Normal Anatomy (Midterm) Flashcards
1
Q
Intersegmental
A
-definite division between borders (ex. hepatic veins)
2
Q
Intrasegmental
A
-border between is unclear (ex. portal veins)
3
Q
What should the liver measure, and where do you measure?
A
- 13 to 17 cm
- measure posterior/superior to anterior/inferior
4
Q
What is the shape of the Lt lobe of the liver?
A
-flag shaped
5
Q
How does the liver appear?
A
- echogenic
- homogenous
- smooth contour
6
Q
How does the liver look compared to the spleen?
A
-the liver is hypoechoic to the spleen
7
Q
How does the liver look compared to the kidney?
A
-the liver is hyperechoic or isoechoic to the kidney
8
Q
What is the difference in appearance of hepatic veins and portal veins and their walls?
A
Hepatic Veins:
-larger and wider as they get closer to IVC
Portal Veins:
- very parallel
- look more echogenic
9
Q
Vasculature of Liver
A
- hepatic veins
- portal veins
- hepatic arteries
10
Q
What does the falciform ligament separate?
A
-Rt and Lt lobes
11
Q
What does the ligamentum venousum separate?
A
-Lt lobe from caudate lobe
12
Q
Which ligament divides the Lt lobe into medial and lateral?
A
-ligamentum teres (round ligament)
13
Q
Where is the hepatoduodenal ligament?
A
-porta hepatis (enterance to liver)
14
Q
Where is the gastrohepatic ligament?
A
-connects lesser curvature of stomach to the liver
15
Q
What do the Rt and Lt triangular ligaments do?
A
-connect the liver to body wall
16
Q
Bare Area
A
- posterior, superior aspect of liver
- direct contact with diaphragm
- only part of the liver not covered by peritoneum
17
Q
Main Lobar Fissure
A
- roughly divides liver into Lt and Rt
- MHV and MPV run within it
- echogenic line that runs from GB to RPV
18
Q
What does the LHV separate?
A
-Lt lateral and Lt medial lobes
19
Q
What does the RHV separate?
A
-Rt anterior and Rt posterior lobes
20
Q
What does the MHV separate?
A
-left and right lobes
21
Q
What are the 3 lobes of the liver?
A
1) left
2) right
3) caudate
4) quadrate (sometimes 4)
22
Q
What is the most basic way to divide the liver?
A
-Lt and Rt lobes
23
Q
Portal Triad
A
- hepatic arteries
- portal veins
- bile ducts
24
Q
Porta Hepatis
A
- proper hepatic artery
- main portal vein
- common bile duct
25
Gallbladder Layers
- fibrous outer layer (outer layer)
- smooth muscle layer (mid)
- mucous membrane (inner)
26
What is the best imaging modality for the biliary system?
-ultrasound
27
What should the CBD measure?
-less than 7mm
28
Couinaud's Segments
- universal description for hepatic lesion localization
- based on portal segments
- functional and pathological importance
- each segment has: blood supply, lymphatic and biliary drainage
- 8 segments
29
Which segment is the left lateral superior?
2
30
Which segment is the Lt lateral inferior?
3
31
Which segment is the Lt medial superior?
4A
32
Which segment is the Lt medial inferior?
4B
33
Which segment is the Rt anterior superior?
8
34
Which segment is the Rt anterior inferior?
5
35
Which segment is the Rt posterior superior?
7
36
Which segment is the Rt posterior inferior?
6
37
Which segment is the caudate lobe?
1
38
Function of the Liver
- detoxification
- metabolic break down
- remove old blood cells
- recycle iron
- secrete bile (approx. 1/2 pint per day)
- stores substances (vitamin A, vitamin B12, vitamin D and iron)
- production of plasma proteins
- hematopoiesis (in fetal life)
39
Which 3 cells is the liver composed of?
