Questions and Answers
What separates the anterior portion of the caudate lobe from the left lobe?
What is the most common benign neoplasm of the liver?
Which of the following may develop in patients with right-sided heart failure and elevated systemic venous pressure?
Which structure separates the right and left lobes of the liver?
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Which of the following is not a retroperitoneal structure?
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Which of the following statements is true about the portal vein?
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The common bile duct is joined by the pancreatic duct as they enter which part of the duodenum?
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What should the sonographer expect to find in a patient with empyema of the gallbladder?
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Which laboratory value is specific for a hepatoma of the liver?
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If the prostate is found to be enlarged, which of the following should the sonographer also check?
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The body of the pancreas is bound on its anterior surface by which structure?
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On a transverse scan, where is the portal vein seen in relation to the inferior vena cava?
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Hyperthyroidism associated with a diffuse goiter is associated with which condition?
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Which part of the pancreas lies anterior to the inferior vena cava and posterior to the superior mesenteric vein?
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In a dissecting aneurysm, the dissection occurs through which layer?
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The adrenal gland can be divided into which parts?
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Where can a patent umbilical vein be found?
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All of the following are characteristic of dilated intrahepatic bile ducts except?
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A retroperitoneal abscess may be found within all of the following except?
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Dilatation of the intrahepatic biliary ducts without dilatation of the extrahepatic ducts may be caused by all of the following except?
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A 42-year-old woman presents postcholecystectomy with right-upper-quadrant pain, elevated serum bilirubin (mainly conjugated), and bilirubin in her urine. Which of the following is this best characteristic of?
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What three structures comprise the portal triad?
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A 4-year-old boy presents with high blood pressure, hematuria, and a palpable left flank mass. This finding is most characteristic of which of the following?
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A patient presents with ampulla of Vater obstruction, distention of the gallbladder, and painless jaundice. Which of the following is this presentation associated with?
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Which of the following will long-standing cystic duct obstruction give rise to?
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While performing an ultrasound examination, the sonographer finds that both kidneys measure 5 cm in length. What should one consider except for?
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Staghorn calculus refers to a large stone within which of the following?
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What gastrointestinal peptide hormone stimulates gallbladder contraction?
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What is the name of the portion of the liver that is not covered by the peritoneum?
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What is the normal thickness of the gallbladder wall?
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Where does the pancreatic head lie?
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Identify the sonographic pattern that best describes hydronephrosis.
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A patient presents with a dilated interhepatic duct, dilated gallbladder, and a dilated common bile duct. This is most characteristic of which one of the following levels of obstruction?
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What is the most common location of a pancreatic pseudocyst?
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Which of the following is true about the extrahepatic portion of the falciform ligament?
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The superior mesenteric artery arises 1 cm below the celiac trunk and courses:
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The division by using Couinaud's sections into right and left lobes of the liver is:
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Which of the following is the portion of the pancreas that lies posterior to the superior mesenteric artery and vein?
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Which vessel courses along the posterior surface of the body and tail of the pancreas?
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Sonographically, where can the gastroesophageal junction be visualized?
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Which of the following describes adenomyomatosis of the gallbladder?
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What is the most common cause of acute pyelonephritis?
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A renal sonogram is performed and an echogenic well-defined mass is identified in the renal cortex. This is characteristic of which of the following?
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The gastroduodenal artery is a branch of which of the following?
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Identify the vessel that is seen anterior to the aorta and posterior to the superior mesenteric artery.
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The liver is covered by a thick membrane of collagenous fibers intermixed with elastic elements. What is this membrane called?
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Which of the following can cause anterior displacement of the splenic vein?
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Which one of the following vessels originates from the celiac axis and is very tortuous?
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When accessory spleens are present, where are they usually located?
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What is a fold at the fundal portion of the gallbladder usually called?
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The inferior vena cava forms at the confluence of which of the following vessels?
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Diffuse thickening of the gallbladder wall can be seen sonographically in all of the following except:
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A gallbladder sonographic examination is performed, and a small gallbladder with intrahepatic dilatation is seen. This may indicate that the level of obstruction is at the level of which of the following?
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What is the maximum inner diameter of the main pancreatic duct in young adults?
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Which of the following is produced by the endocrine function of the pancreas?
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Which laboratory test is used to assess renal function?
