Esp Abdominal Sonography

Front 1

Couinaud's Anatomy

Back 1

Divided liver into 8 segments based on portal and hepatic vein distribution

Front 2

The right and left hepatic lobes are divided by

Back 2

A plane between the GB and IVC. The plane marks the division of the MPV into left and right branches

Transects IVC, middle hepatic vein, GB, and MPV bifurcation

Front 3

The left lobe is divided into

Back 3

Medial and Lateral Segments

Front 4

The right lobe is divided into

Back 4

Anterior and Posterior Segments

Front 5

The right lobe is supplied by

Back 5

The right portal vein

Front 6

The left lobe is supplied by

Back 6

The left portal vein

Front 7

The caudate lobe is supplied by

Back 7

Both the left and right portal veins

Front 8

The caudate lobe lies

Back 8

On the posterior/superior surface of the liver

Front 9

The caudate lobe lies between the

Back 9

IVC and medial left lobe of the liver

Front 10

The caudate lobe lies posterior to the

Back 10

Ligamentum venosum and porta hepatis

Front 11

The caudate lobe lies anterior and medial to

Back 11

The IVC

Front 12

The caudate lobe lies lateral to

Back 12

The lesser sac

Front 13

In the event of caudate lobe enlargement, the __ may be compressed

Back 13

The IVC may be compressed

Front 14

Intersegmental Vessels

Back 14

Course between the lobes and segments

Hepatic veins

Front 15

The hepatic veins have __ walls

Back 15

Non-echogenic walls

Front 16

Intrasegmental Vessels

Back 16

Course to the center of each segment

Vessels of the portal triad

Front 17

The portal triad have __ walls

Back 17

Hyperechoic

Front 18

Portal Triad Vessels

Back 18

Main Portal Vein

Proper Hepatic Vein

Common Hepatic Duct

Front 19

Oblique plane between the IVC and GB fossa

Back 19

Main lobar fissure

Divides the anterior segment of the right and medial segment of the left hepatic lobe

Front 20

Main lobar fissure landmarks

Back 20

GB

IVC

Middle Hepatic Vein

Front 21

Divides right lobe into anterior and posterior segments

Back 21

Right intersegmental fissure

Front 22

Right intersegmental fissure landmark

Back 22

Right hepatic vein

Front 23

Divides left love into medial and lateral segments

Back 23

Left intersegmental fissure

Front 24

Left intersegmental fissure landmarks

Back 24

Left hepatic vein

Ascending left portal vein

Falciform ligament

Ligamentum Teres

Front 25

Remnant of the ductus venosus

Back 25

Ligamentum Venosum

Front 26

Separates the left lobe from the caudate lobe

Back 26

Ligamentum Venosum

Front 27

Remnant of the umbilical vein

Back 27

Ligamentum teres

Front 28

The ligamentum teres runs from

Back 28

The umbilicus to the left portal vein

Front 29

With portal hypertension, the __ recanalizes to form__

Back 29

Ligamentum Teres

A portosystemic venous collateral

Front 30

The ligamentum venosum runs from

Back 30

The left portal vein to the IVC

Front 31

Direction of Fetal Circulation

Back 31

Umbilical Vein (Ligamentum teres) >

LPV >

Ductus Venosus (Ligamentum venosum) >

IVC

Front 32

Hepatopetal

Back 32

Toward Liver

Front 33

Hepatofugal

Back 33

Away from the Liver

Front 34

Portal vein normal flow

Back 34

Low velocity continuous flow toward the liver

Mild undulations

Velocity can increase after eating

Front 35

Hepatic Blood Flow %

Back 35

25% Proper hepatic artery

75% Portal vein

Front 36

Hepatic Oxygenation %

Back 36

50% Proper hepatic artery

50% Portal vein

Front 37

Upper limits of portal vein diameter

Back 37

13mm

Front 38

Larger portal vein diameter suggests

Back 38

Portal hypertension

Front 39

Hepatic vein blood flow

Back 39

Toward the IVC

Away from the transducer

Flow below the baseline

Front 40

Hepatic vein waveform

Back 40

Above and below baseline

Triphasic

Front 41

Triphasic vein waveforms reflect

Back 41

Right atrial filling, contracting, and relaxing

Front 42

Normal spectral analysis above baseline=

Back 42

Flow toward the transducer

Front 43

Normal spectral analysis below baseline=

Back 43

Flow away from the transducer

Front 44

The proper hepatic artery runs parallel to the

Back 44

MPV

(Anterior and to the left)

Front 45

The right hepatic artery may originate from (replaced)

Back 45

The SMA (11%)

Front 46

A replaced right hepatic artery is seen posterior to

Back 46

The head of the pancreas and the MPV

Front 47

A replaced left hepatic artery originates from the

Back 47

Left gastric artery (10%)

Front 48

Hepatic artery waveform

Back 48

Flow through diastole

Low resistance

Front 49

Post liver transplant hepatic artery waveform

Back 49

High resistance suggests venous congestion or organ rejection

Front 50

Post liver transplant hepatic artery parvus tardus waveform suggests

Back 50

Proximal anastomotic stenosis

Front 51

Fold created by the passage of the embryonic umbilical vein from umbilicus to left portal vein

Back 51

Falciform ligament

Front 52

Fold that suspend the liver from the diaphragm

Back 52

Coronary ligament

Surround bare area

Front 53

Fold to the far right and left of the bare area

Back 53

Right and left triangular ligament

Front 54

Hepatomegaly

Back 54

Greater than 15.5 cm

Front 55

Inferior projection of the right lobe of the liver

Back 55

Reidel's lobe

Seen in women

Superior/Inferior dimension of the liver

Front 56

Echogenicity of normal Structures (hyper-hypo)

Back 56

Renal Sinus

Pancreas

Spleen/Liver

Renal Cortex

Front 57

Small organized collection of macrophages that appear as calcifications in the liver and spleen

Back 57

Hepatic Granulomas

Front 58

Hepatic Granulomas are caused by

Back 58

Histoplasmosis and Tuberculosis

Front 59

Caused by spores that float in the air, from fungus in the droppings of birds and bats

Back 59

Histoplasmosis

Common in chicken coops, barns, and caves

Front 60

Liver inflammation resulting from infectious agents

Back 60

Hepatitis

Front 61

Hepatitis may result in the elevation of

Back 61

ALT, AST, Conjugated and Unconjugated Bilirubin

Front 62

Hepatitis A is spread by

Back 62

Fecal/Oral Transmission

Front 63

Hepatitis B is spread by

Back 63

Blood/Body Fluid Transmission

Front 64

Hepatitis C is spread by

Back 64

Blood/Body Fluid Transmission

Front 65

Acute Hepatitis

Back 65

"Starry Night" (Periportal cuffing)

Hypoechoic liver parenchyma

Liver Enlargement

Hyperechoic Portal Veins

Front 66

Chronic Hepatitis

Back 66

Hyperechoic liver parenchyma

Small liver

Decreased echogenicity of PV walls

Front 67

__ is the most common source of pyogenic (bacterial) liver abscesses

Back 67

Biliary tract disease

Front 68

Obstruction of bile flow allows for

Back 68

Bacterial proliferation

Front 69

The __ lobe is more affected by pyogenic abscesses

Back 69

Right

Front 70

RUQ pain, leukocytosis, fever, elevated LFTs

Back 70

Pyogenic (bacterial) abscess

Front 71

RUQ Pain, hepatomegaly, diarrhea, leukocytosis, Elevated LFT's

Back 71

Amebic Abscess

Onset 8-12 weeks from travel

Front 72

Differentiation between an amebic and pyogenic abscess

Back 72

If a patient has recently traveled out of the country, it is most likely amebic

Front 73

Fungal Abscess (Candidiasis)

Back 73

Wheel within a Wheel

Bull's Eye

Uniformly Hypoechoic Lesion

Echogenic focus

Front 74

Hyatid Disease

Back 74

Echinococcal Cyst

Typically a shepphard

Front 75

Cyst within a cyst

Back 75

Echinococcal Cyst/Hyatid Dx

Front 76

Casoni skin test

Back 76

Echinococcal Cyst/Hyatid Dx

Front 77

Rupture or aspiration of an echinococcal cyst is associated with

Back 77

Anaphalatic shock

Front 78

Schistosomiasis

Back 78

One of the most common parasitic infections

Front 79

Schistosomiasis is a major cause of __ worldwide

Back 79

Portal hypertension (Secondary causes)

Occluded PV due to eggs

Front 80

Secondary causes of PV hypertension

Back 80

Splenomegaly

Ascites

Esophageal variceal bleeding

Portosystemic collaterals

Front 81

Sonographic Findings Associated with AIDS (1)

Back 81

Hepatomegaly

Splenomegaly

Lymphadenopathy

Pneumocystis (carinii) jiroveci

Fatty liver infiltration

Front 82

Sonographic Findings Associated with AIDS (2)

Back 82

Non-Hodgkin's

Candidiasis

Cholangitis

Acalculous cholecystitis

Kaposi's Sarcoma

Nephropathy

Front 83

Most common opportunistic infection in persons with HIV infection

Back 83

Pneumocystic (carinii) jiroveci

Usually responsible for Pneumocystis pneumonia

Front 84

Sonographic findings of Pneumocystic (carinii) jiroveci

Back 84

Diffuse, nonshadowing, hyperechoic foci

Front 85

Sclerosing and AIDS Cholangitis

Back 85

Thickened biliary ducts

May compromise the lumen causing biliary obstruction

Front 86

Lymphoma and Kaposi's sarcoma may be seen as

Back 86

An intrahepatic mass or possibly diffuse infiltration without visualization of a sonographic abnormality

Front 87

Focal regions of increased echogenicity within normal liver parenchyma

Back 87

Focal Fatty Infiltration

Front 88

Focal fatty infiltration commonly occurs at

Back 88

The porta hapatis

Front 89

Focal regions of normal liver parenchyma within a fatty infiltrated liver

Back 89

Focal fatty sparing

Front 90

Focal fatty sparing commonly occurs

Back 90

Adjacent to the GB

Front 91

Genetically acquired disorder that results in the excess deposition or glycogen in the liver

Back 91

Glycogen storage dx

von Gierke's dx

Front 92

Diffuse process of fibrosis and distortion or normal liver architecture

Back 92

Cirrhosis

Front 93

With cirrhosis

Back 93

First there is liver enlargement, which results in hepatic atrophy and blood coagulopathy, hepatic encephalopathy, and portal hypertension

Front 94

Causes of Cirrhosis

Back 94

*Right sided heart dx*

*Wilson dx (copper deposition)*

Hepatitis C

Alcoholic liver dx

Front 95

Abnormal liver fuctions- Cirrhosis

Back 95

AST

ALT

GGT

LDH

Conjugated bilirubin

Front 96

Sonographic findings- Cirrhosis

Back 96

*Increased incidence of Hepatocellular Ca*

Caudate lobe enlargement

Hepatomagaly (acute)

Liver atrophy (chronic)

Surface nodularity

Front 97

Nation's leading cause of cirrhotic hepatitis and cirrhosis

Back 97

Hepatitis C

Front 98

Normal PV pressure

Back 98

5-10 mmHg

Front 99

Normal PV diameter

Back 99

<13 mm

Greater than suggests portal hypertension

Front 100

Major cause of portal hypertension

Back 100

Cirrhosis

Front 101

Patients with portal hypertension typically present with

Back 101

Upper GI hemorrhage due to rupture of esophageal varices

Front 102

Surgical techniques to lower portal pressure

Back 102

Portacaval shunt

Splenorenal/Linton shunt

TIPS

Front 103

Collaterals of the distal esophagus and gastric fundus

Back 103

Gastroesophageal varices

Front 104

Re-opening of the ligamentum teres to act as a collateral from the LPV to epigastric veins to IVC

Back 104

Recanalized umbilical vein

Front 105

Tortuous collateral veins seen in the splenic and left renal hilum

Back 105

Splenorenal varices

Front 106

The veins of retroperitoneal structures such as the colon, duodenum, and pancreas anastomose with systemic tributaries

Back 106

Intestinal varices

Front 107

A collateral path in which the inferior mesenteric vein drains into the rectal veins which connect with systemic tributaries

Back 107

Rectal varices (hemorrhoids)

Front 108

Physical signs of collaterals

Back 108

Dilated veins on ant abd wall

Caput Medusa

Hemorrhoids

Ascites

Front 109

Tortuous collaterals around umbilicus

Back 109

Caput medusa

Front 110

TIPS

Back 110

Transjugular Intrahepatic Portal-Systemic Shunt

Front 111

Portosystemic shunts are created to

Back 111

Lower portal pressure

Avoids the development or rupture of gastroesophageal varices and accumulation of ascites

Front 112

TIPS is placed

Back 112

Between a hepatic vein and a portal vein

*Typically RHV and RPV*

Front 113

With a widely patent TIPS, the RPV and LPV should demonstrate ___ flow

Back 113

Hepatofugal

Front 114

Criteria for TIPS malfunction

Back 114

Low shunt velocity

High focal shunt velocity

Hepatopetal LPV or RPV

Hepatofugal MPV

Absent shunt flow

Front 115

With a recanalized umbilical vein, the flow of the LPV may be

Back 115

Hepatopetal or Hepatofugal

Front 116

Most commonly used TIPS material

Back 116

GORE Viatorr

Front 117

Indications for liver transplantation in adults

Back 117

Cirrhosis

Front 118

Indications for liver transplantation in children

Back 118

Biliary atresia

Front 119

Postoperatively, the __ provides the only blood supply to the biliary tree

Back 119

Hepatic Artery

Front 120

Portal vein thrombosis findings

Back 120

Hypoechoic thrombus within the PV

Increased PV caliber

Cavernous transformation

Portal systemic collaterals

Front 121

Numerous worm-like venous collaterals that parallel the chronically thrombosed portal vein

