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Questions and Answers
What characterizes the right crus of the diaphragm compared to the left crus?
What characterizes the right crus of the diaphragm compared to the left crus?
Which diagnostic technique is emphasized for evaluating abdominal wall structures?
Which diagnostic technique is emphasized for evaluating abdominal wall structures?
What types of pathologic processes can be imaged using sonography?
What types of pathologic processes can be imaged using sonography?
What is a key requirement for high-quality sonographic abdominal studies?
What is a key requirement for high-quality sonographic abdominal studies?
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What does the muscular composition of the abdominal wall indicate in less developed individuals?
What does the muscular composition of the abdominal wall indicate in less developed individuals?
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What term describes an anatomical image obtained by recording returning echoes?
What term describes an anatomical image obtained by recording returning echoes?
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Which scanning plane is used to obtain a sonogram of the left kidney?
Which scanning plane is used to obtain a sonogram of the left kidney?
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What does the term 'echogenic' signify about an organ or tissue?
What does the term 'echogenic' signify about an organ or tissue?
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Which of the following best describes the characteristic of an anechoic structure?
Which of the following best describes the characteristic of an anechoic structure?
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How is a hyperechoic structure defined?
How is a hyperechoic structure defined?
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Which term describes a structure that is less echogenic than surrounding tissues?
Which term describes a structure that is less echogenic than surrounding tissues?
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What characteristic defines an isoechoic structure?
What characteristic defines an isoechoic structure?
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Which of the following is a misnomer for anechoic?
Which of the following is a misnomer for anechoic?
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What separates the rectus sheath from the parietal peritoneum inferior to the umbilicus?
What separates the rectus sheath from the parietal peritoneum inferior to the umbilicus?
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Which of the following is NOT a type of abdominal wall pathology mentioned?
Which of the following is NOT a type of abdominal wall pathology mentioned?
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Where are abscesses most likely to be located?
Where are abscesses most likely to be located?
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What is the primary distinguishing characteristic of an anechoic ascitic fluid?
What is the primary distinguishing characteristic of an anechoic ascitic fluid?
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What condition is characterized by fluid collection adjacent to the kidneys?
What condition is characterized by fluid collection adjacent to the kidneys?
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What shape is commonly associated with an abscess?
What shape is commonly associated with an abscess?
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Which condition is likely to appear with echogenic features due to gas content?
Which condition is likely to appear with echogenic features due to gas content?
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Which stage change does NOT correspond with the shape of a hematoma?
Which stage change does NOT correspond with the shape of a hematoma?
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Where is the direct inguinal hernia primarily located in relation to the inferior epigastric vessels?
Where is the direct inguinal hernia primarily located in relation to the inferior epigastric vessels?
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Which type of hernia is often associated with pregnancy?
Which type of hernia is often associated with pregnancy?
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What is a key characteristic of an obturator hernia?
What is a key characteristic of an obturator hernia?
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Which hernia occurs along the edge of the rectus abdominus muscle?
Which hernia occurs along the edge of the rectus abdominus muscle?
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What complication arises from an incarcerated hernia?
What complication arises from an incarcerated hernia?
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Which imaging modality provides an advantage in diagnosing incarcerated hernias?
Which imaging modality provides an advantage in diagnosing incarcerated hernias?
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In which plane is an umbilical hernia typically visualized?
In which plane is an umbilical hernia typically visualized?
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What is the primary feature of a mushroom-shaped hernia?
What is the primary feature of a mushroom-shaped hernia?
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What is located halfway from the umbilicus to the pubic symphysis?
What is located halfway from the umbilicus to the pubic symphysis?
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What is the primary role of the transversalis fascia below the arcuate line?
What is the primary role of the transversalis fascia below the arcuate line?
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Which anatomical structure is formed by the interlacing fibers of the anterior and posterior layers of the rectus sheath?
Which anatomical structure is formed by the interlacing fibers of the anterior and posterior layers of the rectus sheath?
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What anatomical structure is the umbilical ring a defect of?
What anatomical structure is the umbilical ring a defect of?
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What structures traverse the inguinal canal in males?
What structures traverse the inguinal canal in males?
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The deep inguinal ring is known as what?
The deep inguinal ring is known as what?
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What is the measure of the oblique passageway of the inguinal canal in adults?
What is the measure of the oblique passageway of the inguinal canal in adults?
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What unites the layers of the posterior abdominal wall fascia?
What unites the layers of the posterior abdominal wall fascia?
