Abdomen - Midterm Review

What anatomical regions of the abdomen does the liver occupy?

Right upper quadrant, epigastric, some left upper quadrant.

Name the four lobes of the liver.

Right, left, caudate, quadrate.

What echogenic structures represent ligaments and fissures within the liver?

Ligamentum teres, ligamentum venosum, main lobar fissure, falciform ligament

How does the main lobar fissure help identify the gallbladder sonographically?

Trace the bright main lobar fissure downward, it points directly to the gallbladder sitting at its inferior end.

Describe the difference in echogenicity between hepatic veins and portal veins.

Portal veins have bright walls, hepatic veins have no visible wall.

What is Couinaud's system used for?

Divides liver into eight segments to help with surgical planning.

Which liver segment corresponds to the caudate lobe?

Caudate lobe is segment 1.

Which vein divides the right lobe into anterior and posterior segments?

Right hepatic vein.

Is portal venous flow heptopetal or hepatofugal?

Hepatopetal.

Name the primary functions of the liver.

Detox blood, produce bile, store glycogen, synthesize proteins, metabolize nutrients, regulate blood glucose.

The left portal vein forms what shape on ultrasound?

H shape

What is the echogenicity of the liver compared to the renal cortex?

Liver is slightly hyperechoic to renal cortex.

The main portal vein runs through which structure?

Hepatoduodenal ligament.

Normal length of liver?

13 to 17 cm

Define fatty infiltration.

Excess fat accumulation in hepatocytes that makes liver appear brighter on ultrasound.

Main causes of fatty liver?

Alcohol, obesity, diabetes, drugs, hepatitis, malnutrition.

Focal fatty sparing.

Areas of normal liver tissue that remain dark in an otherwise fatty (bright) liver.

What is the most common cause of cirrhosis?

Hepatitis B and C.

Name the collateral pathways seen in portal hypertension.

Esophageal varices, gastric varices, paraesophageal varices, splenorenal shunts, paraumbilical veins.

What is the direction of flow in a recanalized umbilical vein?

Hepatofugal.

Describe sonographic findings of portal vein thrombosis.

In grayscale it is echogenic thrombus in portal vein lumen and vessel enlargement, in color there is reduced flow and no color fills in occluded segment.

Define Budd-Chiari sydrome.

Blockage of the hepatic veins or IVC preventing blood from draining from liver and leads to liver congestion, ascites, and potential liver failure.

Budd-Chiari syndrome symptoms.

Abdominal pain, ascites, hepatomegaly, leg swelling, jaundice, gastrointestinal bleeding.

What lab markers rise with biliary obstruction?

ALP, GGT, bilirubin

Portal hypertension is diagnosed when portal pressure exceeds what?

10 mmHg

What is the most common intrahepatic cause of portal hypertension?

Cirrhosis.

Candidiasis in the liver produces which sign?

Target or bulls-eye.

Which abscess is caused by entamoeba histolytica?

Amebic liver abscess.

How does a cavernous hemangioma typically appear?

Echogenic.

Name the structures that make up the biliary apparatus.

Right and left hepatic duct, common hepatic duct, cystic duct, gallbladder, CBD, ampulla of Vater, sphincter of Oddi.

What drains the liver into the common bile duct?

Common hepatic duct.

What is the normal diameter of the common bile duct?

Under 6 mm.

What is the Sphincter of Oddi?

Muscular ring at end of CBD and panc duct that controls bile and panc juice flow into duodenum and prevents reflux.

What is the purpose of Heister's valves?

Keep cystic duct open so bile can enter and leave gallbladder and prevent collapse or kinking of duct.

What landmark connects the right portal vein to the gallbladder neck?

Rex-Cantlie line

Define hydrops of the gallbladder.

Distended, mucus-filled gallbladder from chronic cystic duct obstruction, without infection.

What is Hartmanns pouch?

Bulbous dilatation at the gallbladder neck and common site for stones to lodge.

What are the three parts of the gallbladder?

Neck, body, fundus.

Which structure joins the cystic duct?

Common hepatic duct (forms the CBD).

What is the size of the cystic duct?

4 cm

What sign is created when portal vein, CBD, and hepatic artery appear together in trans?

Mickey mouse.

What is the normal gallbladder wall measurement?

3 mm or less.

Name the symptoms of gallbladder disease.

Abdominal pain, pain in back or right shoulder, nausea and vomiting, bloating or indigestion, fever and chills, jaundice.

What causes sludge?

Bile stasis, prolonged fasting, pregnancy, rapid weight loss, critical illness, major surgery, certain drugs.

List the intrinsic and extrinsic causes of gallbladder wall thickening.

Intrinsic is cholecystitis, cancer, adenomyomatosis, porcelain gallbladder. Extrinsic is hepatitis, cirrhosis, heart failure, hypoalbuminemia, ascites, renal failure.

What imaging modality uses ionizing radiation?

CT Scan.

What medium limits the effectiveness of ultrasound?

Bone and gas.

What does the celiac axis branch into?

