Abdomen II Final Exam Review PDF

Abdomen II Final Exam Review 8/10/24 Interventional Procedures  Interventional Procedures Used for aspiration of abscesses, cysts, and fluid collections. Paracentesis - removal of peritoneal fluid with a catheter (ultrasound is a gold standard) Thoracentesis – removal of pleur...

Abdomen II Final Exam Review 8/10/24 Interventional Procedures  Interventional Procedures Used for aspiration of abscesses, cysts, and fluid collections. Paracentesis - removal of peritoneal fluid with a catheter (ultrasound is a gold standard) Thoracentesis – removal of pleural fluid collections with catheter Amniocentesis - a procedure used to take out a small sample of the amniotic fluid for testing Cystic collection – aspirations of the large cysts, seromas, Baker’s cysts, joints effusions Abscesses – aspirations of the infected collections including deep pelvic and peritoneal lesions  Interventional Procedures The main advantage of using ultrasound for guidance is to have continuous real-time visualization of the biopsy needle. This allows adjustment of the needle as needed during the procedure. Biopsies are used to confirm if a mass is benign, malignant, or infectious.  IR Possible Complications Postprocedural pain or discomfort Vasovagal reactions Hematomas AV fistulas Hemorrhage Seroma Pancreatitis Pneumothorax Infection Peritonitis Death Inconclusive biopsy results  IR Contraindications uncorrectable bleeding disorder (coagulopathy) ongoing anticoagulative therapy (heparin, coumadin, some supplements, etc.) lack of a safe needle path uncooperative or non- consentable patient Musculoskeletal Ultrasound  MSK Artifacts Anisotropy - occurs when curved surfaces are being imaged, depends on the angle due to the curved structure, heel-toe rocking of the probe creates optimal 90° imaging Refraction- bending of transmitted sound beam to an oblique path, seen as an edge artifact Reverberation – arises when the ultrasound signal reflects repeatedly between highly reflective interfaces  Tendons Achilles is the largest tendon. Normal AP measurement is 5-6 mm. Point of insertion – Calcaneus bone Connects Gastrocnemius and Soleus muscles to Calcaneus  Tendinitis Tendon inflammation due to age-related elasticity loss, rheumatoid arthritis, overuse, or acute trauma. Tendinitis occurs in any tendon, more often in the shoulder, wrist, heel, and elbow. Baker’s Cyst Bursa: small sac between two moving surfaces, usually tendon and bone Types of bursa: communicating and non-communicating Baker’s Cyst – synovial fluid in communicating bursa, located in the medial popliteal fossa Causes: osteoarthritis, rheumatoid arthritis, knee overuse Complications: rupture, hemorrhage, extension to calf  Cellulitis Cellulitis initially results in the thickening of the subcutaneous layer. As cellulitis progresses, subcutaneous edema increases and appears as a “cobblestone” pattern. This pattern results from edema forming around subcutaneous fat globules and connective tissue. Color flow Doppler may highlight areas of hyperemia due to inflammation. It is important to recognize that “cobblestoning” is a nonspecific sign of subcutaneous edema, and diagnosing Muscle Trauma If there is a full tear (grade III), the muscle will be retracted, thickened and potentially surrounded by free fluid.  Muscle Tears Free fluid visualized between 2 muscles  Hematoma A hematoma is a solid swelling of localized bleeding and clotted blood within tissues due to trauma or disease. Which is an intramuscular hematoma and which is a subcutaneous hematoma? Neonatal Spine Neonatal Spine: Indications for US Dimple abnormalities: It is More than 2.5 cm from the recommended anus that these Asymmetrical infants are scanned before 6 Very deep months of age.  Hairy patches  Cutaneous extensions  Lumps along the spine  Hemangioma  Skin tags Neonatal Spine Spinal Canal Contents 4 3 1 2  Let’s try and remember… The caudal end of the spinal cord is the ________ _______________. Nerve roots projecting from the Conus are called the __________ ______________. The thin linear structures of the cauda equina _______________ with respiration. To be considered normal, the conus medullaris should typically end at or before _____.  Neonatal Spine How many lumbar vertebrae are there? How many sacral vertebrae are there? Where is the coccyx located? What is visualized here? Common Benign Finding Cyst of Filum Terminale: no clinical significance if occurs alone What is this structure called?  Meningocele / Meningomyelocele Which has spinal cord, meninges, and cerebrospinal fluid protruding into a defect in the spine? What protrudes in the other? A "tethered cord" is a condition where Tethered Cord the spinal cord is abnormally attached or fixed to surrounding tissues, typically within the lower spinal column. It is a fixation of the spinal cord in an abnormal caudal location. Sonographically, the conus will be low lying below the level of L2. This is the key to diagnosis. There will be an absence of pulsation of cauda equina with real-time observation. That is because the cord is fixated to surrounding tissues.  