Abdomen - Midterm Review 2.0

Fatty infiltration

Fat accumulation in hepatocytes that makes liver brighter on ultrasound.

Causes of fatty liver

Alcohol, obesity, diabetes, drugs, hepatitis, malnutrition

Focal fatty sparing

Areas of normal liver tissue that are dark in an otherwise bright liver

Most common cause of cirrhosis

Hep B and C

Collateral pathways in portal hypertension

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

Recanalized umbilical vein flow

Hepatofugal

Sonographic findings of portal vein thrombosis

Grayscale is echogenic thrombus in portal vein lumen and vessel enlargement, Color is reduced flow and no color fills in occluded segment

Budd-Chiari syndrome

Blocked hepatic veins or IVC prevent blood from draining from liver causing liver congestion and liver failure

Budd-Chiari syndrome symptoms

Abdomen pain, ascites, hepatomegaly, swollen leg, jaundice, gastrointestinal bleeding

High biliary obstruction lab markers

ALP, GGT, bilirubin

Portal hypertension diagnosis pressure

10 mmHg

Common intrahepatic cause of portal hypertension

Cirrhosis

Liver candidiasis sign

Target/bulls-eye

Entamoeba histolytica cause

Amebic liver abscess

Cavernous hemangioma sonographic appearance

Echogenic

Hydrops of gallbladder

Distended and mucus-filled from chronic cystic duct obstruction, no infection

Hartmann’s pouch

Bulbous dilatation at gallbladder neck, common site for stones to lodge

Gallbladder disease symptoms

Abdomen/back/right shoulder pain, nausea/vomiting, bloating/indigestion, fever/chills, jaundice

Causes of sludge

Bile stasis, long fasting, pregnancy, rapid weight loss, critical illness, major surgery, drugs

Gallbladder wall thickening causes

Cholecystitis, cancer, adenomyomatosis, porcelain gallbladder, hepatitis, cirrhosis, heart failure, hypoalbuminemia, ascites, renal failure

Acute cholecystitis

Inflammation of gallbladder from gallstone in cystic duct

Murphy's sign

Tenderness in RUQ during inspiration causing inspiratory arrest

WES sign

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

Emphysematous cholecystitis

Gas in gallbladder wall or lumen from bacterial infection, found in diabetics

Characteristics of gangrenous cholecystitis

Necrosis of wall, ischemia from vascular issues, perforation

Strawberry gallbladder source

Cholesterolosis

Common adenomyomatosis sonographic artifact

comet-tail

Clinical significance of porcelain gallbladder

Comes from gallbladder carcinoma, 6% incidence, requires prophylactic removal

Source of Caroli's disease

Congenital hepatic fibrosis

Common cause of acute cholecystitis

Cystic duct stones

“Five F’s”

Fat, female, forty, fertile, fair

Disease associated with “five F’s”

Cholelithiasis

Primary characteristic of Caroli’s disease

Intrahepatic communicating cysts

Another name for type V choledochal cyst

Caroli’s disease

Two Doppler findings of portal hypertension

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

Condition associated with turbulent renal artery flow and distal parvus tardus waveform

Renal artery stenosis

Abdominal aortic aneurysm

Permanent focal artery dilation more than 1.5x normal diameter

Abdominal aortic aneurysm risk factors

Tobacco, hypertension, vascular disease, COPD, family history

Difference between true aneurysm and a pseudoaneurysm

True aneurysm involves all 3 layers of artery wall, pseudoaneurysm involves blood leak that is contained

Most common tumor in IVC

Renal cell carcinoma

Definitive sign of portal hypertension

Hepatofugal flow

Two types of choledocholithiasis

Primary (stones in bile ducts), Secondary (stones migrated from gallbladder)

Choledochal cyst

Congenital condition, causes cystic dilations of bile ducts, five types based on location and characteristics

Most common choledochal cyst

Type I, fusiform dilation of CBD

Dilated biliary ducts sonographic appearance

Anechoic tubular structures branching through liver, looks like “too many tubes”

