Chapter 1 - abdominal sonography Flashcards by Gabriella Santangelo

Normal echogencity of the abdominal organs from greatest (Brightest) to least (darkest) as follows

renal sinus –> pancreas –> spleen –> liver –> renal core –> renal pyramids –> gallbladder

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without echoes
example : gallbladder ; simple renal cyst

anechoic

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having both cystic and solid components
ex : hemorrhagic cyst ; hepatic access

complex

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structure that produces echoes
ex: fatty liver ; chronic renal disease

echogenic

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of differing composition
ex: graves disease ; diffuse liver metastasis

heterogeneous

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of uniform composition
ex: normal liver ; normal testicle

homogenous

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having many echoes
ex: cavernous hemangioma ; angiomyolipoma

hyperechoic

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having few echoes
ex: hepatic adenoma ; thyroid adenoma

hypoechoic

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having the same echogeniciy
ex: jocular nodular hyperplasia

isoechoic

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demonstrate smooth walls and are round in shape

star criteria

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patients who have some form of itis or infection will have an increased

white blood cell count

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_____ organs release hormones into the blood stream, where as _____ organs use ducts.

Endocrine
Exocrine

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occurs when the sound beam strikes a structure in a no perpendicular manner resulting in a loss of the true echogenicity of the structure
ex ; tendons

Anistrophy

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a type of reverberation caused by several small highly reflective interfaces ; ex seen with adenomyomatosis of the GB

Comet tail

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caused by air or bowel gas – ex most often seen emanating from bowel may be seen posterior to gas within an abscess – dirty shadow most often emanating from bowel, clean shadow most often emanating from gallstone

Dirty shadowing

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reflective or refractive effect seen deep to the margins of a round structure that have a significantly different speed of sound compared to surrounding tissue, may be termed as refractive shadowing – exc often seen arising rom cystic structures and appears as narrow shadow lines originating at the edge of these structures

Edge shadowing

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produced by a strong specular reflector and results in a copy of the anatomy being placed deeper than the correct location – ex seen posterior to the liver and diaphragm

Mirror image

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produced when the sound beam is barely attenuated through a fluid or fluid filled structure ; ex seen posterior to fluid-filled structures as the GB and renal cysts and ascites

posterior acoustic enhancement or through transmission

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– caused by the bending of the ultrasound beam when it passes through an interface between two tissues with vastly dissimilar speeds of sound and the angle of the approach is not perpendicular – ex seen when imaging rectus muscles of abdominal wall

refraction

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caused by a large acoustic interface and subsequent production of false echoes – ex seen as an echogenic region in the anterior aspect of the GB or other fluid filled structures

reverberation

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artifact that appears as a solid streak or a chain of parallel bands radiating away from a structure ; ex deen emanating from gas bubble within the abdomen ex can help in case of pnuembilia

ring down

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caused by attenuation of the sound beam ; ex seen posterior to bone and calculi like gallstones and renal stones

shadowing

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caused by sound beams that are peripheral to the main sound beam – ex ; seen as low level echoes with flud, mimicking sludge , debris or pus within a fluid-filled structure like GB

side lobes

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caused by compression from 3D to 2D images – ex – can stimulate false echoes that could resemble sludge or debris in the urinary bladder or gallbladder

slice thickness

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occurs behind strong granular and irregular surfaces like crystals , calculi or calcifications ex can be seen and useful at identifying a small kidney or biliary stone

twinkle artifact

Supplies the body with oxygen, nutrients, hormones and WBCS and removes waste and toxins by pumping and transferring blood ex: arteries. and arterioles capillaries heart veins and venules

Cardiovascular

Provides metabolism, nutrient uptake, energy storage and the extortion of waste Accessory digestive organs : Liver, GB, Pancreas Esophagus, mouth, small and large bowel , stomach

Digestive

Secretes hormones or juices through ducts ex : breast pancreas salivary glands (parotid glands, submandibular glands, and sublingual glands) liver

EXOCRINE

Secretion of hormones into the blood to control many different body functions. The hypothalamus in the brain controls the pituitary glands secretion of various hormones which in turn controls the secretion of hormones by endocrine organs or glands ex: ALOPPPPTT adrenal glands liver ovaries pancreas parathyroid glands pineal gland pituatirary gland (anterior and posterior) testicles thyroid gland

ENDOCRINE

Collection and transportation of excess fluid, absorption of fats (which are eventually sent to the liver) and immune response ex: A BOY LEFT SCHOOL TOGO TOUR adenoids bone marrow lymph node spleen thymus gland tonsils

Lymphatic

provides the structural support system for the body ex: cartilage connective tissue joints ligaments muscles tendons

MSK

controls almost every organ system and structure in the body ex: brain spinal cord nerves