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Adult polycystic disease may be characterized by all of the following except:
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What is the best sonographic window to image the left hemidiaphragm?
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A patient in the late stages of sickle cell anemia will have a spleen that is which of the following?
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Bilateral hydronephrosis frequently occurs in all of the following except:
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In a patient with acute hepatitis, what is the appearance of the liver parenchyma sonographically?
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What is a hypertrophied column of Bertin?
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What is a ureterovesical junction?
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What is the landmark for the posterolateral border of the thyroid?
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Which of the following is not a clinical sign of renal disease?
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Acute hydroceles may be caused by all of the following except:
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What is the most common malignancy of the adrenal gland in children?
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If a mass in the area of the pancreatic head is found, what other structure should be examined sonographically?
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What is the most common primary carcinoma of the pancreas?
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Study Notes
Portal Triad
- Comprised of the hepatic artery, portal vein, and bile duct.
Wilms' Tumor
- Most common renal cancer in children aged 2-4 years.
- Symptoms include hematuria and hypertension.
Courvoisier's Sign
- Indicates gallbladder distention due to common bile duct obstruction, typically from pancreatic head carcinoma.
- Presents with painless jaundice.
Hydropic Gallbladder
- Results from complete cystic duct obstruction leading to mucocele.
- Gallbladder fills with mucoid secretion.
Kidney Size and Echogenicity
- Echogenic and small kidneys may indicate chronic conditions, but renal vein thrombosis typically shows enlarged kidneys.
Staghorn Calculus
- A large stone located in the renal pelvis, often associated with urinary tract infections.
Cholecystokinin (CCK)
- Gastrointestinal peptide hormone that stimulates gallbladder contraction and bile release.
Bare Area of the Liver
- Section not covered by peritoneum located between the right and left triangular ligaments.
Gallbladder Wall Thickness
- Normal thickness is approximately 3 mm.
Pancreatic Anatomy
- The head of the pancreas is caudad to the portal vein and anterior to the inferior vena cava.
Hydronephrosis Appearance
- Characterized by a fluid-filled pelvocaliceal collecting system.
Bile Duct Obstruction Levels
- Dilated interhepatic ducts, gallbladder, and common bile duct indicate distal common bile duct obstruction.
Pancreatic Pseudocysts
- Most commonly found in the lesser sac, anterior to the pancreas.
Falciform Ligament
- Extrahepatic portion visualizable in cases of massive ascites.
Superior Mesenteric Artery
- Arises 1 cm below the celiac trunk, coursing anterior and parallel to the aorta.
Couinaud's Liver Lobes Division
- Right and left lobes of the liver divided by the main lobar fissure.
Pancreas Uncinate Process
- Lies posterior to the superior mesenteric artery and vein.
Splenic Vein Anatomy
- Courses along the posterior surface of the pancreas's body and tail.
Gastroesophageal Junction Visualization
- Located anterior to the aorta and posterior to the left lobe of the liver.
Adenomyomatosis of Gallbladder
- Benign condition characterized by mucosal proliferation and thickening of the muscle layer.
Acute Pyelonephritis
- Most commonly caused by Escherichia coli infection.
Renal Masses
- An echogenic well-defined mass in the renal cortex is characteristic of angiomyolipoma.
Gastroduodenal Artery
- A branch of the common hepatic artery originating from the celiac axis.
Left Renal Vein
- Seen anterior to the aorta and posterior to the superior mesenteric artery.
Glisson’s Capsule
- Thick membrane covering the liver composed of collagenous and elastic fibers.
Anterior Displacement of Splenic Vein
- Caused by left adrenal hyperplasia.
Splenic Artery Characteristics
- Originates from celiac axis, noted for its tortuous nature.
Accessory Spleens Location
- Commonly found near the splenic hilum.
Phrygian Cap
- A fold at the fundal portion of the gallbladder.
Inferior Vena Cava Formulation
- Forms at the confluence of right and left common iliac veins.
Diffuse Gallbladder Thickening
- Seen in conditions such as acute cholecystitis and hepatitis. Not seen in portal hypertension.
Obstruction Indication in Gallbladder
- Intrahepatic dilatation with a small gallbladder indicates obstruction at the common hepatic duct.
Main Pancreatic Duct Diameter
- Maximum inner diameter in young adults is approximately 2 mm.
