Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
237 Cards in this Set
- Front
- Back
|
In Lobar anatomy, there are how many lobes of the liver?
|
3
|
|
|
In Lobar anatomy, what are the 3 lobes of the liver?
|
right, left, and caudate
|
|
|
In Lobar anatomy, the right lobe is divided into these two segments.
|
anterior
posterior |
|
|
In Lobar anatomy, the left lobe is divided into these two segments
|
medial
lateral |
|
|
The CAUDATE lobe is the smallest of the three lobes and is located _________ and ______ to the left lobe
|
posterior
medial |
|
|
The 3 boundaries of the caudate lobe are the
|
the Inferior Vena Cava (IVC), portal vein, and ligamentum venosum
|
|
|
The ________ is considered the landmark, in sonography, that divides the right and left lobes of the liver.
|
middle hepatic vein
|
|
|
The middle hepatic vein marks the incomplete line of the ______ which extends from the IVC to the gallbladder fossa
|
main lobar fissure
|
|
|
Both the ________ and ________ are correct answers to the question of the dividing landmark of the left and right lobe.
|
middle hepatic vein
main lobar fissure |
|
|
The longitudinal boundaries of the 4 hepatic segments are the _________ veins.
|
Hepatic
|
|
|
The horizontal or transverse boundaries of the 4 hepatic segments are the _______ and _______ portal veins.
|
right
left |
|
|
What are the 9 liver segments?
|
Left Medial Inferior
Left Superior Lateral Left Inferior Lateral Left Superior Medial (quadrate) Right Inferior Anterior Right Inferior Posterior Right Superior Posterior Right Superior Anterior Caudate |
|
|
The ________ is a remnant of the ductus venosus from fetal
origins. It is located, as a line, from the left portal vein to the IVC. It separates the left and caudate lobes from each other. |
ligamentum venosum
|
|
|
The ________, also from fetal origins, originated from the umbilical vein. It runs from the umbilicus to the left portal vein. It is contained in the falciform ligament.
|
ligamentum teres
|
|
|
The __________ dump blood, from the liver, into the IVC
|
hepatic veins
|
|
|
There are generally how many hepatic veins?
|
3
|
|
|
The 3 hepatic veins are the ____, ____, and _____ veins.
|
right
left middle |
|
|
These vessels look less bright than portal veins due to their lack of fibrofatty tissue.
|
Hepatic
|
|
|
Their waveforms generally reflect the waveform of the IVC (triphasic).
|
Hepatic veins
|
|
|
The portal vein carries oxygenated blood to the liver, making it unique to any other vein in the body.
|
portal
|
|
|
The waveform of the portal vein is one that is _______, _____, and _______.
|
phasic
low-velocity continuous |
|
|
It originates off of the celiac trunk and courses towards the liver. Its waveform is low-resistive, meaning that there is constant flow during all cardiac cycles.
|
Hepatic artery
|
|
|
Flow towards the liver-(normal portal vein and hepatic artery flow)
|
Hepatopedal
|
|
|
Flow away from the liver-(normal hepatic vein flow)
|
Hepatofugal
|
|
|
Before birth, the __________ brings blood from the placenta to the fetus
|
umbilical vein
|
|
|
The umbilical vein runs from the umbilicus to the liver through the ________. After birth, this vein atrophies.
|
ligamentum teres
|
|
|
During ______, the umbilical vein may be re-opened due to excessive systemic venous pressure to form an alternate pathway for the blood.
|
portal hypertension
|
|
|
The ______ carries blood from the umbilical vein to the IVC. It also atrophies and then becomes the ligamentum venosum.
|
ductus venosus
|
|
|
A tongue-like projection off of the inferior tip of the right lobe of the liver. It is a normal variant, most common in women, which will cause the liver to appear large when measured in the sagittal plane.
|
Reidel's lobe
|
|
|
The liver is covered by a fibrous peritoneal membrane called Glisson’s capsule. The posterior aspect of the liver that is not covered by peritoneum is called the ______.
|
bare area
|
|
|
When measuring the liver sagittally the common measurement given is 15.5 cm. Anything above this size is considered _________.
|
hepatomegaly
|
|
|
The liver should be slightly brighter or _______ to the kidneys (renal cortex) and be smooth throughout.
|
hyperechoic
|
|
|
The liver will be less bright or ________ compared to the pancreas.
