abd 3 Flashcards by Dalila Juarez

name the portal triad vessels

Main portal vein
proper hepatic artery (rt)
Common hepatic duct (lt)

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what is the direction of the fetal circulation

Umbilical vein → lt portal vein → ductus venosus → ivc

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Name the spectral analysis presentation

Flow toward transducer = above baseline

Flow away from transducer = below baseline

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located in the right intersegmental fissure and divides the anterior and posterior segments of the right lobe

RHV

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located in the main lobar fissure and separates the right and left lobes

MHV

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located in the left intersegmental fissure and divides the lateral and medial segments of the left lobe

LHV

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Intrasegmental in anterior segment of the right lobe and courses centrally in anterior segment of the right lobe

RPV ( anterior branch)

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intrasegmental in posterior segment of the right lobe: courses centrally in posterior segment of the right lobe

RPV ( posterior branch)

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anterior to the caudate lobe, it separates the caudate lobe from medial segment of the left lobe

LPV (horizontal segment)

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Located in the left intersegmental fissure, in divides medial and lateral segments of the left lobe

LPV ( ascending segment)

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located in the main lobar fissure, it separates right and left lobes

GB fossa

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located in the left intersegmental fissure it divides the caudal aspect of the left lobe into medial and lateral segments

ligamentum teres

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located in the left anterior margin of the caudate lobe, it separates the caudate from the left lobe of the liver

ligamentum venosum

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what are the three major forms of liver abscesses

Pyogenic
amebic
fungal

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most often polymicrobial, accounts for 80% of hepatic abscess cases in the united states

pyogenic hepatic abscess

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due to entamoeba histolytica (10% of cases)

amebic abscess

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due to candida species (

fungal abscess

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the differentiation of a pyogenic abscess from an amebic abscess is difficult how do you decide

if the patient has traveled out of the united states than amebic abscess may be the correct diagnosis

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although ___________ infections are not common in the united states, it is estimated that 400,000 infected persons have migrated to the country

schistisomiasis

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what are the four types of portal hypertension

extrahepatic presinusoidal—— portal vein thrombosis
intrahepatic presimusoidal——-schistosomiasis
intrahepatic—————————-cirrhosis (most common)
intrahepatic postsinusoidal——hepatic vein thrombosis

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a patient presents with acute right upper quadrant pain and decreasing hematocrit what is the possible diagnosis?

hemorrhagic cyst

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list of hyperechoic liver masses

hepatic lipoma
hemangioma
echogenic metastases
focal fatty infiltration

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______ ,_______ and ________ are monitured prior to and invasive procedure to ensure proper clotting

PT(INR), PTT, and platelets

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what causes gas in the biliary tree

ERCP
spincter of Oddi papiliotomy
choledochojejunostomy
GB (biliary) fistula
emphysematous cholecystitis

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what structures are in contact with the pancreatic head

``` IVC CBD AMPULLA OF VATER (terminal end of CBD) GDA Duodenal C loop (2nd portion) ```

a spreading inflammatory reaction to an infection which forms a suppurative lesion

Phlegmon

Although not characteristic of insulinomas and gastrinomas, many pancreatic islet cell tumors are commonly located in the

body and tail

what are the most common sites of involvement for Multiple Endocrine Neoplasio (MEN)

``` parathyroids (hyperparathyroidism) Pancreatic islet tumors- insulinoma, gastrinoma pituitary glands- prolactinomas adrenal glands- pheochromocytomas thyroid- medullary thyroid carcinoma ```

