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995 Cards in this Set
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- Back
Couinaud's Anatomy |
Divided liver into 8 segments based on portal and hepatic vein distribution |
|
The right and left hepatic lobes are divided by |
A plane between the GB and IVC. The plane marks the division of the MPV into left and right branches
Transects IVC, middle hepatic vein, GB, and MPV bifurcation |
|
The left lobe is divided into |
Medial and Lateral Segments |
|
The right lobe is divided into |
Anterior and Posterior Segments |
|
The right lobe is supplied by |
The right portal vein |
|
The left lobe is supplied by |
The left portal vein |
|
The caudate lobe is supplied by |
Both the left and right portal veins |
|
The caudate lobe lies |
On the posterior/superior surface of the liver |
|
The caudate lobe lies between the |
IVC and medial left lobe of the liver |
|
The caudate lobe lies posterior to the |
Ligamentum venosum and porta hepatis |
|
The caudate lobe lies anterior and medial to |
The IVC |
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The caudate lobe lies lateral to |
The lesser sac |
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In the event of caudate lobe enlargement, the __ may be compressed |
The IVC may be compressed |
|
Intersegmental Vessels |
Course between the lobes and segments
Hepatic veins |
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The hepatic veins have __ walls |
Non-echogenic walls |
|
Intrasegmental Vessels |
Course to the center of each segment
Vessels of the portal triad |
|
The portal triad have __ walls |
Hyperechoic |
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Portal Triad Vessels |
Main Portal Vein Proper Hepatic Vein Common Hepatic Duct |
|
Oblique plane between the IVC and GB fossa |
Main lobar fissure
Divides the anterior segment of the right and medial segment of the left hepatic lobe |
|
Main lobar fissure landmarks |
GB IVC Middle Hepatic Vein |
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Divides right lobe into anterior and posterior segments |
Right intersegmental fissure |
|
Right intersegmental fissure landmark |
Right hepatic vein |
|
Divides left love into medial and lateral segments |
Left intersegmental fissure |
|
Left intersegmental fissure landmarks |
Left hepatic vein Ascending left portal vein Falciform ligament Ligamentum Teres |
|
Remnant of the ductus venosus |
Ligamentum Venosum |
|
Separates the left lobe from the caudate lobe |
Ligamentum Venosum |
|
Remnant of the umbilical vein |
Ligamentum teres |
|
The ligamentum teres runs from |
The umbilicus to the left portal vein |
|
With portal hypertension, the __ recanalizes to form__ |
Ligamentum Teres
A portosystemic venous collateral |
|
The ligamentum venosum runs from |
The left portal vein to the IVC |
|
Direction of Fetal Circulation |
Umbilical Vein (Ligamentum teres) > LPV > Ductus Venosus (Ligamentum venosum) > IVC |
|
Hepatopetal |
Toward Liver |
|
Hepatofugal |
Away from the Liver |
|
Portal vein normal flow |
Low velocity continuous flow toward the liver Mild undulations Velocity can increase after eating |
|
Hepatic Blood Flow % |
25% Proper hepatic artery 75% Portal vein |
|
Hepatic Oxygenation % |
50% Proper hepatic artery 50% Portal vein |
|
Upper limits of portal vein diameter |
13mm
|
|
Larger portal vein diameter suggests |
Portal hypertension |
|
Hepatic vein blood flow |
Toward the IVC Away from the transducer Flow below the baseline |
|
Hepatic vein waveform |
Above and below baseline Triphasic
|
|
Triphasic vein waveforms reflect |
Right atrial filling, contracting, and relaxing |
|
Normal spectral analysis above baseline= |
Flow toward the transducer |
|
Normal spectral analysis below baseline= |
Flow away from the transducer |
|
The proper hepatic artery runs parallel to the |
MPV (Anterior and to the left) |
|
The right hepatic artery may originate from (replaced) |
The SMA (11%) |
|
A replaced right hepatic artery is seen posterior to |
The head of the pancreas and the MPV |
|
A replaced left hepatic artery originates from the |
Left gastric artery (10%) |
|
Hepatic artery waveform |
Flow through diastole Low resistance |
|
Post liver transplant hepatic artery waveform |
High resistance suggests venous congestion or organ rejection |
|
Post liver transplant hepatic artery parvus tardus waveform suggests |
Proximal anastomotic stenosis |
|
Fold created by the passage of the embryonic umbilical vein from umbilicus to left portal vein |
Falciform ligament |
|
Fold that suspend the liver from the diaphragm |
Coronary ligament Surround bare area |
|
Fold to the far right and left of the bare area |
Right and left triangular ligament |
|
Hepatomegaly |
Greater than 15.5 cm |
|
Inferior projection of the right lobe of the liver |
Reidel's lobe Seen in women Superior/Inferior dimension of the liver |
|
Echogenicity of normal Structures (hyper-hypo) |
Renal Sinus Pancreas Spleen/Liver Renal Cortex |
|
Small organized collection of macrophages that appear as calcifications in the liver and spleen |
Hepatic Granulomas |
|
Hepatic Granulomas are caused by |
Histoplasmosis and Tuberculosis |
|
Caused by spores that float in the air, from fungus in the droppings of birds and bats |
Histoplasmosis
Common in chicken coops, barns, and caves |
|
Liver inflammation resulting from infectious agents |
Hepatitis |
|
Hepatitis may result in the elevation of |
ALT, AST, Conjugated and Unconjugated Bilirubin |
|
Hepatitis A is spread by |
Fecal/Oral Transmission |
|
Hepatitis B is spread by |
Blood/Body Fluid Transmission |
|
Hepatitis C is spread by |
Blood/Body Fluid Transmission |
|
Acute Hepatitis |
"Starry Night" (Periportal cuffing) Hypoechoic liver parenchyma Liver Enlargement Hyperechoic Portal Veins |
|
Chronic Hepatitis |
Hyperechoic liver parenchyma Small liver Decreased echogenicity of PV walls |
|
__ is the most common source of pyogenic (bacterial) liver abscesses |
Biliary tract disease
|
|
Obstruction of bile flow allows for |
Bacterial proliferation |
|
The __ lobe is more affected by pyogenic abscesses |
Right |
|
RUQ pain, leukocytosis, fever, elevated LFTs |
Pyogenic (bacterial) abscess |
|
RUQ Pain, hepatomegaly, diarrhea, leukocytosis, Elevated LFT's |
Amebic Abscess Onset 8-12 weeks from travel |
|
Differentiation between an amebic and pyogenic abscess |
If a patient has recently traveled out of the country, it is most likely amebic |
|
Fungal Abscess (Candidiasis) |
Wheel within a Wheel Bull's Eye Uniformly Hypoechoic Lesion Echogenic focus |
|
Hyatid Disease |
Echinococcal Cyst Typically a shepphard |
|
Cyst within a cyst |
Echinococcal Cyst/Hyatid Dx |
|
Casoni skin test |
Echinococcal Cyst/Hyatid Dx |
|
Rupture or aspiration of an echinococcal cyst is associated with |
Anaphalatic shock |
|
Schistosomiasis |
One of the most common parasitic infections |
|
Schistosomiasis is a major cause of __ worldwide |
Portal hypertension (Secondary causes) Occluded PV due to eggs |
|
Secondary causes of PV hypertension |
Splenomegaly Ascites Esophageal variceal bleeding Portosystemic collaterals |
|
Sonographic Findings Associated with AIDS (1) |
Hepatomegaly Splenomegaly Lymphadenopathy Pneumocystis (carinii) jiroveci Fatty liver infiltration |
|
Sonographic Findings Associated with AIDS (2) |
Non-Hodgkin's Candidiasis Cholangitis Acalculous cholecystitis Kaposi's Sarcoma Nephropathy |
|
Most common opportunistic infection in persons with HIV infection |
Pneumocystic (carinii) jiroveci
Usually responsible for Pneumocystis pneumonia |
|
Sonographic findings of Pneumocystic (carinii) jiroveci |
Diffuse, nonshadowing, hyperechoic foci |
|
Sclerosing and AIDS Cholangitis |
Thickened biliary ducts
May compromise the lumen causing biliary obstruction |
|
Lymphoma and Kaposi's sarcoma may be seen as |
An intrahepatic mass or possibly diffuse infiltration without visualization of a sonographic abnormality |
|
Focal regions of increased echogenicity within normal liver parenchyma |
Focal Fatty Infiltration |
|
Focal fatty infiltration commonly occurs at |
The porta hapatis |
|
Focal regions of normal liver parenchyma within a fatty infiltrated liver |
Focal fatty sparing |
|
Focal fatty sparing commonly occurs |
Adjacent to the GB |
|
Genetically acquired disorder that results in the excess deposition or glycogen in the liver |
Glycogen storage dx
von Gierke's dx |
|
Diffuse process of fibrosis and distortion or normal liver architecture |
Cirrhosis |
|
With cirrhosis |
First there is liver enlargement, which results in hepatic atrophy and blood coagulopathy, hepatic encephalopathy, and portal hypertension |
|
Causes of Cirrhosis |
*Right sided heart dx* *Wilson dx (copper deposition)* Hepatitis C Alcoholic liver dx |
|
Abnormal liver fuctions- Cirrhosis |
AST ALT GGT LDH Conjugated bilirubin |
|
Sonographic findings- Cirrhosis |
*Increased incidence of Hepatocellular Ca* Caudate lobe enlargement Hepatomagaly (acute) Liver atrophy (chronic) Surface nodularity |
|
Nation's leading cause of cirrhotic hepatitis and cirrhosis |
Hepatitis C |
|
Normal PV pressure |
5-10 mmHg |
|
Normal PV diameter |
<13 mm
Greater than suggests portal hypertension |
|
Major cause of portal hypertension |
Cirrhosis |
|
Patients with portal hypertension typically present with |
Upper GI hemorrhage due to rupture of esophageal varices |
|
Surgical techniques to lower portal pressure |
Portacaval shunt Splenorenal/Linton shunt TIPS |
|
Collaterals of the distal esophagus and gastric fundus |
Gastroesophageal varices |
|
Re-opening of the ligamentum teres to act as a collateral from the LPV to epigastric veins to IVC |
Recanalized umbilical vein |
|
Tortuous collateral veins seen in the splenic and left renal hilum |
Splenorenal varices |
|
The veins of retroperitoneal structures such as the colon, duodenum, and pancreas anastomose with systemic tributaries |
Intestinal varices |
|
A collateral path in which the inferior mesenteric vein drains into the rectal veins which connect with systemic tributaries |
Rectal varices (hemorrhoids) |
|
Physical signs of collaterals |
Dilated veins on ant abd wall Caput Medusa Hemorrhoids Ascites |
|
Tortuous collaterals around umbilicus |
Caput medusa |
|
TIPS |
Transjugular Intrahepatic Portal-Systemic Shunt |
|
Portosystemic shunts are created to |
Lower portal pressure
Avoids the development or rupture of gastroesophageal varices and accumulation of ascites |
|
TIPS is placed |
Between a hepatic vein and a portal vein
*Typically RHV and RPV* |
|
With a widely patent TIPS, the RPV and LPV should demonstrate ___ flow |
Hepatofugal |
|
Criteria for TIPS malfunction |