|
hypoechoic
|
|
|
Cirrhosis is a hepatocellular disease that results from injury to the liver due to a variety of reasons including
these 7 |
Alcohol or drug abuse (risk for liver cancer)
Chronic bile retention Obesity Metabolic disorders Cardiac insufficiency Medications Infections (such as hepatitis) |
|
|
Cirrhosis is the _____ leading cause of death in the United States.
|
fifth
|
|
|
The liver will become echogenic due to _______ in the early stages of cirrhosis. In later stages, the liver will atrophy and become fibrotic.
|
fatty infiltration
|
|
|
Sonographic appearances of cirrhosis are (7):
|
Hepatomegaly (early stage)
Enlargement of caudate lobe (end stage) Coarse echotexture-increased echogenicity Nodular surface-irregularity of organ Increased risk of hepatoma (liver cancer) Jaundice Ascites |
|
|
This is a condition that is formed due to an accumulation of triglycerides with the liver cells or hepatocytes.
|
Fatty Infiltration
|
|
|
Sonographic appearances of fatty infiltration are:
|
liver will appear echogenic;
sound beam will also have trouble penetrating the dense liver producing a poor image. Focal fatty infiltration Focal fatty sparing |
|
|
Focal fatty sparing tends to occur in the ________, ______, and _______.
|
periportal region
caudate lobe area adjacent to gallbladder fossa |
|
|
The causes of fatty infiltration include (9):
|
Obesity
Alcohol abuse Malnutrition Diabetes Poorly controlled hyperlipidemia chemotherapy excess corticosteroids total parenteral hyperalimentation glycogen storage disease |
|
|
Disorder of carbohydrate metabolism. Hepatic adenomas are associated with this disease. It is indistinguishable from other causes of fatty infiltration.
|
Glycogen Storage Disease
|
|
|
T/F?
Cysts can occur anywhere in the liver. |
TRUE
|
|
|
If a patient presents with an increased hematocrit level, you should think _________ cyst
|
hemorrhagic
|
|
|
_________ is an inherited autosomal dominant disease. It is often associated with polycystic renal disease. The liver will have a great number of cysts which usually do not cause symptoms or affect liver function.
|
Congenital Polycystic Disease
|
|
|
This is a fatty tumor that is usually incidentally found on ultrasound. It will appear sonographically as a smooth, hyperechoic mass. It is associated with propogation speed artifacts.
|
Lipoma
|
|
|
This is the most common benign tumor of the liver. They are mostly found incidentally and are asymptomatic.
|
Cavernous hemangioma
|
|
|
The sonographic appearance of the cavernous hemangioma is:
|
Well-defined
Hyperechoic Homogeneous Usually less the 3 cm Posterior acoustic enhancement |
|
|
The cavernous hemangioma is Most common in adult ______ (increases with estrogen or pregnancy)
|
women
|
|
|
This is a rare benign tumor. It can be isoechoic to the liver and may be hard to identify sonographically. It can look like a hepatic adenoma, though. A central stellate scar will appear pathologically.
|
Focal Nodular Hyperplasia
|
|
|
3 benign solid lesions in the liver
|
lipoma
cavernous hemangioma Focal Nodular Hyperplasia |
|
|
This is a primary liver tumor in which is fairly common. It is caused by alcoholic cirrhosis or chronic hepatitis B. The tumor usually extends into the portal vein. Sonographic appearance is variable but mostly hypoechoic. Alpha-fetoprotein is present in 70% of them.
|
Hepatoma (Hepatocellular Carcinoma)
|
|
|
These are rare malignant tumors found in infants and children. It causes hepatomegaly and abdominal distention.
|
Hepatoblastoma
|
|
|
Mets are much more common in the liver than are primary cancers. They can have many different sonographic appearances and come from a variety of primary cancers, including:
|
Hyperechoic mets- GI (colon) tumor
Hypoechoic mets-primary non-Hodgkin lymphoma or lymphoma associate with AIDS Bull’s Eye or Target mets-bronchogenic carcinomas Calcified mets-Mucinous adenocarcinoma of the colon Cystic mets-sarcoma |
|
|
The literal meaning of ___________ is inflammation of the liver.
|
hepatitis
|
|
|
The three most common types of hepatitis are______, _______, and ________. These are commonly passed from one person to the next.
|
A (bacterial), B (viral), and C.
