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ABD & SMALL PARTS > that which is not necessary > Flashcards

that which is not necessary Flashcards

1
Q

what is the most common splenic pathology

A

splenomegaly

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2
Q

what is the most common reason for splenomegaly

A

portal HTN

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3
Q

other causes for splenomegaly

A

blood disorders
lymphoma
leukemia
viral infection
chronic inflammatory diseases

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4
Q

what is more common in spleen than in the liver

A

abscesses
infarcts
hematomas
calcifications

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5
Q

what is the most common malignancy of the spleen

A

lymphoma

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6
Q

what is more common in the liver than in the spleen

A

focal lesions, mets and cysts are more common in the liver

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7
Q

post traumatic autottransplantation of splenic tissue

A

splenosis

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8
Q

ptosis of enlarged spleen (uncommon)

A

wandering spleen

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9
Q

congenital association with heterotaxy

A

polysplenia

asplenia

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10
Q

what is often seen with dominant LEFT sided features

A

polysplenia

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11
Q

what absence might you expect with polysplenia

A

absence of prox IVC

absence of GB

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12
Q

dominant RIGHT sided features, would expect what abnormality involving the spleen

A

asplenia (no spleen)

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13
Q

what deformity of the great vessels would you expect with the presence of congenital asplenia

A

IVC and Ao on same side of the spine (RIGHT)

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14
Q

what are the functions of the spleen

A

phagocytosis

lymphopoiesis

immune response

RBC storage

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15
Q

what is the cellular structure of the splenic tissue

A

red and white pulp supporting stroma

surrounding capsule

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16
Q

relationship to peritoneum

A

intraperitoneal

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17
Q

what is considered big for spleen

A

> /= 12 cm

> 200cc

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18
Q

echogenicity in comparison to the liver

A

echogenic

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19
Q

likely dx with palpable spleen, +/- LUQ pain and +/- satiety

A

diffuse splenomegaly

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20
Q

portal HTN aka

A

splenic congestion

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21
Q

what else are you going to look for when you find splenomegaly in association with portal HTN

A

splenic hilar varices

splenorenal varices

other collaterals (coronary v, recanalized paraumb, GE varices)

size of MPV (>/= 1cm)

portal flow direciton

ascites

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22
Q

what is the normal direction of portal flow

A

hepatopetal

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23
Q

what is the normal direction of splenic vein

A

hepatopetal

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24
Q

hematologic causes of splenomegaly

A

polycythemia vera

sickle cell anemia

myelofibrosis

thrombotic thrombocytopenia purpura

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25
Q

neoplastic causes of splenomegaly

A

leukemia

lymphoma

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26
Q

infectious causes of splenomegaly

A

histoplasmosis

mononucleosis

AIDS

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27
Q

chronic inflammatory causes of splenomegaly

A

sarcoidosis

malaria

TB

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28
Q

congestive causes of splenomegaly

A

portal HTN

29
Q

MD feels palpable spleen but it’s a normal friend on u/s - what is this called? what are you going to do?

A

pseudosplenomegaly

look for reasons it might be displaced inferiorly
**LLL enlargement
**LT subphrenic mass
**LT PE
**cardiomegaly

30
Q

types of benign neoplasms of the spleen

A

hemangioma
hamartoma
lymphangioma

**solid, echogenic

31
Q

1/3 of __ malignancies have splenic involvement

A

lymphoma

32
Q

sono feature of primary malignant lesion of the spleen

A

focal, solid and hypoechoic
diffuse splenomegaly
spleen may look normal

33
Q

what is the name of the fancy scan that can localize metabolically active tissue (used for tumour imaging)

A

PET with FDG

**positron emission tomography with fluorodeoxyglucose

34
Q

primary cancers associated with the rare occurence of splenic mets

A

GI
HCC
ovarian

35
Q

if you see mets in the spleen, where else do you expect to see mets?

