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489 Cards in this Set

  • Front
  • Back
In transverse imaging plane, it is the top of the screen.
Anterior
In transverse imaging plane, it is the bottom of the screen.
Posterior
In transverse imaging plane, it is the left side of the screen
patient’s right
In transverse imaging plane, it is the right side of the screen
patient's left
In the longitudinal (sagittal) imaging plane, it is the top of the screen
Anterior
In the longitudinal imaging plane (sagittal), it is the bottom of the screen
Posterior
In the longitudinal imaging plane (sagittal), it is the left side of the screen
Superior/cephalic
In the longitudinal imaging plane (sagittal), it is the right side of the screen
Inferior/caudal
In the coronal imaging plane, it is the top of the screen
lateral
In the coronal imaging plane, it is the bottom of the screen
medial
FREQUENCY is indirectly proportional to ________.
penetration
Higher frequency = ______ penetration.
lower
Lower frequency = ______ penetration
higher
FREQUENCY is directly proportional to _______.
resolution
Higher freq = ________ resolution
higher
Lower frequency = _______ resolution
lower
Two types of aortic aneurysm
Fusiform
Saccular
An aortic aneurysm is when it is over ______ cm's or larger in any dimension.
3
Leaking aneurysms patients have _______ pain.
back
_____ cm or larger aneurysms are indicated for repair
5
These result from the separation of the intima layer from the aorta
Dissections
Seagull sign
coming off of aorta at the hepatic artery and splenic artery origins
Organs we can live without
Spleen
Gallbladder
Appendix
Uterus
Ovaries
Scrotum
Prostate
One kidney
Thyroid
Breasts
Some nodes
Some vessels
Portion of the liver
SMA feeds blood to these two
prox colon
small intestine
IMA feeds blood to these 4
left transverse colon, descending colon,
sigmoid and
rectum
Aorta sits to the ______; IVC sits to the ______.
right
left
T/F The aorta is sometimes posterior
True
The Aorta is a _____; The IVC is a _____.
artery
vein
Aorta has a ________ waveform.
pulsatile
IVC has a ________ waveform.
phasic
T/F Aorta is rigid
TRUE
T/F IVC is collapsible
TRUE
SMV + Splenic vein
Portosplenic confluence
What is the landmark for the pancreas?
Portosplenic confluence
Which renal artery is the longest and posterior to the IVC
Right
4 Characteristics of the left renal vein
longer
Anterior to aorta
Posterior to SMA
Lt. gonadal vein drains into the lt. renal vein
Characteristics of a hematoma
When immediately formed is anechoic - then becomes hypoechoic (still acute) - later becomes hyperechoic over time - degenerates and becomes hypoechoic again
___________ is peritoneal fluid.
Ascites
Ascites is most commonly seen in the ________ gutters and ______ pouch.
pericolic
Morison's
located superior, between
inferior aspect of the diaphragm and superior border of the liver, on the right, and spleen on the left.
subphrenic space
The chest sonogram is done to look for _______ effusion.
pleural
found in positive appendices
Appendicolith
These two merge to form the Common Hepatic Duct
Right hepatic duct
Left hepatic duct
These two merge to form CBD
Common Hepatic Duct
Cystic Duct
The CBD and Wirsung's duct come together to form the _______.
Ampulla of Vater
This accessory duct is not seen on ultrasound. Enters duodenum just above the ampulla of Vater.
Santorini’s duct
Painless jaundice-caused from pancreatic tumor
Courvoisier gallbladder
WES
wall-echo-shadow
The gallbladder can become completely filled with stones causing a clean, echo free shadow with distinct edges in the location of the gallbladder fossa. This is called the ________ or WES sign.
This is called the double arc or “WES” sign (wall-echo-shadow).
double arc
Most common area of biliary obstruction is the
Cystic Duct
positive pain over the gallbladder when scanning
Murphy's sign
What is this sign? portal vein, hepatic artery, bile duct @ porta hepatis
Mickey Mouse sign
hilum of the liver, portal vein, hepatic artery, bile duct @ porta hepatis comprise this area
Porta hepatis
Obstruction at the junction of right and left hepatic ducts. Only the intrahepatic ducts are dilated.
Klatskin tumor
Fold in fundus of gallbladder
Phrygian cap
Fetal remnant of the ductus venosus
Ligamentum venosum
Fetal remnant of the umbilical vein
Ligamentum teres
Liver cirrhosis causes an increased risk of __________ carcinoma.
hepatocellular
Islands of increased
density or echogenicity surrounded by normal
liver tissue. (normally at porta hepatis)
Focal fatty infiltration
Liver is ________-level echogenicity.
medium
Renal transplants are usually placed in the ______ in the retroperitoneum
pelvis
Sonographically we will see these 5 items with renal transplant rejection
Enlarged transplant
Decreased cortical echogenicity
Indistinct corticomedullary boundaries
Prominent Hypoechoic medullary pyramids
Peritransplant fluid collections
Which two lab values delienate renal function?
BUN
Creatinine
Three normal variants of renals
dromedary hump
column of bertin
junctional defect
_________ kidneys are normal but just in an “ectopic” location.
Pelvic
This is where the kidney ascends to the opposite side .You will see two kidneys on one side and none on the other.
Crossed renal ectopia
The kidneys fuse in the pelvis and one kidney ascends carrying the other one with it across the midline. This is where there is a flap of mucosa that has a slit like opening in the area of the prostatic urethra. This is the
most common cause of urinary obstruction in the male infant and
second most common cause of hydronephrosis in the neonate.
Crossed fused renal ectopia
4 causes of hydronephrosis
Obstruction
Stone-most common
Extrinsic obstruction- tumor, etc.
Overdistended urinary bladder-must do post void the patient to see if hydronephrosis resolves
Pregnancy
UTI’s
Patient will present with periumbilical pain, leukocytosis,fever, and rebound tenderness (hurts more when you let go than when you press).
Acute appendicitis
T/F? Normal appendices are usually identified on ultrasound
FALSE
if the following 4 features are seen sonographically, then there is a good chance that
appendicitis has developed.