Back 121

Cavernous transformation

Benign causes of PV thrombosis

Front 122

Disorder characterized by hepatic vein obstruction

Back 122

Budd-Chiari Syndrome

Presents with signs of portal hypertension

Front 123

With Budd-Chiari, the __ lobe is often spared

Back 123

Caudate

Emissary veins drain directly into IVC

Front 124

With Budd-Chiari, the caudate lobe typically

Back 124

Enlarges with the atrophy of the right and left lobes

Front 125

With enlargement of the caudate lobe, the __ may be compressed

Back 125

IVC

Front 126

In infants, intrahepatic PV gas is due to

Back 126

Necrotizing entercolitis

Front 127

Liver cyst sonographic criteria

Back 127

Anechoic

Thin walled

Acoustic enhancement

Front 128

A hemorrhagic cyst will appear as

Back 128

A cyst within a cyst with internal echoes

Front 129

Patient present with RUQ pain and decreasing hematocrit

Back 129

Hemorrhagic cyst

Front 130

Most common benign tumor of the liver

Back 130

Cavernous Hemangioma

Front 131

Cavernous hemangioma sonographic findings

Back 131

Hyperechoic

Posterior enhancement

May appear hypoechoic within the background of a fatty infiltrated liver

Front 132

Cavernous hemangiomas may enlarge with

Back 132

Pregnancy or administration of estrogen

Front 133

Contrast enhanced imaging of cavernous hemangiomas demonstrate

Back 133

Characteristic centripetal flow

Front 134

Benign solid liver mass believed to be a developmental hyperplastic lesion

Back 134

Focal nodular hyperplasia

Front 135

Sonographic findings focal nodular hyperplasia

Back 135

*Central fibrous scar (Hallmark)*

Stellate vascularity

Solitary lesion

Front 136

Focal nodular hyperplasia's are known as the

Back 136

"Stealth Lesion"

Front 137

Hepatic adenomas are associated with the use of

Back 137

Oral contraceptives

Front 138

Hepatic adenomas are associated with

Back 138

Glycogen storage dx

Front 139

Extremely rare fatty tumors

Back 139

Hepatic Lipomas

Front 140

Tuberous sclerosis is associated with

Back 140

Hepatic lipomas and angiomyolipomas

Front 141

Hepatic lipomas sonographic findings

Back 141

Hyperechoic mass

Propagation speed artifact

Front 142

Decreased speed of sound in fat results in a prolonged sound return time

Back 142

Propagation speed artifact

May be seen as a broken diaphragm posterior to the fatty mass

Front 143

Hyperechoic hepatic masses

Back 143

Hepatic lipoma

Hemangioma

Echogenic METS

Focal fatty infiltration

Front 144

Most common primary malignancy of the liver

Back 144

Hepatocellular Carcinoma HCC

Front 145

Hepatocellular carcinoma occurs predominantly in patients with

Back 145

Underlying chronic liver dx and cirrhosis

Front 146

Hepatocellular carcinoma commonly invades

Back 146

Venous structures (PVs, HVs, and IVC)

Front 147

Hepatocellular carcinoma increased LFTs

Back 147

*Alpha fetoprotein*

AST

ALT

Front 148

Hyperechoic mets

Back 148

Gastrointestinal tract

Front 149

Hypoechoic mets

Back 149

Lymphoma

Front 150

Bull's eye/Target mets

Back 150

Lung

Front 151

Calcified mets

Back 151

Mucinous adenocarcinoma of the colon

Front 152

Cystic mets

Back 152

Leiomyosarcoma

Mucinous cystadenocarcinoma

Squamous cell carcinoma

Front 153

Most common malignant liver tumor in early childhood

Back 153

Hepatoblastoma

Front 154

Hepatoblastomas associated with increased levels of

Back 154

Serum alpha fetoprotein

*Lung mets and PV invasion*

Front 155

The liver uses these enzymes to metabolize amino acids and to make proteins

Back 155

Aminotransferases

Front 156

AST=

Back 156

SGOT

Front 157

Present in the liver, heart, skeletal muscle, kidney, and brain

Back 157

AST/SGOT

Front 158

An increase in AST without ALT

Back 158

Myocardial infarction

Heart failure

Front 159

AST is __ for liver dx

Back 159

Non-specific

Front 160

ALT=

Back 160

SGPT

Front 161

ALT is __ for liver dx

Back 161

More specific

Front 162

Elevation in GGT indicates

Back 162

Hepatocellular dx and biliary obstruction

Front 163

Increased GGT+ ALP

Back 163

Biliary obstruction

Front 164

Increased GGT+ ALT

Back 164

Hepatocellular dx

Front 165

Protein synthesized by the fetal liver

Back 165

Alpha fetoprotein AFP

Decrease during the first year of life

Front 166

Elevation of AFP occur in

Back 166

Hepatocellular Ca

Germ cell tumors

Mets (liver)

Hepatoblastoma

Front 167

Monitored prior to an invasive procedure to insure proper clotting

Back 167

PT (INR), PTT, and platelets

Front 168

CA 19-9

Back 168

Pancreatic Cancer

Front 169

CEA

Back 169

Carcinoembryonic Antigen

*Colorectal cancer*

Front 170

HCG

Back 170

Human Chorionic Gonadotropin

*Testicular Cancer*

Front 171

Right and left hepatic ducts join to form

Back 171

Common hepatic duct

Front 172

GB neck tapers to form the

Back 172

Cystic duct

Front 173

Cystic duct joins with the

Back 173

Common hepatic duct

Front 174

The cystic duct joins the common hepatic duct to form the

Back 174

Common bile duct

Front 175

Main pancreatic duct is also known as

Back 175

Duct of Wirsung

Front 176

CBD and Duct of Wirsung join to form

Back 176

The ampulla of Vater

Front 177

The portal triad consists of

Back 177

MPV

Common hepatic duct

Proper hepatic artery

"Mickey Mouse Sign"

Front 178

Spiral fold which controls bile flow in the cystic duct

Back 178

Valve of Heister

Front 179

Abnormal sacculation of the neck of the GB

Back 179

Hartmann's pouch

Front 180

Fold between the body and the fundus of the GB

Back 180

Phrygian cap

Front 181

Fold between the body and the neck of the GB

Back 181

Junctional fold

Front 182

CBD passes __ to the first part of the duodenum and panc head

Back 182

Posterior

Front 183

Normal GB wall thickness

Back 183

Less than 3mm

Front 184

Most common cause of GB wall thickening

Back 184

Cholecystitis

Front 185

Pre-hepatic causes of jaundice

Back 185

Increased bilirubin production

Front 186

Hepatic Causes of Jaundice

Back 186

Acute liver inflammation

Chronic liver dx

Infiltrative liver dx

Inflammation of bile ducts

Genetic disorders

Front 187

Hepatic Genetic Disorders Causing Jaundice

Back 187

Gilbert's syndrome

Crigler-Najjar syndrom

Front 188

Post-hepatic Causes of Jaundice

Back 188

Obstruction of biliary tree

Front 189

Patients with obstruction of the biliary tree present with

Back 189

Jaundice, pale stool and dark urine

Front 190

Calcium bilirubinate granules and cholesterol crystals

Back 190

Sludge

Front 191

Cholelithiasis Sonographic Criteria

Back 191

Mobile

Strongly echogenic

Acoustic Shadowing

Front 192

Gallstones are composed of

Back 192

Cholesterol

Calcium bilirubinate

Calcium carbonate

Front 193

Gallbladder filled with stones seen as a strong shadow in RUQ

Back 193

Double Arc

WES sign

Front 194

WES Sign

Back 194

Wall-Echo-Shadow

GB filled with stones

Front 195

GB wall inflammation due to cystic duct obstruction by a gallstone

Back 195

Acute cholecystitis

Front 196

Acute cholecystitis features

Back 196

Gallstones

Murphy's Sign

Diffuse wall thickening

GB dilation

Sludge

Front 197

Amylase elevation suggests obstruction at the level of the

Back 197

Ampulla of Vater

Front 198

Recurring symptoms of bilary colic due to multiple previous episodes of acute cholecystitis

Back 198

Chronic cholecystitis

Front 199

Acute cholecystitis cue to GB wall ischemia and infection

Back 199

Emphysematous cholecystitis

Front 200

Emphysematous cholecystitisn occurs more commonly in

Back 200

Diabetic men

Front 201

__ artifacts are seen in the GB due to the presence of gas in the wall

Back 201

Comet-tail

Front 202

Reverberation artifact is the same as

Back 202

Comet-Tail artifact

Front 203

Causes of gas in the bilary system

Back 203

*ERCP*

Sphincter of Oddi papilotomy

Choledochojejunostomy

GB Fistula

Emphysematous cholecystitis

Front 204

Purulent material within the GB due to bacteria containing bile associated with acute cholecystitis

Back 204

Empyema of the GB

Front 205

Empyema of the GB symptoms

Back 205

Same as acute cholecystitis with fever

Front 206

Localized fluid collection in the GB fossa

Back 206

GB perforation

Complication of acute cholecystitis

Front 207

Acute cholecystitis without the presence of gallstones

Back 207

Acalculous Chelecystitis

Wall thickening

Murphy Sign

Pericholecystic fluid

*No sludge, no stones*

Front 208

Sludge-like material with a high concentration of calcium

Back 208

Milk of Calcium Bile

Limy Bile

Front 209

Milk of calcium is associated with

Back 209

Chronic cholecystitis and GB obstruction of the cystic duct

Front 210

Calcification of the GB wall associated with chronic cholecystitis

Back 210

Porcelain GB

Front 211

Porcelain GB is associated with

Back 211

GB cx

Front 212

Mucocele of the GB; Overdistended GB filled with mucoid or clear watery contents

Back 212

Hydrops of the GB

Front 213

Round distended, non-inflamed GB due to a chronic cystic duct obstruction

Back 213

Hydrops of the GB

Front 214

GB polyps less than 10mm

Back 214

Unlikely to be cancerous and don't generally require treatment

Front 215

Lipids deposited in the GB wall

Back 215

Cholesterolosis

*Triglycerides and cholesterol*

Front 216

Strawberry GB

Back 216

Cholesterolosis

Golden yellow lipid deposits against red GB mucosa

Front 217

Cholesterolosis appears similar to

Back 217

Adenomyomatosis without reverb artifact

Front 218

GB Carcinoma US Findings

Back 218

Intraluminal mass

Asymmetric wall thickening

Mass that fills GB

*Porcelain GB*

Front 219

Hyperplastic changes involving the gallbladder wall causing overgrowth of the mucosa, thickening of the wall, and formation of diverticula

Back 219

Adenomyomatosis

Front 220

Diverticula within the gallbladder wall

Back 220

Rokitansky-Aschoff sinuses/RAS

Front 221

Adenomyomatosis is associated with __ artifact

Back 221

Comet-tail/Reverberation

*Due to stones in diverticula*

Front 222

In the majority of patients, biliary obstruction in due to pathology in the __ CBD.

Back 222

Distal

Front 223

What are the two most common lesions of biliary obstruction?

Back 223

Gallstones

Carcinoma of the head of the pancreas

Front 224

Elevated:

Alkaline phosphatase

Conjugated bilirubin

Gamma glutamyl transpeptidase

Back 224

Biliary Obsruction

Choledocholithiasis

Front 225

Obstruction of the distal CBD results in dilation of

Back 225

Extrahepatic and intrahepatic biliary tree

Front 226

Causes of Biliary Obstruction

Back 226

Choledocholithiasis

Mirizzi Syndrome

Cholangiocarcinoma

Cholangitis

Biliary Atresia

Front 227

CBD Measurements

Back 227

Normal: = 5mm

Equivocal= 6-7mm

Dilated >/= 8mm

Front 228

Postcholecystectomy, CBD may measure up to

Back 228

10mm

Front 229

"Parallel channel sign" or "Shotgun sign"

Back 229

Refer to the dilated hepatic duct adjacent to the PV

Front 230

Biliary ducts are more totuous than the accompanying portal vein

Back 230

Irregular and tortuous bile ducts

Front 231

Bile ducts branch out in a "star-shaped" configuration

Back 231

Stellate confluence

Front 232

Bile structures attenuate sound less than blood produces

Back 232

Acoustic enhancement

Front 233

Hormone that is released into the blood by ingestion of fatty foods

Back 233

Cholecystokinin

Front 234

Cholecystokinin causes

Back 234

GB contraction

Front 235

Negative fatty meal result

Back 235

Unchanged or decreased size in CBD

Front 236

Positive fatty meal result

Back 236

Increase in CBD

Front 237

Most common location for an obstructing stone

Back 237

Distal CBD

Front 238

With a distal CBD stone obsruction

Back 238

The entire biliary system including the GB distends

Front 239

With a common hepatic obstruction

Back 239

Only the common hepatic duct and intrahepatic ducts will dilate

GB will be contracted

Front 240

Obstruction at the junction of he right and left hepatic ducts

Back 240

Only intrahepatic ducts dilate.

