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160 Cards in this Set
- Front
- Back
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What causes IVC obstruction?
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-right side heart failure
-liver enlargement -lymphadenopathy -compression due to extrisic mass -pancreatic tumours -congenital IVC valve -tumor within ivc |
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the arterial suppply to the gallbladder is via what?
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the cystic artery
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explain renal artery aneurysms?
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extra renal and usually atherosclerotic. Symptoms: hypertension, hematurua, flank pain
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How are arteries affected by atherosclerosis?
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-lose their elasticity
-lumen is narrowed -atheromas may rupture, and blood enters the atheroma makeing the lumen of the artery more narrow. -fatty contents may spill due to atheroma rupture causing thrombus formation |
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What conditions contribute to aortic dissection?
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marfans syndrome, pregnancy, aortic valve disease, congenital heart diseases, cushings syndrome, pheochromocytoma, catheter.
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What are the symptoms of aortic aneurism rupture?
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sudden lower back or abdominal pain.
-hypotension due to blood loss -shock -pushed and deformed tissue within the retroperitoneal cavity |
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what are the symtoms of IVC obstruction?
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sudden lower back or abdominal pain.
-hypotension due to blood loss -shock -pushed and deformed tissue within the retroperitoneal cavity |
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what are the symtoms of IVC obstruction?
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abdominal pain
ascites tender hepatomegaly lower extremity edema |
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What is the effect of IVC thrombus?
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complete thrombus of the IVC is life thretening. Causes include: dissemeinated intravascular coagulopathy, and deep vein thrombus.
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what is the most common tumor to fill the IVC
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venous angioms
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what are the symptoms of IVC thrombus?
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-leg edema
-lower back pain -GI complains -possibl renal and liver abnormalities |
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what vessel passes anterior to the uncinate process?
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SMV
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What are splachnic artery aneurisms caused by?
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atherosclerosis, trauma, infection, inflammation, chronic pancreatitis, or they are congenital, also caused by acute pancreatitis.
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what are some symptoms of hepatic artery aneurisms?
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RUQ pain, jaundice, hemobillia
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what are symptoms of AV fistulas?
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-lower back pain
-increased venous pressure and cardiac output -abdominal mass -swelling of lower trunk and extremities |
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what will cause a hypoechoic mantle surrounding the aorta/
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when the nodes fuse, they forma a hypoechoic mantle of tissue around tha aorta that may elevate it from the spine.
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What is lymphangioma?
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a congenital malformation of the lymph system seen as elongated unicellular or multiocular cysts.
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what are some causes of retroperitoneal infections?
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-primary infection
-spread from an adjacent organ -paraspinal inection spread form disk or vertebral body. |
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What is the usual cause of a lymphocele?
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occur post lymphadenectomy. They develop 10-21 days after surgery and resolve spontaneously.
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what is hodgkins disease?
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cancer of the lymphatic system
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What is the most common sonographic appearance of nodal lymphoma?
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-variable
-hypoechoic massess seen anterior and posterior to great vessels. -nodes someties fuse to form a hypoechoic mantel that surrounds and elevates the aorta from the spine. |
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Why is it importat to diagnose retroperitoneal fibrosis?
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If it isn't diagnosed, it can lead to renal failure, aor can be mistaken for more serious pathology.
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What is retroperitoneal fibrosis?
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-inflammatory mass
-may be from fatty material leaking from an aneurism -can lead to renal failure |
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what is a cavernous hemangioma?
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-most common benign hepatic tumor
-composed of blood filled vascular spaces separated by septa -more common in women and increse in frequency with age. -assymptomatic unless they enlarge -may grow with pregnancy -common in posterior segment of right lobe |
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what do schistosomiasis's look like sonographically/
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-thickenig ad increased echogeniciity of the portal vein walls.
-dialation of the MPV and portal hypertension -enlarged liver(initially) |
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what should you check for when HCC is suspected?
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-measure
-check for vascular invasion -note how many masses -look for vein thrombosis |
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what is an adenoma?
