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ARDMS Abdominal Review > Abdomen Flash cards > Flashcards

Abdomen Flash cards

1
Q

What is pyonephrosis

What are 3 sono features of pyonephrosis

A

Pyonephrosis is the presence of pus in a dilated renal collecting system

3 sono features
1) dependent echoes within a dilated pelvocaliceal system
2) shifting urine debris level
3) gas shadowing from infection

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2
Q

What are 2 of the most common explanations for bilateral renal masses

A

1) malignant lymphoma/Hodgkin disease
2) Mets

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3
Q

Name the 7 tumors that are associated with Von Hippel-Lindau Syndrome

A

1) Renal cell carcinoma
2) Hemangioma
3) Pheochromocytoma
4) Pancreatic cystadenoma
5) Adenoma
6) Islet cell tumor
7) Cysts associated with a variety of organs

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4
Q

What are the 5 causes or renal vein thrombosis

What are 4 sonographic indications for acute renal vein thrombosis

A

5 causes:
1) IVC or renal vein extrinsic compression
2) nephrotic syndrome
3) renal tumors
4) renal allografts
5) trauma

Sono indications:
1) dilated thrombosed renal vein
2) absence of venous flow within kidney
3) enlarged hypoechoic kidney
4) high resistive renal artery waveform

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5
Q

Describe the waveform of the arterial side of an arteriovenous fistula

Describe the waveform of the venous side of an arteriovenous fistula

A

Arterial side- abnormally low resistive arterial flow pattern. Waveform with increased and sustained diastolic flow

Venous side- increased velocity, pulsatility and with spectral broadening due to turbulence

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6
Q

List 4 sonographic criteria for determining renal artery stenosis

A

1) kidney size less than 9 cm
2) peak main renal artery velocity > 180 cm/sec
3) renal artery/ aorta ratio > 3.5
4) intrarenal parvus tardus waveform

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7
Q

Name the 8 disorders associated with AIDS patients

A

1) fatty liver infiltration
2) hepatomegaly
3) hepatitis
4) non-Hodgkins lymphoma
5) candidiasis
6) cholangitis
7) cholecystitis
8) Kaposi sarcoma

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8
Q

Name 5 sonographic findings associated with acute rejection of a renal transplant

A

1) enlarged transplant
2) decreased cortical echogenicity
3) indistinct corticomedullary boundary
4) prominent hypoechoic medullary pyramids
5) peritransplant fluid collections

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9
Q

Name 3 abdominal masses associated with the elevation of alpha-fetoprotein

A

1) hepatocellular carcinoma
2) metastatic liver disease
3) hepatoblastoma

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10
Q

In what 3 locations can pheochromocytomas be found

Pheochromocytomas cause hypersecretion of what substances

A

3 locations:
1) adrenal medulla
2) organ of Zuckerkandl near the aortic bifurcation
3) paravertebral sympathetic ganglia

Pheochromocytomas cause hypersecretion of catecholamines

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11
Q

What 4 criteria define a nonfunctioning cortical adenoma

A

1) a unilateral mass
2) no history of malignancy elsewhere
3) no biochemical evidence of adrenal hyperfunctioning
4) adrenal mass less than 3 cm

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12
Q

Define retroperitoneal fibrosis

Describe the sonographic appearance of retroperitoneal fibrosis

A

Retroperitoneal fibrosis is a dense fibrous tissue proliferation that is confined to the paravertebral and central abdomen region

Presents as a smooth marginated hypoechoic soft tissue mass encasing the AO and IVC

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13
Q

What is the tunica albuginea

What is the tunica vaginalis

A

Tunica albuginea is the fibrous capsule that surrounds the testicle

The tunica vaginalis is an extension of the peritoneum into the scrotal chamber
The inner or visceral layer covers the tesis and epi
The outer or parietal layer lines the walls of the scrotal chamber

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14
Q

Describe the sonographic findings associated with torsion of the spermatic cord

A

The testicle becomes enlarged, inhomogenous, and hypoechoic when compared to the contra lateral normal testis
Enlarged testicle, skin thickening, and reactive hydrocele formation

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15
Q

What are 3 other names for renal cell carcinoma

Renal cell carcinoma is associated with what 4 diseases

A

3 other names:
1) hypernephroma
2) adenocarcinoma
3) von Growitz tumor

Associated with:
1) adult poly cystic kidney disease
2) acquired cystic disease
3) von Hippel-Lindau
4) Tuberous sclerosis

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16
Q

What 4 areas should be evaluated whenever a solid renal mass is detected

A

1) ipsilateral renal vein and IVC
2) contralateral kidney and renal vein
3) retroperitoneum for lymphadenopathy
4) liver for Mets

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17
Q

What are the 3 associated findings with significant acute pyelonephritis

A

1) renal enlargement
2) hypoechoic parenchyma
3) absence of sinus echoes

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18
Q

What are the symptoms of acute diverticulitis

What are the sonographic signs of acute diverticulitis

What is a target or pseudo kidney sign

A

Symptoms:
1) LLQ pain
2) fever
3) leukocytosis

Signs- thickened bowl or abscess formation in the LLQ

Target sign- abnormal bowel wall thickening.