GB will be contracted

Front 241

Formation or presence of calculi in the bile ducts

Back 241

Choledocholithiasis

Front 242

Most common cause of extrahepatic obstructive jaundice

Back 242

Choledocholithiasis

Front 243

Symptoms:

Bilary Colic (RUQ pain)

Jaundice

Back 243

Choledocholithiasis

Front 244

Extrahepatic biliary obstruction due to an impacted stone in the cystic duct causing extrinsic mechanical compression of the common hepatic duct

Back 244

Mirizzi Syndrome

Front 245

Bile duct carcinoma

Back 245

Cholangiocarcinoma

Front 246

Bile duct adenocarcinomas typically originate

Back 246

Within extrahepatic bile ducts

CHD or CBD

Front 247

Cholagiocarcinoma located at hepatic hilum

Back 247

Klatskin tumor

Front 248

Hepatic Hilum

Back 248

Junction of right and left hepatic duct

Front 249

Klatskin tumors result in

Back 249

Intrahepatic but not extrahepatic biliary dilation

*Liver only*

Front 250

Symptoms of Cholagiocarcinoma

Back 250

Jaundice

Weight loss

Abdominal Pain

Front 251

Most common predisposing condition of cholangiocarcinomas

Back 251

Primary sclerosing cholangitis

Front 252

Bacterial infection superimposed on an obstruction of the biliary tree

Back 252

Cholangitis

Bacteria gains access to biliary tree

Front 253

Causes of cholangitis

Back 253

Choledocholithiasis

ERCP

Obstructive tumors

Front 254

RUQ Pain

Fever

Jaundice

Back 254

Cholangitis

Biliary obstruction

Sepsis

Front 255

Increased:

Conjugated bilirubin

ALP

GGT

Amylase and lipase

WBC

Back 255

Cholangitis

Front 256

Suspected when jaundice persists beyond 14 days of age

Back 256

Biliary Atresia

Front 257

Absence of extrahepatic bile ducts

Back 257

CHD and CBD

Biliary Atresia

Front 258

Biliary Atresia is associated with

Back 258

Polysplenia

Absent IVC

Situs Inversus/Ambiguous

Cardiac anomalies

Front 259

Most successful treatment of biliary atresia

Back 259

Kasai Portoenterostomy

If performed before 90 days of life

Front 260

Air in the biliary tract

Back 260

Pneumobilia

Front 261

Pneumobilia is commonly associated with

Back 261

An ERCP

Front 262

Air in the biliary tree is associated with __ artifacts

Back 262

Comet-tail/Reverberation

Front 263

Congenital bile duct anomalies consisting of cystic dilation of the intra or extrahepatic bile ducts

Back 263

Choledochal cysts

Front 264

Most common type of choledochal cyst

Back 264

Involves dilation of CBD

2 cystic structures in the RUQ (GB and dilated CBD)

Front 265

Choledochal cysts are more prevalent in

Back 265

Asia

Front 266

Congenital anomaly of the biliary tract characterized by multifocal segmental dilatation of the intrahepatic bile ducts

Back 266

Caroli's Dx

Front 267

Caroli's dx is associated with

Back 267

Congenital hepatic fibrosis

Portal hypertension

Renal tubular ectasia

Front 268

Multiple cystic structures that converge toward the porta hepatis communicating with the bile ducts

Back 268

Caroli's dx

Front 269

Complications of Caroli's dx

Back 269

Cholangistis

Choledocholihiasis

Hepatic abscess

Cholagiocarcinoma

Front 270

Most common cause of malignant neoplasm obstructing the biliary tree

Back 270

Pancreatic adenocarcinoma

Front 271

Pancreatic adenocarcinoma at the head of the pancreas typically cause

Back 271

Courvoisier gallbladder

Front 272

Enlarged, non-diseased gallbladder due to a mechanical obstruction of the CBD

Back 272

Courvoisier gallbladder

Front 273

Inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts

Back 273

Primary sclerosing cholangitis (PSC)

Front 274

Primary sclerosing cholangitis is associated with

Back 274

Inflammatory bowel dx

ERCP

Cholagiocarcinoma

Front 275

Elevated:

ALP

GGT

ALT/AST

Conjugated bilirubin

Back 275

Primary sclerosing cholangitis

Front 276

US findings for primary sclerosing cholangitis

Back 276

Thickening of bile duct walls

Findings associated with cirrhosis

Front 277

Chronic and progressive cholestasis due to destruction of the small intrahepatic bile ducts leading to end-stage liver dx

Back 277

Primary biliary cirrhosis

Front 278

Elevated:

Antimitochondrial antibodies (AMAs)

ALT/AST

ALP

GGT

Back 278

Primary biliary cirrhosis

Front 279

End product of hemoglobin breakdown

Back 279

Bilirubin

Front 280

Process of removing protein (albumin) from unconjugated bilirubin making it soluble

Back 280

Conjugation

Front 281

Unconjugated Hyperbilirubinemia results from

Back 281

Impaired hepatic bilirubin uptake

Increased bilirubin production

Impaired conjugation of bilirubin

Front 282

Increased bilirubin production

Back 282

Hemolysis

Front 283

The presence of bilirubin in the urine indicates

Back 283

Conjugated Hyperbilirubinemia

*Kidneys cannot filter unconjugated bilirubin as they are bound to albumin*

Front 284

Conjugated (Direct) Hyperbilirubinemia results from

Back 284

Defective bile outflow (bile duct obstruction)

Front 285

Enzyme concentrated in the bile ducts

Back 285

Alkaline Phosphatase

Front 286

Alkaline phosphatase is found in

Back 286

Bone, liver and placenta

Front 287

ALP increases from

Back 287

Dx that impair bile formation *bile duct obstruction*

Bone growth (children)

Pregnancy

Front 288

The pancreas is a __, __ structure

Back 288

Nonencapsulated
Retroperitoneal

Front 289

The pancreas lies between

Back 289

The duodenal loop and the splenic hilum

Front 290

The pancreas is divided into

Back 290

Head

Uncinate process

Neck

Body

Tail

Front 291

Exocrine function of the pancreas

Back 291

Secrete trypsin, lipase, and amylase through the ductal system

Front 292

Endocrine function of the pancreas

Back 292

Non Ductal

Secrete insulin via the islets of Langerhans

Front 293

Normal pancreas measurement (Ant-Post)

Back 293

<= 3cm

Front 294

The __ wall of the stomach overlies the __ border of the pancreatic body and tail

Back 294

Posterior

Anterior

Front 295

Technique used to better visualize the pancreas tail

Back 295

Left Lateral Decub

Pt drinks water to fill the stomach

Then patient is scanned supine or right lateral decub

Front 296

The head of the pancreas is __ to the IVC

Back 296

Anterior

Front 297

The IVC is __ to the head of the pancreas.

Back 297

Posterior

Front 298

The head of the pancreas is __ to the duodenum.

Back 298

Medial

Front 299

The duodenum is __ to the head of the pancreas.

Back 299

Lateral

Front 300

The CBD is __ to the pancreatic head

Back 300

Posterior/Lateral

Front 301

The pancreatic head is __ to the CBD

Back 301

Anterior/Medial

Front 302

The Gastroduodenal artery is __ to the pancreatic head

Back 302

Anterior/Lateral

Front 303

The pancreatic head is __ to the gastroduodenal artery

Back 303

Posterior/Medial

Front 304

The GDA originates off the

Back 304

Common hepatic artery

Front 305

SMA and SMV are __ to the neck of the pancreaa

Back 305

Posterior

Front 306

The pancreas is __ to the SMA and SMV

Back 306

Anterior

Front 307

SMA and SMV are __ to the uncinate process

Back 307

Anterior

Front 308

The uncinate process is __ to the SMA and SMV

Back 308

Posterior

Front 309

The pancreatic head is located __ and __ to the splenic hilum

Back 309

Anterior and Medial

Front 310

The aorta is __ to the body of the pancreas

Back 310

Posterior

Front 311

The celiac axis arises from the aorta at the __ border of the pancreas

Back 311

Superior

Front 312

SMA arises from the aorta at the __ border of the pancreas

Back 312

Inferior

Front 313

The celiac axis gives off the left __ and then divides into __ and __

Back 313

Left gastric

Common Hepatic Artery

Splenic Artery

Front 314

The __ divides into the proper hepatic and gastroduodenal arteries

Back 314

Common hepatic artery

Front 315

The __ travels superiorly toward the liver anterior to the PV and left of the bile duct

Back 315

Proper hepatic artery

Front 316

The right gastric artery is a branch of the __

Back 316

Proper hepatic artery

Front 317

The __ travels posterior to the first portion of the duodenum then anterior to the head of the pancreas

Back 317

GDA

Front 318

The SMA is located inferior to the __

Back 318

Pancreas

Front 319

The SMA is located __ to the uncinate process

Back 319

Anterior

Front 320

The SMA is located __ to the 3rd portion of the duodenum

Back 320

Anterior

Front 321

The __ is located on the posterior aspect of the pancreas

Back 321

Splenic Vein

Front 322

The spelic vein joins the __ to create the MPV

Back 322

Superior mesenteric vein

Front 323

The SMV is located to the __ of the SMA

Back 323

Right

Front 324

The SMV is located __ to the 3rd portion of the duodenum

Back 324

Anterior

Front 325

The SMV is located __ to the uncinate process

Back 325

Anterior

Front 326

The inferior mesenteric vein drains the

Back 326

Left lower quadrant sigmoid and descending colon

Front 327

The CBD travels __ to the 1st portion of the duodenum and the head of the pancreas

Back 327

Posterior

Front 328

The CBD lies to the __ of the main pancreatic duct

Back 328

Right

Front 329

The __ and the __ join to form the ampulla of Vater

Back 329

Common bile duct and duct of Wirsung (main pancreatic duct)

Front 330

The CBD and main pancreatic duct join to form the _-

Back 330

Ampulla of Vater

Front 331

The ampulla of Vater opens into the 2nd portion of the duodenum ate the __

Back 331

Major papilla

Front 332

Accessory pancreatic duct

Back 332

Duct of Santorini

Front 333

50% of the pop. has complete regression of

Back 333

duct of Santorini

Front 334

The duodenum is divided into

Back 334

4 portions

Front 335

The __ and __ portions of the duodenum are

Back 335

Transverse

Front 336

The __ and __ portions of the duodenum are

Back 336

Longitudinal

Front 337

Pancreatic duct is considered abnormal if it is >

Back 337

2mm

Front 338

Structures in contact with the Pancreatic Head

Back 338

IVC

CBD

Ampulla of Vater

GDA

2nd portion of duodenum

Front 339

Inflammatory dx producing temporary pancreatic changes

Back 339

Acute Pancreatitis

Front 340

Most common causes of acute pancreatitis

Back 340

Gallstones

Alcohol Abuse

Front 341

US findings for Acute Pancreatitis

Back 341

Enlarged, hypoechoic gland

Front 342

Inflammatory mass formed by edema and leakage of pancreatic enzymes

Back 342

Pancreatic Phlegmon (Focal pancreatitis)

Front 343

Spreading inflammatory reaction to an infection which forms a suppurative lesion

Back 343

Phlegmon

Front 344

Irreversible destruction due to repeated bouts of pancreatic inflammation

Back 344

Chronic Pancreatitis

Front 345

Most common cause of chronic pancreatitis

Back 345

Alcoholic chronic pancreatitis

Front 346

Elevation of serum amylase and lipase are found only in __ pancreatitis

Back 346

Acute

Front 347

Multiple pancreatic cysts are associated with

Back 347

Adult polycystic kidney dx and von Hippel-Lindau syndrome

Front 348

Exocrine disorder resulting in viscous secretions causing pancreatic dysfunction

Back 348

Cystic Fibrosis

Front 349

Meconium ileus is commonly associated with

Back 349

Cystic Fibrosis

Front 350

Increased pancreatic echogenicity

Gland atrophy

Fibrosis and fatty replacement

Cysts due to ductal obstruction

Back 350

Pancreatic cystic fibrosis

Front 351

Accumulation of pancreatic fluid and necrotic debris confined by the retroperitoneum

Back 351

Pancreatic pseudocyst

Front 352

The pancreas is located within the __ of the retroperitoneum

Back 352

Anterior pararenal space

Front 353

In children, the most common reson for a pancreatic pseudocyst is

Back 353

Abdominal trauma

Front 354

Failure of the dorsal and ventral pancreatic ductal systems to fuse during embryonic development

Back 354

Pancreas divisum

Front 355

Inadequate pancreatic drainage due to pancreas divisum may result in

Back 355

Pancreatitis

Front 356

Congenital anomaly where the ventral pancreas encircle the second portion of the duodenum

Back 356

Annular pancreas

Front 357

"Double-bubble" sign

Back 357

Annular Pancreas

Dilated stomach and duodenal bulb

Front 358

Pancreatic adenocarcinoma typically arises from the __

Back 358

Pancreatic head

Front 359

Elevated:

Conjugated bilirubin

Alk Phos

Amylase/Lipase

GGT

Back 359

Pancreatic adenocarcinoma

Front 360

The Whipple procedure is also known as a

Back 360

Pancreaticoduodenectomy

Front 361

Whipple procedure is performed with

Back 361

Cancer of the head of the pancreas

Front 362

Serous cystadenomas are

Back 362

Benign

Front 363

Pancreatic serous cystadenomas are asociated with

Back 363

von Hippen-Lindau Dx

Front 364

Cluster of grape like cysts on the pancreas

Back 364

Serous Cystadenomas

Front 365

Large multicystic mass with numerous septations and debris in pancreas

Back 365

Mucinous cystic neoplasms

Front 366

Increased CEA levels in a patient with a multicystic pancreatic mass would suggest a diagnosis of

Back 366

Mucinous cystic neoplasm

Front 367

Endocrine tumors are known as

Back 367

Islet cell tumors

Front 368

Islet cell tumors are associated with

Back 368

Multiple endocrine neoplasia

Von Hippel-Lindau dx

Front 369

Most common islet cell tumor

Back 369

Insulinoma

Front 370

Zollinger-Ellison Syndrome

Back 370

Gastrinoma

Second most common islet cell tumor

Front 371

Many pancreatic islet cell tumors are commonly located

Back 371

In the body and tail

Front 372

MEN type 1

Back 372

Wermer syndrome

Front 373

MEN type 2

Back 373

Sipple's syndrome

Front 374

Most common site for MEN

Back 374

Parathyroid (hyperparathyroidism)

Pancreatic islet cells

Pituitary gland

Front 375

Digestive enzyme for carbohydrates

Back 375

Amylase

Front 376

Amylase is produced by

Back 376

The pancreas and salivary glands

Front 377

Pancreatitis and salivary gland dysfunction causes increased levels of

Back 377

Serum Amylase

Front 378

Which persists longer? Amylase or lipase?