Non-compressible appendix
6mm or greater in diameter
appendicolith- (calicified fecal matter that is echogenic with varied amounts of shadowing)
*May also be hypervascular
Rectal bleeding
Intussusception
Characteristics of Pyloric Stenosis
Pyloric muscle thickness greater than 3 or 4 mm
Pyloric channel length of at least 1.2 cm
Cross-section of the entire pyloric muscle of > or = 1.5cm
The liver is suspended from the diaphragm and anterior abdominal wall by the
falciform ligament
the falciform ligament extends from the umbilicus to the diaphragm
The play boy bunny or reindeer sign refers to what?
hepatic veins and IVC
You have detected a mass anterior and to the left (patient's left) of the ligamentum venosum. This mass is located in what lobe of the liver?
left lobe
In patients who develop portal hypertension, the portal blood flow becomes __________ instead of __________.
hepatofugal
hepatopedal
A cyst within a cyst (daughter cysts) is a classic example of which of the following liver masses?
echinococcal (hydatid) cyst
Budd-Chiari syndrome is a rare disorder caused by obstruction of the:
hepatic veins
causes thrombosis of the hepatic veins or IVC
All of the following are ways to tell the difference between the portal and hepatic veins EXCEPT: portal veins have echogenic walls, hepatic veins do not
portal veins are medial in the liver, hepatic veins are lateral
portal veins carry blood towards the liver, hepatic veins take blood away
portal veins dump into the IVC and hepatic veins do not
portal veins dump into the IVC and hepatic veins do not
The most common benign tumor of the liver is:
cavernous hemangioma
Focal fatty liver is most commonly found in which location?
porta hepatis
The common bile duct and hepatic artery enter the liver where?
Porta Hepatis
Patients who have hepatocellular carcinoma are likely to have had:
cirrhosis
hepatocellular carcinoma may develop from cirrhotic livers.
You have identified a single homogenous HYPERechoic lesion measuring 2.4 cm in the posterior aspect of the right lobe of the liver. What is the most common etiology of a mass fitting this description?
cavernous hemangioma
The most common form of neoplastic involvement of the liver is:
metastases
Most common neoplastic involvment in the liver is metastasis. The most common primary, malignant tumor is a hepatoma/hepatocellular carcinoma.
You are performing a sonogram on a slender female and notice a long, thin extension of
the inferior aspect of the right lobe of the liver. This most likely represents:
reidel's lobe
What two landmarks can be used to divide the right and left lobes of the liver?
main lobar fissure and middle hepatic vein
The fossae of the right portal vein (RPV) and gallbladder are found in the:
Main lobar fissure
the main lobar fissure is a hyperechoic line extending from the RPV to the neck of the gallbladder. It is used as a landmark leading t othe gallbladder fossa.
Which of the following should be done to image the near field (anterior) of the liver?
change the transducer from 5.0 to 7.5 mHz
change from a linear to a sector transducer
change from a sector to a mechanical transducer
increase the near gain
change the transducer from 5.0 to 7.5 mHz
You have been asked to perform a liver sonogram on a patient with AIDS. Which of the
following tumors is most commonly associated with this history?
kaposi's sarcoma
During ultrasound evaluation of the liver, a bull's eye or target lesion is identified in the anterior right lobe. The most likely etiology of this mass is:
liver metastasis from lung cancer
Hepatocellular disease can be defined as a process that affects the:
hepatocytes and interferes with liver function
hepatocellular disease can be defined as a process that affects the hepatocytes and interferes with liver function.
A recannalized paraumbilical vein may be seen as a result of which of the following?
portal hypertension
A patient is referred for abdominal ultrasound with a high FEVER and right upper quadrant pain. You document the presence of a large, rounded, homogeneous mass with low-level internal echoes and poorly defined borders. The mass is located in the right lobe of the liver, adjacent to the capsule and shows increased through transmission. This most likely represents:
abscess
What three structures comprise the portal triad?
portal vein, bile duct, hepatic artery
The hepatic artery is __________ to the main portal vein.
anterior
The ligamentum venosum forms the anterior border of what lobe of the liver?
caudate lobe
You are scanning a patient with a single, anechoic, smooth round structure that has posterior acoustic enhancement in the liver. The most likely candidate for this lesion is:
liver cyst
The normal echogenicity of the liver should be_______________.
medium level grays (homogeneous)
Amebic abscess may reach the liver through the:
portal vein
The infection is primarily a disease of the colon. The parasites reach the liver via the portal vein.
What benign liver tumor is located near the free edge of the liver, is solitary, well circumscribed, and is a nonencapsulated multinodular mass?
focal nodular hyperplasia
FNH apprears as well-defined hypoechoic patterns compared to the normal liver parenchyma. Internal echoes may be seen if multiple nodules occur together.
You are scanning a patient with liver cirrhosis and suspected portal hypertension. In
this study, assessment of the size of which of the following is most important?
spleen
The blood flow in the hepatic veins flows _______________ the liver.
away
You are holding your ultrasound probe in the sagittal (long) plane, what would the right side of the screen (your left when looking at the screen) correspond with?
superior
Where does the main portal vein enter the liver?
porta hepatis
The blood flow in the main portal vein flows ___________ the liver.
towards
What ligament divides the left lobe of the liver into medial and lateral segments?
ligamentum teres
If you were holding your ultrasound probe transverse on the abdominal midline, what would the top of the monitor screen correlate with?
anterior surface
Which lobe is the largest?
Caudate
right anterior
left inferior
right anterior
Thickening of the gallbladder wall may be caused by what 3 factors?
hepatitis
pancreatitis
ascites
A 20-year old male presents in the ER for an abdominal ultrasound. You scan his gallbladder and see echogenic, horizontal, non-shadowing lines in the neck of the gallbladder. You can assume that these lines are what 3 structures?
polyps
valves of Heister
junctional parenchymal folds
Valves of Heister would be the best bet in this area although multiple polyps or folds could be remote possibilities.
If a patient has chronic choledocholithiasis, all of the following structures are dilated EXCEPT the:
distal duct
proximal duct
pancreatic duct
common hepatic duct
pancreatic duct
What does the right part of the screen (your left when facing the screen) correspond with on a sagittal image?
superior
T/F? The intrahepatic ductal system includes the CBD.
False
The CBD is an extrahepatic duct.
What cause of chronic cholecystitis is NOT associated with stone obstruction?
Milk of calcium bile
Mucocele
Porcelain gallbladder
Courvoisier's
Courvoisier's
If there is an obstructive stone in the CBD and you ask the patient to eat a fatty meal and come back in 45 minutes, the diameter of the CBD (proximal to the stone, towards the liver) would:
increase in size
it gets larger because it can't let the bile out. The duct is stopped-up. Better call roto-rooter!