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Similar to FNH, but does not contain bile ducts or kuppfer cells. Well identified margins. Found in women of childbearing age. Linked to oral contraceptives. Seen on patients with von gierke's disease.
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what are the symptoms of glycogen storage disease?
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hypoglycemia, fatigue, hunger,, palpable liver, muscle wasting, and accumulation of body fat, frequent bacterial and funcgal infections
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what are the 3 phases of symptoms of hepatitis?
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-prodromal-anorexia, malaise, nausea, and vomiting, and often fever.
-icteric phase-3-10 days, urine darkens followed by jaundice -recovery phase-systemic sympotms regress and patient feels better despite worsening jaundice. Jaundice peaks during 1-2 weeks, and fades 2-4 weeks. -other than these symptoms, some other sympoms are an enlarged and tender liver. |
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what is candiasis?
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when a persons immune system is compromised, their body's normal fungus can overgrow and cause a mass in the liver.
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What are von meyenburg complexes?
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aka biliary hamartomas:
small focal masses in the liver that are made of groups of dialated intrahepatic ducst within dense fibrous tissue. They are benign. |
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what causes fatty infiltration?
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obesity, drugs, alcohol, dibetes melitis, TB, malnutrition, etc.
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what is schistosomiasis?
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a parasite commin in aftrica, asia, south america, and mediteranean. It spreads through contaminated water, and worms penetrate the skin, and travel through lymphatics or blood.
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what is focal nodular hyperplasia?
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-2nd most common benign liver mass
-rapid growth of normal tissue -normal elements of liver tissue, but lacks hepatic architecture, so it functions poorly. -common in women of childbearning ages |
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what is the sonographic appearence of GSD?
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have solid hypoechoic masses.
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what is pneumocystis carinii?
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an organism that can spread to the lung, liver, spleen, pancreas and lymph nodes.(in immunosuppressed patients)
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what are the symptoms of portal hypertension?
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-ascites
-looding of GI tract -poor renal function -hepatorenal syndrome |
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amebic absess
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caused by a parasiste, and transmitted by the fecal-oral route. enters the liver via the portal vein.
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what is budd chiari syndrome?
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hepatic venous outflow obstruction by thrombus or tumor. It is caused by oral contraseptives, tumore invasion, thrombus, radiation, congenital causes
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what does a budd-chiari syndrome look like sonographically?
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-ascites
-large liver -hepatic veins not visble, or look thick walled. -in long standing cases=right lobe atrophy, and left loe hyprtrophy -may see hyperechoic areas from firosis, nodules, ascites, splenomegaly, pleural effusion -doppler may show phasic flow, absent, reversed turbulent or continuous flow. |
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what is the sonographic appearence of a cavernous hemangioma?
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-small hyperechoic mass with wel defined borders, and enhancement
-non-homogenous hypoechoic region in center is typical -doppler doesn't help -larger hemangiomas are more variable. |
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what are some symptoms of echinococcal cysts?
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palpable liver mass, abnormal LFT's, pain or anaphylactic shock
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what are some symptoms of hepatoblastoma?
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-hepatomegaly
-precosious puberty -fever -nausea -vomitting -jaundice -increased WBC count |
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sonographic appearance of portal hypertension?
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-portal vein greater then 13mm
-collateral channels -splenomegaly -increased calebrae of splenic vein and SMV -ascites -portal vein thrombus -cavernous transformation of the portal vein -doppler flow changes. |
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what is the sonographic appreaence of pneumocystitis?
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"starry sky"
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what is a pyogenic absess?
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develops when the immune system is compromised or there is overwhelming sepsis. an infection reaches the liver internally via the billiary tree, protal vein or hepatic artery. Bacteria can also reach the liver externally to the subhepatic region, or subphrenic region.
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what are the symptoms of thiari syndrome?
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-abdominal pain
-jaundice -hematemesis -ascites -hepatomegaly -abnormal LFT's |
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what is renal failure associated with?