Left gastric artery, splenic artery, hepatic artery.

What is the position of the gallbladder relative to the liver?

Medial to right lobe of liver.

What is a structure with no internal echoes and increased through-transmission?

Anechoic cyst.

A high diastolic component is characteristic of which type of vessel?

Non-resistive.

What does hepatofugal flow mean?

Away from the liver.

Define acute cholecystitis.

Acute inflammation of gallbladder, commonly from cystic duct obstruction by gallstone.

What is Murphy's sign?

Tenderness in right upper quadrant during inspiration, causing inspiratory arrest.

What is the WES sign?

Wall-echo-shadow: ultrasound of stone-filled gallbladder with echogenic curve and shadowing.

Describe emphysematous cholecystitis.

Gas in gallbladder wall or lumen from bacterial infection, often in diabetics.

What three characteristics describe gangrenous cholecystitis?

Necrosis of wall, ischemia from vascular issues, potential perforation.

What is the "strawberry gallbladder" associated with?

Cholesterolosis.

What artifact is typical for adenomyomatosis?

Comet-tail.

Why is porcelain gallbladder clinically significant?

Associated with gallbladder carcinoma, around 6% incidence, may need prophylactic removal.

What condition is strongly associated with Caroli's disease?

Congenital hepatic fibrosis.

Most common cause of acute cholecystitis?

Stones in cystic duct.

The "five F's" risk factors (Fat, Female, Forty, Fertile, and Fair) describe risk factors for what?

Cholelithiasis.

Caroli's disease is characterized by what?

Intrahepatic communicating cysts.

Type V choledochal cyst is also known as what?

Caroli's disease.

What artifact produces multiple linear echoes due to sound bouncing between reflectors?

Reverberation.

What is the normal flow of the portal vein?

Hepatopetal.

What kind of waveform do the hepatic veins normally show?

Triphasic.

What imaging modality uses magnetism and radiofrequency waves?

MRI.

What RI does the SMA have while fasting?

high-resistance.

What artifact occurs posterior to fluid-filled structures?

Enhancement.

Name the four scan motions used in abdominal scanning.

Sliding, rotating, tilting, rocking.

What are the four labels required on every ultrasound image?

Patient ID, date & time, institution, transducer orientation, anatomical labels.

What determines whether portal vein flow is hepatopetal or hepatofugal?

Pressure gradient between portal system and liver.

What are the three branches of the celiac axis visible in a transverse image?

Common hepatic artery, splenic artery, left gastric artery.

At the level of the pancreatic head, which artery lies along its anterolateral border?

Gastroduodenal artery.

Where is the IVC in relation to the caudate lobe of the liver?

Posterior.

Morison's pouch is found between what?

Liver and right kidney.

What is the optimal Doppler angle for accurate velocity?

60 degrees or less.

Describe plug flow and where it is typically found.

Flat velocity profile across vessel with clear spectral window, typically found in aorta.

What changes occur in SMA Doppler waveform after eating?

Goes from high to low-resistance with increased systolic and diastolic velocities.

Name two Doppler findings associated with portal hypertension.

Hepatofugal flow in portal vein and decreased portal vein velocity (less than 16 cm/s).

What does a "clear spectral window" typically indicate?

Laminar flow (with minimal turbulence or spectral broadening).

A patient's gallbladder is anechoic lumen, posterior enhancement. What term describes this structure?

Cystic

A vessel shows triphasic flow. Which vessel is this likely to be?

A peripheral artery or hepatic vein.

A transverse scan shows a fluid-filled structure anterior to the right kidney and medial to the liver. What is this structure?

Morison's pouch.

Doppler of the portal vein shows flow below the baseline. What does this indicate?

Hepatofugal flow.

A patient has turbulent renal artery flow and parvus tardus waveform distally. What condition should be suspected?

Renal artery stenosis.

Function of the vascular system?

Transport gases, nutrients, and essential substances to tissues and removes waste for excretion.

What do arteries carry?

Oxygenated blood away from heart.

What are capillaries?

Smallest blood vessels where living tissues receive nutrients and give back waste.

What do veins carry?

Deoxygenated blood back to the heart.

How do arteries and veins differ?

Arteries are elastic and carry blood away from heart, veins are collapsible and carry blood toward heart.

What are the three layers of an artery?

Tunica Intima, Tunica Media, Tunica Adventitia.

What does the SMA supply?

Small bowel via various arteries including inferior pancreatic artery and duodenal artery.

What does the IMA supply?

Left transverse colon, descending colon, sigmoid colon, and rectum.

How does the right renal artery differ from the left?

Right renal artery is longer and travels posterior to IVC.

What is an abdominal aortic aneurysm?

Permanent focal dilation of an artery greater than 1.5x normal diameter.

What are the major risk factors for AAA?

Tobacco, hypertension, vascular disease, COPD, and family history.

What is the difference between a true aneurysm and a pseudoaneurysm?

A true aneurysm involves all 3 layers of artery wall, pseudoaneurysms involve blood leaking through intima but contained by surrounding tissue.