ARDMS Abdomen Ultrasound Registry Review Questions and Answers 100% Correct, Exams of Nursing

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ARDMS Abdomen Ultrasound Registry

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How many segments does the Couinaud system divide the liver into? -ANSWER Eight surgical segments What divides the right lobe of the liver into an anterior and posterior segment? - ANSWER Right hepatic vein What vessel separates the right and left lobe? Where does it lie (fissure)? -ANSWER Middle hepatic vein, which lies in the main lobar fissure LLL is divided into medial and lateral segments by: -ANSWER Left hepatic vein The caudate lobe is separated from the LLL by which ligament? -ANSWER ligamentum venosum Main portal vein is created by the merging of which two vessels? What is this area referred to as? -ANSWER Superior mesenteric vein and splenic vein. Known as the splenic portal confluence What is the name of the capsule surrounding the liver? -ANSWER Glisson capsule Normal AP measurement of the MPV? -ANSWER 13mm or less What is an enlarged (>13mm) portal vein signify? -ANSWER Portal hypertension Normal MPV flow? -ANSWER Hepatopetal and monophasic w/ some respiratory variation Where do the hepatic veins drain? -ANSWER IVC These veins are considered both interlobar and intersegmental -ANSWER hepatic veins. They are located between the segments and the lobes normal hepatic vein flow -ANSWER -Hepatofugal - away from liver -pulsatile, triphasic due to right atrial pressure changes -respiratory variation Narrowing or occlusion of the hepatic veins is indicative of: -ANSWER Budd-Chiari syndrome

The liver hilum is also know as -ANSWER The porta hepatis flow pattern of the hepatic artery should be -ANSWER low resistance since it is feeding the liver After birth the umbilical vein becomes -ANSWER ligamentum teres aka round ligament -runs along with the falciform ligament -will usually be seen near left portal vein in left liver Where can the main lobar fissure be seen? -ANSWER -in sag plane -will appear to connect the neck of the GB with the RPV -also separates right and left hepatic veins hepatic steatosis -ANSWER fatty liver Causes of fatty liver disease -ANSWER Fatty deposits within the hepatocytes. Once it becomes cirrhosis, it is non-reversible.

1. Alcoholic fatty liver disease
2. Non-alcoholic fatty liver disease: -obesity -starvation -chemotherapy -diabetes mellitus -hyperlipidemia -pregnancy -von Gierke disease (glycogen storage dx) -total parental nutrition -cystic fibrosis steatohepatitis -ANSWER inflammation of the liver associated with fat precursor for chronic liver dx leading to fibrosis, cirrhosis, and HCC hepatomegaly size -ANSWER >15cm need to correlate with clinical hx don't confused Riedel's lobe as hepatomegaly Fatty liver symptoms and labs -ANSWER Symptoms: -usually asymptomatic

Labs: -Increased LFTs (especially AST and ALT) Sono appearance of fatty liver dx and focal fatty infiltration -ANSWER -Diffusely echogenic liver -Increased attenuation of sound beam -Walls of hepatic vasculature and diaphragm will not be easily imaged due to increased attenuation -Fatty changes will be diffuse or focal Focal fatty infiltration sono app: -hyperechoic area next to the GB, near the porta hep, or part of lobe may appear echogenic Focal fatty sparing sonographic appearance -ANSWER -entire liver is involved with diffuse fatty infiltration with certain areas spared -Area of sparing can look like a solid hypoechoic mass -Hypoechoic area will be near GB, porta hep, or entire lobe may be spared -Can appear to look like pericholecystic fluid Two most common types of hepatitis: -ANSWER A and B A: Fecal-oral route: contaminated water or food B: Contact with body fluids, mother-to-infant transmission, blood contact (IV drugs) Most common type of hepatitis in healthcare workers -ANSWER Hep C -Spread by blood and body fluid contact Which type of hepatitis is the leading indication for liver transplantation in US? - ANSWER Hepatitis C Wilson disease Hemochromatosis Autoimmune disorders Drugs All of the above can be causes for chronic ________ of the liver -ANSWER Hepatitis What is Wilson disease? -ANSWER -An inherited disorder that causes too much copper to accumulate in the liver, brain and other vital organs. -Also called hepatolenticular degeneration. -Causes fatty changes & fibrosis in the liver. Leads to chronic hepatitis

