Contrast, para, thora, amnio

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1

What does contrast Media consist of?

millions of little bubbles

2

How big are the bubbles created by the contrast agents?

7 microns

smaller that the Red Blood Cells

3

How does contrast agents help us to view the liver?

This allows us to differentiate Normal from Abnormal tissues

4

What is the blood flow in the capillaries?

100,000,000 times slower than in the Aorta

5

What is the best way of introducing Contrast Agents into the body?

IV infusion

6

Why has Tumor angiogenesis been the target of recent efforts in Cancer Therapy?

of its recognition as an essential step in Tumor progression.

7

What are the changes in size of the contrast bubbles proportional to?

the intensity of the incident sound.

8

What is the volume flow rate for fluid in a cappillaries?

1 cc per year per capillary.

9

What is the structure of contrast agents?

Liquid phase

stabilizing shell

gas content

10

What could cause fluid in the space?

disease

infection

cancer

blood

lymph disorders

11

What removes the byproducts of contrast media from the blood?

The Reticulo-endothelial cells

12

Why does contrast agents work well in low doses?

they respond to the Ultrasound pulse waves A transient signal that is rich in strong harmonic echoes

13

What would be the most appropriate for locating abnormalities within solid organs?

Tissue specific contrast agent

14

What are the delivery methods of Contrast Media?

Oral agents

Vascular agents

Tissue Specific agents - solid organs

Infusion

15

What is the best way to introduce contrast agents

Infusion

16

What must contrast agents be?

biodegradable

Safe

17

How do contrast agents work?

bubbles oscillate in size

sound is a pressure wave which makes bubbles oscillate

In solid organs the changes in acoustic properties allows us to determine between normal and abnormal tissue

18

What is dangerous about bubbles?

Large bubbles

19

How can contrast agents be helpful with drug delivery?

may be used to deliver drugs to target areas

20

What happens to the contrast agents after an exam?

The liver

the body gets rid of the microbubbles through its normal physiological way

21

Which cells remove byproducts from the blood

reticulo-endothelial cells

22

What is Thoracentesis?

the removal of fluid from the space between the lungs and the chest wall

23

What is another name for thoracentesis?

Pleural fluid removal

24

Where is the drainage happen?

through the back

25

How long has thoracentesis been performed?

since Hippocrates

26

How was early thoracentesis?

incision or cautery

27

Why was early thoracentesis performed?

to drain an emphysema

28

Why was early thoracentesis rarely done?

considered risky and of little benefit

29

When did thoracentesis become a common procedure?

mid nineteenth century

30

What is the indication for thoracentesis?

unexplained pleural effusion

31

What could case fluid in the space?

disease

infection

cancer

blood

lymph disorders

32

Why would analysis be done?

explain the cause of pleural effusion

33

What happens with pleural effusion less than 1 cm?

it is generally not performed

34

Why is with pleural effusion less than 1 cm not drained?

it is technically difficult.

35

Why is therapeutic thoracentesis indicated?

relieve symptoms from large pleural effusion

visualization of the lungs

relieve a tension pneumothorax

36

What is pneumothorax?

collapsed lung

37

Increased fluid can cause difficulty ______.

breathing

38

What can removing the excess fluid do?

reduce pressure

ease breathing

39

What is the pleura?

thin serous membrane

40

What does the parietal pleura line?

ribs

mediastinum

diaphragm

41

What does the visceral pleura line?

lungs

invaginates into the fissures of the lungs

42

How large is the pleura space?

10 to 12 mm

43

What is a normal amount of fluid in the pleura space?

small amount

44

What does the serous fluid do?

acts as a lubricant when the lungs move

45

Why does fluid enter the pleural space?

Starling transudation

46

What is Starling transudation?

the higher systemic pressure in the parietal pleura drives migration of fluids into the pleura space

the net flow across the visceral pleura is probably zero

47

What is the role of reabsorption of pleural fluid?

Starling forces

lymphatics

48

What is Starling's mechanism influenced by?

hydrostatic pressure and the amount of protein in the fluid

49

What is transudate?

extravascular fluid with low protein content and a low specific gravity

major mechanism for abnormal fluid accumulation are changes in hydrostatic pressure and protein leakage

50

What causes transudate?

congestive heart failure

Nephrotic Syndrome

51

What is exudate?

Lymphatic blockage especially through pleural involvement in disease processes produced an exudate

52

What causes exudate?

neoplasms

pulmonary infections

53

Where does the procedure usually occur?

hospital

outpatient

54

What does the doctor request before thoracentesis?

X-ray

55

What is the patients position?

upright

feet & arms supported

56

What is used to prevent pain during thoracentesis?

local anesthetic

57

Where is the trochar placed?

between the ribs

58

What is the catheter attached to?

suction

59

What is the patient instructed to not do?

cough

60

Why should the patient not cough, breath deep or move suddenly while the doctor inserts the needle?

