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Chapter 13: Gastrointestinal Tract Hagen-Ansert: Textbook of Diagnostic Sonography, 8th Edition
Multiple Choice
1. The mesentery projects from the parietal peritoneum attaching to the: a. large intestine. b. duodenum. c. stomach. d. small intestine.
ANS: D
The coiled small intestine attaches to the peritoneum via a projection of the mesentery.
PTS: 1 REF: p. 338
OBJ: Describe the anatomy and relational landmarks of the gastrointestinal system.
TOP: Anatomy of the gastrointestinal tract a. Pancreatic duct b. Common bile duct c. Ligamentum teres d. Gastroesophageal junction
2. Which one of the following structures is often visualized on a sagittal ultrasound as a “bull’s-eye” or target pattern anterior to the aorta and posterior to the left lobe of the liver?
ANS: D
The gastroesophageal junction is seen on the sagittal scan to the left of the midline as a “bull’s-eye” or target pattern anterior to the aorta, posterior to the left lobe of the liver, and inferior to the hemidiaphragm.
PTS: 1 REF: p. 342
OBJ: Describe the anatomy and relational landmarks of the gastrointestinal system.
TOP: Sonographic evaluation of the gastrointestinal tract a. Gastric carcinoma is the fourth leading cause of death. b. Of the malignant tumors of the stomach, 90% are carcinomas. c. One half of these malignant tumors occur in the pylorus. d. One fourth of these malignant tumors occur in the body and fundus.
3. Which one of the following statements about gastric carcinoma is false?
ANS: A
Gastric carcinoma is the sixth leading cause of death. Of the malignant tumors of the stomach, 90% are carcinomas. One half of these malignant tumors occur in the pylorus, and one fourth of these develop in the body or fundus of the stomach.
PTS: 1 REF: p. 347
OBJ: Differentiate the sonographic appearances of the pathologic features covered in this chapter.
TOP: Pathology of the gastrointestinal tract
4. All of the following are sonographic characteristics of lymphoma of the stomach except: a. relatively large and hypoechoic appearance. b. significant thickening of the gastric walls. c. relatively large and poorly echogenic appearance. d. spoke-wheel pattern.
ANS: C
Lymphoma of the stomach occurs in 3% of all stomach tumors. Sonographic findings include a large hypoechoic echogenic mass, thickening of the gastric walls, and spoke-wheel pattern within the mass.
PTS: 1 REF: p. 347
OBJ: Differentiate the sonographic appearances of the pathologic features covered in this chapter.
TOP: Figure 13-22A and B
5. Small bowel obstruction is associated with: a. dilation of the bowel loops distal to the site of the obstruction. b. dilation of the bowel loops proximal to the site of the obstruction. c. collapsed bowel loops proximal to the site of the obstruction. d. polypoid masses throughout the obstruction.
ANS: B
A small bowel obstruction is associated with dilation of the bowel loops distal to the site of the obstruction.
PTS: 1 REF: p. 348
OBJ: Differentiate the sonographic appearances of the pathologic features covered in this chapter.
TOP: Key Pearls a. hypoechoic b. hyperechoic c. target-shaped d. anechoic
6. Acute appendicitis may be seen on a transverse sonogram as a ___________ mass.
ANS: C
The target-shaped lesion consists of a hypoechoic fluid-distended lumen, a hyperechoic inner ring representing mainly the mucosa and submucosa, and an outer hypoechoic ring representing the muscularis externa.
PTS: 1 REF: p. 350
OBJ: Differentiate the sonographic appearances of the pathologic features covered in this chapter.
TOP: Pathology of the gastrointestinal tract a. fundus b. body c. gastric antrum d. pyloric canal
7. The ___________ has a target shape and is located in the midline anterior to the pancreas body.
ANS: C
The antrum of the stomach is located anterior to the pancreas body and has a target shape.
PTS: 1 REF: p. 342
OBJ: Describe the anatomy and relational landmarks of the gastrointestinal system.
TOP: Sonographic evaluation of the gastrointestinal tract
8. Sonographic findings of Crohn disease may include all the following except: a. symmetrically swollen bowel pattern. b. uniformly increased wall thickness. c. matted-loop pattern. d. calcification.
