ARDMS Abdomen Review (Based off of URR Review Course)

ARDMS Abdomen Review (Based off of URR Review Course) What does an increased RI mean Ans- increased resistance in vascular bed What does an increased pulsatility index mean Ans- increased resistance in vascular bed Normal PI for vessels supplying organs such as kidneys Ans- 0.75 Hydrostatic pressure: when supine at ankle when standing above heart when standing Ans- 0 mmHg 100 mmHg -30 mmHg What vessel is the most posterior abdominal vessel Ans- aorta Paired branches of the aorta (5) Ans- suprarenal arteries (adrenal glands) renal arteries (kidneys) gonadal arteries (ovaries/testicles) lumbar arteries common iliac arteries Unpaired branches of the aorta (4) Ans- celiac axis (common hepatic, splenic, left gastric arteries) SMA IMA median sacral artery What level common iliac arteries bifurcate Ans- L3-4 Decreased hematocrit may indicate what Ans- bleed in body What happens to the aorta as you follow it distally (2) Ans- gets smaller becomes more anterior Aortic Ectasia Ans- lack of tapering of aorta as you move distally (can be precursor to aneurysm) AAA What vessel walls are involved Ans- focal dilation of aorta 3cm or 50% diameter between two adjacent segments all three Most common cause of AAA Ans- atherosclerotic disease Risk factors for AAA (4) Ans- 1. male 2. family history 3. smoking 4. chronic hypertension Saccular aneurysm Ans- localized round out pouching, may have small stalk Fusiform aneurysm Ans- vessel wall stretched in circumferential manner (most common) Mycotic aneurysm Ans- infected aneurysm, seen with syphilis Most common location of fusiform aneurysms Ans- infrarenal At what diameter is surgical intervention done on an AAA Ans- 5.5cm Complications of AAA (5) Ans- 1. rupture 2. decreased blood to lower extremities 3. thrombus accumulation and embolization (blue toe syndrome) 4. affects renal circulation and systemic blood pressure (if suprarenal) 5. compress IVC Yin Yang Sign Ans- sonographic sign with AAA swirling of blood in body of aneurysm on color doppler Splanchnic artery aneurysm most commonly occurs in What gender is this more common in Ans- splenic artery women Aneurysm in the hepatic artery most commonly occurs in what segment Ans- extra hepatic With endovascular aortic repair, what happens to the native aortic sac over time What plane should it be measured in Ans- decreased in size transverse If aortic sac expands more than _____ between exams, a leak should be suspected Ans- 0.6 cm Type I dissection Type II dissection Type III dissection Ans- ascending and descending aorta ascending aorta, associated with Marfan syndrome descending aorta Marfan syndrome Ans- genetic disorder affecting connective tissue of heart, vessels, bones Aortic rupture symptoms Ans- back pain hypotension Leriche syndrome (3) Ans- aortoiliac occlusive disease occlusion of abdominal aorta just above CIA bif causes bilateral lower extremity ischemia symptoms Retroperitoneal fibrosis other name, most common location Ans- Ormond disease most commonly at aortic bifurcation and inferiorly in pelvis Retroperitoneal fibrosis sonographically (4) Ans- soft tissue mass surrounding great vessels hypoechoic smooth borders possible hydronephrosis (due to ureteral obstruction) Abnormal dilation of the abdominal segment of the IVC measures Ans- 2.5 cm Normal Doppler flow of the IVC is Ans- triphasic Most common variation of IVC anatomy Ans- duplicated IVC infrarenal segment duplicated with left IVC entering left renal vein (suprarenal IVC normal) Transposed IVC Ans- IVC on left side of abdomen (instead of right) Interrupted IVC (3) Ans- IVC doesn't go to right atrium enters azygos/hemiazygos veins to reach SVC no intrahepatic segment Causes of IVC dilation (5) Ans- 1. right heart failure (most common) 2. congestive heart failure 3. pulmonary hypertension 4. mass effect 5. pregnancy Greenfield Filter (3) Ans- prevents emboli from reaching lungs infrarenal echogenic "umbrella" Most common malignancy to invade renal vein and IVC Ans- RCC (renal cell carcinoma) Liver is encapsulated by _____ capsule Ans- glisson Portal triad includes Ans- portal vein hepatic artery bile duct In pediatric patients, the liver shouldn't extend more than _____ below the costal margin Ans- 1cm below The right hepatic vein (in right intersegmental fissure) divides the right lobe of the liver into what segments The left hepatic vein (in left intersegmental fissure) divides the left lobe of the liver into what segments Ans- anterior and posterior segments medial and lateral segments Triangular ligament attaches the superior liver Ans- to the diaphragm Falciform ligemant attaches the anterior surface of the liver Ans- to the abdominal wall Ligamentum teres is what What is it also called Ans- remnant of umbilical vein round ligament Ligamentum venosum is Ans- remnant of ductus venosum from fetal circulation (umbilical vein-left portal vein-ductus venosus-IVC-right atrium) Hepatoduodenal ligament contains (3) Ans- MPV hepatic artery CBD Branches of MPV Ans- RPPV RAPV LMPV LLPV MPV carries _____% of all blood entering liver, hepatic artery carries _____% Ans- 80 20 Normal portal vein diameter Ans- 13mm What is the most common variation in hepatic vein anatomy Ans- accessory right hepatic vein Caroli disease Ans- congenital defect of bile ducts, numerous cysts in biliary tree Caroli disease sonographically (3) Ans- 