- functioning hepatocytes
- kupffer cells
- biliary epithelial cells
40
Functioning Hepatocytes
- detoxification
| - form bile (aids in digestion of fats)
41
Kupffer Cells
- also found in spleen
- immunity
- protect hepatocytes
42
Biliary Epithelial Cells
-lines the biliary ducts
43
Dual Blood Supply of Liver
- portal veins
| - hepatic arteries
44
Portal Veins (Hepatic Circulation)
- supply up to half the oxygen requirements (even though the portal venous system is completely oxygenated)
- provides 70 to 80% of the blood supply
- greater flow
45
Portal System
- transports nutrients from intestines to liver
- hepatocytes metabolize and store
- blood is filtered in the liver before it dumps into systemic circulation
46
Hepatic Arteries
- accompany PV's
- very small compared to PV's
- not well seen in US
- 20 to 30% of liver's blood supply
- provide oxygen to the liver
47
Ducts
- carry bile (helps with digestion)
- very small within the liver (sometimes seen along PV's)
- bile is brought by these ducts to the duodenum to help digest food
48
Location of GB
- intraperitoneal
- lies within 'GB fossa'
- RUQ
- posterior inferior aspect of liver
49
Main Lobar Fissure
- separates Rt and Lt lobes
- extends origin of RPV and the GB fossa
- fissure seen in approx. 70% of patients
- landmark for GB fossa
50
What parts is the GB divided into?
- fundus
- body
- neck
51
How does the GB connect to the biliary system?
-cystic duct
52
Which 2 ducts join to form the CBD?
- cystic duct
| - common hepatic duct
53
Cystic duct
- contains valves of Heister (mucosal folds that prevent it from collapsing)
- extrahepatic
54
Bile
- secreted by liver
- stored and concentrated by GB
- aids in digestion, especially breaking down fat
- biliary tree excretes bile into duodenum
55
What happens to the GB after eating?
-contracts and the bile travels via ducts to the duodenum
56
Which hormones stimulate the biliary tree to contract?
- CCK
| - secretin
57
GB Function
- able to expand
- acts as a reservoir
- squeezes out contents on demand
58
What is the normal size of the GB?
-less than 4cm transverse
59
What is the normal wall thickness of the GB?
-less than 3mm
60
What is the echogenicity of the GB?
- lumen is anechoic
| - walls are hyperechoic or echogenic
61
What is the contour of the GB?
-smooth
62
What is the sonographic appearance of the GB in sagittal?
- anechoic, pear shaped structure
- echogenic walls
- in SAG should see whole length (neck, body, fundus)
63
What is the sonographic appearance of the GB in TRV?
- round/oval anechoic structure
- echogenic walls
- appears similar to the AO and IVC
64
How will a non fasting GB appear?
- non distending
- anechoic lumen, but can contain echoes
- thicker walls
- can be mistaken for bowel or a pathology
65
What are typical patient positions for the GB?
- supine
| - Lt lateral decubitus
66
Which windows are used for the liver?
- anterior (subcostal approach)
| - intercostal
67
What may cause difficulty while scanning the GB?
- reverberation
| - bowel gas
68
What can affect the size of the CBD?
- age
| - surgery
69
Normal Embryology of GB
- first is intrahepatic and migrates to liver surface
| - 50 to 70% covered with adventitial tissue (common area to see edema)
70
Intrahepatic GB
- anomaly
- if GB does not migrate
- very rare
- may pose problems for laparoscopic surgery
71
Torsion of GB
- anomaly
- GB fully enveloped in visceral peritoneum
- hanging from mesentery
- increased mobility
72
Agenisis GB
- anomaly
| - rare
73
Ectopic Positions GB
- anomaly
| - suprahepatic, suprarenal, within abdominal wall, in falciform ligament
74
Septate GB
- normal variant
| - 2 or more intercommunicating compartments divided by thin septa
75
GB Duplication
- usually occurs with duplication of cystic duct
- normal variant
- 2 non communicating anechoic structures
76
Phrygian Cap
- normal variant in GB
- kink in fundus
- looks like smurfs hat
77
What is a normal variation of ducts in the GB?
-CHD/CBD is seen inferior to the HA
78
Are the kidneys intraperitoneal or retroperitoneal?
-retroperitoneal
79
Which quadrant are the kidneys located in?
-RUQ
80
Where does the spleen lie in relation to the Lt kidney?
-superior
81
Where does the liver lie in relation to the Rt kidney?