How many types of MEN are there

1. wermer syndrome | 2. sipples syndrome

the head of the pancreas is

anterior to IVC

the head of the pancreas is medial

to the 2nd part of the duodenum

the head of the pancreas is anterior and lateral

to CBD

the head of the pancreas is posterior and lateral

to GDA

the CBD is posterior and lateral to

the head of the pancreas

the GDA is anterior and lateral to

the head of the pancrea

the SMV is to the right of the

SMA

the SMV and SMA are posterior to the

neck of the pancreas

the SMV and SMA are anterior to the

3rd portion of the duodenum

the SMV and SMA are anterior to the

uncinate process

the uncinate process is posterior to the

SMV and SMA

the aorta is posterior to the

body of the pancreas

the celiac axis is superior to the

pancreas

the splenic vein is posterior/ inferior to

pancreas

the stomach is anterior and medial to the

splenic hilum

the stomach is anterior to the

pancreatic body and tail

the tail of the pancreas is posterior to the

stomach

the tail of the pancreas is anterior to the

upper pole of the left kidney

the splenic artery is superior/ anterior to the

pancreas

name the renal vascular flow

main renal artery → segmental →interlobar →arcuate →interlobular

name the types of renal cysts

pylogenic parapelvic peripelvic

calyceal diverticula that sonographically appear as simple cyst

Pylogenic cysts

cortical cysts that buldge into the central sinus of the kidney

parapelvic cyst

lymphatic cysts in the central sinus

peripelvic cysts

what are the locations of renal cysts

cortical or parenchymal- periphery of kidney | peripelvic- located in the center ( renal sinus)

refers to the typical physical appearance of a neonate as a direct result of oligohydramnios and compression while in utero

Potter syndrome

what are some of the causes of potter syndrome

``` bilateral renal agenesis ARPKD ADPKD Multicystic renal Dysplasia Obstructive uropathy (posterior urethral valve defect) Early rupture of membranes ```

Pediatric cancer incidence

``` Leukemia 35.0% CNS tumors 16.6 Lymphoma 15.0 Neuroblastoma 7.8 Soft tissue sarcoma 7.4 Wilms 6.3 Bone 6.0 Hepatic tumors 1.1 ```

name the hyperechoic renal masses

``` Mycetoma Angiomyolipoma Blood clots Pyogenic debris Sloughed papilla Renal stones ```

What is the most common cause of intrarenal (intrinsic) acute kidney injury?

Acute tubular necrosis

what is the normal bladder wall thickness

5mm in nondistended bladder | 3mm in a distended bladder

Renal artery stenosis is determined by

Renal artery/ aorta ratio (RAR) > 3.5

Tardus parvus is defined as a

small slow pulse

What are the stages of chronic kidney disease

1 GFR >90mL/ min/1.73m2 NORMAL 2 GFR 60.-89 mL/ min/1.73m2 MILD 3 GFR 30-59 mL/ min/1.73m2 MODERATE 4 GFR 15-29 mL/ min/1.73m2 SEVERE 5 GFR

What is the most common neonatal abdominal mass?

Multicystic Dysplastic kidney

What is the most common neonatal adrenal mass?

Adrenal hemorrhage

What is the most common childhood adrenal mass?

Neuroblastoma

what is the most common childhood renal mass?

Nephroblastoma

what is the order of the testicles

``` Seminiferous tubules ↓ Tubuli Recti ↓ Efferent tubules ↓ Ductus epidydimis ↓ Vas deferens ```

what is within the spermatic cord

``` Vas deferens Cremastic, deferential and testicular artery Pampiniform plexus of veins Lymphatics Nerves ```

The most common correctible cause of male feritility, 90% are on the left

Varicoceles

The prostate is located in the retroperitoneum bordered anteriorly by

the pubic bone

The prostate is located in the retroperitoneum bordered posteriorly by the

Rectum

The prostate is located in the retroperitoneum bordered superiorly by the

Bladder

The prostate is located in the retroperitoneum bordered inferiorly by the

Urogenital diaphragm

name the prostate glandular zones

peripheral Central Transitional Fibromuscular stroma

Posteriorly located portion of prostate | contains 70% of the prostatic glandural tissue this is the location of most prostate tumors

Peripheral zone

Superiorly located Contains 25% of the prostate glandular tissue. Ejaculatory ducts pass through this zone from the seminal vesicles to the urethra

Central zone

contains 5% of the prostatic glandular tissue. | site of origin of benign prostatic hyperplasia

Transitional zone

anteriorly located nonglandular portion of the prostate, not affected by cancer prostatitis or hyperplasia

Fibromuscular zone

What are the retroperitoneal structures?