Endocrine Function of Pancreas
- Responsible for producing insulin and other hormones.
Laboratory Tests for Renal Function
- Serum creatinine and blood urea nitrogen (BUN) levels are used for evaluation.
Adult Polycystic Kidney Disease
- Autosomal dominant, associated with extra-renal cysts, and typically asymptomatic until later in life.
Left Hemidiaphragm Imaging
- Best visualized through the spleen during ultrasound.
Sickle Cell Anemia and Spleen
- In later stages, the spleen becomes small and hypoechoic due to fibrosis.
Bilateral Hydronephrosis Causes
- Commonly associated with obstructions like benign prostate hypertrophy and fibroid uterus; not due to urinoma.
Liver Parenchyma in Acute Hepatitis
- Typically appears normal sonographically.
Hypertrophied Column of Bertin
- A normal variant in renal anatomy; represents cortical tissue indentation into renal sinus.
Ureterovesical Junction Definition
- Junction between the distal ureter and the base of the bladder.
Thyroid Landmark
- Common carotid artery located posterior-laterally to the thyroid gland.
Clinical Signs of Renal Disease
- Signs include oliguria, flank masses, edema, and hypertension but not jaundice.
Acute Hydroceles Causes
- Can arise from trauma, tumors, or testicular infection but not typically from torsion.
Neuroblastoma
- Most common adrenal gland malignancy in children.
Sonographic Evaluation for Pancreatic Masses
- Check the liver for potential metastasis when a mass is found in the pancreatic head.
Adenocarcinoma in Pancreas
- Most frequent primary carcinoma found in the head of the pancreas.
Ligamentum Venosum Function
- Separates the caudate lobe from the left lobe of the liver.
Common Benign Neoplasm of the Liver
- Hemangioma is the most prevalent benign liver tumor.
Right-Sided Heart Failure Effects
- Elevated systemic venous pressure may lead to dilatation of intrahepatic veins.
Separation of Liver Lobes
- Achieved by the main lobar fissure, distinguishing right and left lobes.
Retroperitoneal Structures
- Kidney, pancreas, aorta, and psoas muscle are retroperitoneal; the spleen is intraperitoneal.
Portal Vein Composition
- Formed by the junction of the splenic vein and superior mesenteric vein.### Anatomy and Diagnostic Considerations
- The splenic vein and superior mesenteric vein converge posterior to the pancreas' neck.
- Common bile duct and pancreatic duct meet before entering the second portion of the duodenum.
Empyema of the Gallbladder
- Characterized by pus accumulation in the gallbladder, often due to acute cholecystitis.
- Symptoms include high fever, chills, leukocytosis, thickened gallbladder walls, and pus-filled lumen.
Liver and Oncological Markers
- Alpha-fetoprotein is a specific laboratory value for diagnosing hepatoma.
- Elevated levels of alkaline phosphatase, bilirubin, serum amylase, and serum albumin are not specific to hepatomas.
Prostate Enlargement
- If prostate enlargement is detected, check kidneys for hydronephrosis, a common complication.
Pancreas Anatomy
- The anterior surface of the pancreas body is bounded by the atrium of the stomach.
- The uncinate process of the pancreas is located anterior to the inferior vena cava and posterior to the superior mesenteric vein.
Vascular Pathology
- In dissecting aneurysms, the dissection occurs through the intima layer of the vessel wall.
Adrenal Gland Structure
- The adrenal gland consists of two main parts: cortex and medulla.
Patent Umbilical Vein
- Can be located in the ligamentum teres, a remnant of the umbilical vein.
Intrahepatic Bile Duct Features
- Dilated intrahepatic bile ducts may show the parallel channel sign, irregular borders, echo enhancement, but not decreasing size toward the porta hepatis.
Retroperitoneal Abscess Locations
- May be located in the psoas, iliacus, and quadratus lumborum muscles, but not the rectus abdominis.
Biliary Duct Dilatation Causes
- Intrahepatic bile duct dilatation can result from a Klatskin tumor or cholangiocarcinoma, but pancreatic carcinoma typically leads to common bile duct obstruction first.
Postcholecystectomy Symptoms
- In a postcholecystectomy patient, symptoms like right upper quadrant pain, elevated conjugated bilirubin in serum, and bilirubin in urine suggest obstruction due to stones, tumors, or strictures in the bile duct system.
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