I have 4 outlines as an ultrasound tech and need them reworded but content must stay the same. Images may be replaced or added to where necessary.
NO PAPER TO BE MADE JUST REWORDING OF INFORMATION WITH SAME CONTENT & SAME LEVEL OF TERMINOLOGY.
4 OUTLINES TOPICS
Obsterics and Gynocological.
· 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.
· Smallest lobe of the liver.
· Separates from the left lobe by the ligamentum venosum.
· Arterial supply through the portal veins or hepatic arteries.
· 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.
· 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.
· Connects the lesser curvature of the stomach to the liver.
· 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.
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.
● 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:
● 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
● Continuation of the subclavian artery at the lateral border of the first rib.
● 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.
● 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.
● 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.
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;
● 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
● 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.
● The Mons Pubis, Labia Majora, Labia Menora, Clitoris, Urethra, Vagina, and Anus.
● The external genitalia is called vulva or pudendum.
● Composed of four bones: two innominate bones, the sacrum and the coccyx.
● Anatomically, the pelvis divided into two continuous compartments the true and false
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
● 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