Sono Sect Anatomy/Abd Physiology (Small Parts)

Where are the lobes of the thyroid situated in the neck? What is the name of the band of tissue that connects the R and L lobes?

Anterio-inferior below the larynx

Isthmus

What is the name of the normal variant that may be found extending superiorly to the isthmus?

Pyramidal lobe

True or False? Normal thyroid parenchyma has a homogeneous appearance?

True

What organ system does the thyroid belong to?

Endocrine

What is the normal range for size measurement of the thyroid?

4-6cm long

1.3-1.8cm AP

1.5-2cm wide

Isthmus: 2-6mm

What structures are visualized along the anterior surface of the thyroid?

Strap muscles (sternohyoid and sternothyroid)

What structures are located laterally to the thyroid?

CCA, Internal jugular, sternocleidomastoid muscles

What muscle is located posterior to thyroid? What is its sonographic appearance?

Longus Colli Muscle (LCM)

Appears triangular in trans

Where is the minor Neurovascular bundle located in relationship to the thyroid?

Posterolateral

Where are the parathyroid glands located? Are they normally visualized?

Posterior surface of lateral lobes

Not normally visualized unless abnormal, except in young pateints

Where is the trachea located and what is its sonographic appearance?

Posterior/medial

Hypoechoic

What would be seen as a target sign posterior to the thyroid and trachea?

Esophagus

The thyroid blood supply comes from the _____________________ that branch off the _______________________

Superior thyroid arteries, Inferior thyroid arteries

What structure does the venous blood from the superior and middle thyroid veins drain into?

IJV

What vessel does the venous blood from the inferior thyroid veins drain into?

Right or left innominate veins

What organs help regulate the thyroid hormones?

Pituitary gland and hypothalmus

What does TSH stand for? Where is it produced? What is its function?

Thyroid stimulating hormone

Produced by the pituitary gland

To stimulate the thyroid hormone secretion

What are the 3 hormones secreted by the thyroid?

Thyroxine (T4)

Triiodothyronine (T3)

Calcitonin

What is the relationship of the prostate to the surrounding structures? (Pubic bone, rectum, urinary bladder, and urogenital diaphragm)

Anteriorly by the pubic bone

Posteriorly by the rectum

Superiorly by the urinary bladder

Inferiorly by the urogenital diaphragm

What size is the prostate? Is only assessing size, you could probably do the exam which way?

4cm length

3cm wide

3.8cm AP

Transabdominally is often sufficient to assess size, less invasive then performing it transrectally

What shape is the prostate? What structure passes through the center of the prostate?

What are these portions called…

• Inferior portion:

• Superior portion:

• Central area:

Come-shaped; prostatic urethra

Inferior: Apex

Superior: Base

Central: Verumontanum

What is the area called that the ejaculatory ducts join the prostatic urethra?

Verumontanum

Where do the seminal vesicles lie in relationship to the prostate?

Just superior to the prostate and posterior to bladder

What are the 2 regions of the prostate? Which is larger?

Fibromuscular region (anterior and smaller)

Glandular region (posterior and larger)

What are the 4 zones of the prostate? What are the percentages associated with each zone?

Peripheral: largest 70%

Central: 20%

Transition (5%)

Periurethral glandular zone

What does the prostate do?

Secretes alkaline fluids that contribute to sperm viability

What vessel is the arterial supply to the prostate?

Inferior vesical artery

What are some of the indications of a transrectal ultrasound?

• Abnormal digital rectal exam

• Elevation of PSA (prostate specific antigen)

• Prostatitis

• Evaluation of benign prostatic hypertrophy (BPH)

• Detection of masses

• Ultrasound guided biopsies

What lab is associated with the prostate gland and monitored for disease of the gland?

PSA

What is the normal lab value for the prostate?

<4.0

What is the sonographic appearance of the following?

• Seminal Vesicles

• Prostate

Seminal Vesicles: low level ovoid structures superior to prostate gland

Prostate: heterogeneous; hypoechoic in comparison with the seminal vesicles, transverse plane will look semilunar near base and rounded at apex

The testicle is surrounded by a fibrous capsule called the…

Tunica albuginea

The mediastinum testes have what appearance by sonography?

Highly echogenic line running along the long axis of the testis

Within the mediastinum testis there is a network of ducts, what is this called?

Rete testis

Which border of the testis does the epididymis run along?

Posterior

What are the 3 parts of the epididymis?

Head (globus major)

Body (runs along the posterior testicle)

Tail (globus minor)

Which part of the epi is the largest?

Head

Is the head of the epi located on the superior or inferior pole of the testicle?

Superior (lateral)

The tail is the epi is located on the _______________ end of the testicle.

Inferiolateral

Production of sperm is a ______________ function of the scrotum?

Exocrine

Internally the scrotum divided into two sacs by the ______________

Tunica dartos

What is the sonographic appearance of the epididymis head in comparison to the testis?

Epi head is isoechoic to slightly hyperechoic to testis

The body and tail is isoechoic to slightly less echogenic than the head

What is the normal sonographic appearance of the testis?

Homogeneous medium level echo texture (looks similar to thyroid)

Vascular

Hyperechoic line running craniocaudal along the long axis of the testis-mediastinum testis

Surrounded by a hyperechoic homogeneous line (scrotal wall)

May see a small amount of fluid between the layers of the tunica vaginalis

Production of testosterone is an ______________ function of the scrotum?

Endocrine

What is the appendix testis and when do you usually see it?

A remnant of the Müllerian duct, a small ovoid structures superior located beneath the head of the epi

Usually only seen with a hydrocele

Which testicular vein drains directly into the IVC?

Right

What is the purpose of the median raphe?

Divides externally into lateral portions

The peritoneum continues and forms the sac that the testis lie in, what is it called? How many layers does it contain?

Tunica vaginalis

3 layers

What streets supply the testicle?

Internal spermatic arteries (branch of AO), testicular arteries, deferential arteries, superior epididymal arteries, and cremasteric artery

What things make up the spermatic cord?

Vas deferens

Cremasteric, deferential, and testicular arteries

Lymphatics

Nerves

Pampiniform plexus

Cremaster muscle

What are the 3 main masses of tissue in the penis?

The corpus spongiosum, and 2 corpora cavernosa

What surrounds the tunica albuginea in the penis?

Buck fascia, thick fibrous tissue layer

What are the relationships of structures in the gastrointestinal system?

The diaphragm is posterior to the stomach

The spleen in posterior/inferior to the stomach

The pancreas is posterior/infeiror to stomach

The left kidney and adrenal gland are posterior to the stomach

The pylorus is attached to what part of the small intestine? What is the pyloric sphincter?

Duodenum

The area of attachment to the duodenum is the pyloric sphincter

The appendix is attached to what part of the large intestine?

Cecum

What is the normal intestinal wall thickness?

3-5mm thick depending on distention of the bowel

Describe the “gut signature.”

Hypoechoic external rim-thick intestinal wall and an echogenic center which is the gut lumen or mucosal ulceration

What are names of other bowel appearance?

Target or pseudokidney sign

Define the gastroesophageal junction?

The standby of the esophagus between the diaphragm and the stomach is called the gastroesophageal junction

Discribe a Meckle’s Diverticulum.

Remains of the utensil yolk stalk (from fetal development) that projects from the ileum

What is the length of a Meckle’s Diverticulum?

5-25cm in length