77 terms

CAHE ABDOMEN II- The Spleen & GIT

STUDY
PLAY

Terms in this set (...)

normal appearance of spleen
-homogeneous
-isoechoic to liver, may be slightly less echogenic
average adult spleen measurements
- 12 cm = length
- 7 cm = transverse
- 4 cm = thickness
wandering spleen
spleen that has migrated from normal location in the LUQ
accessory spleen
-AKA splenculus or splenule

-small, well-defined ectopic nodules of splenic tissue that is a common, normal variant
what may an accessory spleen be confused with?
-enlarged lymph nodes around spleen
-a mass in the tail of pancreas
sonogram of accessory spleen
-small rounded masses
-less than 5 cm in diameter
-located near splenic hilum
-isoechoic to spleen
splenomegaly
-enlargement of spleen
-most common abnormality
common causes of splenomegaly
-portal hypertension (most common)
-congestion
-lymphoma
-infection
-sickle cell anemia
sonogram of splenomegaly
enlargement greater than 12 cm in length or 5 cm in thickness
Granulomatous Disease
focal lesions most commonly caused by:

-histoplasmosis
-TB
-sarcoidosis
sonogram of Granulomatous Disease
-focal bright echogenic lesion
-individual or multiple
-with or without shadowing
splenic cysts
congenital or acquired
congenital splenic cysts
has endothelial lining present
acquired splenic cysts
-"posttraumatic" or "pseudocyst"
-inner cellular wall = absent
-fibrous wall present
-caused by trauma, infection or infarction
sonogram of splenic cysts
-small
-anechoic or mixed echogenicity
splenic infarct
tissue that has been deprived of oxygen eventually dies
causes of splenic infarction
-almost always from emboli of heart
-splenic artery aneurysm
-vasculitis
sonogram of splenic infarction
-as a peripheral hypoechoic wedge shaped lesion
-over time = hyperechoic eventually calcifies
-area of infarction = no color doppler signals
splenic trauma
spleen often injured in cases of blunt trauma
clinical findings of splenic trauma
-LUQ pain
-decreased hematocrit
sonogram of splenic trauma
-intraparenchymal or subcapsular hematomas found when splenic capsule remains
-perisplenic or intraperitoneal hematomas found with capsule rupture- fluid then forms around spleen
sonogram of splenic hematoma
-appears as crescent-shaped fluid collection
-small hypo separation medial to capsule
sonogram of laceration in spleen
Inhomogeneity of the splenic texture
splenic hemangioma
-most common benign tumor of the spleen
-patient = asymptomatic
complication of a splenic hemangioma
splenic rupture when tumor increases in size
sonogram of splenic hemangioma
-well defined
-hyperechoic mass
hamartoma
-rare
-patient = asymptomatic
-tumor = solitary or multiple

mostly benign, focal malformation that resembles a neoplasm in the tissue of its origin
sonogram of hamartoma
-well defined
-both solid and cystic components
-generally hyperechoic
splenic artery aneurysm
-localized dilation of splenic artery
-significant when over 2 cm in diameter when risk of rupture/fatal hemorrhage = present
-most common type
sonogram of splenic artery aneurysm
-cystic mass
-if calcified = hyperechoic shadowing foci in area of splenic artery
- color doppler confirms diagnosis
lymphoma
-most common malignancy of spleen
-hypoechoic mass = focal
-splenomegaly = diffuse
angiosarcoma
-primary malignant tumor of spleen
-sonogram = complex or solid mass
metastases
-result from a hematogenous spread from another primary site
frequent locations of metastases to the spleen
- malignant melanoma = most common
-breast
-kidney
-stomach
-ovary
-lung
sonogram of metastatic lesions
-commonly hypoechoic
hemolytic anemia
increased RBC destruction (hemolysis) resulting from 2 circumstances:

1. abnormality of RBC (sickle cell anemia)
2. destructive process is at work (infection/autoimmune conditions)
spleen appearance in earlier stage of sickle cell anemia seen in infants/children
spleen = enlarged with marked congestion
spleen appearance in later stage of sickle cell anemia
-undergoes progressive infarction/fibrosis
-decreases in size until in adults = only a small mass of fibrous tissue is found (autosplenectomy)
Lymphadenopathy
-lymph nodes = abnormal in either size or consistency

-either localized or generalized (2 or more non-contiguous areas involved)
benign lymphadenopathy
- less than 1 cm
-oval
-preserved echogenic hilum
-homogeneous
-ill defined border
-central hilar vascularity
Malignant Lymphadenopathy
- more than 1 cm
-rounded
-loss of echogenic hilum
-heterogeneous
-well defined border
-show peripheral or mixed vascularity
sandwich sign (hamburger sign)
-refers to a mesenteric vessels enveloped by enlarged mesenteric lymph nodes