ANS: D
The sonographic findings in Crohn disease include a symmetric swollen bowel target pattern and increased wall thickness involving all layers. A matted loop pattern is found in the late stages.
PTS: 1 REF: p. 353
OBJ: Differentiate the sonographic appearances of the pathologic features covered in this chapter.
TOP: Pathology of the gastrointestinal tract
9. The “keyboard” sign is seen in the: a. colon. b. duodenum. c. appendix. d. stomach.
ANS: B
The “keyboard” sign is seen in the duodenum and jejunum. It represents the valvulae conniventes.
PTS: 1 REF: p. 344
OBJ: Describe the anatomy and relational landmarks of the gastrointestinal system.
TOP: Sonographic evaluation of the gastrointestinal tract
10. The appendix is located at: a. iliac crest. b. Mubarney’s point. c. McBurney’s sign. d. McBurney’s point.
ANS: D
The appendix is located at the McBurney’s point. The McBurney’s point is located approximately at the midpoint between the right anterosuperior iliac spine and the umbilicus. The McBurney’s sign is localized pain over the McBurney’s point.
PTS: 1 REF: p. 344
OBJ: Describe the anatomy and relational landmarks of the gastrointestinal system.
TOP: Sonographic evaluation of the gastrointestinal tract a. Duplication cyst b. Gastric bezoar c. Polyp d. Leiomyoma
11. Which one of the following is an embryologic mistake?
ANS: A
A duplication cyst is an embryologic mistake usually found on the greater curvature of the stomach. It occurs more often in female infants.
PTS: 1 REF: p. 345
OBJ: Describe the anatomy and relational landmarks of the gastrointestinal system.
TOP: Pathology of the gastrointestinal tract
12. Metastatic disease to the stomach may be secondary to all of the following except: a. breast. b. lung. c. prostate. d. melanoma.
ANS: C
Metastatic disease to the stomach is rare; it may be secondary to breast, lung, or melanoma.
PTS: 1 REF: p. 348
OBJ: Differentiate the sonographic appearances of the pathologic features covered in this chapter.
TOP: Pathology of the gastrointestinal tract a. 3 b. 4 c. 5 d. 6
13. The maximum outer diameter of the normal appendix can measure up to _____ millimeters (mm).
ANS: D
The maximum outer diameter of the normal appendix can measure up to 6 mm.
PTS: 1 REF: p. 350
OBJ: Describe the anatomy and relational landmarks of the gastrointestinal system.
TOP: Pathology of the gastrointestinal tract
14. A diverticulum is most common in the: a. stomach. b. small intestines. c. colon. d. ileum.
ANS: C
A diverticulum is a pouchlike herniation through the muscular wall of a tubular organ that occurs in the stomach, in the small intestines, and, most commonly, in the colon.
PTS: 1 REF: p. 352
OBJ: Differentiate the sonographic appearances of the pathologic features covered in this chapter.
TOP: Pathology of the gastrointestinal tract a. Crohn disease is regional enteritis. b. The reaction involves only the mesothelium of the bowel wall. c. Clinical symptoms include diarrhea, fever, and right lower quadrant pain. d. Crohn disease affects the terminal ileum or the colon or both.
15. Which one of the following statements about Crohn disease is false?
ANS: B
The reaction involves the entire thickness of the bowel wall.
PTS: 1 REF: p. 353
OBJ: Differentiate the sonographic appearances of the pathologic features covered in this chapter.
TOP: Pathology of the gastrointestinal tract
16. The most common tumor of the gastrointestinal tract in children under 10 years of age is: a. lymphoma. b. polyp. c. leiomyoma. d. fecalith.
ANS: A
Lymphoma is the most common tumor of the gastrointestinal tract in children under 10 years of age.
PTS: 1 REF: p. 354
OBJ: Differentiate the sonographic appearances of the pathologic features covered in this chapter.
TOP: Pathology of the gastrointestinal tract
17. The colon is divided into segments called: a. villi. b. valvulae conniventes. c. haustra. d. rugae.
ANS: C
The colon is divided into segments called haustra.
PTS: 1 REF: p. 338
OBJ: Describe the anatomy and relational landmarks of the gastrointestinal system.