Nervous

Supplies the body with oxygen and removes carbon dioxide from the blood ex: bronchus larynx lungs nasal cavity pharnyx trachea

Respiratory

Produces new life ex: Male - epipydmyis, prostate gland, scrotum , testes, vas deferens Female - Fallopian tubes , ovaries, uterus, vagina

Reproductive

Maintain chemical and water balance, regulate blood pressure and filter waste products from the blood ex: kidneys ureters urethra urinary bladder

Urinary

Intraperitoneal organs (GLOSS)

Gallblader Liver Ovaries Spleen stomach

Retroperitoneal organs (AAAADIKPPUUU)

adrenal glands abdominal lymph nodes aorta ascending colon descending colon IVC kidneys pancreas prostate gland ureters uterus urinary bladder

Inferior to the diaphgram divides into Rt & Left

Subherenic spaces

Divides into right anterior & posterior and left. Right is located between Rt lobe of liver and right kidney posterior subhepatic space also referred to as Morrisons pouch

Subhepatic spaces

Between pubic bone and urinary bladder also referred to as space of Retzius

Retropubic space

between stomach and pancreas, common location for pancreatic psudeocysts

Lesser sac

extend alongside the ascending and descending colon on both of the abdomen

Paracolic gutters

Male : between urinary bladder and rectum (rectovesical pouch) Female : between uterus and rectum (Pouch of Douglas, rectouterine pouch)

Posterior-cul-de-sac

Between urinary bladder and uterus, also called vescouterine pouch in females

anterior-cul-de-sac

Pathologies Associated with Ascites

Acute cholecystitis Cirrhosis Congestive heart failure ectopic pregnancy malignancy portal hypertension reputure of abdominal aortic anyersum

tumor of glandular organ location - most organs Benign

Adenoma

Tumor containing adrenal tissue location - testicle benign

Adrenal rest tumor

Tumor of blood vessels , muscle and fat Location – kidney Benign

Angiomyolipoma

abnormal accumulation of cells within a focal region of an organ Location – liver Benign

Focular nodular hyperplasia

tumor consisting of a group of inclammtory cells Location – liver and spleen benign

Granuloma

Tumor that secretes gastrin Location – pancreas benign

Gastrinoma

tumor consisting of an overgrowth of normal cells of an organ Location – kidney benign

Hamartoma

tumor consisting of blood vessels Location – liver, spleen and kidney benign

Hemangioma

Localized collection of blood location - a anywhere an organ/tissue is affected by trauma benign

Hematoma

Tumor that secretes insulin location - pancreas benign

Insulinoma

tumor that consists of fat location - liver spleen kidney and superficial benign

lipoma

tumor consisting of onocytes location - kidney benign

Oncocytoma

tumro consisting of chromaffin cells of adrenal gland location - adrenal gland benign

phecromocytoma

tumors that consist of three germ cell layers location - testicle/ovary benign

teratoma

localized collection of urine location - adjacent to kidney transplant benign

urinoma

cancer of glandular origin location - pancreas and GI tract malignant

adenocarcinoma

cancer in the lining of vessels (lymphatic or vascular) location - spleen malignant

angiosarcoma

cancer that consists of trophoblastic cells location - testicle malignant

choriocarcinoma

cancer of the bile ducts Location : biliary Tree malignant

cholangiocarcinoma

cancer that is fundamentally adenocarcinoma with cystic components Location : Pancreas malignant

cystadenocarcinoma

cancer that is germ cell origin Location : Testicle malignant

embryonal cell carcinoma

cancer of aggressive abnormal epithelial cells Location : thyroid malignant

follicular carcinoma

cancer that originates the hepatocytes Location : liver malignant

hepatocellular carcinoma (hepatoma)

cancer that originates in the tubules of the kidney Location : Kidney malignant

hypernephroma (renal cell carcinoma)

cancer of the blood cells Location : spleen, liver and testicle MALIGNANT

LEUKEMIA

cancer of the lympathic system Location: spleen kidney and testicle malignant

lymphoma

cancer originating from the parafollicular cells of the thyroid Location : thyroid malignant

medullary carcinoma

cancer that has formation of many irregular fingerlike projection Location : thyroid malignant

papillary carcinoma

cancer that originates in the seminiferous tubules Location : Testicle malignant

seminoma

– cancer that orginates in the transitional epeitehilum of an organ or struct Location : bladder, urerter ; kidney malignant

transitional cell carcinoma

cancer that is of germ cell orgin Location : testicle malignant

yolk sac tumor

pediatric malignant liver tumor

hepatoblastoma

pediatric malignant kidney tumor

nephroblastoma (WILMS TUMOR)

pediatric adrenal gland malignant tumor

neuroblastoma

tumor marker for liver ovarian and testicular cancers

AFP

breast tumor marker

CA 15-3

tumor marker for pancreatic billiary tract stomach colon

CA 19-9

ovarian tumor marker

Ca-125

medullary thyroid cancer tumor marker

calcitonin

testicular cancer and germ cell tumor marker

Beta- HCG

testicular ovarian and other germ cell tumors

LDH

inherited condition that causes cysts in multiple organs usually seen in adults later in life. Location : kidneys, liver, spleen and pancreas

