Abdomen II Final Exam Review

Abdomen II Final Exam Review

• Interventional Procedures: Used for aspiration of abscesses, cysts, and fluid collections.
• Paracentesis: Removal of peritoneal fluid with a catheter (ultrasound is the gold standard).
• Thoracentesis: Removal of pleural fluid collections with a catheter.
• Amniocentesis: A procedure used to collect a sample of amniotic fluid for testing.
• Cystic collections: Aspirations of large cysts, seromas, Baker's cysts, and joint effusions.
• Abscesses: Aspirations of infected collections, including deep pelvic and peritoneal lesions.

Interventional Procedures - Advantages and Biopsies

• Ultrasound Advantage: Continuous real-time visualization of the biopsy needle allows for adjustments during the procedure.
• Biopsy Use: To determine if a mass is benign, malignant, or infectious.

Interventional Procedures - Complications

• Postprocedural pain or discomfort
• Vasovagal reactions
• Hematomas
• AV fistulas
• Hemorrhage
• Seroma
• Pancreatitis
• Pneumothorax
• Infection
• Peritonitis
• Death
• Inconclusive biopsy results

Interventional Procedures - Contraindications

• Uncorrectable bleeding disorder (coagulopathy)
• Ongoing anticoagulant therapy (e.g., heparin, coumadin, some supplements)
• Lack of a safe needle path
• Uncooperative or non-consentable patient

Musculoskeletal Ultrasound - Artifacts

• Anisotropy: Occurs when curved surfaces are being imaged, depending on the angle of the probe's rocking (heel-toe rocking creates optimal 90° imaging).
• Refraction: Bending of transmitted sound beams to an oblique path, appearing as an edge artifact.
• Reverberation: Arises when ultrasound signals repeatedly reflect between highly reflective interfaces.

Tendons

• Achilles: Largest tendon.
• Normal AP Measurement: 5-6mm.
• Insertion Point: Calcaneus bone.
• Connection: Connects gastrocnemius and soleus muscles to the calcaneus.

Tendinitis

• Cause: Age-related elasticity loss, rheumatoid arthritis, overuse, or acute trauma.
• Common Locations: Shoulder, wrist, heel, and elbow.

Baker's Cyst

• Bursa: Small sac between two moving surfaces (tendon and bone).
• Types: Communicating and non-communicating.
• Location: Synovial fluid in the medial popliteal fossa of communicating bursa.
• Causes: Osteoarthritis, rheumatoid arthritis, or overuse of the knee.
• Complications: Rupture, hemorrhage, and extension to the calf.

Cellulitis

• Initial Effect: Thickening of the subcutaneous layer.
• Progression: Subcutaneous edema increases, appearing as a "cobblestone" pattern.
• Mechanism: Edema forms around subcutaneous fat globules and connective tissues.
• Diagnostic Aid: Color flow Doppler may show hyperemia caused by inflammation.

Muscle Trauma

• Full Tear (Grade III): Muscle retracts, thickens, and potentially has free fluid surrounding it.

Muscle Tears

• Visualization: Free fluid between two muscles.

Hematoma

• Definition: A solid swelling caused by localized bleeding and clotted blood within tissues, due to trauma or disease.
• Types: Intramuscular and subcutaneous

Neonatal Spine - Indications for US

• Dimple Abnormalities: More than 2.5 cm from the anus, asymmetrical, or very deep.
• Other Indications: Hairy patches, cutaneous extensions, lumps along the spine, hemangiomas, or skin tags.

Neonatal Spine - Spinal Canal Contents

• Diagram labels: 1 ( ) 2 ( ) 3 ( ) and 4 ( )

Neonatal Spine - Questions

• Caudal End of Spinal Cord: (The question is incomplete here and doesn't provide an expected answer).
• Nerve Roots: (The question is incomplete here and doesn't provide an answer).
• Cauda Equina Structures: (The question is incomplete here and doesn't provide an expected answer)
• Conus Medullaris: To be considered normal, the conus medullaris should typically end at or before (the question is incomplete here and doesn't provide an expected answer).
• Lumbar, Sacral Vertebrae, Coccyx Location: (The question is incomplete here and doesn't provide an answer).