TOP: Anatomy of the gastrointestinal tract a. lumbar b. inferior mesenteric c. splenic d. renal
18. The celiac axis, superior mesenteric artery, and __________ artery supply both the small and large intestines.
ANS: B
The celiac axis, superior mesenteric artery, and inferior mesenteric artery supply both the small and large intestines. The splenic artery is a branch of the celiac axis.
PTS: 1 REF: p. 339
OBJ: Describe the anatomy and relational landmarks of the gastrointestinal system.
TOP: Anatomy of the gastrointestinal tract a. First part b. Second part c. Third part d. Fourth part
19. Which one of the following divisions of the duodenum courses to the level of the gallbladder neck?
ANS: A
The first part or superior portion of the duodenum begins at the pylorus and terminates at the neck of the gallbladder.
PTS: 1 REF: p. 338
OBJ: Describe the anatomy and relational landmarks of the gastrointestinal system.
TOP: Anatomy of the gastrointestinal tract a. esophageal b. diaphragmatic c. thoracic d. cardiac
20. The entrance of the esophagus into the stomach is through the ___________ orifice.
ANS: D
The entrance of the esophagus into the stomach is through the cardiac orifice.
PTS: 1 REF: p. 337
OBJ: Describe the anatomy and relational landmarks of the gastrointestinal system.
TOP: Anatomy of the gastrointestinal tract
21. The greater curvature of the stomach is supported by all of the following ligaments except the: a. greater omentum. b. gastrohepatic ligament. c. gastrophrenic ligament. d. gastrosplenic ligament.
ANS: B
The greater curvature of the stomach is supported by the greater omentum and the gastrosplenic, gastrophrenic, and lienorenal ligaments. The gastrohepatic ligament supports the lesser curvature of the stomach.
PTS: 1 REF: p. 337
OBJ: Describe the anatomy and relational landmarks of the gastrointestinal system.
TOP: Anatomy of the gastrointestinal tract
22. The progression of acute appendicitis to frank perforation is more rapid in: a. preschool children. b. elementary school children. c. adults. d. senior citizens.
ANS: A
The rate of perforation in preschool children can be as high as 70%, compared with 30% for elementary school children and 21% to 22% for adults.
PTS: 1 REF: p. 349
OBJ: Differentiate the sonographic appearances of the pathologic features covered in this chapter.
TOP: Pathology of the gastrointestinal tract
23. Symptoms of appendiceal mucoceles may include all of the following except: a. asymptomatic. b. urinary symptoms. c. bloating. d. sepsis.
ANS: C
Symptoms of appendiceal mucoceles may include right iliac fossa mass, sepsis, and urinary symptoms; 25% are asymptomatic. Bloating is specific to patients with pseudomyxoma peritonei.
PTS: 1 REF: p. 352
OBJ: Differentiate the sonographic appearances of the pathologic features covered in this chapter.
TOP: Pathology of the gastrointestinal tract
24. Gastrointestinal leiomyosarcomas most commonly occur in the: a. duodenum. b. jejunum. c. ileum. d. ascending colon.
ANS: C
Approximately 35% to 55% of these tumors are found in the ileum; 30% to 45% are found in the jejunum, and 10% to 30% are found in the duodenum.
PTS: 1 REF: p. 355
OBJ: Differentiate the sonographic appearances of the pathologic features covered in this chapter.
TOP: Pathology of the gastrointestinal tract
25. The pseudokidney sign may be seen in: a. chronic appendicitis. b. Meckel diverticulum. c. gastric bezoar. d. gastric carcinoma.
ANS: D
In gastric carcinoma, the sonographer should look for the target or pseudokidney sign.
PTS: 1 REF: pp. 346-347
OBJ: Differentiate the sonographic appearances of the pathologic features covered in this chapter.
TOP: Pathology of the gastrointestinal tract
Chapter 14: Peritoneal Cavity and Abdominal Wall Hagen-Ansert: Textbook of Diagnostic Sonography, 8th Edition
Multiple Choice
1. Collections in the right posterior subphrenic space cannot extend between the bare area of the liver and the: a. right kidney. b. diaphragm. c. right pleural space. d. coronary ligament.
ANS: B
Collections in the right posterior subphrenic space cannot extend between the bare area of the liver and the diaphragm because of the coronary ligament.