|
|
|
The sonographic appearance of acute hepatitis is as follows (3):
|
Hypoechoic liver parenchyma
Liver enlargement Hyperechoic portal and hepatic vein walls |
|
|
The sonographic appearance of chronic hepatitis is as follows (3):
|
Hyperechoic liver parenchyma
Small liver Decreased echogenicity of portal vein walls |
|
|
Seen as small calcifications in the liver and spleen. This is caused by histoplasmosis (spore you inhale, sometimes from birds) or tuberculosis infection.
|
Granuloma
|
|
|
These abscesses produce pus and contain masses.
|
Pyogenic Abscess
|
|
|
Pyogenic Abscess can be caused by _______ or _________ infection, simple cyst with hemorrhage, hematoma, or necrotic or cystic neoplasm. It is primarily located in the right lobe. Patients will have a fever and increased WBC’s.
|
amoebic
echinococcal |
|
|
Fungal abscess
|
Candidiasis
|
|
|
Four possible appearances of Candidiasis:
|
Wheel within a wheel
Bull's eye Uniformly hypoechoic focus Echogenic focus |
|
|
calcification representing a scar formation seen late in the disease process.
|
Echogenic focus
|
|
|
Appears like this when the hypoechoic center calcifies.
|
Bull's eye
|
|
|
When the lesion has a hypoechoic outer rim and inner echogenic wheel with a hypoechoic center.
|
Wheel within a wheel
|
|
|
These are also referred to as infections. The Entamoeba histolytica enters the intestine and travels to liver via the portal vein. This abscess can look the same as the pyogenic abscess except that it is primarily found in the right lobe and is contiguous with the liver capsule.
|
Amebic Abscess
|
|
|
This entity can be found in the spleen also. It is a parasite called Echinococcus granulosus. You should ask the patient where they have traveled recently. The parasites can be transmitted from sheep and cattle raising countries. The eggs are transmitted to the liver via the portal vein and embed there.
|
Echinococcus Cyst (Hydatid disease)
|
|
|
The sonographic appearance of this includes:
Simple fertile cysts-looks like the cyst have double layers. Daughter cyst formation-daughter cysts are separate endocysts within the large cyst |
Echinococcus Cyst (Hydatid disease)
|
|
|
This is one of the most common parasitic infections worldwide. It is larvae or parasite gotten from drinking water. These parasites block the portal vein because they are lodged or embedded there.
|
Schistosomiasis
|
|
|
Schistosomiasis causes the following 5 symptoms:
|
jaundice
ascites portal hypertension splenomegaly varices |
|
|
It is the most common organism causing opportunistic infection in patients with AIDS.
|
HIV-AIDS (pneumocystic carinii)
|
|
|
Sonographic findings of involve diffuse, tiny, non-shadowing foci and extensive replacement of normal hepatic tissue by echogenic clumps representing dense calcifications.
|
HIV-AIDS (pneumocystic carinii)
|
|
|
Increased portosystemic blood pressure
|
Portal hypertension
|
|
|
In some diseases, most notably cirrhosis, the liver becomes fibrotic and the blood passage through the liver may be impeded. This back pressure of the portal system increases. What is this?
|
Portal hypertension
|
|
|
4 different types of portal hypertension:
|
Extrehepatic presinusoidal portal hypertension: portal vein thrombosis
Intrahepatic presinusoidal portal hypertension:schistosomiasis Intrahepatic portal hypertension: cirrhosis Intrahepatic postsinusoidal portal hypertension: hepatic vein thrombosis (Budd-chiari) |
|
|
Portal Vein thrombosis is associated with the following 10 events:
|
Hepatocellular carcinoma
Metastatic liver disease Carcinoma of the pancreas Pancreatitis Hepatitis Trauma Splenectomy Portocaval shunts Hypercoagulable states Extrinsic compression (portal lymphadenopathy) |
|
|
Sonographic findings of Portal Vein Thrombosis include the following (4):
|
Echogenic thrombus within lumen of the vein
Portal vein Collaterals Enlargement of thrombosed segment of vein Cavernous transformation of the portal vein |
|
|
This is the thrombosis of the hepatic veins.
|
Budd-Chiari syndrome
|
|
|
Thrombosis of the hepatic veins. The increase blood flow to the caudate lobe causes caudate enlargement.
