ARDMS Abdomen Exam 2024-2025: Questions and Answers, Exams of Physical Activity and Sport Sciences

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Graded A Abnormal sonographic appearance of the TIPS - ANSDiameter less than 8 mm, new onset of ascites, elevated velocity within the stent, velocity within the stent below 60 cm/s, decrease in main portal vein velocity, retrograde flow through the stent Acute cholecystitis - ANSEtiology: obstruction of the cystic duct, infection, idiopathic Risk factors: female prevalence, cholelithiasis, 40-50 yrs old Clinical findings: severe epigastric or RUQ pain, biliary colic, Positive Murphy's sign, nausea/vomiting, fever and chills, Elevated AST, bilirubin, and ALP, leukocytosis Sonographic findings: Thick, edematous gallbladder wall Impacted stone in the gallbladder neck or cystic duct Cholelithiasis (90%) Pericholecystic fluid Positive Murphy's sign Peripheral hyperemia on color doppler Sludge Acute glomerulonephritis - ANSInflammatory response resulting in glomerular damage caused by autoimmune reaction, infection, or exposure to toxins Presenting symptoms: sudden onset of hematuria, proteinuria, azotemia, red bloos cell casts in urine Renal enlargement, hyperechoic medullary pyramids Acute pancreatitis - ANSMost common cause: biliary disease Abrupt onset of epigastric pain, nausea/vomiting, elevated lipase and amylase, paralytic ileus Normal findings (30%) Decrease in parenchymal echogenicity Smooth borders Enlargment Acute pyelonephritis - ANSMost renal infections occur via the ascending route Ultrasound findings include: Renal enlargement, hypoechoic parenchyma, absence of sinus echoes Sonographic findings: bilateral disease, multiple cysts, irregular margins, normal renal parenchyma may not be visualized, associated with cysts in liver, pancreas, and spleen Alanine Aminotransferase (ALT) - ANSAn enzyme found in large concentration in the liver and lower concentrations in the heart, muscle, and kidneys Remains elevated longer than AST Elevation associated with cirrhosis, hepatitis, and biliary obstruction Mild elevation associated with liver mets Aldosterone - ANSSteroid secreted by the cortex Regulates sodium and water levels, which affects blood volume and pressure Alkaline Phosphatase - ANSAn enzyme produced primarily by the liver, bone, and placenta and excreted through the bile ducts Marked elevation is associated with obstructive jaundice Alpha-fetoprotein - ANSA protein normally synthesized by the liver, yolk sack, and GI tract of the fetus Nonspecific marker for malignancy Amylase - ANSbreaks down carbohydrates Angiomyolipoma - ANSHyperechoic benign renal tumor Also called renal hamartoma 80% involve the right kidney associated with tuberous sclerosis Annular Pancreas - ANSRare anomaly caused by failure of normal regression of the left ventral bud The head of the pancreas is surrounds the duodenum, resulting in obstruction of the biliary tree and duodenum Male prevalence Aspartate Aminotransferase (AST) - ANSAn enzyme present in many types of tissues that is released when cells are damaged or injured; levels will be proportional to the amount of damage and time between cell injury and testing Associated with hepatitis, cirrhosis, and Mononucleosis Biliary atresia - ANSEtiology: congenital anomaly, viral infection Symptoms: Persistent jaundice Absent biliary radicles, small or absent gallbladder, absent common hepatic duct, hepatomegaly Biloma - ANSEtiology: surgery, trauma, GB disease Sonographic findings: Anechoic fluid collection near the porta hepatis, fluid may demonstrate mobility with patient position change, check pelvis and paracolic gutter for fluid Blood Urea Nitrogen - ANSProduced from breakdown of food proteins Elevated in urinary obstruction, renal dysfunction, or dehydration Decreased levels associated overhydration, pregnancy, liver failure, decrease in protein intake, and smoking Body of the pancreas - ANSlargest and