Abdomen Quiz 1 (Course Notes)

___________ carry blood from the heart to the tissues. __________ bring blood from tissues back to the heart.

*1. ARTERIES 2. VEINS*

The *GUT* (bowel and stomach) has three principal sonographic manifestations: 1. _______: An echogenic center is surrounded by a thin sonolucent ring. The antrum of the stomach often has this appearance. 2. _________: Acoustic shadowing is present. The shadow has an irregular border, a poorly defined source, and some internal echoes, or alternatively, it forms a banding pattern. 3. __________: Sausage shaped, fluid-filled structures are seen.

*1. EMPTY 2. GAS-FILLED 3. FLUID-FILLED*

When scanning the anterior abdominal wall, the *skin-transducer interface* produces the initial reflection, which is an _______ ________ ______. Deep to this is the relatively __________ _________ ______, a fat and fibrous tissue zone, which produces variable amounts of ___________ echoes.

*1. echogenic linear echo 2. hypoechoic subcutaneous plane* 3. low-level

If the bowel is ____________, it will have a central sonolucency, surrounded by the high-level mucosal echoes. If not, the bowel wall will present as a peripheral _________ region of varying thickness which surrounds the collapsed lumen. This produces the normal "______" configuration.

*1. fluid-filled 2. hypoechoic 3. target*

1. The *fascia surrounding the musculature* of the abdominal wall produces: 2. This means that the *musculofascial plane* consists of a: 3. This is bracketed by:

*1. strongly reflective surfaces 2. relatively thick hypoechoic muscular zone 3. two thin, very echogenic fascial interfaces*

Which is the thickest layer in veins?

*TUNICA ADVENTITIA (tunica externa)*

_________ _________: Outer layer. Thin fibrous layer *(thicker in veins than in arteries)* surrounding elastic tissue.

*TUNICA ADVENTITIA (tunica externa)*

________ _________: (inner layer) composed of a lining of endothelial cells with longitudinal organization that is in contact with the blood. Also has layer of areolar connective tissue and an outer layer of elastic tissue. (areolar = containing minute spaces)

*TUNICA INTIMA (tunica interna)*

Which is the thickest layer in arteries?

*TUNICA MEDIA*

_______ __________: Middle layer. *Thickest layer in arteries.* Not thick in veins. Consists of elastic fibers and smooth muscle.

*TUNICA MEDIA*

Diagnostic sonography examination is *most useful* when it is performed for the purpose of:

*answering a specific, well-formulated question*

The accumulation of *serous fluid* in the peritoneal cavity is known as _________.

*ascites*

The hypoechoic _______ _______ is normally no more than 5 mm thick when not distended, and no more than 3 mm thick when distended.

*bowel wall*

The pattern typical of _________ portions of the GI tract consists of a central, highly reflective, usually linear echo, which represents mucosa

*collapsed*

Arteries have two main properties:

*elasticity and contractility*

*The examiner should not hesitate to:*

*go beyond that which is requested in order to answer the patient's diagnostic question*

*Air creates highly reflective air-soft tissue interfaces which are responsible for:*

*most of the artifacts encountered in abdominal scanning*

*Infection* within the peritoneum is called:

*peritonitis*

*Normal peritoneum is not always: *

*seen as a distinct structure*

The hypoechoic bowel wall is surrounded by a highly reflective interface, representing the__________ ________ of the bowel with its closely related mesenteric attachments

*serosal surface*

When it is an abdomen exam requested, generally (and ideally) the request will be for a __________ organ.

*specific*

*Arteries and veins have similar construction. Both have:*

*three layers as seen in cross-section*

The important working principle is that the *appearance of bowel ________* with bowel contents and degree of distention.

*varies*

The subhepatic space is also called the ___________ recess. It is the most _________ portion of the peritoneal cavity when the patient is supine, therefore the space where a small amount of ______ _________ may be found before it appears in other locations.

1. HEPATORENAL 2. dependent 3. free fluid (ASCITES

The divisions of the SUPRA-MESOCOLIC SPACE are the ____ __________ _________, _____ ___________ __________ , ______ ______________ , ___________ _______ , AND _______ ___________.