The neck is _____________ to the uncinate process.
superficial
The head of the pancreas is inferior to the:
caudate lobe of liver
____________ duct should measure 2mm or less.
The Wirsung's
If the celiac axis is well visualized, the sonographer should move the transducer in which direction to image the pancreas?
inferior
Classic symptoms of gallbladder disease include all BUT:
hematuria
The splenic vein runs along the _________ margin of the pancreas.
inferior
Adenomyomatosis causes what sonographic artifact?
comet tail
In a 60-year-old adult, the normal common bile duct should not measure more than:
6 mm
The most common group of people suffering from a choledochal cyst are:
from asian descent
What type of tumor occurs mostly in the pancreatic body and tail?
islet cell
A phrygian cap of the gallbladder is:
A phrygian cap of the gallbladder is:
The common bile duct is joined by the main pancreatic duct. Together they open through the ______ into the duodenal wall.
ampulla of Vater
The common hepatic duct (hepatic duct) is joined by the _______ to form the ______.
cystic duct; common bile duct
The superior mesenteric artery arises 1 cm below the celiac trunk and runs:
posterior to the pancreas and anterior to the uncinate process
An extrahepatic mass compressing the common bile duct can produce an enlarged gallbladder. This sign is:
Courvoisier's sign
T/F The pancreas is a retroperitoneal gland.
TRUE
_________ is the primary pancreatic duct.
Wirsung's duct
The most common sign for carcinoma of the gallbladder is:
mass will not change with position change
What part of the liver is the portal triad located when scanning transverse?
medial
Generally speaking, the normal pancreas is shown to be:
more echogenic than the liver
The pancreas is both an exocrine and endocrine gland. The exocrine function is to produce:
lipase and amylase
The enzyme that is the most sensitive in the laboratory tests for the diagnosis of acute pancreatitis is:
lipase
T/F The common bile duct may be found anterior and lateral to the portal vein.
TRUE
The head of the pancreas is _________________ to the CBD and ____________ to the GDA.
anteromedial; posteromedial
Dilatation of the right, left and intra hepatic ducts are noted on an abdominal sonogram. What possible pathologies should be considered here?
Biliary atresia
Klatskin tumor
Caroli's disease
don't know. need more information.
All of the above
All of the above
NON-shadowing, low-amplitude echoes in a gravity DEPENDENT gallbladder is most characteristic of:
sludge
A 55-year-old robust female presents in your sonography department for an abdominal scan. She has a "positive" Murphy's sign when scanned. What does that mean?
she has a pain over her gallbladder
Gallstones are present in 40% to 60% of patients with:
acute pancreatitis
Gallstones are present in 40% to 60% in patients with acute pancreatitis. Five percent of patients with gallstones present with acute pancreatitis.
A gallbladder packed with stones could potentially cast a distinct ___________ ultrasound sign.
wall echo shadow
The pancreas is both an exocrine and endocrine gland. The endocrine function is to produce:
insulin
Clinical signs of acute pancreatitis include all BUT:
persistant abdominal pain
diarrhea
erythema
leukocytosis
diarrhea and erythema
The physiologic effect of a fatty meal includes all of the following EXCEPT:
stimulation of cholecystokinin (CCK)
contraction of the gallbladder
decrease of bile flow to the liver
relaxation of the sphincter of Oddi
decrease of bile flow to the liver
After a fatty meal, CCK stimulation causes the contraction of the gallbladder; the sphincter of Oddi relaxes with the outpouring of bile into the duodenum
T/F?
Insulinomas and gastrinomas are always malignant tumors in the pancreas.
False
Each tumor can be benign or malignant.
Splenules are synonymous with what other term?
accessory spleen
When scanning a patient for lymphadenopathy, one should check the:
pelvis
porta hepatis
retroperitoneum
perirenal space
around the major vessels and their tributaries
A fluid collection located between the diaphragm and the spleen may represent:
a subphrenic abscess
Persistent fever, swelling, and tenderness are indicative of:
infection
A potential space located between the liver edge and right kidney is:
Morison's pouch
Gerota's fascia refers to:
the area that separates the kidney and adrenal glands
T/F
The diaphragmatic crus can be seen on ultrasound.
TRUE
Benign ascites is associated with:
floating bowel loops
Splenomegaly is NOT caused by the following:
lymphoma
portal hypertension
pancreatitis
mononucleosis
Pancreatitis is unrelated to the spleen.
Retroperitonal fluid collections may be:
hemorrhage
abscess
Ascites
lymphoceles
all of the above
all of the above
All of these collections could be considered retroperitoneal.
A 55-year-old patient presents to the ultrasound department with abdominal pain. He states that he has had abdominal surgery in the past year. During the abdominal sonogram you notice hypoechoic midline mass. What could this structure be?
retroperitoneal fibrosis
Which of the following is retroperitoneal?
spleen
gallbladder
lung
psoas muscle
psoas muscle
Chronic adrenal hypofunction usually causes what condition?
Addison's syndrome
The abdomen is divided into what two cavities?
peritoneum and retroperitoneum
The spleen is located in which quadrant of the body?
LUQ
What is the most common neonatal adrenal mass?
adrenal hemorrhage
Most common NEONATE adrenal mass.
Which of the following is anatomically correct?
the lesser sac is anterior and superior to the pancreas
the greater sac is anterior and inferior to the pancreas
the lesser sac is anterior and inferior to the pancreas
all of the above
all of the above
The muscle groups of the anterior abdominal wall include all of the following EXCEPT:
the internal oblique
the diaphragm
the external oblique
the transversus abdominus
the rectus abdominus
the diaphragm
Retroperitoneal fluid collections may be:
hemorrhage
abscess
ascites
lymphoceles
all of the above
all of the above
Which of the following is NOT retroperitoneal?
Aorta
inferior vena cava
kidneys
spleen
adrenal glands
spleen
The typical position for scanning the spleen is:
right lateral decubitus
A patient feel on the ice and hit his back on the edge of a step. He was bruised but did not have pain unless he was walking or climbing stairs, in which case he had pain in his right lower back. He was febrile, but his urinalysis and white blood count were normal. He was referred for an ultrasound study, which revealed a__________
hematoma in the iliopsoas muscle
A subcapsular hematoma may appear:
hypoechoic and curvilinear
Enlarged lymph nodes may do all of the following EXCEPT:
compress the ureter
compress the aorta
compress the IVC
Displace the superior mesenteric artery
displace bowel
compress the aorta
Horeshoe kidneys may be confused sonographically with which of the following entities?
carcinoma of the head of the pancreas
lymphadenopathy
hypernephroma
Wilms' tumor
lymphadenopathy
What two vessels converge at the ampulla of Vater?
CBD, Wirsung's
T or F. A scanning protocol for the liver includes 7 strict images.
False
There are many possible images that can be taken of the liver. The most important thing is to SCAN through the entire organ, not just take images.
Oxygenated blood is supplied to the liver via the:
portal vein and hepatic artery
Ureteral jets are visualized when scanning the bladder. This is used to see:
urine draining into bladder
The thin capsule surrounding the liver is known as:
glisson's capsule
T/F?
The adrenal glands are demonstrated more easily in neonates than in the adult.