most anterior aspect of the pancreas lies anterior to the aorta, SMA, SMV, splenic vein, left renal vein, and spine lies posterior to the antrum of the stomach Budd-Chiari Syndrome - ANSEtiology: Hepatoma, tumor extension (liver or renal), Hematologic disorder, Congenital webbing of the IVC or right atrium Sonographic characteristics: Biliary dilation, thickening of the bile duct walls, pneumobilia, gallbladder hydrops, brightly echogenic portal triad Cholecystokinin - ANSproduced in the duodenum to stimulate secretion of pancreatic enzymes and contraction of the GB Choledochal cyst - ANSEtiology: congenital weakness of the bile duct wall, reflux of pancreatic enzymes into the bile duct Nonvascular cystic mass medial to the GB and lateral to the head of the pancreas, dilated CHD, CBD, or cystic duct entering the mass, dilated intrahepatic bile ducts Cholesterolosis - ANSEtiology: local disturbance in cholesterol metabolism, NOT associated with serum cholesterol levels Sonographic findings: Normal GB in majority of cases, echogenic intraluminal foci, nonshadowing, "Strawberry GB"**** Chronic cholecystitis - ANSRecurrent inflammation secondary to infection, obstruction, or metabolic disorders Clinical findings: Asymptomatic, vague RUQ pain, heartburn, fatty food intolerance, intermittent nausea/vomiting, mild increase in AST and ALT, possible increase in ALP and bilirubin Sonographic findings: small or contracted GB, Thick, hyperechoic walls, Cholelithiasis, posterior acoustic shadowing, sludge Chronic Pancreatitis - ANSRepeated, prolonged, or persistent attacks of pancreatitis Chronic RUQ or epigastric pain, nausea/vomiting, weight loss, abnormal glucose tolerance test, normal amylase and lipase Increase in parenchymal echogenicity Irregular borders Calcifications psuedocyst formation atrophy prominent pancreatic duct Chronic pyelonephritis - ANSRenal injury due to recurrent infection Results from recurrent infections due to anatomic anomalies, obstructive lesions, vesicoureteral reflux resulting in parenchymal thinning and renal failure Sonographically, chronic pyelonephritis leading to end-stage renal disease, appears as a small, hypoechoic kidney Cirrhosis - ANSAlcoholism and Chronic Hep C are the most common causes in the US Weakness, fatigue, weight loss, abdominal pain, ascites, elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin, skin changes and hair loss, nonobstructive jaundice Diffuse increase in parenchymal echogenicity Irregular or nodular contour Inability to distinguish portal vein walls increase in sound attenuation enlargement of the caudate lobe splenomegaly ascites Conn syndrome - ANSuncommon condition resulting from excessive aldosterone secretions, Adrenal adenoma is the most common cause, HTN, increased aldosterone secretions, muscular weakness, abnormal electrocardiogram, muscular weakness Creatinine - ANSA waste product produced from meat protein and normal wear and tear on the muscles of the body More specific in determining renal dysfunction than BUN Cyst containing small cysts (daughter cysts) Emphysematous cholecystitis - ANSAcute cholecystitis due to gallbladder wall ischemia and infection Comet-tail reverberation artifacts are seen due to the presence of gas within the wall/lumen of the gallbladder due to gas-producing bacteria Emphysematous pyelonephritis - ANSBacterial infections associated with renal ischemia Most commonly occuring in diabetics, immunosuppressed patients, and patients with urinary obstruction Anerobic bacteria produce gas causing reverberation or comet tail arftifacts Endocrine hormones are secreted by what in the pancreas: - ANSIslets of Langerhans Exocrine enzymes are secreted by what in the pancreas: - ANSAcinar cells Falciform ligament - ANSAttaches the liver to the anterior abdominal wall Extends from the diaphragm to the umbilicus Separate the right and left subphrenic spaces Fatty infiltration - ANSAsymptomatic, elevated liver