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165 Cards in this Set
- Front
- Back
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what is alphafetoprotien and indicator of?what may it be increased with?
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an indicator of liver cancer, but may increase with testicular cancer as well as pregnancy.
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What is bile composed of?
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98% water
-bile pigments -bile salts -fatty acids -cholesterol -lecithin -inorganic salts |
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What does LDH stand for? What type of liver disease does it usually arize with
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Lactate dehyrogenase-arises with hepatitis.
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What does the fissure for the ligamentum venosum divide?
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the liver into medial and lateral segmenst
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What conditions would congugated bilirubin increase?
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-diseased livers sometimes cannot excrete bilirubin, so it's levels build up in the lood.
These diseases include: Hepatitis, cirrhosis, billiary obstruction -billiary blockage would cause a backup of congugated bilirubn in the blood |
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What is the enterohepatic circulation?
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the recirculation of bile salts
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Describe the ligamentum teres
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-resides in the Lt intersegmental fissure
-recannalizes in sever cirrhosis -is an echogenic spot on a transverse scan -is a remnant |
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What lies in the most cephalic aspect of the Lt intersegmental fissure?
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the Lt hepatic vein
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what is the round ligament carred by
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the falciform ligament
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What is the term for increased serum bilirubin?
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hyperbilirubinemia
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What are 2 other names for bilirubin glucoride
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direct and congugated billirubin
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What is the function of bile salts?
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fat digestion and absorption
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What does ALP stand for? What does it arise in?
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Alkaline phosphatase-billiary obstruction
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Where is the ligamentum teres compared to the intersegmental fissure?
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on the caudal aspect
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Describe the albumin/globulin ratio and what it may decrease with?
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a comparasin of the serum albumin to the serum globulin. It may decrese with cirrhosis
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What is gluconeogenesis?
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the liver makes new sugars from non-carbs
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describe conditions which would increase uncogugated bilirubin?
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Hemolytic disorders-if red blood cells are hemolysing in excess, then the liver cannot congugate all of th ebillirubin, and asome of it leaves the liver uncogugated.
-genetic disorders |
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what does the coronary ligament connect?
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the superior liver surface to the diaphragm
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How does bile get out of the hepatocyte?
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through the bile canalaculi
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List the functions of the liver
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-bile formation and secretion
-metabolism -vascular and lymph functions -storage depot -detoxification -phagocytosis -activation of vitamin D |
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What does AST stand for? Is it specific to liver disease?
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Aspertate amino Transferase-arises with hepatitis, and cirrhosis. Greatest amounts in liver, heart, and skeletal.
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what is glycogenolysis?
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the liver frees glycogen by converting it to glucose
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What is glucogenesis?
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the liver converts glucose into glycogen for energy storage.
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What is a synonym for congugated bilirubin?
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bilirubn glycoronide
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How does bilirubin travel through the bloodstream to liver cells?
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it is not water soluble, so it binds with albumiin.
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What does ALT stand for? What pathology is it specific for?
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Alanine amino transferase-specific for liver, kidney, heart and skeletal
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What is disse's space?
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space btw hepatocytes that contains interstitial fluid which drains into the lymphatic systme.
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why does prothrombin time increase with liver disease?
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With liver disease, there is a decrease in vitamin K, and vitamin K helps with blood clotting. Since prothrobin time is the time it takes for blood to clot, this will increase with liver disease due to a decrease in vitamin K.
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What part of the liver is the quadrate lobe?
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Medial lt love
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What is a kupffer cell, and where is it located?
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it is a phagocytic cell that destroys warn out white blood cells, and red blood cells, bacteria, and other foreign matter. Kupffer cells border sinusoids in the liver.
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which muscles lie posterior to the kidneys?
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the psosa nad quadratus lumborum muscles
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what does paritoneal reflection mean?
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visceral paritoneum that connects 2 organs or an organ and the abdominal wall
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what is the difference between the lesser omentum and the greater omentum?
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the lesser omentum connects the lesser curve of the stomach to the liver,and the greater omentum connects the greater curve of the stomach to other organs(diaphragm, spleen, and transvers colon.)
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describe the location of the left paracolic gutter
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connects the left side of the abdominal cavity with the pelvic cavity. Does not communicate with the splenic space
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describe the location of the left subphrenic space
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located inferior to the diaphragm, posterior to the spleen.
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describe the anterior pararenal space(where, what it contains)
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-portion of the the retroperitoeum between the posterior pertoneu, and the anterior portion of the gerotas fascia(renal fascia)\
-contains the pancreas, retroparatoneal duodenum, ascending colon, descending colon, ad some blood vessels |
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what is the differece btw the greater and lesser sac?