Low shunt velocity High focal shunt velocity Hepatopetal LPV or RPV Hepatofugal MPV Absent shunt flow |
|
With a recanalized umbilical vein, the flow of the LPV may be |
Hepatopetal or Hepatofugal |
|
Most commonly used TIPS material |
GORE Viatorr |
|
Indications for liver transplantation in adults |
Cirrhosis |
|
Indications for liver transplantation in children |
Biliary atresia |
|
Postoperatively, the __ provides the only blood supply to the biliary tree |
Hepatic Artery |
|
Portal vein thrombosis findings |
Hypoechoic thrombus within the PV Increased PV caliber Cavernous transformation Portal systemic collaterals |
|
Numerous worm-like venous collaterals that parallel the chronically thrombosed portal vein |
Cavernous transformation Benign causes of PV thrombosis |
|
Disorder characterized by hepatic vein obstruction
|
Budd-Chiari Syndrome
Presents with signs of portal hypertension |
|
With Budd-Chiari, the __ lobe is often spared |
Caudate
Emissary veins drain directly into IVC |
|
With Budd-Chiari, the caudate lobe typically |
Enlarges with the atrophy of the right and left lobes |
|
With enlargement of the caudate lobe, the __ may be compressed |
IVC |
|
In infants, intrahepatic PV gas is due to |
Necrotizing entercolitis |
|
Liver cyst sonographic criteria |
Anechoic Thin walled Acoustic enhancement |
|
A hemorrhagic cyst will appear as |
A cyst within a cyst with internal echoes
|
|
Patient present with RUQ pain and decreasing hematocrit |
Hemorrhagic cyst |
|
Most common benign tumor of the liver |
Cavernous Hemangioma |
|
Cavernous hemangioma sonographic findings |
Hyperechoic Posterior enhancement
May appear hypoechoic within the background of a fatty infiltrated liver |
|
Cavernous hemangiomas may enlarge with |
Pregnancy or administration of estrogen |
|
Contrast enhanced imaging of cavernous hemangiomas demonstrate |
Characteristic centripetal flow |
|
Benign solid liver mass believed to be a developmental hyperplastic lesion |
Focal nodular hyperplasia |
|
Sonographic findings focal nodular hyperplasia |
*Central fibrous scar (Hallmark)* Stellate vascularity Solitary lesion |
|
Focal nodular hyperplasia's are known as the |
"Stealth Lesion" |
|
Hepatic adenomas are associated with the use of |
Oral contraceptives |
|
Hepatic adenomas are associated with |
Glycogen storage dx |
|
Extremely rare fatty tumors |
Hepatic Lipomas |
|
Tuberous sclerosis is associated with |
Hepatic lipomas and angiomyolipomas |
|
Hepatic lipomas sonographic findings |
Hyperechoic mass Propagation speed artifact |
|
Decreased speed of sound in fat results in a prolonged sound return time |
Propagation speed artifact
May be seen as a broken diaphragm posterior to the fatty mass |
|
Hyperechoic hepatic masses |
Hepatic lipoma Hemangioma Echogenic METS Focal fatty infiltration |
|
Most common primary malignancy of the liver |
Hepatocellular Carcinoma HCC |
|
Hepatocellular carcinoma occurs predominantly in patients with |
Underlying chronic liver dx and cirrhosis |
|
Hepatocellular carcinoma commonly invades |
Venous structures (PVs, HVs, and IVC) |
|
Hepatocellular carcinoma increased LFTs |
*Alpha fetoprotein* AST ALT |
|
Hyperechoic mets |
Gastrointestinal tract |
|
Hypoechoic mets |
Lymphoma |
|
Bull's eye/Target mets |
Lung |
|
Calcified mets |
Mucinous adenocarcinoma of the colon |
|
Cystic mets |
Leiomyosarcoma Mucinous cystadenocarcinoma Squamous cell carcinoma |
|
Most common malignant liver tumor in early childhood |
Hepatoblastoma |
|
Hepatoblastomas associated with increased levels of |
Serum alpha fetoprotein
*Lung mets and PV invasion* |
|
The liver uses these enzymes to metabolize amino acids and to make proteins |
Aminotransferases |
|
AST= |
SGOT |
|
Present in the liver, heart, skeletal muscle, kidney, and brain |
AST/SGOT |
|
An increase in AST without ALT |
Myocardial infarction Heart failure
|
|
AST is __ for liver dx |
Non-specific |
|
ALT= |
SGPT |
|
ALT is __ for liver dx |
More specific |
|
Elevation in GGT indicates |
Hepatocellular dx and biliary obstruction |
|
Increased GGT+ ALP |
Biliary obstruction |
|
Increased GGT+ ALT |
Hepatocellular dx |
|
Protein synthesized by the fetal liver |
Alpha fetoprotein AFP Decrease during the first year of life |
|
Elevation of AFP occur in |
Hepatocellular Ca Germ cell tumors Mets (liver) Hepatoblastoma |
|
Monitored prior to an invasive procedure to insure proper clotting |
PT (INR), PTT, and platelets |
|
CA 19-9 |
Pancreatic Cancer |
|
CEA |
Carcinoembryonic Antigen *Colorectal cancer* |
|
HCG |
Human Chorionic Gonadotropin *Testicular Cancer* |
|
Right and left hepatic ducts join to form |
Common hepatic duct |
|
GB neck tapers to form the |
Cystic duct |
|
Cystic duct joins with the |
Common hepatic duct |
|
The cystic duct joins the common hepatic duct to form the |
Common bile duct |
|
Main pancreatic duct is also known as |
Duct of Wirsung |
|
CBD and Duct of Wirsung join to form |
The ampulla of Vater |
|
The portal triad consists of |
MPV Common hepatic duct Proper hepatic artery
"Mickey Mouse Sign" |
|
Spiral fold which controls bile flow in the cystic duct |
Valve of Heister |
|
Abnormal sacculation of the neck of the GB |
Hartmann's pouch |
|
Fold between the body and the fundus of the GB |
Phrygian cap |
|
Fold between the body and the neck of the GB |
Junctional fold |
|
CBD passes __ to the first part of the duodenum and panc head |
Posterior |
|
Normal GB wall thickness |
Less than 3mm |
|
Most common cause of GB wall thickening |
Cholecystitis |
|
Pre-hepatic causes of jaundice |
Increased bilirubin production |
|
Hepatic Causes of Jaundice |
Acute liver inflammation Chronic liver dx Infiltrative liver dx Inflammation of bile ducts Genetic disorders |
|
Hepatic Genetic Disorders Causing Jaundice |
Gilbert's syndrome Crigler-Najjar syndrom |
|
Post-hepatic Causes of Jaundice |
Obstruction of biliary tree |
|
Patients with obstruction of the biliary tree present with |
Jaundice, pale stool and dark urine |
|
Calcium bilirubinate granules and cholesterol crystals |
Sludge |
|
Cholelithiasis Sonographic Criteria |
Mobile Strongly echogenic Acoustic Shadowing |
|
Gallstones are composed of |
Cholesterol Calcium bilirubinate Calcium carbonate |
|
Gallbladder filled with stones seen as a strong shadow in RUQ |
Double Arc WES sign |
|
WES Sign |
Wall-Echo-Shadow GB filled with stones |
|
GB wall inflammation due to cystic duct obstruction by a gallstone |
Acute cholecystitis |
|
Acute cholecystitis features |
Gallstones Murphy's Sign Diffuse wall thickening GB dilation Sludge |
|
Amylase elevation suggests obstruction at the level of the |
Ampulla of Vater |
|
Recurring symptoms of bilary colic due to multiple previous episodes of acute cholecystitis |
Chronic cholecystitis |
|
Acute cholecystitis cue to GB wall ischemia and infection |
Emphysematous cholecystitis |
|
Emphysematous cholecystitisn occurs more commonly in |
Diabetic men |
|
__ artifacts are seen in the GB due to the presence of gas in the wall |
Comet-tail |
|
Reverberation artifact is the same as |
Comet-Tail artifact |
|
Causes of gas in the bilary system |
*ERCP* Sphincter of Oddi papilotomy Choledochojejunostomy GB Fistula Emphysematous cholecystitis |
|
Purulent material within the GB due to bacteria containing bile associated with acute cholecystitis |
Empyema of the GB |
|
Empyema of the GB symptoms |
Same as acute cholecystitis with fever |
|
Localized fluid collection in the GB fossa |
GB perforation Complication of acute cholecystitis |
|
Acute cholecystitis without the presence of gallstones |
Acalculous Chelecystitis
Wall thickening Murphy Sign Pericholecystic fluid
*No sludge, no stones* |
|
Sludge-like material with a high concentration of calcium |
Milk of Calcium Bile
Limy Bile |
|
Milk of calcium is associated with |
Chronic cholecystitis and GB obstruction of the cystic duct |
|
Calcification of the GB wall associated with chronic cholecystitis |
Porcelain GB |
|
Porcelain GB is associated with |
GB cx |
|
Mucocele of the GB; Overdistended GB filled with mucoid or clear watery contents |
Hydrops of the GB |
|
Round distended, non-inflamed GB due to a chronic cystic duct obstruction |
Hydrops of the GB |
|
GB polyps less than 10mm |
Unlikely to be cancerous and don't generally require treatment |
|
Lipids deposited in the GB wall |
Cholesterolosis
*Triglycerides and cholesterol* |
|
Strawberry GB |
Cholesterolosis
Golden yellow lipid deposits against red GB mucosa |
|
Cholesterolosis appears similar to |
Adenomyomatosis without reverb artifact |
|
GB Carcinoma US Findings |
Intraluminal mass Asymmetric wall thickening Mass that fills GB
*Porcelain GB* |
|
Hyperplastic changes involving the gallbladder wall causing overgrowth of the mucosa, thickening of the wall, and formation of diverticula |
Adenomyomatosis |
|
Diverticula within the gallbladder wall |
Rokitansky-Aschoff sinuses/RAS |
|
Adenomyomatosis is associated with __ artifact |
Comet-tail/Reverberation
*Due to stones in diverticula* |
|
In the majority of patients, biliary obstruction in due to pathology in the __ CBD. |
Distal |
|
What are the two most common lesions of biliary obstruction? |
Gallstones
Carcinoma of the head of the pancreas |
|
Elevated: Alkaline phosphatase Conjugated bilirubin Gamma glutamyl transpeptidase |
Biliary Obsruction Choledocholithiasis |
|
Obstruction of the distal CBD results in dilation of |
Extrahepatic and intrahepatic biliary tree |
|
Causes of Biliary Obstruction |
Choledocholithiasis Mirizzi Syndrome Cholangiocarcinoma Cholangitis Biliary Atresia |
|
CBD Measurements |
Normal: = 5mm Equivocal= 6-7mm Dilated >/= 8mm |
|
Postcholecystectomy, CBD may measure up to |
10mm |
|
"Parallel channel sign" or "Shotgun sign" |
Refer to the dilated hepatic duct adjacent to the PV |
|
Biliary ducts are more totuous than the accompanying portal vein |
Irregular and tortuous bile ducts |
|
Bile ducts branch out in a "star-shaped" configuration |
Stellate confluence |
|
Bile structures attenuate sound less than blood produces |
Acoustic enhancement |
|
Hormone that is released into the blood by ingestion of fatty foods |
Cholecystokinin |
|
Cholecystokinin causes |
GB contraction |
|
Negative fatty meal result |
Unchanged or decreased size in CBD |
|
Positive fatty meal result |
Increase in CBD |
|
Most common location for an obstructing stone |
Distal CBD |
|
With a distal CBD stone obsruction |
The entire biliary system including the GB distends |
|
With a common hepatic obstruction |
Only the common hepatic duct and intrahepatic ducts will dilate
GB will be contracted |
|
Obstruction at the junction of he right and left hepatic ducts |
Only intrahepatic ducts dilate.
