compressing and expanding
159
what do the bubbles do as they oscillate?
produce a non-linear frequencies (harmonic) and a strong signal
160
what is the MI in contrast agents?
0.1-0.3
161
descrive the mechanism with MI?
the oscillations are no longer synchronized with the applied U/S beam and scattering with harmonic frequencies ensues (non-linear response)
162
how long do the agent doses last?
4-6 minutes
163
what is the contrast agent dose for all adults?
0.1-0.3 ml
164
what is the dose of contrast agents for pediatrics?
varies depending in the weight of the patient
165
when may lower doses of contrast agents be used?
with newer equipment
166
what did the very first generation of contrast agents do?
air based, proved unstable during lung passage
167
what are the contrast agents that are no longer in use?
- echovist
| - levovist
168
what are the brand names for second generation contrast agents?
- sonovue
- definity
- optison
- lumason
169
what do all machines have for contrasts?
contrast specific software used to display the harmonic bubble signal well
170
what does the contrast preset do?
set to enhance the image with the use of contrast agents NOT the organ itself
171
what is the image opitimization for CEUS?
- low MI
- Dual screen is utilized
- focus zone places atnthe posterior part of image NOT AOI
- use of timer
- shallow breathing may be needed
- store cine clips during procedure
172
what are the images in the dual screen?
- one image 2-D (keeps AOI in sight)
| - one image black (pre and post injection)
173
why do we plaace the focus zone at the posterior part of the image?
bubbles tend to burst at the area of the focal zone
174
what do we do before the contrast is injected to the cine clips?
- increase length of clips prior to procedure
| - store images from cine clips post procedure
175
what organs and vessels are used to enhance imaging organs and vessels?
- abdominal
- small parts
- vascular
- cardiac
176
contrast enhancement is _______
echogenic
177
what does anechoic mean in CEUS?
anechoic indicates an area of no blood flow
178
what is wash in phase?
early phase of injection, entry of agent into the plane of imaging
179
what is wash out phase?
late phase of injection, exit of agent from the plane of imaging
180
why does the liver have 3 phases?
dual blood supply
181
what are the 3 phases with the liver and in what order?
- arterial phase
- portal venous phase
- sinusoidal phase (parenchyma)
182
what is the CEUS characterization for benign lesions?
lesions will remain enhanced in the late phase, stays echogenic from early phase to late phase
183
what is the CEUS characterization for malignant lesions?
- fast wash in and fast wash out
- lesions will wash out in late phase going from echogenic to hypoechoic in the late phase
- irregular vessel pattern
184
what can CEUS vessels show?
- ulcerative plaque
- hypoechoic plaque
- dissections
185
what arm is preferred for a CEUS?
left arm
186
what are the steps for a CEUS?
- obtain consent
- start IV (cannula 20G)
- pre procedural images
- mark skin
- switch to contrast pre set
187
what must be done when switching to contrast preset?
- dual screen
- increase cine clip length
- annotate prior to injection
188
what must be done to the drug before injecting it in CEUS?
shake and must be at room temperature
189
what is injected with contrast?
saline
190
what are the possibles side effects for a CEUS?
minimal but some may experience
- transient altered taste sensation
- headache
- backache
- dizziness
- palpations
- urticaris (hives)
191
what are the CEUS advanatges?
- accurate and reliable diagnosis
- strong safety profile
- no radiation
- no iodinated dye
- no risk of nephrotoxicity
- no anesthesia or sedation
- help characterize type of lesion
- can be used during and post interventional procedures
- cheaper equip
- easy to use
- portable
192
what are CEUS disadvanatges?
- very small risk of allergic reaction
- microbubbles dont last very long in blood
- usually on one area of the body can be evaluated per injection
