Cross Sectional Anatomy

List the 9 Addison’s regions. Which one are sonographers most likely to use as a reference in imaging the abdomen?

• Right and Left Hypochondrium

• Epigastric

• Right and Left Lumbar

• Umbilical

• Right and Left Iliac Fossa

• Hypogastrium

The most common region to use would be the epigastrium. The majority of organs we scan (liver, pancreas, GB, major vessels) are contained in the epigastrium. Can be more useful to use Addison’s 9 instead of 4 quadrants bc these organs do not remain in just one quadrant.

When you are looking at a CT scan, it is as if you are looking

from the feet up to the head

On a CT, you will see a “hat” on top of each kidney. This is called the

adrenal gland

Which organ is NOT an organ found in the pelvic cavity?

kidneys

A gallbladder stone will appear echogenic on ultrasound but will not be echogenic on CT.

false

Image B shows an image taken in what plane

coronal

List the 3 layers of the arterial wall, what type of cells/tissue they are composed of, and describe the difference when compared to a vein wall.

• tunica intima: endothelial cells and smooth muscle cells

• tunica media: thickest layer, thicker in arteries than veins; smooth muscle cells and fibroblasts

• tunica adventitia: thickest layer in veins; fibroblasts, endothelial cells, smooth muscle cells, nerve cells, and immune cells

List the three sections of the entire aorta (not just the abdominal aorta)

• ascending aorta

• aortic arch

• descending aorta / thoracic aorta

• (abdominal aorta)

List the anterior branches of the aorta

• celiac artery/axis/trunk

• superior mesentary artery

• inferior mesentary artery

• median sacral iliac artery

Normal range for the aorta measurements

• Should not exceed 3 cm at any section

• Proximal: 2-2.6 cm

• Mid: 1.6-2.4 cm

• Distal: 1.1-2.0 cm

What is the most common cause of portal hypertension?

cirrhosis

What are varices?

Dilated vessels in venous circulation.

#1 Indicates

none of the above

#2 indicates

thoracic aorta

#3 refers to the rectus abdominus muscle

false

The aorta bifurcates into _______ at the level of the _________

Lt and Rt Common Iliac arteries; umbilicus

All of the following are anterior branches of the aorta, EXCEPT:

renal arteries

The sonographic image displayed is in which of the following orientations

transverse

What vascular structure is visualized?

celiac axis and branches

If you are scanning your patient in the transverse plane at the level demonstrated in the image, which way would you slide your transducer to see the SMA?

inferiorly

On the diagram, what do numbers 3 and 4 refer to?

medial and lateral branches of the left portal vein

What do #6 and @7 refer to?

splenic vein and IMV

Which numbers on the diagram/image indicate portal venous structures?

2 and 4

What branch of the MPV is shown in the image?

left

What are the names of the smaller branches of the vessel shown?

left medial and left lateral portal veins

Which blood vessel courses anterior to the aorta and posterior to the SMA?

LRV

Which blood vessel courses more anteriorly, renal arteries or renal veins?

veins

All of the following are lower extremity arteries except:

greater saphenous artery

Which of the following colors of cursors are demonstrating a CORRECT AP measurement of the mid aorta segment on the image?

red

What vascular landmark divides the aorta into proximal and mid segments?

SMA

The image is demonstrating the aorta from what probe orientation?

longitudinal

When scanning the upper abdominal vessels what would be the preferred prep for the patient?

NPO for at least 6-8 hours prior

Describe the location and relationship to other liver structures of the following: the right hepatic vein, the right posterior portal vein, the left hepatic vein, and the ligamentum teres.

• right hepatic vein: separates and drains the anterior and posterior segments of the right lobe

• left hepatic vein: separates and drains the medial and lateral segments of the left lobe

• right posterior portal vein: supplies the caudate lobe with blood

• ligamentum teres: divides the medial and lateral left lobe portions

Name two ligaments that can be seen in the liver and describe the anatomic relationship to the liver.

• ligamentum venosum separates the caudate lobe from the left lobe, and it marks the left anterolateral border of the caudate lobe. Travels within the transverse fissure

• falciform ligament and the ligamentum teres are located within the left intersegmental fissure, which divides the medial and lateral segments of the left lobe. The falciform ligament divides the right and left lobes, and ends at the ligamentum teres inferiorly.

Describe the relationship of the hepatic artery, the common bile duct, and the portal vein.

They form the portal triad.

• The hepatic artery is anterior and medial to the portal vein

• the CBD is lateral to the portal vein

They enter the liver at the porta hepatis.

Describe the sonographic appearance of this image.

• Left lobe of the liver, specifically the hepatic veins.

• The liver tissue appears homogenous and hyperechoic to the vessels. It is bordered by an echogenic line, which is the diaphragm. The hepatic veins appear anechoic throughout, and they are hypoechoic to the surrounding tissue.

Name and describe this image: Include scan plane, and name the structure identified by the white arrow.

• longitudinal image of the right lobe of the liver

• the structure is the right portal vein

• liver tissue appears homogenous throughout and is hyperechoic to the vessel’s lumen. The vessel is anechoic, with echogenic borders.

The liver occupies a major portion of the:

right hypochondrium

The IVC and its visible branches are primarily evaluated to detect

intraluminal thrombosis or tumor invasion

All of the following are ligaments of the liver EXCEPT:

bare area

On the left anteriorly, the ligamentum teres divides the

medial from the lateral left lobe

The caudate lobe is bordered posteriorly by the _____ and anteriorly by the ______.

