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ARDMS Abdomen Review (Based off of URR Review Course) Questions and Complete Solutions Graded A+
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ARDMS Abdomen Review (Based off of URR Review Course) Questions and Complete Solutions Graded A+ Denning [Date] [Course title]
What does an increased RI mean - Answer: increased resistance in vascular bed What does an increased pulsatility index mean - Answer: increased resistance in vascular bed Normal PI for vessels supplying organs such as kidneys - Answer: < 0. Hydrostatic pressure: when supine at ankle when standing above heart when standing - Answer: 0 mmHg 100 mmHg -30 mmHg What vessel is the most posterior abdominal vessel - Answer: aorta Paired branches of the aorta (5) - Answer: suprarenal arteries (adrenal glands) renal arteries (kidneys) gonadal arteries (ovaries/testicles) lumbar arteries common iliac arteries Unpaired branches of the aorta (4) - Answer: celiac axis (common hepatic, splenic, left gastric arteries) SMA IMA median sacral artery What level common iliac arteries bifurcate - Answer: L3- Decreased hematocrit may indicate what - Answer: bleed in body
What happens to the aorta as you follow it distally (2) - Answer: gets smaller becomes more anterior Aortic Ectasia - Answer: lack of tapering of aorta as you move distally (can be precursor to aneurysm) AAA What vessel walls are involved - Answer: focal dilation of aorta >3cm or >50% diameter between two adjacent segments all three Most common cause of AAA - Answer: atherosclerotic disease Risk factors for AAA (4) - Answer: 1. male
hypotension Leriche syndrome (3) - Answer: aortoiliac occlusive disease occlusion of abdominal aorta just above CIA bif causes bilateral lower extremity ischemia symptoms Retroperitoneal fibrosis other name, most common location - Answer: Ormond disease most commonly at aortic bifurcation and inferiorly in pelvis Retroperitoneal fibrosis sonographically (4) - Answer: soft tissue mass surrounding great vessels hypoechoic smooth borders possible hydronephrosis (due to ureteral obstruction) Abnormal dilation of the abdominal segment of the IVC measures - Answer: > 2.5 cm Normal Doppler flow of the IVC is - Answer: triphasic Most common variation of IVC anatomy - Answer: duplicated IVC infrarenal segment duplicated with left IVC entering left renal vein (suprarenal IVC normal) Transposed IVC - Answer: IVC on left side of abdomen (instead of right) Interrupted IVC (3) - Answer: IVC doesn't go to right atrium enters azygos/hemiazygos veins to reach SVC no intrahepatic segment Causes of IVC dilation (5) - Answer: 1. right heart failure (most common)
What is it also called - Answer: remnant of umbilical vein round ligament Ligamentum venosum is - Answer: remnant of ductus venosum from fetal circulation (umbilical vein-left portal vein-ductus venosus-IVC-right atrium) Hepatoduodenal ligament contains (3) - Answer: MPV hepatic artery CBD Branches of MPV - Answer: RPPV RAPV LMPV LLPV MPV carries _____% of all blood entering liver, hepatic artery carries _____% - Answer: 80 20 Normal portal vein diameter - Answer: <13mm What is the most common variation in hepatic vein anatomy - Answer: accessory right hepatic vein Caroli disease - Answer: congenital defect of bile ducts, numerous cysts in biliary tree Caroli disease sonographically (3) - Answer: 1. focal cystic areas
alcohol abuse obesity starvation cystic fibrosis Diffuse fatty infiltration sonographically (5) - Answer: mild: slight increase in fine echoes, normal visualization of diaphragm and vessel borders moderate: moderate increase in fine echoes, impaired visualization of diaphragm and vessel borders severe: marked increase in fine echoes, poor or non-visualization of diaphragm and vessel borders hepatomegaly possible narrowing of hepatic veins Focal fatty infiltration sonographically (5) - Answer: focal increased echogenicity possible irregular borders usually adjacent to portal structures similar to hemangioma no displacement of surrounding structures Focal fatty sparing sonographically (5) - Answer: focal decreased echogenicity (remaining liver tissue increased echogenicity) possible irregular borders usually adjacent to gallbladder fossa similar to malignancy no displacement of surrounding structures Amyloid disease (2) - Answer: deposit of amyloid protein in vessel walls of various organs commonly involving liver Glycogen storage disease, most common type - Answer: autosomal recessive
