Contrast, para, thora, amnio
What does contrast Media consist of?
millions of little bubbles
How big are the bubbles created by the contrast agents?
smaller that the Red Blood Cells
How does contrast agents help us to view the liver?
This allows us to differentiate Normal from Abnormal tissues
What is the blood flow in the capillaries?
100,000,000 times slower than in the Aorta
What is the best way of introducing Contrast Agents into the body?
Why has Tumor angiogenesis been the target of recent efforts in Cancer Therapy?
of its recognition as an essential step in Tumor progression.
What are the changes in size of the contrast bubbles proportional to?
the intensity of the incident sound.
What is the volume flow rate for fluid in a cappillaries?
1 cc per year per capillary.
What is the structure of contrast agents?
What could cause fluid in the space?
What removes the byproducts of contrast media from the blood?
The Reticulo-endothelial cells
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
What would be the most appropriate for locating abnormalities within solid organs?
Tissue specific contrast agent
What are the delivery methods of Contrast Media?
Tissue Specific agents - solid organs
What is the best way to introduce contrast agents
What must contrast agents be?
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
What is dangerous about bubbles?
How can contrast agents be helpful with drug delivery?
may be used to deliver drugs to target areas
What happens to the contrast agents after an exam?
the body gets rid of the microbubbles through its normal physiological way
Which cells remove byproducts from the blood
What is Thoracentesis?
the removal of fluid from the space between the lungs and the chest wall
What is another name for thoracentesis?
Pleural fluid removal
Where is the drainage happen?
through the back
How long has thoracentesis been performed?
How was early thoracentesis?
incision or cautery
Why was early thoracentesis performed?
to drain an emphysema
Why was early thoracentesis rarely done?
considered risky and of little benefit
When did thoracentesis become a common procedure?
mid nineteenth century
What is the indication for thoracentesis?
unexplained pleural effusion
What could case fluid in the space?
Why would analysis be done?
explain the cause of pleural effusion
What happens with pleural effusion less than 1 cm?
it is generally not performed
Why is with pleural effusion less than 1 cm not drained?
it is technically difficult.
Why is therapeutic thoracentesis indicated?
relieve symptoms from large pleural effusion
visualization of the lungs
relieve a tension pneumothorax
What is pneumothorax?
Increased fluid can cause difficulty ______.
What can removing the excess fluid do?
What is the pleura?
thin serous membrane
What does the parietal pleura line?
What does the visceral pleura line?
invaginates into the fissures of the lungs
How large is the pleura space?
10 to 12 mm
What is a normal amount of fluid in the pleura space?
What does the serous fluid do?
acts as a lubricant when the lungs move
Why does fluid enter the pleural space?
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
What is the role of reabsorption of pleural fluid?
What is Starling's mechanism influenced by?
hydrostatic pressure and the amount of protein in the fluid
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
What causes transudate?
congestive heart failure
What is exudate?
Lymphatic blockage especially through pleural involvement in disease processes produced an exudate
What causes exudate?
Where does the procedure usually occur?
What does the doctor request before thoracentesis?
What is the patients position?
feet & arms supported
What is used to prevent pain during thoracentesis?
Where is the trochar placed?
between the ribs
What is the catheter attached to?
What is the patient instructed to not do?
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
What is Pneumothorax?
A collapsed lung
What is hemothorax?
presence of blood in the pleural space
What should the patient do after the procedure?
monitored for an hour
When should the patient notify their healthcare worker?
hard time breathing after discharge
What are the contradictions of a thoracentesis?
chest wall infection
very small effusion
What does coagulopathies include?
prolonged prothrombin time
critically low platelet counts
When should thoracentesis be delayed?
until coagulopathy is corrected
What should you do if a patients chest wall is infected?
thoracentesis should not be done unless an unifected area can be used
Pros & Cons of commercially prepared thoracentesis trays?
save time in setting up
trays may not have all of the equipment
What is Ascites?
the presence of excess fluid in the peritoneal cavity
What is Free fluid?
Why does ascites most frequently occur?