Pneumothorax and hemothorax is always a possible complication

61

What is Pneumothorax?

A collapsed lung

62

What is hemothorax?

presence of blood in the pleural space

63

What should the patient do after the procedure?

lie still

monitored for an hour

64

When should the patient notify their healthcare worker?

hard time breathing after discharge

65

What are the contradictions of a thoracentesis?

Uncooperative patient

coagulopathy

chest wall infection

very small effusion

66

What does coagulopathies include?

prolonged prothrombin time

critically low platelet counts

anticoagulant

67

When should thoracentesis be delayed?

until coagulopathy is corrected

68

What should you do if a patients chest wall is infected?

thoracentesis should not be done unless an unifected area can be used

69

Pros & Cons of commercially prepared thoracentesis trays?

save time in setting up

more expensive

trays may not have all of the equipment

70

What is Ascites?

the presence of excess fluid in the peritoneal cavity

71

What is Free fluid?

AKA ascites

72

Why does ascites most frequently occur?

Chronic liver disease

73

What are the causes of ascites?

decreased hydrostatic pressure

decreased osmotic pressure

increased permeability of peritoneal capillaries

leakage of fluid into the peritoneal cavity

74

What are the causes of decreased hydrostatic pressure?

Cirrhosis

hepatic vein occlusion

inferior vena cava obstruction

constrictive pericarditis

Congestive heart failure

75

What are the causes of decreased osmotic pressure?

end-stage liver disease with poor protein synthesis

Nephrotic syndrome with protein loss

malnutrition

protein-lowing enteropathy

76

What are the causes of increased permeability of peritoneal capillaries?

tuberculous

bacterial peritonitis

malignant disease of the peritoneum

77

What are the causes of leakage of fluid into the peritoneal cavity?

Bile ascites

pancreatic ascites 2nd to leaking pseudocyst)

Chylous ascites

Urine ascites

78

What are the miscellaneous causes of ascites?

Ovarian disease (Meigs syndrome)

chronic hemodialysis

79

What are the clinical symptoms of ascites?

vary

asymptomatic

increased abdominal girth

early satiety

respiratory distress

80

What is the clinical signs of ascites?

abdominal distention

bulging flanks

tympany of the top

fluid wave

shifting dullness

puddle sign (poke stays)

81

Why would an U/S exam be performed for ascites?

to detect or exclude the presence of fluid in the physical examination is not definitive

* abdominal U/S can detect small amounts of fluid as 100mL

82

How small of an area of ascites can U/S detect?

100 mL

83

When should abdominal paracentesis with analysis of the ascites fluid be done in patients?

new onset

patients requiring hospitalization due to ascites

patients whose condition deteriorates during hospitalization

84

What are the risks and of paracentesis?

pregnant with bleeding

pregnant with unstable vitals

slight risk of needle puncture - bowel, bladder, vessel

85

What precautions should be made during Paracentesis? How often?

Blood pressure and temperature should be checked every 15 minutes

patients should be watched for any complications such as shock

86

What images are required for a paracentesis?

pre & post procedure image

87

Paracentesis placement?

Don't pick a place too lateral or medial

88

What are the lab tests performed on ascites?

Cell count

cytology

culture

gram stain

total protein

glucose

lactate dehydrogenase (LDH)

amylase

mycobacterial smear and culture

89

When should amniocentesis be performed?

only when the risk of having a baby with a major birth defect is greater than the risk of the procedure

90

What is the risk of amniocentesis?

1 in 400

91

What is amnio fluid made of?

cells from skin, lungs, umbilical cord, and urination

92

What are the types of amniocentesis?

genetic

lung maturity

93

why is early amnio not performed?

high risk of fluid loss

high risk of loss of fetus

94

When is a genetic amniocentesis performed?

between 15 - 18 weeks

95

what happens if amniocentesis is performed before 12 weeks?

increased risk of club foot & scoliosis

96

When do the kidneys take over production of amniotic fluid?

16 weeks

97

When is amniocentesis performed to check lung maturity?

between 30 - 36 week

98

What is the sonographers role during an amniocentesis procedure?

perform detailed fetal scan

assist physician

evaluate fetus after procedure with m-mode

99

What equipment is used for an amniocentesis procedure?

Amniocentesis kit

Sterile gloves

100

When scanning for an optimal site what should you look for during an amniocentesis??

Away from the fetus, cord and placenta

Near maternal midline

101

Why do you want to be near midline during an amniocentesis?

to avoid uterine arteries

102

Explain the Amniocentesis procedure.

Scan the abdomen for an optimal site.