Trademark feature: Copper ring around iris What is hemochromatosis? -ANSWER Iron overload disease resulting in abnormal deposition of iron Can lead to fatty changes and chronic hepatitis Clinical signs and symptoms of hepatitis -ANSWER -Nonobstructive Jaundice (related to hep on a cellular level NOT biliary obstruction) -Hepatosplenomegaly -Dark urine -F/N/V -Elevated LFTs -Fatigue -Chills Hepatic encephalopathy -ANSWER -central nervous system dysfunction resulting from overexposure of brain to toxins -causes confusion and intermittent loss of consciousness What is refractory hypertension? -ANSWER Hypertension that is unresponsive to medication

• is related to renal artery stenosis Clinical signs and symptoms of renovascular hypertension and renal artery stenosis (RAS)? -ANSWER -Refractory HTN (doesn't respond to meds -Very high systemic blood pressure (malignant HTN) -Abd bruit -Elevated creatinine and cholesterol -Unexplained CHF or pulmonary edema Most common cause of RAS and location? -ANSWER Most common: Atherosclerosis -loc: Proximal segment 2nd most common: FMD -loc: distal 2/3 of artery What is the kidneys response when they receive less blood flow (due to RAS) - ANSWER -Perceive the body as having reduced systemic BP -will activate renin-angiotensin aldosterone system

  this will raise BP to try to increase flow to the kidneys, ultimately causing systemic HTN What can long standing RAS lead to? -ANSWER -Renal parenchymal damage -Renal failure

Most common indication for a renal transplant -ANSWER End stage renal disease caused by diabetes Allograft -ANSWER transplantation of healthy tissue from one person or cadaver to another person; also called homograft Where will a transplant kidney mostly be placed? -ANSWER In pelvis The donor renal artery is usually connected to the recipients: (which artery)? What about the renal vein? -ANSWER External iliac artery (EIA) and external iliac vein (EIV) Contraindications to renal transplant -ANSWER -preexisting infection -serious cardiac dx -peripheral artery dx -metastatic dx Normal pancreas anatomy -ANSWER -nonencapsulated -retroperitoneal structure between duodenal loop and splenic hilum Exocrine function of pancreas -ANSWER Secretes: -trypsin -lipase -amylase Through the ductal system Endocrine function of pancreas -ANSWER non-ductal Secretes: insulin via islets of Langerhans Normal AP measurement of pancreas -ANSWER ≤3mm What supplies blood to the pancreas? -ANSWER -Celiac axis -SMA -Splenic A Spatial relationship of pancreas -ANSWER -Anterior to IVC -Head is medial to duodenum -CBD is posterior/lateral to panc head -GDA is anterior/lateral to panc head -SMA and SMV are posterior to neck of panc -SMA and SMV are anterior to uncinate process

-Tail is anterior/medial to splenic hilum Spatial relationship of panc and its vessels -ANSWER -Ao is posterior to body -Celiac axis arises from ao @ superior border of panc -SMA arises from ao @ inferior border of panc Branches of the celiac axis -ANSWER Gives off left gastric artery and then divides into CHA and splenic artery splenic artery follows along superior border of body/tail of panc What does the common hepatic artery divide into? -ANSWER Divides into proper hepatic A (PHA) and gastroduodenal arteries Where does PHA course? -ANSWER superiorly from CHA toward the liver (anterior to portal vein) and left of the bile duct Two ducts of the pancreas -ANSWER main duct: duct of Wirsung accessory: duct of santorini

50% of the population has complete regression of this duct What two ducts join to form the ampulla of vater, which empties into duodenum (at the major papilla)? -ANSWER CBD and duct of wirsung Which is NOT a branch of the celiac axis? a. common hepatic artery b. right gastric artery c. splenic artery d. left gastric artery -ANSWER b. right gastric artery in most people, the right gastric artery arises from the proper hepatic artery Superior mesenteric VEIN origin and termination -ANSWER Origin: Ascends from small bowel Courses superior and then anterior to uncinate process Termination: splenic portal confluence -joins the splenic vein to form portal vein Inferior mesenteric VEIN origin and termination -ANSWER origin: large bowel termination: ascends and terminates into splenic vein (which will eventually join SMV and become portal vein)

The portal vein divides into the _________ and __________ branch inside the liver - ANSWER left and right What is ALT and where is it found? -ANSWER Alanine aminotransferase. Concentrated in the liver High levels of ALT indicate -ANSWER Liver damage or disease Cholecystokinin (CCK) is produced by the __________ and released in response to __________ in the stomach -ANSWER duodenum; food (especially fatty) Flow of bile - the pathway -ANSWER liver → biliary radicles → right or left hepatic duct → common hepatic duct → cystic duct → GB → common bile duct (CBD) → ampulla of Vater (mixes w/ panc juice) → sphincter of Oddi → duodenum (mixes w/ chyme) Most stones in the CBD are located near the _______ ___ _____ -ANSWER Ampulla of Vater Four main labs that are elevate with choledocholithiasis -ANSWER 1. ALP