1. LT. SUBPHRENIC SPACE (SS) 2. RT. SUBPHRENIC SPACE (SS) 3. PERI-SPLENIC SPACE (PS) 4. SUBHEPATIC SPACE (SH) 5. LESSER SAC(LS)

_________ _____: The stomach, lesser omentum and anterior leaf of the greater omentum form the anterior wall of the part of the peritoneal cavity known as this. It is a completely enclosed peritoneal recess that communicates with the rest of the peritoneal cavity behind the free edge of the lesser omentum at the upper border of the duodenum. The opening here is the foramen of Winslow or the epiploic foramen.

LESSER SAC

__________: Folds of peritoneum running from one organ to another or from one organ to the body wall. They have special names related to the structures they connect. e.g. hepatorenal ligament.

LIGAMENTS

_____________: One extension of the peritoneum. It is an outward fold of the serous coat of the small intestine. The tip of the fold is attached to the posterior abdominal wall. The mesentery binds the small intestine to the wall.

MESENTERY

___________: A fold of the peritoneum which binds the large intestine to the posterior wall. It- also carries blood vessels and lymphatics to the intestines.

MESOCOLON

Another term for hepatorenal fossa:

Morrison's Pouch or hepatorenal space

A patient must be ____ for a minimum of ___ hours before a pancreas ultrasound exam is performed.

NPO 8

__________: A double layer of peritoneum running to the stomach. 1. Lesser omentum - attaches to the lesser curvature 2. Greater omentum attaches to the greater curvature

OMENTUM

The ___________ _________ lines the walls of the abdominal cavity.

PARIETAL PERITONEUM

The space between the parietal and visceral portions of the peritoneum is called the ___________ ___________.

PERITONEAL CAVITY

The ___________ is the largest serous membrane of the body.

PERITONEUM

_____________: The serous membrane lining the walls of the abdominal and pelvic cavities (parietal peritoneum) and investing contained viscera (visceral peritoneum.), the two layers enclosing a potential space, the peritoneal cavity.

PERITONEUM

The __________ _________ (arrow) limits communication among the left subphrenic, the peri-hepatic, and the peri-splenic spaces and the left paracolic gutter.

PHRENOCOLIC LIGAMENT

_________ allows the sonographer to distinguish bowel from abnormal masses or fluid collections in the peritoneal cavity.

Peristalsis

____________: In certain locations in the peritoneal cavity, folds of peritoneum leave cul-de-sacs or pouches. These have clinical importance in that they are areas of fluid collection in certain pathological states.

RECESSES

_____________ organs remain behind the peritoneum and are merely covered in front with peritoneum

RETROPERITONEAL

*What are lymph nodes?*

Rounded or oval nodes that lie in the abdomen in various locations. When normal, they are generally not identified with ultrasound.

THE INFRA-mesocolic space is separated into right and left compartments by the root of the _________ ___________ __________.

SMALL BOWEL MESENTERY (sm)

Above the transverse mesocolon is the ___________ _________ __________. This is separated into further subdivisions.

SUPRA-MESOCOLIC SPACE

____________: That between the transversalis muscle and the peritoneum.

TRANSVERSE FASCIA

*What is included in the posterior pararenal space?*

contains lymph nodes and blood vessels embedded in fat

_____________ = pertaining to the omentum

epiploic

Anteriorly (and posteriorly), the parietal peritoneum is separated from the anterior abdominal wall by _______ and _______ ________. Posteriorly, it is separated from the retroperitoneum by the same.

fat and connective tissue

*What is the diaphrgam crura?*

fibromuscular bands that connect the spinal column and the diaphragm

If an upper GI or barium study of any kind is scheduled on the same day, the sonograms must be done _______.

first

The _______________ __________ lies just anterior to the aorta and is surrounded by the crus of the diaphragm. Sonographically, it usually produces a typical (although somewhat elongated) target (or bulls-eye) configuration.

gastroesophageal junction

Routinely, preparation for abdominal ultrasound include the patients being:

kept NPO overnight

Which organs remain retroperitoneal after embryological development?

kidneys, adrenal glands, and ureters

In ultrasound practice, the retroperitoneum survey is generally an exam that includes the:

kidneys, adrenal glands, psoas muscles, iliacus muscles, quadratus lumborum muscles, presacral area, and the prevertebral vessels.