Back 378

Lipase

Front 379

Head of the pancreas is __ to the second portion of the duodenum

Back 379

Medial

Front 380

CBD is __ to the head of the pancreas

Back 380

Posterolateral

Front 381

The head of the pancreas is __ to the CBD

Back 381

Anteromedial

Front 382

The gastroduodenal artery is __ to the head of the pancreas

Back 382

Anterolateral

Front 383

SMA and SMV are __ to the neck of the pancreas

Back 383

Posterior

Front 384

The uncinate process is __ to the SMA and SMV

Back 384

Posterior

Front 385

The celiac axis is __ to the pancreas

Back 385

Superior

Front 386

The splenic vein is __ to the pancreas

Back 386

Posteroinferior

Front 387

SMA and SMV are __ to the 3rd portion of the duodenum

Back 387

Anterior

Front 388

The stomach is __ to the splenic hilum

Back 388

Anterior/Medial

Front 389

The tail of the pancreas is __ to the stomach

Back 389

Posterior

Front 390

The tail of the pancreas is __ to the upper pole of the kidney

Back 390

Anterior

Front 391

The splenic artery is __ to the pancreas

Back 391

Superior/Anterior

Front 392

The kidneys are ureters are located __ in the abdomen

Back 392

Retroperitoneally

Front 393

The right adrenal gland is __ to the right kidney

Back 393

Superomedial

Front 394

The liver is __ to the right kidney

Back 394

Superolateral

Front 395

The right colic flexure is __ to the right kidney

Back 395

Inferior

Front 396

The 2nd portion of the duodenum is __ to the right kidney

Back 396

Medial

Front 397

The left adrenal gland and spleen are __ to the left kidney

Back 397

Superior

Front 398

The pancreatic tail is __ to the upper pole of the left kidney

Back 398

Anterior

Front 399

The left colic flexure is __ to the left kidney

Back 399

Inferior

Front 400

The diaphragm, psoas muscle, and quadratus lumborum muscle are on the __ aspect of the kidneys

Back 400

Posterior

Front 401

At the hilum of the kidney, the __ exits anteriorly

Back 401

Vein

Front 402

At the hilum of the kidney, the __ exits between the vein and ureter

Back 402

Artery

Front 403

At the hilum of the kidney, the __ exits posteriorly

Back 403

Ureter

Front 404

Renal cortex echogenicity

Back 404

Isoechoic or hypoechoic

Front 405

Medullary pyramids echogenicity

Back 405

Anechoic

Front 406

Renal sinus echogenicity

Back 406

Hyperechoic

Front 407

Outer renal parenchyma from renal sinus to renal capsule

Back 407

Renal cortex

>1cm

Front 408

Inner portion of kidney from base of pyramids to center of kidney

Back 408

Renal medulla

Front 409

Inner hyperechoic portion of the kidney which contains fat, calyces, renal pelvis, connective tissue, renal vessels and lymphatics

Back 409

Renal sinus

Front 410

Anechoic, equally spaces triangles of collecting tubules between cortex and renal sinus

Back 410

Medullary pyramids

Front 411

Medullary pyramids are commonly seen in

Back 411

Neonatal and pediatric kidneys

Front 412

Funnel-shaped transition from the major calyces to the ureter

Back 412

Renal pelvis

Front 413

Medial opening for entry/exit of artery, vein, and ureter

Back 413

Renal hilum

Front 414

3 extensions for the renal pelvis

Back 414

Major calyces

Front 415

Extensions of the major calyces that collects urine from the medullary pyramids

Back 415

Minor calyces

Front 416

Apex of medullary pyramids

Back 416

Renal papilla

Front 417

Fibrous sheath enclosing kidney and adrenal glands

Back 417

Gerota's fascia

Front 418

Perirenal space

Back 418

Gerota's fascia

Front 419

Functional unit of the kidney

Back 419

Nephron

Front 420

Consists of glomerulus and glomerular capsule

Back 420

Renal corpuscle (malpighian body)

Front 421

Bowman's capule

Back 421

Glomerular capsule

Front 422

The __ supplies the kidneys with blood which branches off the aorta

Back 422

Main renal artery

Front 423

At the hilum, the main renal artery divides into

Back 423

5 segmental arteries

Front 424

The segmental arteries divide between the

Back 424

Medullary pyramids

Front 425

The segmental arteries divide into

Back 425

Interlobar arteries

Front 426

Interlobar arteries branch into

Back 426

Arcuate arteries

Front 427

The arcuate arteries branch into

Back 427

Interlobar arteries

Front 428

Smallest renal arteries

Back 428

Interlobar

Front 429

Renal vessels between the pyramids

Back 429

Interlobar

Front 430

Failure of the kidneys to "ascend" into the abdomen

Back 430

Ectopic/Pelvic Kidney

Front 431

With ectopic kidneys, there is an increased incidence of

Back 431

UPJ Obstruction

Ureteral obstruction

Mulicystic renal dysplasia

Front 432

Most common renal fusion anomaly

Back 432

Horshoe kidney

Front 433

Fusion anomaly in which the lower poles of the kidney connect across the midline anterior to the aorta

Back 433

Horseshoe kidney

Front 434

Developing kidneys fuse in the pelvis and one kidney ascends to the normal position carrying the other midline

Back 434

Cross-fused renal ectopia

Front 435

With cross-fused renal ectopia, the ureters

Back 435

Connect on both sides of the bladder thus one ureter crosses the midline

Front 436

Kidneys fuse to form a round mass in the pelvis

Back 436

Fused Pelvic Kidkey

Pancake kidney

Front 437

Common variant of cortical thickening on the lateral aspect of the kidney

Back 437

Dromedary hump

Front 438

Triangular hyperechoic area on the anterior aspect of the upper pole of the right kidney

Back 438

Junctional parenchymal defect

Front 439

Partial fusion of the renunculi

Back 439

Fetal lobulation/Junctional parenchymal defect

Front 440

Duplication of the collecting system

Back 440

Duplex Kidney

Front 441

Complete duplication of the collecting system

Back 441

Two ureters

Front 442

Incomplete duplication of the collecting system

Back 442

1 ureter

Front 443

Kidney that is typically longer than normal and has a complete central cortical break with hyperechoic sinus

Back 443

Duplex Kidney

Front 444

With complete double ureters, the ureter draining the upper pole typically inserts

Back 444

In an ectopic location on the bladder

Looks like a cyst on the bladder

Front 445

A frequent complication of ectopic ureter is a

Back 445

Ureterocele

Front 446

Complete duplication of the renal system will result in

Back 446

Hydroureter and hydro of the upper collecting system of the kidney

Front 447

Normal variation of prominent renal cortical parenchyma located between 2 medullary pyramids

Back 447

Column of Bertin

Front 448

Bilateral renal agenesis is associated with

Back 448

Oligohydraminos and pulinary hypoplasia

Incompatible with life

Front 449

Unilateral agenesis is associated with

Back 449

Bicornuate uterus

Seminal vesicle agenesis

Front 450

Extrarenal pelvis lies

Back 450

Outside the renal sinus

Appears as a cystic collection medial to the renal hilum

Front 451

Common cause of urinary obstruction in the male neonatal patient

Back 451

Posterior urethral valve

Front 452

Obstruction due to a flap of mucosa that has a slit like opening in the area of the prostatic urethra

Back 452

Posterior urethral valve

Front 453

Large bladder

Hydroureter

Hydronephrosis

Urinoma

Back 453

Posterior urethral valve

Front 454

Acoustic enhancement

Absence of internal echoes

Sharply defined thin wall

Round/Oval shape

Back 454

Cyst

Front 455

Calyceal diverticula that sonographically appear as a simple cyst

Back 455

Pylogenic cyst

Front 456

Cortical cysts that bulge into the central sinus of the kidney

Back 456

Parapelvic cysts

Front 457

Lymphatic cycts in the central sinus

Back 457

Peripelvic cysts

Front 458

Renal cysts located in the periphery of the kidney

Back 458

Cortical or parenchymal cysts

Front 459

An abscess vs a hemorrhagic cyst may only be made by

Back 459

Percutaneous aspiration

Front 460

Bilateral renal enlargement due to the development of numerous cysts of varying sized

Back 460

Autosomal Dominant Polycystic Kidney Dx

Adult

Front 461

Autosomal Dominant Polycystic Kidney Dx is associated with cysts in

Back 461

The liver, pancreas, and spleen

Front 462

Autosomal Dominant Polycystic Kidney Dx is associated with

Back 462

Arterial aneurysms especially cerebral arterial aneurysms in the circle of Willis

Front 463

Enlarged bilateral kidneys

Hyperechoic parenchyma

Loss of cortical medullary distinction

Back 463

Autosomal Recessive Polycystic Kidney Disease

Infantile

Front 464

Typical physical appearance of a neonate as a direct result of oligohydramnios and compression while in utero

Back 464

Potter Syndrome

Front 465

Most common cause of an abdominal mass in newborns

Back 465

Multicystic Dysplastic Kidney

Front 466

Form of renal dysplasia characterized by multipole noncommunicating cysts with the absence of renal parenchyma

Back 466

Multicystic Dysplastic Kidney

Front 467

Result of atresia of the ureteropelvic junction during fetal development

Back 467

Multicystic Dysplastic Kidney

Front 468

Congenital UPJ obstruction is caused by

Back 468

Ureteral hypoplasia

High insertion of ureter into renal pelvis

Compression by segmental artery

Front 469

UPJ obstruction anomalies include

Back 469

Multicystic Dysplastic Kidney

Renal agenesis

Duplicated collecting system

Horseshoe kidney

Ectopic kidney

Front 470

Development of multiple cysts in chronically failed kidneys during long term hemodialysis

Back 470

Acquired cystic disease

Front 471

Acquired cystic kidney disease often results in

Back 471

Hemorrhage resulting in pain and hematuria

Front 472

Acquired cystic disease is associated with

Back 472

An increased incidence of renal cell carcinoma

Front 473

Congenital dysplastic cystic dilatation of the medullary pyramids due to tubular ectasia or dysplasia

Back 473

Medullary Sponge Kidney

Front 474

Hyperechoic medullary pyramids due to the formation of calcium deposits

Back 474

Medullary Sponge Kidney

Front 475

Inherited disease which usually presents in the second to third decade of life with serious visual impairment

Back 475

Von Hippel-Lindau Disease

Front 476

Tumors associated with Von Hippel-Lindau Disease

Back 476

Renal cell carcinoma

Pheochromocytomas

Islet Cell Tumors

Renal and Pancreatic cysts

Front 477

Hyperechoic benign renal tumor. Echogenicity is greater than or equal to the renal sinus

Back 477

Angiomyolipoma

Front 478

An angiomyolipoma may present with a __ artifact

Back 478

Propagation speed artifact

Due to slower acoustic velocity in the fatty mass

Posterior displacement of structures

Front 479

80% of angiomyolipomas involve the __ kidney

Back 479

Right

Front 480

Multi-System genetic dx presented with Seizures, mental retardation, and facial angiofibromas

Back 480

Tuberous Sclerosis

Front 481

Why are the kidneys the main focus in a patient with tuberous sclerosis?