2. ALT
3. GGT
4. Bilirubin A patient with jaundice, pain, and fever secondary to stone lodge in cystic duct whhich compresses the common duct -ANSWER Mirizzi syndrome biliary duct walls (not gb) should measure _____ or less -ANSWER 4mm Most common cause of cholangitis -ANSWER Bile duct obstruction resulting from choledocholithiasis Most common types of cholangitis -ANSWER -acute bacterial -AIDS -oriental (recurring bacterial) -sclerosing Charcot triad -ANSWER refers to biliary obstruction symptoms
5. Fever
6. Jaundice
7. RUQ pain Sono findings of cholangitis -ANSWER 1. Biliary dilatation
8. Biliary sludge or pus
9. Choledocholithiasis

4. Bile duct wall thickening recent biliary or gastric surgery, emphysematous or prolonged acute cholecystitis, and fistula formation are associated with: -ANSWER Pneumobilia (air in biliary tree) Sonographic appearance of pneumobilia -ANSWER Echogenic linear structures within the ducts (both intra and extrahepatic) that produce ring-down artifacts and dirty shadowing Parasitic roundworm that is transmitted through fecal-oral route and makes its way from the small intestine to the biliary system -ANSWER Ascariasis Sono findings of ascariasis -ANSWER -worm noted in biliary duct as linear structure in sagittal plane -movement confirms diagnosis Cholangiocarcinoma what is it, prognosis, and what are its RFs. Most common manifestation (Type) -ANSWER primary bile duct cancer prognosis: POOR RF:
5. primary sclerosing cholangitis
6. recurrent biliary infections
7. stone disease most common manifestation: Klatskin tumors what is a Klatskin tumor and where is it located -ANSWER -the most common manifestation of cholangiocarcinoma at the junction of the left and right hepatic ducts causing dilation of intrahepatic ducts Jaundice, pruritis, unexplained weight loss, abd pain. Elevated bili and ALP. What malignancy is most likely? -ANSWER Cholangiocarcinoma -- most commonly Klatskin tumor type sono findings cholangiocarcinoma -ANSWER -dilated intrahepatic ducts that abruptly terminate -sometimes: solid mass noted within liver or ducts normal measurement of intrahepatic duct is less than: -ANSWER 2mm Which anatomical landmark can help locate a gallbladder that is difficult to visualize? - ANSWER Main lobar fissure

A pancreatic mass causing hydrops of the GB without stones or pain is termed - ANSWER Courvoisier's gallbladder exocrine function of pancreas -ANSWER release digestive enzymes through duct of wirsung (main panc duct) into the small intestines duct of wirsung → ampulla of vater → sphincter of oddi → duodenum -amylase -lipase sodium bicarbonate -trypsin endocrine function of pancreas -ANSWER islets of langerhans secrete insulin and glucagon into blood stream What triggers the sphincter of oddi to open? -ANSWER CCK produced by the duodenum in response to the presence of chyme What does glucagon do? What does insulin do? -ANSWER promotes the release of glucose by the liver to increase blood sugar levels insulin: stimulates body to use up glucagon to produce energy Which artery supplies blood to the head of the pancreas? how about the body and the tail? -ANSWER Head: Gastroduodenal artery GDA body and tail: Splenic and SMA Which veins drain the pancreas? -ANSWER splenic v, SMV, IMV, and portal Is the pancreas hyper, iso, or hypoechoic to the liver? -ANSWER The pancreas is hyperechoic to the liver The main panc duct (duct of Wirsung) should not exceed ____ mm -ANSWER 2mm What is another term for a peripancreatic fluid collection? -ANSWER phlegmon With moderate and severe pancreatitis, the body will attempt to encapsulate the damaging digestive enzymes that leak from the pancreas, forming a _______ - ANSWER pseudocyst Between which two organs is the lesser sac located? -ANSWER pancreas and stomach