``` Kidneys and ureters adrenal glands ascending and descending colon 2,3,& 4th parts of the duodenum pancreas aorta IVC Renal vessels superior messenteric vessels gonadal vessels Lymphatics Prostate Rectum esophagus ```

what is the abd sandwich

anterior Transvesalis fascia Anterior parietal peritoneum Peritoneal space Posterior perietal peritoneum Anterior Pararenal space anterior renal fascia Perirenal space Posterior renal fascia Posterior pararenal space Posterior transversalis Fascia

the Azygous vein is located on the

right

the Hemiazygous vein is located on the

left

the crus of the diaphragm is located anterior to

the aorta

the crus of the diaphragm is located supertior to

the celica axis

the crus of the diaphragm is located posterior to the

IVC

Excessive cortisol secretion is associated with

Cushing syndrome

Excessive aldosterone is associated with

Conn syndrome

Excessive androgen

Hirsutism

What is the most likely diagnosis in a newborn with an abdominal mass and decreasing hematocrit?

Adrenal hemorrhage

In what direction will the IVC be displaced with a right liver mass?

Posterior

In what direction will the IVC be displaced with a right renal artery aneurysm?

In what direction will the IVC be displaced with a tortous aorta?

to the right

In what direction will the IVC be displaced with a right adrenal mass

medial/ anterior

In what direction will the IVC be displaced with a right renal mass

medial/ left

Lymphadenopathy typically surrounds vessels, but commonly displaces the IVC and SMA

Anteriorly

In what direction will the splenic vein be displaced by a left adrenal gland mass?

Anteriorly

In what direction will the bladder be displaced by a hematoma in the pouch of douglas?

With gastric outlet obstruction and dilatation of the stomach, in what direction will wht pancreatic tail be displaced?

Posterior

In what direction will a mass in the uncinate process displace the smv?

anteriorly

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

posterior

the normal intestinal wall is ____________ thick?

3-5mm

name the layers of the gut wall

mucusa submucusa Muscularis externa Adventitia (serosa)

what is the typical location of appendicitis

Posterior to the terminal ileum | anterior to iliac vessels

what are the sono characteristics of appendicitis

Non compressible appy >6mm diameter appendicolith (hyperemia)

what are the characteristics of Hypertrophic Pyloric Stenosis

Neonatal 3-8 wks Vomiting (nonbloody, nonbilious) projectile palpable "olive" shaped pylorus visible peristalsis

what are the pylorus size criteria?

Muscle thickness >3mm (3-4mm) Channel length >17mm ( 14-24mm) cross section diameter 15mm

what is the criteria for intussusception?

``` 6m-3 yrs intermittent abd pain right sided mass vomiting lethargy and irritability ( may be only symptom) ```

Intussusception in the long view looks like

Pseudokidney

Intussussception in the trans view looks like ?

a target sign

the strap muscles are ______ to the thyroid

the sternocleidomastoid are ______ to the thyroid

anterolateral

the CCA and IJV are ______ to the thyroid

lateral

the minor neurovascular bundle is ______ to the thyroid

postetior

the longus colli muscle is ______ to the thyroid

posterior

the parathyroid glands are ______ to the thyroid

posterior

what are the glands that regulate the thyroid hormones

Thyroid (T4, T3) Pituitary (TSH) Hypothalamus (thyrotropin releasing hormone) TRH

with a normal funtioning pituitary and hypothalamus __________goes up and _________ go down, this is considered hypothyroidism

TSH ↑ | T3, T4↓

with a normal funtioning pituitary and hypothalamus __________ goes down and ___________ goes up this is considered Hyperthyroidism

TSH↓ | T3,T4 ↑

Spreads to the lymphatics to nearby lymphoceles

Papillary carcinoma

spreads via the bloodstream

Follicular carcinoma

Secretes calcitonin and is associated with multiple endocrine Neoplasia syndrome

Medullary carcinoma

what are the features associated with thyroid cancer

``` microcalcification solid hypoechogenicity Irregular margins Absence of halo Intranodule central vascularity taller than wider ```

Primary Hyperparathyroidsm (parathyroid adenoma) increases __________ and ___________

↑serum parathyroid hormone (parathyroid hyperplasia) | ↑ serum calcium

Secondary hyperparathyroidism ( parathyroid hyperplasia) had increased ____________ and decreased ___________

↑serun Phosphates | serum calcium

Cystic hygromas are associated with?

