Free ARDMS Abdomen (AB) Exam Flashcards

13-15.5 cm is normal. A span greater than 15.5 cm meets the sonographic threshold for hepatomegaly.

The caudate lobe (Couinaud segment I), because it has an independent vascular supply. Relative caudate hypertrophy compared to a shrunken right lobe is a classic cirrhosis clue.

The fibrosed remnant of the fetal umbilical vein, seen as an echogenic focus in the left intersegmental fissure (free edge of the falciform ligament), which separates the medial (segment IV) and lateral segments of the left lobe.

Measured inner-wall-to-inner-wall; normal is under 6-7 mm. Diameter can normally increase up to about 10 mm after cholecystectomy.

Add roughly 1 mm per decade of life after age 60 - a diameter that would be borderline-abnormal in a 40-year-old can be normal in an 80-year-old.

Under 3 mm is normal when the gallbladder is distended. Thickening beyond this in a properly fasted patient raises suspicion for cholecystitis or other GB pathology.

Under 2-3 mm. A duct dilated beyond this raises concern for obstruction, chronic pancreatitis, or a pancreatic head/periampullary mass.

A spleen measuring over 12-13 cm in length is enlarged; normal splenic length is under 12 cm.

9-12 cm is the normal range for adult kidney length. A size discrepancy greater than about 2 cm between the two kidneys is abnormal and warrants further evaluation.

Normal renal cortex is hypoechoic (less echogenic) relative to the liver. Cortex that is iso- or hyperechoic to the liver suggests medical renal disease.

The renal sinus, because it is composed largely of fat surrounding the collecting system and vessels, and fat is highly echogenic on ultrasound.

5.5 cm in men and 5.0 cm in women - the lower threshold in women reflects their higher rupture risk at smaller diameters.

Normal portal flow is hepatopetal (toward the liver). Reversed, hepatofugal flow is abnormal and is classically seen with portal hypertension.

A triphasic waveform reflecting transmitted right atrial pressure changes through the cardiac cycle. A flattened or monophasic pattern suggests decreased liver compliance, such as from cirrhosis or fibrosis.

Normal renal RI is under 0.7. An RI over 0.7 is abnormal and can indicate intrinsic renal disease, obstruction, or - in a transplant - rejection.

Diffusely increased (hyperechoic) parenchymal echogenicity compared to the renal cortex, with poor sound penetration and beam attenuation into the deeper liver and diaphragm.

A small, nodular, coarse-echotexture liver with a shrunken right lobe and compensatory caudate/left lobe hypertrophy, plus signs of portal hypertension such as ascites and splenomegaly.

A well-defined, homogeneously hyperechoic mass - the most common benign liver tumor, typically small and asymptomatic.

Thrombosis or obstruction of the hepatic veins (or IVC), causing impaired venous outflow. Sonography shows absent, reversed, or turbulent hepatic vein flow with an enlarged, congested liver.

It indicates a gallbladder packed with stones: the GB Wall, a bright reflector Echo from the stone surface, and posterior acoustic Shadowing, with little to no visible bile between them.

Focal tenderness elicited when the transducer is pressed directly over a sonographically visualized gallbladder. A positive sign strongly supports acute cholecystitis.

A palpable, painless, distended gallbladder in a jaundiced patient - classically associated with a malignant distal biliary/pancreatic head obstruction rather than gallstone disease.

A cholangiocarcinoma arising at the biliary hilum (confluence of right and left hepatic ducts), causing intrahepatic ductal dilation without gallbladder or extrahepatic CBD dilation.

Bosniak I is a simple, anechoic, thin-walled benign cyst with no septa or calcification. Bosniak II is minimally complex - it may have a few thin septa or fine calcification - but is still considered benign.

IIF ('F' for follow-up) describes a cyst with slightly more complexity than category II. It requires periodic follow-up imaging rather than immediate intervention, since a small percentage prove malignant over time.

Bosniak III is indeterminate/complex and warrants surgical evaluation because a substantial proportion are malignant. Bosniak IV is clearly malignant, showing enhancing soft-tissue components, and is treated as cancer.

A small, well-defined, uniformly echogenic mass due to its fat content. The echogenic appearance helps distinguish it from a solid renal cell carcinoma, though overlap can occur.

Aliasing - a wraparound artifact where high velocities wrap to the opposite end of the color or spectral scale. Correct it by increasing the scale/PRF, shifting the baseline, lowering the transducer frequency, or increasing the Doppler angle.

An enlarged, edematous kidney with absent or reversed venous flow on Doppler; arterial waveforms may show elevated resistance or reversed diastolic flow.

Compression of the left renal vein between the aorta and the superior mesenteric artery (SMA), causing dilation proximal to the compression and symptoms such as hematuria and flank pain.

Splenomegaly, ascites, portosystemic varices, a dilated and often non-compressible portal vein, and possible hepatofugal (reversed) portal flow.

Perihepatic (Morrison's pouch), perisplenic, pelvic, and cardiac (subxiphoid) views - screening for free intraperitoneal or pericardial fluid after trauma.

It is the most dependent potential space in the peritoneal cavity in the supine position (the hepatorenal recess), so even small volumes of free fluid pool there first.

A rising resistive index (RI), often with graft swelling and loss of corticomedullary differentiation, compared to the patient's prior baseline scan.

At or above the level of the inguinal ligament, distinguishing it from a femoral hernia, which occurs below the ligament.

The Valsalva maneuver - having the patient bear down increases intra-abdominal pressure, pushing bowel or fat through the defect and making the hernia bulge more visible.

Its lower operating frequency and wider, diverging field of view give better penetration for deep abdominal organs, whereas linear transducers run at higher frequency and suit superficial structures.

Reverberation off small crystalline or cholesterol deposits in the gallbladder wall; it is the classic sign of adenomyomatosis.

Lower the transducer frequency to increase depth of penetration, accepting a tradeoff in resolution; harmonic or compound imaging can also help reduce noise.

Color Doppler shows flow direction but is angle-dependent and prone to aliasing. Power Doppler is more sensitive for detecting low-flow states but does not display flow direction.

NPO (nothing by mouth) for 6-8 hours before the exam. Fasting lets the gallbladder distend with bile for better evaluation and reduces bowel gas from digestion that could obscure the pancreas and other structures.

A distended bladder acts as an acoustic window, displacing bowel gas out of the pelvis and improving visualization of pelvic organs and the distal ureters.

Liver function tests such as bilirubin, AST/ALT, and alkaline phosphatase for hepatobiliary studies; BUN and creatinine for renal studies - abnormal labs help focus and interpret the scan.

60 degrees or less. Beyond this, small errors in angle measurement cause increasingly large errors in the calculated velocity, since the Doppler equation depends on the cosine of the angle.

Within the lumen of the vessel being interrogated, ideally centered in the flow stream, to avoid wall artifact and get a representative velocity measurement.

Correct patient identity, procedure site, and laterality, along with documented informed consent - a pre-procedure 'time-out' confirms these before the needle is placed.

HIPAA (Health Insurance Portability and Accountability Act) - it protects the privacy and security of patient health information and restricts who can access or share exam findings and records.

Repositioning can move bowel gas out of the way, confirm that mobile debris (like sludge) redistributes with gravity rather than staying fixed, and help distinguish gravity-dependent findings from true fixed masses.

Documented informed consent - the patient or authorized representative must be informed of the procedure's risks, benefits, and alternatives before it is performed.

The patient should be monitored for complications such as bleeding, hematoma formation, or new pain, and a post-procedure image is often obtained to document the needle path and rule out immediate complications.