Biology

 Which of the following statements regarding appendicitis is FALSE? a. A calcifi ed appendicolith can help identify an

infl amed appendix

b. An infl amed appendix will demonstrate hyperemic fl ow with color or power Doppler

c. A noncompressible appendix greater than 6 mm is considered abnormal

d. Sonography cannot visualize a normal appendix

16. A 20-year-old patient presents with right lower quadrant pain. The sonogram demonstrates an 8-mm noncompressible target shaped lesion at the area of maximum tenderness. A calcifi cation is seen within the lesion. What is the most likely diagnosis? a. Crohn’s disease

b. Appendicitis with appendicolith

c. Intussusception with bowel tumor

d. Ileus with bowel distention

17. Where do the majority of colon cancers occur? a. Sigmoid colon

b. Ascending colon

c. Cecum

d. Rectum and rectosigmoid colon

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9 — The Gastrointestinal Tract 83

18. Your patient complains of abdominal pain; while scanning over the area of tenderness, you locate a loop of bowel with visible haustra. This is characteristic of which part of the GI tract? a. Stomach

b. Small intestine

c. Large intestine

d. All parts of the GI tract display this characteristic feature

19. Which part of the GI tract can be seen curving around the pancreatic head? a. Stomach

b. Duodenum

c. Jejunum

d. Ileum

20. A patient presents with abdominal pain and your evaluation reveals multiple dilated fl uid fi lled small bowel loops with markedly increased peristalsis. What is the most likely diagnosis? a. Intussusception

b. Crohn’s disease

c. Bowel obstruction

d. Diverticulitis

FILL-IN-THE-BLANK

1. Sonography is not often the examination of choice for

evaluating the GI tract due to the diffi culty caused by

the presence of in the GI tract.

2. Both and

approaches may be used to evaluate the GI tract

sonographically.

3. Sonographically, the bowel wall is described as

layers. The layers are the innermost

echogenic layer representing the

interface. Next is a hypoechoic layer made up of

the , , and

. Next is the echogenic

, followed by the hypoechoic

, and fi nally the echogenic

.

4. Squamous cell carcinoma can present with the

clinical symptom of , or diffi culty

swallowing.

5. The fundus of the stomach lies

to the spleen and to the left

kidney. The body and antrum lie anterior to the

.

6. Chronic gastritis may present with generalized

thickening of the hypoechoic layer

of the stomach wall.

7. Gastric peptic ulcers are much less common than

ulcers in the United States,

typically appearing along the antral portion of the

.

8. The folds that can sometimes be seen projecting into

the fl uid-fi lled lumen of the small bowel are called

.

9. Sonographically, the small bowel is typically more

distended with an than with an

ileus.

10. With ileus, the small bowel is distended with

or , and peristalsis

can be normal to .

11. A volvulus will appear as a dilated,

-shaped loop containing only

and no air.

12. Intussusception is more common in

than in . When it does occur in

adults, it is almost always secondary to a bowel

.

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84 PART 1 — ABDOMINAL SONOGRAPHY

13. Crohn’s disease is a common cause of bowel wall

infl ammation and presents sonographically as

of the bowel wall and surrounding

. The typical sonographic

appearance is a lesion.

14. The normal appendix extends from the

and should measure no more

than mm in diameter with a wall

thickness of mm or less.

15. The appendix is located under

point, which is located by drawing an imaginary line

from the right anterosuperior to

the umbilicus. The appendix is usually found at the

midpoint of this line.

16. When evaluating the appendix, the sonographer

should use the technique to

displace gas- or fl uid-fi lled bowel loops and locate the

area of maximum tenderness.

17. Complications of appendicitis include

formation, , or .

18. Lymphadenopathy in the right lower quadrant

surrounding the cecum is termed

. Lymph nodes greater than

mm are considered abnormal.

19. The colon lies along the of the

abdomen, is larger in diameter than the small bowel,

and contains characteristic folds.

When the colon is not distended, the wall should

measure mm thick.

20. Ulcerative colitis is an infl ammatory disease that

affects the and

layers of the colon. Infl ammation starts in the

and may extend throughout the

colon.

SHORT ANSWER

1. Although the majority of evaluations of the GI tract are performed transabdominally, endoluminal examinations can provide useful information. What structures can be evaluated with an endoluminal examination, and how does it compare to a transabdominal examination?