9 regions of the abdomen -ANSWER right hypochondriac, epigastric, left hypochondriac, right lumbar, umbilical, left lumbar, right iliac, hypogastric, left iliac Plegmon -ANSWER peripancreatic fluid resulting from inflammation of the pancreas -can occur with both acute and chronic pancreatitis pancreatic pseudocyst -ANSWER collection of debris, fluid, pancreatic enzymes, and blood as a complication of acute pancreatitis. Body attempts to wall it off. Pseudocysts will occur in the lesser sac, which is the area between the pancreas and the _______ -ANSWER stomach Medial to right lobe of liver, posterior to IVC, superomedial to the kidney, and lateral to the right crura. Which organ does this describe and on which side is it? -ANSWER Right adrenal gland Where in the kidney are the loops of henle located? -ANSWER In the medulla. Also called nephron loop. Nephrons are in the parenchyma and loops of henle dive into the medulla Two large antegrade diastolic and systolic waves followed by a small retrograde component that corresponds with the atrial contraction. This describes which liver vessels? -ANSWER Hepatic veins What are the hepatic veins triphasic? -ANSWER Due to the proximity to the heart Most common dysgenesis of the kidneys -ANSWER Duplication: complete or incomplete What is the name for the CBD when it is in the liver? -ANSWER Common hepatic duct Longus colli muscle is _______ to the thyroid. -ANSWER posterior Which is more posterior in the body: aorta or IVC? -ANSWER Aorta First branch off of the common hepatic artery? A. Cystic artery B. Pancreatic artery C. Duodenal artery D. Gastroduodenal artery -ANSWER D. Gastroduodenal artery -Supplies the pancreas and duodenum with blood

Pancreatic transplants usually require arterial resection using a Y-graft w/ two arms that are connected to: A. Common hepatic artery and splenic vein B. Common hepatic artery and splenic vein C. SMV and portal vein D. SMA and splenic artery -ANSWER D. Superior mesenteric artery and splenic artery Why? Because branches of these arteries usually supply the native pancreas A single large bump bulging off of the lateral kidney. What is this normal variant? - ANSWER Dromedary hump. Normal "bump" of normal renal parenchyma More commonly seen on the lateral left kidney. The _________ gland is anterior to the ear and is drained by the _______ A. parotid, Stensen duct B. submandibular, Stensen duct C. submandibular, Wharton duct D. sublingual, Wharton duct -ANSWER A. parotid, Stensen duct Which of the following is a part of the renal parenchyma? A. Major calyces B. Pyramids C. Minor calyces D. Segmental arteries -ANSWER B. Pyramids -they are in the medulla portion of the parenchyma all other choices are a part of the sinus *remember that the parenchyma includes the cortex AND medulla The pancreas is found in which retroperitoneal space? A. Posterior pararenal B. Retrofascial C. Anterior pararenal D. Perirenal -ANSWER C. Anterior pararenal Which renal arterial branches are used to assess parenchymal resistance? A. interlobular or segmental

B. Segmental or arcuate C. Segmental or interlobar D. Interlobar or arcuate -ANSWER D. Interlobar or arcuate arteries -arcuates preferred but run parallel to capsule so interlobar are easier The normal gallbladder is usually less than _____ in transverse diameter A. 3mm B. 5cm C. 3cm D. 8cm -ANSWER B. 5cm The renal pyramids are located in the: A. Medulla B. Cortex C. Sinus D. Calyces -ANSWER A. Medulla Diffuse acute pancreatitis will typically result in A. A diffusely shrunken, hyperechoic gland B. A diffusely enlarged, hypoechoic gland C. A diffusely enlarged, hyperechoic gland D. A shrunken gland with diffuse areas of calcifications -ANSWER B. A diffusely enlarged, hypoechoic gland Which has the potential for malignancy: serous (microcystic) or mucinous (macrocystic) cystadenoma? Where is it located in the pancreas? -ANSWER Macrocystic, or mucinous cystadenoma has a malignant potential. Both cystadenomas usually arise from the body and tail of the panc Sono appearance of serous (microcystic) cystadenomas? -ANSWER Mass that may appear solid and echogenic due to the small size of the cysts Sono appearance mucinous (macrocystic) cystadenomas? -ANSWER -Multilocular cystic masses -may contain mural nodules and calcification -pancreatic duct may be dilated Insulinoma. Sono app? -ANSWER a benign tumor of the pancreas from islet cells that causes hypoglycemia by secreting additional insulin Islet cells are the pancreatic cells that secrete insulin