PTS: 1 REF: p. 374
OBJ: Compare and contrast the different locations of fluid and their sonographic findings.
TOP: Anatomy and sonographic evaluation of the peritoneal cavity and abdominal wall
2. Anterior displacement of the kidney and ureter suggests a mass in the: a. intraperitoneum. b. subcapsular space. c. retroperitoneum. d. interperitoneum.
ANS: C
A mass is confirmed to be in the retroperitoneum with the anterior displacement of the kidneys and ureters.
PTS: 1 REF: p. 369
OBJ: Discuss the pathologic and sonographic findings of the peritoneal cavity, mesentery, omentum, and peritoneum.
TOP: Anatomy and sonographic evaluation of the peritoneal cavity and abdominal wall a. Tendons b. Fibers c. Falciform ligament d. Peritoneal ligaments
3. Which one of the following structures is found on the right side of the liver to form the subphrenic and subhepatic spaces?
ANS: D
The peritoneal cavity is made up of multiple peritoneal ligaments and folds that connect the viscera to each other and to the abdominopelvic cavity.
PTS: 1 REF: p. 357
OBJ: Compare and contrast the different locations of fluid and their sonographic findings.
TOP: Anatomy and sonographic evaluation of the peritoneal cavity and abdominal wall
4. The left lateral extension of the greater omentum that connects the gastric greater curvature to the superior splenic hilum is called the ligament. a. splenorenal b. gastrosplenic c. falciform d. gastrorenal
ANS: B
The gastrosplenic ligament is the left lateral extension of the greater omentum that connects the gastric greater curvature to the superior splenic hilum and forms a portion of the left lateral border of the lesser sac.
PTS: 1 REF: p. 360 OBJ: List the peritoneal and retroperitoneal organs.
TOP: Anatomy and sonographic evaluation of the peritoneal cavity and abdominal wall a. Gastrosplenic b. Falciform c. Splenorenal d. Costophrenic
5. Which one of the following ligaments forms the posterior portion of the left lateral border of the lesser sac and separates the lesser sac from the renosplenic recess?
ANS: C
The splenorenal ligament forms the posterior portion of the left lateral border of the lesser sac and separates the lesser sac from the renosplenic recess.
PTS: 1 REF: pp. 360-361 OBJ: List the peritoneal and retroperitoneal organs.
TOP: Anatomy and sonographic evaluation of the peritoneal cavity and abdominal wall
6. The lesser sac is located: a. superior to the pancreas. b. anterior to the stomach. c. superior to the stomach. d. anterior to the pancreas.
ANS: D
The lesser sac lies anterior to the pancreas and posterior to the stomach.
PTS: 1 REF: p. 358
OBJ: Compare and contrast the different locations of fluid and their sonographic findings.
TOP: Anatomy and sonographic evaluation of the peritoneal cavity and abdominal wall
7. Inflammatory or malignant ascites demonstrate all of the following characteristics except: a. anechoic patterns with smooth borders. b. matting of bowel loops. c. fine or coarse internal echoes. d. loculations.
ANS: A
Inflammatory or malignant ascites is demonstrated as coarse internal echoes, irregular walls, loculations, and matting or clumping of the bowel.
PTS: 1 REF: p. 365
OBJ: Compare and contrast the different locations of fluid and their sonographic findings. TOP: Pathology of the peritoneal cavity a. Fibroid b. Teratoma c. Lipoma d. Hemangioma
8. What lesion may mimic a gas-containing abscess?
ANS: B
A teratoma may mimic the pattern of a gas-containing abscess, but clinical history and radiograph examinations exclude this tumor from the diagnosis.
PTS: 1 REF: p. 365
OBJ: Discuss the pathologic and sonographic findings of the peritoneal cavity, mesentery, omentum, and peritoneum. TOP: Pathology of the peritoneal cavity
9. Differential diagnosis of a lesser-sac abscess should include all of the following except a: a. pseudocyst. b. gastric outlet obstruction. c. fluid-filled stomach. d. pancreatic carcinoma.
ANS: D
Differential diagnosis of a lesser sac abscess should include a pseudocyst, pancreatic abscess, gastric outlet obstruction, and fluid-filled stomach.