|
Budd-Chiari syndrome
|
|
|
3 symptoms of Budd-Chiari syndrome
|
ascites
hepatomegaly splenomegaly |
|
|
5 causes of Budd-Chiari are as follows
|
Membranous obstruction of the IVC
Hypercoagulation states Compression of hepatic veins (liver tumors and cirrhosis) Tumor invasion Unknown etiology |
|
|
________-like occlusion of hepatic vein is not Budd-Chiari
|
Thread
|
|
|
It is the fourth most common site for aneurysm in the abdomen. The Doppler image will show turbulent flow within a sonolucent mass in the right upper quadrant. If the aneurysm is calcified, the ultrasound eval. will be difficult.
|
Hepatic artery aneurysm
|
|
|
This appears as linear bright structures in the periphery of the liver. This is usually the result of ischemic bowel (ulcerative colitis or chrohn’s disease).
|
Portal vein gas
|
|
|
In infants, portal venous gas is due to _________.
|
necrotizing entercolitis
|
|
|
After this, ultrasound is used to evaluate patency of the hepatic artery, portal vein, IVC, hepatic veins, and common bile duct.
|
Liver transplants
|
|
|
_________ is a common reason for liver transplant in children.
|
Biliary atresia
|
|
|
4 common reasons for adults to obtain a liver transplant
|
cirrhosis
hepatitis inborn errors in metabolism unresectable hepatoma |
|
|
Placed in patients to decompress the portal system in portal hypertension.
|
Portosystemic Shunts (surgical shunts)
|
|
|
One of 5 routes to taken to decompress the liver. The side of the portal vein is joined to the side of the IVC. Portal vein will flow hepatofugal, blood will arrive in liver via hepatic artery only.
|
Portocaval (side-to-side)
|
|
|
One of 5 routes to taken to decompress the liver. The portal vein is severed. The splenic end if joined to the side of the IVC.
|
Portcaval (end-to-end)
|
|
|
One of 5 routes to taken to decompress the liver. Splenectomy is performed. The hepatic end of the splenic vein is joined to the side of the left renal vein.
|
Proximal splenorenal shunt
|
|
|
One of 5 routes to taken to decompress the liver. Graft material is used to join the side of the superior mesenteric vein to the side of the IVC.
|
Mesocaval interposition
|
|
|
One of 5 routes to taken to decompress the liver. This is a shunt which connects the right hepatic vein to the right portal vein.
|
Transjugular intrahepatic portosystemic shunt (TIPS)
|
|
|
Which is the most common malignant tumor of the liver?
a. Focal nodular hyperplasia b. Hepatic adenoma c. Cavernous hemangioma d. Metastatic cancer |
Metastatic cancer
|
|
|
What is considered to be the division of the right and left lobes of the liver?
a. Main lobar fissure b. Right hepatic vein c. Portal triad d. Ligamentum venosum |
Main lobar fissure
|
|
|
The ligmentum teres is a remnant of what fetal vessel?
a. Ductus venosus b. Umbilical vein c. Portal vein d. Gastroduodenal artery |
Umbilical vein
|
|
|
The ductus venosus is the anterior border of what lobe of the liver?
a. Left lobe b. Reidel’s lobe c. Right lobe d. Caudate lobe e. Quantrill’s lobe |
Caudate lobe
|
|
|
The porta hepatis is the entrance point to the liver for what vessel?
a. Portal vein b. Middle hepatic vein c. Right hepatic vein d. Superior mesenteric vein |
Portal vein
|
|
|
You are scanning a patient with fatty infiltration for an abdominal ultrasound. All of the following
are sonographic features of fatty infiltration EXCEPT: a. Focal fatty infiltration b. Focal fatty sparing c. Shrunken caudate lobe d. Echogenic |
Shrunken caudate lobe
|
|
|
Hepatic adenomas are associated with which metabolic disorder of the liver?