GB will be contracted |
|
Formation or presence of calculi in the bile ducts |
Choledocholithiasis |
|
Most common cause of extrahepatic obstructive jaundice |
Choledocholithiasis |
|
Symptoms: Bilary Colic (RUQ pain) Jaundice |
Choledocholithiasis |
|
Extrahepatic biliary obstruction due to an impacted stone in the cystic duct causing extrinsic mechanical compression of the common hepatic duct |
Mirizzi Syndrome |
|
Bile duct carcinoma |
Cholangiocarcinoma |
|
Bile duct adenocarcinomas typically originate |
Within extrahepatic bile ducts
CHD or CBD |
|
Cholagiocarcinoma located at hepatic hilum |
Klatskin tumor
|
|
Hepatic Hilum |
Junction of right and left hepatic duct |
|
Klatskin tumors result in
|
Intrahepatic but not extrahepatic biliary dilation
*Liver only* |
|
Symptoms of Cholagiocarcinoma |
Jaundice Weight loss Abdominal Pain |
|
Most common predisposing condition of cholangiocarcinomas |
Primary sclerosing cholangitis |
|
Bacterial infection superimposed on an obstruction of the biliary tree |
Cholangitis
Bacteria gains access to biliary tree |
|
Causes of cholangitis |
Choledocholithiasis ERCP Obstructive tumors |
|
RUQ Pain Fever Jaundice |
Cholangitis Biliary obstruction Sepsis |
|
Increased: Conjugated bilirubin ALP GGT Amylase and lipase WBC |
Cholangitis |
|
Suspected when jaundice persists beyond 14 days of age |
Biliary Atresia |
|
Absence of extrahepatic bile ducts |
CHD and CBD
Biliary Atresia |
|
Biliary Atresia is associated with |
Polysplenia Absent IVC Situs Inversus/Ambiguous Cardiac anomalies |
|
Most successful treatment of biliary atresia |
Kasai Portoenterostomy
If performed before 90 days of life |
|
Air in the biliary tract |
Pneumobilia |
|
Pneumobilia is commonly associated with |
An ERCP |
|
Air in the biliary tree is associated with __ artifacts |
Comet-tail/Reverberation |
|
Congenital bile duct anomalies consisting of cystic dilation of the intra or extrahepatic bile ducts |
Choledochal cysts |
|
Most common type of choledochal cyst
|
Involves dilation of CBD
2 cystic structures in the RUQ (GB and dilated CBD) |
|
Choledochal cysts are more prevalent in |
Asia |
|
Congenital anomaly of the biliary tract characterized by multifocal segmental dilatation of the intrahepatic bile ducts |
Caroli's Dx |
|
Caroli's dx is associated with |
Congenital hepatic fibrosis Portal hypertension Renal tubular ectasia |
|
Multiple cystic structures that converge toward the porta hepatis communicating with the bile ducts |
Caroli's dx |
|
Complications of Caroli's dx |
Cholangistis Choledocholihiasis Hepatic abscess Cholagiocarcinoma |
|
Most common cause of malignant neoplasm obstructing the biliary tree |
Pancreatic adenocarcinoma |
|
Pancreatic adenocarcinoma at the head of the pancreas typically cause |
Courvoisier gallbladder |
|
Enlarged, non-diseased gallbladder due to a mechanical obstruction of the CBD |
Courvoisier gallbladder |
|
Inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts |
Primary sclerosing cholangitis (PSC) |
|
Primary sclerosing cholangitis is associated with |
Inflammatory bowel dx ERCP Cholagiocarcinoma |
|
Elevated: ALP GGT ALT/AST Conjugated bilirubin |
Primary sclerosing cholangitis |
|
US findings for primary sclerosing cholangitis |
Thickening of bile duct walls Findings associated with cirrhosis |
|
Chronic and progressive cholestasis due to destruction of the small intrahepatic bile ducts leading to end-stage liver dx |
Primary biliary cirrhosis |
|
Elevated: Antimitochondrial antibodies (AMAs) ALT/AST ALP GGT |
Primary biliary cirrhosis |
|
End product of hemoglobin breakdown |
Bilirubin |
|
Process of removing protein (albumin) from unconjugated bilirubin making it soluble |
Conjugation |
|
Unconjugated Hyperbilirubinemia results from |
Impaired hepatic bilirubin uptake Increased bilirubin production Impaired conjugation of bilirubin |
|
Increased bilirubin production |
Hemolysis |
|
The presence of bilirubin in the urine indicates |
Conjugated Hyperbilirubinemia
*Kidneys cannot filter unconjugated bilirubin as they are bound to albumin* |
|
Conjugated (Direct) Hyperbilirubinemia results from |
Defective bile outflow (bile duct obstruction) |
|
Enzyme concentrated in the bile ducts |
Alkaline Phosphatase |
|
Alkaline phosphatase is found in |
Bone, liver and placenta |
|
ALP increases from
|
Dx that impair bile formation *bile duct obstruction*
Bone growth (children) Pregnancy |
|
The pancreas is a __, __ structure
|
Nonencapsulated
Retroperitoneal |
|
The pancreas lies between |
The duodenal loop and the splenic hilum |
|
The pancreas is divided into |
Head Uncinate process Neck Body Tail |
|
Exocrine function of the pancreas |
Secrete trypsin, lipase, and amylase through the ductal system |
|
Endocrine function of the pancreas |
Non Ductal Secrete insulin via the islets of Langerhans |
|
Normal pancreas measurement (Ant-Post) |
<= 3cm |
|
The __ wall of the stomach overlies the __ border of the pancreatic body and tail |
Posterior Anterior |
|
Technique used to better visualize the pancreas tail |
Left Lateral Decub Pt drinks water to fill the stomach Then patient is scanned supine or right lateral decub |
|
The head of the pancreas is __ to the IVC |
Anterior |
|
The IVC is __ to the head of the pancreas. |
Posterior |
|
The head of the pancreas is __ to the duodenum. |
Medial |
|
The duodenum is __ to the head of the pancreas. |
Lateral |
|
The CBD is __ to the pancreatic head |
Posterior/Lateral |
|
The pancreatic head is __ to the CBD |
Anterior/Medial |
|
The Gastroduodenal artery is __ to the pancreatic head |
Anterior/Lateral |
|
The pancreatic head is __ to the gastroduodenal artery |
Posterior/Medial |
|
The GDA originates off the |
Common hepatic artery |
|
SMA and SMV are __ to the neck of the pancreaa |
Posterior |
|
The pancreas is __ to the SMA and SMV |
Anterior |
|
SMA and SMV are __ to the uncinate process |
Anterior |
|
The uncinate process is __ to the SMA and SMV |
Posterior |
|
The pancreatic head is located __ and __ to the splenic hilum |
Anterior and Medial |
|
The aorta is __ to the body of the pancreas |
Posterior |
|
The celiac axis arises from the aorta at the __ border of the pancreas |
Superior |
|
SMA arises from the aorta at the __ border of the pancreas |
Inferior |
|
The celiac axis gives off the left __ and then divides into __ and __ |
Left gastric
Common Hepatic Artery
Splenic Artery |
|
The __ divides into the proper hepatic and gastroduodenal arteries |
Common hepatic artery |
|
The __ travels superiorly toward the liver anterior to the PV and left of the bile duct |
Proper hepatic artery |
|
The right gastric artery is a branch of the __ |
Proper hepatic artery |
|
The __ travels posterior to the first portion of the duodenum then anterior to the head of the pancreas |
GDA |
|
The SMA is located inferior to the __ |
Pancreas |
|
The SMA is located __ to the uncinate process |
Anterior |
|
The SMA is located __ to the 3rd portion of the duodenum |
Anterior |
|
The __ is located on the posterior aspect of the pancreas |
Splenic Vein |
|
The spelic vein joins the __ to create the MPV |
Superior mesenteric vein |
|
The SMV is located to the __ of the SMA |
Right |
|
The SMV is located __ to the 3rd portion of the duodenum |
Anterior |
|
The SMV is located __ to the uncinate process |
Anterior |
|
The inferior mesenteric vein drains the |
Left lower quadrant sigmoid and descending colon |
|
The CBD travels __ to the 1st portion of the duodenum and the head of the pancreas |
Posterior |
|
The CBD lies to the __ of the main pancreatic duct |
Right |
|
The __ and the __ join to form the ampulla of Vater |
Common bile duct and duct of Wirsung (main pancreatic duct) |
|
The CBD and main pancreatic duct join to form the _- |
Ampulla of Vater |
|
The ampulla of Vater opens into the 2nd portion of the duodenum ate the __ |
Major papilla |
|
Accessory pancreatic duct |
Duct of Santorini |
|
50% of the pop. has complete regression of |
duct of Santorini |
|
The duodenum is divided into |
4 portions |
|
The __ and __ portions of the duodenum are |
Transverse |
|
The __ and __ portions of the duodenum are |
Longitudinal |
|
Pancreatic duct is considered abnormal if it is > |
2mm |
|
Structures in contact with the Pancreatic Head |
IVC CBD Ampulla of Vater GDA 2nd portion of duodenum |
|
Inflammatory dx producing temporary pancreatic changes |
Acute Pancreatitis |
|
Most common causes of acute pancreatitis |
Gallstones Alcohol Abuse |
|
US findings for Acute Pancreatitis |
Enlarged, hypoechoic gland |
|
Inflammatory mass formed by edema and leakage of pancreatic enzymes |
Pancreatic Phlegmon (Focal pancreatitis) |
|
Spreading inflammatory reaction to an infection which forms a suppurative lesion |
Phlegmon |
|
Irreversible destruction due to repeated bouts of pancreatic inflammation |
Chronic Pancreatitis |
|
Most common cause of chronic pancreatitis |
Alcoholic chronic pancreatitis |
|
Elevation of serum amylase and lipase are found only in __ pancreatitis |
Acute |
|
Multiple pancreatic cysts are associated with |
Adult polycystic kidney dx and von Hippel-Lindau syndrome |
|
Exocrine disorder resulting in viscous secretions causing pancreatic dysfunction |
Cystic Fibrosis |
|
Meconium ileus is commonly associated with |
Cystic Fibrosis |
|
Increased pancreatic echogenicity Gland atrophy Fibrosis and fatty replacement Cysts due to ductal obstruction |
Pancreatic cystic fibrosis |
|
Accumulation of pancreatic fluid and necrotic debris confined by the retroperitoneum |
Pancreatic pseudocyst |
|
The pancreas is located within the __ of the retroperitoneum |
Anterior pararenal space |
|
In children, the most common reson for a pancreatic pseudocyst is |
Abdominal trauma |
|
Failure of the dorsal and ventral pancreatic ductal systems to fuse during embryonic development |
Pancreas divisum |
|
Inadequate pancreatic drainage due to pancreas divisum may result in |
Pancreatitis |
|
Congenital anomaly where the ventral pancreas encircle the second portion of the duodenum |
Annular pancreas |
|
"Double-bubble" sign |
Annular Pancreas Dilated stomach and duodenal bulb |
|
Pancreatic adenocarcinoma typically arises from the __ |
Pancreatic head |
|
Elevated: Conjugated bilirubin Alk Phos Amylase/Lipase GGT |
Pancreatic adenocarcinoma |
|
The Whipple procedure is also known as a |
Pancreaticoduodenectomy |
|
Whipple procedure is performed with |
Cancer of the head of the pancreas |
|
Serous cystadenomas are |
Benign |
|
Pancreatic serous cystadenomas are asociated with |
von Hippen-Lindau Dx |
|
Cluster of grape like cysts on the pancreas |
Serous Cystadenomas |
|
Large multicystic mass with numerous septations and debris in pancreas |
Mucinous cystic neoplasms |
|
Increased CEA levels in a patient with a multicystic pancreatic mass would suggest a diagnosis of |
Mucinous cystic neoplasm |
|
Endocrine tumors are known as |
Islet cell tumors |
|
Islet cell tumors are associated with |
Multiple endocrine neoplasia Von Hippel-Lindau dx |
|
Most common islet cell tumor |
Insulinoma |
|
Zollinger-Ellison Syndrome |
Gastrinoma
Second most common islet cell tumor |
|
Many pancreatic islet cell tumors are commonly located |
In the body and tail |
|
MEN type 1 |
Wermer syndrome |
|
MEN type 2 |
Sipple's syndrome |
|
Most common site for MEN |
Parathyroid (hyperparathyroidism) Pancreatic islet cells Pituitary gland |
|
Digestive enzyme for carbohydrates |
Amylase |
|
Amylase is produced by |
The pancreas and salivary glands
|
|
Pancreatitis and salivary gland dysfunction causes increased levels of |
Serum Amylase |
|
Which persists longer? Amylase or lipase? |
Lipase |
|
Head of the pancreas is __ to the second portion of the duodenum |
Medial |
|
CBD is __ to the head of the pancreas |
