abd 3 prep

Abscess

Irregular shape

Variable echogenicities

May contain gas

Abdominal Wall Tear/Trauma

Area of tear = loss of muscle striations, complex appearance with hematoma and muscle swelling/thickness

Abdominal Wall Penetration Trauma

Hypoechoic penetration tract where muscles were separated -> will heal hyperechoic

Hematoma "Life" Cycle

Anechoic

Increased size and echogenicity

Solid, mid-level grey

Decreased size, complex

Seroma - cystic

Reabsorption and/or scar tissue

Abdominal Hernia

Opening in abdominal wall with contents protruding through

Ventral/Anterior Abdominal Wall Hernia

Spogelian Hernia

Along Spigelian fascia

Inguinal Hernia

Direct = contents do not pass through inguinal ring

Indirect = contents pass through inguinal ring

Lipoma

Benign, fatty tumor

Isoechoic (mostly) to hyperechoic

Malignant abdominal wall neoplasms

Irregular shape

Hyperechoic to complex

Inhomogenous

Diaphragm Paralysis

Damaged phrenic nerve

Can be unilateral or bilateral

Diaphragmatic Eventration

Denting of diaphragm

Diaphragm does not function properly = breathing issues

Diaphragmatic Hernia

Abdominal contents enter thorax

Congenital issue

Diaphragmatic Inversion

Little movement of diaphragm with respiration

Sonographic Appearance of Fatty Infiltration

Increased echogenicity

Decreased penetration

Focal Fatty Sparing

Entire liver is fatty with small area of normal tissue

Focal Fatty Infiltration

Entire liver is normal with small area of fatty tissue

Causes of Fatty Infiltration

Alcoholism

Diabetes

Obesity

Hepatitis

Steroids

Chronic illness

Chemotherapy

Grade 1 Fatty Infiltration

Grade 2 Fatty Infiltration

Grade 3 Fatty Infiltration

Hepatitis

Inflammation of liver

Causes of Hepatitis

Viruses

Toxins

Symptoms of Hepatitis

Fever/chills

N/V

Hepatomegaly

Jaundice

Lab Values for Hepatitis

Elevated:

ALT

AST

Conjugated bilirubin

Unconjugated bilirubin

Sonographic Appearance of Acute Hepatitis

Normal to hypoechoic parenchyma

Portal vein walls are very visible -> starry sky

Splotchy/inhomogenous

Hepatomegaly

Splenomegaly

Sonographic Appearance of Chronic Hepatitis

Hyperechoic parenchyma

Decreased liver size

Granular and course texture

Sonographic Appearance of Cirrhosis

Decreased liver size

Hypertrophied caudate lobe

Surface nodularity

Portal HTN

Hypertrophied Caudate Lobe

Liver Surface Nodularity

Portal HTN

Advanced Cirrhosis Collaterals

Recanalized umbilical vein

Symptoms of Cirrhosis

Asymptomatic

Fatigue

Weight loss

Diarrhea

Jaundice

Ascites

Portal HTN

Lab Values for Cirrhosis

Elevated:

ALT

AST

Lactase dehydrogenase

Serum and fecal conjugated bilirubin

Serum alkaline phosphatase

Urine uribilinogen

Decreased:

Serum albumin

Glycogen Storage Disease

Genetic disorder

Might see solid masses

Lymphoma

Cancer of lymphatic system

Hepatomegaly

Splenomegaly

Lymphadenopathy

Multiple masses

Bullseye pattern

Focal Lymphoma

Stellate (star) pattern

Diffuse Lymphoma

Simple Cysts

Oval to round

Smooth margins

No internal echos

Posterior enhancement

Multicystic Liver

Multiple simple cysts

No genetic component

Polycystic Liver Disease

Genetic

Biliary duct anomalies

Will have polycystic kidney disease and pancreatic cysts at the same time

Hematoma

Fresh - hyperechoic

Older - cystic/anechoic and possibly complex

Echinococcal Cyst

Parasitic/hydatid cyst

Abscess

Localized infection with pus

Complex appearance

Will have fever/chills, pain, N/V, fatigue, hepatomegaly

Granuloma

Byproducts from inflammation present as hyperechoic masses throughout the liver

Vary in size, shadowing depends on size

Schistosomiasis

Parasitic infection

Eggs are lodged in liver tissue

Immune response produces lesions

Leads to liver fibrosis and portal HTN

Pneumocystis Carinii

Fungal infection

Seen with HIV-AIDS

Presents as multiple, small, echogenic foci throughout the liver

Hemangioma

Benign collection of small vessels

Capillary Hemangioma

Small - 1-3 cm

Homogenous

Posterior enhancement

Well defined margins

Cavernous Hemangioma

Larger 3-10 cm

Complex appearance

Irregular

Liver Cell Adenoma

Linked to oral contraceptives

Can actively bleed - halo appearance and posterior enhancement

Focal Nodular Hyperplasia

Isoechoic

Area where cells are not put together correctly, do not function well but not cancerous