a. Glycogen storage disease b. Fatty infiltration c. Cirrhosis d. Hepatitis |
Glycogen storage disease
|
|
|
Diseases affecting the liver may be classified as:
a. Cystic b. Hepatocellular c. Obstructive d. B and C |
B and C
|
|
|
The vascular tumor composed of blood vessel cells with nonspecific sonographic findings is:
a. Adenoma b. Hemangioma c. Ewing’s angioma d. Hamartoma |
Hemangioma
|
|
|
The rare hepatic malignant tumor seen in infancy and childhood is:
a. Adenoma b. Wilm’s c. Adenolipoma d. Hepatoblastoma |
Wilm's
|
|
|
A 55-year-old female presents at the hospital with non-specific abdominal pain that has been
continuing for the past 6 months. The patient states that she has been an alcoholic for many years. What disorder would you suspect under these conditions? a. Hepatitis b. AIDS c. Cirrhosis d. Glycogen Storage Disease |
Cirrhosis
|
|
|
12. You are scanning a patient who presents with a single, anechoic, smooth round structure that has
posterior acoustic enhancement in the liver. The most likely candidate for this lesion is: a. Portal vein aneurysm b. Focal nodular hyperplasia c. Metastatic cancer d. Liver cyst |
Liver Cyst
|
|
|
Which of the following is associated with infestation of a parasite that gets lodged in the portal
vein from drinking water? a. Schistosomiasis b. Hydatid disease c. Ameboic abscess d. Echinococcus Cyst |
Schistosomiasis
|
|
|
Which of the following is NOT a cause of cirrhosis:
a. Obesity b. Alcohol c. medication d. pancreatitis |
pancreatitis
|
|
|
What three structures make up the portal triad?
a. Hepatic vein, hepatic artery, bile duct b. Bile duct, hepatic vein, portal vein c. Portal vein, bile duct, hepatic artery d. Hepatic vein, hepatic artery, portal artery |
Portal vein, bile duct, hepatic artery
|
|
|
In patients who develop portal hypertension, the portal blood flow becomes ______________
instead of ___________________. a. Hepatopedal, hepatofugal b. Hepatofugal, hepatopedal c. Hepatopetal, hepatofluge d. Hepatofugal, hepatopudal |
Hepatofugal, hepatopedal
|
|
|
The normal Doppler velocity pattern of the inferior vena cava is :
a. Biphasic b. Triphasic c. Cyclical d. Resistive |
Triphasic
|
|
|
You are scanning a patient with a history of fever, abnormal liver function tests, and right upper
quadrant tenderness. The liver is enlarged with decreased echogenicity, the gallbladder wall is thickened and thick echogenic bands are noted surrounding the portal veins. Which of the following conditions is most likely? a. Fatty liver b. Cirrhosis c. Picwickian syndrome d. Hepatitis e. Normal liver |
Hepatitis
|
|
|
A female patient presents sonographically with a long, slender projection off of the right lobe of
the liver. The BEST choice for this is most likely: a. Malignant tumor b. Reidel’s lobe c. Normal liver parenchyma d. Cirrhosis |
Reidel's lobe
|
|
|
The liver should be ______________ to the renal cortex sonographically.
a. Hyperechoic b. Hypoechoic c. Anechoic d. Isoechoic |
Hyperechoic
|
|
|
3 metabolic disorders of the liver
|
Cirrhosis
Fatty infiltration Glycogen Storage Disease |
|
|
3 benign solid lesions of the liver:
|
Lipoma
Cavernous hemangioma Focal Nodular Hyperplasia |
|
|
3 malignant solid lesions of the liver:
|
Hepatoma (Hepatocellular Carcinoma)
Hepatoblastoma Metastatic Cancer |
|
|
8 infectious diseases of the liver
|
Hepatitis
Granuloma Pyogenic Abscess Candidiasis (Fungal Abscess) Amebic Abscess Echinococcus Cyst (Hydatid disease) Schistosomiasis (larvae or parasite) HIV-AIDS (pneumocystic carinii) |
|
|
5 vascular disorders of the liver
|
Portal hypertension
Portal vein thrombosis Budd-Chiari syndrome Hepatic artery aneurysm Portal vein gas |
|
|
5 forms of gallbladder pathology
|
sludge
cholelithiasis acute cholecystitis chronic cholecystitis gallbladder tumors |
|
|
A tubular muscular structure seen anterior to the aorta and posterior to the IVC above the level of the celiac axis and superior mesenteric artery.
|
Crus of the Diaphragm
|
|
|
The _______ crus of the diaphragm arises from the lateral aspect of the first three lumbar vertebral bodies.
|
right
|
|
|
The ______ crus arises from the first two lumbar vertebral bodies.
|
left
|
|
|
Sonographically, the crus is seen as a thin _______ band.
|
hypoechoic
|
|
|
Echogenic structure within the left lobe of the liver, formed when the ductus venosus atrophies after birth.
|
Ligamentum Teres
|
|
|
Echogenic line anterior to the caudate lobe and posterior to the left lobe of the liver
|
Ligamentum Venosum
|
|
|
Runs between the right and left lobes of the liver.