IVC; left portal vein

The main portal vein enters the _______ and divides into left and right portal veins.

porta hepatis

The main lobar fissure is seen as an echogenic line connecting the ______ to the ______.

gallbladder; right portal vein

The portal triad consists of

CBD, HA, PV

The common hepatic duct is ______ to the portal vein.

anterior

All of the following are divisions of the gallbladder EXCEPT

cystic duct

Which of the following is not a probe position for a Gallbladder Fast Exam

low/lateral view

The right and left hepatic ducts emerge from the right lobe of the liver in the porta hepatis and unite to form the:

common hepatic duct

The hepatic duct is joined by the ____ to form the ____.

cystic duct; common bile duct

The distal duct lies ____ with the anterior wall of the IVC.

parallel

The cystic duct connects the _____ of the gallbladder with the common hepatic duct to form the ____.

neck; CBD

The function of the gallbladder is:

reservoir for bile

The bright linear echo within the liver connecting the gallbladder and the right or main portal vein is the:

main lobar fissure

The ____ branch of the hepatic artery can be seen between the common duct and the portal vein as a small circular structure.

right

The common bile duct is joined by the main pancreatic duct. Together they open through the ____ into the duodenal wall.

ampulla of Vater

The Mickey mouse sign contains which of the following structures…

HA, CBD, PV

The walls of the portal vein are ____ when compared to the liver parenchyma

hyperechoic

“Shotgun sign” seen in the liver parenchyma is indicative of:

dilated biliary ducts

What vein brings oxygen enriched blood to the liver?

portal vein

The portal triad is made up of the CBD, PV, and what other structure?

hepatic artery

Within the liver, which is one of the ligaments that divides the right lobe from the left lobe?

main lobar fissure

A contracted gallbladder packed with stones will give the ____ sign

WES

On ultrasound, a gallstone appears

hyperechoic with posterior shadowing

A benign growth that protrudes from the wall of the gallbladder is called a

polyp

A patient presents to the ER with acute RUQ pain. Upon examination you find that the gallbladder wall measures 4 mm and there are stones within the gallbladder, and some fluid is seen anterior to the gallbladder. The most likely diagnosis would be:

acute cholecystitis with cholelithiasis

Causes of gallbladder wall thickening include everything EXCEPT:

deep vein thrombosis

What are the common signs and symptoms of biliary disease?

• RUQ pain

• jaundice

• nausea

• joint pain

• fatigue

• fever

Low level, nonshadowing echoes in the dependent portion of the gallbladder can be described as

biliary sludge

The GB is located on the

posterior and inferior portion of the right lobe of the liver

The left and right hepatic ducts join at approximately the level of

porta hepatis

The cystic duct connects the gallbladder to the

common hepatic duct

The common bile duct extends from the point where the cystic duct joins the

common hepatic duct

The overall length of the GB is

highly variable

Bile enters the intestinal tract at the

ampulla of Vater

The _____ supplies blood to the GB and liver

proper hepatic artery

The intrahepatic ducts run alongside of the

portal vein and hepatic arteries

The three landmarks that may be helpful in locating the GB on a longitudinal image are

PV, main lobar fissure, and the right kidney

What anatomic structures are included in the GI tract?

• mouth

• pharynx

• esophagus

• stomach

• small intestines

• liver/GB

• pancreas

• large intestines

• rectum

• anus

Name and describe the location of the two ducts of the pancreas.

• Duct of Wirsung: main pancreatic duct runs through the body and tail of the pancreas. Connects to the CBD + enters duodenum through Ampulla of Vater

• Duct of Santorini: accessory duct located closer to head of pancreas and CBD. Joins Duct of Wirsung to join CBD

Name and describe two normal variants of the pancreas.

• Ectopic pancreas: found outside of normal location, closer to stomach or intestines

• Annular pancreas: ring of pancreatic tissue covers the duodenum (C-loop portion)

Normal measurements of the pancreas.

• length: 12-18 cm

• head: 2-3 cm

• body: 2-3 cm

• neck: 1.5-2.5 cm

• tail: 1-2 cm

Explain the term Courvoiser’s gallbladder

Enlargement of the GB caused by a slow progressive obstruction of the distal CBD from an external mass (such as adenocarcinoma of the pancreatic head)

The hepatic duct is joined by the _____ to form the ____.

cystic duct; CBD

The head of the pancreas lies in the:

lap of the duodenum

The head of the pancreas is inferior to the:

caudate lobe

The _____ is the anterolateral border of the pancreatic head

gastroduodenal artery

The tail of the pancreas is found:

anterior to the left kidney, near the splenic hilum

The primary pancreatic duct is the

duct of Wirsung

The duct of Santorini is a/an:

accessory duct to the pancreas

The splenic artery is considered to be the:

superior border of the pancreas

The pancreas is reflective in its sonographic appearance because of

fat between the lobules

Approximately 2% of the pancreatic gland is endocrine

false

The largest component of pancreatic juice is hydrochloric acid.

false

The _____ is a posteromedial projection of the pancreas head.

uncinate process

Pancreatic juice from the acini cells are drained by ______,

intercalated ducts

Transverse scanning plane images best demonstrate the ______ section of the pancreas.

longitudinal

Sagittal scanning plane images best demonstrate the _____ section of the pancreas.

axial

A normal pancreatic duct variant that enters the duodenum is called the ______.

duct of Santorini