von Gierke disease Glycogen storage disease with excessive storage of glycogen sonographically (2) - Answer: hepatomegaly increased echogenicity Glycogen storage disease with reduced storage of glycogen sonographically (3) - Answer: hypo echoic parenchyma prominent portal walls "starry sky" (similar to hepatitis) What is hemochromatosis What is it inherited from Sonographic appearance - Answer: abnormal iron deposition inherited or due to anemia sonographically includes features of fibrosis and cirrhosis Wilson disease (2) - Answer: autosomal recessive disease excessive deposition of copper in liver Wilson disease symptoms (5) - Answer: jaundice hematemesis portal hypertension ascites rusty/brown-colored ring around iris of eye (Kayser-Fleischer rings) Wilson disease sonographically (3) - Answer: echogenic fatty liver fibrotic periportal thickening nodular cirrhotic changes
Cirrhosis symptoms (5) - Answer: increased abdominal girth (ascites) jaundice liver atrophy splenomegaly weight loss Causes of cirrhosis (9) - Answer: hep C alcohol abuse chronic liver disease biliary obstruction hep B glycogen storage disease hemochromatosis wilson disease Budd Chiari syndrome Cirrhosis sonographically (6) - Answer: nodular surface hepatomegaly or right lobe atrophy with compensatory hypertrophy of left lobe portal hypertension splenomegaly thickened gallbladder wall ascites Symptoms of hepatitis (6) - Answer: jaundice hepatomegaly nausea fever/chills malaise
dark urine Acute hepatitis sonographically (4) - Answer: "starry sky" appearance (normal liver texture or portal vein borders may be more prominent) increased echogenicity hepatosplenomegaly gallbladder wall thickening Chronic hepatitis sonographically (4) - Answer: coarse echo texture decreased brightness of portal triads normal size increased liver echogenicity (due to fibrosis) Echinococcal cysts sonographically (3) - Answer: large cyst with "daughter cysts" within honeycomb appearance, water lily sign most commonly found in right lobe What is schistosomiasis - Answer: parasitic infection (most common in humans) Schistosomiasis sonographically (4) - Answer: thick, echogenic portal vein walls debris/occlusion in intrahepatic portal venous system decreased liver size portal hypertension Pneumocystis jirovecci (pneumocystis carinii) cause and what patients is it most common in - Answer: yeast-like fungus AIDS patients Pneumocystis jirovecci (pneumocystis carinii) sonographically (1) - Answer: multiple non-shadowing echogenic foci
Granulomatous infections sonographically (1) - Answer: multiple echogenic foci (granulomas) in spleen and liver Three types of hepatic abscess - Answer: pyogenic amoebic fungal Hepatic abscess symptoms (6) - Answer: fever nausea diarrhea RUQ pain hepatomegaly leukocytosis Pyogenic hepatic abscess sonographically (2) - Answer: solitary or multiple complex lesions fluid collections in: morison's pouch, subdiaphragmatic, subphrenic space Amebic hepatic abscess sonographically (3) - Answer: complex lesion typically in right lobe history of travel Most common benign lesion of the liver What gender is it more common in What lobe is it usually found in Usual symptoms What can cause it to enlarge - Answer: hemangioma women right
asymptomatic pregnancy, estrogen therapy Hepatic hemangioma sonographically (3) - Answer: homogenous hyper echoic well-defined Most common benign vascular tumor in infancy Most common symptom When does it spontaneously regress by - Answer: infantile hemangioendothelioma cardiac failure age 2 Second most common benign liver mass What gender and age group is it more common in Most common symptom - Answer: focal nodular hyperplasia women of child bearing years asymptomatic Focal nodular hyperplasia sonographically (2) - Answer: well-defined lesion hyper echoic to isoechoic What gender is liver cell adenoma more common in What medication is it associated with What disease is it commonly associated with - Answer: women oral contraceptives glycogen storage disease Liver cell adenoma sonographically (3) - Answer: well-defined lesion
