Abdominal RP Review

What organs should be closely interrogated if the common bile duct is dilated?

Complete biliary tree, liver, gallbladder, and pancreas

What is the main role of sonography post abdominal aortic aneurysm (AAA) repair?

Evaluate for graft patency and leakage at attachment sites.

What is Charcot triad?

Fever, right upper quadrant pain, and jaundice

Which of the following exams would require the sonographer to practice surgical asepsis?

Fine needle aspiration of liver nodule

Which of the following should the sonographer carefully examine in the urinary bladder of a patient who has undergone a pancreatic transplant?

Formation of an urinoma secondary to a bladder anastomosis.

If a patient's lab results indicate increased amylase, increased lipase, and increased bilirubin, which of the following organs is likely diseased?

Gallbladder

A patient presents with RUQ pain, weight loss, jaundice, and hepatomegaly. What is the most likely diagnosis in the presence of an asymmetrically thickened gallbladder wall?

Gallbladder carcinoma

Which of the following correctly orders the normal organs from least echogenic to most echogenic?

Gallbladder, renal cortex, pancreas

What is a complication of acute cholecystitis if it is not treated?

Gangrenous cholecystitis

Which type of islet cell tumor causes patients to develop peptic ulcers?

Gastrinoma

Arterial blood supply to the pancreas is supplied by which of the following arteries?

Gastroduodenal artery, splenic artery, and superior mesenteric artery

Which splenic pathology is often associated with Beckwith-Wiedemann syndrome?

Hamartoma

A patient presents with elevated liver function tests and the sonogram reveals diffuse increase in echogenicity, hepatomegaly, and a poorly visualized diaphragm. Which of the following conditions is most likely?

Hepatic steatosis

Sonographic features of gallbladder sludge include which of the following?

Hepatization of the gallbladder

Which of the following is a benign mass found in the liver parenchyma found in patients taking oral contraceptives?

Hepatocellular adenoma

A male patient presents with a history of chronic hepatitis and Wilson disease. Sonography reveals a heterogeneous mass in the right lobe that appears to invade the IVC and the hepatic veins appear to be narrowed. What is the most likely diagnosis?

Hepatoma with Budd-Chiari syndrome

A patient presents with diarrhea, fever, nausea, and vomiting with crampy LLQ pain. Sonogram demonstrated a segment of thickened bowel with an inflamed outpouching of the intestine. What is the most likely diagnosis?

Diverticulitis

Which of the following patient populations is at greater risk of complications from a thoracentesis?

Elderly

What is the most significant lab result indicating acute pancreatitis?

Elevated lipase

What is a common cause of pneumobilia?

Emphysematous cholecystitis

Which of the following is a differential diagnosis for porcelain gallbladder?

Emphysematous cholecystitis

Which of the following complications of chronic pyelonephritis demonstrates gas or air within the renal parenchyma with dirty shadowing?

Emphysematous pyelonephritis

Which of the following best describes the sonographic appearance of an enlarged lymph node that is likely benign?

Enlarged oval node with decreased echogenicity

What is the sonographic appearance of Addison disease in the acute stage?

Enlarged, hypoechoic adrenal glands bilaterally

A patient presents with pulmonary edema. On sonography, an area of lung has the same echotexture as the liver but with areas of linear pattern echogenicities. What is the most likely diagnosis?

Lung consolidation

A 3-year-old patient presents with nausea, LUQ pain, and abdominal distension. On sonographic exam, multicystic masses with hypoechoic locules and hyperechoic septations are demonstrated. What is the most likely diagnosis?

Lymphangioma

Which of the following best describes malignant disease of the spleen?

Lymphoma is the most common malignancy of the spleen presenting as multiple hypoechoic masses throughout the spleen.

What is exudate ascites in the subhepatic space?

Malignant form of ascites found between the liver and the kidney

What is the proper method for measuring the common bile duct?

Measure the segment on the extrahepatic side of the cystic duct with an inner-to-inner measurement.

Which of the following renal disorders presents sonographically with echogenic renal pyramids due to accumulation of calcium in dilated collecting ducts?

Medullary sponge kidney

What hepatic pathology demonstrates the sonographic findings of multiple target lesions within the liver parenchyma?

