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DRG3007 Sono > Week 10 > Flashcards

Week 10 Flashcards

1
Q

what organs are not routinely included in upper abdomen scans and why

A

stomach & large intestines due to presence of air which causes 99% of beam to be reflected from air-tissue interface and obstructs viewing of deeper structures

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2
Q

ALT

A

Alanine transaminase

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3
Q

AST

A

aspartate transaminase

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4
Q

ALP

A

alkaline phosphatase

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5
Q

GGT

A

gamma-glutamyl transferase

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6
Q

abnormal liver function tests include:

A

ALT, AST, ALP, GGT, serum bilirubin, albumin

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7
Q

why is fasting done

A
  • minimizes bowel gas & peristalsis
  • empty stomach
  • bowels not distended
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8
Q

why should one not smoke / chew gum

A

increases subcostal gas

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9
Q

transducer used for upper abdomen

A

low frequency curvilinear transducer for greater penetration

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10
Q

purpose of turning oblique and lateral for patient position of upper abdomen

A
  • makes liver fall away from ribs
  • gas in hepatic flexure rises away from liver
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11
Q

what planes are scanned for complete upper abdomen analysis

A

longitudinal, transverse, oblique

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12
Q

scanning is usually done with arrested __

A

deep inspiration

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13
Q

what is the purpose of deep inspiration

A
  • expands ribcage
  • diaphragm contracts
  • liver moves inferiorly
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14
Q

what organs are scanned transverse & longitudinal

A

right & left lobe of liver, kidneys, pancreas

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15
Q

what organs are scanned longitudinal

A

spleen, gallbladder & biliary system

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16
Q

liver is made up of 3 lobes which are __

A

right, left & caudate lobe

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17
Q

smallest lobe

A

caudate lobe

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18
Q

caudate lobe is delineated by fissure of __

A

ligamentum venosum

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19
Q

liver vessels include __

A

portal vein, hepatic artery & hepatic veins

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20
Q

liver blood supply

A

portal vein (75%) & hepatic artery (25%)

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21
Q

liver drains into __

A

right, middle & left hepatic veins

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22
Q

what divides liver into right & left lobes

A

middle hepatic vein

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23
Q

what does hepatic artery carry

A

oxygen

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24
Q

what does portal vein carry

A

nutrients

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25
Q

how does liver appear compared to right kidney

A

hyperechoic

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26
Q

what is the transducer position for longitudinal imaging of left liver

A

transducer parallel to MSP at midline, inferior to xiphoid process

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27
Q

what is the transducer position for transverse imaging of right liver

A

transducer placed subcostal, oblique and angled cephaladly
- patient must be LPO

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28
Q

what differentiates portal veins and hepatic veins in US images

A

portal veins have echogenic & reflective fibrofatty walls which are reflective

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29
Q

portal veins flow into __

A

liver / hepatopetal flow

30
Q

hepatic veins drain into __

A

IVC / hepatofugal flow

31
Q

how does fatty infiltration appear and why

A

liver echoes appear more echogenic compared to right kidney due to triglyceride deposition which increases sound wave reflection

32
Q

how does liver cirrhosis appear

A

liver parenchyma appears coarse & irregular due to fibrosis / jagged edges

33
Q

most common complication of liver cirrhosis

A

portal hypertension which causes
- enlarged portal vein
- reversed portal vein flow
- splenomegaly