Veins have considerably ______ elastic tissue and smooth muscle than arteries. This means veins are distensible enough to adapt to variations in the volume and pressure of blood passing through them and do not need walls as strong as arteries.

less

Anteriorly the lesser peritoneal sac is bounded by the:

lesser omentum

The ________ _________ _____ also communicates with the subhepatic spaces.

lesser peritoneal sac

The ________ ______ , a potential space, is bounded anteriorly by the stomach and its mesentery, inferiorly by the mesentery (arrow) of the transverse colon, and posteriorly by the retroperitoneal structures.

lesser sac

The small bowel and its mesenteric attachment (2 arrows) are inferior to the _________ _______.

lesser sac

The __________ _________ of the large bowel form the major boundaries of the peritoneal cavity.

mesenteric attachments (M)

Almost all of the _________ is within the retroperitoneum. *It is a retroperitoneal organ.*

pancreas

The duodenum, together with the gallbladder and proper vascular landmarks, forms a triad that helps to localize the __________ ________.

pancreatic head

The infracolic spaces are bounded externally by ________ _______ which may serve as communications between the pelvis and supramesocolic compartments.

paracolic gutters

Peritoneal folds cannot be seen as distinct structures with sonography, and the peritoneal cavity is not an empty cavity and therefore cannot be seen as such unless:

pathology of that time (ascites, etc.) is present

The __________ __________ attaches the colon to the left hemidiaphragm and forms an effective barrier between the relatively shallow left paracolic gutter and the perihepatic and perisplenic spaces

phrenicocolic ligament

Embryological development of all abdominal organs occurs ____________.

retroperitoneally

The pancreas and a portion of the third portion of the duodenum are situated in the __________ deep to the lesser sac.

retroperitoneum

The falciform ligament separates the:

right and left subphrenic spaces

9 Regions of the Abdomen:

right hypochondrium: below cartilage epigastric: above stomach left hypochondrium: below cartilage right lumbar umbilical left lumbar right iliac hypogastric (or pubic) below stomach left iliac

These basic subhepatic spaces communicate freely with the:

right subphrenic space

*What is the function of the vascular system?*

Blood vessels form a network of tubes that carry blood away from the heart, transport it to the tissues of the body, and then return it to the heart. Blood vessels are called: 1. arteries 2. arterioles 3. capillaries 4. venules 5. veins

________ ______ yields a high-amplitude echo with no through transmission.

Bowel gas

POTENTIAL SPACES WHERE FLUID CAN COLLECT: 1. _________ ___________: Between the diaphragm and the dome of the liver. 2. ______________: Between the inferior posterior aspect of the liver and the right kidney. 3. ______ ________: Between the spleen and the left hemi-diaphragm. 4. ________ ______: A large potential space mainly anterior to the pancreas and posterior to the stomach. 5. ___________ _____ ____ ____: Posterior to the uterus and anterior to the rectum. 6. ___________ ________: Along the flanks lateral to the colon. 7. ___________: Around the kidneys.

1. RIGHT SUBPHRENIC 2. SUBHEPATIC (Morrison's Pouch) 3. LEFT SUBPRRENIC 4. LESSER SAC 5. PELVIC CUL-DE-SAC 6. PARACOLIC GUTTERS 7. PERINEPHRIC

The ____ ___________ ________ is lateral to the ascending colon. The ___ _____________ ___________ is lateral to the descending colon.

1. RT. PARACOLIC GUTTER (PG) 2. LT. PARACOLIC GUTTER (PG)

The root of the small bowel mesentery runs obliquely from slightly to the left of midline at the ligament of _______ to the cecum, thereby separating the ___________ compartments into two _______ spaces.