  • Away from the fetus, cord and placenta
  • Near maternal midline

Prep the abdomen with antimicrobial

Transducer is placed within a sterile bag

A sterile needle guide may be attached

Sterile gel is placed on the abdomen

The sonographer wears a sterile glove and a nonsterile glove

The needle is visualized during procedures

When proper depth is reached a syringe is attached

The physician will discard the first few milliliters

30 ml are withdrawn

* if past 20 weeks 40 ml will be needed

The needle is withdrawn under ultrasound guidance.

Hold pressure and add bandage

Post procedure fetal heart rate is documented

103

What is done during an amniocentesis procedure during multiple pregnancies?

Each amniotic sac must be sampled

After first sample indigo blue dye is injected

If second sample is not clear would indicate reentry into previous sac

104

What is karyotyping

is a test to examine chromosomes in a sample of cells, which can help identify genetic problems as the cause of a disorder or disease. This test can: Count the number of chromosomes. Look for structural changes in chromosomes

105

How many chromosomes?

23 chromosomes

  • 22 autosomes
  • 1 sex chromosome
106

What is Abdominal Wall Defects?

omphalocele - herniation of abdominal organs into a sac

gastroschisis - herniation of abdominal organs into the amniotic cavity

*An opening in the abdominal wall can often be surgically repaired at birth, with a good outcome.

107

What is Down Syndrome?

occurs when an individual has a full or partial extra copy of chromosome 21.

108

What is an Open Neural Tube Defect?

an opening in the spinal cord or brain that occurs very early in human development.

109

What is Anencephaly?

the absence of a major portion of the brain, skull, and scalp that occurs during embryonic development.

110

What is Spina Bifida Occult?

mildest form of spina bifida. The outer part of some of the vertebrae is not completely closed but the spinal cord does not protrude. The skin at the site of the lesion may be normal, or it may have some hair growing from it; there may be a dimple in the skin, or a birthmark

111

What is Spina Bifida Meningocele?

the least common form of spina bifida. In this form, the vertebrae develop normally, but the meninges are forced into the gaps between the vertebrae

112

What is Spina Bifida Myelomeningocele?

the spinal cord protrudes through the opening

113

What is Trisomy 18?

Occurs when an individual has a full or partial extra copy of chromosome 18

114

What is Sickle Cell Disease?

abnormal hemoglobin stick to one another and form long, rod-like structures. These structures cause red blood cells to become stiff, assuming a sickle shape. The RBCs tend to clump and cause obstruction.

115

What is Cystic Fibrosis?

genetic disease that causes thick, sticky mucus to form in the lungs, pancreas, and other organs.

116

What is Thalassemia?

abnormal formation of hemoglobin results in improper oxygen transport and destruction of red blood cell

117

What is Tay-Sach’s?

Fat invades nervous tissue.

progressive deterioration of nerve cells and of mental and physical abilities that begins around six months of age and usually results in death by the age of four.

118

What is Huntington’s disease?

causes the progressive breakdown (degeneration) of nerve cells in the brain.

119

What is a hysterosonogram?

The uterus is filled with saline and then scanned transvagally

120

Why would a hysterosonogram be performed?

abnormal bleeding in pre and post menopausal patients

limitations of transvaginal exam and the diagnosis of abnormal uterine bleeding

121

What is transvag exam good at diagnosis of?

myomas

thickened endometrium

122

What is hysterosonogram good at diagnosis that a transvag is not?

polps

submucous myomas

homogeneously thickened endometrium

123

What is the sensitivity of a hysterosonogram?

94.9 %

124

What is the specificity of hysterosonogram?

89.3%

125

What is sensitivity?

percentage of people who have a problem that were correctly identified

126

What is SIS?

Saline induced sonohysterogram

127

SIS delineates masses or defects in the uterine wall

...

128

SIS distinguishes between focal lesions and global endometrial thickening

...

129

What is a speculum used for during an SIS?

expose the cervix

which is then cleaned with iodine swab

130

Once the cervix is clean what is the next step?

a catheter is guided in toward the cervical OS

advancement of the catheter is aided by grasping the end 2 - 5 cm from the tip with a ring forceps and gently feeding through the cervix to position the tip beyond the endocervical canal

131

What is used to slow down the escape of fluid during an SIS procedure?

acorn

132

How much saline is needed during an SIS exam?

2 - 5 ml

all that is needed to distend the cavity adequately

133

What is the prep for a SIS procedure?

empty the bladder

134

What is a submucosal fibroid?

grows into the endometrium cavity

135

What are the adverse events of a SIS procedure?

DIscomfort

cramping

Pain (menstral like)

infection

136

What is the percentage of cramping after an SIS procedure?

33.3 %

137

How many women have pain after a SIS procedure?

11.5 %

138

What is the percentage of infection after an SIS exam?

2.5%