Posterolateral |
|
The head of the pancreas is __ to the CBD |
Anteromedial |
|
The gastroduodenal artery is __ to the head of the pancreas |
Anterolateral |
|
SMA and SMV are __ to the neck of the pancreas |
Posterior |
|
The uncinate process is __ to the SMA and SMV |
Posterior |
|
The celiac axis is __ to the pancreas |
Superior |
|
The splenic vein is __ to the pancreas |
Posteroinferior |
|
SMA and SMV are __ to the 3rd portion of the duodenum |
Anterior |
|
The stomach is __ to the splenic hilum |
Anterior/Medial |
|
The tail of the pancreas is __ to the stomach |
Posterior |
|
The tail of the pancreas is __ to the upper pole of the kidney |
Anterior |
|
The splenic artery is __ to the pancreas |
Superior/Anterior |
|
The kidneys are ureters are located __ in the abdomen |
Retroperitoneally |
|
The right adrenal gland is __ to the right kidney |
Superomedial |
|
The liver is __ to the right kidney |
Superolateral |
|
The right colic flexure is __ to the right kidney |
Inferior |
|
The 2nd portion of the duodenum is __ to the right kidney |
Medial |
|
The left adrenal gland and spleen are __ to the left kidney |
Superior |
|
The pancreatic tail is __ to the upper pole of the left kidney |
Anterior |
|
The left colic flexure is __ to the left kidney |
Inferior |
|
The diaphragm, psoas muscle, and quadratus lumborum muscle are on the __ aspect of the kidneys |
Posterior |
|
At the hilum of the kidney, the __ exits anteriorly |
Vein |
|
At the hilum of the kidney, the __ exits between the vein and ureter |
Artery |
|
At the hilum of the kidney, the __ exits posteriorly |
Ureter |
|
Renal cortex echogenicity |
Isoechoic or hypoechoic |
|
Medullary pyramids echogenicity |
Anechoic |
|
Renal sinus echogenicity |
Hyperechoic |
|
Outer renal parenchyma from renal sinus to renal capsule |
Renal cortex >1cm |
|
Inner portion of kidney from base of pyramids to center of kidney |
Renal medulla |
|
Inner hyperechoic portion of the kidney which contains fat, calyces, renal pelvis, connective tissue, renal vessels and lymphatics |
Renal sinus |
|
Anechoic, equally spaces triangles of collecting tubules between cortex and renal sinus |
Medullary pyramids
|
|
Medullary pyramids are commonly seen in |
Neonatal and pediatric kidneys |
|
Funnel-shaped transition from the major calyces to the ureter |
Renal pelvis |
|
Medial opening for entry/exit of artery, vein, and ureter |
Renal hilum |
|
3 extensions for the renal pelvis |
Major calyces |
|
Extensions of the major calyces that collects urine from the medullary pyramids |
Minor calyces |
|
Apex of medullary pyramids |
Renal papilla |
|
Fibrous sheath enclosing kidney and adrenal glands |
Gerota's fascia |
|
Perirenal space |
Gerota's fascia |
|
Functional unit of the kidney |
Nephron |
|
Consists of glomerulus and glomerular capsule |
Renal corpuscle (malpighian body) |
|
Bowman's capule |
Glomerular capsule |
|
The __ supplies the kidneys with blood which branches off the aorta |
Main renal artery |
|
At the hilum, the main renal artery divides into |
5 segmental arteries |
|
The segmental arteries divide between the |
Medullary pyramids |
|
The segmental arteries divide into |
Interlobar arteries |
|
Interlobar arteries branch into |
Arcuate arteries |
|
The arcuate arteries branch into |
Interlobar arteries |
|
Smallest renal arteries |
Interlobar |
|
Renal vessels between the pyramids |
Interlobar |
|
Failure of the kidneys to "ascend" into the abdomen |
Ectopic/Pelvic Kidney |
|
With ectopic kidneys, there is an increased incidence of |
UPJ Obstruction Ureteral obstruction Mulicystic renal dysplasia |
|
Most common renal fusion anomaly |
Horshoe kidney |
|
Fusion anomaly in which the lower poles of the kidney connect across the midline anterior to the aorta |
Horseshoe kidney |
|
Developing kidneys fuse in the pelvis and one kidney ascends to the normal position carrying the other midline |
Cross-fused renal ectopia |
|
With cross-fused renal ectopia, the ureters |
Connect on both sides of the bladder thus one ureter crosses the midline |
|
Kidneys fuse to form a round mass in the pelvis |
Fused Pelvic Kidkey Pancake kidney |
|
Common variant of cortical thickening on the lateral aspect of the kidney |
Dromedary hump |
|
Triangular hyperechoic area on the anterior aspect of the upper pole of the right kidney |
Junctional parenchymal defect |
|
Partial fusion of the renunculi |
Fetal lobulation/Junctional parenchymal defect |
|
Duplication of the collecting system |
Duplex Kidney |
|
Complete duplication of the collecting system |
Two ureters |
|
Incomplete duplication of the collecting system |
1 ureter |
|
Kidney that is typically longer than normal and has a complete central cortical break with hyperechoic sinus |
Duplex Kidney |
|
With complete double ureters, the ureter draining the upper pole typically inserts |
In an ectopic location on the bladder
Looks like a cyst on the bladder |
|
A frequent complication of ectopic ureter is a |
Ureterocele |
|
Complete duplication of the renal system will result in |
Hydroureter and hydro of the upper collecting system of the kidney |
|
Normal variation of prominent renal cortical parenchyma located between 2 medullary pyramids |
Column of Bertin |
|
Bilateral renal agenesis is associated with |
Oligohydraminos and pulinary hypoplasia
Incompatible with life |
|
Unilateral agenesis is associated with |
Bicornuate uterus Seminal vesicle agenesis |
|
Extrarenal pelvis lies |
Outside the renal sinus
Appears as a cystic collection medial to the renal hilum |
|
Common cause of urinary obstruction in the male neonatal patient |
Posterior urethral valve |
|
Obstruction due to a flap of mucosa that has a slit like opening in the area of the prostatic urethra |
Posterior urethral valve |
|
Large bladder Hydroureter Hydronephrosis Urinoma |
Posterior urethral valve |
|
Acoustic enhancement Absence of internal echoes Sharply defined thin wall Round/Oval shape |
Cyst |
|
Calyceal diverticula that sonographically appear as a simple cyst |
Pylogenic cyst |
|
Cortical cysts that bulge into the central sinus of the kidney |
Parapelvic cysts |
|
Lymphatic cycts in the central sinus |
Peripelvic cysts |
|
Renal cysts located in the periphery of the kidney |
Cortical or parenchymal cysts |
|
An abscess vs a hemorrhagic cyst may only be made by |
Percutaneous aspiration |
|
Bilateral renal enlargement due to the development of numerous cysts of varying sized |
Autosomal Dominant Polycystic Kidney Dx Adult |
|
Autosomal Dominant Polycystic Kidney Dx is associated with cysts in |
The liver, pancreas, and spleen |
|
Autosomal Dominant Polycystic Kidney Dx is associated with |
Arterial aneurysms especially cerebral arterial aneurysms in the circle of Willis |
|
Enlarged bilateral kidneys Hyperechoic parenchyma Loss of cortical medullary distinction |
Autosomal Recessive Polycystic Kidney Disease Infantile |
|
Typical physical appearance of a neonate as a direct result of oligohydramnios and compression while in utero |
Potter Syndrome |
|
Most common cause of an abdominal mass in newborns |
Multicystic Dysplastic Kidney |
|
Form of renal dysplasia characterized by multipole noncommunicating cysts with the absence of renal parenchyma |
Multicystic Dysplastic Kidney |
|
Result of atresia of the ureteropelvic junction during fetal development |
Multicystic Dysplastic Kidney |
|
Congenital UPJ obstruction is caused by |
Ureteral hypoplasia High insertion of ureter into renal pelvis Compression by segmental artery |
|
UPJ obstruction anomalies include |
Multicystic Dysplastic Kidney Renal agenesis Duplicated collecting system Horseshoe kidney Ectopic kidney |
|
Development of multiple cysts in chronically failed kidneys during long term hemodialysis |
Acquired cystic disease |
|
Acquired cystic kidney disease often results in |
Hemorrhage resulting in pain and hematuria |
|
Acquired cystic disease is associated with |
An increased incidence of renal cell carcinoma |
|
Congenital dysplastic cystic dilatation of the medullary pyramids due to tubular ectasia or dysplasia |
Medullary Sponge Kidney |
|
Hyperechoic medullary pyramids due to the formation of calcium deposits |
Medullary Sponge Kidney |
|
Inherited disease which usually presents in the second to third decade of life with serious visual impairment |
Von Hippel-Lindau Disease |
|
Tumors associated with Von Hippel-Lindau Disease |
Renal cell carcinoma Pheochromocytomas Islet Cell Tumors Renal and Pancreatic cysts |
|
Hyperechoic benign renal tumor. Echogenicity is greater than or equal to the renal sinus |
Angiomyolipoma |
|
An angiomyolipoma may present with a __ artifact |
Propagation speed artifact
Due to slower acoustic velocity in the fatty mass
Posterior displacement of structures |
|
80% of angiomyolipomas involve the __ kidney |
Right |
|
Multi-System genetic dx presented with Seizures, mental retardation, and facial angiofibromas |
Tuberous Sclerosis |
|
Why are the kidneys the main focus in a patient with tuberous sclerosis? |
Increased incidence of renal cysts and *angiomyolipomas* |
|
Angiomyolipomas are typically bilateral in patients with |
Tuberous Sclerosis |
|
Most common solid renal mass in the adult |
Renal Cell Carcinoma Unilateral encapsulated mass |
|
With renal cell carcinoma, __ is recommended |
Nephrectomy |
|
Rencal cell carcinoma tumor commonly extends into |
The renal veins and IVC |
|
Malignant cells from leukemia and lymphoma can metastasize in the |
Kidney |
|
Nephroblastoma AKA |
Wilm's tumor |
|
Most common childhood renal tumor |
Wilm's tumor/Nephroblastoma |
|
Large asymptomatic flank mass Hypertension Fever Hematuria
In child |
Wilm's tumor/Nephroblastoma |
|
Wilm's tumor extension can be seen into the |
Renal vein and IVC |
|
Most renal infections occur via |
An ascending route from the bladder |
|
Renal enlargement Hypoechoic parenchyma Absence of sinus echoes |
Acute pyelonephritis |
|
When acute pyelonephritis is focal it is called |
Acute focal bacterial nephritis or lobar nephronia |
|
Focal wedge shaped area or hypoechoic renal lobe |
Acute focal bacterial nephritis or lobar nephronia |
|
Bacterial infection associated with renal ischemia |
Emphysematous pyelonephritis |
|
Emphysematous pyelonephritis commonly occurs in |
Diabetics Immunosuppressed patients Patients with urinary tract obstruction |
|
Anerobic bacteria produce |
Intrarenal gas |
|
Intrarenal gas causes __ artifacts |
Reverberation or comet-tail artifacts |
|
__ is usually treated to treat renal infection |
Nephrectomy |
|
Renal injury induced by recurrent renal infections |
Chronic pyelonephritis |
|
Chronic pyelonephritis appears as |
Small, hyperechoic kidney with cortical thinning |
|
Type of chronic phelonephritis resulting from chronic infections due to a long term obstruction |
Xanthogranulomatous Pyelonephritis (XGPN) |
|
Failure to depict a normal kidney associated with a staghorn calculus suggests |
Xanthogranulomatous Pyelonephritis (XGPN) |
|
Purulent material in the collection system of the kidney associated with an infection secondary to renal obstruction |
Pyonephrosis |
|
Treatment of pyonephrosis |
Percutaneous or surgical drainage |
|
Hyperechoic debris in a dilated renal collecting system |
Pyonephrosis |
|
Mycetoma |
Fungal ball |
|
Most common renal fungal dx |
Candidiasis |
|
Fungal balls appear as |
Hyperechoic nonshadowing massesH |
|
Hyperechoic renal masses |
Mycetoma Angiomyolipoma Blood clots Pyogenic debris Sloughed papilla Renal stones |
|
Abrupt decline in renal function, manifested by decreased urinary output and elevation in plasma BUN and serum creatinine |
Acute kidney injury |
|
3 main mechanisms of acute kidney injury |
Prerenal failure Intrinsic intrarenal failure Postrenal failure |
