Spleen, GI, Hernia, FAST, Thyroid For Final Pt 1

General GI approach uses a ______ high frequency transducer

Linear

For a general GI exam, the patient is in the _________position, though _______ positions may also be used.

supine, decub

What scanning technique is used for GI

“Mowing the Lawn”

Normal sonographic findings of the GI Tract

Bowel is compressible, shows a layered appearance, peristalsis is present

Large intestine wall thickness

<4mm

Small intestine wall thickness

3-4mm

The appendix is a remnant of the __________ of the cecum, and is a long __________ structure

apex; tubular

The appendix is located in the ________________ point and can extend in any direction

McBurney’s

Appendix length

9cm - 3-3.5 inches

Appendix is covered in proximal ______ w/peritoneum

2/3

Appendicitis is an _____________process of the appendix

inflammatory

Appendicitis is most common in _______________

children/young adults

Appendicitis is caused by:

Obstruction which leads to infection

Complication of appendicitis:

Peritonitis which can lead to perforation (life-threatening)

S/S of appendicitis:

N/V, fever, diarrhea, elevated body temperature, elevated WBC, REBOUND TENDERNESS, + McBurney’s sign

Appendicitis pain begins in the ____________ region and radiates to the RLQ

Periumbilical

Crohn’s disease is an _________ GI process with unknown cause and can effect ____ part of the GI tract

Inflammatory; any

Crohn’s Disease occurs most commonly in:

young adults

Most common site for Crohn’s

Terminal ileum

S/S for Crohns

Painful right iliac mass, crampy abdominal pain, intermittent diarrhea, weakness, fever, elevated WBC, poor malabsorption

Crohn’s disease is often associated with a narrowed _______

lumen

Evaluation for Crohn’s disease includes:

Monitoring the wall for thickness, evaluate for abscess and FF, look for lymph adenopathy, increased vascularity may be seen, attempt to evaluate for FISTULAS to skin, bladder or other bowel

Ulcerative Colitis does NOT result in ____________ formation

fistula

Ulcerative Colitis is a similar inflammatory process to Chron’s disease and shows a ________ bowel wall, with ____________ vascularity compared to Crohn’s, appearance is ________ ___________

thickened; increased; worm-like

USA of appendicitis

Targetoid or bulls-eye appearance, non-compressible, lacks peristalsis, fat surrounding appendix, may or may not have appendicolith, hypoechoic w/blunted end

In appendicitis, the diameter is more than _____ mm

6

FAST stands for:

Focused Abdominal Sonography for Trauma

Purpose of FAST exams:

Evaluate for life-threatening FF/Blood in trauma patients within the peritoneal cavity

How long does a FAST exam take and who is it performed by?

5 minutes, by a resident/physician

FAST views

Morrison’s pouch, Peri splenic view, Paracolic Gutters (2), Pericardium, pelvic

Morrison’s pouch is located between the

liver and kidney

RUQ fluid pathology often involves:

RUQ fluid collection

Perisplenic view evaluates interface between _________ and ___________. Common findings include FF at the ______ ________

spleen; kidney; splenic hilum

Pelvic view is evaluated with a _____ bladder, at a ______ view, and is sensitive to detecting ____ in the posterior cul-de-sac

full; midline; FF

Paracolic gutters are located along the ________ abdomen borders, FF may collect here and float _________

bilateral; intestines

Pericardial view is typically imaged with a _________ approach, but you can also use a ________ view. This evaluates for ____ around the heart

sub-xiphoid; parasternal; FF

eFAST evaluates for chest emergencies such as:

Hemothorax, pleural effusion, and pneumothorax

Perinephric hematoma may occur post-________

biopsy

Parenchyma injuries are common in the _______ and _____ due to trauma

liver; spleen

Parenchymal injuries appearance changes over time, initially: ___________ w/low-level echoes, as coagulation occurs: __________, Eventually_________ due to hemolysis

hypoechoic; echogenic; anechoic

Urolithiasis Clinical S/S:

Spasmodic flank pain that radiates to the pelvis, fever, syncope

Urolithiasis USA:

Echogenic foci w/shadowing, hydro may be seen

Aortic Dissection Clinical S/S:

Sudden chest pain, syncope

Aortic Dissection USA:

Aneurysm, intimal flap, false lumen

Paraumbillical Hernia Clinical S/S:

Lower abdominal mass, visible w/Valsalva maneuver

Paraumbillical Hernia USA:

Bowel peristalsis in mass, reducible w/pressure

Time out:

Immediately before a procedure, performed w/everyone in the room, confirm patient, procedure, location and reason

FNA

Fine needle aspiration, thin needle

Core Bx:

Thicker needle, samples a larger area, can be an option when FNA isn’t sufficient

Lab values to review before a Paracentesis

Platelet count, coagulation factors

Adrenal Cyst

Uncommon, female prevalence, asymptomatic, incidental finding, incidental findings, unilateral

Adrenal hemorrhage

Rare in adults, common in neonates w/traumatic delivery

S/S of adrenal hemorrhage

Abdominal mass, anemia, hyperbilirubinemia

USA of adrenal hemorrhage

Hyperechoic mass like initially, cystic and complex as regresses and gets reabsorbed

Adrenal Adenoma

Benign, usually less than 2.5cm, increased prevalence in older patients w/diabetes or HTN

USA of adrenal adenoma

Well defined, round, homogeneous, hypoechoic, symmetrical

Malignant adrenal tumors

rare, female prevalence, can cause Cushing’s (change in function)

Malignant adrenal tumors USA:

Small, well defined, homogeneous, hypervascular

METS in adrenals

4th most common site, from liver, lungs, and bone

Adrenal medulla tumor: Pheochromocytoma

Mass than secretes excess epinephrine and norepinephrine, usually benign

Adrenal Pheochromocytoma S/S:

HTN, headaches, heart palpations

USA of Pheochromocytoma

Homogeneous poor transmission, unilateral, large and bulky, hyperechoic surrounding area

Most common malignancy of adrenal in childhood?

Adrenal neuroblastoma

USA Adrenal Neuroblastoma

Heterogeneous, poorly defined borders, calcifications and necrosis, color will show capsular flow, doppler analysis demonstrates low resistance arterial flow

Most common Primary retro tumor?

Lymphoma

Lymphnodes suspicious if …

Greater than 2cm, round, RI greater than 0.7

Urinoma

Walled off collection of extravated urine, trauma, surgery or obstruction, usually around kidney or perinephric space

Urinoma USA

Sonolucent unless complicated or long standing

A neck ultrasound is ordered to evaluate a patient with hypercalcemia. What is the first pathology that you would evaluate for?

Parathyroid ademoma

A patient has been referred for a parathyroid ultrasound for a suspected parathyroid adenoma in the superior parathyroid gland. Where would you look for this pathology?

Posterior to mid thyroid

According to TI-RAD, what defines a very hypoechoic nodule? 

Darker than the surrounding muscles.

The right and left lobes of the thyroid gland are connected across the midline by the _________.

Isthmus

The most common thyroid carcinoma is:

Papillary

True/False: Thyroid carcinoma is a rare entity.

True

1

Sternocleidomastoid

2

Strap muscles

3

Jugular vein

4

Carotid artery

5

Thyroid gland

6

Trachea

7

Esophagus

8

Longus Coli Muscles

9

Cervical spine

10

Skin

List 2 indications to perform a lymph leveling exam.

Assist tumor staging and evaluate the neck region

hypoechoic gland with fibrous strands

Hashimoto’s Thyroiditis

Cystic nodule with comet tail artifact

Colloid Cyst

hypoechoic nodule with multiple microcalcifications

Papillary carcinoma

homogeneous gland that measures 6cm in length

Goiter

Adenoma

solid, peripheral halo

Cyst

Smooth wall, sonolucent w/enhancement

Goiter

enlargement of thyroid gland, wt gain, hair loss, deep voice

Caricnoma

irregular contour, echodense

Hypothyroidism

Lethargic, sluggish

Hyperthyroidism

wt. loss, nervousness

What is the USA of a normal thyroid gland?

Homogeneous with mid-high level grays

What are the 3 main lab values that we look for when correlating for thyroid exams?

T3, T4, TSH

What type of composition is this? Does it have a benign or malignant correlation according to TI-RADS

spongiform, benign 

When evaluating a lymph node in the neck which of the following criteria that would signify a benign process

wider than tall, centralized hilum, centralized vascularity 

Hyperthyroidism

Hypermetabolic state, increased amount of thyroid hormones (Grave’s)