Sono: Usually solitary mass within panc Gastrinoma. What syndrome is it associated with? Sono app? -ANSWER an islet cell tumor found within the pancreas -associated with zollinger-ellison syndrome -multiple masses within panc. Can be difficult to image Zollinger-Ellison syndrome -ANSWER excessive secretion of acid by the stomach that leads to peptic ulcers In 80% of pancreatic transplants, a ______ transplant will also be performed at the same time -ANSWER renal When the pancreas is transplanted at the same time as the kidney, the pancreas will be placed within the ______ side of the abdomen while the kidney is placed on the ______ side -ANSWER panc: right kidney: left exocrine bladder drainage pancreatic transplant -ANSWER -vasculature of donor pancreas is anastomosed to the recipient's common iliacs vessels -donor duodenum is anastomosed to the bladder and the recipient bladder is used to expel duodenum pancreatic juices Exocrine enteric drainage pancreas transplant -ANSWER -Donor's duodenum is anastomosed to a loop of jejunum -Splenic artery and SMA are connected w/ donor iliac arteries. This forms a "Y" graft -Donor common iliac portion is anastomosed to the recipients CIA and EIA -transplants are usually located in RUQ and have vertical orientation **more common Which is the more common method for pancreatic transplants? Exocrine bladder drainage or exocrine enteric drainage? -ANSWER Exocrine enteric drainage tx A transplant pancreas should be __________ and _________ just after transplant A. Enlarged and heterogeneous B. Homogeneous and hypoechoic C. Heterogeneous and hyperechoic D. Small and homogeneous -ANSWER B. Homogeneous and hypoechoic

A hypoechoic and heterogeneous pancreas post-transplant may be a sign of: - ANSWER transplant rejection or pancreatitis a hypoechoic or heterogeneous gland with elevated resistive indices in a transplant pancreas may be due to: -ANSWER Acute pancreatic transplant rejection A hyperechoic echotexture, atrophy, and calcifications of a transplant pancreas may indicate: -ANSWER Chronic pancreatic transplant rejection The most common location of focal pancreatitis is within the: A. Head of panc B. Neck of panc C. Body of panc D. Tail of panc -ANSWER A. Head of panc What is the most common islet cell tumor? A. Granuloma B. Gastrinoma C. Insulinoma D. Cystadenoma -ANSWER C. Insulinoma Which cells perform the exocrine function of the pancreas? A. Whipple cells B. Islets of Langerhans C. Delta cells D. Acinar cells -ANSWER D. Acinar cells von Hippel-Lindau disease -ANSWER a hereditary disease that includes the development of cysts within the pancreas, kidneys, reproductive tract, brain, etc Gas or air produces a: A. clean shadow B. dirty shadow -ANSWER B. dirty shadow. A clean shadow comes from sound absorbing materials such as stones Both acute and chronic splenic infarcts appears as wedge shaped mass in the spleen. An acute infarct will appear more _______ (hypoechoic/hyperechoic), while a chronic infarct will appear more _________ (hypoechoic/hyperechoic) -ANSWER Acute: Hypoechoic

Chronic: Hyperechoic Splenosis -ANSWER the implantation of ectopic splenic tissue secondary to splenic rupture Most common benign tumor of the spleen? -ANSWER Hemangioma Patients with a history of tuberculosis, histoplasmosis, or sarcoidosis have an increased risk of splenic ___________ -ANSWER granulomas A disease that results from the inhalation of an airborne fungus. Can affect the lungs and then spread to other organs -ANSWER Histoplasmosis A systemic disease that results in the formation of granulomas throughout the body - ANSWER sarcoidosis A benign tumor-like malformation that consists of disorganized cells. Can be found in liver, spleen, breast, GI, etc -ANSWER Hamartoma These benign tumors are associated with beckwith-wiedemann syndrome and tuberous sclerosis. Splenic ___________ -ANSWER hamartoma Presence of Reed-Sternberg cells indicates which: Hodgkin's or non-Hodgkin's lymphoma? -ANSWER Hodgkin's lymphoma Which has a poorer prognosis: Hodgkin's lymphoma or non-Hodgkin's? -ANSWER Non- Hodgkin's has a poorer progonosis. -Hodgkin's is highly treatable -Non-Hodgkin's is not as treatable but is more common What is the exceeding rare PRIMARY malignant tumor of the spleen? -ANSWER Angiosarcoma -lymphoma or leukemia is the most common tumor of the spleen but they are secondary spread Lymphangiomas are most commonly seen in what kind of patient? A. Women B. Men C. Children D. Pregnant women -ANSWER C. Children

