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Obsterics and Gynocological. 


Anatomical Analysis:

· The liver is the largest organ in the body

· Weigh up to 1600 grams in males and 1400 grams in females

· Focal sparing Hypoechoic mass on to RPV and GB

· Left lobe divides into medial and lateral segments by the left hepatic vein and ligamentum of teres.

· Separated from the caudate lobe by the ligamentum of venosum.

· Separated from the right lobe by the middle hepatic vein superiorly and the main lobar fissure inferiorly falciform ligament.

· Right lobe divides into the anterior and posterior segments by the right hepatic vein

· Six times larger than the left lobe

· Three posterior fossa: gallbladder, porta hepatis and inferior vena cava.

Caudate Lobe:

· Smallest lobe of the liver.

· Separates from the left lobe by the ligamentum venosum.

· Arterial supply through the portal veins or hepatic arteries.

Liver Ligaments:

· Liver is attached to the diaphragm, anterior to the abdominal wall, stomach and retroperitoneum by ligaments.


· Consists of an upper and a lower layer.

· The upper layer is formed by the peritoneum from the upper margin of the bare area to the undersurface of the diaphragm.

· The lower layer is reflected from the lower margin of the bare area to the right kidney and is termed the hepatorenal ligament.

· The right and left triangular ligaments are part of the coronary ligament.

· Connects the posterior liver to the diaphragm.

Falciform :

· Attaches the liver to the anterior abdominal wall.

· Extends from the diaphragm to the umbilicus.

· Separates the right and left subphrenic spaces.

· It’s seen in cases of ascites.

Gastrohepatic :

· Connects the lesser curvature of the stomach to the liver.

Hepatodoudenal :

· Connects the liver to the proximal duodenum.


· Lies within the falciform ligament.

· Previous delta umbilical vein.

· Divides left lobe into medial and lateral segments.

· Is inferior to the left portal vein.


· The most lateral portion of the coronary ligament.

· Connects the liver to the body wall.


· Separates the left lobe from the caudate lobe of the liver.

· Obliterated Ductus Venosum.

· Lesser omentum attaches to the liver in the fissure of the ligamentum Venosum.

Liver Spaces

Morrison Pouch (Hepatorenal Pouch):

· Located lateral to the right lobe of the liver and anterior to the right kidney.

· Communicates with the right paracolic space.

Subhepatic Space


Aortic Arch:

● Commences at the Upper part of the left ventricle.

● Consists of the ascending aorta, transverse arch and descending aorta.

● Has three main branches which are the innominate artery, left common carotid

artery and left subclavian.

● The innominate artery divides into the right common carotid artery and the right


● The left common carotid artery second branch on the left side of the aortic arch

terminates at the carotid bifurcation.

● Left subclavian artery third branch on the left side of an aortic arch and

terminates at the thoracic outlet.

Upper extremity arteries:

Subclavian Artery:

● Located posterior to the clavicle and courses between the anterior and middle

scalene muscle and first rib.

● Right subclavian artery originates from the innominate artery.

● Left subclavian artery originates off the aortic arch; an important branch of the

subclavian artery is the internal mammary artery which is used in coronary artery

bypass surgery.

Axillary Artery:

● Continuation of the subclavian artery at the lateral border of the first rib.

Brachial Artery:

● At the level of the head of the humerus, the axillary artery becomes the brachial

artery and extends to the bend of the elbow.

● Initially lies medial to the humerus and gradually courses anteriorly to the

antecubital fossa where it bifurcates into the radial and ulnar arteries.

Radial Artery:

● Continuation of brachial artery.

● Passes along the lateral side of the forearm (radius ) to the wrist.

● It continues to the palm to form a deep palmar arch.

Ulnar Artery:

● Largest of the two terminal branches of the brachial artery.

● Passes along the medial side of the forearm (Ulnar) to the wrist

● Continues to the palm to form the superficial palmar arch.

Palmar Arch (Volar):

● Deep palmar arch: after the radial artery gives off a branch to the ulnar artery; it

terminates as the deep palmar arch.

● Superficial palmar arch; after the ulnar artery gives off a branch to the radial, it

terminates as superficial palmar arch.

● Deep palmar arch is located more proximal, closer to the wrist ; superficial

palmar arch is located more distal, closer to the digits.

● Digital arteries of hand arise off the palmar arches to feed the fingers.

Cervical Carotid

Common Carotid Artery:

● Located lateral to the trachea and thyroid gland; bifurcates into internal carotid

and external carotid arteries at the superior aspect of the thyroid.