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-increased blood urea nitrogen
-increase creatine -acute tubular nechrosis |
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what is seen sonographically with xanthrogranulomateous pyelonephritis
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-large kidney with smooth shape
-lack or corticomedullary differentiation -multiple hypoechoic masses in parynchma -dialated calyces -echogenic renal sinus with shadowing |
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nephrocalcinosis
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calcification within the renal parenchyma usually due to:
-too much calcium circulating in the blood -Something causes injury to the kidney and calcium is laid down as a protective measure in resonse to injury. |
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What is another name for carbuncle? What is it?
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aka renal cortical abscess
-bacteria that has spread to the kidney via the bloodstream -same symptoms as pyelonephrits, and positibe blood culture. |
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what causes mets calcification?
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hyperparathyroidsism, renal tubular acidosis, renal failure.
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what are congenital megacalices?
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-enlargement of the calycles caused by underdevelopment of the papillae
-faulty bud division is one possible cause -calices are more dialated with medullary tip having a semilunar shape -usually unilaterl -increased incidence of infectionand stones -normal function |
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Who is at risk for renal tumors?
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-dialysis patient-90%chance of getting renal cysts after 5 years on dialysis. Shrunken atrophic kidney.
-von-hippo-lindau disease-abnormal growth of vessels in the body -tuberous sclerosis-genetic disease characterized by benign tumor growth throughout the body |
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What does multiocular cyctic nephroma look like sonographically?
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-variable appearence
-If large locules=multiple non-communicating cysts seen -If small=solid non-specific mass -focal echogenic areas -calcification -impossible to differentiate btw RCC |
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explain acute and cortical necrosis
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a. Acute Tubular Necrosis:
-most common cause of ARF -death of tubular cells because they don't get enough oxygen(ischemic ATN), or due to exposure to a toxic drug or molecule b. Acute Cortical Necrosis-rare form of ARF causes: shock, sepsis, hemorrhage, burns, renal vein thrombosis, hemolytic uremic syndrome, PIH, severe dehydration |
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what are the lab diagnoses of renal TB?
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-sterile pyuria(nothing has cultured from the urine
-microscopic hematuria -acid pH -growth or acid-fast bacilli(TB bugs) |
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what are the categories of metastatic calcification?
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cortical-causing shadowing in the cortex
medullary-pyramids are more echogenic than the cortex |
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Explain perirenal involvement with lymphoma?
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-involvement of the perirenal space produces a hypoechoic halo
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what are the symptoms of APKD?
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40-50's
-palpable mass -pain -hypertension -hematuria -UTI |
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emphysematous pyelonephritis
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-severe necrotisig infection of the renal parynchma
-bacteria leading to the presence of gas within the kidney substance and in the perinephric space -most patients are diabetics -usually left sided -life thretening |
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what are some causes of papillary nechrosis?
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-pyelonephritis
-Cirrhosis -analgesic abuse -renal transplant -rejection -diabetes melitis systemic vascularities |
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What is seeen songraphically with papillary necrosis
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-swoolen renal pyramids(or cystic cavity within)
-clubbed calyx -calcification in pyramids -sloughed papilla(echognic, non-shadowig structure) |
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What is candia albicans? what is seen sonographically?
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-Most common fungal infection which causes focal renal parynchmal abscesses.
SONOGRAPHICALLY: -microabscesses-hypoechoic parenchymal mass -fungus balls-echogenic non-shadowing mass in the collecting system -calcified mass |
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What causes a pediatric kidney to have nephrocalcinosis?
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child on furosemide which is diuretic increasing urine production
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What do duplex collecting systems look like sonographically?
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-2 central echogenic sinuses with renal parynchma btw.
-hydronephrosis of upper pole -ureterocele in bladder |
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What are 4 known sonographic patterns of lymphoma?
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-focal parenchmal masses(most common)
-diffuse infiltration -invasion ofrom a retroperitoneal mass -perirenal involvement(surrounding the kidney) |
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When is there potential for fungal infections? What is the most common fungal infection?
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Anytime a patients immune system is compromised, or something foreign is introduced. Ex. Diabetes, catheters, malignanacy, hamatopeitic disorder(leukemia), chronic antibiotic or steroid therapy, trasplant, IV drug abuse.
