Chapter 19 - Emergent Abdominal Ultrasound Procedures

Peritoneal lavage

The procedure, called _________, is used to sample the intraperitoneal space for evidence of damage to the viscera and blood vessels.

blunt

Peritoneal lavage is usually used as a diagnostic technique in certain cases of _______ abdominal trauma.

intraperitoneal

Peritoneal lavage carries a risk of organ injury and decreases the specificity of subsequent ultrasonagraphy or computed tomography (CT) because of the introduction of __________ fluid and air.

FAST

The ________ scan in the emergency department is limited examination of the abdomen or pelvis to evaluate free fluid or pericardial fluid.

hemorrhage

In the context of traumatic injury, free fluid is usually a result of ________ and contributes to the assessment of the circulation.

perihepatic, parasplenal, paracolic gutters and cul-de-sac

The FAST scan area of evaluation is widespread, extending from the pericardial sac to the urinary bladder and including the _______ area (including Morison's pouch), the _______ region (including splenorenal recess), ________ and _______.

speed

Accessibility and _______ of performance are critical in the trauma setting.

four, pericardial

The goal is to scan the _________ quadrants, _________ sac, and cul-de-sac for the presence of free fluid or hemoperitoneum.

dependent

Hemorrhage in the peritoneal cavity collects in the most

________ area of the abdomen.

Liver

______ lacerations or contusions are more easily detected with ultrasound than any other visceral abdominal injury.

anechoic

A brisk intraparenchymal hemorrhage may be identified as a _________ region within the abnormal parenchyma, whereas a global parenchymal injury may project into the liver as a widespread architectural disruption with the absence of the normal vascular pattern.

physiologic

In female patients of reproductive with trauma, free fluid isolating to cul-de-sac is likely _________.

acute cholecystitis

If the patient is female with symptoms of right upper quadrant pain, fever, and leukocytosis, ________ should be ruled out.

Cholelithiasis

The most common cause of acute cholecystitis is ________ with a cystic duct obstruction.

acute pancreatitis

Mid epigastric pain that radiates to the back is characteristic of _________.

hypoechoic

Sonographic findings and acute pancreatitis show a normal to edematous gland that is somewhat ____ to normal texture.

urolithiasis

Flank pain caused by ________ is a common problem in patients presenting to the emergency department.

hematuria

If the stone completely obstructs the ureter, no ________ will be pleasant.

hydronephrosis

When obstruction occurs, ultrasound is very effective in demonstrating the secondary sign of ____________.

cephalic

With the bladder distended, the color doppler is an excellent tool to image the presence of ureteral jets into the bladder; the transducer should be angled a(n) ________ presentation through the distended urinary bladder.

decreased

The pulse repetition frequency should be ________ to assess the low velocity of the ureteral jet flow.

dissecting aorta aneurysm

A(n) ___________ is a condition in which a propagating intramural hematoma actually dissects along the length of a vessel, stripping away the intima and, in some cases, part of the media.

Root of aorta with extension into arch level of left subclavian artery with extension into descending/abdominal aorta, only of ascending aorta

Most aortic dissections will occur at 1 of 3 sites:

ascending

Most aortic dissections are located in the ________ aorta

systemic

__________ hypertension is nearly always associated with aortic dissection.

chest

The most typical presentation of an aortic dissection is that of a sudden of severe tearing __________ pain radiating to the arms, neck or back.

McBurney's

With appendicitis, the patient will usually have rebound tenderness, "________" sign associated with peritoneal irritation.

hernia

A(n) _________ forms when the abdominal wall muscles are weakened, which allows the viscera to protrude into the weakened abdominal wall

peristatic

Sonography allows visualization of the ____________ movement of the bowel valsalva maneuvers and determines the presence or absence of vascular flow with the defect.

colon, omentum, fat

Most periumbilical hernias contain ________, _________ and _________.

Valsalva

The patient should be instructed to perform a(n) _________ maneuver to determine the side of wall defect and confirm the presence of the protruding hernia.

