Spleen, GB, & Biliary System - NORMAL

When does the spleen form

5th week GA

Function during fetal life

Hematopoiesis- blood formation; Discontinues after 5th or 6th month

WHat is the spleens function after birth

Largest lymphoid tissue in the body, Defense against disease, Produces lymphocytes, Storage of iron, Maturation, storage, and removal of erythrocytes

What is the location of the spleen

left hypochondrium, Intraperitoneal except for the hilum

What is the size of the spleen

8-13cm length, 4-6 cm width

What is the shape of the spleen

Convex superior surface, Concave inferior surface

What is on the medial (visceral surface) of the spleen

Stomach, Left kidney, Pancreas, Splenic flexure of colon

What is the vascular supply for the spleen

Splenic Artery, Splenic Vein, Enter and exit the hilum

What is Responsible for phagocytosis (engulfing & destroying old cells), Produces lymphocytes, plasma cells, antibodies, Stores iron

Reticuloendothelial system

small nodular masses of lymphoid tissue attached to smaller arterial branches

Malpighian corpuscles

What Produces lymphocytes & monocytes, Active in ingesting & digesting harmful pathogens that enter the bloodstream

White Pulp

What Surrounds venous sinuses, Holds large volume of red blood cells that can be quickly release into the circulatory system if needed, Lymphocytes & macrophages

Red Pulp

What process called pitting and culling

Phagocytosis

Is phagocytosis a part of Red or white pulp

red

% of RBC per volume of blood; low indicates hemorrhage

Hematocrit

PResence of bacteria within the body

bacteremia

increase in number of WBC

leukocytosis

abnormal decrease in WBC

leukopenia

abnormal decrease in platelets

thrombocytopenia

What is the sonographic appearance of the spleen

Fine homogenous, low-level echo pattern, Similar to liver echotexture, May have calcifications

What are some congenital anomalies of the spleen

wandering spleen, accessory spleen or Splenule, asplenia

What is wandering spleen

Ectopic, Embryologic anomaly of supporting ligaments, Map vasculature to find

What is accessory spleen or splenule

Rounded, mass-like area near spleen, Same echotexture as spleen, Most commonly seen at the hilum

What is asplenia

rare, Associated with congenital heart defect

What is enlargement of the spleen

splenomeagly

What is the most common disease process of the spleen

splenomeagly

All of these are causes of what disease process of the spleen

Congestion, Neoplasm, Storage disease, Infection, Hemolytic anemia, Extramedullary hematopoiesis, Collagen-vascular disease, Trauma, Portal HTN- (due to cirrhosis is most common cause of congestive splenomegaly)

What are some Erythropoietic abnormalities from diffuse disease

Sickle cell anemia, Hemolytic anemia, Chronic anemia, Polycythemia vera, Thalassemia

What is the sonographic appearance of diffuse disease of the spleen

hypoechoic compared to the liver

What are some focal disease of the spleen

abscess

What Causes include bacterial endocarditis, drug abuse, trauma, septicemia,

infection spread from other parts of abdomen

abscess

What is the sonographic appearance of an abscess

ill-defined, complex mass, may see gas as, high level echoes with dirty shadowing. May appear similar to cyst in the spleen. Clinical information helpful with diagnosis

What are some focal disease of the spleen

abscess, splenic infection and (AIDS), cysts, trauma, Posttraumatic Splenosis, splenic infarction

What causes splenomegaly and multiple nodules

splenic infection and AIDS

What are some different focal disease cysts

ADPKD, Hydatid cysts, Epidermoid cysts

What gives the “tree rings” appearance

epidermoid cysts

What are two outcomes of blunt abdominal trauma

intact capsule and ruptured capsule

What is the subcapsular hematoma

intact capsule

What is the intraperitoneal hematoma (life threatening)

ruptured capsule

What does FAST mean

focused assessment with sonography for trauma

When is FAST used

utilized in ER to document free fluid in peritoneal cavity.

What does FAST evaluate

hemoperricardium, hemothorax, solid organ damage, and retroperitoneal injury

Splenic cells implant throughout peritoneal cavity following rupture or surgery

posttraumatic splenosis

What is it called when the spleen autotransplants

posttraumatic splenosis

What is the sonographic appearance of blood

it depends on age, amount, physical state of clot.