True
Name the 3 structures that surround the tail of the pancreas:
stomach, splenic artery, and hilum of the spleen
Which of the following syndromes are associated with an adrenal mass?
Cushing's syndrome
Metastatic lymphadenopathy disease can occur by lymphatic or hematogeneous spread. It may be secondary to carcinoma of the: (there are 3)
breast, lung, or testis
T/F?
Ascities will displace the bladder inferiorly but not posteriorly
False
When scanning a liver you notice a hypoechoic structure on the anterior surface of the liver. What machine control can you adjust to help determine if the structure is cystic or solid?
optimize focal zone
T/F? A renal carbuncal is an abscess that forms outside the renal parenchyma.
FALSE
What is the portal triad composed of?
portal vein, common duct, hepatic artery
Dilatation of the intrahepatic biliary tree without dilatation of the extrahepatic duct includes all of the following EXCEPT:
Klatskin tumor
enlarged portal lymph nodes
cholangiocarcinoma
pancreatic carcinoma
pancreatic carcinoma
_____ are on the right side of the liver form the subphrenic and subhepatic spaces.
ligaments
A BENIGN fatty tumor of the kidney is:
angiomyolipoma
This will appear echogenic.
A congenital abnormality in which both kidneys are united at their lower poles is termed:
horseshoe kidney
With renal genetic abnormalities, what other organ(s) will you most commonly see defects also?
reproductive
Adult polycystic renal disease appears on a sonogram as:
multiple cysts of varying sizes
Most renal cysts are located where?
cortex
An enlarged Column of Bertin leads to a frequent misdiagnosis of:
tumor
A typical frequency used to scan an adult abdomen is:
3 mHz
T/F?
The hepatic veins carry blood from the IVC to the liver.
FALSE
What is ultrasound's role in evaluating acute renal failure?
determination of presence of hydronephrosis
Hydration of the patient may result in:
prominent renal pyramids
Hypernephromas commonly invade the IVC via the:
renal vein
In acute renal disease, kidney size is
generally enlarged
What is the most involved technique used to visualize the kidney, spleen and pancreas?
filling stomach with water
Which structure divides the left and right lobes of the liver?
middle hepatic vein
Name the vessel that lies posterior to the IVC.
right renal artery
The kidney is seen with color blood flow. Which arteries are see in the cortex?
arcuate
Of the following renal tumors, which is NOT a benign lesion?
hamartoma
angiomyolipoma
hypernephroma
column of Bertin
hypernephroma
Pyonephrosis refers to the:
presence of pus in a dilated collected system
Renal arteries arise from the:
anterolateral aortic wall
T/F?
The adrenal glands are peritoneal structures.
False
The adrenals are retroperitonal structures.
Renal sonography is not helpful in evaluating which of the following:
obstructive uropathy
cyst formation
renal function
angiomyolipoma
renal function
Which of the following should be done to image the near field (anterior) of the liver?
change the transducer from 5.0 to 7.5 mHz
The kidney lies on what group of muscles?
psoas, quadratus lumborum
What organ is the Heister's valves located?
gallbladder
The retroperitoneal space is the area between the:
posterior portion of the parietal peritoneum and the posterior abdominal wall muscles
The body of the pancreas is bound on its posterior surface by:
aorta
T/F?
Sinus lipomatosis is clinically significant.
FALSE
The left kidney is in contact with the:
spleen, pancreas, colon, and jejunum
The routine gallbladder is scanned and an echogenic line called posterior acoustic enhancement is seen posterior. There also seems to be a shadow on the either side of the gallbladder running down posterior, parallel to the enhancement. What are these shadows caused by?
edge shadow artifact
The left renal vein courses:
anterior to the aorta
Urine passes, in the order given, through which of the following structures?
renal pelvis, ureter, bladder, urethra
You are asked to scan an adult patient for a positive Murphy's sign. What does that mean?
the patient has pain over the gallbladder/RUQ
The process of disposing of metabolic wastes from the blood is called:
excretion
T/F?
The renal artery is superior to the renal veins.
TRUE
The renal pyramids are also called the:
medulla
T/F?
The pancreas is located anterior to the aorta, SMA and splenic vein.
TRUE
To fulfill the criteria of a cyst, one must demonstrate sonographically:
an anechoic structure
distal acoustic enhancement
smooth walls
all of the above
all of the above
T/F
The term anechoic is synonymous with the term hypoechoic.
FALSE
A pelvic kidney has a _____ appearance in a ______ location:
normal appearance in an abnormal location
It looks like a normal kidney just located in the pelvis. It still functions like it were in the correct location.
A column of Bertin is most commonly seen where?
right kidney
A 3-year-old boy presents with hematuria and a palpable left flank mass. Sonography depicts a solid renal mass. This finding would most likely represent:
Wilm's tumor
Ectopic ureterocele is associated with which complication?
upper pole hydronephrosis
The ureterocele blocks the ureter and doesn't allow urine to pass through to the bladder (or very little passes). This causes the upper pole of the kidney to become obstructed.
What is the most common NEONATAL adrenal mass?
adrenal hemorrhage
The most common sign for carcinoma of the gallbladder is:
a mass that will not move with position change
The pancreatic head lies:
superior to the portal vein and medial to the SMV
superior to the portal vein and anterior to the IVC
A patient presents in your department with left upper quadrant pain after falling down some stairs. You see the spleen with a large hypoechoic area superiorly but outside the organ. What do you think is going on here?
perisplenic hematoma
The main registry review courses offered nationally are as follows:
pegasus lectures (www. pegasus.com), edelman (www.esp-inc.com) and gulf coast (www.gcus.com)
You, as a Washburn student, receive a 50% discount on registration to a pegasus lectures seminar. This includes physics and one specialty. You also receive a discount on their products.
All of the following describe the inferior vena cava EXCEPT that:
valsalva maneuver results in a change in the diameter of the inferior vena cava
it lies immediately anterior to the surface of the spine, to the right of the aorta
the caliber of the inferior vena cava increases as it courses cephalad
it passes through the caval hiatus of the diaphragm to enter the LEFT atrium
The inferior vena cava passes through the caval hiatus of the diaphragm to enter the RIGHT atrium.
it passes through the caval hiatus of the diaphragm to enter the LEFT atrium
The inferior vena cava passes through the caval hiatus of the diaphragm to enter the RIGHT atrium.
Elevation of the following laboratory data may indicate renal failure EXCEPT for:
blood urea nitrogen (BUN)
alkaline phosphatase
creatinine
protein
alkaline phosphatase
Laboratory data that may indicate renal failure consists of an elevated blood urea nitrogen, creatinine, and increased protein in the urine. Alkaline phosphatase is elevated in hepatobiliary disease.