|
Main lobar fissure
|
|
|
Can be visualized between the gallbladder and the right portal vein
|
Main lobar fissure
|
|
|
Echogenic region where the portal vein, hepatic artery, and cbd enter the liver.
|
Porta Hepatis
|
|
|
Central area of the medial aspect of the spleen where vessels enter or exit
|
Splenic Hilum
|
|
|
The ______ separates the medial and lateral segments of the left lobe.
|
left hepatic vein
|
|
|
The _______ separates the anterior and posterior segments of the right lobe of the liver.
|
right hepatic vein
|
|
|
The _______ represents the inferior end of the separation between right and left lobes of the liver.
|
gallbladder
|
|
|
The ____ represents the inferior end of the separation between the medial and lateral segments of the left lobe.
|
ligamentum teres
|
|
|
Sonographic visualization of the gasttrointestinal tract can be challenging due to the _______ usually present.
|
intraluminal air
|
|
|
The bowel wall is composed of how many layers?
|
5
|
|
|
The layers of the bowel wall appear alternately ________ (first, third, and fifth layers) and ________ (second and fourth layers) by ultrasound.
|
echogenic
hypoechoic |
|
|
T/F???
In general, large bowel is more difficult to visualize than small bowel. |
FALSE
|
|
|
The ______ muscles arise from the vertebral bodies of T-12 through L-5 and run lateral to the spine to join the iliacus muscles in teh pelvis.
|
psoas
|
|
|
The _______ muscles form the posterior wall of the abdomen behind the kidneys. They arise from the inferior border of the 12th ribs.
|
quadratus lumborum
|
|
|
Along with the internal oblique and transverse abdominal muscles, these three flat muscles form the anterolateral abdominal wall.
|
External oblique muscles
|
|
|
The _________muscles lie deep to the external oblique muscles. They arise from the anterior two thirds of the iliac crest and lateral two thirds of the inguinal ligament and insert into the inferior borders of the 10th to 12th ribs.
|
Internal oblique muscles
|
|
|
The _______ encloses the rectus abdominis muscles that run vertically along the anterior aspect of the abdomen.
|
rectus sheath
|
|
|
The rectus sheath is not an unusual site for _______ or ________ development.
|
hematoma
abscess |
|
|
Veins can sometimes be too small to visualize. __________ will allow them to expand and be more easily identified.
|
Deep inspiration
|
|
|
AO
|
Aorta
|
|
|
CA
|
Celiac axis
|
|
|
CD
|
Common duct
|
|
|
CHD
|
Common hepatic duct
|
|
|
DU
|
Duodenum
|
|
|
GDA
|
Gastroduodenal artery
|
|
|
HA
|
Hepatic artery
|
|
|
K
|
Kidney
|
|
|
L
|
Liver
|
|
|
LRV
|
Left Renal Vein
|
|
|
P
|
Pancreas
|
|
|
PD
|
Pancreatic duct
|
|
|
PV
|
Portal Vein
|
|
|
RRV
|
Right renal vein
|
|
|
SP
|
Spleen
|
|
|
SA
|
Splenic artery
|
|
|
SV
|
Splenic vein
|
|
|
ST
|
Stomach
|
|
|
Enzyme secreted by the pancreas, responsible for breaking down complex carbohydrates.
|
Amylase
|
|
|
Bruising of flanks secondary to retroperitoneal bleeding.
|
Grey-Turner's Sign
|
|
|
Elevated concentration of lipid in teh blood. Can cause pancreatitis.
|
Hyperlipidemia
|
|
|
Dilated bowel secondary to decreased motility. Causes include acute pancreatitis, peritonitis, bowel ischemia, myocardial infarction, infection, and certain medications.
|
Ileus
|
|
|
Increase in number of white blood cells in bloodstream. Can be due to infection.
|
Leukocytosis
|
|
|
Digestive enzyme secreted by the pancreas that breaks down fats. Usually elevated along with amylase in acute pancreatitis.
|
Lipase
|
|
|
Fluid that results from a ruptured pancreatic pseudocyst.
|
Pancreatic Ascites
|
|
|
Accumulaion of pancreatic fluid in a cyst-like loculus, but without an epithelial lining. May occur within or outside the pancreas.
|
Pancreatic Pseudocyst.
|
|
|
Acute or chronic inflammation of the pancreas.
|
Pancreatitis
|
|
|
Edematous, enlarged pancreas. Most commonly caused by alcohol or biliary dissease.
