role of a sonographer a specific behavior that an individual demonstrates to others Anechoic without echoes, sonolucent Hyperechoic more echogenic than the surrounding tissue Gallstones cholelithiasis single large or hundreds of tiny ones internal reflections without the lumen, and posterior acoustic shadowing Homogenous structures liver, thyroid, testes, spleen Solid mass irregular borders, internal echoes, decreased through-transmission Cystic mass smooth, well defined borders, anechoic, increased through-transmission echogenic / hyperechoic echo producing structure, reflects brighter intensity Heterogeneous not uniform texture or composition Homogeneous completely uniform in texture Hypoechoic low level echoes within a structure Isoechoic very close to the normal paenchyma echogenisity pattern Imaging Planes sagital, coronal, transverse, median Location of liver right hypochondrium. inferior to the diaphragm. extends several centimeters below the qiphoid process. left lobe is anterior and medial to the fundus of the stomach Location of hepatic artery arises from the celiac trunk and courses to the right of the abdomen and branches into the gastroduodenal artery and proper hepatic artery SMA arises from the anterior abdominal aortic wall approx 1 cm inferior to the celiac trunk. runs posterior to the neck of the pancreas and anterior to the uncinate process, then branches into the mesentary and colon hepatic duct emerges from the right lobe of the liver in the porta hepatis and uunites to form the common hepatic duct. which then passes caudaly and medialy. runs paralles with the portal vein Muscles of the anterior abdominal wall rectus abdominus porta hepatus central area of the liver where the portal vein, common duct and hepatic artery enter caudate lobe most superior aspect of the liver falciform ligament extends into the diaphragm, from the umbilicus to the diaphragm ligamentum teres the rounded termination of the falciform, divides the medial and lateral segments of the left lobe ligamentum venosum separates the left lobe from the caudate lobe, linear horizontal line just anterior to the caudate lobe portal venous system main portal aproaches the porta hepatis in a rightward, cephalic, and slightly posterior direction clinical significance of peritoneal recess fluid and infection may accumulate in the recess portal triad porta hepatis, central area of the liver where the portal vein, common duct, and hepatic artery enter cruz of the diaphragm muscular structure in the upper abdomen at the level of the celiac axis falciform ligament attaches the liver to the diaphragm Morrison's pouch space between right lobe of the liver and anterior righ kidney renal cell carcinoma most common tumor to fill the IVC portal vein carries blood from the intestine to the liver vein formed by the union of the superior mesenteric vein and splenic vein near the porta hepatis of the liver gall bladder arterial supply via the cystic artery Superior mesenteric vein passes anterior to the uncinate process of the pancrease Aorta size 3 cm Budd Chiari syndrome demostrates thrombosis of the hepatic veins left renal vein courses between the aorta and SMA mosty common cause of abdominal aneurysms arterio sclorosis echogenic linear structure fund anterior to the caudate lobe and posterior to the left lobe of the liver ligamentum venosum group of muscles that orginate at the hilum of the kidney and lie lateral to the spine psoas muscles triangular shaped echogenic structure seen within the left lobe of the liver ligamentum teres portal confluence is formed by splenic vein and SMV gastroduodenal artery courses along the anterolateral border of the head of the pancreas main lobar fissure projects from the right poral vein to the neck of the gallbladder aneurysms greater than _____ have an increased risk of catastrophic rupture 5 cm any plane paralles to the median plane sagital vertical plane that bisects the body into right and left halves median any plane at right angles to both the median and coronal planes transverse any vertical plane at right angles to the median plane coronal arises from the anterior abdominal aorta approximately at the level of the third or fourth lumbar vertebra. proceeds to the left to distribute arterial blood to the descending colon, sigmoid colon, and rectum. branches into the left colic, sigmoid and superior rectal arteries. inferior mesenteric artery arteries that for the anterior, posterior, medial and inferior borders of the pancreas celiac axis and branches - for superior border , includes left gastric, common hepatic, splenic splenic - superior border common hepatic - superior border of the body and head gastroduodenal - anterolateral sma - posterior obstruction of the renal vein resulting in the kidney becoming enlarged and edematoas renal vein thrombosis increased lipid accumulation. seen in alcoholic liver disease, diabetes, obesity, pregnancy, severe hepatitis, chronic illness, and steroids fatty liver sonographic findings of acute hepatitis liver texture may appear normal or portal vein borders are more prominent than usual. the liver parenchyma is slightly more echogenic than normal or attenuation may be present l. hepatosplenomegaly is present and the gallbladder wall is thickened most common type of benign tumor of the liver cavernous hemangioma benign tumors of the liver cavernous hemangioma liver cell adenoma hepatic cystadenoma focal nodular hyperplasia symptoms of abscess fever of unknown origin tenderness swelling chills weakness malaise localized pain liver cells or hepatocytes as primary problem hepatocellular disease most common presentation of an athersclerotic aneurysm, usually occurs at the bifurcation fusiform spherical and large, connected to a vascular lumen by a mouth that may be as large as the aneurysm, may be partially or completely filled with thrombus saccular Portal triad common bile duct, hepatic artery, main portal vein ligament that is the remnant of the fetal umbilical vein ligamentum teres the true anatomic boundary between the right and left lobes of the liver (segmental) falciform ligament normal size of the liver's anterior-posterior length 12 cm the echogenicity of the liver is _____ hyperechoic liver is enclosed by a fibrous capsule called _____ glissom capsule the functioning part of the liver is ____ parenchyma or lobule a pulsatile hematoma wich results from the leakage of blood into soft tissuewith subsequent fibrous encapsulation pseudoaneurysm