In a fasting state (pre-prandial), the superior mesenteric artery has:
a low-resistive waveform
a high-resistive waveform
reversed diastolic flow
no resistance
a high-resistive waveform
In a normal patient, doppler signals wil change from high resistive to low resistive when the patient goes form fasting to a post-prandial state.
Elevated serum amylase may be secondary to all of the following EXCEPT:
Pancreatic duct obstruction
acute pancreatitis
liver disease
obstruction of the ampulla of vater
liver disease
If a leaking aneurysm is suspected one should:
check the retroperitoneum
Serum glutamic pyruvic transminase (SGPT) is also referred to as:
alanine aminotransferase (ALT)
In a dissecting aortic aneurysm, the dissection is through:
the media and intima
The best way of delineating a dissecting aneurysm on sonography is to:
show an intimal flap vibration with the flow of blood
Sonographically, the best way of delineating a dissecting aneurysm is by showing the intimal flap waving along with the pulsations of blood through the aorta.
The celiac trunk originates within the first 2 cm from the diaphragm and immediately branches into all of the following EXCEPT:
common hepatic artery
left gastric artery
splenic artery
renal artery
renal artery
The left gonadal vein typically drains into the:
left renal vein
Which of the following IS a branch of the celiac axis?
proper hepatic artery
gastroduodenal artery
right gastric artery
left gastric artery
left gastric artery
Sonographically, the gastroesophageal juction can be visualized where:
anterior to the aorta and posterior to the left lobe of the liver
T/F?
The normal appendix is always seen on ultrasound.
FALSE
Hypertrophic pyloric stenosis is characterized by all of the following EXCEPT which 2?
presents as a palpable abdominal mass
more common in females
a cross-section diameter of > or = 1.5 cm
pyloric muscle thickness > 4 mm
pyloric channel length > or = 1.2 cm
more common in females
pyloric channel length > or = 1.2 cm
High levels of serum amylase may be a result of all of the following EXCEPT:
liver disease
acute pancreatitis
blockage of the pancreatic duct by a stone
liver disease
High levels of serum amylase can be due to pancreatitis. One of the most common causes of pancreatitis is cholelithiasis.
A 4 month old presents with abdominal pain, rectal bleeding, and a palpable abdominal mass. What is the most likely pathology?
intussusception
These are the signs and symptoms of intussusception
The substance that is secreted by the kidney when the renal artery is stenosed causing an increase in the patient's blood pressure is called:
renin
The gastroduodenal artery is a branch of the:
common hepatic artery
The superior mesenteric vein and the splenic vein join to form the:
main portal vein
Which of the following statements about infantile hypertrophic pyloric stenosis are true?
causes projectile vomiting
predominately a disorder of male infants
the hypertrophied pyloric muscle measures less than 3 mm
it appears sonographically as a target-shaped lesion
the hypertrophied pyloric muscle measures less than 3 mm
The normal pyloric measures less than 15 mm in diameter and its muscular periphery less than 5 mm in thickness. In the presence of pyloric stenosis, the muscle increases in size and measures more than 5 mm in thickness
The substance that is released when fat is present in the bowl and contracts the gallbladder is:
cholecystokinin
Which of the following causes infertility in men?
spermatoceles
hydroceles
hematoceles
varicoceles
epididymal cysts
varicoceles
A palpable "olive" sign is one of the common criteria used by clinicians to request which of the following ultrasound examinations?
renal sonogram on a patient with a history of adult polycystic kidney disease
sonogram of the pancreas on a patient with an elevated amylase
sonogram of the groin after femoral catherization and subsequent swelling (pseudo-aneurysm)
sonogram of the aorta on an elderly patient with epigastric pain
sonogram of the stomach on an infant with persistent projectile vomiting
sonogram of the stomach on an infant with persistent projectile vomiting
Density of tissue times the speed of sound in tissue.
Acoustic Impedance
The speed of sound waves in body tissue is relatively constant at approx ________ meters per second
1,540
Strength or height of the wave, measured in decibels
Amplitude
Progressive weakening of the sound beam as it travels through body tissue, caused by scater, absorption, and reflection.
Attenuation
Directed acoustic field produced by a transducer
Beam
Substance within the transducer that converts electrical impulses into sound waves and vice versa.
Crystal
Per-second freq at which teh crystal vibrates. The number of cycles per second determines frequency.
Cycle
A unit used to express the intensity of amplitude of sound waves; does not specify voltage.
Decibel (dB)
The depth of the sound beam where resolution is highest
Focal Zone
Helps to increase the intensity and narrow the width of the beam at a chosen depth.
Focusing
Area where transmitted beam begins to diverge
Fraunhofer Zone (Far Field).
Number of times the wave is repeated per second as measured in hertz.
Frequency
Usable frequencies, except in the eye where higher freq can be used, lie between ____ and _____ million per second.
2.5
13
Area close to the transducer where the beam form is uneven.
Fresnel Zone (Near Field)
Standard unit of freq; equal to one cycle per second
Hertz (Hz)
Occurs whenever two tissues of different acoustic impedance are in contact.
Interface
1,000,000 Hz.
Megahertz (MHz)
Effect caused by crystals (such as zirconate and titanate) changing shape when in an electrical field or when mechanically stressed, so that an electrical impulse can generate a sound wave or vice versa.
Piezoelectric Effect
Quantity of energy generated by the transducer, expressed in watts.
Power (Acoustic)
The number of times per second that a transmit-receive cycle occurs.
Pulse Repetition Rate
Ability to distinguish between two adjacent structures (interfaces).
Resolution
Reflection from a smooth surface at right angles to the sound beam
Specular Reflector
A device capable of converting energy from one form to another. The term is used to refer to the crystal and the surrounding housing.
Transducer (Probe).
Speed of the wave, depending on tissue density.
Velocity
The speed of sound in soft tissues is between _____ and _____ meters per second.
1500
1600
Velocity is standardized at ________ meters per second on all current systems.
1540
Distance a wave travels in a single cycle. As frequency becomes higher, wavelengths become smaller
Wavelength
Ultrasound uses sound waves between ____ and ____ MHz.
1
30
The closer the molecules are, the faster the sound wave moves through a medium so _____ conduct sound exceedingly well.
bone
T/F
Air-filled lungs and bowel containing air conduct sound so poorly that they cannot be imaged with ultrasound in struments.
TRUE
A ________ serves as a window for the uterus. Without one, the uterus cannot be seen.
distended urinary bladder
According to this principle, the electrical pulse strikes the crystal and produces a sound beam which propagates through the tissues.