34
Q

how does portal hypertension cause splenomegaly

A
  • cirrhosis causes hardening
  • bloodflow resistance to liver increases; becomes sluggish
  • progression leads to reversed PV blood flow = increased tension to spleen = splenomegaly
35
Q

how does liver simple cyst appear in US images

A
  • round
  • anechoic
  • posterior enhancement due to low attenuation of sound beam
  • well-defined wall
36
Q

how does liver complex cyst appear in US images

A

thick, irregular wall with septations / internal echoes / mass effect / bleeding

37
Q

most common benign liver lesion

A

liver hemangioma

38
Q

how does liver hemangioma appear in US images

A
  • hyperechoic compared to liver parenchyma
  • well-defined wall
  • no vascularity on doppler
39
Q

what is the 2nd most common benign lesion

A

focal nodular hyperplasia

40
Q

how does liver focal nodular hyperplasia appear in US images

A
  • isoechoic
  • peripheral & central vascularity seen
41
Q

how does liver abscess appear in US images

A

irregular complex solid cystic area

42
Q

common indications of liver abscess

A
  • high fever
  • pain
  • nausea
  • raised WBC
43
Q

most common liver carcinoma

A

liver hepatoma / hepatocellular carcinoma (HCC)

44
Q

what is liver hepatoma associated with

A

chronic liver diseases
- hepatitis B/C
- cirrhosis

45
Q

how does liver hepatoma appear in US images

A
  • hypervascularity on doppler
  • wide range of US appearances
46
Q

patients with liver hepatoma tend to complain about __

A

abdominal pain, weakness, weight loss

47
Q

how does non-fasted GB appear compared to normal GB

A

contracted and thickened walls

48
Q

portal triads contains __

A

bile ducts, hepatic artery, portal vein

49
Q

where can portal traid seen in __ bile ducts

A

intrahepatic

50
Q

what is commonly not visualized for IH bile ducts

A

bile ducts & hepatic artery

51
Q

what forms CHD

A

right + left hepatic duct

52
Q

what forms CBD

A

CHD + cystic duct

53
Q

List the extrahepatic bile ducts

A

CBD, CHD, cystic duct

54
Q

what is measured for CBD

A

internal lumen only

55
Q

why could CBD appear dilated

A

post GB removal / cholecystectomy and obstructed

56
Q

how are GB and CBD scanned in routine abdominal US

A

scanned 90 degrees to LCM

57
Q

GB is __ to right kidney

A

anterior

58
Q

CBD __ to portal vein

A

anterior

59
Q

how does gallstone disease / cholelithiasis appear in US images

A
  • echogenic with strong posterior shadowing
  • mobile which differentiates this from polyps
60
Q

how does GB stones appear in supine, LPO and erect

A

supine = neck of GB
LPO = body of GB
erect = fundus of GB

61
Q

how does acute cholecystitis appear in US images

A
  • thickened GB wall
  • gallstones +/- sludge
  • presence of pericholecystic fluid around GB
  • positive Murphy’s sign
62
Q

what is Murphy’s sign

A

GB is tender upon US probe palpation while in inspiration

63
Q

acute cholecystitis complications

A
  • perforation
  • gangrenous cholecystitis
64
Q

how does GB sludge appear in US images

A
  • echogenic material within GB
  • no posterior shadows
  • moves slowly when patient changes positions
65
Q

how does GB polyps appear in US images

A
  • protrude into GB lumen
  • does not gravitate with position changes
  • does not cast posterior shadows
  • less echogenic than gallstones
66
Q

when is GB polyps surgically indicated

A

> 1 cm

67
Q

how does adenomyomatosis appear in US images

A
  • overgrowth of mucosal wall
  • intramural sinus tracts formed
  • comet tail artifacts within sinus
68
Q

how does GB carcinoma appear in US images

A

sizable intraluminal mass with internal vascular flow

69
Q

how does dilated common duct appear in US images

A
  • CBD dilatation
  • presence of stones in CBD / choledocholithiasis
  • intrahepatic bile duct dilatation / many tubes seen
70
Q

The presence of comet tail artifacts in the gallbladder is a feature of

A

Adenomyomatosis

71
Q

What is the most common benign liver tumor detectable with ultrasound?

A

Hemangioma

72
Q

Which of the following structure divide the liver into anatomical RIGHT and LEFT lobe?

A

Middle hepatic vein

DRG3007 Sono (11 decks)

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