Abdomen Exam 1

Intro 1 &2, Abdominal Vasculature

What is ultrasound?

Sound frequencies beyond the upper limits of human hearing (\>20kHz)

What is the range of audible frequency?

20 Hz - 20 kHz

Acoustic is the study of ?

generating and propagating sound waves

What is Diagnostic Medical Sonography?

An imaging technique used to visualize soft tissue structures of the body by recording the returning reflection of ultrasonic waves directed into the body

Echogenic

the ability of a structure to produce echoes

Anechoic

no echoes (sonolucent) -appears black on ultrasound

Hypoechoic

less reflective and low amount of echoes, appears as varying shades of gray

Hyperechoic

highly reflective and echo rich appears bright

Isoechoic

having similar echogenicity to a neighboring structure

Identify the echogenicity

Anechoic

Identify the echogenicity

Isoechoic

Identify the echogenicity

Hypoechoic

Identify the echogenicity

Hyperechoic

What is the echogenicity of the bladder?

Anechoic

What is the kidney’s echogenicity to the liver?

Isoechoic

The liver contains two areas (arrows) that are ____________ compared with the rest of the echogenicity of the liver

hyperechoic

What is the echogenicity of the mass in the liver?

Hypoechoic

Homogeneous organ parenchyma is \__________ in echogenicity

uniform

Inhomogeneous or heterogeneous organ parenchyma is \___________ in echogenicity

not uniform

What is the texture of this liver?

Homogeneous (uniform texture)

What does the anechoic structures within the liver represent?

vessels & ducts

What is the texture of this liver?

Inhomogeneous (not uniform)

Simple cyst

* Reverberation may be seen on the anterior wall of the cysts
* Anechoic (completely)
* Posterior Enhancement
* Smooth walled

(RAPS)

This image displays a

simple cyst

What does the arrows tell you in this image?

Complex cyst bc there is a thin, hair-like structure & septation

What is this an image of? And how do you know?

Complex cyst bc there are multiple loculations/compartments

This image displays a

Complex cyst

Solid mass

* Homogeneous or inhomogeneous (heterogeneous)
* Hypoechoic or hyperechoic
* May attenuate sound partially or completely (poor transonicity)

\
(Anything but anechoic)

This image displays a

Hypoechoic solid mass

Complex cyst

* Smooth-walled, Anechoic, Posterior enhancement
* Septations that appear echogenic
* Fluid-fluid layers
* Multiocular compartments
* Internal echos
* Calcification

In complex cysts, septations appear as

Echogenic hair-like strands

In complex cysts, internal echoes may indicate

hemorrhage or infection

In complex cysts, fluid-filled layers may represent

blood, fluid, or fat layers

In complex cysts, calcification appear as

highly reflective echoes (hyperechoic) w/ posterior shadowing

What plane runs perpendicular to the sagittal plane?

coronal/frontal

In \________ view markers points to the patient right side

transverse

In \_________ view markers points to the patients head

longitudinal

When the ultrasound probe is sagittal (longitudinal) the top of the picture is _________

anterior

When the ultrasound probe is sagittal (longitudinal) the bottom of the picture is _________

posterior

When the ultrasound probe is sagittal (longitudinal) the left of the image is _________

cephalic (towards head)

When the ultrasound probe is sagittal(longitudinal) the right of the picture is _________

caudal (towards feet)

The probe marker is towards the patient's \__________ when the probe orientation is sagittal

head

The probe marker is towards the patient's \__________ when the probe orientation is transverse

right

When the ultrasound probe is transverse (cross-sectional) the top of the picture is _____

anterior

When the ultrasound probe is transverse (cross-sectional) the bottom of the picture is ______

posterior

When the ultrasound probe is transverse (cross-sectional) the left of the picture is ______

lateral (right)

When the ultrasound probe is transverse (cross-sectional) the right of the picture is _______

medial (left)

body cavities

spaces within the body that contain, protect, and support internal organs

What are the 2 principal cavities?

dorsal & ventral

Dorsal cavity contains

cranial cavity and spinal cavity

Ventral cavity contains

thoracic cavity and abdominopelvic cavity

abdominal quadrants

RUQ, LUQ, RLQ, LLQ

SSALT

size, shape, acoustics, location, transonicity

What are the measurements you need for organs?

length, width, depth

Gain knob

controls overall brightness of the image

Time Gain Compensation (TGC)

allows adjustment of image brightness at selective depth

depth knob

Allows adjustment of the depth of field of view

focus knob

allows focus of ultrasound beam to area of interest

How should a patient prepare for a general abdominal exam?

fasting (NPO) for 8-12 hrs

NPO

Nulla Para Ora - Nothing by mouth

Why NPO?

Minimizes abdominal gas which can blur ultrasound image

Why is patient positioning important?

* easier to visualize a target organ
* brings area of interest closer to probe
* minimize gas in patient to allow better image

supine

lying on back (face up)

prone

lying face down

decubital

lying on the side

left lateral decubital

lying on the left side

right lateral decubital

lying on the right side

oblique

halfway on the side

Ultrasound transducers convert \__________ energy to \___________ energy

mechanical; electrical

What are the most commonly used ultrasound transducers?

sector & linear

How are images displayed with linear transducers?

rectangle or parallelogram

The size of the field of view in linear transducers is

equal in both near and far field

Linear transducers are optimal for

superficial structures (ex: testes)

How are images displayed with sector transducers?

wedge or pie-shaped section

The field of view with sector transducer is

wider in the far field than in near field

Sector traducers are commonly used for

routine abdominal & pelvic imaging

Linear and sector transducers have a range of frequencies generally varying from

2.0 to 12.0 MHz

Transducer selection is based on

type of exam & patient's body

Low-frequency traducers have a frequency of

2.0 MHz

Low-frequency traducers have a sector format that results in

increased sound penetration but with loss of resolution

Low-frequency transducers are suitable for

abdominal & pelvic exams, obese patients

Medium-frequency transducers have a frequency range of

3.0 - 5.0 MHz

What is the format of medium-frequency transducers?

generally sector

Some 5.0 MHz medium-frequency transducers are in what formats?

both linear & sector

Medium-frequency sector transducers are suitable for imaging

most adults

What is the frequency range of high-frequency transducers?

7.0 - 12.0 MHz

Format of high-frequency transducers

linear or sector

High-frequency transducers results in

increased resolution but w/ reduced penetration

High-frequency transducer **sector probes** are suitable for

pediatric patients

High-frequency **linear probes** are best suitable for

imaging superficial structures

In the upper abdomen, sonographers should find a

good acoustic window through which to transmit the sound beam (ex: healthy liver is an excellent window)

Movements of transducers (transducer manipultations)

sliding, tilting, rotating, angling

sliding

movement of transducer from one location to another

tiling

angling transducer from side to side

rotating

turning 90 degrees to change image from sagittal to transverse view

angling

same as tilting

Focal point

a control that has one or more toggle buttons

Focal point allows the operator to

choose the level at which the ultrasound beam is focused to increase resolution at specific points

The focal point control should be set at the

most posterior aspect of the organ or structure being imaged

What is the transducer display in this image?

linear (rectangle)