Pulse-echo principle
When the sound beam is perpendicular to the organ interface, ______ echoes are produced.
specular
When teh sound beam is not perpendicular to the organ interface, _______ is seen.
scatter
In acute hepatitis, overall echogenicity is _______ so that the porttal vein's borders stand out more brightly.
lowered
The strength of the returning echo is related to the ______ at which the beam strikes the acoustic interface.
angle
The more nearly _______ the beam is, the stronger the returning echo will be.
perpendicular
To demonstrate the borders of a body structure, the transducer must be placed so that the beam strikes the borders at a more-or-less ______ angle.
right
Acoustic impedance related to tissue ________.
density
The greater the difference in density between two trustures is, the _______ the returning interface echoes.
stronger
The bright interface at the diaphragm is due largely to differences in acoustic ________ compared w/ the liver.
impedance
Transducers come in many different frequencies but typically these five -
2.5
3.5
5
7
10
What happens to the sound beam beyond the focal zone?
It widens
A one-dimensional image displaying the amplitude strength of the returning echo signals along the vertical axis and teh time (and, thererfore, the distance from the transducer) along the horizontal axis.
A-Mode (Amplitude Modulation)
A type of phased array transducer utilizing several concentric ring-shaped elements. Not commonly used in modern equipment.
Annular Array
Depth axis. Resolution along the axis of hte ultrasound beam. Represents the smallest spacing required between two reflectors to be resolved as independent reflectors.
Axial
A method of displaying the intensity (amplitude) of an echo by varying the brightness of a dot to correspond to echo strength. Real0time scanners are baseed on B-mode.
B-Mode (Brightness Modulation).
The ability to steer the beam of a linear transducer to the left or right in two-dimenionssal (2D) (grayscale) imaging.
Beam Steering
The system memory stores the most recent sequence of image frames before the freeze button is pressed. The operator can then review teh sequence of images frame by frame or in real time.
Cine Loop
The term used to describe the monitor on which thh image is displayed
Cathode Ray Tube (CRT)
Linear array transducers with a curved scan head. Focusing is electronically controlled. Useful in abdominal and obstetric/gynecologic imaging.
Curved Linear Transducer (Curved Array)
Material attached to the back of the transducer crystal to decrease ring time (continued vibration of the crystal after the internal responses).
Damping Material
Term used to describe the capture and storage of a cine loop of images. Allows review a real-time clip after the exam is ended.
Dynamic Clip
The ability to select focal zones at different depths throughout the image. As the number of focal zones increases, the frame rate decreases.
Dynamic Focusing
The range of signals that a system's components can process. Relates echo amplitude to the assigned grayscale value. Unit of measure is decibels (dB).
Dynamic Range
Each element, or group of elements, within a transducer is pulsed seeparately to focus the beam at a particular area of interest. Used in array technology of all types.
Electronic Focusing
High-frequency transducer that is designed to be used for endorectal as well as endovaginal imaging.
Endocavity Transducer
High-frequency transducer that is placed into the rectum to evaluate the prostate and rectal wall. Some probes have both longitudinal and transverse transducers mounted on the same probe head (biplane transducers).
Endorectal Transducer
A high-frequency probe, which is introduced into the vagina for evaluating the pelvic organs.
Endovaginal Transducer
The act of narrowing the ultrasound beam to a small width (slice thickness). Image detail increases within the narrowed region.
Focusing
Term used to describe the portion of the transducer that is in contact with the patient.
Footprint
Rate at which the image is refreshed in a real-time system display. Frame rate varies with system settings such as focal zones, depth of the image display, preprocessing settings, and image width.
Frame Rate (Image Rate).
Control that stops a moving realtime image for photography or prolonged evaluation.
Freeze frame
A transducer with many small electronically coordinated elements oriented slide by side, producing a rectangular image. Useful in small parts, intraoperative, and vascular imaging between the ribs, making abdominal imaging difficult.
Linnear Array
Minimizes the difference in acoustic impedance between the transducer crystal and skin.
Matching Layer
The physical movement of the element or mirror that causes the sound beam to sweep through the tissue, providing a real-time image.
Mechanically Steered Transducer
Term used for the TV display
Monitor
Utilize multiple rows of transducer elements fired in sequence to improve imaging slice thickness
Multi-D Array Transducer
The ability to cycle between two or more sending frequencies within a given transducer
MultiHertz
The TV display screen. Not used in modern equipment. May be found on dedicated A-mode machines.
Oscilloscope
Electronically steered system in which many small elements are electronically coordinated to produce a focused wavefront. Used in curved linear, linear, sector, and phased-array transducers.
Phased Array
Type of imaging in which many frames are run together to create a cinematic view of the tissue.
Real-Time (Dynamic) Imaging
Length of time that a transducer crystal vibrates after it has been activated.
Ring-time
A device that gathers all of the signals and organizes them on the basis of their location to give a 2D display.
Scan Converter
Transducer with a small head that produces a pie-shaped image. May be a mechanical or phased array.
Sector Scanner
Small footprint transducer that utilizes the entire transducer face to form the image. Produces a trapezoid image with a larger field of view than the traditional sector.
Vector Array
Allows a linear transducer to be displayed as a trapezoidal image format. Increases the field of view of a linear transducer for easier measurements and display of larger regions of interest.
Virtual Format Imaging
The most basic form of diagnostic ultrasound in which a single beam of ultrasound is analyzed. Almost obsolete now.
A-mode
Because sound traveling through a fluid-filled structure is barely attenuated, the structures distal to a cystic lesion appear to have more echoes than neighborhing areas. Also referred to as through transmission.
Acoustic Enhancement
Without internal echoes. Not necessarily cystic unless there is distal echo enhancement.
Anechoic
A structure that has both fluid-filled (echo-free) and solid (echogenic) areas.
Complex
On the other side of the body
Contralateral
Spherical, fluid-filled structure with well-defined walls that contains few or no internal echoes and exhibits good acoustic enhancement.
Cyst
In ultrasonography, the word cystic does not necessarily refer to a cyst. The term is used inaccurately by some to describe any fluid-filled structure (e.g., urine-filled bladder or bile-filled gallbladder).
Cystic
The extremity (limb) end of a body structure.
Distal
Describes a structure that produces echoes. Usually a relative term. The pancreas is slightly more than the liver.
Echogenic
Term usfed by some to describe an ultrasonic exam, especially in cardiac work; an echocardiogram is frequently referred to as an "echo."
Echogram
Without internal echoes; not necessarily cystic.
Echolucent
A few echoes within a structure; less echogenic. The normal kidney is echopenic relative to the liver.
Echopenic
Interface between two fluids w/ different acoustic characteristics. This interface has a horizontal level that varies w/ patient position.