function tests, hepatomegaly Diffuse increase in parenchymal echogenicity, normal vessel wall margins, normal liver parenchyma appears as a hypoechoic mass adjacent to the IVC or anterior to the porta hepatis Focal Nodular Hyperplasia - ANSHormone influence, second most common benign liver mass, congenital vascular malformation Asymptomatic Hyperechoic or isoechoic well-defined mass, subcapsular location, hypoechoic central stellate scar, peripheral and central blood flow, frequently found in the right lobe Functional Islet cell tumors - ANSInsulinoma: Increase in insulin levels, hypoglycemia, headaches, obesity, confusion Gastrinoma: Gastric hyperstimulation associated with peptic ulcer disease Small well-defined hypoechoic mass Large tumors are more echogenic Typically located in the body or tail Necrotic cystic areas are more likely to be malignant majority are hypervascular Gallbladder carcinoma - ANSEtiology: 5th most common malignancy Adeocarcinoma in greater than 90% of cases Risk factors: cholelithiasis, porcelain gallbladder, cholecystitis, female prevalence, greater than 60 years old Thick, irregular GB wall, irregular intraluminal mass, immobile mass, cholelithiasis (90%), lymphadenopathy, metastatic liver lesions Gangrenous cholecystitis - ANSGangrenous- tissue loss due to decrease blood supply Signs suggestive of gangrenous cholecystitis: Asymmetric wall thickening, wall striations, intraluminal membranes, pericholecystic fluid **Most common in diabetics Gastrin - ANSsecreted by the stomach to stimulate release of gastric acids; stimulates growth of mucosa of the exocrine pancreas Splenomegaly Increased echogenicity in chronic cases Hepatoblastoma - ANSGerm cell tumor Most common malignant tumor in children 3 yrs or less Abdominal distension, nausea/vomiting, weight loss, precocious puberty, marked elevation of AFP Heterogeneous, hyperechoic mass; Cystic mass with internal septation, low- resistance internal blood flow Hepatocellular Carcinoma (Hepatoma) - ANSCauses: Cirrhosis, Chronic Hepatitis B Palpable mass, abdominal pain, weight loss, unexplained fever, elevated AST, ALT, ALP, Positive alpha-fetoprotein, jaundice Solid mass with variable echogenicity, may demonstrate a hypoechoic halo, multiple masses or diffuse infiltrative masses may also be noted, hepatomegaly, ascites Hepatomegaly - ANSEtiology: congestive heart failure, inflammatory processes, polycystic disease, fatty infiltration, biliary obstruction, neoplasm, budd-chiari syndrome Sonographic characteristics: Length exceeding 18 cm, Anterior-posterior diameter exceeding 15 cm Hormones secreted by the adrenal medulla - ANSEpinephrine Norepenephrine Hormones secreted the adrenal cortex: - ANSMineral corticoids (Aldosterone) Glucocorticoids (Cortisol) Androgens Horseshoe kidney - ANSFusion of the kidneys usually at the lower pole, connected by an isthmus of functioning or nonfunctioning parenchyma, separate collecting systems, most common renal fusion Bilaterally, low-lying medially placed kidneys with partial or complete fusion of the lower poles Isthmus of tissue demonstrated anterior to the aorta Hydropic Gallbladder (GB hydrops) - ANSetiology: obstruction of the cystic duct, prolonged biliary stasis, surgery, hepatitis, gastroenteritis, diabetes Enlargment of the GB Diameter exceeding 4 cm Thin, hyperechoic walls Hypertrophied pyloric stenosis - ANSPyloric wall thickness above 3-4 mm Pyloric diameter exceeding 15 mm length of the pyloric canal exceeding 17 mm Projectile vomiting, palpable upper abdominal mass (olive sign), lethargy, change in stools, Insulin - ANSSecreted by beta cells Decreases blood sugar levels Junctional fold: - ANSfold or septation of the gallbladder at the junction of the neck and the body Klatskin tumor - ANSSymptoms: jaundice, acute onset of abdominal pain, biliary colic, weight loss, elevated bilirubin and alkaline phosphatase levels, mild elevation of AST and ALT Small echogenic mass near