|
Prerenal failure |
Hypotension Volume depletion Decreased cardiac output |
|
Intrinsic (intrarenal) Renal Failure |
Medical renal dx
Acute tubular necrosis Glomerular dx Interstitial nephritis Autoimmune dx |
|
Post renal failure |
Bilateral renal obstruction |
|
Hydronephrosis indicates |
Post renal failure |
|
Abnormal renal resistive index suggests |
Intrinsic renal failure |
|
Laboratory studies used to evaluate AKI |
Urine output Urinalysis BUN Serum creatinine |
|
Most accurate method in determining AKI |
Changes in serum creatinine reflecting changes in glomerular filtration rate |
|
Renal vein thrombosis is associated with |
Extrinsic compression Nephrotic syndrome Renal tumors Renal transplant Trauma |
|
Renal vein thrombosis findings |
**High resistance renal artery waveform increased RI**
Dilated thrombosed renal vein Absent intrarenal venous flow Enlarged hypoechoic kidney |
|
Sudden cause of prerenal failure that presents as flank pain, hematuria, sudden rise in BP |
Renal artery thrombosis |
|
Focal hypoechoic areas of infarct Absence of intrarenal arterial flow Renal enlargement |
Renal artery thrombosis |
|
Most common cause of acute kidney injury |
Acute tubular necrosis |
|
Results from prolonged ischemia and nephrotoxins causing damage to tubular epithelium of the nephron leading to acute renal failure |
Acute tubular necrosis |
|
Acute tubular necrosis most likely occurs in patient with |
Hx of recent surgery Sepsis Hypovolemia |
|
ATN findings |
Renal enlargement Increased RI |
|
Inflammatory response resulting in glomerular damage caused by infectious and noninfectious causes |
Acute glomerulonephritis |
|
Most common infectious cause of acute glomerulonephritis |
Streptococcus due to upper respiratory and skin infections |
|
Acute glomerulonephritis symptoms |
Sudden onset hematuria Proteinuria RBC casts in urine |
|
Dilatation of the renal pelvis and calyces |
Hydronephrosis |
|
Hydronephrosis secondary to obstruction can lead to |
Hypertension Loss of renal function Sepsis |
|
Three common areas of renal obstruction by a stone |
*Ureterovesical junction* Ureteropelvic junction Pelvic brim |
|
Obstructive nephropathy is diagnosed by |
Intrarenal vascularity |
|
A threshold resistive index of greater than __ suggests obstructive hydronephrosis |
0.7 |
|
Disorders of calcium metabolism resulting in the formation of calcium renal stones and deposition of calcium in the renal parenchyma |
Nephrocalcinosis |
|
Nephrolithiasis |
Renal stones |
|
Main symptom of nephrolithiasis |
Flank pain |
|
Color doppler artifact that appears as rapidly alternating mixture of red and blue doppler signals distal to a strong reflective surface such as a renal stone |
Twinkle sign |
|
Causes of nephrocalcinosis |
Medullary nephrocalcinosis Cortical nephrocalcinosis |
|
Medullary nephrocalcinosis cause of nephrocalcinosis |
*Primary hyperparathyroidism* most common Renal tubular acidosis Medullary sponge kidney |
|
Ischemia of the medullary pyramids |
Papillary necrosis *Sloughed papillae in urine* |
|
Papillary necrosis is associated with |
Diabetes mellitus Urinary tract obstruction Analgesic abuse Sickle cell dx |
|
Papillary necrosis findings |
Echogenic material in collecting system Triangular cystic collections in absence of medullary pyramids Bright echoes produced by arcuate arteries at periphery of cystic space |
|
Increased renal sinus fat that replaces normal renal parenchyma |
Renal sinus lipomatosis |
|
Renal sinus lipomatosis findings |
Increase in the central sinus echo complex with cortical thinning |
|
Urinary bladder is located behind |
The pubic bone |
|
Bladder apex points |
anteriorly |
|
Bladder apex is connected to the umbilicus by |
The median umbilical ligament |
|
The ureters enter the bladder at |
The superolateral angle of the trigone |
|
The ureters exit the bladder via |
The urethra |
|
Normal bladder wall thickness |
Nondistended <5mm Distended <3mm |
|
Herniations of the bladder mucosa through the bladder through the bladder wall musculature |
Bladder diverticula |
|
Most acquired bladder diverticula are associated with longstanding bladder outlet obstruction due to |
Benign prostatic hypertrophy |
|
Cystic dilatation of the fetal urachus |
Urachal cyst |
|
Median umbilical ligament connecting the bladder to the umbilicus |
Urachus |
|
Cystic structure superior and anterior to the bladder |
Urachal cyst |
|
Ureters exit the kidney |
Posterior to the renal artery and vein |
|
Cyst like enlargement of the lower end of the ureter which projects into the bladder lumen at the ureterovesical junction |
Ureterocele |
|
Ureteroceles are most common found in association with |
Complete ureteral duplication |
|
Most common bladder neoplasm |
Transitonal cell carcinoma |
|
Solid mass or focal thickening of the bladder wall should raise the suspicion of a |
Transitional cell carcinoma |
|
Most common clinical presentation of transitional cell carcinoma |
Hematuria |
|
Normal renal artery demonstrates |
Continuous forward flow during diastole, low resistance perfusion |
|
Resistive index is commonly used to |
Evaluate renal transplant rejection Access suspected hydronephrosis Evaluate medical renal dx |
|
RI= |
Peak systolic freq. - End diastolic freq ________________________________________ Peak systolic freq |
|
Normal resistive index |
<0.7 |
|
Symptoms of renal artery stenosis |
Sudden onset hypertension Uncontrollable hypertension |
|
A hemodynamically significant renal artery stenosis may produce |
Decreased renal size <9cm in length |
|
Renal artery evaluation methods |
Renal artery velocities Intrarenal waveform eval |
|
Renal artery stenosis diagnostic criteria |
Direct: Renal artery/Aorta Ratio (RAR) >3.5
Indirect: Parvus tardus Absent early systolic peak |
|
Small slow pulse |
Parvus Tardus |
|
Poor function of the renal transplant may be the result of |
Acute tubular necrosis |
|
Sonographic findings of acute renal transplant rejection |
Renal enlargement Decreased echogenicity Loss of cortical medullary boundary Increasing flow resistence |
|
Resistive index |
<0.7= Normal 0.7-0.8= Questionable transplant dysfunction >0.8= Transplant dysfunction |
|
Indicates the microscopic examination of sediment and qualitative evaluation of protein, glucose, ketones, blood, nitrites, and WBCs |
Urinalysis |
|
Break-down product of skeletal muscle |
Serum creatinine |
|
Calculated by determining creatinine clearance |
Glomerular filtration rate |
|
Waste product of protein metabolism |
Urea |
|
Decrease in glomerular filtration rate resulting in increase of BUN and creatinine |
Azotemia |
|
Most common neonatal abdominal mass |
Multicystic dysplastic kidneys |
|
Most common neonatal adrenal mass |
Adrenal hemorrhage |
|
Most common childhood/infantile adrenal mass |
Neuroblastoma |
|
Most common neonatal massMult |
Multicystic dysplastic kidneys |
|
Most common childhood renal mass |
Wilm's tumor |
|
Fibrous capsule surrounding the testicle |
Tunica albuginea |
|
Multiple septations arising from the tunica albuginea |
Mediastinum testis |
|
Echogenic linear band extending longitudinally within the testis |
Mediastinum testis |
|
The septula forms wedge shaped compartments that contain the |
Seminiferous tubules |
|
The seminiferous tubules converge to form the |
Tubuli recti |
|
The tubuli recti connect the seminiferous tubule to the |
Rete testis |
|
Anastomosing network of delicate tubules located in the hilum of the testicle |
Rete testis |
|
Carries sperm to the epididymis |
Rete testis |
|
Carry seminal fluid from the rete testis to the epididymis |
Efferent ductules |
|
Parallel to the testicle |
Epididymis |
|
Remnant of the Mullerian duct |
Appendix testis |
|
Small ovoid structure located beneath the head of the epididymis |
Appendix testis |
|
Small stalk projecting off the epididymis |
Appendix epididymis |
|
Derived from the Wolffian duct |
Appendix epididymis |
|
Layer of muscle fibers, lying beneath the scrotal skin and dividing the scrotum into two chambers |
Dartos |
|
Division of the two scrotal chambers |
Scrotal raphe |
|
Saccular extension of the peritoneum into the scrotal chambers |
Tunica vaginalis |
|
The visceral layer of the tunica vaginalis covers |
The testis and epididymis |
|
The parietal layer of the tunica vaginalis lines |
The scrotal chamber |
|
Testicular blood flow |
Deferential artery Cremasteric artery Testicular artery |
|
The testiclar artery divides into the __ and __ branches |
Capsular Centripetal |
|
Spermatic cord |
Vas deferenc Cremasteric, deferential, testicular art Pampiniform plexus Lymphatics Nerves |
|
Most extratesticular masses are |
Benign |
|
Majority of intratesticular lesions are |
Malignant |
|
MOst common malignancy in men 15-35 |
Testicular neoplasms |
|
Most common testicular cancers |
Germ cell tumors |
|
Most common germ cell type found in both pure seminoma and mixed germ cell testicular masses |
Seminoma |
|
Risk factors for testicular tumors |
*Cryptorchidism* Infertility Fam hx of testicular ca |
|
__ is associated with nonseminomas |
Alpha Fetoprotein |
|
Most common testicular tumor in infants and young children |
Yolk sac tumors |
|
Rare stromal testicular tumor occuring in boys and men |
Leydig cell tumor *Always benign in children* |
|
Leydig cell tumors produce |
Testosterone Results in precocious puberty |
|
Blood chemistry profile for testicular tumors |
Beta-human chorionic gonadotropin Alpha fetoprotein Lactic dehydrogenase |
|
Elevation of serum beta-hGC and AFP levels inconjunction with a testicular mass suggests |
Testicular cancer |
|
Benign testicular cysts |
Tunica Albuginea Intratesticular |
|
Well-circumscribed solid tumors lying beneath the tunica albuginea |
Epidermoid cyst |
|
Epidermoid cyst findings |
Solid, hypoechoic masses with an echogenic capsule or onion ring pattern formed by multiple layers of keratin
"Bow Tie" central echogenic patterm |
|
Testicular abscesses are usually a complication of |
Epididymo-orchitis |
|
Enlarged testicle containing a predominantly fluid-filled mass with hypoechoic or mixed echogenic areas |
Testicular abscess |
|
"Scrotal pearls" may be located |
Within the testicle or between the layers of the tunica vaginalis |
|
Triangular shaped avascular intratesticular lesiom |
Testicular infarct |
|
Serous fluid that accumulates within the tunica vaginalis or between the layers of the tunican vaginalis |
Hydrocele |
|
Most hydroceles are caused by |
Failed closure of the processus vaginalis at the internal ring |
|
Dilatation of the pampiform venous plexus of the testicular veins which drain the testicle |
Varicocele |
|
90% of varicoceles are on the __ side |
Left |
|
Varicoceles are the most common correctable cause of |
Male infertility |
|
Results from bowel protruding through the inguinal canal into the tunica vaginalis of the scrotum |
Scrotal hernia |
|
Small hernias can be visualized by using the |
Valsalva maneuver |
|
Most common extratesticular tumor |
Adenomatoid tumor |
|
Cystic masses of the epididymis that result from dilatation of the epididymal tubules |
Spermatoceles (Epididymal cysts) |
|
Difference between spermatoceles and epididymal cysts |
Spermatoceles are more common and filled with thick milky fluid containing spermatozoa
Epididymal cysts are filled with clear fluid |
|
Most common condition that causes acute scrotal pain |
Acute epididymitis |
|
Acute epididymitis is usually caused by |
STDs |
|
Epididymitis findings |
Enlarged hypoechoic epididymis Increased blood flow Reactive hydrocele Scrotal wall thickening |
|
Orchitis findings |
Enlarged hypoechoic testicle Increased blood flow Decreased arterial resistance |
|
Bell clapper deformity |
