Emergent RUQ article intro and assignment Student
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ARTICLE ASSIGNMENT #2b
EMERGENT RIGHT UPPER QUADRANT SONOGRAPHY
INTRODUCTORY INFORMATION:
One of the most common emergency ultrasound examinations performed
This article is a very good review of biliary, pancreatic and liver diseases which may present in the ER
Correlation with CT findings
Most of the information contained in this article is not new to you. The purpose of this article is to cause you to revisit those pathologies which you have already been introduced to, and to add some more detail.
BACKGROUND INFORMATION:
WATCH THE ACCOMPANYING POWER POINT
Many ultrasound departments do not allow scanning of the RUQ alone—they require the entire abdomen to
be visualized. However, in busy centers, the protocol may require RUQ alone, only in the interest of time. Technicians are required to perform whatever the protocol of the department states.
Note the listing of “normal” values, on page 480 of the article, and the disclaimer below stating that “not all normal values given here are universally agreed on.” Table 2 pg 481. RUQ sonographic and CT signs
Terminology which may be new to you from the accompanying power point
1. Ball-on-the-wall sign – polyp attached to wall – stalk not visible
2. Mercedes-Benz sign – a radiology term used in plain films and with CT
Though infrequently seen, a characteristic finding of gallstones is the "star" sign or "Mercedes - Benz" sign.
Gallstones contain gas which appears as stellate–triradiate pattern resembling the insignia of Mercedes-Benz automobile. CT seems to delineate better the quantity of air inside the stones. 3. Starry – Sky sign (sometimes called starry-night) – increased echogenicity of portal vessel walls often seen with acute hepatitis.
4. Pericholecystic fluid - fluid in close proximity to the gallbladder
ARTICLE ASSIGNMENT #2b
EMERGENT RIGHT UPPER QUADRANT SONOGRAPHY
1. What distinguishes a sludge ball from a tumour or polyp. What specific maneuver would you do in order to demonstrate this while performing an ultrasound?
Its mobile you can use the “gravity dependent maneuver”, which is when u turn your patien tin their
side allowing the sludge to settle.
2. List 3 sonographic criteria which may be visualized during a scan of a patient with acute cholecystitis.
1.
_positive murphy’s sign_____________________ 2. _GB wall thickening ______________________ 3. __Pericholecystic fluid ______________________________________ 3. How does this article describe the sonographic appearance of wall-necrosis?
They described it as hyperechoic and even hypoechoic bands in a thickened irregular GB wall.
4. Wall edema may be seen with acalculous cholecystitis, or it may be present because of other conditions. Name two other conditions which may be result in this appearance.
Congestive heart failure and ascites 5. What is the most common type of gall bladder polyp and what size are they usually?
The most are Cholesterol polyps and are usually smaller than 5 mm. 6. What is name of the gallbladder condition characterized by focal or diffuse mucosal hyperplasia of the GB wall? It is associated with mucosal herniation into the Rokitansky-Aschoff sinuses
.
It’s adenomyomatosis and yes, its pathologically associated with mucosal herniation into the Rokitansky-Aschoff sinuses.
7. List 2 sonographic biliary findings may be evident in a patient with Human Immunodeficiency Virus (HIV)?
Gallbladder wall thickening without gallstones or pericholecystic fluid.
8. What is the most common location for biliary obstruction and what are the 3 most common causes?
The most common obstructions are in the distal duct. The 3 most common causes are,common bile duct stones, pancreatitis, or pancreatic cancer.
9. What is the most common diffuse liver infection encountered in the acute setting and what is the sonographic appearance?
Viral hepatitis ( “starry sky” appearance)
10. List 2 common grey-scale signs of liver cirrhosis and 1 Doppler criterion. Grey-scale
1. _coarsening and nodularity 2. __ loss of portal triad definition _______________________
Doppler
1. __ arterial flow diversion to portal system ____________________
11. What are the two hallmark signs of acute pancreatitis on sonography?
1. ___Pancreatic enlargement_________________
2. _____decreased echogenicity________________
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