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greater sac-makes up most of the paritoneal cavity
lesser sac-is part of the paritoneal cavity fond posterior to the stomach. |
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describe what messentary is, whether it is single or double layered, and what it contains.
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It is the name of visceral peritoneum when it connects to the posterior abdominal wall.
-the messentary is double layered and contains blood vessels, nerves and lymphatics, and fat. |
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what organs re held in place by messentary?
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small bowel, olon, and the appendix
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describe the location of the rigtht paracolic gutter
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connects with the right subphrenic space and porrison's pouch
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describe what omentum is?
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peritoneum connecting the stomach to something
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What is another name for morrisons pouch?
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right hepatic space
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what ligaments comprise the lesser omentum?
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gastrohepatic and hepatoduodenal.
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which 3 ligaments make up the greater omentum?
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gastrosplenic ligament(stomach to spleen)
gastrophrenic ligament(stomach to diaphragm) gastrocolic ligament(stomach to transvers colon) gastrocoli |
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describe the location of the lesser sac
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posterior to the stomach
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what vessel passes anterior to the uncinate process?
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the SMV
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What is the normal relationship btw the SMV and the SMA
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run parallel to eachother; The SMA is to the left of the SMV
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what is the normal relationship btw the splenic vein and SMA?
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THe splenic vein is anterior, and runs perpendicular to the SMA
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Describe the course of the veins that make up the portal vein
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SMV-Drains blood from the small intestine, and portions of the large intestine, stomach, and pancreas
-IMV-passes into the splenic vein, and drains a portion of the lg. intestine. -splenic vein-drains blood from the spleen, pancreas, stomach, and part of the lg. intestine. |
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What is the valsalva maneuver?
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patient hols their breath, and "bears down". This initially causes the IVC to decrese in size, but it will eventually increase.
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what is the medial sacral artery?
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small branch just before the Aortic bifercation(not routinely visible on ultrasound)
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Compare the splenic vein to the tail of the pancreas
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the splenic vein is posterior to the tail of the pancreas
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Where do ovarian arteries arize from?
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the posterior aspect of the aorta
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what are the 3 branches of the celiac axis, and descrie the route that each takes to it's respective organs.
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splenic artery-Comes off to the left, and travels along the superior border of the pancreas. It supplies the spleen, and pancreas.
hepatic artery-Comes off to the right. IT is lateral and anterior the the main portal vein. It supplies the left lobe Lt gastric artery-travels supreior and to the left. It supplies the stomach and esophagus |
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what are the branches of the IVC in order from origin?
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Right gonadal, Renal, adrenal, hepatic
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Where do lumbar arteries arize from?
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the posterior aspect of the aorta(there are usually 4 on each side)
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where is the portal triad found found in relation to the epiploic foramen?
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the portal triad is to the right of the epiploic foramen
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Where is the pancreas in realation to the duodenum
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the pancreas is medial to the duodenum
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From which pancreatic structures do the pancreatic enzymes arise?
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main pancreatic duct
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From which pancreatic structures are the sodium bicarbonate ions and water released?
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epithelial cells lining small pancreatic ducts
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Identify three endocrine secretions of the pancreas and state their cells of origin?
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Cholectystokinin-cells of the duodenum
secretin-cells of the duodenum gastrin-secreted by the stomach |
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State the function of the endocrine secretion?
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Cholecystokinin-stimulates the pancreas to secrete large quantities of digestive enzymes
Secretin-stimulates duct cells to secrete water and bicarbonate to flush out digestive enzymes gastrin-stimulates acid secrettion in stomach and stimulates pancreas cells to secrete digestive enzymes. |
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calcium test
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hypocalcium is associated with fat nucrosis
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Where are the valves or spiral folds of heister located?
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-in the cystic duct and neck of the GB.
-they prevent the collaps of the cystic duct -They may cause shadowing and be confused with stones in the neck or cystic duct. |
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what are rokitansky-Aushoff sinuses, and what possible significance are they to common disease processes?
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They are small outpouchings of the gallbladder that extend to underlying connective tissues and sometimes the muscular layer. They are significant because they may indicate tissue injury or mucosal herniation.
-they are seen in diseased GB, and may show comet tail artifacts. |
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Where are the ducts of luschka located, and what significance do they play as far as pathology of teh gallbladder is concerned?
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They are located in the gallbladder, and they are a site where bile thickens, and stasis of bacteria and debris occurs,so this may cause inflammatory disease in the gallbladder.
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Where is the common duct located relative to the epiploic foramen?