Chronic liver disease
What are the causes of ascites?
decreased hydrostatic pressure
decreased osmotic pressure
increased permeability of peritoneal capillaries
leakage of fluid into the peritoneal cavity
What are the causes of decreased hydrostatic pressure?
hepatic vein occlusion
inferior vena cava obstruction
Congestive heart failure
What are the causes of decreased osmotic pressure?
end-stage liver disease with poor protein synthesis
Nephrotic syndrome with protein loss
What are the causes of increased permeability of peritoneal capillaries?
malignant disease of the peritoneum
What are the causes of leakage of fluid into the peritoneal cavity?
pancreatic ascites 2nd to leaking pseudocyst)
What are the miscellaneous causes of ascites?
Ovarian disease (Meigs syndrome)
What are the clinical symptoms of ascites?
increased abdominal girth
What is the clinical signs of ascites?
tympany of the top
puddle sign (poke stays)
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
How small of an area of ascites can U/S detect?
When should abdominal paracentesis with analysis of the ascites fluid be done in patients?
patients requiring hospitalization due to ascites
patients whose condition deteriorates during hospitalization
What are the risks and of paracentesis?
pregnant with bleeding
pregnant with unstable vitals
slight risk of needle puncture - bowel, bladder, vessel
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
What images are required for a paracentesis?
pre & post procedure image
Don't pick a place too lateral or medial
What are the lab tests performed on ascites?
lactate dehydrogenase (LDH)
mycobacterial smear and culture
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
What is the risk of amniocentesis?
1 in 400
What is amnio fluid made of?
cells from skin, lungs, umbilical cord, and urination
What are the types of amniocentesis?
why is early amnio not performed?
high risk of fluid loss
high risk of loss of fetus
When is a genetic amniocentesis performed?
between 15 - 18 weeks
what happens if amniocentesis is performed before 12 weeks?
increased risk of club foot & scoliosis
When do the kidneys take over production of amniotic fluid?
When is amniocentesis performed to check lung maturity?
between 30 - 36 week
What is the sonographers role during an amniocentesis procedure?
perform detailed fetal scan
evaluate fetus after procedure with m-mode
What equipment is used for an amniocentesis procedure?
When scanning for an optimal site what should you look for during an amniocentesis??
Away from the fetus, cord and placenta
Near maternal midline
Why do you want to be near midline during an amniocentesis?
to avoid uterine arteries
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
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
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
How many chromosomes?
- 22 autosomes
- 1 sex chromosome
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.
What is Down Syndrome?
occurs when an individual has a full or partial extra copy of chromosome 21.
What is an Open Neural Tube Defect?
an opening in the spinal cord or brain that occurs very early in human development.
What is Anencephaly?
the absence of a major portion of the brain, skull, and scalp that occurs during embryonic development.
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
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
What is Spina Bifida Myelomeningocele?
the spinal cord protrudes through the opening
What is Trisomy 18?
Occurs when an individual has a full or partial extra copy of chromosome 18
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.
What is Cystic Fibrosis?
genetic disease that causes thick, sticky mucus to form in the lungs, pancreas, and other organs.
What is Thalassemia?
abnormal formation of hemoglobin results in improper oxygen transport and destruction of red blood cell
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.
What is Huntington’s disease?
causes the progressive breakdown (degeneration) of nerve cells in the brain.
What is a hysterosonogram?
The uterus is filled with saline and then scanned transvagally
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
What is transvag exam good at diagnosis of?
What is hysterosonogram good at diagnosis that a transvag is not?
homogeneously thickened endometrium
What is the sensitivity of a hysterosonogram?
What is the specificity of hysterosonogram?
What is sensitivity?
percentage of people who have a problem that were correctly identified
What is SIS?
Saline induced sonohysterogram
SIS delineates masses or defects in the uterine wall
SIS distinguishes between focal lesions and global endometrial thickening
What is a speculum used for during an SIS?
expose the cervix
which is then cleaned with iodine swab
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
What is used to slow down the escape of fluid during an SIS procedure?
How much saline is needed during an SIS exam?
2 - 5 ml
all that is needed to distend the cavity adequately
What is the prep for a SIS procedure?
empty the bladder
What is a submucosal fibroid?
grows into the endometrium cavity
What are the adverse events of a SIS procedure?
Pain (menstral like)
What is the percentage of cramping after an SIS procedure?
How many women have pain after a SIS procedure?
What is the percentage of infection after an SIS exam?