-superior and anterior
82
External Layers of Kidney's
1) renal capsule (aka true capsule, fibrous capsule)
- tough fibrous capsule
2) perirenal fat (aka perinephric fat, adipose capsule, packing fat of zuckerkandl)
- surrounds capsule
3) gerota's fascia (aka perirenal fascia, perinephric fascia)
- anchor's the kidney's
4) pararenal fat/body
83
Anterior Pararenal Space (retroperitoneum)
-fat area between the posterior peritoneum and Gerota's fascia
84
What organs and vessels are in the anterior pararenal space (retroperitoneum)?
- pancreas
- descending duodenum
- ascending and descending colon
- superior mesenteric vessels
- inferior portion of CBD
85
Posterior Pararenal Space
-between gerota's fascia and the posterior abdominal wall muscles
86
What is the the posterior pararenal space?
- iliopsoas
- QL
- posterior abdominal wall
- fat
- nerves
87
Perirenal Space
-separated from the pararenal space by gerota's fascia
88
What is in the perirenal space?
- kidneys
- adrenal glands
- perinephric fat
- ureters
- renal vessels
- aorta and IVC
- lymph nodes
89
What do the pararenal and perirenal fat accommodate for?
-movement during respiration
90
What 2 areas is the kidney divided into?
- renal parenchyma
| - central sinus
91
Renal Parenchyma
- cortex
| - medulla
92
Central Sinus
- renal sinus
- renal hilum
- inner aspect
- blood vessels
- renal pelvis
- nerves
- fat
93
Renal Cortex
- outer portion
| - superficial layer of parenchyma
94
Medulla
- deep layer of parenchyma
- folds into projections (renal pyramid)
- renal pyramids
- renal columns
95
Renal Pyramids
- cone shaped (triangular) sections in medulla parenchyma
- 8 to 18
- base of pyramids is toward the outer kidney
- apices (tip) converge toward sinus
- renal papilla at the apices
96
Where are the renal columns?
-between the renal pyramids
97
Renal Hilum
- where the ureter, renal artery and renal vein leave the kidneys
- renal sinus is continous with the hilum
98
Are kidneys vascular?
-highly
99
What is the collecting system of the kidney?
-where urine flows out and makes it's way to the bladder, then out of the body
100
Parts of the Collecting System Within the Kidney
- minor calyces
- major calyces
- renal pelvis
- ureter
101
Kidney Contour
-smooth borders
102
Kidney Shape
- bean shape
- convex laterally
- concave medially
103
Kidney Size
- 11 cm in length
| - varies with size of person and age
104
Parenchymal Reduction
- cortex of kidney (outer layer) decreases with age
| - measure of AP thickness
105
Echogenicity of Kidney
- hypoechoic or isoechoic to the liver
| - hypoechoic to spleen
106
How would you determine if you are backwards in sagittal and transverse when scanning the kidney?
-hilum would be facing laterally, instead of medially
107
How do I know if I am sagittal medial, lateral or longest length?
medial- can see hilum
lateral- no hilum
-sweep back and forth to find longest axis
108
What should a TRV kidney look like?
upper pole- cortex and sinus
mid- at hilum
lower pole- cortex and sinus
109
Where do the adrenal glands sit?
-medial aspect of kidneys
110
Where is the Rt adrenal gland located?
- between IVC and UP of kidney
| - near liver
111
Where is the Lt adrenal gland located?
- near diaphragm
| - superioposterior border of spleen
112
What is another name for the adrenal glands?
-suprarenal
113
2 Main Parts of Adrenal Glands
Cortex
- 3 layers
- endocrine tissue
- coricosteroids
Medulla
- neurosecretory tissue
- catecholamines
114
Function of Adrenal Glands
- regulate homeostasis
- sodium and water balance
- fight or flight response
115
Adrenal Gland Lab Tests
- aldosterone
| - cortisol
116
Why don't we routinely image the adrenal glands in adults?
-difficult to visualize (small)
117
Why is it important to know the location of the adrenal glands?
-abnormalities can be detected with US
118
What do the adrenal glands look like on US in adults?
-thin hypoechoic layers, separated by hyperechoic layers
119
What do adrenal glands look like on paediatric patients?
