DMS Extern -Chapter 2

Which transducer is best suited for a sonographic examination of the superficial abdominal wall?

12 MHz linear array

Ascites

Accumulation of serous fluid in the peritoneal cavity

Describe the process of abscess formation and resolution.

An abscess is the result of an inflammatory response. If the cellular and fluid exudates from the inflammatory response do not resolve, fibrous tissue growth can occur in a process called organization. If necrosis of the tissues occurs, dead tissue and pus collect in a cavity that is called an abscess. As time goes on the fluid contents are reabsorbed and calcifications may develop.

Which of the following has the primary function of attaching muscles to the fixed points?

Aponeuroses

Sonographically, how would one distinguish ascites from pleural effusion?

Ascites is an accumulation of fluid in the abdominal cavity and will be located inferior to diaphragm whereas a pleural effusion is an accumulation of fluid within the pleural cavity and will be located superior to the diaphragm.

The superficial fascia inferior to the umbilicus is divided into two layers; the ________ fascia, a fatty layer containing small vessels and nerves, and the ________ fascia which is deep membranous layer.

Camper's; Scarpa's

Abscess

Cavity containing dead tissue and pus that forms due to an infectious disease

Pneumothorax

Collapsed lung that occurs when air leaks into the space between the chest wall and lung

Omphalocele

Congenital defect in the midline abdominal wall that allows abdominal organs to protrude through the wall into the base of the umbilical cord.

Which statement regarding the diaphragm is False?

Due to diaphragmatic contraction, the IVC dilates during inspiration

Which of the following is an abnormal evaluation of the diaphragm due to a developmental anomaly?

Eventration

What is the most common content in an abdominal wall hernia?

Fat

Linea Alba

Fibrous structure that runs down the midline of the abdomen from the xiphoid process to the symphysis pubis

Fascia

Fibrous tissue network that is richly supplied by blood vessels and nerves located between the skin and underlying structures

The four indications of inflammatory response are ________, ________, ________, and ________.

Heat; redness; pain; swelling

Which of the following is an inflammatory response?

Hernia

Which of the following is another term for pleural effusion?

Hydrothorax

A 68-year-old man presents with a clinical history of an umbilical hernia post aortic aneurysm repair. You scan over the area and are not sure that you can visualize the hernia. What technique will you use to hopefully make the hernia more visible and what five things must you evaluate when performing an examination on an abdominal hernia?

If the hernia isn't visible in supine position, the valsalva maneuver can frequently help demonstrate the hernia. Having the patient perform the maneuver while scanning over the area may aid in visualization. Changing the patient position may help as well Having the patient sit upright or stand can help demonstrate in real time. Location, size, contents of the hernia should be documented with response to valsalva and reductibility of lesion.

Which of the following is not a ventral hernia?

Inguinal

Which of the following is an anatomical area where vessels can enter and exit the abdominal cavity and is a potential site for hernias?

Inguinal canal

Which of the following is a true statement about the right crus of the diaphragm?

It appears anterior to the caudate lobe

Aponeurosis

Layers of flat fibrous sheets composed of strong connective tissue, which serve as tendons to attach muscles to fixed points

Which of the following is the most common benign tumor of the abdominal wall?

Lipoma

Which of the following may be seen in the thoracic cavity in a fetus with a congenital diaphragmatic hernia?

Liver, Spleen and Stomach

Which of the following typically occurs when a nerve is damaged during surgery?

Neuroma

In order to determine if an abscess is intraperitoneal or extraperitoneal, what structure must the sonographer demonstrate?

Peritoneal Line

Which of the following statements regarding hematomas is False?

Postsurgical hematomas are usually retroperitoneal

Which of the following muscles is not part of the anterolateral abdominal wall?

Psoas muscle

Which of the following is not a paired muscle?

Pyramidalis muscle

The ________ ________ is a fibrous compartment that contains the rectus abdominis , pyramidalis muscle, blood and lymphatic vessels, and nerves.

Rectus Sheath

Erythema

Redness or inflammation of the skin or mucous membranes

Over half infants born with a congenital diaphragmatic hernia die from what medical condition?

Respiratory failure

Peristalsis

Rhythmic muscular contractions that squeeze food through the esophagus into the stomach

Which of the following may be a contraindication to sonography guided aspiration?

Septations within the abscess

Ecchymosis

Skin discoloration caused by leakage of blood into the subcutaneous tissue

You receive a request to perform an examination of the anterior abdominal wall on a patient with recent history of abdominal surgery. The area surrounding the incision is red and warm to touch and the referring physician is concerned about the presence of an abscess. What techniques and precautions will you use to limit the spread of infection to this subsequent patients?

Standard precautions must be followed to avoid spreadin infection to this and other patients. The transducer should be cleaned with a sterilizing agent and should be covered with a sterile transducer cover. Sterile gel should also be used. After the exam the transducer should be cleaned again and gloves should be worn during the exam.

The human body is divided into the ventral and dorsal cavities. The ventral cavity is separated by the diaphragm into the ________ and the ________ cavity?

Thoracic; Abdominopelvic

What is the most common type of ventral hernia?

Umbilical

When evaluating a hernia with sonography, the ________ ________ can be used to demonstrate widening of the hernia and movement of the hernia contents.

Valsalva manuever

A diaphragmatic hernia allows ________ contents such as ________, ________, and ________ to enter the thoracic cavity.

abdominal; stomach; bowel; liver

Pleural Effusion

abnormal accumulation of fluid in the pleural space/cavity

Paralysis of one hemidiaphragm can be detected sonographically by showing ________ or ________ motion on the affected side and normal or ________ motion on the contralateral side.

absent; paradoxical; exaggerated

Discoloration of the abdominal wall called ________ and a falling ________ value are often clinical signs of a rectus sheath hematoma.

ecchymosis; hematocrit

Sonographically, the diaphragm is seen as a thin ________ band in children and adults and a ________ band in fetuses.

hyperechoic; hypoechoic

Three main categories of disease that affect the abdominal wall include ________, ________, and ________ changes.

inflammatory; traumatic; neoplastic

The ________ ________ of the abdominopelvic cavity and is formed by a single layer of epithelial cells and supporting connective tissue.

parietal peritoneum

Sonographically, a ________ ________ is diagnosed when fluid is visualized superior to the diaphragm.

pleural effusion

The posterior abdominal wall is composed of ________ ________, ________, and ________ ________.

psoas major; illacus, quadratus lumborum

Superficial abdominal wall hematomas most commonly occur within the ________.

rectus sheath

A ________ is a collection of serum that results from surgical procedure or from the liquefaction of a hematoma and typically appears anechoic to hypoechoic sonographically.

seroma

The shape of an abscess can vary but the typical shape is ________ or ________.

spherical; elliptical

When evaluating a superficial lesion in the abdominal wall, a ________ ________ may be used to eliminate the "main bang" artifact.

standoff pad

Two complications that can occur with midline hernias include ________, which can compromise blood supply and cause ischemia, and ________, which occurs when the contents of the sac cannot be pushed back into the abdominal cavity.

strangulation; incarceration

If edema is present after an injury, a contused abdominal muscle may appear ________ and more ________.

thicker; anechoic

The two main categories of abdominal wall hernias are ________ and ________.

ventral; groin