PTS: 1 REF: p. 366
OBJ: Discuss the pathologic and sonographic findings of the peritoneal cavity, mesentery, omentum, and peritoneum. TOP: Pathology of the peritoneal cavity
10. The most common primary lesions to develop peritoneal metastasis originate in the: a. kidneys, testicles, and uterus. b. stomach, pancreas, and colon. c. ovaries, stomach, and colon. d. pancreas, biliary tract, and kidneys.
ANS: C
Peritoneal metastases develop from cellular implantation across the peritoneal cavity. The most common primary sites are the ovaries, stomach, and colon. Other less common sites are the pancreas, biliary tract, kidneys, testicles, and uterus.
PTS: 1 REF: p. 369
OBJ: Discuss the pathologic and sonographic findings of the peritoneal cavity, mesentery, omentum, and peritoneum. TOP: Pathology of the mesentery, omentum, and peritoneum
11. The most common site(s) for abdominal abscess formation is(are) the: a. appendix. b. retrovesical space. c. hepatic recesses and perihepatic spaces. d. portal vein.
ANS: C
The hepatic recesses and perihepatic spaces are the most common sites for abscess formation.
PTS: 1 REF: p. 368
OBJ: Compare and contrast the different locations of fluid and their sonographic findings. TOP: Pathology of the peritoneal cavity a. Lesser sac b. Hepatorenal recess c. Greater sac d. Retroperitioneal
12. Generalized ascites, inflammatory fluid from acute abdominal processes can be found in which area?
ANS: B
Generalized ascites, inflammatory fluid from acute cholecystitis, fluid resulting from pancreatic autolysis, or blood from a ruptured hepatic neoplasm or ectopic gestation may contribute to the formation of hepatorenal fluid collections.
PTS: 1 REF: pp. 364-365
OBJ: Discuss the pathologic and sonographic findings of the peritoneal cavity, mesentery, omentum, and peritoneum. TOP: Pathology of the peritoneal cavity
13. An extrahepatic loculated fluid collection that may develop because of a spontaneous rupture of the biliary tree is called: a. biloma. b. bilitis. c. cholangitis. d. choledochitis.
ANS: A
Bilomas are extrahepatic loculated collections of bile that may develop because of iatrogenic, traumatic, or spontaneous rupture of the biliary tree.
PTS: 1 REF: p. 367
OBJ: Discuss the pathologic and sonographic findings of the peritoneal cavity, mesentery, omentum, and peritoneum. TOP: Pathology of the peritoneal cavity
14. A cystic mass between the umbilicus and the bladder is called a: a. seroma. b. urachal cyst. c. uroma. d. urinoma.
ANS: B
A urachal cyst appears as a cystic mass between the umbilicus and bladder. It may be small or large, multiseptated, and even external to the upper abdomen.
PTS: 1 REF: p. 369
OBJ: Discuss the pathologic and sonographic findings of the peritoneal cavity, mesentery, omentum, and peritoneum. TOP: Pathology of the mesentery, omentum, and peritoneum a. Mesentery b. Peritoneum c. Greater omentum d. Lesser omentum
15. Which one of the following lies freely over the intestines similar to an apron?
ANS: C
The greater omentum is an apronlike fold of peritoneum that hangs from the greater curvature of the stomach.
PTS: 1 REF: p. 359 OBJ: List the peritoneal and retroperitoneal organs.
TOP: Anatomy and sonographic evaluation of the peritoneal cavity and abdominal wall a. lateral b. posterior c. inferior d. dependent
16. Fluid collects in the most ________ areas of the abdomen and pelvis.
ANS: D
Fluid collection sites depend on the patient’s position. Fluid collects in the dependent (lowest) areas of the abdomen and pelvis.
PTS: 1 REF: p. 359
OBJ: Compare and contrast the different locations of fluid and their sonographic findings.
TOP: Pathology of the peritoneal cavity
17. A double layer of peritoneum, extending from the liver to the lesser curvature of the stomach, is called the: a. greater omentum. b. mesentery. c. lesser omentum. d. peritoneum.
ANS: C
A double layer of peritoneum, extending from the liver to the lesser curvature of the stomach, is called the lesser omentum. This structure acts as a sling for the stomach, suspending it from the liver.