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19
Q

What are the symptoms of hypertrophic pyloric stenosis

What are the sonographic criteria for hypertrophic pyloric stenosis

A

Symptoms:
1) projectile vomiting
2) palpable olive like abdominal mass

Sono criteria:
-pyloric muscle thickness >4 mm
- pyloric channel length > 1.2 cm
- pyloric cross section > 1.5 cm

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20
Q

Name the 3 symptoms of intussusception

What is the sonographic appearance of an intussusception

A

Symptoms:
1) intermittent abdominal pain
2) vomiting
3) blood through rectum

Sono appearance- oval pseudokidney mass with central echoes

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21
Q

Describe the sonographic appearance of an abscess

A

Complex collections containing cystic and solid components. Irregular thick borders that demonstrate posterior enhancement

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22
Q

Name 3 causes of urinomas

What 2 conditions are commonly associated with urinomas

A

3 causes:
1) renal trauma
2) renal surgery
3) obstructing lesion

Conditions:
1) renal transplantation
2) posterior urethral valve obstruction

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23
Q

What does the presence of portal venous gas indicate

What is the sonographic appearance of portal venous gas

A

Indicates- bowel infarction

Sono appearance- linear echogenic branches in the periphery of the liver

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24
Q

Name and describe 2 cystic masses associated with pancreas in patients without a history of autosomal dominate PKD

A

1) pseudocyst- encapsulated collection of pancreatic enzymes
2) cystadenoma- Fluid collection that arise from the epithelium of the pancreatic duct

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25
Q

Describe the sonographic characteristics of emphysematous cholecystitis

What are the presenting symptoms in a patient with emphysematous cholecystitis

A

Acute infection of the GB wall

Sonographically appears as a thickened GB wall that produces comet-tail or reverb artifact

Symptoms:
1) RUQ pain
2) fever
3) leukocytosis

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26
Q

Name 5 techniques to access a renal artery stenosis

A

1) main renal artery peak systolic velocity
2) renal artery/ aorta velocity ratio
3) pulsus parvus et tardus
4) absent early systolic peak
5) acceleration (intrarenal waveform)

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27
Q

Define acceleration time

Define acceleration index

A

Acceleration time- the interval of time from the beginning of systole to the initial peak velocity

Acceleration index- derived by dividing the acceleration slope by the transmitted frequency

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28
Q

Define the term tardus

Define the term parvus

A

Tardus- a prolonged or delayed early systolic acceleration

Parvus- a decreased amplitude and rounding of the systolic peak

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29
Q

Name 6 causes of GB wall thickening

A

1) ascites
2) cholecystitis
3) adenomyomatosis
4) hypoalbuminea
5) congestive heart failure
6) acute hepatitis

30
Q

Name 5 reasons for an enlarged GB

A

1) prolonged fasting
2) hydrops of the GB
3) choledocholithiasis
4) courvoisier GB
5) diabetes

31
Q

What 5 sonographic findings are indicative of acute renal vein thrombosis

A

1) a dilated and echo filled renal vein
2) absence of intrarenal venous flow
3) enlarged kidney
4) hypoechoic renal parenchyma
5) highly resistive renal artery waveform

32
Q

What pathology will displace the IVC anteriorly

What is the typical sonographic appearance of lymph nodes

A

Retroperitoneal lymphadenopathy displaces the IVC anteriorly

Lymph nodes appear as anechoic or hypoechoic masses without acoustic without acoustic enhancement

33
Q

Describe the appearance of a column of Bertin

Describe the appearance of an extra renal pelvis

A

Column of Bertin- hypertrophy of renal cortical parenchyma located between 2 medullary pyramids. May give the appearance of a mass effect.

Extrarenal pelvis- renal pelvis protrudes outside the renal hilum.