What is a splenic lymphangioma? -ANSWER A benign lesion from a congenital malformation of the lymphatic system -multicystic -can have hypo or anechoic locules and hyperechoic septations Blood disorder found more commonly in middle east, Mediterranean, and Caribbean Hispanic child in US -ANSWER Sickle cell anemia -also very common in african americans Acute vs recurrent sickle cell crises affect on the spleen -ANSWER acute: splenomegaly recurrent: spleen becomes fibrotic and atrophic Autosplenectomy (fibrosis and shrinkage). Association? -ANSWER sickle cell anemia with multiple infarctions Patients undergoing a sickle cell crisis may have a decreased ___________ (labs) - ANSWER hematocrit retroperitoneal organs -ANSWER -Suprarenal (adrenal) glands -Aorta and IVC -Duodenum -Pancreas (except tail) -Ureters and Urinary bladder -Colon -Kidneys -Esophagus -Rectum "SAD PUCKER" Reticuloendothelial System (RES) -ANSWER System of phagocytic cells including monocytes and macrophages spleen, liver, lungs are highly involved Tissue within the spleen responsible for its phagocytic function? A. Red pulp B. White pulp C. Culling pulp D. Pitting pulp -ANSWER A. Red pulp

Nephron begins to function by _____ weeks gestation -ANSWER nine Maintain homeostasis by: -detoxify and filter blood -excrete metabolic waste -reabsorb amino acids, ions, glucose, and water -maintain normal pH, iron, and salt levels in blood -regulate blood pressure -ANSWER Kidneys renunculi -ANSWER -the two embryonic parenchymal tissue masses that combine to create the kidney -descend into fetal abdomen by 12 weeks -this is one of the reasons ectopic kidney locations are common Most common place for ectopic kidney to be located -ANSWER pelvis (pelvic kidney) The _________ kidney is higher than the other side (right/left) -ANSWER left -b/c liver is on right side making rk lower The renal pyramids are located in the -ANSWER renal medulla The part of the kidney responsible for filtering and excretion -ANSWER cortex The part of the kidney responsible for absorption -ANSWER medulla minor calices, major calices, renal pelvis, and infundibula make up the: -where is this located? -ANSWER renal collecting system -located in renal sinus Structure that collects urine before it empties into ureter -ANSWER renal pelvis put the renal arteries in order from the abdominal aorta to the glomerulus -interlobular -arcuate -main renal artery -interlobar -afferent arterioles -segmentals -glomulerus -aorta -ANSWER aorta→main renal artery→segmental→interlobar→arcuate→interlobular→afferent arterioles→glomulerus

elevated bun and creatinine may indicate what? -ANSWER renal disease most common congenital anomaly of urinary tract? -ANSWER duplex or duplicated collecting system average range for kidney length in adults -ANSWER 8-13 cm in length normal kidney cortex should be isoechoic or _____echoic to the liver or spleen - ANSWER hypoechoic cortical thinning of the kidney is _______cm or less -ANSWER 1cm or less most common cause of acute renal failure -ANSWER Acute tubular necrosis (ATN) other causes: -RAS -infection -urinary tract obstruction -amyloidosis (amyloid build up) -henoch-schonlein purpura What is acute tubular necrosis (ATN)? -ANSWER ischemic damage to the tubules, resulting in cell death and necrosis, ultimately resulting in renal failure causes: poison (antifreeze or others), drugs, and other harmful substances reversible sono: -enlarged -increased RI in parenchymal vessels -prominent pyramids The following are clinical signs of what? -elevated BUN and creatinine -oliguria -hypertension -leukocytosis -hematuria -edema -hypovolemia -ANSWER acute renal failure The most common cause of chronic renal failure? -ANSWER diabetes mellitus

others: glomerulonephritis, chronic pyelonephritis, infection, UT obstruction In order to treat chronic renal failure, patients may be placed on dialysis or need a donor kidney. T/F -ANSWER True The following are clinical signs of what? -malaise -elevated BUN and creatinine -fatigue -HTN -hyperkalemia (high potassium) -ANSWER Chronic renal failure -small, echogenic kidneys -cortical thinning -loss of corticomedullary differentiation -possible renals cysts These are sono findings of: acute or chronic renal failure? -ANSWER Chronic Which type of dialysis may cause some ascites in the body? A. hemodialysis B. hemofiltration C. Peritoneal dialysis -ANSWER C. Peritoneal dialysis This is because it uses a solution that is instilled into abdomen through a catheter Exophytic -ANSWER Grows outward from tissue This renal dx has a strong association with polycystic liver dx -ANSWER autosomal dominant polycystic kidney disease (ADPKD) -with ADPKD, the cysts can be found in other organs as well, such as the liver, panc, and spleen A staghorn calculus, hydronephrosis, and a perinephric fluid collection are often seen with: -ANSWER xanthogranulomatous pyelonephritis

