spleen/abd wall study guide Flashcards
uniform, homogeneous mid to low echo patterns. Texture more echogenic than liver
Normal echotexture
Left kindey lies inferior and medial
Describe the location of the spleen in relationship to the left kidney
Splenorenal
Phrenicocolic,
2 ligaments that help anchor the spleen
Breakdown of hemoglobin, Formation of antibodies and immunity, red cell production, blood reservoir
Common functions of spleen
splenic hilum (or tail of pancreas) 1 cm and also have an echo texture.
Common location of accessory spleen
reticuloendothelial Considered the largest lymphatic organ production of lymphocytes and plasma cells, antibodies, storage of iron and other metababolites
What system is the spleen part of
bright echogenic lesion with or without shadowing Associated with hepatic and pulmonary calcifications. Curvilinear calcification seen in the splenic artery or a splenic artery aneurysm are seen commonly at the splenic hilum Splenic calcifications are associated with pneumocystic carinii Calcification of splenic infarcts can occur in sickle cell disease
Sonographic signs of histoplasmosis
tumor (benign and malignant) infarction, abcess and cyst
Major focal defects
most common: cavernous hemangioma, hamartoma, cystic lymphangioma Splenomegaly is the first indication of an abnormality. Most of these tumors appear isoechoic compared with the normal splenic parenchyma
Common benign neoplasms
hemangiosarcoma, lymphoma, Arises from the vascular endothelium Sonographically complex or solid
Lymphoma- Hodgkin and non-Hodgkin
Differentiation is determined by the presence of Reed-Sternberg cells
Hodgkin has these and the cure rate is very high
Non-Hodgkin is not as easily managed and is more common than Hodgkin lymphoma
Name of the malignant neoplasm
associated with left pleural effusion, happens in splenic trauma, 2 types: peri splenic and sub capsular
Splenic rupture
dorsal mesentery fails to fuse with peritoneum, no supporting ligaments, presents as mass, intermittent pain, belongs in LUQ pain
Wandering spleen/ ectopic spleen
size adult 8-13 cm Length, 7cm diameter, less 5 cm thickness, varies with age, decrease as you get older. splenomegaly : more than 13cm most common manifestation You will feel LUQ pain
Size of spleen/splenomegaly
cause liver to get small, spleen gets bigger congestive splenomegaly: portal hypertension look at liver as well if spleens enlarged
Describe the effect of cirrhosis to the spleen
}Chronic disease of unknown cause that involves all bone marrow elements
}Characterized by an increase in red blood cell mass and hemoglobin concentration
}Clinical symptoms
◦Weakness and fatigue
◦Vertigo
◦Tinnitus
◦Irritability
◦Splenomegaly
◦Flushing of the face
◦Redness and pain in the extremities
◦Blue-and-black spots
Polycythemia vera
◦Spleen is variably enlarged, rather firm, and blue-red.
Infarctions and thromboses are common
Polycythemia vera
}Sonographic findings
}Metastases are the result of a hematogenous spread from another primary site.(spread by the blood)
}The spleen is the tenth most common site of metastases, which may originate from the breast, lung, ovary, stomach, colon, kidney, or prostate, as well as from melanoma.
Metastatic tumors may be microscopic, causing no symptoms
Primary tumors that may metastasize to the spleen
Active in blood formation during the initial part of fetal life (Hematopoiesis)/ (erythropoiesis) RBC
Hematopoeisis
lesser sac
subphrenic
subcapsular
liver
biloma
kidney
general abdominal
appendicel
Sites for abscess formations
}Look for findings in the ascitic fluid that would suggest an inflammatory or malignant process
◦Fine or coarse internal echoes
◦Loculation
◦Unusual distribution, matting, or clumping of bowel loops
◦Thickening of interfaces between the fluid and neighboring structures
Malignant/inflammatory ascites
}Are extrahepatic loculated collections of bile.
}May develop because of iatrogenic, traumatic, or spontaneous rupture of the biliary tree
Biloma
}Incomplete regression of the urachus during development
◦Apex of the bladder continuous with the allantois becomes obliterated and forms a fibrous core, the urachus.
Urachus persists throughout life as a ligament that runs from the apex of the bladder to the umbilicus and is called the median umbilical ligament
Urachal cyst
Cystic mass is found between the umbilicus and the bladder; the mass may be small or giant, multiseptated, and extend into the upper abdomen
Urachel cyst
}Sonographic findings
◦Cystic with weak internal echoes or a fluid-fluid level if clots or debris are not present
◦Sharp margins
Extrahepatic biloma abscesses are usually crescentric, surrounding and compressing structures with which they come in contact
Biloma Sonographic findings
an apron like fold of peritoneum that hands from the greater curvature of the stomach
Greater omentum
Patient may have a fever of unknown origin or tenderness and swelling from a postoperative procedure
Clinical symptoms of infection
Collection of fluid that occurs after surgery in the pelvis, retroperitoneum, or recess cavities
Lymphoceles
◦Generally look like loculated, simple fluid collections.
◦May have a more complex, usually septated, morphology.
Lymphoceles
}Sonographic findings
}from loculated ascites is usually possible because the mass effect of a lymphocele that is under tension displaces the surrounding organs.
from other fluid collections is mainly made by aspiration.
Lymphoceles differentiation
spread of infection from its usual site via the blood
Sepsis
should include pseudocyst, pancreatic abscess, gastric outlet obstruction, and fluid-filled stomach
Differential diagnosis for lesser sac abscess
is the serous membrane that forms the lining of the abdominal cavity
It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mesothelium supported by a thin layer of connective tissue.
The peritoneum supports the abdominal organs and serves as a conduit for their blood vessels, lymph vessels, and nerves
Peritoneum
are similar to those found in the liver and can be distinguished by their intracystic contents such as daughter cysts
Hydatid cyst in the spleen
Candidiasis is a fungal infection caused by yeasts that belong to the genus Candida.
hepatosplenic candidiasis may show irregular masses within the spleen, the “wheels within wheels” pattern with the outer wheel representing the ring of fibrosis surrounding the inner echogenic wheel of inflammatory cells
more prevalent in AIDS patients or patientsw with weakened immune systems
Candidiasis
◦Demonstration of an abdominal wall defect
◦Presence of bowel loops or mesenteric fat in a lesion
◦Exaggeration of the lesion with strain (Valsalva maneuver)
◦Reducibility of the lesion by gentle pressure
}Sonographic criteria for a hernia
}Complications may arise if edema develops or
if the opening constricts to the extent that the protrusion cannot be placed back into position.
}Strangulation (interruption of the blood supply)
of the bowel can also occur in an incarcerated hernia that is not surgically repaired in a timely manner.
}Bowel can become necrotic and require resection.
Abdominal Hernia
