US

Question 1

Vessel anatomy - inner to most outward?

Answer 1

Tunica interna
(connective tissue) inbetween these two
Tunica Media
Tunica externa

Question 2

AAA
Symptoms?
Measurement on US?
Additional images to take?
Causes?

Answer 2

SOB, back pain, flank pain, N/V, Abdo pain
>3cm - thrombus on the lumen
•Aneurysm measured in transverse and longitudinal planes (depth and width)
•Assess for clot or thrombus
•Longitudinal images of iliac vessels from bifurcation to the most distal segment
Transvers scans of iliacs below the bifurcation. (need to determine where it is).

Question 3

Dissecting aneurysm

Answer 3

Aortic dissection is a tear in the aortic intima that enables blood to force its way between the other layers of the vessel wall, forming an intimal flap that divides the aorta into a true and false lumen.

Question 4

What are the three classifications of dissecting aneurysm

Answer 4

• Type 1 &2: involve ascending aorta and arch.

* Typer 3: descending aorta at a level inferior to left subclavian artery

Question 5

what is cylinder tangent effect?

Answer 5

Your plane of the beam enters the aorta at a tangent and falsely reduced AP diameter is resulted

Question 6

What makes the portal conflunce?

Answer 6

where the portal vein and splenic vein meet

Question 7

Where is the GDA and CBD located?

Answer 7

Gastroduodenal artery is superior in the head of the pancreas

Common bile duct is inferior in the head of pancreas

Question 8

why does the pancreas become more echogenic in older patients?

Answer 8

Fatty infiltration

Question 9

what happens to the GB when we eat?

Answer 9

When we eat - stomach stimulates the GB to excrete bile into the duodenum and stimulate the pancreas to excrete digestive enzymes

Question 10

Excocrine cells (97%) - what do they do? How does it work

Answer 10

Pancreatic duct conveys pancreatic digestive secretions to the duodenum

Pancreatic duct empties into the duodenum via the major papilla after meging with the CBD in the ampulla

Question 11

What are the three ezymes that acinar cells secrete and what do they help with?

Answer 11

Amylase, lipase, peptidase

Digestion

Question 12

Endocrine cells (3%) 
What are they responsible for?

Answer 12

Insulin productions

Question 13

What are the insulin hormones called in the pancreas?

Answer 13

Islets of langerhan - found in clusters

Question 14

What are the islets of langerhan hormones cells divided into?

Answer 14

Alpha- glucagon, stop the levels from dropping to low

Beta- Insulin, controls blood glucose levels - help storage of it

Gamma - pancreatic polypeptide - regulates pancreatic secretion

Delta - somatostatin - inhibits the secretion of pancreatic hormones including glucagon and insulin

Question 15

Acute pancreatitis

Answer 15

Acute inflammaotry process of the pancreas
Caused by destruction by own digestive enzymes - occue when digestive enxymes become activated while still in the pacreas - causing inflammation

Causes: gallstone in the ampulla of vater, alcohol

Signs and symptoms: epigastric pain, nausea, vomitting, pain

Question 16

ultrasound appearance pancreatic periampullary neoplasm

Answer 16

ill defined margins
alter in gland controur
solid hypoechoic lesion
ductal dilation
double duct sign pacreatic duct and CBD dilation

Question 17

Intraductal papillary mucinous neoplasm (arise from main pancreatic duct and its side branches) US appearance

Answer 17

Pancreatic duct dilation

formation of cysts

Question 18

Mucinous cystic neoplasms (arise from peripheral ducts) US appearance

Answer 18

in body/tail
round of ovoid-shaped unilocular or multilocular cysts
fine echoes, thick walkks, calcifications on the wall of sepata.
Parietal nodules and papillary vegetations

Question 19

Serous cystadenoma (benign lesion/ tiny cysts) US appearance

Answer 19

Head

microcystic appearance, lobulated margins internal septa arrange radially and converging on the central scar

Question 20

name two neuroendocrine tumours andultrasound appearance

Answer 20

Gstrinoma (focal isoechoic mass, single or multiple) - produce large amounts of hormone gastrin - stimulates excess production of excess gastric acid from the stomach - can lead to zollinger ellison syndrome

Insulinoma (homogneously hypoechoic, round in shape with distinct margins - make extra insulin more than your body can use. Causes hypogylcemia or low blood sugar (can go into coma).

Question 21

What is zollinger-ellison syndrome

Answer 21

rare digestive disorder that results in too much gastric acid. causes peptic ulcers in your stomach and intestine

Question 22

Choledochal cyst

Answer 22

congenital dilations of the bile ducts

most common is - diffuse dilation of the extrahepatic bile duct

Question 23

Caroli disease

Answer 23

congenital disease of the intrahepatic biliary tree. biliary tree does not form. Causes biliary stasis

Appearance: dilated ducts with sacculation

type one: simple
typer two: congenital hepatic fibrosis also associated with cystic renal disease

Question 24

Choledocholothiasis

Answer 24

stones made of calcium bilirubinate.
Primary: within the ducts - distal duct or at the ampulla of vater.

Secondary: Migration of stones from the gallbladder into the CBD (most common)

Highly echogenic
posterior shadowing

Question 25

Cholangitis

Answer 25

Biliary tree infections
Biliary obstruction most common causes.

Dilation of biliary tree
Choledoc /sludge
Bile wall thickening
CBD greater than 6

Question 26

three types of cholethiasis stones?

Answer 26

Cholesterol supersaturation

Excess bilirubin

Question 27

Ultrasound appearance of Cholelithiasis

Answer 27

Highly echogenic

posterior acoustic enhancement

May demonstrate twinkling artefact

Question 28

Gallbladder sludge

Answer 28

sludge forms when bile remain in the GB for too long.

Low level echoes within GB with no acoustic shadowing
Mobile sludge
Lack of internal vascularity.
Sludge has same echotecture as the liver, camouflaging the GB called hepatisation.

Question 29

Acute /chronic cholecystitis

Answer 29

Acute -caused by gallstones in more than 90% impaction of stones in the cystic duct or GB neck

Chronic - reoccuring events. swelling and irritation of the GB - advanced stages will have no positive murphy sign and hyperemia

Thickened GB >3mm
Distension of GB lumen 4cm
High echogenic gallstones - posterior acoustic enhancement
impacted stone in cystic ducts of GB neck
Pericholecystic fluid collection
hyperemic GB on doppler

Question 30

Adenomyomastosis (GB)

Answer 30

benign condition caused by hyperplastic changes. Causes over growth of mucosa,, thickening of the muscular wall, formation of intramural diverticula (rokitansky-ascoff)

Focal or diffuse
tiny echogenic foci in the GB with comet tail artefact

Question 31

Pneumobilia

Answer 31

Air within the biliary tree
from intervention

Bright echogenic linear structure following the portal triads

Posterior dirty shadowing, reverberations and ring down artefact

Question 32

Biliary atresia

Answer 32

Blockage in the ducts - congenital - occurs when bile ducts inside or outside the liver do not develop normally.

Jaundice, dark urine, >bilirubun, jaundice

Echogenic fibrous tissue anterior to the portal triangular cord sign

GB ghost triad - <19mm in length, irregular or lobular contour, lack of smooth/complete echogenic mucosal lining with indistinct wall