-Candia albicans is the most common fungal infection |
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what is the clinical presentation of acute pyelonephritis?
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-flank, back, or suprabic pain
-Fever, chills -dysiuria -lab tests show pyuria, bacteruria, leukoytosis, hematuria |
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waht is the sonographic appearence of chronic pyelonephritis?
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inability to distinguish the cortex from the medullary regions
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Chronic renal failure
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-Irriversable.
Sonographic findings are not disease specific. As mentioned before, the kidneys in CRF or end-stage renal disease are shrunken, often echogenic (although not always), have a thin cortex (less than 7 mm) and often have no visible pyramids. |
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xanthogranulomatous myelonephritis
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-chronic suppurative(pussy)infection causing destruction of the renal parynchma and relacement of parynchmal tissue within lipid laden macrophages.
-usually unilateral -often found in diabetics -May be segmental, focal or diffuse -strong association w/renal stones and obstruction -associated with staghorn calculi -this infection has been linked to the bacteria proteus mirabilis |
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what are the renal anomolies related to the uretal bud?
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-renal agenesis
-supernumerary kidney -douplex collecting system -ureteropelvic junction obstruction -congenital megacalices |
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what does Oncocytoma look like sonograhically?
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-small and hypoechoic
-originates in parynchma and may indent sinus -may have a central stellite scar(fig. 9-50) |
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what does chronic pyelonephritis look like sonographically?
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-gas in parynchma w/distal dirty shadow
-renal or perinephric luid collections |
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acute renal failure
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Acute renal failure is potentially reversible, and if recognized early, treatment can begin. If untreated, reduction in GFR causes irreversible damage to the kidney.
There are two phases of ARF: Oliguric and Diuretic Oliguric: patient has extremely low urine output as the kidneys are struggling to remove wastes from the blood. Diuretic: as the patient recovers from ARF, the nephrons begin to function normally and urine output increases. |
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what patients are more prone to AML's
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patients with tubeous sclerosis
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what is seen songraphically with renal tuberculosis?
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-kidney develops multiple small tuberulomas that may be bilateral
-hypoechoic structures within parynchma; larger hypoechoic structures with calcifications within |
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What problems with the kidney does aids cause
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-acute tubular necrosis
-nephrocalicinosis -interstitial nephrtis -tumors such as lymphoma(kaposi's sarcoma, which is a skin tumor) |
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renal cell carcinoma
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aka. hypernephroma, renal adenocarcinoma:
-most common malignant tumore of the kidney -presents after 50, and affects males twice as often as females |
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oncocytoma
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-characterized by vascular adenoma
-generally benign, and often found in older men -usually asymptomatic -may outstip its blood supply leading to hemorrage ad necrosis |
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Explain multiocular cystic nephroma
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-Uncommon
-benign cystic neoplasm -multiple non-communicating cysts contain within a well defined capsule -males >4; Females 2-20, 20-40 |
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what happens if a kidney is obstructed with hydropnephrosis?
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Renal sinus and pelvis begin to fill. Which leads to filling of major calyces, minor calyces, papilla, collecting ducts.
-increased pressure within the collecting ducts causes increased hydrostatic pressure which cause a decrease in GFR. THis leads to a build of toxins in the blood because they cannot be filtered out fast enought. |
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Renal tuberculosis
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-caused by the bacteria-mycobacterium tuerculosis.
-usually effects the lungs; lungs are very vascular, so seeding is possible. |
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what is the clinical presentation of transitional cell carcinoma?
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-painless hematuria
-more common in males over 50 |
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what is caroli's disease? what is the sonographic appearence of it?
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when the intrahepatic ducts are cystically dialated
sonographic appearence: -multiple dialated tubular structures that extend to the liver periphery -tubular structures communicate with cystic areas -central dot sign. |
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what is courvoiser's law?
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states that a palpable gallbladder in a jaundiced paitent means that there is likely a tumor at the distal common bile duct (often in the head of the pancreas). This causes obstruction of the biliary tree (including CBD, gallbladder and intrahepatic ducts).
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what is a adenomyomatosis? what is the sonographic appearence of it?