34
Q

Describe the sono appearance of infantile polycystic kidney disease

What 3 anomalies are associated with infantile polycystic kidney disease

A

Sono appearance- bilaterally enlarged echogenic kidneys with loss of the cortical medullary boundary

3 anomalies:
1) lung hypoplasia
2) periportal hepatic fibrosis
3) oligohydraminos

35
Q

What is medullary sponge kidney

Describe the sonographic appearance of medullary sponge kidney

A

Medullary sponge kidney is dysplastic cystic dilatation of the collecting tubules of the medullary pyramids

Sono appearance- equally spaced hyperechoic medullary pyramids

36
Q

List 4 sonographic features of multi cystic dysplastic kidney disease

What 3 contralateral renal abnormalities are found when multicystic dysplastic kidney disease is unilateral

A

4 sono features
1) cysts of varying shape and size
2) absence of communication between cysts
3) absence of renal sinus
4) absence of renal parenchyma

3 abnormalities:
1) urteripelvic junction obstruction
2) renal agenesis or hypoplasia
3) pelvocalectasis

37
Q

Name 3 anatomic anomalies that appear as pseudo tumors of the kidney

A

1) column of Bertin
2) Dromedary Hump
3) fetal lobulation

38
Q

Describe the sono appearance of crossed renal ectopia

Describe the sono appearance of crossed fused renal ectopia

A

Crosses renal ectopia- occurs when a kidney ascends to the contralateral side. Appears as 2 kidneys on one side of the abdomen.

Crossed fused renal ectopia- developing kidneys fuse in the pelvis. Appears as 2 kidneys fused at the upper and lower poles on one side of the abdomen

39
Q

Name 5 structures that appear as cystic splenic masses

A

1) cystic degeneration of infarcts or hematomas
2) cysts associated with adult PKD
3) parasitic cysts of the spleen
4) epidermis cysts of the spleen
5) pancreatic pseudocysts

40
Q

When severely affected, what is the sonographic appearance of the pancreas in a patient with cystic fibrosis

A

Increased echogenicity of the pancreatic parenchyma

41
Q

Name 4 sonographic indications of portal vein thrombosis

A

1) echogenic thrombus within vessel lumen
2) increase in portal vein diameter
3) Portosystemic collateral circulation
4) cavernous transformation

42
Q

What are the 2 sonographic features associated with a choledochal cyst

A

1) 2 cyst like structures in the RUQ the GB and CBD
2) dilated intrahepatic biliary tree

43
Q

What is the sonographic appearance of Carolis disease

What 3 genetically acquired conditions are associated with Carolis disease

A

Sono appearance- saccular, communicating intrahepatic duct dilatation

Conditions associated with:
1) infantile PKD
2) congenital hepatic fibrosis
3) choledochal cysts

44
Q

What is Courvoisier gallbladder

A

Is an enlarged nondiseased gallbladder associated with an extrinsic compression of the distal CBD

45
Q

What 5 predisposing conditions are associated with cholangiocarcinoma

A

1) ulcerative colitis
2) sclerosing cholangitis
3) Caroli disease
4) choledochal cysts
5) parasitic infections

46
Q

What is the sonographic appearance of acute pancreatitis

What are the 4 sonographic signs of chronic pancreatitis

A

Acute pancreatitis- increasing severity, decreased echogenicity and increased gland size

4 signs of chronic pancreatitis:
1) small echogenic gland
2) calcifications
3) pancreatic duct dilatation
4) pseudo cyst formation.

47
Q

What 6 findings are associated with pancreatic adenocarcinoma

A

6 findings:
1) dilated biliary system
2) dilated pancreatic duct
3) liver Mets
4) ascites
5) lymphadenopathy
6) pseudocyst formation

48
Q

What are Islet cell tumors

Name and describe the 2 most common islet cell tumors

A

Islet cell tumors- are small, well circumscribed masses usually found in the pancreatic body and tail

Common islet cell tumors:
1) insulinoma- characterized by hyperinsulinoma and hypoglycemia
2) gastrinoma- are associated with gastric hyper sections and peptic ulcer disease

49
Q

What are pancreatic pseduocysts

Name 4 causes of pancreatic pseudocysts

Name 5 locations of pancreatic pseduocysts

A

Pancreatic pseduocysts- collections of pancreatic fluid encapsulated by fibrous tissue

4 causes:
1) acute pancreatitis
2) chronic pancreatitis
3) trauma
4) pancreatic cancer

5 locations:
1) pancreas- most common
2) intraperitoneal
3) retroperitoneal
4) intraparenchymal
5) thorax

50
Q

What are 4 functions of the spleen

A

1) breakdown of hemoglobin
2) formation of bile pigment
3) formation of antibodies
4) reservoir for blood

51
Q

What 3 things does a significant elevation of conjugated bilirubin levels indicate