1. This liver lobe is divided into 2 posterior and 2 anterior lobes (left/right)
2. This liver lobe is divided into 2 medial and 2 lateral segments (left/right) both are divided by portal branches -ANSWER 1. right

2. left The pancreas _________ in echogenicity with age -ANSWER increases -as a child it is hypo or isoechoic to the liver and increases w/ age -cystic fibrosis causes an increase in echogenicity In most people, the proper hepatic A bifurcates into left and right hepatic arteries. In 10% of people, the right hepatic A originates from the ______ and the LHA originates from the _____ -ANSWER SMA ; left gastric artery Normal wall thickness of the bowel is: A. <3mm B. <3m C. <5cm D. <5mm -ANSWER D. <5mm Distended bowel normal wall: 3mm Non-distended: 5mm Arteries that are dopplered within the testicular parenchyma? A. Deferential B. Gonadal C. Centripetal D. Cremasteric -ANSWER C. Centripetal If there is vascular resistance, such as a vessel narrowing, the RI will: (increase/decrease) -ANSWER Increase. RI is proportional to vascular resistance and compliance normal retroperitoneal lymph nodes usually measure less than _____ in length A. 0.5cm B. 1cm C. 1.5cm D. 2cm -ANSWER B. 1cm Which are intERsegmental? portals or hepatic veins? -ANSWER hepatic veins. They course between liver segments

A renal hamartoma can also be called a -ANSWER angiomyolipoma central stellate scar within a renal tumor is indicative of: -ANSWER oncocytoma -2nd most common renal mass -male, 60s -asymp Vascular, hyperechoic benign mass in kidney with areas of calcifications. Appearance is similar to RCC -ANSWER renal adenoma What vascular abnormality causes the following: -Hematuria -Proteinura -Possible L abd or flank pain -Pelvic pain -Left-sided testicular pain -ANSWER Nutcracker syndrome. left renal vein compressed by SMA and Ao A renal artery ratio (RAR) greater than 3.5 and downstream tardus-parvus is indicative of: -ANSWER Renal artery stenosis A waveform with a prolonged upstroke (systolic acceleration), and rounded peak is called? _______ _______. -ANSWER Tardus parvus Allograft (homograft) A. Tissue from the patient taken from another area of the body B. Tissue from the same species but not genetically identical C. Tissue from a different species with similar genetic qualities D. Tissue from an identical twin of patient -ANSWER B. Tissue from the same species but not genetically identical Term is commonly used in transplants, especially renal While vessels are the transplant renal vessels most commonly attached to? -ANSWER Donor artery and vein usually connected to EIA and EIV Sonographically, the transplanted kidney should appear _______ to a normal kidney - ANSWER similar Mild pelviectasis is considered ______ in the transplanted kidney -ANSWER normal Waveform of the renal artery after transplant should yield ______ (low/high) resistance flow with ____________ (delayed/continuous) diastolic flow, while the renal vein should

demonstrate ______ (continuous/pulsatile) flow away from the kidney -ANSWER low, continuous, continuous lymphocele, urinoma, hematoma, abscess are associated with -ANSWER post kidney transplant complications Most common vascular complication following renal artery transplant? -ANSWER Renal artery stenosis anuria, oliguria, elevated creatinine and BUN, proteinuria, HPTN, and enlargement are associated with -ANSWER kidney transplant rejection color aliasing and turbulent flow at level of anastomosis site may indicate: A. Normal post-transplant flow B. Renal artery stenosis C. Renal vein thrombosis D. AV fistula -ANSWER B. Renal artery stenosis will also have elevated peak systole and a velocity greater than 200-250cm/s Most common cause of congenital hydronephrosis in infants/children: -ANSWER UPJ obstruction -- ureteropelvic junction obstruction; also know as PUJ (pelvicureteric junction obstruction) Abnormal retrograde flow of bladder urine into the ureters and possibly to the kidneys; what is it caused by? -ANSWER vesicoureteral reflux (VUR) -often caused by an abnormal angle of insertion of the distal ureter into bladder -can cause infection, scarring, and permanent damage Megacystitis is associated with which syndrome? -ANSWER Prune belly syndrome (eagle barrett) absent abdominal muscles, undescended testis, urinary tract abnormalities: -ANSWER Triad for prune belly syndrome Weigert-Meyer rule (in association with duplicated pelvicalyceal systems) -ANSWER Upper pole moiety in duplex kidney is prone to obstruction b/c abnormal insertion into bladder. Lower pole moiety is prone to reflux. Nephroblastoma is also known as: -ANSWER Wilms tumor Most common pediatric malignant abdominal mass that tends to mets to the liver and lungs. Also tends to invade the renal vein and IVC: -ANSWER Nephroblastoma/Wilms tumor