Fluid-fluid level
Descriptive term for the amount of transducer face in contact with the patient (a small-head transducer has a small footprint).
Footprint
The strength of the echoes throughout the image can be varied by changing the power output from the system.
Gain
Of uniform composition. The normal texture of several parenchymal organs is homogeneous (liver, thyroid, and pancreas).
Homogeneous
Strong echoes that delineate the boundary of organs and that are caused by the diference between the acoustic impedance of two adjacent structures. An interface is usually more pronounced when the transducer is perpendicular to it.
Interface
On the same side of the body
Ipsilateral
Of the same echogenicity as a neighboring area, but not necessarily of hte same texture
Isoechoic
Artifactual echoes resulting from too much gain rather than from true anatomic structures.
Noise
The trunk end of a limb or organ
Proximal
An artifact that results from a strong echo returning from a large acoustic interface to the transducer. This echo returns to the tissues again, causing additional echoes parallel to the first.
Reverberation
Extreme form of reverberation artifact that occurs when a long series of echoes caused by a very strong acoustic interface and consequent reverberations are seen.
Ring down
Failure of the sound beam to pass through an object. This blockage is caused by reflection or absorption of the sound and may be partial or complete. For example, air bubbles in the duodenum allow poor transmission of the sound beam because most of the sound is reflected. A calcified gallstone does not allow any sound to pass through, and shadowing is pronounced.
Shadowing
A mass or organ that contains uniform low-level echoes because the cellular tissues are acoustically very similar.
Solid (Homogeneous)
A structure that transmits sound poorly. A dense structure can attenuate sound to greatly that the back wall is poorly defined.
Sonodense
Handsome ultrasound image, such as a good example of vascular anatomy
Sonogenic
A physician who specializes in ultrasonography and has appropriate training
Sonologist
Without echoes. Not necessarily cystic unless there is good through transmission.
Sonolucent (Anechoic)
Structure that creates a strong echo because it interfaces at right angles to the sound beam and has significantly different acoustic impedance from a neighborhing structure (e.g., diaphragm/liver or posterior bladder wall/bladder).
Specular reflector
Not real time. B-scans produced with a fixed-arm system. Obsolete technique.
Static Scan
The echo pattern within an organ; could be homogeneous or irregular.
Texture
The amount of sound passing through a structure. Same as acoustic enhancement.
Through Transmission
Term used to indicate the amount of sound passing through a mass or cyst, usually qualified as good or poor. Same as acoustic enhancement.
Transonicity
A position in which a recumbent patient is tilted so that the feet are higher than the head
Trendelenburg
Structure lying toward the front of the patient
Anterior or Ventral
Awy from the origin
Distal
Terms denoting a structure closer tothe patient's feet
Inferior or Caudal
Structure lying away from the midline
Lateral
Structure lying toward the midline
Medial or Mesial
Structure lying toward the back of the patient
Posterior or Dorsal
The patient lies on his or her stomach
Prone
Nearer to the center of the body
Proximal
The abdomen is divided into four quarters, each known as a __________.
quadrant
Interchangeable terms denoting a structure closer to the patient's head
Superior, Cranial, or Cephalad
The patient lies on his or her back.
Supine
When the image is taken from the patient's side, whether he or she is decubitus or supine, if you are scanning the abdomen.
Coronal
The beam should be as _________ as possible to the structure as possible.
perpendicular
Two advantages of shape-sector or small footprint scanner
Useful for areas of small access: between ribs, through a urinary bladder, through a fontanelle.
Good for angling up under or for wedging in between tight spots.
One disadvantage of shape-sector or small footpring scanner
The wedge-shaped image gives you a limited near field of view
Three advantages of curved linear array
Much bigger field of view, good for large structures and overviews.
Near field is wider than sector
Useful for second- and third-trimester obstetric patients, anywhere in abdomen that it will fit
Three disadvantages of curved linear array
Larger transducer face than sector, may not fit in acoustic window
May acquire artifacts along sides of image due to poor contact
Near field is still more limited than linear array, but not by much, so it is the most popular transducer design.
Two advantages of Linear Array
"Block" shape of image allows for large field of view in superficial areas; excellent for small parts, renal transplants, subfacial hematomas, etc.
Possible to hook up two images to form one very large field of view in cases when it is important not to extrapolate measurements.
Two disadvantages of Linear Array
Can only be used when there is a large window, such as in the midline or in a pregnant uterus. Cannot get between ribs.
Even where there are no ribs, the flat surface of the transducer makes it difficult to angle around pockets of gas or small windows.
Five advantages of using Endovaginal transducer
No full bladder needed
Better resolution because decreased distance allows higher frequency
Good way to assess cervix w/o distortion caused by full bladder
Can see anatomy and fetal heart motion sooner than transabdominally
Using the transducer as a palpating tool allows recognition of the source of pain
Two disadvantages of using Endovaginal transducer
Limited field of view (difficult to visualize a fibroid or large ovarian mass).
More invasive;
If a tumor doesn't "light up" with color, it may still be a vascular tumor with _____-velocity flow.
low
If you can't duplicate a "lesion", maybe it was a(n) _______ in the first place.
artifact
Contrast media are not readily available except in this field of sonography.
Echocardiography
The bladder should be __________ to provide an acoustic window to the pelvic structures in patients undergoing a transabdominal pelvic scan. Outpatients should be instructed to drink enough fluid - at least _____ ozs - to make their bladder slighlty uncomfortable at the time of the exam.
distended
16
Inpatients instructed to ingest nothing by mouth require alternative arrangements: an indwelling ______ catheter can be clamped ahead of time.
Foley
For ________ transabdominal obstetric scans, the bladder should be distended enough to visualize the lower uterine segments.
early
After _______ weeks, the bladder should be empty to properly evalaute the cervix and its relationship to the placenta.
20
Ao
Aorta
Azv
Azygous vein (ascending lumbar vein)
Ca
Celiac artery
CBD
Common bile duct
CHa
Common hepatic artery
CHD
Common hepatic duct
Cla
Common Iliac artery
Cr
Crus of the diaphragm
Du
Duodenum
GBI
Gallbladder
Gda
Gastroduodenal artery
Hea
Hepatic artery
Hev
Hepatic Vein
IMa
Inferior mesenteric artery
IMv
Inferior mesenteric vein
K
Kidney
L
Liver
LGa
Left gastric artery
LGv
Left gastric vein
LHev
Left hepatic vein
LPv
Left portal vein
LRa
Left renal artery
LRv
Left renal vein
MHev
Middle hepatic vein
P
Pancreas
PHa
Proper hepatic artery
Ps
Psoas muscles
Pv
Portal vein
QL
Quadratus lumborum
RA
Rectus abdominis
RGv
Right gastric vein
RHev
Right Hepatic vein
RPv
Right portal vein
RRa
Right renal artery
RRv
Right renal vein
S
Spine
SGv
Splenogastric vein
SMA
Superior mesenteric artery
SMV
Superior mesenteric vein
Spa
Splenic artery
Spv
Splenic vein
St
Stomach
Main trunk of the arterial system.