-specific sign for mesenteric lymphoma (lymphatic system cancer)
normal bowel of GI tract
-compressible
-should have observable peristalsis
normal intestinal wall thickness
3-5 mm
differentiating between ischemia and inflammatory masses in GI tract
-ischemia = no color doppler
-inflammatory process = increased color doppler
location of antrum of stomach
-anterior to pancreas body
-target shape
Gastroesophageal Junction
point where distal esophagus joins the proximal stomach
location of Gastroesophageal Junction on sagittal scan
-to left of midline as target/bull's eye pattern
-anterior to aorta
-posterior to left lobe of liver
blood supply for small and large intestines
-celiac axis
-SMA
-IMA
appendix
-long, narrow blind ended tube
-in RLQ, opening into the cecum
-max outer diameters = up to 6 mm
appendicitis
-inflammation of the appendix
-most common cause of abdominal pain resulting in surgery
acute appendicitis
may result from some form of obstructive process like an appendicolith, lymph node, tumor or parasite
complication of appendicitis
- perforation
-peritonitis
-abscess formation
-possible death
clinical findings of appendicitis
-history of epigastric pain
-periumbilical pain
-general abdominal pain confining over time to RLQ
-leukocytosis
mcburney's sign
-rebound tenderness in RLQ
-technique = apply gradual/uniform pressure with probe over area of interest
transducer used to evaluate acute appendicitis
5 or 7.5 MHz linear array
sonogram findings for acute appendicitis
-non-compressible, blind ended tube
-measures more than 6 mm in diameter (outer-to-outer)
-appendicolith = echogenic shadowing structure within lumen
-Periappendiceal fluid collection
-hyperemic flow within wall of inflamed appendix
mechanical obstruction of intestines
results from bowel being physically blocked by something
non-mechanical obstruction of intestines
AKA paralytic ileus

when bowel lacks normal peristalsis
sonogram of intestinal obstruction
-multiple dilated fluid-filled loops of bowel proximal to obstruction site
-abrupt termination point of distended bowel
-peristaltic motion = increased with signs of to-and-fro motion of intraluminal contents (mechanical ONLY)
keyboard sign
valvulae conniventes may be seen in longitudinal section as linear echo densities outlined by a fluid in duodenum and jejunum
adenocarcinoma
-most common malignant tumor of GI tract commonly arising from stomach
gastric carcinoma sonogram
-hypoechoic
-irregular shaped
-bulk mass
-measure up to 10 cm
ascites
-abnormal accumulation of free fluid in peritoneal cavity (abdomen)
-found in association with liver failure, abdominal trauma, malignancy
common location ascitic fluid collects
-morrison's pounch
-paracolic gutters (spaces b/w colon & abdominal wall)
-pouch of douglas (in supine)
transudative ascites (benign ascites)
-characterized as a lack of protein and cellular materials in the fluid
-associated with portal hypertension & congestive cardiac disease
exudative ascites
-fluid that seeps out from blood vessels & contains a large amount of protein & cellular material
-can be malignant form
-associated with renal failure, inflammatory or ischemic bowel disease, peritonitis, malignancy
sonogram of pleural effusion
-superior to right hemidiaphragm within chest cavity
-lung seen suspended within fluid
-no fluid seen inferior to diaphragm in subphrenic space
vascular resistance following ingestion of a meal
-decreases to meet metabolic demands for additional blood flow associated with digestion

-systolic and diastolic velocities normally increase at least twofold to meet demand
normal SMA & IMA flow pre-prandial
high resistance
normal SMA & IMA flow post-prandial
low resistance with increase diastolic flow
Abnormal SMA and IMA flow postprandial
no change in resistance
diagnosis of mesenteric ischemia
-with stenosis/occlusion of TWO or MORE of the 3 major arteries supplying small bowel/colon with oxygenated blood (CA, SMA, IMA)

-patient experiences reproducible pain AFTER eating due to bowel ischemia
IMA doppler spectral waveforms in fasting & postprandial states
mimic those of the SMA
resistance to blood flow in patient with SMA stenosis when digestive system is active
resistance to blood flow remains high after eating
normal pre-prandial SMA high-resistance spectral waveform
-rapid acceleration in systole
-rapid deceleration in diastole
-low diastolic flow
-flow reversal commonly seen in early diastole with little or no flow in end diastole
normal postprandial SMA low-resistance spectral waveform
-increase in diastolic flow
YOU MIGHT ALSO LIKE...
STUDY GUIDE