URR 37 Flashcards by Billie Harney

The pancreatic duct should normally be less than __ in diameter in children and young adults.
a. 0.5mm
b. 1mm
c. 2mm
d. 4mm

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A cyst within a cyst (daughter cyst) is a classic sign of:
a. polycystic liver disease
b. hydatid cyst or fungal abscess
c. echinococcal cyst or pyogenic abscess
d. hydatid cyst or echinococcal cyst

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A patient presents with a history of fever and vomiting with increased serum levels of amylase and lipase. While scanning the abdomen you note a complicated cyst in the anterior pararenal space on the left side. These findings are most consistent with:
a. GI tract mass
b. splenic aneurysm
c. splenic varices
d. pancreatic pseudocyst

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A mass is identified in the left testicle. It is rounded with well-defined borders. There are internal rings of hyperechoic and hypoechoic tissues giving the appearance of an onion. No color flow is demonstrated within the mass. These findings are consistent with:
a. sperm granuloma
b. testicular infarct
c. epidermoid cyst
d. dilated rete testes

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If a patient has a non-reactive Thompson test, what problem do they have?
a. complete tear of Achilles tendon
b. fungal abscess of liver
c. hydatid cyst of the liver
d. baker cyst in the popliteal fossa

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What can be used to alter the displayed brightness of the image after it has been stored in the memory?
a. compression
b. rejection
c. pre-processing
d. post-processing

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A patient presents with mild testicular pain that has increased over the last few months. The US exam demonstrates a normal right testicle. The left testicle demonstrates many tiny cysts clustered centrally along the mediastinum. No color flow is identified within the cystic structures. Which of the following best describes the findings?
a. cystadenoma
b. tubular ectasia
c. spermatocele
d. varicocele

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normal arrangement of abdominal organs

situs solitus

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organs are reversed in mirror image formation, liver on left, stomach and spleen on right

situs inversus

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disorganized rearrangement of the abdominal organs

situs ambiguous

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situs ambiguous is also called:

heterotaxia

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absence of the spleen

asplenia

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Asplenia is a type of:

heterotaxia

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double right-sidedness; usually occurs in cases of multiple congenital anomalies; very rare; (spleen)

asplenia

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In asplenia, _____ defects are common

congenital heart defect

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Polysplenia is a type of ____

heterotaxia

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formation of multiple spleens

polysplenia

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double left-sidedness; (spleen)

polysplenia

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Asplenia usually occurs in causes of multiple congenital anomalies such as ___, ___, ____, ___

right sided aorta
duplicated IVC
midline liver
horseshoe kidneys and adrenal glands

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Polysplenia is associated with ___, ____, ____, ____

biliary atresia
absence of the gb
interrupted IVC
intestinal malrotation

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With polysplenia ___ defects are common

congenital heart

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most common congenital anomaly of the spleen

accessory spleen/splenule

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An accessory spleen is found in the region of ____

pancreas tail

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An accessory spleen is located near the ___

splenic hilum

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Sonographic appearance of accessory spleen

round/oval solid structures isoechoic to spleen <5 cm in diameter

An ectopic spleen is also known as a:

wandering spleen

Weak splenic ligaments lead to the organ migrating to unusual locations, due to abnormal location, may undergo torsion resulting in acute pain

ectopic spleen

One or more of the genes that control red blood cell production abnormal

hereditary hemolytic anemia

Hereditary hemolytic anemia can lead to abnormalities with the ___. __, or ___

hemoglobin cell membrane enzymes that maintain healthy red blood cells

Hereditary hemolytic anemia is associated with increased risk of ____ due to accelerated break down of red blood cells into bilirubin

cholelithiasis

In the US hereditary hemolytic anemia is more common in ___

African americans

Spleen processes the abnormal RBCs that do not carry the necessary normal hemoglobin

hereditary hemolytic anemia

With hereditary hemolytic anemia, lab values demonstrate ____ and/or ____

abnormally shaped cells abnormal hemoglobin

Symptoms of Hereditary Hemolytic Anemia

pallor jaundice LUQ pain from splenomegaly

Hereditary hemolytic anemia can lead to ___, ____, ____, ____

stroke pulmonary HTN blindness priapism

Types of Hereditary Hemolytic anemia

homozygous sickle cell anemia heterozygous sickle cell anemia thalassemias spherocytosis/elliptocytosis G6PD deficiency/pyruvate kinase deficiency

abnormal hemoglobin and crescent (sickle) shaped RBCs

sickle cell anemia

spleen enlarges early in life as it tries to keep up with filtering the abnormal cells and then atrophies and shrinks later when it gets "clogged" with abnormal cells and stops working; spleen becomes very difficult to visualize; may appear bright with calcifications

homozygous sickle cell anemia

spleen fibrosis occurs with loss of function

autosplenectomy

usually presents as splenomegaly with signs of infarction

heterozygous sickle cell anemia

body does not make enough hemoglobin, low RBC count

thalassemias

cell membrane abnormalities of red blood cells

spherocytosis/elliptocytosis

abnormal enzyme levels cause the RBCs to be easily destructed

G6PD deficiency/pyruvate kinase deficiency

Acquired hemolytic anemia is an acquired disorder caused by ____ or _____

infection medication for hypersplenism

Leads to excessive destruction of normal red blood cells causing the release of hemoglobin

acquired hemolytic anemia

The liver uses released hemoglobin to produce:

bilirubin

As more RBCs are destroyed, more ___ is found in the bloodstream

bilirubin

hallmark sign of hemolytic anemia

increased indirect bilirubin

____ levels decrease because of the low red blood cell count in acquired hemolytic anemia

hemoglobin

Lab tests associated with acquired hemolytic anemia

low levels of red blood cells, hemoglobin, and hematocrit with increased serum bilirubin levels