Metastatic disease from lung or colon cancer

A patient presents with jaundice, right upper quadrant pain, an elevated serum bilirubin and a fever. Sonogram demonstrates a common hepatic duct measuring 12 mm. What is the most likely diagnosis?

Mirizzi syndrome

Which of the following best describes a mucinous cystadenocarcinoma?

Multilocular cystic mass with mural nodules and internal echoes with dilation of the duct of Wirsung

A 45-year-old female patient with a history of chronic dieting presents with acute abdominal pain after fatty meals that radiates to her shoulders. Which of the following sonographic presentations do you expect to find?

Multiple mobile echogenic masses that produce acoustic shadowing

Which of the following best describes a splenic granuloma?

Multiple small echogenic masses with acoustic shadowing

Which of the following correctly describes acute cholecystitis?

Nausea and vomiting, positive sonographic Murphy's sign, symmetric gallbladder wall thickening, and gallstones

Which patient population is most likely to demonstrate an adrenal hemorrhage?

Neonates

What benign renal mass is described sonographically as a hypervascular, hyperechoic mass with internal echoes producing acoustic shadowing?

Renal adenoma

Which renal tumor has an asymptomatic presentation in its early stages but over time patients complain of gross hematuria, weight loss, and palpable flank mass?

Renal cell carcinoma

A patient presents with a history of medically treated migraines, back/flank pain, weight loss, and vomiting. What retroperitoneal pathology should the sonographer consider?

Retroperitoneal fibrosis

Which of the following best describes the location of the left adrenal gland?

Retroperitoneal, located medial to the superior pole of the LT kidney

Which of the following best describes a chronic condition that results in fibrotic replacement and atrophy of the spleen?

Sickle cell anemia

What is the measurement used to determine if pyloric stenosis is present?

Single-walled muscle thickness of 3 mm or greater and 17 mm or greater length

What is the classic sonographic appearance of a pancreas demonstrating chronic pancreatitis?

Small, hyperechoic, heterogeneous, atrophic gland with ill-defined borders

What sonographic feature is consistent with a benign mass?

Smooth borders

What are the criteria of a simple cyst?

Smooth borders, anechoic, through transmission, and round shape

How is splenomegaly diagnosed from ultrasound?

Spleen extends beyond inferior pole of left kidney and measures >13 cm length or >6 cm thickness.

A complex cystic mass is demonstrated in the spleen with posterior dirty shadow in a febrile patient. What is the most likely diagnosis?

Splenic abscess

What acute disorder is best described sonographically as a hypoechoic wedge-shaped mass within the spleen?

Splenic infarct

What is the most common complication of a wandering spleen?

Splenic torsion

What is the term used to describe an enlarged spleen?

Splenomegaly

What is a tumor marker?

Substances produced by cancer cells or organs when cancer is present

What is the innermost layer of the bowel identifiable by sonography?

Superficial mucosa

What posterior landmark can the sonographer use to aid in delineation of the pancreas?

Superior mesenteric vein and splenic vein

How is blood supplied to the adrenal glands?

Suprarenal branches of aorta, suprarenal branches of inferior phrenic arteries, and suprarenal branches of main renal artery

What is the typical sonographic pattern demonstrating an intussusception?

Target shaped mass in the transverse plane and pseudokidney sign in the longitudinal plane

A patient presents with epilepsy and skin lesions. The sonogram demonstrated bilateral renal cysts and angiomyolipoma. What is the most likely diagnosis?

Tuberous sclerosis

What is the term used to describe the inner layer of the aorta wall?

Tunica intima

What are the complications associated with choledochal cyst?

Cholangitis, portal hypertension, pancreatitis, and liver failure

What is the least common cause of bile duct obstruction?

Cholelithiasis

What gallbladder pathology is described as a projection of tissue from the gallbladder wall caused by a metabolic accumulation of cholesterol and triglycerides?

Cholesterolosis

Which of the following is most likely a malignant tumor?

Choriocarcinoma

If the gallbladder wall is demonstrated as symmetrically thickened, what is the most likely pathologic cause?

Chronic cholecystitis

An elevation of albumin, alkaline phosphatase, and aspartate aminotransferase would lead the sonographer to investigate which of the following conditions?