1. focal cystic areas 2. connecting to biliary tree 3. resembles polycystic disease Cyst criteria (5) Ans- 1. smooth borders 2. regular walls 3. no internal echoes 4. through transmission 5. posterior enhancement Hemorrhagic cyst sonographically (5) Ans- 1. septations with fluid levels 2. smooth borders 3. regular walls 4. through transmission 5. posterior enhancement Polycystic Liver disease What age does it present Ans- autosomal dominant presents 30-40 years Polycystic liver disease sonographically (4) Ans- 1. focal cystic areas 2. varying sizes 3. thin septations 4. may have cysts in pancreas, kidneys, spleen Biliary Hamartomas (Von Meyenburg Complexes) Ans- dilated intrahepatic ducts with dense stroma Biliary Hamartomas (Von Meyenburg Complexes) sonographically (3) Ans- 1. small echogenic nodules 2. heterogeneous liver 3. 1cm Causes of fatty infiltration of liver (5) Ans- diabetes alcohol abuse obesity starvation cystic fibrosis Diffuse fatty infiltration sonographically (5) Ans- mild: slight increase in fine echoes, normal visualization of diaphragm and vessel borders moderate: moderate increase in fine echoes, impaired visualization of diaphragm and vessel borders severe: marked increase in fine echoes, poor or non-visualization of diaphragm and vessel borders hepatomegaly possible narrowing of hepatic veins Focal fatty infiltration sonographically (5) Ans- focal increased echogenicity possible irregular borders usually adjacent to portal structures similar to hemangioma no displacement of surrounding structures Focal fatty sparing sonographically (5) Ans- focal decreased echogenicity (remaining liver tissue increased echogenicity) possible irregular borders usually adjacent to gallbladder fossa similar to malignancy no displacement of surrounding structures Amyloid disease (2) Ans- deposit of amyloid protein in vessel walls of various organs commonly involving liver Glycogen storage disease, most common type Ans- autosomal recessive von Gierke disease Glycogen storage disease with excessive storage of glycogen sonographically (2) Ans- hepatomegaly increased echogenicity Glycogen storage disease with reduced storage of glycogen sonographically (3) Ans- hypo echoic parenchyma prominent portal walls "starry sky" (similar to hepatitis) What is hemochromatosis What is it inherited from Sonographic appearance Ans- abnormal iron deposition inherited or due to anemia sonographically includes features of fibrosis and cirrhosis Wilson disease (2) Ans- autosomal recessive disease excessive deposition of copper in liver Wilson disease symptoms (5) Ans- jaundice hematemesis portal hypertension ascites rusty/brown-colored ring around iris of eye (Kayser-Fleischer rings) Wilson disease sonographically (3) Ans- echogenic fatty liver fibrotic periportal thickening nodular cirrhotic changes Cirrhosis symptoms (5) Ans- increased abdominal girth (ascites) jaundice liver atrophy splenomegaly weight loss Causes of cirrhosis (9) Ans- hep C alcohol abuse chronic liver disease biliary obstruction hep B glycogen storage disease hemochromatosis wilson disease Budd Chiari syndrome Cirrhosis sonographically (6) Ans- nodular surface hepatomegaly or right lobe atrophy with compensatory hypertrophy of left lobe portal hypertension splenomegaly thickened gallbladder wall ascites Symptoms of hepatitis (6) Ans- jaundice hepatomegaly nausea fever/chills malaise dark urine Acute hepatitis sonographically (4) Ans- "starry sky" appearance (normal liver texture or portal vein borders may be more prominent) increased echogenicity hepatosplenomegaly gallbladder wall thickening Chronic hepatitis sonographically (4) Ans- coarse echo texture decreased brightness of portal triads normal size increased liver echogenicity (due to fibrosis) Echinococcal cysts sonographically (3) Ans- large cyst with "daughter cysts" within honeycomb appearance, water lily sign most commonly found in right lobe What is schistosomiasis Ans- parasitic infection (most common in humans) Schistosomiasis sonographically (4) Ans- thick, echogenic portal vein walls debris/occlusion in intrahepatic portal venous system decreased liver size portal hypertension Pneumocystis jirovecci (pneumocystis carinii) cause and what patients is it most common in Ans- yeastlike fungus AIDS patients Pneumocystis jirovecci (pneumocystis carinii) sonographically (1) Ans- multiple non-shadowing echogenic foci Granulomatous infections sonographically (1) Ans- multiple echogenic foci (granulomas) in spleen and liver Three types of hepatic abscess Ans- pyogenic amoebic fungal Hepatic abscess symptoms (6) Ans- fever nausea diarrhea RUQ pain hepatomegaly leukocytosis Pyogenic hepatic abscess sonographically (2) Ans- solitary or multiple complex lesions fluid collections in: morison's pouch, subdiaphragmatic, subphrenic space Amebic hepatic abscess sonographically (3) Ans- complex lesion typically in right lobe history of travel Most common benign lesion of the liver What gender is it more common in What lobe is it usually found in Usual symptoms What can cause it to enlarge Ans- hemangioma women right asymptomatic pregnancy, estrogen therapy Hepatic hemangioma sonographically (3) Ans- homogenous hyper echoic well-defined Most common benign vascular tumor in infancy Most common symptom When does it spontaneously regress by Ans- infantile hemangioendothelioma cardiac failure age 2 Second most common benign liver mas