Acquired hemolytic anemia is commonly seen in ___ patients

AIDS

Acquired hemolytic anemia is associated with an increased risk of ____ due to accelerated break down of red blood cells into bilirubin

cholelithiasis

Gaucher disease is an autosomal ____ disorder

recessive

the body lacks a specific enzyme and this causes a buildup of some fatty substances in certain organs, usually the spleen and liver

Gaucher disease

Gaucher disease can also affect ___, ___, and ___, but less common

brain spinal cord bone

Gaucher disease causes abdominal pain due to:

hepatomegaly massive splenomegaly (>18cm)

About __% of Gaucher disease cases have nodular formation

Gaucher disease is associated with ___, ____, and ___

myeloma leukemia lymphoma

Cystic abnormalities of the spleen

simple cysts/primary cysts autosomal dominant polycystic disease parasitic echinococcal cysts pseudocysts infarct with degeneration peliosis hematoma

cysts filled with keratin subtance that is echogenic; can produce layers of hypoechoic and hyperechoic material; usually large, >10 cm, calcified walls

epidermoid cyst

Mot common type of abdominal branch aneurysm

splenic artery

Splenic artery aneurysms are more common in:

females

Splenic artery aneurysms are associated with ____ and ____

pregnancy pancreatic pseudocyst formation

Symptoms of splenic artery aneurysm

asymptomatic LUQ pain abdominal bruit

The ____ makes a splenic artery aneurysm a critical finding requiring immediate intervention

risk of rupture

the splenic artery originates from:

celiac axis

The splenic artery courses across the ___ surface of the pancreas to the splenic hilum

superior

Splenic vein thrombosis is associated with ___, ____, and ____

chronic pancreatitis pseudocysts portal HTN

Splenic vein thrombosis may result ___, which is a potentially fatal complication

upper GI bleeding from gastric varices

Blood collection forms between capsule and splenic pulp

subcapsular hematoma

With a ____ hematoma, the capsule remains intact

subcapsular

A subcapsular hematoma appears:

outer borders of spleen

A perisplenic hematoma is also known as:

intraperitoneal hematoma

blood collection inside peritoneal cavity

perisplenic hematoma

Perisplenic hematoma occurs when:

splenic capsule ruptures

Results in free fluid outside the spleen

perisplenic hematoma

Blood collection within the parenchyma, capsule intact

intraparenchymal hematoma

clinical symptoms of splenic rupture

LUQ pain decreasing hematocrit hypotension

Splenic rupture is usually caused by:

trauma

Spontaneous rupture of the spleen can be seen in patients with __, __, ___, ___, and __

hepatitis A malaria cytomegalovirus mononucleosis HIV

autotransplantation of splenic tissue in the peritoneal cavity when the spleen ruptures

splenosis

free intraperitoneal fluid; absence of normal spleen in LUQ, may see irregular complex mass of tissue in LUQ

splenic rupture

demonstrates small masses of homogeneous splenic tissue

splenosis

areas of tissue death, blood supply is cut off

splenic infarct

Splenic infarcts are found in patients with ____, ___, ___, ___

leukemia sickle cell anemia pancreatitis bacterial endocarditis

sonographic appearance of acute splenic infarct

hypoechoic, wedge shaped area within peripheral parenchyma

Sonographic appearance of chronic splenic infarct

becomes hyperechoic and more wedge shaped with the broad base on the surface of the spleen and the triangular point towards the hilum

Hyperechoic linear-shaped bands within splenic infarct lesions of different ages

bright band sign

Congestive splenomegaly is also known as:

Banti Syndrome

caused by excessive pooling of blood in the splenic tissues

congestive splenomegaly

common causes of congestive splenomegaly

portal htn congestive heart failure splenic vein thrombosis

Sonographic findings of congestive splenomegaly

splenomegaly splenic varices increased resistance in the splenic artery with reduced or reversal of diastolic flow

most common cause of splenomegaly

portal hypertension

decrease in the rate of blood flow through the liver will cause an increase in the portal pressure in the portal system

portal hypertension

anatomical and/or functional obstruction to blood flow into the portal venous system

portal hypertension

caused by an increase in total portal venous flow or increased resistance in the portal venous system/liver

portal hypertension

Increased portal venous flow volume may develop as a result of:

congenital or acquired fistula or shunt

Portal hypertension can result in varices at the ___

splenic hilum

3 categories of increased resistance to portal venous flow

prehepatic intrahepatic posthepatic

most likely to occur due to obstruction of the extrahepatic portal vein

prehepatic portal hypertension