A

1) obstructive jaundice
2) intrahepatic cholestasis
3) biliary tree obstruction

52
Q

Describe acute cholecystitis

Name 5 symptoms of acute cholecystitis

Name 5 sono criteria that define acute cholecystitis

A

Acute cholecystitis- a stone obstructing the cystic duct

5 symptoms:
1) RUQ pain
2) guarding
3) fever
4) chills
5) leukocytosis

Sono criteria:
1) gallstones
2) murphys sign
3) diffuse wall thickening
4) gallbladder dilatation
5) sludge

53
Q

What is emphysematous cholecystitis

Describe the sono appearance of emphysematous cholecystitis

A

Emphysematous cholecystitis- infection associated with gas forming bacteria within the wall of the gallbladder

Sono appearance- gas shadowing from the wall of the gallbladder

54
Q

Describe the mechanism of hydrops of the gallbladder

A

Hydrops is as distended non inflamed gallbladder due to total obstruction of the cystic duct

55
Q

What is the sono presentation of GB carcinoma

What 3 other findings should be investigated to confirm the diagnosis of GB carcinoma

A

Sono presentation- intraluminal mass, asymmetric wall thickening or a mass filled gallbladder

3 findings:
1) liver Mets
2) lymphadenopathy
3) bile duct dilatation

56
Q

What are the 2 most common causes of biliary tract obstruction

What 3 lab values are most likely to be elevated due to biliary tract obstruction

A

Causes:
1) gallstones
2) carcinoma of the pancreas

3 lab values:
1) alkaline phosphatase
2) conjugated bilirubin
3) GGT

57
Q

What is Mirizzi syndrome

Name 3 sono findings associated with Mirizzi syndrome

A

Mirizzi syndrome- extrahepatic bile duct obstruction due to a stone in the cystic duct

Findings:
1) intrahepatic bile duct dilatation
2) normal sized CBD
3) large stone in the cystic duct

58
Q

Name 3 extrahepatic biliary ducts

A

1) common hepatic duct
2) cystic duct
3) common bile duct

59
Q

Describe the sono appearance of pneumobilia

What is the most common reason for pneumobilia

A

Sono appearance- echogenic foci in the biliary tree resulting in acoustic shadowing and reverb artifact, commonly seen in the hilum of the liver

Common reason is after an ERCP

60
Q

Name 5 sonographic findings of Budd-Chiari syndrome

A

1) hepatic vein thrombosis
2) ascites
3) heptomegaly
4) caudate lobe enlargement
5) portal hypertension.

61
Q

Name 4 well defined hyperechoic liver masses

A

1) hemangiomas
2) hepatic lipomas
3) echogenic Mets
4) focal fatty infiltration.

62
Q

Name 5 portosystemic shunts

A

1) portocaval shunt
2) proximal splenorenal shunt
3) distal splenorenal shunt (Warren)
4) mesocaval
5) TIPS

63
Q

What are the 4 sono appearances of a fungal abscess

A

1) wheel within a wheel
2) bulls eye
3) hypoechoic mass
4) echogenic mass

64
Q

Describe the sono appearances of an amoebic abscess within the liver

A

1) round or oval shaped hypoechoic mass
2) absence of a prominent wall
3) fine low level internal echoes
4) distal enhancement
5) contiguous with diaphragm

65
Q

What is the most significant vascular event associated with schistosomiasis?

Describe the sono apperance of schistosomiasis

A

Most significant event- portal vein occlusion

Sono appearance- distended echogenic debris filled intrahepatic portal veins

66
Q

What is the most common organism causing infections in AIDS and other immunocompromised patients

How does this infection appear sonographically

A

Most common organism- pneumocystis

Appears as nonshadowing echogenic foci

67
Q

What are the boundaries of the caudate lobe

A

1) posteriorly by the IVC
2) Anteroinferiorly by the prox left portal vein
3) anterolaterally by the ligamentum venosum
4) inferiorly by the MPV

68
Q

What is the bare area

What is the coronary ligament

What are the right and left triangular ligaments

A

Bare area- posterior crescent shaped portion of liver not covered by peritoneum

Coronary ligament- reflection of parietal peritoneum

Right and left triangular ligaments- reflections or coronary ligaments at each corner of the bare area

69
Q

Describe how pyogenic abscesses develop in the liver

What is the sono appearance of pyogenic abscess

A

Pyogenic abscesses are solitary and occur in the right lobe of the liver. Caused by bacteria which reach the liver via the bile ducts, portal veins, hepatic arteries or lymphatic channels

Appear as hypoechoic rounded fluid filled masses with variable degree of internal echoes

70
Q

What are the 3 sonographic findings of portal vein thrombosis

A

1) intraluminal thrombus
2) increased vein diameter
3) cavernous transformation

ARDMS Abdominal Review (14 decks)

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