PTS: 1 REF: p. 359 OBJ: List the peritoneal and retroperitoneal organs.
TOP: Anatomy and sonographic evaluation of the peritoneal cavity and abdominal wall
18. Clinical signs and symptoms of infection include all of the following except: a. chills. b. weakness. c. localized tenderness. d. elevated liver function tests.
ANS: D
Clinical symptoms include fever of unknown origin, chills, weakness, swelling or tenderness (generalized or localized), elevated white blood count, general sepsis, and normal liver function tests.
PTS: 1 REF: p. 365
OBJ: Discuss the pathologic and sonographic findings of the peritoneal cavity, mesentery, omentum, and peritoneum. TOP: Pathology of the peritoneal cavity a. passes inferior to b. separates c. overlies d. encompasses
19. The splenorenal ligament _________the left kidney.
ANS: C
The splenorenal ligament is formed by the posterior reflection of the peritoneum of the spleen and passes inferiorly to overlie the left kidney.
PTS: 1 REF: p. 360 OBJ: List the peritoneal and retroperitoneal organs.
TOP: Anatomy and sonographic evaluation of the peritoneal cavity and abdominal wall
20. A smooth membrane that lines the entire abdominal cavity and is reflected over the contained organs is the: a. perineum. b. mesentery. c. peritoneum. d. retroperitoneum.
ANS: C
The peritoneum is a smooth membrane that lines the entire abdominal cavity and is reflected over the contained organs.
PTS: 1 REF: p. 357 OBJ: List the peritoneal and retroperitoneal organs.
TOP: Anatomy and sonographic evaluation of the peritoneal cavity and abdominal wall a. Epigastric b. Umbilicus c. Inguinal d. Rectus abdominis
21. Which one of the following hernia locations typically contains fat?
ANS: A
Epigastric hernias are found in the widest part of the linea alba between the xiphoid and umbilicus. This hernia is usually filled with fat.
PTS: 1 REF: p. 373
OBJ: Discuss the pathologic and sonographic findings of the peritoneal cavity, mesentery, omentum, and peritoneum. TOP: Pathology of the mesentery, omentum, and peritoneum
22. A lymphocele may be defined as a: a. walled-off collection of extravasated urine. b. lymph-filled space without a distinct epithelial lining. c. complex irregular mass. d. cystic space anterior to the aorta.
ANS: B
A lymphocele is a fluid collection that occurs after surgery in the pelvis, retroperitoneum, or recess cavities and is a lymph-filled space without a distinct epithelial lining.
PTS: 1 REF: p. 371
OBJ: Discuss the pathologic and sonographic findings of the peritoneal cavity, mesentery, omentum, and peritoneum. TOP: Pathology of the abdominal wall
23. The superior portion of the subhepatic space is called: a. the bare area of the liver. b. Morison’s pouch. c. the anterior pararenal space. d. the subphrenic space.
ANS: B
The superior portion of the subhepatic space is called Morison’s pouch.
PTS: 1 REF: p. 360
OBJ: Compare and contrast the different locations of fluid and their sonographic findings.
TOP: Anatomy and sonographic evaluation of the peritoneal cavity and abdominal wall a. lesser omentum b. peritoneum c. mesentery d. greater omentum
24. The ___________________ is able to adhere to diseased organs.
ANS: D
The greater omentum is able to adhere to diseased organs, which helps prevent further spread of infected fluid by essentially “walling it off” from the rest of the body.
PTS: 1 REF: p. 359
OBJ: Discuss the pathologic and sonographic findings of the peritoneal cavity, mesentery, omentum, and peritoneum.
TOP: Anatomy and sonographic evaluation of the peritoneal cavity and abdominal wall
25. On ultrasound, a discrete linear echogenicity in the deepest layer of the anterior abdominal wall is the: a. linea alba. b. rectus sheath. c. peritoneal line. d. subcutaneous fat.
ANS: C
The peritoneal line is seen sonographically as a discrete linear echogenicity in the deepest layer of the anterior abdominal wall.
PTS: 1 REF: p. 363
OBJ: Describe the normal anatomy of the abdominal wall.
TOP: Anatomy and sonographic evaluation of the peritoneal cavity and abdominal wall