Testicle is not attached to the tunica vaginalis leaving it capable to rotate freely on the spermatic cord |
|
With testicular ischemia, the testicle becomes |
Enlarged and hypoechoic |
|
After _ hours with testicular torsion, the salvage rate markedly decreases |
6 |
|
What will better optimize slow blood to rule out a complete torsion |
Decreasing pulse repetition frequency (color scale) |
|
Undescended testicle |
Cryptorchidism |
|
Complications or cryptorchidism |
Infertility and cancer |
|
Patients with cryptorchidism have an increased risk of developing a |
Malignancy in both the undescended testis and contralateral testis |
|
Common location of the cryptorchid testis |
Inguinal canal |
|
Congenital absence of the testical |
Anorchia |
|
The prostate is located in the |
Retroperitoneum |
|
The prostate is bordered anteriorly by the |
Pubic bone |
|
The prostate is bordered posteriorly by the |
Rectum |
|
The prostate is bordered superiorly by the |
Urinary bladder |
|
The prostate is bordered inferiorly by the |
Urogenital diaphragm |
|
Arterial supply to the prostate |
Inferior vesical artery |
|
Inferior portion of the prostate situated superior to the urogenital diaphragm |
Apex |
|
Superior portion of the prostate situated below the inferior margin of the urinary bladder |
Base |
|
Two sac-like out-pouchings of the vas deferenssituated adjacent to the superior/posterior aspect of the prostate |
Seminal vesicles
Between urinary bladder and rectum |
|
Duct that passes through the central zone and empties into the urethra |
Ejaculatory duct |
|
This duct originates from the combination of the vas deferens and the seminal vesicle |
Ejaculatory duct |
|
Longitudinal ridge within the urethra in which the orifices of the ejaculatory ducts are located on either side |
Verumontanum |
|
Calcifications commonly seen in the inner gland of the prostate |
Corpora amylacea |
|
Demarcation between the inner prostate gland and outer prostate gland |
Surgical capsule |
|
Shadowing created by calcification in the area of the urethra and verumontanum |
Eiffel tower sign |
|
Posteriorly locates portion of the prostate |
Peripheral zone |
|
Contains 70% of the prostatic glandular tissue |
Peripheral zone |
|
Location of most prostate cancers |
Peripheral zone |
|
The peripheral zone extends into |
The apex of the prostate |
|
Superiorly located portion of the prostate |
Central zone |
|
Contains 25% of the prostatic gland tissue |
Central zone |
|
Ejaculatory duct passes through this zone from the seminal vesicles to the urethra |
Central zone |
|
Contains 5% of the prostatic glandular tissue |
Transitional zone |
|
Site of origin of benign prostatic hyperplasia |
Transitional zone |
|
Anteriorly located non glandular portion of the prostate |
Fibromuscular stroma * Not affected by cancer* |
|
Used to evaluate the prognosis of men with prostate cancer |
Gleason Grading system |
|
>80% of prostate cancers are diagnose in men older than |
85 |
|
African american men are up to _x more likely to develop prostate cancer than white men |
2 |
|
Indications for transrectal US |
Abnormal digital rectal exam Elevation of PSA |
|
PSA |
Prostate specific antigen Increases with age and prostatic volume |
|
PSA levels |
<4 ng/mL Normal 4-10 ng/mL Benign/Potential malignancy >10 ng/mL Most likely cancer |
|
PSA density |
Relationship between PSA and prostate volume |
|
Classic appearance of prostate cancer |
Hypoechoic, peripherally-oriented lesion |
|
Pre transrectal ultrasound prep |
Cleansing enema Pre and post prophylactic antibiotics |
|
Enlargement of the transitional zone of the prostate |
Benign prostatic hyperplasia |
|
Benign prostatic hyperplasia symptoms |
Difficult initiation of voiding Urinary frequency Small stream |
|
Prostate volume formula |
Height x width x length x 0.52 |
|
Seminal vesicle agenesis is associated with |
Ipsilateral renal agenesis |
|
Seminal vesicle cysts can be seen |
POsterior to the blasser |
|
Cysts of the seminal vesicle are associated |
Ipsilateral renal agenesis or dysplasia and atresia of the ejaculatory duct |
|
Have a tear drop shape with a midline location at the level of the verumontanum |
Utricle cystsM |
|
Mullerian duct cysts |
Midline cyst very difficult or impossible to distinguish from a prostatic utricle cyst |
|
Ejaculatory duct cysts result in |
Hematospermia, ejaculatory pain and infertility |
|
The spleen is a __ organ |
Peritoneal |
|
The spleen lies between |
The stomach and the diaphragm |
|
The spleen filters |
Damaged cells Microorganisms Particulate matter |
|
The average spleen measures |
12 cm longitudinal 8cm transverse 4cm thick |
|
Splenomegaly |
>12cm longitudinally
Or if the spleen is inferior to the lower pole of the left kidney |
|
The fundis of the stomach, lesser sac, and pancreatic tail are __ and __ to the splenic hilum |
Medial and anterior |
|
The left kidney lies __ and __ to the spleen |
Inferior and medial |
|
The pancreatic tail is located __ to the upper pole of the left kidney in the splenic hilum |
Anterior |
|
Accessory spleens are located |
Near the splenic hilum and have identical echogenicity to the spleen |
|
Most common type of splenic granulomas |
Histoplasmosis and tuberculosis |
|
True splenic cysts lined by squamous epithelium |
Epidermoid cysts (Solitary cyst 10cm. May be calcified with echogenic contents) |
|
__ may erode into the spleen due to their proximity |
Pancreatic pseudocysts |
|
Most common benign primary neoplasm of the spleen |
Hemangioma |
|
__ more frequently metastasise to the spleen |
Malignant melanoma |
|
Splenic infarcts are common in patients with |
Bacterial endocarditis and splenic artery aneurysms |
|
Peripheral wedge-shaped hypoechoic splenic lesion |
Splenic infarct |
|
Splenic abscess may be the result of |
Sepsis due to endocarditis, dental infections, or urosepsis |
|
Splenic abscess US |
Complex cystic lesion
Presence of gas may produce reverberation (comet-tail) artifact |
|
Due to a mutant hemoglobin S |
Sickle Cell Dx |
|
Sickle cell dx |
Spleen begins to enlarge (1st year) Spleen remains enlarged due to a pooling of sickled cells Spleen become fibrotic and shrinks before the end of childhood |
|
Most common cause of splenomegaly |
*Portal hypertension* Splenic vein thrombosis |
|
Splenomegaly |
Spleen enlarges and extends in the anterior, medial, and inferior direction |
|
Blood disorder resulting in uncontrolled RBC production causing hyperviscosity and hypercoagulation |
Polycythemia vera |
|
Polycythemia vera may be the cause of |
Splenomegaly Budd-Chiari syndrome Portal vein thrombosis Splenic infarcts |
|
A calcified circle seen in the LUQ |
Splenic artery aneurysm |
|
Normal asymmetrical arrangement of anatomy |
Situs solitus |
|
Mirror image of situs inversus |
Situs inversus |
|
The disruption in the development of the normal asymmetric arrangement of abdominal organs and vessels |
Situs ambiguous or heterotaxia |
|
Polysplenia is associated with |
Bilary atresia Intestinal malrotation Azygous continuation of interupted IVC Cardiac defects |
|
Asplenia is associated with |
Midline liver and GB INtestinal malrotation Reversed position AO and IVC Cardiac defects |
|
Subcapsular or intraparenchymal hematomas results when |
The splenic capsule remains intact |
|
Perisplenic or intraperitoneal hematomas result with |
Capsule rupture Fluid around spleen |
|
Utilized in the ER to document the presence of free fluid in the peritoneal cavity |
Focused assessment with sonography for trauma
FAST |
|
Volume of RBS found in 100ml of blood |
Hematocrit |
|
With hx of splenic rupture/surgery, splenic cells may implant throughout the peritoneal cavity resultingin an ectopic spleen |
Posttraumatic splenosis |
|
Serous membranethat forms the lining of the abdominal cavity and covers most of the abdominal organs |
Peritoneum |
|
Lines the abdominal wall |
Parietal peritoneum |
|
Covers abdominal organs |
Visceral peritoneum |
|
Space that is situated between the liver, pancreas and stomach |
Lesser sac |
|
Entrance to the lesser sac |
Epiploic foramen |
|
Space you image ascites with floating bowel |
Greater sac |
|
Peritoneal recess extending between the rectum and the uterus |
Pouch of Douglas |
|
Intraperitoneal Structures |
Stomach, jejunum, 1st part of duodenum, appendix, spleen, cecum, trv and sigmoid colon, rectum, liver, uterus, fallopian tubes, and ovaries |
|
Posteriorly located compartment that lies between the transversalis fascia and posterior parietal peritoneum |
Retroperitoneum |
|
Kidneys and adrenal glands lie within the __ space |
Perirenal |
|
Retroperitoneal Structures |
Kidneys and ureters, adrenal glands, ascending and descending colon, 2nd 3rd and 4th duodenum, pancreas, AO/IVC, renal vessels, superior mesenteric vessels, gonadal vessels, lymphatics, prostate, rectum, esophagus |
|
The quadratus lumborum and psoas muscles lie |
Posterior to the posterior pararenal space |
|
First major branch as the AO descends through the diaphragm |
Celiac axis |
|
Celiac axis branches |
Common hepatic artery Left gastric artery Splenic artery |
|
"Sea gull" or "dove" sign |
Bifurcation of celiac axis into common hepatic and splenic artery |
|
Common hepatic artery bifurcates into the |
Proper hepatic artery and gastroduodenal artery |
|
SMA is __ to the celiac axis |
Inferior |
|
SMA is __ to the body of the pancreas |
Posterior/Inferior |
|
SMA __ the aorta |
Parallels |
|
SMA doppler waveform when fasting |
High resistance |
|
SMA doppler waveform postprandial |
Low resistance, increased velocity |
|
Renal arteries arise |
From the lateral walls of the AO below SMA |
|
Which is longer? Right or left renal artery |
Right renal artery |
|
Gonadal arteries |
Arise directly off the distal AO |
|
IVC lies to the __ of the AO |
Right |
|
IVC dilates with |
Cardiac failure and fluid overload |
|
Most common tumor to involve the IVC |
Renal cell carcinoma |
|
A liver mass would displace the IVC |
Posterior/medial |
|
A right renal artery aneurysm mass would displace the IVC |
Anterior |
|
Lymphadenopathy would displace the IVC |
Anterior |
|
A tortuous AO would displace the IVC |
Right/Lateral |
|
A right renal/adrenal mass would displace the IVC |
Anterior/Medial |
|
Most common IVC filter |
Greenfield |
|
IVC filters are used to prevent |
The ascend of lower extremity vein thrombosis |
|
Proper location for IVC filters |
Inferior to the renal veins |
|
IVC filters are placed through |
Catheters at the femoral or internal jugular vein |
|
Left renal vein passes |
Between the SMA and AO from left kidney to IVC |
|
Engorgement of the left renal vein due to compression by the SMA and AO |
"Nutcracker syndrome" |
|
Right gonadal vein drains |
Into the IVC |
|
The left gonadal vein drains |
Into the left renal vein |
|
Which is longer? Left or right renal vein |
Left |
|
Dense fibrous tissue proliferation confined to the paravertebral region |
Retroperitoneal fibrosis |
|
Retroperitoneal fibrosis is associated with |
Bilateral ureteral obstruction
Envelopes structures rather than displacing them |
|
Azygos IVC vein ais located |
On the right |
|
Hemiazygos IVC vein is located |
On the left |
|
Ascending lumbar veins are branches of the |
Common iliac veins |
|
Right adrenal gland |
Shaped like a triangle |
|
RIght adrenal gland is located |
Superior, anterior, and medial aspect of the right kidney
Posterior to IVC |
|
The crus of the diaphragm lies __ and __ to the right adrenal gland |
Medial and posterior |
|
Left adrenal gland |
Crescent shaped |
|
Left adrenal gland is located |
Anteriomedial to the upper pole of the left kidney |
|
The AO and crus of the diaphragm are located __ and __ to the left adrenal gland |
Medial and left |