Cirrhosis

On a transverse sonogram of the mid abdominal aorta, what vessels make up the seagull sign?

Common hepatic artery makes up left wing, splenic artery makes up right wing, and celiac axis makes up body.

What are the normal measurements for a fasting gallbladder?

8 to 10 cm length, ≤5 cm diameter, ≤3 mm wall thickness

What measurement describes an enlarged lymph node?

> 10 mm

Which of the following best describes a pyogenic hepatic abscess?

A complex cyst with thick walls and internal debris producing dirty shadow is noted in the dome of the liver.

A motor vehicle patient from the emergency room presents with LUQ pain and decreased hematocrit. What should the sonographer look for on the abdominal scan?

A complex or hypoechoic mass in the spleen with posterior enhancement and an echogenic line within the spleen demonstrating the laceration

A 50-year-old patient presents with an acute episode of choledocholithiasis and thickening of the bile duct walls. If the patient is presented with Charcot triad clinically, what is the most likely diagnosis?

Acute bacterial cholangitis

A patient presents with hypotension, weakness, hyperkalemia, and hyperpigmentation. Which adrenal disorder is most likely?

Addison disease

A patient presented with abdominal pain, weight loss, and vomiting. Sonography revealed a 10-cm hypoechoic irregular shaped mass in the LLQ. What is the most likely diagnosis?

Adenocarcinoma

A patient presents with weight loss, jaundice, and epigastric pain. The sonogram demonstrates a hypoechoic mass in the pancreatic head and a dilated CBD. What is the most likely diagnosis?

Adenocarcinoma

What is the most common primary pancreatic malignancy?

Adenocarcinoma

What is the most common benign solid tumor of the adrenal gland?

Adrenal adenoma

Which of the following is an example of an endocrine organ?

Adrenal gland

Which of the following are often associated with congenital adrenal hyperplasia and Cushing syndrome?

Adrenal rests

What is the purpose of having a patient fast for 8 hours prior to an abdominal ultrasound?

Allows for maximal distension of the gallbladder

A patient presents with intense chest and abdominal pain radiating to the lower back. A mildly dilated area of the aorta is identified with demonstration of an intimal flap with color Doppler. What is the most likely diagnosis?

Aortic dissection

What pathology is diagnosed by the sonographic demonstration of worms in the bile ducts?

Ascariasis

What are the symptoms of a nonfunctioning adrenal adenoma?

Asymptomatic

Which of the following best describes a simple splenic cyst?

Asymptomatic, round, smooth-walled mass with posterior enhancement

Which of the following is not a sonographic finding for acute pancreatitis?

Atrophic hypoechoic pancreas

What renal disorder presents with decreased renal function in the 3rd to 4th decades of life, and bilaterally enlarged kidneys containing multiple cortical cysts?

Autosomal dominant polycystic kidney disease

What disorder is characterized by neonatal jaundice, cirrhosis, portal hypertension, and the triangular cord sign?

Biliary atresia

What is the origin of the splenic artery?

Branch of celiac axis

What sonographic feature gives an adrenal cyst concern for malignancy?

Calcified cyst wall

How is pelvocaliectasis diagnosed with sonography?

Dilation of the calices and renal pelvis

What is the typical sonographic appearance of an intestinal obstruction?

Distended fluid-filled loops of bowel

What other disorder should be investigated for if pancreatic cysts are noted on a sonogram?

Hippel-Lindau disease

A 3-week-old infant presented with projectile vomiting, dehydration, weight loss, and insatiable appetite. Sonography demonstrated a cervix sign in the long axis. What is the most likely diagnosis?

Hypertrophic pyloric stenosis

What benign pediatric tumor presents clinically with hepatomegaly and skin hemangiomas?

Infantile hemangioendothelioma

Which artery arises from the anterior surface of the abdominal aorta just inferior to the gonadal arteries?

Inferior mesenteric artery

Where is the abdominal aorta located?

Inferior to the diaphragm, just anterior to the spine, and slightly to the left of the midline

Which statement below is true with respect to the normal liver?

Intraperitoneal organ located in right upper quadrant (RUQ) responsible for bile synthesis

Which of the following best describes the location of the spleen?