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anterior to the epiploic foramen
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which blood vessels supply the gallbladder?
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the cystic artery and pancreatoduodenal arteries
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Describe how the duct of santirini is formed?
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It is part of the dosrsal portion of the pancreas, and when the pancreas forms, it either connects with the pain pancreatic duct, or drains directly into the duodenum
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From which pancreatic structures do the pancreatic enzymes arise?
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Membrane bound seretory granules contain digestive enzymes and are secreted into the lumen of the acinus. They then flow into larger intralobar ducts, and to the main pancreatic duct.
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What are teh functions of the sodium bicarbonate ions?
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to activate pancratic enzymes, and neurtralize acid PH of the stomach
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State two methods of regulation of pancreatic secretions:
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nervous regulation, and hormonal regulation
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name and explain the types of ducts within the GB wall?
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Ducts of luschka-sites for inspissation(thickening) of bile as well as stasis of debris which may contribute to inflammatory disease.
-Rokinansky-ashoff sinus(inflammatory pseudodiverticulum)-outpouching occasionally found in nomral GB's, but often found in diseased ones(adenomyomatosis) -neck glands-fucous gland found in the GB neck |
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what does the main lobar fissure connect?
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gallbladder eck to the right portal vein.
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What is the function of the duct of wirsung?
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aka pancreatic duct: carries the exocrine products from the pancreas to the duodenum
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Explain what happens in the pancreas when there is low blood glucose?
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-stimulates alpha cells to secrete glucagon
-glucogon acts on hepatocytes to convert glycogen to glucose, and orm glucose from lactic acid and amino acids -glucose released by hepatocytes raises blood glucose to normal |
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What is pancreatic juice composed of?
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bicarbonate and digestive enzymes.
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What are the enzymed secreted in the pancreas and their functions?
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amylase-breaks down carbs into usable sugars(maltose)
lipase-breaks down fats(w/ bile salts) proteases-digestion of proteins is initiated by pepsin in the stomach, but the pancreas does the bulk of digestion |
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What cells make up the juxtamedullary apperatus?
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macula densa
granular cells mesangial cells |
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Explain autoregulation in regards to decreased BP?
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As BP drops, GFR drops, and blood vessel walls are relaxed. Afferent arterioles dialate causing increased GFR
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what structures does the renal sinus contain?
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fat
nerves lymphatics ureter |
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what blood vessels recieve the absorbed substances from the renal tubule?
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paritubular capillaries
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What will happen to GFR as a result of increased hydrostatic pressure in bowmans capsule?
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GFR will decrease
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What happens if plasma protiens decrease?
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-plasma oncotic pressure decreases
-more fluid leads into bowmans capsule -GRF increases |
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what is the order of the flow of urine from the renal tubule to the bladder?
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renal tubule
collecting ducts papillary duct minor calyx major calyx renal pelvis ureter bladder |
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which cells secrete renin?
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granular cells
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What substances are normally found in urine?
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water, urea, creatine, uric acid, amino acids, electrolytes
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what is renin produced by? whhat does it do?
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it is produced by the kidneys, and it helps regulate BP
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what substances are not normally found in urine?
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glucose, blood cells, protien, keytones
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what is the renal corpuscle composed of?
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glomerulus, and bowmans capsule
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what are the functions of the kidney?
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-control blood consentration and volume by removing selected amounts of water and solutes
-regulating blood PH -removing toxic waste from the blood -producing erythropoetin |
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where does aldosterone come from and what is it's effect on the kidney?
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produced in the adrenal cortex, and it decreases urinary output to increase blood volume
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What is capsular hydrostatic pressure?
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mechanical force exerted from bowmans space by urine in tubule and bladder
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what 3 mechanisms does the kidney use to maintain homeostasis?
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renal autoregulation
neural regulation hormonal regulation |
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what is the effect of renin on the kidney?
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leads to angiotensin 2 which leasds to vasodialation
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what is found in the cortex and medulla of the kidney?
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cortex:
-renal corpuscle -proximal and distal convuluted tubule Medulla: -loop of henle -pyramids -columns of bertin |
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what are the structures of the juxtamedullary apperatus?
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afferent arteriole
macula densa distal convoluted tubule |
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what is osmotic pressure?
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blood protiens and other solutes increase pressure in the blood.
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what happens to GFR as capsular pressure increases?
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GFR decreases
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State the function of each endocrine secretion
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insulin-removes glucose from the blood
glucagon-converts glycogen to glucose somatostatin-inhibits release of insulin and glucagon |
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Tripsinogen
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activated by enterokinase, converted to trypsin
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What would increase prodominately with biliary obstruction?