Turner syndrome Trisomy 21,18,13 Klinefelter syndrome (xxy)

name the vessels of the aortic arch?

innominate artery (brachiocephalic)(rt carotid & rt subclavian) Left common carotid artery left subclavian artery

There is only ____ innominate ( rt) artery and _____ innominate veins

one and two

in the abscence of gas within a collection , differentiation of and abscess from a hematoma is by

percutaneous aspiration

what are the risk factors for hip dysplasia

``` Female First born Frank breech presentation Family history of DDH Oligohydramnios ```

a stress maneuver where dislocation of the hip by adducting and pushing the leg posteriorly

Barlow

Stress maneuver where relocation of the dislocated hip by abducting the legs, a palpable "clunk" is noted as the femoral head slips back into the socket

Ortolani

Beta angle is

Alpha angle is

>60 degrees

lymphoma is noted to displace the IVC and SMA

anteriorly

a result of bleeding from the superior and inferior epigastric vessels (superior and inferior to umbilicus) or from a tear of the rectus muscle a recognized complication of anticoagulation therapy

Rectus sheath hematoma

labs found in hepatitis

↑ALT(SGPT) ↑AST(SGOT) ↑CONJUGATED BILIRUBIN ↑UNCONJUGATED BILIRUBIN

labs found in Amebic abscess

↑LFT'S

labs found in Cirrhosis:

``` ↑ALT(SGPT) ↑AST(SGOT) ↑CONJUGATED BILIRUBIN ↑GGT ↑LDH ```

labs found in Hepatocellular carcinoma (HCC)

↑ALT(SGPT) ↑AST(SGOT) ↑ALPHA FETOPROTEIN

labs found in hepatoblastoma

↑ALPHA FETOPROTEIN

↑GGT + ↑ALP=

biliary obstruction

↑GGT + ↑ALT=

hepatocellular disease

labs with biliary obstruction and Choledocholithiasis

↑GGT ↑ALP ↑CONJUGATED BILIRUBIN

Labs with cholangitis

``` ↑CONJUGATED BILIRUBIN ↑ALP ↑GGT ↑AMYLASE ↑LIPASE ↑WBC ```

labs with Primary sclerosing Cholangitis

``` ↑ALT(SGPT) ↑AST(SGOT) ↑CONJUGATED BILIRUBIN ↑GGT ↑ALP (dominates profile) ```

labs in Primary BIliary Cirrhosis

``` ↑ALT(SGPT) ↑AST(SGOT) ↑ALP ↑GGT ↑ANTIMICROBIAL ANTIBODIES (AMA'S) hallmark ```

labs in acute attacks of pancratitis

serum amylase | serum lipase

labs in pancreatic carcinoma

``` ↑CONJUGATED BILIRUBIN ↑ALP ↑GGT ↑serum amylase ↑serum lipase ```

what raises later and lasts longer

Lipase

Labs for a seminoma

↑Beta hCG | ↑LDH

labs for a neuroblastoma

↑epinephrine ↑Norepinephrine ↑dopamine

Lab analysis for a paracentesis or a thoracentesis should include

``` Total protein LDH Cell count and differantial Gram stain Aerobic and Anaerobic bacterial cultures cytology ```

the left lateral is segments

II and III

the left medial is segments

IVa and IVb

the right anterior is segments

V and VIII

the right posterior is segments

VI and Vii

the right hepatic lobe is supplies by the

right portal vein

the left hepatic lobe is supplied by the

left portal vein

the caudate lobe is supplied by

both right and left portal veins

the caudate lobe is posterior to the

ligamentum venosum and porta hepatis

the caudate lobe is anterior and medial to

the IVC

the caudate lobe is lateral to

the lesser sac

in the event of caudate enlargement the IVC may be

compressed

Which lab value is most sensitive to hepatocellular disease?

ALT

An increase in AST without ALT is seen with

Myocardial infarction

Which lab value is specific for obstructive jaundice?

Conjugated(direct)

abd 3 Flashcards

(167 cards)