● Right common carotid artery usually originates from the innominate artery;

Menstrual Cycle

● A female reproductive years begin around 11 to 13 years of age at the onset of menses

and end around age 50, when menses ceases.

● The average menstrual cycle is approximately 28 years in length, beginning with the first

day of menstrual bleeding.

● Premenarche is the physiological status of pre puberty , the time before the onset of


● Menarche is the state after reaching puberty in which menses occur normally every 28


● Menopause refers to the cessation of menses.

Follicular Development and Ovulation

● During the menarcheal years, an ovum is released once a month once a month by one of

the two ovaries.

● All ova begin development during embryonic life and remain in suspended animation

within pre-antral follicle as an immune oocyte until the onset of menarche.

● Each ovary contains approximately 200,000 oocytes at the time of birth.

● When a young girl reaches puberty, the hypothalamus begins the pulsatile release of

gonadotropin releasing hormones.

● Which stimulates the anterior pituitary gland to secrete varying levels of gonadotropin(

primarily follicle-stimulating hormone and luteinizing hormone).

● The luteinizing hormone level will typically increase rapidly 24 to 36 hours before

ovulation in a process known as LH surge.

● It is the LH surge, accompanied by a smaller FSH surge that triggers ovulation in day 14.

● After ovulation, the ovary enters the luteal phase. This phase begins with ovulation and is

14 days in length.

● During Luteal Phase, the cells in the lining of the rupture ovarian follicle begin to

multiply and create corpus luteum or yellow body.

● The corpus luteum immediately begins secreting progesterone.

● As progesterone levels decline, menstruation occurs and the cycle begins.

Anatomy and physiology of female pelvis

● Two approaches are used to sonographically evaluate the female pelvis: transabdominal

and endovaginal(transabdominal).

● Transabdominal requires a full bladder for acoustic windows.

● Requires the 3.5 to 5 MHz transducer for adequate penetration.

● An edovaginal examination is performed with empty bladder and uses a 7.5 to 10 MHz


● The transabdominal scan offers wider field view for general screening of pelvic anatomy.

Pelvic Landmarks:

● The Mons Pubis, Labia Majora, Labia Menora, Clitoris, Urethra, Vagina, and Anus.

● The external genitalia is called vulva or pudendum.

Bony Pelvic:

● Composed of four bones: two innominate bones, the sacrum and the coccyx.

● Anatomically, the pelvis divided into two continuous compartments the true and false


The Heart
Location size and position:

● Cone shape

● Fibromuscular organ

● Located in the mediastinum between the 2 lungs laterally.

● The sternum anteriorly and the thoracic spine posteriorly.

● Two thirds of the heart is to the left side and one third is to the right.

● Size is roughly the size of a closed fist of its owner.

External Features of the Heart:

● 6 sides or 6 borders

● Base is the superior border of the heart where the great arteries originate.

● The apex the tip of the left ventricle

● Lies directly above the diaphragm at the fifth intercostal space.

● It points anteriorly, inferiorly and to the left.

● The anterior surface is mainly made by the Rv( behind the sternum) with a small portion

of the LV and RA.

● The right border is formed by the left ventricle.

● The posterior surface is formed by the atria and large veins.

● Inferior surface lies on the diaphragm and formed primarily by the left ventricle and

small portion of the RV.

The Apex and the Base Of the Heart:

● The apex and blunt point of the lower edge is directed inferiorly, anteriorly and to the left.

● Lies on the diaphragm at the diaphragm at the intersection of the left 5Th intercostal

space with the mid -clavicular line.

● Heart beets are best heard at this point( called apical beat or point of maximal impulse).

● The base of the heart is the superior part positioned at the level of the 2nd intercostal


External Features of the Heart:

● A depression called the atrioventricular groove separates the atria from the ventricles.

● Posterior AV groove contains the coronary sinus that drains the blood from the

myocardium to the right atrium.

● The interventricular groove separates the RT and Lt ventricles.

● The posterior interventricular groove contains the posterior descending coronary artery.

● Each atrium has a blind pouch called appendage that lies superior to RA and overlies the

root of the aorta.

The Walls of the heart:

● The pericardium is the outer sac-like layer.

● The myocardium is the muscular middle layer.

● The endocardium the inner lining of the heart chambers.

Basic Imaging Principles

Tomographic Imaging:

● Nomenclature of standard views is determined by the acoustic window.

● Parasternal ( long axis and short axis)

● Apical (4-chamber, 2-chamber, 3 chamber)

● Subcostal window (long axis and short axis)

● Suprasternal window

● Nomenclature also includes the axis of the LV rather than by skeletal plans and the

number of cardiac chambers.

● Long axis plane vs. short axis plane

● A