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congugated/direct bilirubin
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Somatostatin
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released by delta cells
-inhibits release of insulin, glucogon and others |
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What are the primary exocrine secretions?
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bicarbonate
digestive enzymes |
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What are the ducts of luschka?
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they are located in the perimusclular layer of the wall of the GB, and they are a sight wher bile thickens(inspissation), and stasis of bacteria and debris occurs, so this may cause inflammatory disease in the GB.
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Where is the cystic duct in relation to the neck of the gallbladder?
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superior
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chymotripsinogen
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activated by trypsin
converted to chomotrysin |
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Describe hormonal regulation in the pancreas
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cholecystokin-stimulated by protein and fats
secretin-stimulated by acid, causes bicarbonate release gastrin-stinultes acid and enzyme secretion |
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Descibe aspects of glucagon
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-secreted by alpha cells
-converts glygogen into glucose -stimulates glucogenesis -relesed as a result of low blood sugar |
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where are the cells of the pancreas located?
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acinar cells are grouped throughout the pancreas, and islets of langerhans are found btw acinar cells
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which two types of tissue and function does the pancreas have?
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exocrine-acini
endocrine-islets of langerhan |
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What is the most specific indicator of biliary obstruction?
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ALP
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Identify three endocrine secretions of the pancreas and state their cells of origin.
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insulin-beta cells
glucogon-alphacells somatostatin-delta cells |
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What are some digestive enzymes produced by the pancreas?
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amylase-breaks down carbs
lipase-breaks down fat proteases(tripsonogen and chymotrypsinogen) |
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what is the location of the pancreas relative to the common hepatic artery
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anterior
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what are the functions of the sodium bicarbonate ions?
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to activate pancreatic enzymes and neutralize acid PH of the stomach
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what are the exocrine products of the pancreas?
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amylase, lipase, trypsin,
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how do you deliate the head and the neck of the pancreas?
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draw an imagionary line from the gastroduodenal artery to the SMV
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what are the processes that the nephron is involved with?
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Filtraation
resorbtion secretion |
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what are the functions of the nephron?
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-remobe toxic wastes from the blood
-controlling blood concentration and volume by removing selected amounts of water and solutes -helping to regulate blood pH |
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what is the nephron comprised of? what are they each comprised of?
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-Renal corpuscle(glomerulus and bowman's capsule): involved in filtration
-Renal Tubule(proximal, distal, loop of henle): involved in resorption and secretion. |
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Describe what the glomorulus is, and it's function?
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-vascular structure fed by the afferent arterial
-blood circulates through the glomorulus and solutes are driven through the pores of the glomerular vessels. -The fluid that gets through is called filtrate which carries on throught the renal tubule and the nephron restores vital nutrients and water back to the blood. -Blood leaves the glomerulus through the efferent arteriole and makes it's way through the peritubular capillary |
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what is the difference btw hydrostatic pressure and osmotic pressure?
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-Hydrostatic pressure=induced by mechanical force exerted on a wall. (Ie. heart pumping puts frce on glomerular wall.)
-Osmotic pressure=pressure induced by solutes dissoved in fluid.(ie. more protien in blood=more osmotic pressure) |
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what is the juxtamedullary aperatus made up of?
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glomerulus, and a portion of the dustal convuluted tubule.
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Describe where ADH comes form, and what it's function is?
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ADH is produced by the posterior pituitary, and increases when the body is experiencing a lack of fluid.
-causes an increase in water reabsorption in the distal convuluted tubule |
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Describe where aldosterone comes from, and what it's function is?
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-Produced in the adrenal cortex, and is released when there is increased intracellular potassium.
-It causes increased sodium(and thus water) reabsorption in the distal conbuluted tubule. |
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T/F the creatinine blood test is more sensitive than the blood urea nitrogen test?
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true
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What are the ligaments that hold up the bladder?
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3 ligaments:
2 lateral umbilical ligaments 1 medial umbilical ligament(remnant of fetal urachus) |
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what did the medial umbilical ligament used to be?
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fetal urachus connecting the bladder to the umbilicus
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What is a desirable post void bladder volume?
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<100ml
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Explain sonographically how to find the left adrenal gland?
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The splenic artery and vein cross btw the pancreas the the left adrenal gland, so you can use them as a landmark
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what is the arterial supply of the adrenal gland?
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inferior phrenic artery
aorta renal artery |
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Compare the size of the adrenal gland in adults to in a fetus?
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Adrenal glands of the fetus are nearly 10 times larger than the adult gland relative to body weight
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Explain sonographically how to find the right adrenal gland?