A

liver
lungs
adrenal

**very rare to be isolated

36
Q

sono feature of mets

A

focal, solid nodule
hyper or hypoechoic
single or multiple

sometimes demonstrate ‘bullseye’ or thick capsule

37
Q

causes for splenic cysts

A

post trauma
pancreatic pseudocysts
hydatid
congenital

**uncommon

+/- fluid levels
+/- wall calc
+/- internal echoes

38
Q

congenital cysts aka

A

true cysts

rare in the spleen

39
Q

hydatid cyst aka

A

echinococcus granulosus

40
Q

sono features of hydatic cysts

A

daughter cysts

‘water lily’ sign

calcified rim

low level echoes (‘hydatid sand’)

**use hx

41
Q

collection of pus typically due to a bacterial infection

A

abscess

**can be fungal, amebic

42
Q

what demographic are you most likely see abscess in spleen

A

hospitalized pt

**hematogenous spread

43
Q

if you see a bullseye sign in a spleen, what should you think of first

A

abscess more common than mets in spleen and can demonstrate this appearance

**should be avascular

44
Q

small echogenic foci seen within the spleen

A

granulomas

45
Q

sono features of granulomas

A

+/- shadowing
often multiple
pt typically well and asymptomatic
old tuberculosis or histoplasmosis

46
Q

what are the two types of infarcts

A

segmental
total

47
Q

where is the most likely area for splenic infarcts

A

peripheral

48
Q

causes of segmental splenic infarcts

A

septic emboli
local arterial thrombosis

49
Q

sono feature of a segmental infarct

A

wedge-shaped peripheral lesion

hypoechoic = recent
hyperechoic = chronic

50
Q

causes of total splenic infarction

A

splenic vein thrombosis
**pancreatitis; panc cancer

splenic artery thrombosis

**usually pt is already hospitalized

51
Q

what is more common, a venous thrombosus or an arterial thrombus

A

venous

52
Q

sono features of total splenic infarct

A

normal or enlarged spleen
+/- heterogeneous
no perfusion of spleen
***use power Doppler to assess

53
Q

__ sign is acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity.

**demonstrated in the LEFT is highly suggestive of ____

A

Kehr’s sign

suggestive of splenic rupture

54
Q

focal areas of siderosis (iron deposition) that may occur due to portal HTN

A

gamna gandy bodies

55
Q

sono feature of gamna gandy bodies

A

appear as punctate echogenic foci (indistinguishable form granuloma)

56
Q

what causes increased incidence of splenic artery calcification

A

age
DM

57
Q

why do you put Doppler on a thrombus?

A

to rule out tumour thrombus

58
Q

what are the 2 criteria to help determine wandering spleen

A

congenitally extra long and mobile mesentery

splenomegaly

59
Q

situs solitus aka

A

normal situs

60
Q

situs inversus totalis aka

A

mirror image of situs solitus

61
Q

situs ambiguous aka

A

HETEROTAXY

left atrial isomerism (dominant left)

or right atrial isomerism (dominant right)

62
Q

2 left atria, 2 bilobed lungs, polysplenia, and absence of GB

A

left atrial isomerism

63
Q

2 right atria, 2 trilobed lungs, asplenia, ML liver, IVC and Ao on same side of spine

A

right atrial isomerism

64
Q

which atrial isomerism (heterotaxy) is associated with increased incidence of anomalies

A

right atrial isomerism

*increase risk of heart problems, infections, etc.

65
Q

how does the spleen filter blood

A

phagocytosis performed by macrophages

66
Q

what is the breakdown product from RBCs

A

bilirubin is produced from breakdown and sent to liver to be excreted in bile

67
Q

what stores the RBCs, platelets and plasma

A

red pulp in spleen

1/4 L

68
Q

what stores WBCs

A

white pulp

25% of lymphocytes in body (B and T cells)

69
Q

why is the spleen important for immune system

A

makes antibodies

B cells in white pulp activated by antigens; resulting in release of specific antibodies

ABD & SMALL PARTS (16 decks)

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