Module 14 : Abdominal Wall Flashcards
(33 cards)
1
Q
indications for abdominal wall ultrasound
A
- palpable mall
- surgical wound assessment
- trauma
- findings on other modalities
2
Q
scanning techniques
A
- high frequency linear transducer
- minimal pressure (standoff pad needed)
- no patient prep needed
3
Q
abdominal wall layers
A
- epidermis
- subcutaneous tissue
- muscle
4
Q
epidermis
A
- 1-4mm thick
- highly reflective appears echogenic
5
Q
subcutaneous layer
A
- fat
- variable thickness and echogenicity
- typically less echogenic than muscle
6
Q
factors that influence the echogenicty of fat
A
- water content
- increase water increase echogenicity
7
Q
muscle layer - anterior and lateral
A
- rectus abdominus
- linea alba
- arcuate line
- external oblique
- internal oblique
- transversus abdominus
8
Q
rectus abdominus
A
- paired midline MOST ANTERIOR
- originates at symphysis pubis and pubic crest and inserts into the diploid process
- separated by line alba in middle
- rectus sheath encloses the RA muscle formed by the aponeuroses of internal and external and transverses abdominus
- contains 3 tendinous insertions that attach rectus sheath anteriorly = localize hemtomas
9
Q
aponeuroses
A
- flat sheet of strong fibrous connective tissue that serve as tendons to attach muscle to fixed points
10
Q
linea alba
A
- fibrous band that extends from the diploid to symphysis pubis
- formed by aponeuroses of 3 lateral abdominal muscles
- wider above umbilicus
- echogenic
- creates refractive duplication artifact
11
Q
arcuate line
A
- point between umbilicus and symphysis pubis where posterior portion of rectus sheath passes in front of rectus muscle
12
Q
external oblique
A
- outer layer
- origin = outer surface of lower 8 ribs
- runs diagonally (outer jacket pocket)
13
Q
internal oblique
A
- lies deep to external oblique
- runs in diagonal fashion 90’ to external
- inner jacket pocket
14
Q
transversus abdominus
A
- deep to internal oblique
- run horizontal
- innermost
15
Q
sonographic appearance of muscle
A
- hypo echoic to sonolucent
- specular reflectors
- striated
16
Q
muscle layer - posterior wall
A
- psoas major
- quadratus lumborum
- iliacus
17
Q
psoas major
A
- fan shaped
- origin = sides of vertebral column
- inserts = lesser trochanters of femur
- appears hypo echoic and lateral to spine
18
Q
quadratus lumborum
A
- posterolateral to psoas
- flat muscle
- origin = iliac crest
- inserts = 12th rib and upper 4 lumbar vertebrae
- directly posterior to kidney
19
Q
iliacus
A
- origin = iliac fossa sacrum and SI joint
- inserts = psoas major and lesser trochanter
20
Q
inguinal canal
A
- obliquely oriented tunnel
+ runs inferior and medial - slit like passage way
- opening at each end
+ deep intgional ring / internal
+ superficial inguinal ring / external - contains spermatic cord and round ligament
- anterior wall formed by aponeurosis of external oblique
- posterior wall formed by transversalis fascia
21
Q
deep inguinal ring / internal
A
- opening at superior end of canal
- midway between anterior superior iliac spine ASIS and symphysis pubis
- defect in transversalis fascia
22
Q
superficial inguinal ring / external
A
- opening at inferior end of canal
- through external oblique aponeurosis
23
Q
diaphragm
A
- dome shaped partition separating the thorax from abdominal cavity
- muscle and tendon
- major active muscle of respiration
- originates at periphery of thoracic cage with 3 groupf of muscle fibre
+ lumbar spine (crura)
- right = broader and longer
- join in midline to form arcuate ligament
+ lower sternum
+ lower 6 ribds - 3 groups coverage radially and insert into central tendon
24
Q
diaphragm on ultrasound
A
- highly echogenic arc
25
crura on ultrasound
- thin hypo echoic band
- superior to celiac axis - anterior to aorta
- at celiac axis lateral to aorta
- poster to IVC
26
2 scanning approaches to assess pleural space
- abdominal approach (subcostal)
| - intercostal
27
2 windows used when scanning inferior aspect of pleural space - abdominal approach
- liver
| - spleen
28
normal thickness of diaphragm
- 5 mm
29
mirror image artifact
- evidence of absence of pleural effusion
| + if no reflection then fluid in pleural space
30
distance of pleural space to rib interface - intercostal
- pleural space within 1 cm from rib interface
31
visceral pleura ultrasound
- on the lungs
- bright linear interface
- moves with respiration
32
parietal pleura ultrasound
- weak echogenic line or obscured
| - hypo echoic separation of parietal and visceral pleural
33
gliding sign
- visceral pleura moving with long during respiration