Back 481

Increased incidence of renal cysts and *angiomyolipomas*

Front 482

Angiomyolipomas are typically bilateral in patients with

Back 482

Tuberous Sclerosis

Front 483

Most common solid renal mass in the adult

Back 483

Renal Cell Carcinoma

Unilateral encapsulated mass

Front 484

With renal cell carcinoma, __ is recommended

Back 484

Nephrectomy

Front 485

Rencal cell carcinoma tumor commonly extends into

Back 485

The renal veins and IVC

Front 486

Malignant cells from leukemia and lymphoma can metastasize in the

Back 486

Kidney

Front 487

Nephroblastoma AKA

Back 487

Wilm's tumor

Front 488

Most common childhood renal tumor

Back 488

Wilm's tumor/Nephroblastoma

Front 489

Large asymptomatic flank mass

Hypertension

Fever

Hematuria

In child

Back 489

Wilm's tumor/Nephroblastoma

Front 490

Wilm's tumor extension can be seen into the

Back 490

Renal vein and IVC

Front 491

Most renal infections occur via

Back 491

An ascending route from the bladder

Front 492

Renal enlargement

Hypoechoic parenchyma

Absence of sinus echoes

Back 492

Acute pyelonephritis

Front 493

When acute pyelonephritis is focal it is called

Back 493

Acute focal bacterial nephritis or lobar nephronia

Front 494

Focal wedge shaped area or hypoechoic renal lobe

Back 494

Acute focal bacterial nephritis or lobar nephronia

Front 495

Bacterial infection associated with renal ischemia

Back 495

Emphysematous pyelonephritis

Front 496

Emphysematous pyelonephritis commonly occurs in

Back 496

Diabetics

Immunosuppressed patients

Patients with urinary tract obstruction

Front 497

Anerobic bacteria produce

Back 497

Intrarenal gas

Front 498

Intrarenal gas causes __ artifacts

Back 498

Reverberation or comet-tail artifacts

Front 499

__ is usually treated to treat renal infection

Back 499

Nephrectomy

Front 500

Renal injury induced by recurrent renal infections

Back 500

Chronic pyelonephritis

Front 501

Chronic pyelonephritis appears as

Back 501

Small, hyperechoic kidney with cortical thinning

Front 502

Type of chronic phelonephritis resulting from chronic infections due to a long term obstruction

Back 502

Xanthogranulomatous Pyelonephritis (XGPN)

Front 503

Failure to depict a normal kidney associated with a staghorn calculus suggests

Back 503

Xanthogranulomatous Pyelonephritis (XGPN)

Front 504

Purulent material in the collection system of the kidney associated with an infection secondary to renal obstruction

Back 504

Pyonephrosis

Front 505

Treatment of pyonephrosis

Back 505

Percutaneous or surgical drainage

Front 506

Hyperechoic debris in a dilated renal collecting system

Back 506

Pyonephrosis

Front 507

Mycetoma

Back 507

Fungal ball

Front 508

Most common renal fungal dx

Back 508

Candidiasis

Front 509

Fungal balls appear as

Back 509

Hyperechoic nonshadowing massesH

Front 510

Hyperechoic renal masses

Back 510

Mycetoma

Angiomyolipoma

Blood clots

Pyogenic debris

Sloughed papilla

Renal stones

Front 511

Abrupt decline in renal function, manifested by decreased urinary output and elevation in plasma BUN and serum creatinine

Back 511

Acute kidney injury

Front 512

3 main mechanisms of acute kidney injury

Back 512

Prerenal failure

Intrinsic intrarenal failure

Postrenal failure

Front 513

Prerenal failure

Back 513

Hypotension

Volume depletion

Decreased cardiac output

Front 514

Intrinsic (intrarenal) Renal Failure

Back 514

Medical renal dx

Acute tubular necrosis

Glomerular dx

Interstitial nephritis

Autoimmune dx

Front 515

Post renal failure

Back 515

Bilateral renal obstruction

Front 516

Hydronephrosis indicates

Back 516

Post renal failure

Front 517

Abnormal renal resistive index suggests

Back 517

Intrinsic renal failure

Front 518

Laboratory studies used to evaluate AKI

Back 518

Urine output

Urinalysis

BUN

Serum creatinine

Front 519

Most accurate method in determining AKI

Back 519

Changes in serum creatinine reflecting changes in glomerular filtration rate

Front 520

Renal vein thrombosis is associated with

Back 520

Extrinsic compression

Nephrotic syndrome

Renal tumors

Renal transplant

Trauma

Front 521

Renal vein thrombosis findings

Back 521

**High resistance renal artery waveform increased RI**

Dilated thrombosed renal vein

Absent intrarenal venous flow

Enlarged hypoechoic kidney

Front 522

Sudden cause of prerenal failure that presents as flank pain, hematuria, sudden rise in BP

Back 522

Renal artery thrombosis

Front 523

Focal hypoechoic areas of infarct

Absence of intrarenal arterial flow

Renal enlargement

Back 523

Renal artery thrombosis

Front 524

Most common cause of acute kidney injury

Back 524

Acute tubular necrosis

Front 525

Results from prolonged ischemia and nephrotoxins causing damage to tubular epithelium of the nephron leading to acute renal failure

Back 525

Acute tubular necrosis

Front 526

Acute tubular necrosis most likely occurs in patient with

Back 526

Hx of recent surgery

Sepsis

Hypovolemia

Front 527

ATN findings

Back 527

Renal enlargement

Increased RI

Front 528

Inflammatory response resulting in glomerular damage caused by infectious and noninfectious causes

Back 528

Acute glomerulonephritis

Front 529

Most common infectious cause of acute glomerulonephritis

Back 529

Streptococcus due to upper respiratory and skin infections

Front 530

Acute glomerulonephritis symptoms

Back 530

Sudden onset hematuria

Proteinuria

RBC casts in urine

Front 531

Dilatation of the renal pelvis and calyces

Back 531

Hydronephrosis

Front 532

Hydronephrosis secondary to obstruction can lead to

Back 532

Hypertension

Loss of renal function

Sepsis

Front 533

Three common areas of renal obstruction by a stone

Back 533

*Ureterovesical junction*

Ureteropelvic junction

Pelvic brim

Front 534

Obstructive nephropathy is diagnosed by

Back 534

Intrarenal vascularity

Front 535

A threshold resistive index of greater than __ suggests obstructive hydronephrosis

Back 535

0.7

Front 536

Disorders of calcium metabolism resulting in the formation of calcium renal stones and deposition of calcium in the renal parenchyma

Back 536

Nephrocalcinosis

Front 537

Nephrolithiasis

Back 537

Renal stones

Front 538

Main symptom of nephrolithiasis

Back 538

Flank pain

Front 539

Color doppler artifact that appears as rapidly alternating mixture of red and blue doppler signals distal to a strong reflective surface such as a renal stone

Back 539

Twinkle sign

Front 540

Causes of nephrocalcinosis

Back 540

Medullary nephrocalcinosis

Cortical nephrocalcinosis

Front 541

Medullary nephrocalcinosis cause of nephrocalcinosis

Back 541

*Primary hyperparathyroidism* most common

Renal tubular acidosis

Medullary sponge kidney

Front 542

Ischemia of the medullary pyramids

Back 542

Papillary necrosis

*Sloughed papillae in urine*

Front 543

Papillary necrosis is associated with

Back 543

Diabetes mellitus

Urinary tract obstruction

Analgesic abuse

Sickle cell dx

Front 544

Papillary necrosis findings

Back 544

Echogenic material in collecting system

Triangular cystic collections in absence of medullary pyramids

Bright echoes produced by arcuate arteries at periphery of cystic space

Front 545

Increased renal sinus fat that replaces normal renal parenchyma

Back 545

Renal sinus lipomatosis

Front 546

Renal sinus lipomatosis findings

Back 546

Increase in the central sinus echo complex with cortical thinning

Front 547

Urinary bladder is located behind

Back 547

The pubic bone

Front 548

Bladder apex points

Back 548

anteriorly

Front 549

Bladder apex is connected to the umbilicus by

Back 549

The median umbilical ligament

Front 550

The ureters enter the bladder at

Back 550

The superolateral angle of the trigone

Front 551

The ureters exit the bladder via

Back 551

The urethra

Front 552

Normal bladder wall thickness

Back 552

Nondistended <5mm

Distended <3mm

Front 553

Herniations of the bladder mucosa through the bladder through the bladder wall musculature

Back 553

Bladder diverticula

Front 554

Most acquired bladder diverticula are associated with longstanding bladder outlet obstruction due to

Back 554

Benign prostatic hypertrophy

Front 555

Cystic dilatation of the fetal urachus

Back 555

Urachal cyst

Front 556

Median umbilical ligament connecting the bladder to the umbilicus

Back 556

Urachus

Front 557

Cystic structure superior and anterior to the bladder

Back 557

Urachal cyst

Front 558

Ureters exit the kidney

Back 558

Posterior to the renal artery and vein

Front 559

Cyst like enlargement of the lower end of the ureter which projects into the bladder lumen at the ureterovesical junction

Back 559

Ureterocele

Front 560

Ureteroceles are most common found in association with

Back 560

Complete ureteral duplication

Front 561

Most common bladder neoplasm

Back 561

Transitonal cell carcinoma

Front 562

Solid mass or focal thickening of the bladder wall should raise the suspicion of a

Back 562

Transitional cell carcinoma

Front 563

Most common clinical presentation of transitional cell carcinoma

Back 563

Hematuria

Front 564

Normal renal artery demonstrates

Back 564

Continuous forward flow during diastole, low resistance perfusion

Front 565

Resistive index is commonly used to

Back 565

Evaluate renal transplant rejection

Access suspected hydronephrosis

Evaluate medical renal dx

Front 566

RI=

Back 566

Peak systolic freq. - End diastolic freq

________________________________________

Peak systolic freq

Front 567

Normal resistive index

Back 567

<0.7

Front 568

Symptoms of renal artery stenosis

Back 568

Sudden onset hypertension

Uncontrollable hypertension

Front 569

A hemodynamically significant renal artery stenosis may produce

Back 569

Decreased renal size

<9cm in length

Front 570

Renal artery evaluation methods

Back 570

Renal artery velocities

Intrarenal waveform eval

Front 571

Renal artery stenosis diagnostic criteria

Back 571

Direct:

Renal artery/Aorta Ratio (RAR)

>3.5

Indirect:

Parvus tardus

Absent early systolic peak

Front 572

Small slow pulse

Back 572

Parvus Tardus

Front 573

Poor function of the renal transplant may be the result of

Back 573

Acute tubular necrosis

Front 574

Sonographic findings of acute renal transplant rejection

Back 574

Renal enlargement

Decreased echogenicity

Loss of cortical medullary boundary

Increasing flow resistence

Front 575

Resistive index

Back 575

<0.7= Normal

0.7-0.8= Questionable transplant dysfunction

>0.8= Transplant dysfunction

Front 576

Indicates the microscopic examination of sediment and qualitative evaluation of protein, glucose, ketones, blood, nitrites, and WBCs

Back 576

Urinalysis

Front 577

Break-down product of skeletal muscle

Back 577

Serum creatinine

Front 578

Calculated by determining creatinine clearance

Back 578

Glomerular filtration rate

Front 579

Waste product of protein metabolism

Back 579

Urea

Front 580

Decrease in glomerular filtration rate resulting in increase of BUN and creatinine

Back 580

Azotemia

Front 581

Most common neonatal abdominal mass

Back 581

Multicystic dysplastic kidneys

Front 582

Most common neonatal adrenal mass

Back 582

Adrenal hemorrhage

Front 583

Most common childhood/infantile adrenal mass

Back 583

Neuroblastoma

Front 584

Most common neonatal massMult

Back 584

Multicystic dysplastic kidneys

Front 585

Most common childhood renal mass

Back 585

Wilm's tumor

Front 586

Fibrous capsule surrounding the testicle

Back 586

Tunica albuginea

Front 587

Multiple septations arising from the tunica albuginea

Back 587

Mediastinum testis

Front 588

Echogenic linear band extending longitudinally within the testis

Back 588

Mediastinum testis

Front 589

The septula forms wedge shaped compartments that contain the

Back 589

Seminiferous tubules

Front 590

The seminiferous tubules converge to form the

Back 590

Tubuli recti

Front 591

The tubuli recti connect the seminiferous tubule to the

Back 591

Rete testis

Front 592

Anastomosing network of delicate tubules located in the hilum of the testicle

Back 592

Rete testis

Front 593

Carries sperm to the epididymis

Back 593

Rete testis

Front 594

Carry seminal fluid from the rete testis to the epididymis

Back 594

Efferent ductules

Front 595

Parallel to the testicle

Back 595

Epididymis

Front 596

Remnant of the Mullerian duct

Back 596

Appendix testis

Front 597

Small ovoid structure located beneath the head of the epididymis

Back 597

Appendix testis

Front 598

Small stalk projecting off the epididymis

Back 598

Appendix epididymis

Front 599

Derived from the Wolffian duct

Back 599

Appendix epididymis

Front 600

Layer of muscle fibers, lying beneath the scrotal skin and dividing the scrotum into two chambers

Back 600

Dartos

Front 601

Division of the two scrotal chambers

Back 601

Scrotal raphe

Front 602

Saccular extension of the peritoneum into the scrotal chambers

Back 602

Tunica vaginalis

Front 603

The visceral layer of the tunica vaginalis covers

Back 603

The testis and epididymis

Front 604

The parietal layer of the tunica vaginalis lines

Back 604

The scrotal chamber

Front 605

Testicular blood flow

Back 605

Deferential artery

Cremasteric artery

Testicular artery

Front 606

The testiclar artery divides into the __ and __ branches

Back 606

Capsular

Centripetal

Front 607

Spermatic cord

Back 607

Vas deferenc

Cremasteric, deferential, testicular art

Pampiniform plexus

Lymphatics

Nerves

Front 608

Most extratesticular masses are

Back 608

Benign

Front 609

Majority of intratesticular lesions are

Back 609

Malignant

Front 610

MOst common malignancy in men 15-35

Back 610

Testicular neoplasms

Front 611

Most common testicular cancers

Back 611

Germ cell tumors

Front 612

Most common germ cell type found in both pure seminoma and mixed germ cell testicular masses