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the epithelium undergoes hyperplasic changes exgtending the diverticula into the adjacent muscular wall
SONOGRAPHY: -thickened GB wall -internal cystic spaces -comet tail artifacts seen distally. |
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Who would normally get emphysemtous cholecystitis? What is the typical sonographic appearence of it?
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Mostly in men with diabetes:
sonography: -may not have associated gallstones -intraluminal/intramural gas. |
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what is the triangular cord?
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remnant of the CBD in the porta. Associated with billiary atresia.
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what is perforation?
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Small defect in the wall of the GB and it happens with acute cholecystitis:
-a clue is deflation of GB and loss of normal shape |
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explain the anatomy of interposition of the GB?
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There is an absence of the CHD, and cystic duct, so the right and left hepatic ducts feed directly into the GB, and the GB drains directly into the CBD
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what is a trapped zone?
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when a stone is in a GB mass( likely malignant)
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what are the clinical symptoms and sonographic appearence of cholecocho cysts?
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clinical:
-pain -palpable subheptaic mass -fever -jaundice Sonography: -cystic mass in porta hepatis separate from GB -communication btw the cyst, and the bile duct -may see dialated intraheptaic ducts -sludge in cysts |
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what is an enlarged GB known as?
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a courvoirsier sign
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what is the typical clinical presentation of acute cholecystitis?
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-RUQ pain
-positive murphys' sign -nausea, vomitting, distension, fever -jaundice |
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what is gangrenous cholecystitis? what is the sonographic appearence of it?
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from absent blood supply or infection.
sonography: -irregular walls and lumen -mucosal sloughing(bands of non-layering, echogenic tissue within the lumen) |
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what is a hypropic gallbladder? what is the typical sonographic appearence?
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When the GB fills with mucous as a result of a stone imacted in the neck.
SONOGRAPHIC APPEARENCE: -increase GB size -distended/swoolen GB -normal wall thickness -no symptoms |
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what is bouvaret's syndrome?
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-gallstone ileus caused by the erosion of a stone through the GB and into the duodenum.
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which of the congenital anomalies features an absence of the common hepatic duct and cystic duct? what is the typical clinical presetation of this anomoly? what is the sonographic appearence?
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interposition of GB:
clinical: -childhood jaundice -surgically correctable Sonography: -dialated intrahepatic duct -normal GB and CBD |
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what is cholangitis? describe some typical sonographic appearences, and symptoms of it?
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inflammation of the ducts
symptoms: -jaundice -itching -fatigue Sonography: -dialated intrahepatic ducts -unremarkable bile ducts -thickened duct walls which dialate proximally |
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what conditions are associated with gallbladder carcinoma?
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chronic cholecystitis
-porcelin GB |
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which of the congeital anomalies features absense of the billiary system? what are the clinical symptoms, and sonographic appearence of this?
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billiary atresia:
clinical: -persistant of sudden jaundice -light stool, and dark urine -irritability, and weight loss -swoolen abdomen(enlarged liver) Sonographic appearence: -absence of CBD -triangular cord -fasting GB>1.5 cm. -intrahepatic biliary dialation -hepatomegaly -splenomegaly -ascites |
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what is a klaskin tumor?
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a cholangiocarcinoma that arises in the LHD and is usually found near the RHD and LHD confluence.
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explain a cholangiocarcinoma, the symptoms and sonographic appearence of it?
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primary malignancy arising from the wall of the bile ducts that grows slowly and extends along the length of the CHD and CBD.
SYMPTOMS: -jaundice, pruities, and elevated LFT's SONOGRAPHY: -persistant soft tissue tumor with similar echogenicity to the liver. -signs of malignancy and billiary obstruction might be seen |
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what are some other types of cholangitis?
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Ascending- from surgery or biliary stasis
Pyogenic (Oriental) cholangitis is a condition common in Asia, occurring because of biliary stasis due to biliary flukes AIDS cholangitis caused by bacteria that are normally kept in check by a functioning immune system. Since the AIDS patient is immune compromised, these bacteria cause infection |
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Describe how different levels of billiary obstruction can cause different levels of billiary dialatation?