central hyper echoic area surrounded by halo What is the most common primary malignancy of the liver What is the most common risk factor What gender is it more common in - Answer: hepatocellular carcinoma cirrhosis males Hepatocellular carcinoma symptoms (5) - Answer: fever hepatomegaly palpable mass ascites weight loss Hepatocellular carcinoma sonographically (4) - Answer: solitary massive tumor multiple nodules throughout liver diffuse infiltrative masses variable Most common pediatric primary liver malignancy What age does it occur before What lab value is associated with it - Answer: hepatoblastoma age 2 elevated alpha-fetoprotein Hepatoblastoma is associated with (2) - Answer: Beckwith-wiedemann syndrome familial adenomatous polyposis
Hepatoblastoma symptoms (3) - Answer: abdominal enlargement hepatomegaly palpable mass Hepatoblastoma sonographically (4) - Answer: solid echogenic mass may have cystic portions/septations may contain calcification may invade hepatic and portal veins Most common primary sites of liver mets (4) - Answer: gallbladder (1) colon stomach pancreas Liver mets sonographically (3) - Answer: multi-locular well-defined hypoechoic What is kaposi sarcoma, most common liver malignancy seen with - Answer: malignancy of connective tissue HIV/AIDS What is lymphoma, what is it commonly associated with - Answer: malignancy of lymphatic system HIV/AIDS Lymphoma sonographically (3) - Answer: solid tumor single or multiple hypoechoic and/or complex
Budd-Chiari Syndrome - Answer: obstruction of hepatic veins by thrombus or tumor Budd-Chiari sonographically (8) - Answer: variable thick hepatic vein walls hepatomegaly or atrophy IVC compression ascites splenomegaly slow/reversed portal vein flow absent/reversed/turbulent/continuous hepatic vein flow Air in hepatic veins cause, sonographic appearance - Answer: bacterial infection releasing air into bloodstream mobile echogenic foci with dirty shadowing and/or ring down artifact Hepatic infarct sonographically (1) - Answer: wedge-shaped hypoechoic area with no flow What is hepatic congestion associated with (2) - Answer: congestive heart failure reduced cardiac function Hepatic congestion sonographically (5) - Answer: hepatomegaly dilated hepatic veins enlarged IVC ascites biphasic waveform in hepatic veins Most common cause of portal hypertension - Answer: cirrhosis from alcoholism Portal hypertension sonographically (7) - Answer: portal vein > 13mm
dilated splenic and SMV hepatofugal flow varices abnormal portal vein flow ascites splenomegaly Abnormal portal vein flow (5) - Answer: pulsatile biphasic slow (<16) reversed absent Collateral pathways with portal hypertension (3) - Answer: splenorenal esophageal recanalized umbilical vein Transjugular intrahepatic portosystemic shunt (TIPS) - Answer: hepatic vein connected to portal vein Linton shunt - Answer: proximal splenic vein connected to renal vein Warren shunt - Answer: distal splenic vein connected to renal vein Mesocaval shunt - Answer: SMV connected to IVC Normal portosystemic or portal-caval shunt sonographically (4) - Answer: flow from portal to hepatic system MPV hepatopedal flow intrahepatic branches hepatofugal
peak velocity between 50-200 cm/s Most common reason for liver transplant in adults and children - Answer: hepatitis C biliary atresia What artery supplies the gallbladder What artery does it originate from What vein drains the gallbladder - Answer: cystic artery right hepatic artery cystic vein Gallbladder wall layers from inner to outer - Answer: mucosa muscle serosa Where are the ducts of luschka located What is their function - Answer: within gallbladder wall bile thickening Cystic duct carries bile to and from what What regulates the flow in the cystic duct - Answer: gallbladder spiral valves of heister CBD _____ considered dilated with gb present CBD _____ considered dilated in patients without gb - Answer: > 8 mm
12 mm Which wall of the gallbladder should be measured Normal wall measurement - Answer: anterior wall
< 3 mm How does cholecystokinin affect the gallbladder - Answer: causes contraction Second most common congenital anomaly of the gallbladder - Answer: phrygian cap Most common congenital gallbladder anomaly - Answer: junctional fold What gender and ethnicity are choledochal cysts more common in - Answer: women Asian Five types of choledochal cysts - Answer: I: fusiform dilation of CBD (most common) II: diverticulum of CBD III: dilation of intraduodenal portion IV: dilation of intrahepatic and extra hepatic ducts V: dilation of intrahepatic ducts (Caroli disease) Biliary atresia sonographically (2) - Answer: triangular cord sign small/absent gb in fasting patient Calculous cholecystitis cause, what gender is it more common in Acalculous cholecystitis cause, what gender is it more common in - Answer: gallstones females bile stasis men Acute cholecystitis sonographically (4) - Answer: positive murphy sign increased color doppler flow pericholecystic fluid