Back 612

Seminoma

Front 613

Risk factors for testicular tumors

Back 613

*Cryptorchidism*

Infertility

Fam hx of testicular ca

Front 614

__ is associated with nonseminomas

Back 614

Alpha Fetoprotein

Front 615

Most common testicular tumor in infants and young children

Back 615

Yolk sac tumors

Front 616

Rare stromal testicular tumor occuring in boys and men

Back 616

Leydig cell tumor

*Always benign in children*

Front 617

Leydig cell tumors produce

Back 617

Testosterone

Results in precocious puberty

Front 618

Blood chemistry profile for testicular tumors

Back 618

Beta-human chorionic gonadotropin

Alpha fetoprotein

Lactic dehydrogenase

Front 619

Elevation of serum beta-hGC and AFP levels inconjunction with a testicular mass suggests

Back 619

Testicular cancer

Front 620

Benign testicular cysts

Back 620

Tunica Albuginea

Intratesticular

Front 621

Well-circumscribed solid tumors lying beneath the tunica albuginea

Back 621

Epidermoid cyst

Front 622

Epidermoid cyst findings

Back 622

Solid, hypoechoic masses with an echogenic capsule or onion ring pattern formed by multiple layers of keratin

"Bow Tie" central echogenic patterm

Front 623

Testicular abscesses are usually a complication of

Back 623

Epididymo-orchitis

Front 624

Enlarged testicle containing a predominantly fluid-filled mass with hypoechoic or mixed echogenic areas

Back 624

Testicular abscess

Front 625

"Scrotal pearls" may be located

Back 625

Within the testicle or between the layers of the tunica vaginalis

Front 626

Triangular shaped avascular intratesticular lesiom

Back 626

Testicular infarct

Front 627

Serous fluid that accumulates within the tunica vaginalis or between the layers of the tunican vaginalis

Back 627

Hydrocele

Front 628

Most hydroceles are caused by

Back 628

Failed closure of the processus vaginalis at the internal ring

Front 629

Dilatation of the pampiform venous plexus of the testicular veins which drain the testicle

Back 629

Varicocele

Front 630

90% of varicoceles are on the __ side

Back 630

Left

Front 631

Varicoceles are the most common correctable cause of

Back 631

Male infertility

Front 632

Results from bowel protruding through the inguinal canal into the tunica vaginalis of the scrotum

Back 632

Scrotal hernia

Front 633

Small hernias can be visualized by using the

Back 633

Valsalva maneuver

Front 634

Most common extratesticular tumor

Back 634

Adenomatoid tumor

Front 635

Cystic masses of the epididymis that result from dilatation of the epididymal tubules

Back 635

Spermatoceles (Epididymal cysts)

Front 636

Difference between spermatoceles and epididymal cysts

Back 636

Spermatoceles are more common and filled with thick milky fluid containing spermatozoa

Epididymal cysts are filled with clear fluid

Front 637

Most common condition that causes acute scrotal pain

Back 637

Acute epididymitis

Front 638

Acute epididymitis is usually caused by

Back 638

STDs

Front 639

Epididymitis findings

Back 639

Enlarged hypoechoic epididymis

Increased blood flow

Reactive hydrocele

Scrotal wall thickening

Front 640

Orchitis findings

Back 640

Enlarged hypoechoic testicle

Increased blood flow

Decreased arterial resistance

Front 641

Bell clapper deformity

Back 641

Testicle is not attached to the tunica vaginalis leaving it capable to rotate freely on the spermatic cord

Front 642

With testicular ischemia, the testicle becomes

Back 642

Enlarged and hypoechoic

Front 643

After _ hours with testicular torsion, the salvage rate markedly decreases

Back 643

6

Front 644

What will better optimize slow blood to rule out a complete torsion

Back 644

Decreasing pulse repetition frequency (color scale)

Front 645

Undescended testicle

Back 645

Cryptorchidism

Front 646

Complications or cryptorchidism

Back 646

Infertility and cancer

Front 647

Patients with cryptorchidism have an increased risk of developing a

Back 647

Malignancy in both the undescended testis and contralateral testis

Front 648

Common location of the cryptorchid testis

Back 648

Inguinal canal

Front 649

Congenital absence of the testical

Back 649

Anorchia

Front 650

The prostate is located in the

Back 650

Retroperitoneum

Front 651

The prostate is bordered anteriorly by the

Back 651

Pubic bone

Front 652

The prostate is bordered posteriorly by the

Back 652

Rectum

Front 653

The prostate is bordered superiorly by the

Back 653

Urinary bladder

Front 654

The prostate is bordered inferiorly by the

Back 654

Urogenital diaphragm

Front 655

Arterial supply to the prostate

Back 655

Inferior vesical artery

Front 656

Inferior portion of the prostate situated superior to the urogenital diaphragm

Back 656

Apex

Front 657

Superior portion of the prostate situated below the inferior margin of the urinary bladder

Back 657

Base

Front 658

Two sac-like out-pouchings of the vas deferenssituated adjacent to the superior/posterior aspect of the prostate

Back 658

Seminal vesicles

Between urinary bladder and rectum

Front 659

Duct that passes through the central zone and empties into the urethra

Back 659

Ejaculatory duct

Front 660

This duct originates from the combination of the vas deferens and the seminal vesicle

Back 660

Ejaculatory duct

Front 661

Longitudinal ridge within the urethra in which the orifices of the ejaculatory ducts are located on either side

Back 661

Verumontanum

Front 662

Calcifications commonly seen in the inner gland of the prostate

Back 662

Corpora amylacea

Front 663

Demarcation between the inner prostate gland and outer prostate gland

Back 663

Surgical capsule

Front 664

Shadowing created by calcification in the area of the urethra and verumontanum

Back 664

Eiffel tower sign

Front 665

Posteriorly locates portion of the prostate

Back 665

Peripheral zone

Front 666

Contains 70% of the prostatic glandular tissue

Back 666

Peripheral zone

Front 667

Location of most prostate cancers

Back 667

Peripheral zone

Front 668

The peripheral zone extends into

Back 668

The apex of the prostate

Front 669

Superiorly located portion of the prostate

Back 669

Central zone

Front 670

Contains 25% of the prostatic gland tissue

Back 670

Central zone

Front 671

Ejaculatory duct passes through this zone from the seminal vesicles to the urethra

Back 671

Central zone

Front 672

Contains 5% of the prostatic glandular tissue

Back 672

Transitional zone

Front 673

Site of origin of benign prostatic hyperplasia

Back 673

Transitional zone

Front 674

Anteriorly located non glandular portion of the prostate

Back 674

Fibromuscular stroma

* Not affected by cancer*

Front 675

Used to evaluate the prognosis of men with prostate cancer

Back 675

Gleason Grading system

Front 676

>80% of prostate cancers are diagnose in men older than

Back 676

85

Front 677

African american men are up to _x more likely to develop prostate cancer than white men

Back 677

2

Front 678

Indications for transrectal US

Back 678

Abnormal digital rectal exam

Elevation of PSA

Front 679

PSA

Back 679

Prostate specific antigen

Increases with age and prostatic volume

Front 680

PSA levels

Back 680

<4 ng/mL Normal

4-10 ng/mL Benign/Potential malignancy

>10 ng/mL Most likely cancer

Front 681

PSA density

Back 681

Relationship between PSA and prostate volume

Front 682

Classic appearance of prostate cancer

Back 682

Hypoechoic, peripherally-oriented lesion

Front 683

Pre transrectal ultrasound prep

Back 683

Cleansing enema

Pre and post prophylactic antibiotics

Front 684

Enlargement of the transitional zone of the prostate

Back 684

Benign prostatic hyperplasia

Front 685

Benign prostatic hyperplasia symptoms

Back 685

Difficult initiation of voiding

Urinary frequency

Small stream

Front 686

Prostate volume formula

Back 686

Height x width x length x 0.52

Front 687

Seminal vesicle agenesis is associated with

Back 687

Ipsilateral renal agenesis

Front 688

Seminal vesicle cysts can be seen

Back 688

POsterior to the blasser

Front 689

Cysts of the seminal vesicle are associated

Back 689

Ipsilateral renal agenesis or dysplasia and atresia of the ejaculatory duct

Front 690

Have a tear drop shape with a midline location at the level of the verumontanum

Back 690

Utricle cystsM

Front 691

Mullerian duct cysts

Back 691

Midline cyst very difficult or impossible to distinguish from a prostatic utricle cyst

Front 692

Ejaculatory duct cysts result in

Back 692

Hematospermia, ejaculatory pain and infertility

Front 693

The spleen is a __ organ

Back 693

Peritoneal

Front 694

The spleen lies between

Back 694

The stomach and the diaphragm

Front 695

The spleen filters

Back 695

Damaged cells

Microorganisms

Particulate matter

Front 696

The average spleen measures

Back 696

12 cm longitudinal

8cm transverse

4cm thick

Front 697

Splenomegaly

Back 697

>12cm longitudinally

Or if the spleen is inferior to the lower pole of the left kidney

Front 698

The fundis of the stomach, lesser sac, and pancreatic tail are __ and __ to the splenic hilum

Back 698

Medial and anterior

Front 699

The left kidney lies __ and __ to the spleen

Back 699

Inferior and medial

Front 700

The pancreatic tail is located __ to the upper pole of the left kidney in the splenic hilum

Back 700

Anterior

Front 701

Accessory spleens are located

Back 701

Near the splenic hilum and have identical echogenicity to the spleen

Front 702

Most common type of splenic granulomas

Back 702

Histoplasmosis and tuberculosis

Front 703

True splenic cysts lined by squamous epithelium

Back 703

Epidermoid cysts

(Solitary cyst 10cm. May be calcified with echogenic contents)

Front 704

__ may erode into the spleen due to their proximity

Back 704

Pancreatic pseudocysts

Front 705

Most common benign primary neoplasm of the spleen

Back 705

Hemangioma

Front 706

__ more frequently metastasise to the spleen

Back 706

Malignant melanoma

Front 707

Splenic infarcts are common in patients with

Back 707

Bacterial endocarditis and splenic artery aneurysms

Front 708

Peripheral wedge-shaped hypoechoic splenic lesion

Back 708

Splenic infarct

Front 709

Splenic abscess may be the result of

Back 709

Sepsis due to endocarditis, dental infections, or urosepsis

Front 710

Splenic abscess US

Back 710

Complex cystic lesion

Presence of gas may produce reverberation (comet-tail) artifact

Front 711

Due to a mutant hemoglobin S

Back 711

Sickle Cell Dx

Front 712

Sickle cell dx

Back 712

Spleen begins to enlarge (1st year)

Spleen remains enlarged due to a pooling of sickled cells

Spleen become fibrotic and shrinks before the end of childhood

Front 713

Most common cause of splenomegaly

Back 713

*Portal hypertension*

Splenic vein thrombosis

Front 714

Splenomegaly

Back 714

Spleen enlarges and extends in the anterior, medial, and inferior direction

Front 715

Blood disorder resulting in uncontrolled RBC production causing hyperviscosity and hypercoagulation

Back 715

Polycythemia vera

Front 716

Polycythemia vera may be the cause of

Back 716

Splenomegaly

Budd-Chiari syndrome

Portal vein thrombosis

Splenic infarcts

Front 717

A calcified circle seen in the LUQ

Back 717

Splenic artery aneurysm

Front 718

Normal asymmetrical arrangement of anatomy

Back 718

Situs solitus

Front 719

Mirror image of situs inversus

Back 719

Situs inversus

Front 720

The disruption in the development of the normal asymmetric arrangement of abdominal organs and vessels

Back 720

Situs ambiguous or heterotaxia

Front 721

Polysplenia is associated with

Back 721

Bilary atresia

Intestinal malrotation

Azygous continuation of interupted IVC

Cardiac defects

Front 722

Asplenia is associated with

Back 722

Midline liver and GB

INtestinal malrotation

Reversed position AO and IVC

Cardiac defects

Front 723

Subcapsular or intraparenchymal hematomas results when

Back 723

The splenic capsule remains intact

Front 724

Perisplenic or intraperitoneal hematomas result with

Back 724

Capsule rupture

Fluid around spleen

Front 725

Utilized in the ER to document the presence of free fluid in the peritoneal cavity

Back 725

Focused assessment with sonography for trauma

FAST

Front 726

Volume of RBS found in 100ml of blood

Back 726

Hematocrit

Front 727

With hx of splenic rupture/surgery, splenic cells may implant throughout the peritoneal cavity resultingin an ectopic spleen

Back 727

Posttraumatic splenosis

Front 728

Serous membranethat forms the lining of the abdominal cavity and covers most of the abdominal organs

Back 728

Peritoneum

Front 729

Lines the abdominal wall

Back 729

Parietal peritoneum

Front 730

Covers abdominal organs

Back 730

Visceral peritoneum

Front 731

Space that is situated between the liver, pancreas and stomach

Back 731

Lesser sac

Front 732

Entrance to the lesser sac

Back 732

Epiploic foramen

Front 733

Space you image ascites with floating bowel

Back 733

Greater sac

Front 734

Peritoneal recess extending between the rectum and the uterus

Back 734

Pouch of Douglas

Front 735

Intraperitoneal Structures

Back 735

Stomach, jejunum, 1st part of duodenum, appendix, spleen, cecum, trv and sigmoid colon, rectum, liver, uterus, fallopian tubes, and ovaries

Front 736

Posteriorly located compartment that lies between the transversalis fascia and posterior parietal peritoneum

Back 736

Retroperitoneum

Front 737

Kidneys and adrenal glands lie within the __ space

Back 737

Perirenal

Front 738

Retroperitoneal Structures

Back 738

Kidneys and ureters, adrenal glands, ascending and descending colon, 2nd 3rd and 4th duodenum, pancreas, AO/IVC, renal vessels, superior mesenteric vessels, gonadal vessels, lymphatics, prostate, rectum, esophagus