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-CBD obstruction=intrahepatic bile duct dialation
-cystic duct obstruction=hyropic GB -complete CBD obstruction=GB dialation -obstruction at ampulla=dialation of pancreas and CBD |
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What is porcelin GB?what is the typical sonographic appearence of porcelin GB?
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it is rare, and is where the GB wall is calcified. Associated with increased risk of carcinoma
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What is mirrizi's syndrome?
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clinical syndrome of jaundice with pain and fever resulting from obstruction of the CHD by a stone impacted in the cystic duct.
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what is empymea?what are some symptoms of it
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puss in GB:
patient's fever spikes, chills, and high WBC count |
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explain perforation with the appendix
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Once perforation occurs, the appendix decompresses and is not seen well with ultrasound.
-sonographic feature: loss of the echogenic submucosa, increased pericecal echogenicity, and a complex mass or focal fluid collection. |
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what is creeping fat?
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mesenteric fat "creeps" over the affected section of bowel, leading to a hyperechoic mass effect
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EXPLAIN GI OBSTRUCTION
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-dialation of bowel proximal to obstruction
-hyperperistalsis at first, but then no peristalsis is seen - |
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what are the symptoms of HPS?
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-projectile vomiting,
-palpable oplive shaped mass in epigastrium detected by physician -gastric hyperperistalsis may be visible on the abdominal wall |
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what is the most common malignacy of the GI tract
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adenocarcinoma
different sonographic appearences: -thickened gut wall -usually hypoechoic -target or pseudokidney -air in mucosal ulcerations may produce ringdown -may cause intestial obstruction |
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what is the technique and sonographic appearence of HPS?
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Technique:
-5.0 - 7.5 MHz linear array transducer -lay baby with its right side down (to allow fluid in stomach to pool near pylorus) -2 hours after a feed may give baby a glucose solution to aid examination -a transverse plane=long axis of pylorus Sonographic Appearance: -short axis view,target appearance -wall thickness of equal to or greater than 3mm -elongated channel (greater than or equal to 17mm) |
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explain mets with GI
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-may come from malignant melanoma, lung or breast
-most commonly occurs in the stomach, then small bowel, and then colon -Secondary neoplasms may affect the omentum and peritoneum, producing ascites, superficial nodules on the gut surface, and omental "cakes" |
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what are some possible complications with chron's disease?
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abscesses
fistula obstruction perforation appendicitis |
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explain intestial intusseption, its sonographic appearence, tecnhique, etc
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-most common acute abdominal disorder of early childhood
-segment of intestine prolapses into a more caudal segment of intestine(most commonly iliocolic issuseption) -When the intestine prolapses, it pulls the mesenteric arteries with it, causing ischemia and death of a segment of intestine. Symptoms: -abdominal pain -currant-jelly stools (blood in stool) -palpable abdominal mass Technique: -graded compression technique -linear 5.0 - 7.5 MHz -follow colon from right to left Sonographic appearance: -transverse-mass lesion larger than 3 cm in maximal diameter(doughut appearence) |
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lymphoma of GI
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Usually large hypechoic, ulcerated masses (see figure 8-14 in Rumack)
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Usually large hypechoic, ulcerated masses (see figure 8-14 in Rumack)
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-sudden epigastric pain relating to back pain.
-nausea, vomittig, fever, sweating -self-limiting disease |
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what is the usual sonographic appearence of a macrocystic cystadenoma?
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-mass with cuts larger than 2 cm that may contain calcifications.
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what types of endocrine tumors are found in the pancreas?
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-B-cell/insulinoma-mosct common type of islet celltumor; usually benign, and found int eh body and tail of the pancreas
-glucagonoma-high instance of malignancy |
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what is a functional tumore?
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benign tumor-mass producing hormones causing physical symptoms
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what is the typical sonographic appearence of acute pancreatitis?
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-Severe:enlarged hypoechoic pancreas
-pancreas may appear heterogenous -fluid collections(lesser sac, ant. pararenal spaces, mesocolon, parirenal spaces, paripancreatic soft tissue) -dialated pancreatic duct -small stones in billiary system -focal pancreatitis can mimic mass |
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Describe the typical sonographic appearence of the pancreas in a patient with cystic fibrosis?