Aorta
The aorta lies ________ to the spine and bifurcates into the right and left _____ _____ arteries at the level of the umbilicus.
anterior
common iliac
Arises just below the liver from the anterior aorta and is usually only 2 to 3 cm in length.
Celiac Artery (axis, trunk)
The Celiac Artery almost immediately divides into these 3 arteries.
splenic
left gastric
common hepatic
Seen in the inguinal region, these arteries arise from the iliac arteries and extend into the upper thigh.A branch - the profunda femoris - originates just below the inguinal ligament.
Common Femoral Arteries
These originate from the aorta at the level of the umbilicus and extend toward the groin. Less than 15mm in diameter at their origin is normal.
Common Iliac Arteries
The vessel arising from the aorta, closest to the diaphragm is the _______ artery.
Celiac
The celiac artery is a 1- to 2-cm trunk that bifurcates into these two arteries.
splenic
common hepatic
The common hepatic artery bifurcates into these two arteries:
proper hepatic
gastroduodenal
The SMA arises from the _______ surface of the aorta at a level just inferior to the celiac artery.
anterior
The less-frequently visualized left gastric artery originates from the ________ artery.
celiac
Originates from the common hepatic trunk and supplies the stomach and duodenum. It is a landmark delineating the anterolateral aspect of the head of the pancreas
Gastroduodenal artery
Originates from the celiac trunk and courses toward the liver. It branches into the proper hepatic artery and the gastroduodenal artery. Supplies the stomach, pancreas, duodenum, liver, gallbladder, and greater omentum.
Hepatic Artery (Common).
A branch of the common hepatic artery that supplies the liver and gallbladder. It runs medial to the cbd and anterior to the portal vein into the liver within the porta hepatis.
Hepatic Artery (Proper)
Originates from the abdominal aorta close to the umbilicus. Supplies the left portion of the transverse colon, the descending and sigmoid colon, and part of the rectum. It is not usually visualized by ultrasound except at its origin.
Inferior Mesenteric Artery
Arises from the superior margin of the celiac axis and can be seen by ultrasound for only 1 or 2 cm; supplies the stomach
Left Gastric Artery
Originate from the abdominal aorta just below the level of the SMA. They supply teh kidneys, adrenals, as well as the ureters, and are often best seen when the patient is in the appropriate decubitus position. The left renal artery arises from the posterolateral wall of the aorta and enters the left renal hilum. The right arises from the posterolateral wall of the aorta, runs posterior to the IVC, and enters the right renal hilum
Renal arteries, left and right
The _______ artery outlines the anterolateral margin of the head of the pancreas, whereas the ______ marks the posterolateral margin.
gastroduodenal artery
CBD
A normal variatn in which the right hepatic artery arises from the SMA, rather than the proper hepatic artery and celiac axis.
Replaced Right Hepatic Artery
Originates from the celiac trunk and courses superior to the body and tail of the pancreas. It primarily supplies the spleen.
Splenic Artery
Originates from the anterior abdominal aorta, just below the celiac axis and runs parallel to the aorta. It lies posterior to the body of the pancreas. Supplies the small bowel, cecum, ascending colon, and part of the transverse colon.
SMA
Lies posterior to the IVC and is not usually seen unless enlarged secondary to congestive heart failure or portal hypertension.
Azygous Vein
Accessory vessels that develop when portal vein pressure is increased (e.g., portal hypertension).These can be seen in the region of the pancreas, around the esophagogastric junction (anterior to the upper portion of the aorta), in the porta hepatis, and in the splenic hilum.
Collaterals
The junction of the superior mesenteric vein and splenic vein, which forms the main portal vein.
Confluence
Lie medial to the femoral arteries in the groin and upper thigh. They are normally larger than the arteries. These veins normally compress easily and do not pulsate.
Femoral veins
Drain the liver and empty into the IVC just below the diaphragm.
Hepatic Veins
Divides the liver into right anterior and right posterior segments
Right hepatic vein
Divides the left medial and left lateral segments of the liver.
Left hepatic vein
Divides the right and left lobes of the liver
Middle hepatic vein
The left, middle, and right hepatic veins can be imaged as they empty into the IVC just beneath the _______ _________.
right diaphragm
The main branch of the portal vein is seen in its extrahepatic location just ________ to the head of the pancreas.
superior
The right renal artery is visualized posterior to the ___
IVC
Courses to the left of the SMV to join the Splenic vein. It is usually too small to visualize by ultrasound. Drains the left third and upper portion of the colon.
Inferior Mesenteric Vein
Returns blood from teh lower half of the body and enters the right atrium of the heart. It is formed by the union of the iliac veins. A marked change in caliber can be appreciated with respirations.
IVC
Drains the left kidney. Runs anterior to the aorta and posterior to the superior mesenteric artery to enter the lateral wall of the IVC. The left renal vein is much longer than the right renal vein.
Left Renal Vein
The splenic vein and superior mesenteric vein join (at the confluence) to form the ______.
main portal vein
When the portal vein branches into the liver, it forms these two veins:
left portal vein
right portal vein
Venous structures should dilate at the end of deep inspiration or _______. This maneuver can help confirm the venous nature of the vessels and enlarge the vessels to make it easier to image.
Valsalva
Drains blood from teh digestive tract and empties into the liver.
Main Portal Vein
The Main portal vein divides into the _______, which supplies blood to the left lobe of the liver and the _______, which supplies the right lobe of the liver.
left portal vein
right portal vein
Portal veins characteristically run in triads with the ______ and _________ and branch away from the porta hepatis. They can be identified by their echogenic walls that occur due to acoustic reflection arising from the fibrous tissue that surrounds these triads.
hepatic arteries
bile ducts
Courses along the falciform ligament. Connects the left portal vein to other collateral vessels near the umbilicus. This vein is only seen in the setting of portal hypertension.
Paraumbilical Vein
Drains the right kidney and enters the lateral wall of the IVC
Right Renal Vein
Drains the spleen. It runs posterior to the pancreas and joins the smv, thereby forming the main portal vein.
Splenic Vein
Drains the cecum, transverse and sigmoid colon, and small bowel. Courses anterior to the IVC to join the splenic vein just next to the confluence behind the head of the pancreas.
SMV
The portal vein branches into these two veins.
left and right portal veins
The gallbladder is ______ to the duodenum.
lateral