Front 739

The quadratus lumborum and psoas muscles lie

Back 739

Posterior to the posterior pararenal space

Front 740

First major branch as the AO descends through the diaphragm

Back 740

Celiac axis

Front 741

Celiac axis branches

Back 741

Common hepatic artery

Left gastric artery

Splenic artery

Front 742

"Sea gull" or "dove" sign

Back 742

Bifurcation of celiac axis into common hepatic and splenic artery

Front 743

Common hepatic artery bifurcates into the

Back 743

Proper hepatic artery and gastroduodenal artery

Front 744

SMA is __ to the celiac axis

Back 744

Inferior

Front 745

SMA is __ to the body of the pancreas

Back 745

Posterior/Inferior

Front 746

SMA __ the aorta

Back 746

Parallels

Front 747

SMA doppler waveform when fasting

Back 747

High resistance

Front 748

SMA doppler waveform postprandial

Back 748

Low resistance, increased velocity

Front 749

Renal arteries arise

Back 749

From the lateral walls of the AO below SMA

Front 750

Which is longer? Right or left renal artery

Back 750

Right renal artery

Front 751

Gonadal arteries

Back 751

Arise directly off the distal AO

Front 752

IVC lies to the __ of the AO

Back 752

Right

Front 753

IVC dilates with

Back 753

Cardiac failure and fluid overload

Front 754

Most common tumor to involve the IVC

Back 754

Renal cell carcinoma

Front 755

A liver mass would displace the IVC

Back 755

Posterior/medial

Front 756

A right renal artery aneurysm mass would displace the IVC

Back 756

Anterior

Front 757

Lymphadenopathy would displace the IVC

Back 757

Anterior

Front 758

A tortuous AO would displace the IVC

Back 758

Right/Lateral

Front 759

A right renal/adrenal mass would displace the IVC

Back 759

Anterior/Medial

Front 760

Most common IVC filter

Back 760

Greenfield

Front 761

IVC filters are used to prevent

Back 761

The ascend of lower extremity vein thrombosis

Front 762

Proper location for IVC filters

Back 762

Inferior to the renal veins

Front 763

IVC filters are placed through

Back 763

Catheters at the femoral or internal jugular vein

Front 764

Left renal vein passes

Back 764

Between the SMA and AO from left kidney to IVC

Front 765

Engorgement of the left renal vein due to compression by the SMA and AO

Back 765

"Nutcracker syndrome"

Front 766

Right gonadal vein drains

Back 766

Into the IVC

Front 767

The left gonadal vein drains

Back 767

Into the left renal vein

Front 768

Which is longer? Left or right renal vein

Back 768

Left

Front 769

Dense fibrous tissue proliferation confined to the paravertebral region

Back 769

Retroperitoneal fibrosis

Front 770

Retroperitoneal fibrosis is associated with

Back 770

Bilateral ureteral obstruction

Envelopes structures rather than displacing them

Front 771

Azygos IVC vein ais located

Back 771

On the right

Front 772

Hemiazygos IVC vein is located

Back 772

On the left

Front 773

Ascending lumbar veins are branches of the

Back 773

Common iliac veins

Front 774

Right adrenal gland

Back 774

Shaped like a triangle

Front 775

RIght adrenal gland is located

Back 775

Superior, anterior, and medial aspect of the right kidney

Posterior to IVC

Front 776

The crus of the diaphragm lies __ and __ to the right adrenal gland

Back 776

Medial and posterior

Front 777

Left adrenal gland

Back 777

Crescent shaped

Front 778

Left adrenal gland is located

Back 778

Anteriomedial to the upper pole of the left kidney

Front 779

The AO and crus of the diaphragm are located __ and __ to the left adrenal gland

Back 779

Medial and left

Front 780

The tail of the pancreas is located __ to the left adrenal gland

Back 780

Anterior

Front 781

The crus of the diaphragm is located anterior to the

Back 781

AO

Front 782

The crus of the diaphragm is located superior to the

Back 782

Celiac axis

Front 783

The crus of the diaphragm is located posterior to the

Back 783

IVC

Front 784

The crus of the diaphragm is located medial and posterior to all structures except the

Back 784

AO

Front 785

Adrenal cortex US

Back 785

Hypoechoic and less echogenic than retroperitoneal fat

Front 786

Adrenal medulla US

Back 786

Echogenic linear structure within adrenal gland

Front 787

Arteries that supply each adrenal gland

Back 787

Suprarenal of inferior phrenic art

Suprarenal branch of AO

Suprarenal branch of renal art

Front 788

Right suprarenal vein drains into

Back 788

IVC

Front 789

Left suprarenal vein drains into

Back 789

Left renal vei

Front 790

The adrenal cortex produces

Back 790

Aldosterone

Cortisol

Androgens

Front 791

Adrenal cortical hormones are regulated by

Back 791

Adrenocorticotropic hormones

Front 792

The __ and __ function together to regulate hormone production

Back 792

Adrenal gland

Anterior pituitary gland

Front 793

Adrenal medulla produces

Back 793

Catecholamines:

Epinephrine

Norepinephrin

Front 794

Excessive cortisol secretion

Back 794

Cushing's syndrome

Front 795

Excessive aldosterone secretion

Back 795

Conn syndrome

Front 796

Excessive androgen production

Back 796

Hirsutism

Overabundance of hair

Front 797

Majority of patients with adrenal cortical carcinomas present with

Back 797

Cushing's syndrome

*Rare tumor with poor prognosis*

Front 798

Adrenal cortical carcinomas have a tendency to invade the

Back 798

Renal veins and IVC

Front 799

Pheochromocytomas secrete

Back 799

Norepinephrine/Epinephrine

Front 800

Pheochromocytomas are associated with

Back 800

MEN

Von Hippel-Lindau dx

Front 801

MAlignant tumor arising from the sypathetic nervous system, comonnly occuring in the adrenal medulla

Back 801

Adrenal neuroblastoma

Front 802

Most common adrenal mass of infancy and early childhood

Back 802

Adrenal neuroblastoma

Front 803

Adrenal neuroblastoma US

Back 803

Solid mass that displaces the ipsilateral kidney inferiorly into the pelvis

Front 804

Increased blood and urine catecholamines

Back 804

Adrenal neuroblastoma

Front 805

Benign, nonfunctioning adrenal masses that contain fat and bone elements

Back 805

Myelolipoma

Front 806

Myelolipoma US

Back 806

Hyperechoic masses in adrenal bed

Front 807

Myelolipomas are associated with

Back 807

Propagation speed artifacts due to fat composition

Front 808

Most common adrenal lymphoma

Back 808

Non-hodgkin dx

Front 809

Adrenal lymphoma involvement is commonly and frequently

Back 809

Bilateral

Front 810

Met sites in order

Back 810

Lungs

Liver

Bone

Adrenal glands

Front 811

Adrenal hemorrhage is most common in

Back 811

Neonates

Front 812

What is the most common adrenal mass in a newborn?

Back 812

Adrenal hemorrhage

Front 813

Lymphadenopathy commonly displaces

Back 813

IVC and SMA anteriorly

Front 814

What direction will the splenic vein be displaced by a left adrenal mass?

Back 814

Anterior

Front 815

What direction will the bladder be displaced by a hematoma in the Pouch of Douglas?

Back 815

Anterior

Front 816

With a gastric outlet obstruction and dilation of the stomach, what direction will the pancreatic tail be displaced?

Back 816

Posterior

Front 817

What direction will a mass in the uncinate process displace the SMV?

Back 817

Anterior

Front 818

What direction will a neuroblastoma displace the ipsilateral kidney?

Back 818

Inferior

Front 819

What direction will a mass in the left lobe of the liver displace the gastroesophageal junction?

Back 819

Posterior

Front 820

3 types of aneurysms

Back 820

True

False (Pseudo)

Dissecting

Front 821

Small saccular aneurysm commonly located in the cerebrum

Back 821

Berry

Front 822

Infected aneurysm

Back 822

Mycotic

Front 823

Results in the weakening of the media in severe atherosclerosis

Back 823

Atherosclerotic aneurysm

Front 824

Spindle-shaped dilatation in which the stretching process affects the entire circumference of the artery

Back 824

Fusiform artery

Front 825

Localized spherical outpouching of the vessel wall

Back 825

Saccular aneurysm

Front 826

True aneurysm

Back 826

Involves all three layers of the AO

Front 827

Aneurysms

Back 827

Focal dilatation with at least a 50% increase over normal AO diameter

Front 828

Most AO aneurysms occur

Back 828

In the distal AO

Front 829

False AO aneurysms result from

Back 829

Injury to the vessel wall and extravasated blood is walled off by surrounding tissue

Front 830

Pseudoaneurysm waveform

Back 830

Bidirectional seen at stalk

Front 831

Dissecting aneurysms typically originate

Back 831

At the aortic arch in the thorax

Front 832

Dissecting aneurysm

Back 832

Separation of the intima from the media of the aortic wall

Front 833

The dissecting artery can extend to

Back 833

The carotid arteries or down the AO to the femoral arteries

Front 834

Endovascular stent graft

Back 834

Alternative to open AO surgery

Inserted into groin and deplored within AO

Front 835

Chronic mesenteric ischemia presents as

Back 835

Postprandial abdominal pain and weight

Front 836

Sonographic evaluation for mesenteric ischemia involves

Back 836

Celiac axis

SMA

Inferior mesenteric artery

Front 837

Mesenteric artery stenosis criteria

Back 837

SMA velocity >275 cm/sec

CA velocity >200 cm/sec

Front 838

Celiax axis compression syndrome is also known as

Back 838

Arcuate ligament compression syndrome

Front 839

Compression of the proximal celiac axis by the median arcuate ligamentof the diaphragm

Back 839

Celiac axis compression syndrome

Front 840

Celiac axis compression syndrome expiration

Back 840

Median arcuate ligament compresses the ventral aspect of the celiac axis producing an "S" shaped celiac axis and a significant stenosis

Front 841

Celiac axis compression syndrome inspiration

Back 841

Celiac axis straightens and the stenosis disappears and elevated systolicvelocities decrease to normal values (<200 cm/sec)

Front 842

Abnormal connection between an artery and a vein

Back 842

Arteriovenous shunt/fistula

Front 843

Arteriovenous shunts/fistulas are commonly associated with

Back 843

Angiographic punctures of the common femoral artery just inferior to the groin

Front 844

ARteriovenous fistulas present as

Back 844

Bruit or thrill depending on their location

Front 845

Sonographic characteristics of arteriovenous shunt

Back 845

Color flow bruit

Pulsatile venous flow

Low resistive arterial flow

Front 846

Intrarenal arteriovenous shunts are the result of

Back 846

Renal biopsy

Front 847

An arteriovenous shunt will produce a __ waveform

Back 847

High velocity, low resistance

Front 848

Normal intestinal wall

Back 848

3-5mm

Front 849

Layers of the gut wall

Back 849

Mucosa

Submucosa

Muscularis externa

Adventitia

Front 850

Intestinal pathology sonographic pattern

Back 850

"Target" or "Pseudokidney"

Front 851

Segment of esophagus between the diaphragm and the stomach

Back 851

Gastroesophageal junction

Front 852

Presence of air within the the peritoneal cavity

Back 852

Pneumoperitoneum

*Black screen image on test*

Front 853

Most common cause of an acutely painful abdomen

Back 853

Acute appendicitis

Front 854

Typical location for the appendix

Back 854

Posterior to the terminal ileum

Anterior to iliac vessels

Front 855

The RLQ location of the appendix between the umbilicus and the iliac crest

Back 855

McBurney's point

Front 856

Caused by the obstruction of the appendiceal lumen by a fecalith or hyperplasia of the submucosa

Back 856

Appendicitis

Front 857

Sonographic criteria for diagnosing inflammatory appendix

Back 857

Non-compressible appendix

>6mm diameter

Appendicolith

Front 858

Causes a functional gastric outlet obstruction as a result of hypertrophy and hyperplasia of the muscular layers of the pylorus

Back 858

Hypertrophic pyloric stenosis

Front 859

Hypertrophic pyloric stenosis neonate (3-8 weeks) patients present with

Back 859

Vomiting (non-bloody non-bilous)

Palpable "olive-shaped" pylorus

Visible peristalsis

Front 860

Pylorus size criteria

Back 860

Muscle thickness >3mm (3-4mm)

Channel length >17mm (14-24mm)

Cross section diameter >15mm

Front 861

What is the most accurate measurement for pyloric stenosis?