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-Scan the upper pole of the right kidney intercostally angling medially to the kidney
-The adrenal gland can be located btw the liver and the diaphragmatic crus. -continue angling medially towards the IVC and the central ridge of the gland is seen behind the IVC> |
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How much of the spleen does the peritoneum cover?
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all but @ the hilum
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Differentiate btw red pulp and white pulp?
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red pulp-found on the outer region of the spleen. Functions in red blood cell destruction
white pulp-found more centrally in the spleen. Composed of lyphatic tissue. Only makes up about 15% of the splenic mass. |
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Explain the phrenicolic ligament?
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Attaches the colon to the diaphragm. Spleen is not attached, but it acts as a hammock for the spleen.
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what is the normal splenic volume index?How is this figured out?
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between 8-35
SVI=L x W x H/27 |
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what do pathological lymph nodes look like?
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more hypoechoic with the loss of a fatty hilum.
irregular contour |
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what do the antrum and body of the stomach look like sonographically/
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targetlike appearace inferior to the left lobe sagitally
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what are the 3 primary functions of the lymphatic system?
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1. Maintain homeostasis by returning interstitial fluid to the blood stream
2. transport absorbed fats and fat soluble vitamins from the small intestine 3. immunity via lymphocytes and lymp nodes. |
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explain the flow of lymph from capillaries to veins?
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Capillaries
lymphatic vessels lymphatic trunk Thoracic duct and Rt lymphatic duct Right lymphatic duct---Rt subclavian V Thoracic duct to Lt subclavian Vein. |
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What are 4 functions of the spleen?
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-Blood reservoir
-red blood cell and platelet destruction by macrophages -lymphocyte manufacture -heatopeietic functions-make red blood cells in the 5-6th month of fetal life |
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what is the course of lymph?
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cappillaris----lymphatic vessles-----lyphatic trunk-----thoracic duct/rt lymphatic duct-----subclavian veins.
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Where do the parts of the adrenal gland originate?
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the medulla orginates from the neural crest cells, and the cortex develops from the mesderm of the posterior abdominal wall.
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which 4 ligaments are responsile for keeping the spleen in ts place? Explain them
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Gastrosplenic-greater curve to medial splee
Splenorenal-spleen to posterior abdomenal wall splenocolic-spleen to trx colon phrenicolic-colon to diaphragm |
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what are the landmarks to finding the adrenal gland
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liver, ivc, crus of diaphragm
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what is the funciton of the red pulp of the spleen?
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outer region. Red blood cell and platelet destruction.
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what is the funciton of the red pulp of the spleen?
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outer region. Red blood cell and platelet destruction.
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where does the splenic vein run in relation to the pancreas?
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superior to the body and tail of the pancres
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what is the part of the adrenal gland that secretes aldosterone?
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the glomerulosa
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What are the functions of the lymphatic system?
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-maintian homostasis
-digest fatty acids(small intestine) -produce lymphocytes -remove debris, and organisms |
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what are chromaffin cells?
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catacholamines such as epinephrine, and norepinephrine
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what is the keyboard sign?
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folds that appear as echogenic "air bumps" in the colon
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what are haustral folds?
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folds that appear as echogenic "air bumps" in the colon
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what is the funciton of the white pulp of the spleen?
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central in the spleen and composed mainly of lyphocytes which function in immunity
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what are the 3 layers of the cortex of the adrenal gland, and what hormones do they secrete?
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zona glomerulosa-moneralcourticoids(aldosterone)
zona fasciculata-glucocorticoids(steroids) reticularis-sex hormones(adrogens) |
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What are the 5 sonographic layers of the bowel, and their echogenicity?
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-Fluid/mucosal interface(echogenic)
-Mucosal, lamina propria, muscularis mucosa(hypoechoic) -Submucosa(echogenic) -Muscularis propria(hypoechoic) -Serosa(echogenic) |
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what are the 4 4 layers to the bladder wall?
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-inner mucosa(transitional epithelium)
-connective tissue(submucosa) -detrusor muscle -adventitia |
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where do the adrenal glands drain?
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the right adrenal gland drains directly into the IVC, and the Lt drains into the left renal vein
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what are the 2 outer coats of adrenal glands?
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peritoneal(external)
fibroelastic(internal) |
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what are peyers patches?
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secondary lymphoid organs found on the ileum of the small intestine
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What does the medulla of the adrenal glands secrete?
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epinephrine and nor-epinephrine
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what do t-cells, an b-cells do?
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t-cells-destroy invaders, and are located in the cortex
b-cells-create antiodies and are found throughout the node |
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what courses btw the pancreas and lt adrenal gland?
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the splenic artery and vein
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