B

People go to the emergency department for all of the following frequency reasons except:

A) chest pain

B) ear pain

C) flank pain

D) respiratory distress

D

The complications of peritoneal lavage include all of the following except:

A) bowel perforation

B) bladder penetration

C) vascular laceration

D) pneumothorax

A

In the trauma setting, the most common finding of free fluid in the abdomen or pelvis is:

A) hemoperitoneum

B) ascites

C) bowel

D) urine

D

The sonographic finding in aortic dissection includes all of the following except:

A) echogenic membrane

B) enlarged aorta

C) moving echogenic flap

D) laminar blood flow pattern

B

Three types of abdominal hernias include all of the following except:

A) reducible hernia

B) carcerated hernia

C) incarcerated hernia

D) strangulated hernia

A

The most common sonographic finding of a hernia is:

A) peristalsis of the bowel during a Valsava maneuver

B) positive Murphy's sign

C) negative McBurney's sign

D) positive strangulation sign

D

The traditional modality of choice for evaluating urolithiasis is:

A) noncontrast abdominal computed tomography (CT) scan

B) abdominal x-ray examination

C) renal ultrasound

D) intravenous urography

B

For years, which one of the following techniques has been used as a surgical tool for the diagnosis of hemoperitoneum?

A) paracentesis

B) peritoneal lavage

C) laparoscopy

D) focused assessment with sonography for trauma (FAST)

A

Post trauma, the most common location for fluid to accumulate is in the ______.

A) Morison's pouch

B) pouch of Douglas

C) paracolic gutters

D) subphrenic space

D

The initial surgery of a FAST scan is directed to the:

A) paracolic gutter

B) subhepatic space

C) posterior cul-de-sac

D) pericardium

C

Torsion of the spermatic cord occurs as a result of which one of the following?

A) inflammation of the testis

B) abnormal size of the testis

C) abnormal mobility of the testis

D) inflammation of the epididymis

A

In the early stages of testicular torsion, the echogenicity of the testis appears ______.

A) normal

B) complex

C) hypoechoic

D) hyperechoic

C

One of the most common conditions that necessitate emergent surgery is:

A) acute cholelithiasis

B) urolithiasis

C) acute appendicitis

D) acute pancreatitis

B

Sonographic findings of acute cholecystitis include all of the following except:

A) thickened gallbladder wall

B) small gallbladder

C) pericholecystic fluid

D) immobile gallstone

D

Sonographic findings in acute pancreatitis may include which one of the following?

A) atrophy

B) microcalcifications

C) hyperechoic parenchyma

D) normal-appearing parenchyma

C

Midepigastric pain radiating to the back is characteristic of:

A) acute cholecystitis

B) urolithiasis

C) acute pancreatitis

D) acute appendicitis

D

The most common cause of acute cholecystitis is:

A) acute pancreatitis

B) chronic pyelonephritis

C) cholelithiasis

D) obstruction of the cystic duct

C

Stones as small as _______ millimeters (mm) may be visualized with ultrasound.

A) 1

B) 2

C) 0.5

D) 1.5

B

Approximately 70% of aortic dissection occur in the:

A) aortic arch

B) ascending aorta

C) descending aorta

D) abdominal aorta

C

Which one of the following is nearly always associated with aortic dissection?

A) trauma

B) pregnancy

C) hypertension

D) coarctation of the aorta

B

A pseudodissection demonstrates which one of the following?

A) intimal flap

B) turbulent blood flow pattern

C) decrease in blood flow

D) false lumen

B

Paraumbilical hernia occurs more often in which one of the following?

A) infants

B) female adults

C) male adults

D) children

C

A hernia in the bowel that cannot be reduced is a(n) _____ hernia.

A) reducible

B) carcerated

C) incarcerated

D) strangulated

C

A hernia with vascular compromise is _____.

A) carcerated

B) incarcerated

C) strangulated

D) torsioned

D

In reproductive-age women, free fluid isolated to the posterior cul-de-sac is likely which one of the following?

A) ascites

B) hemoperitoneum

C) abscess

D) physiologic