Back 861

Muscle wall thickness

Front 862

Inflammation of diverticulum

Back 862

Diverticulitis

Front 863

Symptoms of diverticulitis

Back 863

LLQ Pain

Fever

Leukocytosis

Front 864

Diverticulitis US

Back 864

Thickening of bowel wall (>4mm)

Abscess formation

Inflammed diverticula (pseudokidney)

Front 865

Mechanical small-bowel obstruction can be caused by

Back 865

Intraluminal (food bolus)

Bowel wall lesion (tumor/Crohns)

*Extrinisic (hernia)* most common

Front 866

Bowel obstruction colon

Back 866

Haustra markings

Front 867

Most common cause of intestinal obstruction in infant toddler age group

Back 867

Intussusception (telescoping of bowel)

Front 868

Intussusception clinical presentation

Back 868

**Bloody diarrhea like currant jelly**

Intermittent abdominal pain

Vomiting

Front 869

Intussusception US

Back 869

Pseudokidney

Target sign

Concentric rings of folded bowel

Front 870

Normal thyroid variant extending superior to the isthmus

Back 870

Pyramidal lobe

Front 871

Sonolucent bands along the anterior surface of the thyroid gland

Back 871

Strap muscles

Front 872

Sternocleidomastoid muscles are located

Back 872

Anterolaterally to the thyroid

Front 873

Wedge-shaped sonolucent structure adjacent to the cervical vertebrae

Back 873

Longus colli muscle

Posterior to the thyroid

Front 874

Composed of the recurrent laryngeal nerve and inferior thyroid vessels

Back 874

Minor neurovascular bundle

Front 875

Vague, hypoechoic area between the longus colli muscle and the thyroid gland

Back 875

Minor neurovascular bundle

Front 876

*Neck* Midline, curvilinear reflecting surface with associated reverberation artifact

Back 876

Trachea

Front 877

Target sign trsv, usually hidden from sonographic visualization from the trachea

Back 877

Esophagus

Front 878

Strap muscles are __ to the thyroid

Back 878

Anterior

Front 879

Stenocleidomastoid is __ to the thyroid

Back 879

Anterolateral

Front 880

Common carotid/ Int jugular veins are __ to the thyroid

Back 880

Lateral

Front 881

Minor neurovascular bundle is __ to the thyroid

Back 881

Posterior

Front 882

Longus colli muscle is __ to the thyroid

Back 882

Posterior

Front 883

Parathyroid glands are __ to the thyroidP

Back 883

Posterior

Front 884

The superior thyroid arteries branch off the

Back 884

External carotid arteries

Front 885

The inferior thyroid arteries branch off the

Back 885

Thyrocervical trunk

Front 886

Venous blood from the thyroid is drained into

Back 886

The internal jugular vein via the superior and middle thyroid veins

The innominate veins via the inferior thyroid veins

Front 887

Glands that regulate thyroid hormones

Back 887

Thyroid (T3/4)

Pituitary (TSH)

Hypothalamus (TRH)

Front 888

Produced by the pituitary to stimulate the thyroid to produce thyroid hormones

Back 888

Thyroid stimulating hormones (TSH)

Front 889

An increase in TSH is usually the fist indication of

Back 889

Hypothyroidism

Front 890

^ TSH

v T4/T3

Back 890

Hypothyroidism

Front 891

v TSH

^T4/T3

Back 891

Hyperthyroidism

Front 892

MOst commonly encountered benign thyroid nodule

Back 892

Follicular adenoma

Front 893

Thyroid adenoma US

Back 893

Solitary, spherical and encapsulated

Front 894

Thyroid cancer risk factors

Back 894

Age: <20 and >60

Head and neck irradiation

Family hx

Front 895

Most common primary thyroid cancer 75-80% of all cases

Back 895

Papillary carcinoma

Front 896

Papillary carcinoma US

Back 896

Hypoechoic with possible calcifications

Front 897

Follicular carcinoma of the thyroid

Back 897

10-20%

Encapsulated

Spread via blood stream rather than the lymphatics

Front 898

Secretes hormone calcitonin

Back 898

Thyroid medullary carcinoma

Front 899

Medullary carcinoma is associated with

Back 899

MEN syndrome

Front 900

Anaplastic carcinoma

Back 900

1% of thyroid cancers

Aggressive behavior

Poor prognosis

Front 901

Most effective method for diagnosing malignancy in a thyroid mass

Back 901

Fine needle aspiration

Front 902

FNA applications

Back 902

Nodule:

>1 cm with microcalcifications

>1.5cm predominantly solid

>2cm mixed components

Demonstrating growth

Front 903

Peripheral or eggshell calcified nodule

Back 903

Benign nodule

Front 904

Fine or punctate calcified nodules

Back 904

Suggestive of malignancy

Front 905

Features associated with Thyroid Cancer

Back 905

Microcalcifications

Solid hypoechogenicity

Irregular margins

Absence of halo

Intranodule central vascularity

More tall than wide

Front 906

Generalized enlargement of the thyroid

Back 906

Diffuse thyroid dx (goiter)

Front 907

Painless, diffuse enlargement of the thyroid in young or middle aged woman.

Back 907

Hashimoto's

Autoimmune thyroid dx

Front 908

Hashimoto's US

Back 908

Hypoechoic diffuse enlargement with course parenchymal echo texture

Front 909

Enlarged thryoid gland

Back 909

Goiter

Diffuse or nodular

Front 910

Most common cause of a goiter

Back 910

Iodine deficiency

Front 911

Autoimmune disorder characterized by hyperthyroidism due to circulating antibodies

Back 911

Graves dx

Front 912

Most common cause of hyperthyroidism

Back 912

Graves dx

Front 913

Graves dx hallmark sign

Back 913

Prominent eyes

Front 914

Graves dx US

Back 914

Diffusely hypoechoic and inhomogeneous

Hypervascular

Audible bruit

Front 915

How many parathyroid glands are there?

Back 915

4

Front 916

Oval, hypoechoic mass posterior to thr thyroid gland

Back 916

Parathyroid adenoma

Front 917

Most common type of hyperparathyroidism

Back 917

Primaty due to development of an adenoma associated with one of the parathyroid glands

Front 918

Primary hyperparathyroidism is suspected with an increase in

Back 918

Serum calcium levels

Front 919

Primary hyperparathyroidism levels

Back 919

^ PTH

^ Serum Calcium

Front 920

Secondary hyperparathyroidism occurs in patients with

Back 920

Chronic renal failure

*Failure so synthesize vitamin D*

Front 921

Most common manifestation of MEN

Back 921

Secondary hyperparathyroidism

Front 922

Secondary hyperparathyroidism levels

Back 922

^Serum phosphates

v Serum Calcium

Front 923

Exocrine glands that secrete saliva and the enzyme amylase

Back 923

Salivary glands

Front 924

Largest of the salivary glands

Back 924

Parotid glands

Front 925

Parotid glands are found

Back 925

Anterior to the ear

Front 926

Stensons duct drains the

Back 926

Parotid glands into the oral cavity

Front 927

Submandibular glands are located

Back 927

Beneath the jaw

Front 928

Wharton's ducts drain

Back 928

The submandibular glands into the oral cavity

Front 929

Sublingual glands are located

Back 929

Beneath the tongue

Anterior to the submandibular glands

Front 930

Most common superficial midline neck mass

Back 930

Thyroglossal duct cyst

(Adolescents w upper respiratory infection)

Front 931

Solitary, predominantly cystic mass appearing on the lateral aspect of the neck

Back 931

Branchial cleft cysts

Front 932

Branchial cleft cysts are a remnant of

Back 932

Embryonic development

Front 933

Cystic hygromas typically occur

Back 933

In the neck

Evident at birth

Front 934

Vessels of the aortic arch

Back 934

Innominate artery

Left CCA

Left subclavian arterty

Front 935

Left CCA and subclavian originate off of

Back 935

The aortic arch

Front 936

Innominate artery (brachiocephalic) divides into

Back 936

Right CCA and External carotid artery

Front 937

There is only 1 innominate __ and bilateral innominate __

Back 937

Artery

Veins

Front 938

ICA is located

Back 938

Lateral and posterior

Front 939

ECA is located

Back 939

Medial and anterior

Front 940

ICA has a __ waveform

Back 940

Low resistance

Front 941

ECA has a __ waveform

Back 941

High

Front 942

First branch of the ICA

Back 942

Opthalmic

Front 943

First branch of the ECA

Back 943

Superior thyroid artery

Front 944

The internal jugular and subclavian vein drain into

Back 944

The brachiocephalic/innominate vein

Front 945

The external jugular vein is located

Back 945

Superficially on the lateral aspect of the neck

Front 946

Abscess US

Back 946

Typically a complex mass (solid and cystic)

Debris, septations, and gas can be seen within the abscess

Front 947

Gas within the abscess may produce a __ artifact

Back 947

Reverberation (comet-tail)

Front 948

Abscesses typically demonstrate

Back 948

Posterior enhancement depending on the cystic component of the abscess

Front 949

Most reliable finding in pts with abscess

Back 949

Presence of fever

Increased WBC count

Front 950

Differentiation of abscess without gas from a hematoma

Back 950

Percutaneous aspiration

Front 951

Extrahepatic collections of extravasated bil

Back 951

Biloma

Front 952

Bilomas are associated with

Back 952

Abdominal trauma, GB dx, biliary surgery

Front 953

Bilomas US

Back 953

Predominantly cystic masses located in RUQ

Front 954

Lymphoceles are complications of

Back 954

Renal transplant

Gynecologic sx

Vascular sx

Urological sx

Front 955

Leakage of lymph from a renal allograft, or by a surgical disruption of the lymphatic channels

Back 955

Lymphocele

(fluid collection)

Front 956

Collection of urine located outside of the kidney or bladder

Back 956

Urinoma

Front 957

Urinomas are caused by

Back 957

Renal trauma

Renal sx

Obstructing lesionU

Front 958

Urinomas are most commonly associated with

Back 958

Renal transplantation

Posterior urethral valve obstruction

Front 959

Spectrum of disorders affecting the proximal femur and acetabulum that leads to hip subluxation and dislocation

Back 959

Hip Dysplasia

Front 960

Risk factors for hip displasia

Back 960

Female

First-born children

Frank breech presentation

Family history of DDH

Oligohydramnios

Front 961

Dislocation of the hip by adducting and pushing the leg posteriorly

Back 961

Barlow maneuver

Front 962

Relocation of the dislocated hip by abducting the leg

Back 962

Ortolani maneuver

Palpable and audible "clunk" noted

Front 963

Lymphoma groups

Back 963

Non-Hodgkin lymphoma

Hodgkin's dx

Front 964

Lymph nodes US

Back 964

Anechoic/hypoechoic mas containing a central echogenic foci

Front 965

"Mantle" or "sandwich" sign

Back 965

Perivessel lymphoma

Front 966

Lymphoma is noted to displace the IVC and AO __

Back 966

Anteriorly

non-Hodgkins typically

Front 967

Excessive accumulation of serous fluid in the peritoneal cavity

Back 967

Ascites

Front 968

Two mechanisms that produce ascites

Back 968

Low serum osmotic pressure (protein loss)

High portal vein pressure

Front 969

Causes of Ascites

Back 969

Cirrhosis *most common*

Renal failure

Congestive heart failure

Cancer *malignant ascites*

Front 970

Hypoalbuminemia can be the result of

Back 970

Liver failure

Nephrotic syndrome

Malnutrition

Front 971

Hypoalbuminemia

Back 971

Low protein

Front 972

What can successfully treat ascites by lowering portal pressure

Back 972

Transjugular intrahepatic portal-systemic shunt

TIPS

Front 973

Ascites is commonly found at the

Back 973

Inferior aspect of the RLL

Morison's pouch

Pelvic cul de sac

Paracolic gutters

Front 974

GB __ is frequently seen with ascites

Back 974

Thickening

Front 975

Malignancy characterized by the progressive accumulation of mucus-secreting tumor cells within the peritoneum

Back 975

Pseudomyxoma Peritonei

*Commonly associated with cancer of the appendix*

Front 976

Pseudomyxoma Peritonei US

Back 976

Bowel loops matted to the posterior abdominal wall

Front 977

Procedure to remove ascites from the peritoneal cavity

Back 977

Abdominal paracentesis

Front 978

Diagnostic paracentesis

Back 978

To perform laboratory testing on the fluid

Front 979

Therapeutic paracentesis

Back 979

To relieve abdominal pressure causing respiratory difficulties or pain

Front 980

Accumulation of fluid within the pleural space

Back 980

Pleural effusion

Front 981

Caused by increased hydrostatic pressure and decreased plasma oncotic pressure

Back 981

Transudative effusion

*Pressure infiltration*

Front 982

Caused by increased capillary permeability

Back 982

Exudative effusions

*Inflammation*

Front 983

The absence of gliding of the parietal and visceral pleura and the presence of comet-tail artifact between those layers

Back 983

Pneumothorax

Front 984

Procedure to aspirate fluid from the pleural space of the chest

Back 984

Thoracentesis

Front 985

Diagnostic thoracentesis

Back 985

Laboratory evaluation of fluid to determine cause of the pleural effusion

Front 986

Therapeutic thoracentesis

Back 986

To relieve dyspnea

Front 987

A thoracentesis is typically performed with the patient

Back 987

Sitting at the edge of the bed leaning over a bedside table with their back rounded

Front 988

Collection of synovial fluid in the popliteal fossa

Back 988

Baker's cyst

*Medial aspect*

*Can extend into the calf*

Front 989

Second most common tumor of the hand and wrist

Back 989

Giant cell tumor

*Tendon Sheath*

Front 990

Most common cell tumor of the hand and wrist

Back 990

Ganglion cyst

Front 991

Result of bleeding from the superior or inferior epigastric vessels or from a tear of the rectus muscle

Back 991

Rectus sheath hematoms

Front 992

Rectus sheath hematomas superior to the arcuate line

Back 992

Are confined between the anterior and posterior sheaths and should not move across the midline due to the linea alba

Front 993

A rectus muscle hematoma inferior to the arcuate line

Back 993

Will extend into the space of Retzius within the pelvis causing external compression and irritation of the urinary bladder

Front 994

Rectus sheath hematomas occur due to

Back 994

External trauma

Trauma from surgery

Vigorus muscle contraction

Pregnancy

Front 995

Rectus sheath hematoma is a recognized complication of

Back 995

Anticoagulation therapy