Pneumobilia

Air within biliary tree due to liver biopsy or trauma

Hemobilia

Blood in biliary tree due to recent biliary surgery or trauma

Typical sonographic findings of pneumobilia

Bright linear echoes in ducts, dirty shadowing, reverberation artifacts

Hemobilia symptoms

RUQ pain, jaundice, GI bleeding, drop in hemoglobin

Dilated common bile duct sign

Shotgun (double barrel), CBD next to portal vein

Significance of biliary mass when primary cancer is present

Possibility of secondary cancer spreading to biliary tree

Causes of dilated biliary ducts

Stones, tumors, inflammation, post-surgical changes

Splenomegaly

Enlarged spleen over 13 cm in adults

Splenomegaly causes

Storage diseases, congestion, portal hypertension, infections, trauma, neoplasms

Most common cause of splenic infarction

Cardiac emboli from atrial fibrillation

Gaucher disease

Genetic storage disease involving lipid-laden macrophages in spleen

Sonographic appearance of splenic infarction

Wedge-shaped hypoechoic area at periphery of spleen

Appearance of spleen with sickle cell anemia

Enlarged from congestion of red pulp in early stages

Sonographic appearance of splenic abscess

Complex cystic mass with debris, gas, irregular walls

Niemann-Pick disease

Rare, fatal storage disease involving sphingomyelin accumulation

Sonographic appearance of amyloidosis in the spleen

Diffuse and hypoechoic with splenomegaly

Benign tumors of the spleen

Cystic lymphangioma, hamartoma, and hemangioma

Causes of splenic trauma

Blunt trauma leading to hematomas and lacerations

Anatomical liver location

RUQ, epigastric, partial LUQ

Four lobes of liver

right, left, caudate, quadrate

Echogenic ligaments and fissures within liver

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

Main lobar fissure role in identifying gallbladder sonographically

Trace main lobar fissure down, it points to gallbladder

Echogenic difference between hepatic vein and portal vein

Portal vein has bright walls, hepatic vein has no visible walls

Purpose of Couinaud's system

Divides liver into eight segments, helps surgical planning

Caudate lobe liver segment

Segment 1

Vein that divides right liver lobe into anterior and posterior

Right hepatic vein

Portal venous flow type

Hepatopetal

Primary liver functions

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

Liver echogenicity compared to renal cortex

Liver is slightly hyperechoic to renal cortex

Normal liver length

13 to 17 cm

Biliary apparatus structures

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

Sphincter of Oddi

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

Purpose of Heister's valves

Keeps cystic duct open so bile can enter and leave gallbladder and prevents collapse or kinking of duct

Gallbladder parts

Neck, body, fundus

Normal gallbladder wall measurement

3 mm or less

Celiac axis branches into

Left gastric artery, splenic artery, hepatic artery

Gallbladder position relative to liver

Medial to right lobe of liver

Hepatofugal flow meaning

Away from liver

Hepatic vein waveform

Triphasic

SMA resistive index (RI) while fasting

high-resistance

SMA Doppler waveform changes after eating

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

Vascular system functions

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

SMA supplies the

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

IMA supplies the

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

Right and left renal artery differences

Right renal artery is longer and travels posterior to IVC

Glisson’s capsule separates

Right and left liver lobe

Falciform ligament location

Extends from anterior abdominal wall into liver surface

Ligamentum teres

Remnant of umbilical vein within falciform ligament

Spleen location

Left hypochondrium

Normal size of spleen

12 cm or less in length

Ligaments that hold spleen in place

Splenorenal, gastrosplenic, phrenicocolic

Two types of pulp in spleen

White pulp (immune defense), red pulp (destroys old/damaged RBCs)

Function of culling in spleen

Removes abnormal red blood cells

Function of pitting in spleen

Removes nuclei from red blood cells

Immune cells produced in spleen

Lymphocytes (T cells and B cells)