- larger
- well visualized
- pyramid shape
120
Renal Functions
1) urine formation
- #1 function
- excrete metabolic waste from blood in the form of urine
2) homeostasis
- regulates water/salt and acid/base balance
3) endocrine gland
- secretes hormones
121
Basic Functional Unit of the Kidney's
- nephron
- approx. 1 million (microscopic)
- filter blood
- in the cortex and medulla
122
Cortical Nephron
- in cortex
| - shorter loop of henle
123
Juxtamedullary Nephrons
- in medulla
| - longer loops of henle
124
What is the renal corpuscle also known as?
- glomerulus
| - bowman's capsule
125
Where is the loop of henle located?
-medulla
126
What happens in the nephron?
Filtration: filters blood, produces urine
Tubular Reabsorption: substances needed by the body are reabsorbed into the blood
Tubular Secretion: waste products and excess water pass into collecting ducts as urine
127
What percentage of renal function may be lost before blood levels will be elevated on tests?
50%
128
Serum Creatinine
- formed in muscle in small amounts, passed into blood and excreted in urine
- increased creatinine causes a disturbance in function
129
BUN (blood urea nitrogen)
Urea- end product of protein metabolism (normally low)
BUN level increase = function or perfusion impared
- dehydration
- urinary tract obstructions
- mental confusion, disorientation or coma
130
Transient Pyelectasis
- normal
- when patient drinks a lot of water (well hydrated)
- calyces and pyramids are more anechoic and prominent
- resolve's after patient pees
- not normal if the whole collecting system is anechoic
131
3 Sets of Kidney's in Embryo
1) pronephros
2) mesonephros
3) metanephros
132
Pronephroi
- early in 4th week gestation
| - rudimentary and nonfunctioning
133
Mesonephroi
- late in 4th week
| - function as interim kidney's
134
Metanephroi
-permanent kidneys
135
What do the metanephroi (permanent kidney's develop from)?
- ureteric bud
| - metanephrogenic blastema
136
Ureteric Bud
- ureter
- renal pelvis
- calices
- collecting ducts
-ureteric bud interacts with and penetrates the metanephrogenic blastema
137
Hypertrophied Column of Bertin (HCB)
- normal variant
- usually on upper and middle thirds of kidney
- renal cortex is continuous with adjacent cortex
- contain pyramids
138
Junctional Cortical (parenchymal) Defect
- normal variant
- located anteriorly and superiorly
- traced medially to inferiorly into renal sinus
139
Extrarenal Pelvis
- normal variant
| - mildly dilated UPJ medial to hilum
140
Dromedary Hump
- normal variant
- bulge on lateral aspect of kidney
- not clinically significant
141
Lower Urinary System
- ureters and urethra function as a conduit's
| - bladder functions as a reservoir for urine
142
How long are the ureters?
-approx 25 to 30 cm
143
Where do the ureters course?
- inferiorly behind the parietal peritoneum
- anterior to the psoas
- crosses iliac vessels anterior to the SI joint
- enters inferior bladder
144
What are the layers of the ureters?
- inner mucosal layer
- medial layer of longitudinal and circular smooth muscle
- outer fibrous layer
145
Function of Ureters
-transorts urine to bladder by urethral peristalsis
146
Proximal Ureter
- leaves kidney
| - UPJ (ureteropelvic junction)
147
Distal Ureter
- enters bladder
| - UVJ (ureterovesicle junction)
148
Where is the bladder located?
- pelvic cavity
- retroperitoneal
- female: anterior to vagina, superior to uterus
- male: superior to prostate
149
Bladder Wall
- smooth muscle
| - inner layer forms folds (rugae)
150
Trigone
- ureters (corners)
| - urethral opening (anterior, lower corner)
151
Function of the Bladder
- reservoir for urine
| - expels urine from the body (aided by urehra)
152
Bladder Volume (cc) =
(L x W x H) x 0.523
153
How is the bladder measured?
SAG: long axis, diagonally
TRV: measure AP (height) and Rt to Lt (width)
-prevoid and postvoid volume
154
What does colour doppler help with when scanning the bladder?
- shows ureter jets at the UVJ
| - aids in proving no obstruction
155
What happens when the bladder grows?