thick wall Chronic cholecystitis sonographically (4) - Answer: small, contracted gallbladder thick wall usually stones layering sludge levels Emphysematous cholecystitis sonographically (4) - Answer: thickened wall enlarged gallbladder bright echo with ring down artifact dirty shadowing (packed bag or WES sign) Gangrenous cholecystitis sonographically (4) - Answer: echogenic debris non shadowing not gravity dependent no layering effect What is porcelain gallbladder What is it associated with - Answer: calcification of part of all of gallbladder wall increased risk of gallbladder carcinoma Porcelain gallbladder sonographically (3) - Answer: echogenic wall posterior shadowing (no WES sign) possible stones Symptoms of cholangitis (3) - Answer: fever RUQ pain jaundice
Cholangitis sonographically (2) - Answer: dilated bile ducts thick walls (> 2 mm) Most common cause of biliary obstruction Most common disease of the gallbladder - Answer: gallstones gallstones Risk factors of cholelithiasis (5) - Answer: fat female fertile forty fair skinned Cholelithiasis symptoms (3) - Answer: radiating RUQ pain (to shoulder) nausea vomiting Cholelithiasis sonographically (4) - Answer: one or more echogenic foci posterior acoustic shadow mobile WES sign What is Mirizzi syndrome - Answer: stone in cystic duct causes compression on common hepatic duct Mirizzi syndrome sonographically (2) - Answer: normal CBD gb, common hepatic, and intrahepatic ducts dilated Normal gallbladder length and transverse diameter - Answer: 8-12cm long <5cm transverse diameter
Polyp measuring _____ indicates strong suspicion for malignant mass formation - Answer: > 10mm What is cholesterolosis What is it also called What gender is it more common in - Answer: type of hyperplastic cholecystitis strawberry gallbladder women Cholesterolosis sonographically (3) - Answer: normal wall thickness multiple non shadowing masses attached to gallbladder wall What is adenomyomatosis Most common symptom - Answer: type of hyper plastic cholecystitis asymptomatic Adenomyomatosis sonographically (2) - Answer: wall thickening comet tail artifact What is pneumobilia What is it a complication of - Answer: air in biliary tree recent biliary intervention Pneumobilia sonographically (2) - Answer: echogenic foci in bile ducts dirty shadowing and ring down artifact Another name for gallbladder carcinoma What age group and gender is it more common in - Answer: adenocarcinoma
women over 60 Gallbladder carcinoma (adenocarcinoma) sonographically (3) - Answer: variable focal or diffuse wall thickening solid mass replacing gallbladder Cholangiocarcinoma sonographically (3) - Answer: dilated intrahepatic and extra hepatic ducts adjacent to or within ducts irregular isoechoic mass What is the most common type of cholangiocarcinoma What is another name for it Where is it found - Answer: klatskin tumor hilar cholangiocarcinoma liver hilum Klatskin tumor sonographically (2) - Answer: dilated intrahepatic ducts non union of right and left ducts Primary sites of metastases to gallbladder (4) - Answer: melanoma (1) pancreas ducts liver Gallbladder metastasis sonographically (3) - Answer: solid mass without shadowing focal gallbladder wall thickening vascular flow in mass Is the pancreas an encapsulated organ
Is it a retroperitoneal organ Average length, width, AP measurements List the five parts Is the pancreas an exocrine or endocrine gland - Answer: no yes, except small portion of head 12-18cm length 1-1.5 cm width 2.5 cm AP head neck body tail uncinate process exocrine and endocrine gland What is the name of the main pancreatic duct What other duct does it join What structure does this joining form Normal diameter - Answer: Duct of Wirsung common bile duct ampulla of vater (at 2nd portion of duodenum) <2mm What is the name of the secondary pancreatic duct What portion of the pancreas does it drain - Answer: duct of santorini the head What artery feeds the head of the pancreas What arteries feed the body and tail of the pancreas