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-increased echogenicity(die to fatty repalcement)
-decreased size with atrophy -fluid collections proximal to obstruction |
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what is a pancreatic phlegmon?
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when the soft tissues surrounding the pancreas become iflammed resulting ina hypoechoic, ill-defined mass.(from acute pancreatitis)
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what are the causes of acute pancreatitis?
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the five b-s:
-Booze -Billiary disease -blood(trauma/surgery) -bugs(infections) -birth |
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What are some results of cystic fibrosis?
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-pressure in proximal fluid collections and intrapnacreatic pressure increases
-proximal distenstion of ducts and acini leads to their degeneration -pancratic insufficency results from fibrous, fatty repacement and cyst formation. |
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what are some symptoms of exocrine tumors?
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-vague, diffuse epigastric pain that radiates to the back
-jaundice(if billiary system is obstructed), and a palpable gallbladder -weight loss -loss of appetite, nausea, vomitting if the tumor is in the tail, it may obstruct the splenic vein, cuasing splenomegaly. |
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what is a gastrointestinal hemmorrhage?
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When a pseudocyst errodes into the stomach or bleeding varicies. May also errode into an ajacent artery causing hemorrage or formation of a pseudoanerysm
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what is an exocrine tumor?
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tumor found in the head of the pancreas(malignant). When they grow large enough, they can cause billiary obstruction, and cause a courvoisier GB.
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what is cystic fibrosis?
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a congenital disease that affects the exocrine glands in the lungs an GI tract, which produce abnormallyhighly viscous mucous secreteions. These precipitations coagulate to obstruct ducts.
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what is pancratic insufficiency?
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results from fibrosis, fatty repacement and cystic formation.
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explain wandering spleen, the symptoms, potential complications, and sonographic appearence?
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-uncommon anomoly where the gastrosplenic and splenorenal ligamnets are not attached
-potential complications-infection, abscess, peritonitis, bowel obstruction, necrosis -sonography-spleen in atypical location, lack of color in splenic artery |
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explain sickel cell anemia
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-red blood cells shrivel into "sickle" forms and end up occluding the splenic arteries.
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what is the most common solid mass found in the spleen?
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GRANULOMA:
-caused by histopastomosis or TB -focal echogenic mass w/out shadowing -not a neoplasm |
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explain parasitic infection in the spleen
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-is another cause of splenic cysts
-usually Echinococcus (tapeworm) -the most common type of splenic cyst worldwide |
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what is the most common cause of splenomegaly?
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portal hypertension
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what is the size and splenic index of spenomegaly? What are the causes of mild and marked splenomegaly
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-Spleen is greater than 12 cm in length or has a splenic index > 35.
-Causes of Mild to moderate splenomegaly are: -portal hypertention(most common) -infection -aids CAUSES OF MARKED SPLENOMEGALY: -leukemia -lymphoma -infectious mononucleosis (rumack 5-5; 5-7) -myelofibrosis -mono |
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what does the cortex contain? explain
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-glomerulosa: mineralcorticoids(aldosterone)
-Fasciculata:glucocorticoids-steroids -reticularis:sex hormones-androgens |
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What does the medulla of the adrenal gland contain?
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Chromaffin cells:
-catacholamines: -epinephrine and nor-epinephrine(fight or flight) |
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name some developmental abnoramalities of adrenal glands
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-agenesis
-adrenal hyperplasia -adrenal hypoplasia -addison's disease |
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explain adrenal hyperplasia
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adrenogenital syndrome:
-increased ACTH -underproduction of aldosterone -underproduction of cortisol -overproduction of androgens |
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what are some examples of benign adrenal neoplasms?
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adenomas(cushings syndrome, conn's syndrome)
pheochromocytoma |
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sonography of hyperadrenalism
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-Adenoma: Solitary or bilateral hypoechoic mass in the place of adrenal gland that is larger than 1 cm.