2. What techniques may be used to evaluate the stomach and duodenum sonographically?

3. You are asked to perform an abdominal sonogram to rule out appendicitis in a 10-year-old patient. Describe the technique used to locate and evaluate the appendix for appendicitis.

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9 — The Gastrointestinal Tract 85

IMAGE EVALUATION/PATHOLOGY

Review the images and answer the following questions.

1. A 45-year-old patient presents with acute pancreatitis, abdominal pain, and distention. Peristalsis is noted within the bowel and is mildly increased. Describe the image shown. What is a possible diagnosis? What normal structures are the arrows pointing to?

2. A 59-year-old patient presents for an abdominal sonogram with severe epigastric pain. The patient is able to demonstrate an area that is the most painful. This image is taken at that area. Multiple concentric rings are demonstrated within the visualized bowel. This is diagnostic of what bowel pathology? In adults, what is the most common cause of this pathology?

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86 PART 1 — ABDOMINAL SONOGRAPHY

3. A 24-year-old patient presents with a history of Crohn’s disease. Describe the bowel seen in this image. Which part of the bowel is most commonly affected by Crohn’s disease?

4. A 14-year-old patient presents with severe RLQ pain, nausea and vomiting, and leukocytosis. Your examination of the RLQ reveals this image. What are the arrows pointing to? What is the normal measurement for the wall of the appendix? What is the normal diameter of the appendix?

5. Describe what is seen in this image of the stomach. In what layer of the stomach wall do gastric carcinomas typically occur?

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9 — The Gastrointestinal Tract 87

CASE STUDIES

1. A 6-year-old patient presents with RLQ pain and fever. These images are taken in the RLQ. Describe what is seen. What is the diagnosis? What complications may occur with this pathology?

2. A 64-year-old patient presents with abdominal pain and a history of diverticulosis. What are the arrows in this image pointing to? Where does this pathology most commonly occur? What complications may arise?

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89

REVIEW OF GLOSSARY TERMS

MATCHING

Match the key terms wtith their defi nitions.

Key Terms Defi nititons

1. Azotemia

2. BUN

3. Creatinine

4. Diuresis

5. Dysuria

6. Gerota’s fascia

7. Hematuria

8. Hypernephroma

9. Nephrectomy

10. Nephropathy

11. Oliguria

12. Proteinuria

13. Pyuria

14. Urosepsis

a. Blood in the urine b. Blood test along with BUN used to measure the

kidneys’ ability to remove waste in the blood c. Bacterial infection in the bloodstream as a result of a

urinary tract infection d. An overload of nitrogenous wastes such as blood

urea nitrogen, uric acid, and creatinine, which occur with renal failure

e. Pus in the urine f. Painful urination g. Kidney disease h. Blood test that evaluates the amount of nitrogenous

waste in the blood and serves as a measure of kidney function

i. Low output of urine that is the result of many possible causes including dehydration, renal failure, or urinary obstruction

j. Increased production of urine that can occur with diabetes mellitus, acute renal failure, or increased fl uid intake

k. Another term for renal cell carcinoma l. Also known as the renal fascia; dense connective

tissue that surrounds and helps anchor the kidney, adipose capsule, and the adrenal gland

m. Surgical removal of the kidney n. Protein in the urine; sign of kidney disease

10 The Kidneys

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90 PART 1 — ABDOMINAL SONOGRAPHY

ANATOMY AND PHYSIOLOGY REVIEW

IMAGE LABELING

Complete the labels in the images that follow.

B C

D

EFG

A

J

I H

1. Retroperitoneal anatomy

C

A

B

D

E

F

G

L5

2. Urinary systsem

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10 — The Kidneys 91

B

E

F

G H

AK

L

M

J

I

C

D

3. Renal anatomy

4. Renal anatomy

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92 PART 1 — ABDOMINAL SONOGRAPHY

CHAPTER REVIEW

MULTIPLE CHOICE

Complete each question by circling the best answer.

1. Which of the following is sonography of the kidneys NOT used for? a. Assess the size of the kidney, including length,

width, and thickness

b. Evaluate the echogenicity of the renal cortex, medulla, and sinus

c. Evaluate the function of the kidneys

d. Differentiate between cystic and solid lesions

2. What is the functional unit of the kidney? a. Mesonephros

b. Nephron

c. Hepatocyte

d. Pronephros

3. Approximately when do the kidneys begin to function? a. 4 weeks

b. 6 weeks

c. 8 weeks

d. 10 weeks

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