What is the early. sonographic appearance of blood

anechoic>hyperechoic

What is caused by the occlusion of the splenic artery or its branches

splenic infarction

What are the causes of splenic infarction

Sickle cell anemia, Bacterial endocarditis, Splenic artery aneurysms

What is the sonographic appearance of splenic infarction

peripheral hypoechoic, wedge-shaped lesions. May become anechoic, calcified, or hyperechoic over time

What is Most commonly seen in immunocompromised patients

Tuberculosis

What appears as focal, bright echogenic lesions

tuberculosis

What is the sonographic appearance of granulomatous disease

Multiple calcified foci within the spleen

What is a hemangioma

vascular mass

What is histoplasmosis

Birds and their droppings make people breathe in things that are environmentally damaging

How does a hemangioma appear

hyperechoic

Where is a hemangioma more commonly seen

liver

What causes suspicion of a splenic artery aneurysm

Calcified circle in LUQ on x-ray

What may appear as a cystic mass in the area of the splenic artery (hilum)

splenic artery aneursym

Artery should be trace from the celiac axis along the anterior aspect of pancreas tail to the splenic hilum

aneurysm

What are the two types of splenic congestion

acute and chronic

What are the causes of splenic congestion

portal HTN, thrombosis of portal or splenic vein, heart failure, cirrhosis, cystic fibrosis, sickle cell anemia

What is due to mutant hemoglobin S

sickle cell disease

Sickle Cell disease results in sickling of ___

RBC

What are some complications of sickle cell disease

anemia, infection, decreased O2 stat, pain-vascular occulssuion/ischemia, stroke, cholecystistis (chronic hemolysis), pulmonary HTN

For sickle cell disease the Spleen begins to enlarge at the end of ___ year of life

1st

why does the spleen remain enlarged for sickle cell disease

splenic sequestration (pooling of sickled cells)

what causes spleen to become fibrotic and shrink (autosplenectomy) before the end of childhood

repeated infarction

abnormal deposit of amyloid protein

Amyloidosis

fatty substance deposited in cells and organs

Gaucher’s Disease

Amyloid found in walls of sheathed arteries and follicles

nodular

Amyloid found in red pulp, Spleen greatly enlarged

diffuse

What are storage diseases

amyloidosis and Gaucher’s Disease

What is the sonographic appearance of gauchers disease

Solid nodules, Well defined, Heterogeneous-Hypoechoic, Hyperechoic or mixed, Splenomegaly

Malignant tumor of vascular tissue, Rare, Mixed cystic appearance

Hemangiosarcoma

which malignant tumor appears as a Diffuse involvement, Focal small nodular lesions, Focal large nodular lesions, Bulky nodular lesions

lymphoma

Where are the sites of origin for mets

Melanoma-more common, Breast, Lung, Ovary, Stomach, Colon, Kidneys, and Prostate

what is the sonographic appearance of mets

bulls eye or target

What is the location of. the gallbladder

•Between Rt & Lt hepatic lobes in the same plane as Main Lobar Fissure, Inferior to the liver in the anterior RUQ, Can be visualized midline when patient is on Lt side

What are the three portions of the gallbladder

neck, body, and fundus

What is the normal size of the gallbladder

Length: 7-10cm, Transverse: 3cm, **Wall thickness:  < 3mm**

folds along the inner border of the gallbladder- (can accumulate sludge or stones here

rokitanksy aschoff sinuses

tiny valves in the cystic duct that help prevent kinking of the duct and regulate the flow of bile

heister’s valve

diverticulum of the neck of the gallbladder

hartmans pouch

fold between the body and fundus of GB

phrygian cap

fold between the body and neck of the GB

junctional fold

what is biliary tract

hepatic ducts, right and left, common, cystic duct, cbd

What joins at the level ofthe porta hepatis to form the common bile duct

Right and Left Hepatic Ducts

Where are the hepatic ducts directed

caudally and medially (towards midline)

What does the cystic duct connect to

the gallbladder to the CHD forming the common bile duct

Lumen contains ___

mucosal folds

What are spiral valves of heister

cystic duct

What is the normal diameter of the common bile duct

up to 6mm

What is formed from the union of the cystic duct and common hepatic duct

common bile duct

__ refers to the extra hepatic ductal system

common duct

Where does the CBD lay

passes posterior to duodenum and pancreatic head

Where does the CBD join

wirsungs duct at the ampulla of vator

End portions of CBD, pancreatic duct, and ampulla of vator are surrounded by

sphincter of oddi in duodenal wall

Where do you measure the CBD

within the lumen (inner to inner)

What are the measurements of CBD

Normal </= 5 mm, Equivocal 6-7 mm, Dilated >/= 8 mm

The CBD increases __ per decade

1mm