the hepatic hilum Dilation of the intrahepatic bile ducts Mesenteric ischemia - ANSAcute abdominal pain, postprandial pain, weight loss Celiac systolic peak velocity greater than 200 cm/s with post stenotic turbulence SMA peak systolic velocity greater than 280 cm/s with post stenotic turbulence A minimum of 2 mesenteric vessels must demonstrate stenosis Mirizzi Syndrome - ANSImpacted stone in the cystic duct or gallbladder neck, obstruction of the CHD, jaundice, dilated CHD superior to the obstruction Clinical findings: RUQ pain, jaundice, elevated bilirubin and alkaline phosphatase, increase in AST, ALT Immobile calculus in the cystic duct or neck of the GB Dilation of the intrahepatics and common hepatic Normal CBD Most common cancer to met to the GB: - ANSMelanoma Most common cancer to met to the liver: - ANSColon Cancer Multicystic dysplastic kidney - ANSAffects the left kidney more frequently Noninherited disease Urinary obstruction in early embryology Male prevalence Infants of diabetic mothers Unilateral disease, Numerous cysts of variable shape and size, associated with ureteropelvic junction obstruction and malrotation, Normal renal parenchyma may not be visualized Neck of the pancreas - ANSLies directly anterior to the superior mesenteric vein and portosplenic confluence Nephrocalcinosis - ANSDisorder of calcium metabolism that result in the formation of calcium renal stones and deposition of calcium salts in the renal parenchyma Hyperechoic medullary pyramids may demonstrate shadowing Neuroblastoma - ANSNeoplasm of the adrenal gland common in young children Male prevalence Half occur before the age of 2 more common on the left Heterogeneous mass, poorly defined wall margins, pinpoint calcifications, lymphadenopathy, mass encases the IVC, aorta, SMA, and vein no invasion of the renal vein Normal appendix measurements: - ANSShould not exceed 2 mm in wall thickness and 6 mm in diameter Normal bladder wall thickness - ANSLess than 5 mm in a nondistended bladder Less than 3 mm in a distended bladder Normal Gallbladder measurements: - ANS8 to 10 cm length 3 to 5 cm in diameter Wall measuring less than 3 mm Pancreatic carcinoma - ANSAdenocarcinoma in 90% of cases 75% involves the head of the pancreas Abdominal pain, severe back pain, weight loss, weight loss, painless jaundice, anorexia, new onset of diabetes Hypoechoic mass in the pancreas, irregular borders, dilated biliary tree, hydropic gallbladder, liver mets, ascites Porcelain GB - ANSEtiology: Decrease in vascular supply to the GB, cystic duct obstruction causing bile stasis, chronic low-grade infection Risk factors: Female prevalence Symptoms: Asymptomatic, vague abdominal pain Gallstones (95%), hyperechoic wall, marked posterior acoustic shadowing, diffuse or localized Portal Hypertension - ANSEtiology: Cirrhosis, hepatitis, fatty infiltration, portal vein obstruction, budd-chiari syndrome Clinical findings: splenomegaly, hepatomegaly, increase in liver function tests, hematemesis, jaundice, abdominal distension Sonographic findings: Intrinsic liver disease, Main portal vein diameter >13 mm, Splenomegaly, ascites, Splenic and superior mesenteric veins measuring greater than 10 mm, Changes in portal venous flow: hepatofugal, pulsatile, decrease in velocity, portosystemic collaterals, Resistive index of the hepatic artery exceeding 0.8 implies portal hypertension Postvoid residual should not exceed - ANS20 ML Potassium - ANSEssential to normal function of every organ system maintains necessary concentrations of nutrients inside and outside the cell elevation increased in addison's disease Prothrombin time - ANSNormal clotting time is 10-15 seconds enzyme produced by the liver production depends on amount of Vitamin K elevation associated with cirrhosis, malignancy, malabsorption of Vitamin K, and clotting failure Decreases with subacute or acute cholecystitis, internal biliary fistula, carcinoma of the GB, injury to the bile