-displace retroperitoneal fat anteriorly |
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explain addisons disease, and the symptoms of it
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-chronic primary hypoadreanlism
-autoimmune, TB, hemorrage -weakness, hypotension, pigmentatin of skin from high ACTH |
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Pheochromocytoma
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-hyperfunctioning tumor of the medulla
-norepinephrine/epinephrine -usually soltary -usually benign(85%) -HTN, headaches, palpations, excessive perspiration |
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What are some malignant adreanl tumors?
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neuroblastoma
primary adrenal carcinoma metastatic disease |
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explain neuroblastoma, and what it looks like sonographically?
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-most common tumore in children besides in the head
-originates in the medulla SONOGRAPHICALLY: -heterogenous -echogenic and poorly defined -internal CA -necrotic areas |
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Adrenal primary adenocarcinoma
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-extremely rare
-hyperfunctioning -associations |
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name and explain the malignant tumors of the bladder
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-Malignant bladder masses are most common in males between the ages of 50 to 70.
-Transitional cell carcinoma- most common malignant bladder mass SONOGRAPHICALLY: an irregular echogenic mass projecting from the bladder wall into the bladder. It may or may not shadow. -Squamous cell carcinoma -most aggressive form of bladder cancer, and spreads quickly. -associated with chronic infections, stones or strictures |
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name and explain the 4 urachal anomolies
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1. Patent Urachus -persistent channel between bladder and umbilicus
CLINICALLY: -umbilical drainage -periumbilical infection 2. Urachal Sinus: channel is obliterated at bladder, but still patent near umbilicus CLINICALLY: -umbilical drainage -periumbilical infections 3. Urachal Diverticulum peristence of the urachal channel at the bladder end CLINICALLY: -clinically asymptomatic but may present as an abdominal mass 4. Urachal Cyst an encapsulation of fluid within a portion of the urachus that is closed at both ends -clinically asymptomatic but may present as an abdominal mass |
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name some important facts about bladder tumors
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-All bladder tumors (benign and malignant) may produce hematuria
- macroscopic hematuria-when a patient can see the blood -microscopic hematuria-when the lab can see the blood, -Painless hematuria is a common symptom of bladder masses. -Whenever a focal thickening or mass of the bladder wall is detected, malignancy should be suspected. -Cancers may also metastasize to the bladder from the kidneys, ureters, cervix, uterus, prostate and rectum. |
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posterior urethral valves and sonographic appearence
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-Mucosal flap within the prostate gland which obstructs the urethra, and urind has a hard time leaving the bladder.
Sonographically: -thickened bladder wall (due to the muscle hypertrophying to contract more), -hydroureter -hydronephrosis -dilated and elongated prostatic urethra("key hole sign") |
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what is empysematous cystitis?
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when gas permeates the bladder wall.
-affects females with diabetes and chronic urinary retention Sonographically: -increased thickenss of bladder wallthe bladder wall -foci of increased echogenicity with distal dirty shadow |
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if your patient has an umbilical seapage, and during your scan you notice an elongated hypoechoic area connected to the umbilicus, what is your probable diagnosis?
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urachal cyst
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bladder diverticula and sonographic appearance
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-herniations of the bladder mucosa through the detrusor muscle fibers.
-rarely congenital -acquired due to reflux, neurogenic bladders or obstructed urethras. -acquired=multiple -congenital=solitary and larger diverticulae -patients present with incontinence or urinary tract infection. Sonography: -round/oval fluid collections -dilated distal ureter -congenital=smooth bladder walls -acquired=trabeculated -look for: stones, obstruction, purulent material within the lumen (infection) |
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papilloma
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a benign bladder mass, that most commonly projects from the lateral bladder wall, or in the trigone area. They are usually small (approximately 0.5 - 2.0 cm).
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neurogenic bladder
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-malfunctioning urinary bladder due to neurologic dysfunction or insult due to: internal or external trauma, disease, or injury.
For our purposes, we will study the most common sonographic appearance of neurogenic bladder, and that is a thickened,and trabeculated bladder wall. Also watch for stones, debris within the bladder and hydronephrosis! |