Neonatal Spine - Additional Information

• Structures Seen: The spinal cord, spinal cord, and other structures are visualized in images.
• Common Benign Findings: Cysts in the filum terminale are often seen. These are usually inconsequential
• Meningocele/Meningomyelocele: Spinal cord, meninges, cerebrospinal fluid protrudes.
• Tethered Cord: Spinal cord fixation at an abnormal caudal location.
• Hydromelia: Dilation of central canal
• Diastematomyelia: Splitting of spinal cord into symmetrical or asymmetrical hemi-cords.

Neonatal Head - Identifying Cranium Bones

• Images provide labelled locations: 1 ( ), 2 ( ), 3 ( ), 4 ( )

Neonatal Head - Identifying Structures

• Midline Structures: The text does not provide the specific names for these structures.

Neonatal Head - Choroids

• Choroids: Masses of special cells within choroid plexuses formed bilaterally.
• Function: Regulate intraventricular pressure through secretion and absorption.

Neonatal - Christmas Tree Image: Tentorium Cerebelli

• Tentorium Cerebelli: V-shaped extension of dura in the posterior fossa, separating the cerebellum from the cerebrum.

The Ventricles

• Locations: The ventricles are in various planes sagittal, parasagittal, and coronal. The fluid content is the brain tissue itself.

The Caudothalamic Groove

• Location: Fusion area for the thalamus and caudate nucleus.
• Significance: A site of increased capillary fragility that is a frequent site of periventricular bleeds

PVL - Periventricular Leukomalacia

• Definition: Related to a lack of oxygen or a reduction of cerebral perfusion resulting in multiple periventricular white matter infarcts and necrosis; noticeable on ultrasound as asymmetrical areas of increased echogenicity.

Neonatal Hips

• Indications for Ultrasound: Hip “click” on manipulation, shortening of the femur, asymmetrical thigh skin folds, Galeazzi sign.

Risk Factors for Developmental Hip Dysplasia (DDH)

• Factors: Female neonate, family history of DDH, breech presentation, primigravida uterus, oligohydramnios, and swaddling.

Galeazzi Sign

• This sign describes the angle of the iliac bones, and it is an indicator of hip displacement.

Anatomy of the Pelvis

• Bones: Ilium, Ischium, Pubis make up the pelvic girdle.

Anatomy of the Hip

• Ball and Socket: The femoral head (ball) is paired with acetabulum (socket)..
• Cartilage and Bone: The acetabulum is made up of cartilage and bone.
• Ossification: The femoral head starts ossifying between 2 and 8 months.

Naming Parts (Coronal Neutral Image)

• Numbers 1-10 refer to different structures in a coronal neutral X-ray image.

Iliac Bone

• Location: Positioned in the image.
• Orientation: Coronal flexion view and relation to the transducer.

Hip Abnormalities - Subluxation and Dislocation

• Subluxation: The femoral head is partially out of the acetabulum, but not completely separated.

Barlow and Ortolani Maneuvers

• Barlow: Move hips toward the midline.
• Ortolani: Move hips to the midline.

The Angles: Alpha and Beta

• Alpha Angle: Normal measurement is > 60 degrees
• Beta Angle: Normal measurement is <55 degrees

Views of the Hip: Coronal, Axial

• Coronal: Flexion and Extension views.
• Axial: Flexion and Extension views; observe a U-shape in the axial flexed hip image.

Breast

• Layers: There are different layers that are labelled 1-6 in an image.

Mass Location

• Quadrant: Using the 12 o'clock method, locate the breast mass.
• Relation to Nipple: Where the mass is located relative to the nipple, using clock position.

Breast - Do You Remember Questions

• Common Cancer Site:
• Common Benign Mass:
• Cooper's Ligaments: Their role in breast support.
• Tail of Spence: Its location in the breast
• Hard Finding: Features of breast cancer.

Gynecomastia

• Cause: Hypertrophy of male breast ductal elements due to testosterone deficiency

Additional notes:

Overall the presentation covers various ultrasound techniques for imaging various sections of the human body, including the abdomen, musculoskeletal system, spine, hip, breast, and head. Many of the provided texts also include details on abnormalities and/or pathologies that may be seen in the various imaging scans.

Prepare for your Abdomen II final exam with this comprehensive review on interventional procedures. The quiz covers key techniques such as paracentesis, thoracentesis, and amniocentesis, along with their advantages, biopsy processes, and possible complications. Test your knowledge and ensure you're ready for your exam!