1. Trietz 2. inframesocolic 3. infracolic

Borders of the Retroperitoneum: a) The _________ border is the posterior peritoneum b) The _______ border is the transversalis fascia c) The ________ borders include the quadratus lumborum and peritoneal leaves of the mesentery d) _________ it is bordered by the diaphragm and inferiorly by the pelvic floor

1. anterior 2. posterior 3. lateral 4. Superiorly

The __________ __________ _______ will often be seen, especially on longitudinal scans, inferior to the plane of the pancreas and stomach. The gas-containing hepatic flexure may produce artifacts simulating gallbladder disease, much like the artifacts produced by the __________.

1. collapsed transverse colon (large intestine) 2. duodenum

On the right, the paracolic gutter is _______ and leads superiorly to the subhepatic space and its' posterosuperior extension, the _________ ________ (Morrison's Pouch).

1. deeper 2. hepatorenal fossa

Superiorly, the abdominal cavity is bounded by the __________, where the parietal peritoneum is attached to the _________ _______.

1. diaphragm 2. diaphragmatic fascia

Vessels are part of the circulatory system along with the ______ and _________. Their function is to provide for the ______ of ______, _____ ______, and other ______ _______ *to* the tissues and the subsequent transport of ________ ________ *from* the cells to the appropriate sites for their excretion.

1. heart and lymphatics 2. transport of gases, nutrient materials, and other essential substances 3. waste products

The right free edge of the lesser omentum forms the ___________ ligament and the anterior wall of the epiploic foramen or (___________ of _________).

1. hepatoduodenal 2. foramen of Winslow

The remainder of the lesser omentum spreads to join with the _________ of the ________, contributing to several ligaments between the stomach, liver, spleen, and diaphragm. This forms the: The inferior border of the lesser sac is the:

1. mesentery of the stomach 2. anterior wall, the closed superior recesses, and the left lateral borders of the lesser sac. 3. transverse mesocolon.

The hepatorenal fossa (or hepatorenal space or Morrison's Pouch) is a __________ space, and is the *most ______________ of the abdominal cavity spaces when the patient is supine.* This means that this is one of the first places the sonographer will look when exploring for free fluid in the abdomen.

1. paravertebral 2. *fluid-dependent*

We will consider the abdominal cavity to end inferiorly at the ______ _______, at which point it becomes the _______ ______.

1. pelvic brim 2. pelvic cavity

__________: That portion of the body within the abdominal wall.

ABDOMINAL CAVITY

The junction of two or more vessels supplying the same body region is called an:

ANASTOMOSIS

The alternate route of blood to a body part through an anastomosis is known as:

COLLATERAL CIRCULATION

*General anatomy of aorta:*

a) The aorta enters through the aortic opening of the diaphragm around the level of the 12th thoracic vertebra and bifurcates at the level of the 4th lumbar vertebra b) It lies in close relationship to the anterior portion of the spine

___________: A sheet or band of fibrous tissue such as lies deep to the skin or invests muscles and various body organs.

FASCIA

Communication with the subhepatic space and the lesser sac occurs through the ________ of __________. (star)

FORAMEN OF WINSLOW

_______ __________ is present on the right among the subhepatic space, the subphrenic space, and the lesser sac and the right paracolic gutter.

Freer communication

Inferior to the transverse mesocolon is the ___________ __________.

INFRA-MESOCOLIC SPACE (IS)

The __________ _________ covers some of the organs and constitutes their serosa.

VISCERAL PERITONEUM

*General anatomy of the IVC:*

a) The IVC is slightly more lengthy in the abdomen than the aorta b) The origin is at the level of the fifth lumbar vertebra

What is considered *the gut*?

bowel and stomach

The right subphrenic and subhepatic spaces are in gross continuity and may be thought of as either:

subphrenic or perihepatic.

*What is included in the perirenal space?*

the kidneys, adrenals, and great vessels the space is contained by Gerota's Fascia

*What is included in the anterior pararenal space?*

the pancreas, duodenal sweep, ascending and transverse colon

Normal peritoneum typically cannot be separated from the organs or may not be seen at the abdominal wall unless it is:

thickened, herniated, or ascites is present

The ________ ________ divides the abdominal cavity into supramesocolic and inframesocolic spaces.

transverse mesocolon