ducts, and prolonged extrahepatic biliary obstruction Pseudocyst - ANSFocal collection of inflammatory necrotic tissue, blood, and pancreas secretions Most often located in the lesser sac Abdominal mass, abdominal pain, elevated amylase Anechoic or complex mass, well-defined borders, variable shape Pyonephrosis - ANSPrulent material in the collecting system of the kidney associated with an infection secondary to obstruction Ultrasound findings include hyperechoic debris in dilated renal collecting system Renal artery aneursym - ANSRisk factor: pregnancy Clincial findings: Asymptomatic, hypertension, flank pain, hematuria Sonographic findings: doubling of the normal artery, artery diameter measuring 1.5 cm or greater, risk of rupture when diameter is greater than 2 cm Renal artery stenosis - ANSSymptoms: uncontrollable hypertension, renal insufficiency, abdominal bruit, decrease in urine sodium calcium concentration, hematuria Sonographic findings: Peak systolic velocity greater than 180 cm/s** spectral broadening absence of diastolic flow** delayed acceleration time** Renal artery ratio greater than 3.5*** Visual narrowing of the renal artery by atherosclerosis or thickening of the arterial wall Kidney atrophy Kidney infarct Increases with pancreatitis, obstruction of pancreatic duct, pancreatic cancer, acute cholecystitis, cirrhosis, and severe renal disease Sigmoid kidney - ANSVariant of the horseshoe kidney Superior pole of one kidney is fused with the inferior pole of another kidney S-shaped SMA supplys: - ANSjejunum, ileum, cecum, ascending colon, portions of the transverse colon, and head of the pancreas Somatostatin - ANSSecreted by delta cells Autoregulator Splenomegaly - ANSEtiology: Congestive heart failure, cirrhosis, portal hypertension, portal vein thrombosis, infection, diabetes mellitus, hypertension, hepatitis, trauma, hemolytic anemia Sonographic findings: enlargement of the spleen, length exceeding 13 cm Superior Mesenteric artery - ANSHigh-resistance multiphasic flow when fasting Low-resistance elevated systolic and diastolic velocities, continuous forward flow after a meal Distance from the anterior wall of the aorta to the posterior wall of the SMA should not exceed over 11 mm Tail of the pancreas - ANSMost superior portion of the pancreas lying anterior and parallel to the splenic vein Lies anterior to the upper pole of the left kidney, posterior to the stomach, and lateral to the spine Generally extends toward the splenic hilum The common benign neoplasm of the spleen - ANScavernous hemangioma Transjugular intrahepatic portosystemic shunt (TIPS) - ANSA shunt is placed between a portal vein and hepatic vein, commonly placed between the right portal vein and right hepatic vein Brightly echogenic, nonshadowing structure tubular structure connecting a portal vein to hepatic vein stent should measure 8-12 mm in diameter throughout; hepatopetal flow in main portal vein, hepatofugal flow in right and left portal veins, peak flow velocity between 65-225 cm/s within stent trypsin - ANSbreaks down proteins Uncinate process - ANSportion of the pancreatic head located directly posterior to the superior mesenteric vein and anterior to the aorta and IVC Urachal cyst - ANScystic dilation of the fetal urachus This is the medial umbilical ligament connecting the bladder to the umbilicus Sonographically, this is seen as a cystic structure superior and anterior to the bladder Ureterocele - ANScyst-like enlargement of the distal ureter which projects into the bladder lumen at the ureteropelvic junction Ectopic ureteroceles are usually associated with duplex kidney. The distal ectopic ureterocele results in obstruction of the upper pole of the collecting systems Whipple procedure (pancreatoduodenectomy) - ANSGallbladder is removed Common duct is ligated superior to the cystic duct and anastomosed to the duodenum distal to the pancreas Remaining pancreatic tissue is attached to the duodenum