Remnant of embryonic development that extends from umbilicus to the apex of the bladder. Failure to close can result in UTI and palp abd mass between umbilicus and bladder. Seen in peds -ANSWER Urachus Portion of ureter that connects to the renal pelvis is called the __________ _________. Portion of ureter that connects to the bladder is called the _________ __________ - ANSWER ureteropelvic junction; ureterovesicular junction Most common area for urinary stone to become lodged: ___________ ________ - ANSWER ureterovesicular junction Muscle that controls emptying of the urinary bladder -ANSWER detrusor muscle trigone of the bladder is (superior/inferior)? -ANSWER inferior urethra and ureters open here When distended, an abnormally thickened bladder wall will measure A. Over 4cm B. Over 4mm C. Less than 4mm D. 5-10cm -ANSWER b. Over 4mm L x W x H x 0.56 is how you calculate ________ of the _________ -ANSWER volume of the bladder Bladder that functions poorly due to neurologic disorder. pts may not feel the need to urinate (extremely distended bladder) or an unnecessary need to void -ANSWER Neurogenic bladder With a neurogenic bladder, these structures may be seen on the wall -ANSWER trabeculae ; these can also result from chronic bladder infection How can bladder diverticulum (OUTpouching) cause a UTI? -ANSWER Urinary stasis within the diverticulum Nocturia and a wall thickness over 4mm are associated w/ -ANSWER Cystitis Malignancy associated with gross hematuria and passing blood clots -ANSWER Transitional Cell Carcinoma (TCC) of the bladder`

Smooth/papillary mass projecting into bladder lumen. Non-mobile and will show vascularity. Malignant. What is this? -ANSWER Transitional cell carcinoma How to differentiate TCC from a blood clot -ANSWER Use color doppler and decub the patient Blood clots will not show vascularity and often they are mobile. TCC will have vascularity and is non-mobile TCC of the kidney is usually found in the: A. Cortex B. Medulla C. Minor calyx D. Renal pelvis -ANSWER D. Renal pelvis -hypoechoic or isoechoic mass within the renal sinus -varying degrees of hydro -pt smoking history -gross hematuria -Mostly in renal pelvis Which malignancy is this associated with? -ANSWER transitional cell carcinoma (TCC) of the kidney _______temia: elevation of blood urea nitrogen (BUN) and serum creatinine levels. - ANSWER azotemia Which of the following renal conditions is associated with the development of cysts within the pancreas and liver? A. ARPKD B. ADPKD C. MCDK D. Acquired renal cystic disease -ANSWER B. ADPKD Which of the following is not considered an intrinsic cause of hydronephrosis? A, Ureterocele B. Urethritis C. Urolithiasis D. Ureteropelvic junction obstruction -ANSWER B. Urethritis Which of the following is not considered an extrinsic cause of hydronephrosis?

A. Ureteral stricture B. Pregnancy C. Neurogenic bladder D. Uterine leiomyoma -ANSWER A. Ureteral stricture Endocrine disorder that results from hypofunction of the adrenal cortex -ANSWER Addison disease Controlled by hormones produced by hypothalamus, which are then released by the anterior pituitary gland: -ANSWER Adrenal glands aka suprarenal glands A hormone secreted by the anterior pituitary gland, which controls the release of hormones by the adrenal glands A. Gonadotropin releasing hormone (GH) B. Vasopressin C. adrenocorticotropic hormone (ACTH) D. Somatostatin -ANSWER C. Adrenocorticotropic hormone (ACTH) Zones of Adrenal Cortex (superficial to deep) -ANSWER -Zona glomerulosa -Zona Fasciculata -Zona Reticularis (GFR) Aldosterone, androgens, and cortisol are produced by the adrenal: (cortex/medulla) - ANSWER Cortex The adrenal medulla produces: -ANSWER Catecholamines - epinephrine (adrenaline) and norepinephrine Aldosterone function -ANSWER Regulate blood pressure by controlling sodium and water in body made by adrenal cortex Androgen function -ANSWER Development of male characteristics made by adrenal cortex Cortisol function -ANSWER -glucose metabolism -blood pressure regulation -immune function -inflammatory response