|
The tail of the pancreas is located __ to the left adrenal gland |
Anterior |
|
The crus of the diaphragm is located anterior to the |
AO |
|
The crus of the diaphragm is located superior to the |
Celiac axis |
|
The crus of the diaphragm is located posterior to the |
IVC |
|
The crus of the diaphragm is located medial and posterior to all structures except the |
AO |
|
Adrenal cortex US |
Hypoechoic and less echogenic than retroperitoneal fat |
|
Adrenal medulla US |
Echogenic linear structure within adrenal gland |
|
Arteries that supply each adrenal gland |
Suprarenal of inferior phrenic art Suprarenal branch of AO Suprarenal branch of renal art |
|
Right suprarenal vein drains into |
IVC |
|
Left suprarenal vein drains into |
Left renal vei |
|
The adrenal cortex produces |
Aldosterone Cortisol Androgens |
|
Adrenal cortical hormones are regulated by |
Adrenocorticotropic hormones |
|
The __ and __ function together to regulate hormone production |
Adrenal gland Anterior pituitary gland |
|
Adrenal medulla produces |
Catecholamines: Epinephrine Norepinephrin |
|
Excessive cortisol secretion |
Cushing's syndrome |
|
Excessive aldosterone secretion |
Conn syndrome |
|
Excessive androgen production |
Hirsutism Overabundance of hair |
|
Majority of patients with adrenal cortical carcinomas present with |
Cushing's syndrome *Rare tumor with poor prognosis* |
|
Adrenal cortical carcinomas have a tendency to invade the |
Renal veins and IVC |
|
Pheochromocytomas secrete |
Norepinephrine/Epinephrine |
|
Pheochromocytomas are associated with |
MEN Von Hippel-Lindau dx |
|
MAlignant tumor arising from the sypathetic nervous system, comonnly occuring in the adrenal medulla |
Adrenal neuroblastoma |
|
Most common adrenal mass of infancy and early childhood |
Adrenal neuroblastoma |
|
Adrenal neuroblastoma US |
Solid mass that displaces the ipsilateral kidney inferiorly into the pelvis |
|
Increased blood and urine catecholamines |
Adrenal neuroblastoma |
|
Benign, nonfunctioning adrenal masses that contain fat and bone elements |
Myelolipoma |
|
Myelolipoma US |
Hyperechoic masses in adrenal bed |
|
Myelolipomas are associated with |
Propagation speed artifacts due to fat composition |
|
Most common adrenal lymphoma |
Non-hodgkin dx |
|
Adrenal lymphoma involvement is commonly and frequently |
Bilateral |
|
Met sites in order |
Lungs Liver Bone Adrenal glands |
|
Adrenal hemorrhage is most common in |
Neonates |
|
What is the most common adrenal mass in a newborn? |
Adrenal hemorrhage |
|
Lymphadenopathy commonly displaces |
IVC and SMA anteriorly |
|
What direction will the splenic vein be displaced by a left adrenal mass? |
Anterior |
|
What direction will the bladder be displaced by a hematoma in the Pouch of Douglas? |
Anterior |
|
With a gastric outlet obstruction and dilation of the stomach, what direction will the pancreatic tail be displaced? |
Posterior |
|
What direction will a mass in the uncinate process displace the SMV? |
Anterior |
|
What direction will a neuroblastoma displace the ipsilateral kidney? |
Inferior |
|
What direction will a mass in the left lobe of the liver displace the gastroesophageal junction? |
Posterior |
|
3 types of aneurysms |
True False (Pseudo) Dissecting |
|
Small saccular aneurysm commonly located in the cerebrum |
Berry |
|
Infected aneurysm |
Mycotic |
|
Results in the weakening of the media in severe atherosclerosis |
Atherosclerotic aneurysm |
|
Spindle-shaped dilatation in which the stretching process affects the entire circumference of the artery |
Fusiform artery |
|
Localized spherical outpouching of the vessel wall |
Saccular aneurysm |
|
True aneurysm |
Involves all three layers of the AO |
|
Aneurysms |
Focal dilatation with at least a 50% increase over normal AO diameter |
|
Most AO aneurysms occur |
In the distal AO |
|
False AO aneurysms result from |
Injury to the vessel wall and extravasated blood is walled off by surrounding tissue |
|
Pseudoaneurysm waveform |
Bidirectional seen at stalk |
|
Dissecting aneurysms typically originate |
At the aortic arch in the thorax |
|
Dissecting aneurysm |
Separation of the intima from the media of the aortic wall |
|
The dissecting artery can extend to |
The carotid arteries or down the AO to the femoral arteries |
|
Endovascular stent graft |
Alternative to open AO surgery Inserted into groin and deplored within AO |
|
Chronic mesenteric ischemia presents as |
Postprandial abdominal pain and weight |
|
Sonographic evaluation for mesenteric ischemia involves |
Celiac axis SMA Inferior mesenteric artery |
|
Mesenteric artery stenosis criteria |
SMA velocity >275 cm/sec CA velocity >200 cm/sec |
|
Celiax axis compression syndrome is also known as |
Arcuate ligament compression syndrome |
|
Compression of the proximal celiac axis by the median arcuate ligamentof the diaphragm |
Celiac axis compression syndrome |
|
Celiac axis compression syndrome expiration |
Median arcuate ligament compresses the ventral aspect of the celiac axis producing an "S" shaped celiac axis and a significant stenosis |
|
Celiac axis compression syndrome inspiration |
Celiac axis straightens and the stenosis disappears and elevated systolicvelocities decrease to normal values (<200 cm/sec) |
|
Abnormal connection between an artery and a vein |
Arteriovenous shunt/fistula |
|
Arteriovenous shunts/fistulas are commonly associated with |
Angiographic punctures of the common femoral artery just inferior to the groin |
|
ARteriovenous fistulas present as |
Bruit or thrill depending on their location |
|
Sonographic characteristics of arteriovenous shunt |
Color flow bruit Pulsatile venous flow Low resistive arterial flow |
|
Intrarenal arteriovenous shunts are the result of |
Renal biopsy |
|
An arteriovenous shunt will produce a __ waveform |
High velocity, low resistance |
|
Normal intestinal wall |
3-5mm |
|
Layers of the gut wall |
Mucosa Submucosa Muscularis externa Adventitia |
|
Intestinal pathology sonographic pattern |
"Target" or "Pseudokidney" |
|
Segment of esophagus between the diaphragm and the stomach |
Gastroesophageal junction |
|
Presence of air within the the peritoneal cavity |
Pneumoperitoneum
*Black screen image on test* |
|
Most common cause of an acutely painful abdomen |
Acute appendicitis |
|
Typical location for the appendix |
Posterior to the terminal ileum Anterior to iliac vessels |
|
The RLQ location of the appendix between the umbilicus and the iliac crest |
McBurney's point |
|
Caused by the obstruction of the appendiceal lumen by a fecalith or hyperplasia of the submucosa |
Appendicitis |
|
Sonographic criteria for diagnosing inflammatory appendix |
Non-compressible appendix >6mm diameter Appendicolith |
|
Causes a functional gastric outlet obstruction as a result of hypertrophy and hyperplasia of the muscular layers of the pylorus
|
Hypertrophic pyloric stenosis
|
|
Hypertrophic pyloric stenosis neonate (3-8 weeks) patients present with |
Vomiting (non-bloody non-bilous) Palpable "olive-shaped" pylorus Visible peristalsis |
|
Pylorus size criteria |
Muscle thickness >3mm (3-4mm) Channel length >17mm (14-24mm) Cross section diameter >15mm |
|
What is the most accurate measurement for pyloric stenosis? |
Muscle wall thickness |
|
Inflammation of diverticulum |
Diverticulitis |
|
Symptoms of diverticulitis |
LLQ Pain Fever Leukocytosis |
|
Diverticulitis US |
Thickening of bowel wall (>4mm) Abscess formation Inflammed diverticula (pseudokidney) |
|
Mechanical small-bowel obstruction can be caused by |
Intraluminal (food bolus) Bowel wall lesion (tumor/Crohns) *Extrinisic (hernia)* most common |
|
Bowel obstruction colon |
Haustra markings |
|
Most common cause of intestinal obstruction in infant toddler age group |
Intussusception (telescoping of bowel) |
|
Intussusception clinical presentation |
**Bloody diarrhea like currant jelly** Intermittent abdominal pain Vomiting |
|
Intussusception US |
Pseudokidney Target sign Concentric rings of folded bowel |
|
Normal thyroid variant extending superior to the isthmus |
Pyramidal lobe |
|
Sonolucent bands along the anterior surface of the thyroid gland |
Strap muscles |
|
Sternocleidomastoid muscles are located |
Anterolaterally to the thyroid |
|
Wedge-shaped sonolucent structure adjacent to the cervical vertebrae |
Longus colli muscle Posterior to the thyroid |
|
Composed of the recurrent laryngeal nerve and inferior thyroid vessels |
Minor neurovascular bundle |
|
Vague, hypoechoic area between the longus colli muscle and the thyroid gland |
Minor neurovascular bundle |
|
*Neck* Midline, curvilinear reflecting surface with associated reverberation artifact |
Trachea |
|
Target sign trsv, usually hidden from sonographic visualization from the trachea |
Esophagus |
|
Strap muscles are __ to the thyroid |
Anterior |
|
Stenocleidomastoid is __ to the thyroid |
Anterolateral |
|
Common carotid/ Int jugular veins are __ to the thyroid |
Lateral |
|
Minor neurovascular bundle is __ to the thyroid |
Posterior |
|
Longus colli muscle is __ to the thyroid |
Posterior |
|
Parathyroid glands are __ to the thyroidP |
Posterior |
|
The superior thyroid arteries branch off the |
External carotid arteries |
|
The inferior thyroid arteries branch off the |
Thyrocervical trunk |
|
Venous blood from the thyroid is drained into |
The internal jugular vein via the superior and middle thyroid veins
The innominate veins via the inferior thyroid veins |
|
Glands that regulate thyroid hormones |
Thyroid (T3/4) Pituitary (TSH) Hypothalamus (TRH) |
|
Produced by the pituitary to stimulate the thyroid to produce thyroid hormones |
Thyroid stimulating hormones (TSH) |
|
An increase in TSH is usually the fist indication of |
Hypothyroidism |
|
^ TSH v T4/T3 |
Hypothyroidism |
|
v TSH ^T4/T3 |
Hyperthyroidism |
|
MOst commonly encountered benign thyroid nodule |
Follicular adenoma |
|
Thyroid adenoma US |
Solitary, spherical and encapsulated |
|
Thyroid cancer risk factors |
Age: <20 and >60 Head and neck irradiation Family hx |
|
Most common primary thyroid cancer 75-80% of all cases |
Papillary carcinoma |
|
Papillary carcinoma US |
Hypoechoic with possible calcifications |
|
Follicular carcinoma of the thyroid |
10-20% Encapsulated Spread via blood stream rather than the lymphatics |
|
Secretes hormone calcitonin |
Thyroid medullary carcinoma |
|
Medullary carcinoma is associated with |
MEN syndrome |
|
Anaplastic carcinoma |
1% of thyroid cancers Aggressive behavior Poor prognosis |
|
Most effective method for diagnosing malignancy in a thyroid mass |
Fine needle aspiration |
|
FNA applications |
Nodule: >1 cm with microcalcifications >1.5cm predominantly solid >2cm mixed components Demonstrating growth |
|
Peripheral or eggshell calcified nodule |
Benign nodule |
|
Fine or punctate calcified nodules |
Suggestive of malignancy |
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Features associated with Thyroid Cancer |
Microcalcifications Solid hypoechogenicity Irregular margins Absence of halo Intranodule central vascularity More tall than wide |
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Generalized enlargement of the thyroid |
Diffuse thyroid dx (goiter) |
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Painless, diffuse enlargement of the thyroid in young or middle aged woman. |
Hashimoto's Autoimmune thyroid dx |
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Hashimoto's US |
Hypoechoic diffuse enlargement with course parenchymal echo texture |
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Enlarged thryoid gland |
Goiter Diffuse or nodular |
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Most common cause of a goiter |
Iodine deficiency |