ADPKD

inherited condition that causes cysts in the kidneys, renal failure and hepatic fibrosis, usually discovered in utero or in new borns Location : kidneys and liver

ARPKD

virus that attacks the immune system Location : liver, spleen, lymph nodes and skin tumors (karposi sarcoma)

HIV & AIDS

growth disorder that causes enlargement of many organs and structures ; increased risk for kidney and cancer in children Location : skull, abdominal visceromegaly, and tongue (macroglossia

Beckwidth Weidemann syndrome

narrowing or occlusion of the hepatic veins and IVC Location : liver and IVC

Budd-Chiari

results from high levels of aldosterone can be caused by adrenal adenoma Location : adrenal glands

Conn syndrome

autoimmune disease that causes chronic inflammation of the GI Location : GI tract

Chrohns disease

results from high levels of vortisol can be caused ny adrenal adenoma Location : adrenal glands

Cushing syndrome

caused by hyposecretion or hypoactivity of insulin Type 1 – early onset (juvenile or young adult) Type 2 – Adult onset Location : multiple organs include ; eyes extremities, kidneys nerves and vasculature

Diabetes

rare complication of PID causing inflammation around tissue of liver Location : liver

Fitz Hugh Curtis syndrome

associatd with hyperthyroidism Location thyroid

Graves disease

associated with hypothyroidism Location: thyroid

Hashimoto disease

genetic condition in which a male has an extra X chromosome Location : testicle and male breast

Klinefelter syndrome

disorder of the connective tissue Location : heart, vasculature structures and skeleton

Marfan syndrome

jaundice pain, and fever associated with a stone lodged in the cystic duct Location : liver, GB and biliary tract

Mirizzi syndrome

– damaged filtration of kidney causes excessive protein in the urine (proteinuria) Location : kidneys, swlling of feet and ankles

Nephrotic syndrome

infllammtory disease that results in scar tissue development in multiple organs Location : liver, spleen, kidneys, testicles , lymphatics and lungs

Sarcoidosiss

rare genetic disorder that leads to development of tumros within various organs Location : lungs, lymphatics and testicles

Tuberculosis

rare genetic disorder that leads to development of tumors within various organs Location – brain, heart and kidneys (angiomyolipoma)

Tuberous sclerosis

rare genetic disorder characterized by cysts and tumors in various organs Location : pancreas, kidneys and adrenal glands

Von-hippel-lindau disease

tumor (gatsrinoma_ in the pancreas of intestine that causes an increase in the roduction of gastrin Location : prancreas and stomach ( produces excessive

Zollinger - Ellison syndrome

1. Transitional cell carcinoma is commonly found in all of the following locations except a. Liver b. Renal pelvis c. Urinary bladder d. Ureter

2. A patient with cholecystis most likely has an elevation in which of the following labs a. Afp b. Wbc count c. Lactate dehydrogenase d. Chromaffin

3. The neuroblastoma is a malignant pediatric mass commonly found in the a. Kidney b. Liver c. Testicle d. Adrenal gland

4. What is a substance produced by a cancerous tumor or an organ or structure in response to cancer a. Onocyte b. Tumor marker c. Lymphadenopathy d. Homestatin

5. The pheochromocytoma is a benign mass commonly located in the a. Testicle b. Thyroid gland c. Adrenal gland d. Liver

6. A tumor that is of similar echotexture to normal liver tissue is discovered in the liver of an aysymptomatic patient. What is the echogenicity of the tumor a. Echogenic b. Hypoechoic c. Isoechoic d. Hypodense

7. Which of the following is not considered to be an intraperitoneal organ a. Liver b. Pancreas c. Gallbladder d. Spleen

8. Which of the following are not considered retroperitoneal organs a. Abdominal lymph nodes b. Adrenal glands c. Kidneys d. Ovaries

9. What is another name for Morrison pouch A. posterior right subhepatic space B. Posterior cul-de-sac C. Anterior subhepatic space D. Anterior cul de sac

10. The hypernephroma may also be referred to as the A. Nephroblastoma B. Neuroblastoma C. Hepatocellular carcinoma D. Renal cell carcinoma

11. A type of reverberation artifact caused by several small, highly reflective interfaces such as gas bubble describes a. Mirror image b. Posterior shadowing c. Comet tail artifact d. Ring-down artifact