Intraperitoneally located in the left upper quadrant (LUQ)

What feature below is consistent with a malignant adrenal tumor originating from the adrenal cortex?

Invasion of adrenal vein and IVC

What is a common complication of Wilms tumor, renal transitional cell carcinoma, and Budd-Chiari syndrome?

Invasion of the IVC

Which of the following statements is false with respect to transjugular intrahepatic portosystemic shunt (TIPS) procedures?

It is considered an abnormal finding post stent placement for the flow to reverse within the right and left portal veins.

What is the path of venous drainage of the LT adrenal gland?

LT suprarenal vein drains into the LT renal vein

What are the sonographic findings associated with retroperitoneal fibrosis?

Large, hypoechoic mass surrounding the abdominal aorta

When imaging the liver, in which image are you likely to note fluid around the lung?

Liver/Right kidney interface

In what image is the crus of the diaphragm typically demonstrated on sonography?

Transverse image of the kidney

A 2-year-old male presents with a palpable abdominal mass with abdominal and back pain. A 10-cm heterogeneous ill-defined mass with calcifications is identified in the RT abdomen. Mets were identified in the liver. What is the most likely diagnosis?

Neuroblastoma

A patient presents with fever, leukocytosis, and rebound tenderness. What should the sonographer expect to find on the sonogram?

Noncompressible blind-ended tubular structure in the RLQ measuring >6 mm.

What is the cause of Conn syndrome?

Overproduction of aldosterone by a functional adrenal tumor

What congenital anomaly of the pancreas causes a functional obstruction leading to pancreatitis?

Pancreatic divisum

Which portion of the pancreas lies in the C-loop of the duodenum?

Pancreatic head

Which of the following is a hyperfunctioning adrenal mass that results in uncontrollable hypertension and excessive perspiration?

Pheochromocytoma

What is a possible complication of a thoracentesis?

Pneumothorax

Which of the following falsely describes an accessory spleen?

Polysplenia

What is the most common cause of splenomegaly?

Portal hypertension

A patient presents with a history of diverticulitis. On ultrasound, small bright reflectors are noted within the portal vein producing ring-down artifact. What condition is most likely?

Portal venous gas

How is an aortic rupture diagnosed?

Presence of an AAA with adjacent hematoma.

Which of the following can cause the appearance of false hydronephrosis?

Prominent renal vein

Which of the following is a vascular complication associated with acute pancreatitis?

Pseudoaneurysm of the splenic artery

What lung pathology is described as a separate mass of nonfunctioning lung tissue with its own blood supply?

Pulmonary sequestration

Which of the following artifacts causes a laterally displaced duplication of the real structure?

Refraction

What signals the adrenal gland to release hormones?

Release of adrenocorticotropic hormone by the anterior pituitary gland

Which of the following is a false statement about the renal arteries? -The right renal artery (RRA) courses posterior to the IVC prior to entering the renal hilum. - The LT renal artery is longer than the RT. - The left renal artery (LRA) comes off the aorta at approximately the 4:00 position. - Normal renal arteries demonstrate low resistance flow.

The LT renal artery is longer than the RT.

Why is a 2- to 5-MHz transducer generally utilized for imaging the liver?

The lower frequencies allow for better penetration because the liver is a large organ.

How does acute renal failure differ from chronic renal failure?

The most common cause of chronic renal failure is diabetes mellitus and it presents as small kidneys with cortical thinning on sonography whereas acute renal failure is most commonly caused by acute tubular necrosis and presents as normal appearing kidneys.

If colitis is suspected, what sonographic finding is most consistent?

Thickened hypoechoic colon wall with hyperemia

What is the classic sonographic presentation of adenomyomatosis?

Tiny comet tail artifacts projecting from the gallbladder wall into the gallbladder lumen

What is the purpose of standard precautions?

To decrease the spread of infection

What term is used to describe dilation of the ureter as it enters the bladder?

Ureterocele

Which of the following best describes the sonographic appearance of the IVC?

Variable diameter that changes with respiration, pulsatile waveform close to the heart with a phasic waveform at its origin.

Which of the following clinical symptoms is a common feature of colitis?

Watery and/or bloody diarrhea

Which solid pediatric malignancy occurs in the kidney?

Wilms tumor