- distal mesonephric ducts become part of the CT in trigone
| - ureters open into bladder
156
Anomalies Related to Growth of the Urinary Tract
- hypoplasia
- fetal lobulation
- compensatory hypertrophy
157
Hypoplasia
- under development
- small kidneys
- reduced nephrons
158
Persistant Fetal Lobulation
- normally present in children until 4 to 5 years of age
- persists in some adults (51%)
- smooth indentations
159
Compensatory Hypertrophy
- diffuse or focal
- diffuse: contralateral nephrectomy, renal agenesis, renal hypoplasia, renal atrophy, renal displasia
- focal: area of normal tissue enlarged in diseased kidney (looks like a mass)
160
Anomalies Related to Ascent of Kidney
- ectopia
- crossed renal ectopia
- horseshoe kidney
161
Renal Ectopia
- not in normal location
- pelvis or thorax
- no symptoms
- 50% of ectopic kidneys have reduced function
162
Possible Complications of Renal Ectopia
- infection
- stones
- blunt trauma
163
Renal Ectopia US
-not within renal fossae
164
Crossed Renal Ectopia
- displacement of 1 kidney to the opposite side
- 2 forms: fused (85% to 90%) OR lying on 1 side without fusion
- Lt kidney going to Rt is more common
165
Horseshoe Kidney
- fused lower poles at midline
- cancerous tumours are more likely to appear
- no treatment necessary if no symptoms
- may need surgery if symptoms
166
Symptoms of Horseshoe Kidney
- abd pain
- nausea
- stones
- UTI
167
Horseshoe Kidney US
- lower level than normal
| - bridge of renal tissue (isthmus) connecting 2 kidneys
168
Renal Agenesis
- failure of formation
| - unilateral or bilateral
169
Causes of Renal Agenesis
- anomaly of urethral bud
- absense of metanephrogenic blastema
- absense of urethral bud development
- absense of interaction and penetration of the urethral buds with metanephrogenic blastema
170
Supernumery Kidney
- anomaly of urethral bud
- rare
- extra kidney (smaller)
- location above, below or in front of normal kidney
- can be functioning
171
Symptoms of Supernumery Kidney
- pain
- fever
- hypertension
- palpable abd mass
172
Duplex Ureter System and Uretrocele
- complete or incomplete
- unilateral or bilateral
- congenital abnormality in distal ureter
- distal ureter balloons at UVJ forming a sac like pouch
- associated with duplication of collection system
173
Duplex Collecting System Complications
- uretral obstruction
| - reccurent UTI's
174
Treatment for Duplex Collecting System
-surgery
175
Congenital Megaureter
- more common in males
- results in functional ureteric obstruction
- Lt ureter is more common
176
Retrocaval Ureter
- abnormal embryogenesis of IVC
- ureter passes behind IVC before entering the pelvis
- usually Rt
- more common in males
- symptoms: Rt flank pain and UTI
177
Bladder Agenesis
- very rare anomaly
| - stillborn
178
Bladder Duplicaion
3 Types:
1) peritoneal fold
2) internal septum
3) transverse band: band of muscle that divides bladder into 2 cavities
179
Bladder Extrophy
- part of the bladder is present outside the body
- often inside out
- more common in males
- failure of abd wall to close during fetal development
180
Urachus
-remnant of the channel between the bladder and umbilicus
181
Uretral Diverticulum
-pocket/outpouching forms next to the urethra and connects with urethra
182
Renal Duplication Artifact
- result of sound beam refraction between lower portion of spleen or liver and adjacent fat
- Lt kidney of obese patients
183
What does renal duplication artifact sometimes look like?
- duplex collecting system
- suprarenal mass
- upper pole thickening
184
How can we resolve renal duplication artifact?
- change transducer position
| - using deep inspiration (liver and spleen as window)
185
What imaging modalities are used for the urinary system?