12. The term choloangiocarcinoma denotes a. Bile duct carcinoma b. Hepatic carcinoma c. Pancreatic carcinoma d. Splenic carcinoma

13. Which of the following occurs when the doppler sampling rate (PRF) is not high enough to display the doppler frequency shift a. Doppler noise b. Aliasing c. Mirror image d. Twinkle artifact

14. The hepatoma is a a. Benign tumor of the spleen b. Benign tumor of the liver c. Malignant tumor of the panvrea d. Malignat tumor of the liver

15. The hepatoblastoma is a A. Benign tumor of the pediatric liver B. Malignant tumor of the adult liver C. Malignant tumor of the pediatric liver D. Malignant tumor of the pediatric adrenal gland

16. Which of the fllowing is the space located between the pancreas and the stomach A. Morrison’s pouch B. Lesser sac C. Space of retzius D. Pouch of douglas

17. Which of the following is another name for the wilms tumor a. Nephroblastoma b. Hepatoblastoma c. Neuroblastoma d. Hepatoma

18. An angiosarcoma would most likely be discovered in the a. Rectum b. Gallbladder c. Spleen d. Pancreas

19. Which of the following is not an endocrine organ or structure a. Thymus b. Pancreas c. Thyroid d. Spleen

20. Which of the following is an artifact that alters the echogenicity of a tendon a. Acoustic enhancement b. Anistrophy c. Ring down artifact d. Mirror image artifact

21. The gastrinoma would most likely be discovered in the a. Pancreas b. Adrenal gland c. Stomach d. Spleen

22. Of the list below which is considered to be an intraperitoneal organ a. Left kidney b. Aorta c. IVC d. Liver

23. Which of the following is considered to be a malignant testicular neoplasm a. Neuroblastoma b. Hepatoma c. Yolk sac tumor d. Hamartoma

24. Which of the following is caused by the bending of the ultrasound beam when it passes through an interface between two tissues with vastly dissimilar speeds of sound and the angle of the approach is not perpedincular a. Comet tail b. Refraction c. Reverberation d. Acoustic enhancement

25. These potential spaces extend alongside the ascending and descending colon on both sides of the abdomen a. Parcolic gutters b. Periumbilical gutters c. Greater gutters d. Pericentric gutters

26. This common tumor of the kidney , contains blood. Vessels , muscle and fat a. Hemangioma b. Angiomyolipoma c. Oncocytoma d. Lipoma

27. Which of the following is not a salivary gland a. Thyroid gland b. Parotid gland c. Submandibular glanf d. Sublingual land

28. Which of the following is not a pediatric malignant tumor a. Hepatoblastoma b. Neuroblastoma c. Pheochromocytoma d. Nephroblastoma

29. A tumor that consists of tissue from all three germ cell layers is the a. Pheochromocytoma b. Hamartoma c. Adrenal rest tumor d. Teratoma

30. Which of the following lab values would be most hekpful in evaluating a patient who had suffered from recent trauma a. Wbc count b. Afp c. BUN d. Hematocrit

31. The insulinoma is a a. Malignant pediatric adrenal tumor b. Benign pancreatic tumor c. Malignant pancreatic tumor d. Benign liver tumor

32. A tumor that consists of a group of inflammatory cells best describes the a. Hematoma b. Hepatoma c. Lymphoma d. Granuloma

33. A tumor that. Consist of a focal collection of blood best describes the a. Hematoma b. Hamartoma c. Lipoma d. Angiomyolipoma

34. Which of the following is a tumor marker that may be used in cases of suspected testicular malignancy a. Bun b. Creatnening c. Hcg d. Calcitonin

35. The malignant testicular tumor that consists of trophoblastic cells is the a. Choriocarcinoma b. Yolk sac tumor c. Teratoma d. Insulinoma

36. What is the artifact likely encountered posterior to a gallstone a. Acoustic enhacment b. Shadowing c. Ring down d. Reverberation

37. A collection of abdominal fluid within the peritoneal cavity often associated with c ancer is termed a. Transudate ascites b. Chromaffin ascites c. Peritoneal d. Exudate ascites

38. Which of the following is not a rule of surgical asepsis a. If you recognoxe that an item has become nonsterile act immediately b. If one sterile person must pass another, they must pass face to face c. A sterile field must never be left unmonitored. If a sterile field is left unattended it is considered non sterile d. A sterile person does not lean a across a sterile field

39. Which of the following occurs behind a strong granular and irregular surfaces like cyrstals, calculi or calcifactions such as a kidney stone a. Twinkle artifact b. Refraction c. Anistrophy d. Side lobes

40. Which of the following has both endcrine and an exocrine function a. Adrenal gland b. Spleen c. Pancreas d. Duodenum

Chapter 1 - abdominal sonography Flashcards

(147 cards)