What is this? Is this mass likely benign or malignant? What type of material is the mass composed of?  Oh the Myelia’s This is hydromeyelia. It is a dilation of the central canal and may be present above the lesion or tethered cord. This is diastematomyelia. It is a splitting of the spinal cord into 2 symmetrical or asymmetrical hemi-cords which unite caudally. Neonatal Head  Identify the Bones of the Cranium 1 2 3 4  What is this? It is also called the __________ _______________. Do you know the portion of the white matter that connects the cerebral hemispheres? It is a structure we see in the midline sagittal view. It’s getting a little bumpy! What are the prominences or convolutions on the surface of the brain called? What are the shallow grooves called? What are the deeper grooves called? What’s the “mater”? The dura, arachnoid, and pia mater are known as the ___________________. These cover the brain and spinal cord.  What are these midline structures? 3 2 4 1 5 Ah the Choroids The choroids are a mass of special cells that rest in the ______________ _____________. ___________________ is formed in the choroid plexuses bilaterally. The choroids regulate intraventricular pressure by secreting and absorbing _______. The Christmas Tree Image The Tentorium Cerebelli is a V- shaped extension of the dura in the posterior fossa that separates the cerebellum from the cerebrum.  The Ventricles Which ventricles are seen in the sagittal midline view? Which ventricles are seen in the parasagittal view? Can we see them all in this coronal view? What is the fluid? What connects the lateral ventricles to the 3rd ventricle? What connects the 3rd and 4th ventricles? Isn’t this groovy? The caudothalamic groove is the area of fusion for the thalamus and caudate nucleus. This is an area of increased capillary fragility. As a result, this is the most common site for a periventricular bleed to occur. What do you think is happening here?  PVL What does PVL stand for? PVL is related to a lack of oxygen or a reduction of cerebral perfusion. It is characterized as multiple periventricular white matter infarcts and necrosis. On ultrasound, it is visualized as asymmetrical areas of increased echogenicity. As it progresses, there may be cystic periventricular regions visualized. PVL Examples Neonatal Hips Indications for Hip Ultrasound Hip “click” on manipulation Shortening of the femur Asymmetrical thigh skin folds Galeazzi sign  Risk Factors for DDH female neonate family history of DDH breech presentation primigravida uterus oligohydramnios swaddling Galeazzi Sign Is this patient positive for DDH? Why or why not? Anatomy of the Pelvis What 3 bones make up the pelvic girdle!  Anatomy of the Hip The hip joint is a “ball and socket” joint. The “ball” is the femoral head, and the “socket” is the acetabulum. The femoral head is cartilaginous at birth and begins to ossify between 2 - 8 months. The acetabulum comprises cartilage and bone. Normally, the femoral head sits deep in the acetabulum and 50% of  Name the Parts 1. _______________________ 2. _______________________ 3. _______________________ 4. _______________________ 5. _______________________ 6. _______________________ 7. _______________________ 8. _______________________ 9. _______________________ 10.______________________ _ Iliac Bone Where is the iliac bone in this image? What is its orientation (in the coronal flexion view), in relation to the transducer? Hip dislocation - femoral head is located outside of the Hip Abnormalities acetabulum The bones of the hip joint are Subluxation – “when the ball is not in contact with each other. not fully in the socket” Femoral head is shallow in Dislocation may be reducible or irreducible. location Occurs when a joint partially Subluxated dislocates. or This means the bones in the dislocated? joint are not in their normal positions, but are not completely separated either.  Barlow and Ortolani With the Barlow maneuver, the hips are moved _________ the midline. In the Ortolani maneuver, the hips are moved _____________ the midline. Which manipulation would confirm that the hip can be dislocated?  The Angles Alpha Angle normal measurement is > 60 Beta degrees Beta Angle normal measurement is < 55 degrees Alpha Which angle is better at describing acetabular depth ? Views of the Hip: Coronal  Views of the Hip: Axial Notice the U-shape in the axial flexed image. Breast  Identify the Layers 4 3 5 2 6 1  Where is the Mass? What quadrant is the mass in? Using the 123 method, where would you place the mass in relation to the nipple? What o’clock position Right Breast would be used to  Do you remember? Where is the most common site to find breast cancer? What is the most common benign mass found in the breast? What do cooper’s ligaments do? What is the tail of spence? What is a “hard finding” for breast cancer? Gynecomastia The ductal elements of the male breast hypertrophy due to a loss of testosterone.  Good Luck! If you study this power point thoroughly, you will do amazing on the final! Reminder, anyone that completed the full abdomen study as extra credit will have 5 points added to the final exam. You guys got this!!!