- IVP
- nuclear medicine
- CT
- US
186
IVP (intravenous pyelography)
- radiographic exam
- IV admin of contrast medium
- functional and anatomical info
- shows whole urinary tract on a few films
- ideal imaging calculi
187
Nucelar Medicine
- admin of IV radionuclide filtered through kidneys at a specific rate and concentration
- series of films demonstrate renal perfusion and function
- disadvantage: rely on renal function, demonstrates only gross anatomy
188
CT of Urinary Tract
- best detail
- can differentiate between different masses
- disadvantages: expensive, limited, ionizing radiation
189
Location of Spleen
- LUQ
- left hypochondriac
- intraperitoneal
190
What is the spleen in contact with superiorly, laterally and posteriorly?
-diaphragm
191
What is the inferiomedial aspect of the spleen in contact with?
-stomach, Lt kidney, pancreas and splenic flexure
192
Where is the spleen in relation to the stomach?
-posterior
193
Where is the spleen in relation to the pancreas tail?
-superior and lateral
194
What is the spleen surrounded by?
-fibrous capsule
195
What is the shape of the spleen?
- ovoid
| - convex superolaterally and concave inferomedially
196
Border's of the Spleen
- smooth: posterior, superior and lateral
| - gental indentations: medial
197
Hilum of Spleen
- splenic artery and vein enter and exit
| - highly vascular organ
198
What is the spleen composed of?
- white pulp
| - red pulp
199
Splenic Ligaments
- splenorenal ligament
- phrenicocolic ligament
- gastrosplenic ligament
**not usually seen, unless patient has ascites
200
Functions of Spleen
- defense (immunity)
- tissue repair
- hematopoeisis: monocytes and lymphocytes develop
- RBC and platelet destruction
- blood reservoir: pulp and sinus store blood
201
Can the spleen be congenitally absent?
Yes.
202
Can the spleen be surgically removed?
Yes.
203
What should you ask your patient before scanning the spleen?
- surgery
- trauma
- sickness
204
Size of Spleen
- eyeball
- compare to Lt kidney
- 11cm to 12cm long (8 to 13 is normal)
- 5 cm to 7cm AP
- dependant on centre and body height
205
Volume of Spleen
-60 to 200mL
206
Weight of Spleen
- less than 150 grams (80 to 300g is normal)
- decreases as we age
- smaller in women
207
Shape of Spleen
- convex superolaterally
| - concave inferomedially
208
Contour of Spleen
-smooth
209
Echogenicity of Spleen
-hyperechoic to liver and Lt kidney
210
Echotexture of Spleen
-parenchyma is homogenous
211
Is it normal to see calcified arteries in the spleen?
- yes
| - as the patient ages
212
What other imaging modalities can be useful for the spleen?
- CT
| - MRI
213
Accessory Spleen
- aka splenule
- normal variant/congenital anomaly
- most common
- homogenous, isoechoic mass, similar to the spleen
- found at hilum or inferior border
214
Asplenia
- complete absense
- rare
- congenital abnormality
215
Polysplenia
-multiple sm accessory spleens
216
Wandering Spleen
- migrated from it's normal location in the LUQ
- dorsal mesentery fails to fuse properly with posterior peritoneum
- lack of support ligaments
217
Ectopic Spleen
-out of position
218
How many lymph nodes do we have?
-500 to 600
219
Lympatics refers to...
- lymph
- lymphatic vessels
- lacteals
- lymph nodes
- spleen
- bone marrow
- thymus gland
220
Function of Lymphatic System
- collects and transports excess fluids and lymph from interstitial spaces back into the venous system
- absorbs fats from sm intestine and transports to liver
- stimulates lymphoid tissue and organs to produce cells that fight and dispose of foreign material (immune system)
221
Common Sites for Lymph Nodes
- paraaortic and paracaval (near great vessels)
- peripancreatic area
- portahepatic area
- renal hilar area
- mesenteric region
222
Lymph Node Appearance
- less than 1 cm
- ovoid
- cortex: hypoechoic
- hilum: hyperechoic, fatty
- AP is smaller that width or length
223
The prostate is posterior to...
-symphysis pubis
224
The prostate is anterior to...
-rectum
225
The prostate is inferior to...
- seminal vesicles
| - bladder
226
How is semen transported outside?