|
Acute Pancreatitis
|
|
|
Histological changes within the pancreas secondary to repeated episodes of acute pancreatitis. Results in gland atrophy as well as stone and cyst formation.
|
Chronic Pancreatitis
|
|
|
Bleeding within the pancreas, associated with acute pancreatitis.
|
Hemorrhagic Pancreatitis
|
|
|
Inflammatory process that spreads to the soft tissues surrounding the pancreas.
|
Phlegmonous Pancreatitis
|
|
|
Congenital variant in which the dorsal and ventral pancreatic ducts fail to fuse. This condition may result in inadequate enzyme drainage, predisposing the individual to pancreatitis. More recent thinking casts doubt upon this possible association.
|
Pancreas Divisum
|
|
|
Ulceration in the wall or the stomach or duodenum.
|
Peptic Ulcer Disease (PUD).
|
|
|
Laboratory test that is elevated in the setting of acute pancreatitis. Also elevated with mumps, ischemic bowel disease, pelvic inflammatory disease, acute cholecystitis, renal failure, and PUD.
|
Serum Amylase
|
|
|
Liquid form of nutrition administered through a central line.
|
Total Parenteral Nutrition
|
|
|
Portion of the head of the pancreas that lies posterior to the smv.
|
Uncinate Process
|
|
|
Lipase values
|
0-160 U/L
|
|
|
Serum amylase
|
23-85 U/L
|
|
|
White blood cell count
|
5,000 - 10,000 U/L
|
|
|
The gallbladder is located in the _______ and can vary in shape and size.
|
RUQ
|
|
|
The gallbladder lies on the ________ surface of the liver at the _______ end of the main lobar fissure.
|
inferior
inferior |
|
|
The gallbladder is comprised of what 3 parts?
|
Fundus
Body Neck |
|
|
The neck of the gallbladder connects with the _________.
|
cystic duct
|
|
|
A small diveriticulum in the neck of the gallbladder is called ___________.
|
Hartmann's pouch
|
|
|
The gallbladder wall should be less than ____ mm in thickness.
|
3
|
|
|
The branches of the ___________ ducts converge to form a right and left hepatic duct.
|
intrahepatic
|
|
|
The right and left hepatic ducts converge to form the ________.
|
common hepatic duct
|
|
|
The cystic duct connects to the _______ of the gallbladder.
|
neck
|
|
|
The opening of the cystic duct is controlled by the _________.
|
valves of Heister
|
|
|
These will possibly look like echogenic, horizontal lines bisecting the cystic duct walls.
|
valves of Heister
|
|
|
T/F? The cystic duct will be uncommon to see on ultrasound.
|
True
|
|
|
The __________ and _________ combine to form the common bile duct.
|
common hepatic
cystic ducts |
|
|
The CBD is referred to as the extrahepatic duct because it is located outside the ______.
|
liver
|
|
|
The CBD passes posterior to the __________ and ___________ to join the main pancreatic duct at the ampulla of Vater.
|
duodenum
pancreatic head |
|
|
This _______ is controlled by
the sphincter of Oddi. |
ampulla of Vater
|
|
|
The bile finally ends up in the _______.
|
duodenum.
|
|
|
This is a fold of the gallbladder located in the fundus. It
may appear as a septation. |
Phrygian cap
|
|
|
This is a fold between the body and neck of the gallbladder.
|
Junctional fold
|
|
|
The gallbladder contracts when stimulated by an enzyme called ________.
|
cholecystokinin.
|
|
|
If the patient has been adequately fasting and the
gallbladder appears contracted then it is probably abnormally ________. |
functioning
|
|
|
The gallbladder wall should be measured at it’s fully distended, ______state.
|
fasting
|
|
|
Wall thickening can be a sign of any of the following 9 things.
|
Cholecystitis (most common cause of GB wall thickening).