Lipoma

Fatty tumor

Hyperechoic, circumscribed, good margins

cause velocity artifact - diaphragm does not seem complete

Hepatocellular Carcinoma

Most common primary liver malignancy (but more rare than liver metastasis)

Cirrhosis from Hepatitis B or C leads to increased risk

Solid, inhomogenous, irregular mass

Hepatic Metastasis

Most common secondary liver cancer (more common than HCC)

Presents as multiple lesions througout the liver

Can have bullseye or halo sign

Achalangic Biliary Cirrhosis

Due to partial or complete agenesis of intrahepatic biliary ducts

Alcoholic Cirrhosis

Due to excessive alcohol intake

Atrophic Cirrhosis

Decreased liver size

Biliary Cirrhosis

Due to obstruction or infection of intrahepatic biliary ducts

Cardiac Cirrhosis

Due to congestive heart failure

Fatty Cirrhosis

Due to alchohol abuse

Metabolic Cirrhosis

Due to metabolic storage disorders

Stasis Cirrhosis

Due to obstruction in hepatic veins

Posthepatic Cirrhosis

Due to chronic hepatitis

Postnecrotic Cirrhosis

Due to to viral hepatitis, drugs, toxins, autoimmune destruction

Amylase

Elevated with inflammation or infection

Lipase

Elevated with inflammation or infection

Conjugated/Direct Bilirubin

Elevated with biliary tract obstruction

Urobilinogen

Decreased with biliary tract obstruction

ALT - Alanine Aminotransferase

Elevated with liver cell damage, acute hepatitis, benign hepatic obstruction

AST - Asparate Aminotransferase

Elevated with liver cell damage, cirrhosis, liver mets

ALP - Alkaline Phosphatase

Elevated with everything...

GGT - Gamma Glutamyl Transpeptidase

Elevated with biliary tract obstruction

Globulin

Elevated with inflammation and cancers

Albumin

Decreased with cirrhosis

Cholesterol

Elevated with biliary tract obstruction

Decreased with chronic liver disease

Sonographic appearance of congenital cysts

Anechoic

Well-defined

Posterior enhancement

Singular or multiple

Simple or localated

Causes of congenital cysts

Epithelial origin

Lymphomangiomas in children

Signs and symptoms of congenital cysts

Asymptomatic

Symptomatic when large

Sonographic appearance of acquired cysts

Complex

Ill-defined, thick, irregular borders

Multiple

Dirty shadow if gas is present

Causes of acquired cysts

Post-inflammation -> abscess

Endocarditis

Septicemia

Trauma

Diverticulitis

Other infections

Signs and symptoms of acquired cysts

LUQ pain

High-grade fever

Vomiting

Chest/shoulder pain

Splenic Pseudocysts

Post-trauma

Ex. Hematoma

Sonographic appearance of parasitic cysts

Well defined

Daughter cysts (loculations)

Mural calcifications

Posterior enhancement

Simple or complex

Causes of parasitic cysts

Echinococcal parasites

(is considered a hydatid cyst)

Splenic Rupture or Fracture

Heterogenous appearance

Look for free fluid

Spleen looks enlarged

Splenosis

Sequele of splenic rupture

Splenic tissue transplants into peritoneal cavity

Intrasplenic Splenic Hematoma

Within splenic parenchyma

Subcapsular Splenic Hematoma

Blood trapped between splenic capsule and parenchyma

Splenic Infarction

Occlusion of splenic artery - loss of blood supply

Splenic infarctions are secondary to...

Hematologic disorders

Atheromatous disease

Signs and symptoms of splenic infarctions

Asymptomatic

LUQ pain - worsens with inspiration

Sonographic appearance of splenic infarctions

Well-demarcated

Wedge-shaped

Hypoechoic (echogenicity increases with age of infarction)

Splenic Calcifications

Hyperechoic

Shadow

Starry Sky appearance

Splenic Hemangioma

Most common benign tumor of the spleen

Made of excess new blood vessels

Variable echogenicities

Similar to liver hemangiomas

Splenic Hamartoma (splenoma)

Benign splenic tumor

Associated with syndromes

Homogeneous

Solid

Well-defined

Variable echogenicities

Splenic Lymphoma

Malignant splenic tumor

Hodgkin + Non-Hodgkin lymphomas are most common

Sonographic appearance of focal splenic lymphoma

Hypoechoic lesions with poorly-defined margins

Signs and symptoms of splenic lymphomas

Node enlargement

Fever

Fatigue

Weight loss

Coughing

Pressure

Congestion

Elevated WBC

Anemia

Sonographic appearance of diffuse splenic lymphoma

Modularity and heterogeneity of entire parenchyma