- epididymis
- vas deferens
- join seminal vesicles
- ejaculatory ducts
- urethra
227
Seminal Vesicles
- 2 hollow structures
- base of bladder
- superior to prostate
- inferior to vas deferens and ureters
228
Prostate
- small, chestnut shaped
- base: superior part
- apex: inferior part
229
Ejaculatory Ducts
-join urethra approx. mid way through prostate
230
Prostatic Urethra is Divided into...
- proximal
| - distal
231
Male Pelvic Ducts
-transport seminal fluid
232
Seminal Vesicles
-add secretions to seminal fluid
233
Prostate
-adds secretions to seminal fluid
234
Male Urethra
-conduit for semen and urine
235
Prostaticovesical Arteries
- from internal iliac arteries
| - prostatic and inferior vesicle artery
236
Inferior Vesicle Artery
-supplies the base of the bladder, seminal vesicles and ureter
237
Prostatic Artery
- branches to capsular and urethral arteries
| - supply prostate
238
Venous Supply of Male Pelvis
- network around sides and base of prostate
| - deep dorsal penile vein draining into the internal iliac veins
239
2 Regions of Prostate Gland
- fibromuscular region/stroma: smaller, anterior
| - glandular region: posterior
240
4 Zones of Prostate
- peripheral
- central
- transitional
- periurethral glandular
241
Peripheral Zone of Prostate
- largest
- 70% of glandular tissue
- 70% of cancers found here
- posterior, lateral and apical regions of the prostate
- resembles 'egg cup'
242
Central Zone of Prostate
- 25% of prostatic glandular tissue
- 5% of cancer located in central zone
- where the vas deferens and seminal vesicles enter
243
Transitional Zone of Prostate
- lateral aspects of proximal urethra
- 5% of glandular tissue
- 20% of cancers
244
Periurethral Glandular Zone of Prostate
-tissue that lines proximal prostatic urethra
245
Verumontanum
-divides prostatic urethra into proximal and distal where the ejaculatory ducts meet the urethra
246
Clinical Indications for Scanning Male Pelvis
- problem suspected: size, cancer, feel lump during rectal exam
- increased lab values: PSA
- urinary problems: nocturne, frequency, weak stream
247
DRE
-digital rectal exam
248
PSA
- prostate specific antigen
- blood test
- glycoprotein produced exclusively by the prostate
- increase: possible prostate cancer
- higher the elevation, the more likely it's cancer
249
Why is PSA not ideal?
- normal does not excuse cancer
- 20% to 40% have cancer with normal
- elevated does not definitely mean cancer
- prostate size increases, so does PSA
250
Serial PSA Tests
-check if levels change over time
251
What anatomy is assessed for a male pelvis US?
- prostate
- seminal vesicles
- bladder
252
What kind of US is used to better visualize the prostate?
TRUS
253
Why is an abd US not the best for prostate?
- limited to size, shape, weight
| - not detailed
254
Normal Prostate Size
weight = 20g
4cm (wide) x 3cm (AP) x 3.8cm (length)
volume x 0.523 = 23.8cc
255
Main Reasons for a TRUS
- prostate cancer evaluation
- biopsy
- guidance of procedures
256
Positioning for TRUS
- Lt lateral decub
- legs together and bent up
- DRE performed prior
257
Frequency of TRUS probe?
-7 to 11 MHz
258
Inner Prostate Gland (central)
- transitional
- anterior fibromuscular stroma
- glandular tissue
- internal urethral sphincter
- hypoechoic, heterogenous
259
Outer Prostate Gland (peripheral)
- peripheral zone
- central zone
- uniform, homogenous texture
- hyperechoic to inner gland
260
Surgical Capsule
- separates inner and outer prostate glands
- not a true capsule
- not always seen in young males
261
Sonographic Appearance of Seminal Vesicles
- multiseptated
| - hypoechoic
262
Sonographic Appearance of Vas Deferens
-adjacent to seminal vesicles
263
Benign Ductal Ectasia
- normal prostatic variant
- older men
- caused by atrophy and dilation of prostatic ducts
- single or grouped structures in peripheral zone
- 1 to 2mm diameter
264
Prostatic Calcifications and Corpora Amylacea
-normal variant
-older men
bright echogenic foci/clumps in prostate
265
Corpora Amylacea
- proteinaceous debris
| - sound attenuating preventing TRUS