Ascites Hypoalbuminemia Congestive heart failure Hepatitis Renal failure pancreatitis peptic ulcer disease acute pyelonephritis |
|
|
This is due to hepatic disease such as viral hepatitis.
|
Hepatic jaundice
|
|
|
This is due to destructive RBC disease such as sickle cell anemia.
|
Hemolytic jaundice
|
|
|
This is due to obstructive pathology of the biliary system by bile duct stones (choledocholithiasis). (Direct bilirubin increases).
|
Surgical jaundice
|
|
|
This is a combo of calcium-bilirubinate granules and cholesterol crystals.
|
Sludge
|
|
|
Sludge is pathology associated with biliary stasis secondary to:
|
Prolonged fasting
Hyperalimentation Hemolysis Cystic duct obstruction Acute or chronic cholecystitis Sonographically sludge appears as: Nonshadowing Echogenic Homogeneous material which layers and shifts with patient position |
|
|
Gallstone
|
Cholelithiasis
|
|
|
A gallstone appears sonographically as the following 3:
|
Mobile
Strongly echogenic Posterior acoustic shadowing |
|
|
Gallstones are composed of the following 3 things:
|
cholesterol
calcium bilirubinate calcium carbonate |
|
|
Some of the complications of cholelithiasis are the following 6.
|
Acute cholecystitis
Empyema Perforation Pericholecystic abscess Peritonitis Cholesytointestinal fistula with gallstone ileus |
|
|
There is a high incidence of ______ associated with carcinoma of the gallbladder.
|
gallstone
|
|
|
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 double arc or _______.
|
WES sign
|
|
|
The usual scenario of cholecystitis is a stone obstructing the ________. This results in necrosis and infection. This may cause RUQ tenderness, guarding, fever, chills, and leukocytosis.
|
cystic duct
|
|
|
The sonographic features of Acute Cholecystitis include the following 5:
|
Gallstones
Murphy’s sign Diffuse wall thickening Gallbladder dilatation sludge |
|
|
Rare condition that is life-threatening to the patient. The gallbladder gets gas in the wall and lumen from an infection. This condition is considered a surgical emergency.
|
Emphysematous cholecystitis
|
|
|
This is a condition that can look like a thickened gallbladder wall, ulceration, hemorrhage, necrosis, pericholecystic fluid, and rounded appearance to the gallbladder.
|
Gangrenous cholecystitis
|
|
|
This is a gallbladder that contains pus and hemorrhagic
debris. It will look like atypical inhomogeneous bile echoes within the gallbladder. |
Empyema
|
|
|
This is the inflammation of the gallbladder without the pesence of stones. Most likely due to the cystic artery having decreased blood flow.
|
Acalculous cholecystitis
|
|
|
Four forms of Acute cholecystitis
|
Emphysematous cholecystitis
Gangrenous cholecystitis Empyema Acalculous cholecystitis |
|
|
Four forms of Chronic Cholecystitis
|
Milk of Calcium bile
Porcelain gallbladder Hydrops Courvoisier gallbladder |
|
|
This is associated with chronic cholecystitis and gallstone obstruction in the cystic duct. The gallbladder contains a high concentration of calcium carbonate, calcium phosphate, and calcium
bilirubinate. |
Milk of calcium bile
|
|
|
This is when the gallbladder becomes completely calcified.
This is associated with chronic cholecystitis and cholelithiasis. |
Porcelain gallbladder
|
|
|
This is when a stone becomes impacted in cystic duct and
completely obstructs the duct. |
Hydrops
|
|
|
Hydrops of the gallbladder is called a _______. The gallbladder becomes extremely dilated. The patient
presents with a RUQ palpable mass and no pain or jaundice. |
Mucocele
|
|
|
This is known as a mechanical obstruction of the common bile duct (CBD). This is generally caused by a pancreatic tumor. The patient will present with a palpable RUQ mass and PAINLESS
JAUNDICE. 25% of the patients that have pancreatic cancer have this. |
Courvoisier gallbladder
|
|
|
Four types of gallbladder tumors:
|
Polyps
Cholesterolosis Adenomyomatosis Malignancy |
|
|
These are structures that are out-pouchings from the gallbladder wall. They are fixed, non-moving, and do not shadow on ultrasound, therefore, they can not be mistaken for stones.There can be one or many.
|
Polyps
|
|
|
This is also known as the”strawberry gallbladder” because the gallbladder develops abnormal cholesterol deposits that form like strawberry seeds within the gallbladder wall. This is usually asymptomatic for the patient.
|
Cholesterolosis
|
|
|
This is when a focal surface of the gallbladder wall seems
abnormally thick with an echogenic foci visible within the wall. These areas are diverticula or Rokitansky-Aschoff sinuses (RAS). These can contain bile or cholesterol crystals that produce small ring down or comet tail artifacts. |
Adenomyomatosis
|
|
|
This is demonstrated as a mass in the lumen or asymmetric wall thickness.
Remember to use your color and Doppler functions to determine if the mass has blood flow to it. |
Malignancy
|