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Autoimmune disorder characterized by hyperthyroidism due to circulating antibodies |
Graves dx |
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Most common cause of hyperthyroidism |
Graves dx |
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Graves dx hallmark sign |
Prominent eyes |
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Graves dx US |
Diffusely hypoechoic and inhomogeneous Hypervascular Audible bruit |
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How many parathyroid glands are there? |
4 |
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Oval, hypoechoic mass posterior to thr thyroid gland |
Parathyroid adenoma |
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Most common type of hyperparathyroidism |
Primaty due to development of an adenoma associated with one of the parathyroid glands |
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Primary hyperparathyroidism is suspected with an increase in |
Serum calcium levels |
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Primary hyperparathyroidism levels |
^ PTH ^ Serum Calcium |
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Secondary hyperparathyroidism occurs in patients with |
Chronic renal failure *Failure so synthesize vitamin D* |
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Most common manifestation of MEN |
Secondary hyperparathyroidism |
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Secondary hyperparathyroidism levels |
^Serum phosphates v Serum Calcium |
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Exocrine glands that secrete saliva and the enzyme amylase |
Salivary glands |
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Largest of the salivary glands |
Parotid glands
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Parotid glands are found |
Anterior to the ear |
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Stensons duct drains the |
Parotid glands into the oral cavity |
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Submandibular glands are located |
Beneath the jaw |
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Wharton's ducts drain |
The submandibular glands into the oral cavity |
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Sublingual glands are located |
Beneath the tongue Anterior to the submandibular glands |
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Most common superficial midline neck mass |
Thyroglossal duct cyst (Adolescents w upper respiratory infection) |
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Solitary, predominantly cystic mass appearing on the lateral aspect of the neck |
Branchial cleft cysts |
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Branchial cleft cysts are a remnant of |
Embryonic development |
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Cystic hygromas typically occur |
In the neck Evident at birth |
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Vessels of the aortic arch |
Innominate artery Left CCA Left subclavian arterty |
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Left CCA and subclavian originate off of |
The aortic arch |
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Innominate artery (brachiocephalic) divides into |
Right CCA and External carotid artery |
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There is only 1 innominate __ and bilateral innominate __ |
Artery Veins |
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ICA is located |
Lateral and posterior |
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ECA is located |
Medial and anterior |
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ICA has a __ waveform |
Low resistance |
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ECA has a __ waveform |
High |
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First branch of the ICA |
Opthalmic |
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First branch of the ECA |
Superior thyroid artery |
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The internal jugular and subclavian vein drain into |
The brachiocephalic/innominate vein |
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The external jugular vein is located |
Superficially on the lateral aspect of the neck |
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Abscess US |
Typically a complex mass (solid and cystic)
Debris, septations, and gas can be seen within the abscess |
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Gas within the abscess may produce a __ artifact |
Reverberation (comet-tail) |
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Abscesses typically demonstrate |
Posterior enhancement depending on the cystic component of the abscess |
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Most reliable finding in pts with abscess |
Presence of fever Increased WBC count |
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Differentiation of abscess without gas from a hematoma |
Percutaneous aspiration |
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Extrahepatic collections of extravasated bil |
Biloma |
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Bilomas are associated with |
Abdominal trauma, GB dx, biliary surgery |
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Bilomas US |
Predominantly cystic masses located in RUQ |
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Lymphoceles are complications of |
Renal transplant Gynecologic sx Vascular sx Urological sx |
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Leakage of lymph from a renal allograft, or by a surgical disruption of the lymphatic channels |
Lymphocele (fluid collection) |
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Collection of urine located outside of the kidney or bladder |
Urinoma |
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Urinomas are caused by |
Renal trauma Renal sx Obstructing lesionU |
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Urinomas are most commonly associated with |
Renal transplantation Posterior urethral valve obstruction |
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Spectrum of disorders affecting the proximal femur and acetabulum that leads to hip subluxation and dislocation |
Hip Dysplasia |
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Risk factors for hip displasia |
Female First-born children Frank breech presentation Family history of DDH Oligohydramnios |
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Dislocation of the hip by adducting and pushing the leg posteriorly |
Barlow maneuver |
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Relocation of the dislocated hip by abducting the leg |
Ortolani maneuver Palpable and audible "clunk" noted |
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Lymphoma groups |
Non-Hodgkin lymphoma Hodgkin's dx |
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Lymph nodes US |
Anechoic/hypoechoic mas containing a central echogenic foci |
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"Mantle" or "sandwich" sign |
Perivessel lymphoma |
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Lymphoma is noted to displace the IVC and AO __ |
Anteriorly non-Hodgkins typically |
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Excessive accumulation of serous fluid in the peritoneal cavity |
Ascites |
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Two mechanisms that produce ascites |
Low serum osmotic pressure (protein loss) High portal vein pressure |
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Causes of Ascites |
Cirrhosis *most common* Renal failure Congestive heart failure Cancer *malignant ascites* |
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Hypoalbuminemia can be the result of |
Liver failure Nephrotic syndrome Malnutrition |
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Hypoalbuminemia |
Low protein |
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What can successfully treat ascites by lowering portal pressure |
Transjugular intrahepatic portal-systemic shunt TIPS |
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Ascites is commonly found at the |
Inferior aspect of the RLL Morison's pouch Pelvic cul de sac Paracolic gutters |
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GB __ is frequently seen with ascites |
Thickening |
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Malignancy characterized by the progressive accumulation of mucus-secreting tumor cells within the peritoneum |
Pseudomyxoma Peritonei *Commonly associated with cancer of the appendix* |
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Pseudomyxoma Peritonei US |
Bowel loops matted to the posterior abdominal wall |
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Procedure to remove ascites from the peritoneal cavity |
Abdominal paracentesis |
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Diagnostic paracentesis |
To perform laboratory testing on the fluid |
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Therapeutic paracentesis |
To relieve abdominal pressure causing respiratory difficulties or pain |
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Accumulation of fluid within the pleural space |
Pleural effusion |
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Caused by increased hydrostatic pressure and decreased plasma oncotic pressure |
Transudative effusion *Pressure infiltration* |
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Caused by increased capillary permeability |
Exudative effusions *Inflammation* |
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The absence of gliding of the parietal and visceral pleura and the presence of comet-tail artifact between those layers |
Pneumothorax |
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Procedure to aspirate fluid from the pleural space of the chest |
Thoracentesis |
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Diagnostic thoracentesis |
Laboratory evaluation of fluid to determine cause of the pleural effusion |
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Therapeutic thoracentesis |
To relieve dyspnea |
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A thoracentesis is typically performed with the patient |
Sitting at the edge of the bed leaning over a bedside table with their back rounded |
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Collection of synovial fluid in the popliteal fossa |
Baker's cyst *Medial aspect* *Can extend into the calf* |
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Second most common tumor of the hand and wrist |
Giant cell tumor *Tendon Sheath* |
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Most common cell tumor of the hand and wrist |
Ganglion cyst |
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Result of bleeding from the superior or inferior epigastric vessels or from a tear of the rectus muscle |
Rectus sheath hematoms |
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Rectus sheath hematomas superior to the arcuate line |
Are confined between the anterior and posterior sheaths and should not move across the midline due to the linea alba |
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A rectus muscle hematoma inferior to the arcuate line |
Will extend into the space of Retzius within the pelvis causing external compression and irritation of the urinary bladder |
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Rectus sheath hematomas occur due to |
External trauma Trauma from surgery Vigorus muscle contraction Pregnancy |
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Rectus sheath hematoma is a recognized complication of |
Anticoagulation therapy |