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Study Notes
Sonography Definitions
- Sonogram: Image created from returning echoes of an organ scanned with ultrasound
- Echogenic: Tissues that create echoes when sound waves bounce off them
- Anechoic: Portion of image that appears echo-free; examples include urine-filled bladder, bile-filled gallbladder, and blood-filled ventricle
- Hyperechoic: Brighter than surrounding tissues or brighter than normal for a tissue or organ; results from increased sound scatter
- Hypoechoic: Less bright than surrounding tissues or less bright than normal; results from reduced sound scatter
- Echopenic: Structure less echogenic than others with few internal echoes
- Isoechoic: Structure of equal echo density
Abdominal Wall Sonography
- Diaphragmatic crura: Musculotendinous bands arising from anterior surfaces of the superior three lumbar vertebrae, anterior longitudinal ligament, and intervertebral discs
- Right crus is larger and longer than the left
- Right crus arises from the first three lumbar vertebrae and appears posterior to the caudate lobe of the liver
- Left crus arises from the first two lumbar vertebrae
- Variations in fat and muscle content affect sonographic appearance of abdominal wall
- Well-developed individuals have identifiable muscle layers
- Less-developed individuals will have indistinct muscle groups
- Obese patients have significant fatty layer variations
- Sonography is fast, available, less expensive, and noninvasive
- Sonography can image superficial layers of abdomen
- Useful for post-trauma or postsurgical evaluation
- Newer high-frequency, short focus transducers (7.56MHz or higher linear array) are used to image lesions
- Pathologic processes to be imaged include: inflammatory lesions, hemorrhage, hernia and masses
- Newer high-frequency, short focus transducers (7.56MHz or higher linear array) are used to image abdominal wall lesions
- Stand-off pads can sometimes be necessary
- Transverse sections of the anterior abdominal wall demonstrate the subcutaneous tissue, linea alba, and rectus abdominis muscle
- Superior to the umbilicus, the both the anterior and posterior rectus sheath are seen
- Inferior to the umbilicus, the rectus sheath is separated from the parietal peritoneum only by the transversalis fascia
Abdominal Wall Pathologies
- Major categories of abdominal wall pathologies include:
- Abdominal wall tissues
- Peritoneum
- Abdominal spaces
- Abdominal wall tissues and membranes lining its spaces can exhibit inflammatory, traumatic, or neoplastic changes
- Abscess: Fluid collection near a surgical site or painful area
- Hematoma: Blood collection near a wound or surgical site
- Ascites: Fluid in the peritoneal cavity, commonly found in the most dependent areas of the body
- Urinoma: Fluid collection adjacent to the kidneys
- Lymphocele: Fluid collection adjacent to a renal transplant
Anatomy of the Abdominal Wall
- Arcuate line: Transition terminating the posterior rectus sheath covering proximal superior ¾ of the rectus abdominis muscles
-
Linea alba:
- Formed by fibers of the anterior and posterior layers of sheath interlace in the anterior median line
- Course vertically entire length of abdomen
- Separates bilateral rectus sheaths
- Wider superiorly, narrows more inferiorly
- In thin/muscular people, a groove in the skin may be visualized
-
Umbilicus:
- All layers of the anterolateral abdominal wall fuse
- Umbilical ring is a defect in linea alba located under umbilicus
- Site where fetal umbilical vessels passed to and from the cord and placenta
- Fat accumulation in subcutaneous tissue raises the umbilical ring and depresses the umbilicus after birth
Inguinal Region
- Inguinal ligament: Forms the inferior border of the external oblique muscle as it extends between the ASIS and the pubic tubercle
-
Inguinal canal: Located superior and medial to the inguinal ligament
- Formed during fetal development
- Structures enter and exit the abdominal cavity
- Pathways are potential sites for hernias
- Oblique passageway measuring approximately 4cm long in adults
- Male inguinal canal contains the spermatic cord
- Female inguinal canal contains the round uterine ligament
- Also contains blood vessels, lymphatic vessels and illioinguinal nerves
-
Inguinal canal openings:
- Deep (internal) inguinal ring: Entrance
- Superficial (external) inguinal ring: Exit for spermatic cord or round ligament
Posterior Abdominal Wall
- Covered with continuous layer endoabdominal fascia, which is continuous with transversalis fascia
- Psoas fascia is continuous with the three layers of the thoracolumbar fascia and the quadratus lumborum fascia along with the muscles and vertebrae
Abdominal Wall Hernias
- Direct inguinal hernia: Located medial to the inferior epigastric vessels
-
Femoral hernia: Occurs within the femoral canal adjacent to the femoral vein just below the groin crease
- Associated with pregnancy
- Spigelian hernia: Occurs along the edge of the rectus abdominis muscle through the spigleian fascia, several inches lateral to the middle of the abdomen
-
Obturator hernia: Protrudes from the pelvic cavity through an opening in the pelvic bone (obturator foramen)
- Difficult to diagnose due to lack of visible bulging
-
Umbilical hernia: Protrusion through a dilated umbilical ring
- May contain fat and bowel
-
Paraumbilical hernia: Protrusion through the abdominal wall near the umbilicus
- May contain fat
-
Spigelian hernia: Protrusion through both the torn transverse abdominis and internal oblique muscles
- External oblique muscle is intact
- Mushroom-shaped or anvil-shaped hernia: Correlates with non-reducibility and an increased risk of strangulation
-
Inguinal hernia: Protrusion through the inguinal canal
- May contain the uterus and ovary in females
-
Incarcerated hernia: Herniated tissue becomes trapped and cannot be easily returned to its original location
- May lead to bowel obstruction or strangulation
- Can become strangulated, which cuts off blood flow to the trapped tissue
Advantages of sonography
- Sonography offers specific advantages over other imaging modalities in assessing abdominal wall pathology
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Description
Test your understanding of sonography terminology and concepts related to the abdominal wall. This quiz covers essential definitions like echogenic, anechoic, and terms related to diaphragmatic crura. Perfect for students in medical imaging and sonography courses.
