ARDMS ABDOMEN BUNDLED EXAM//WITH
EXPLANATIONS /GRADE A+ & VERIFIED ANSWERS.
Body of the pancreas - CORRECT ANSWERS -largest and most anterior aspect of the
pancreas
lies anterior to the aorta, SMA, SMV, splenic vein, left renal vein, and spine
lies posterior to the antrum of the stomach
Neck of the pancreas - CORRECT ANSWERS -Lies directly anterior to the superior
mesenteric vein and portosplenic confluence
Head of the pancreas - CORRECT ANSWERS -Lies medial to the descending portion
of the duodenum, lateral to the SMV, and anterior to the IVC
Gastroduodenal artery lies in the anterolateral portion of the pancreatic head
CBD lies in the posterolateral portion of the pancreatic head
Uncinate process - CORRECT ANSWERS -portion of the pancreatic head located
directly posterior to the superior mesenteric vein and anterior to the aorta and IVC
Duct of Wirsung - CORRECT ANSWERS -Primary secretory duct extending the entire
length of the pancreas
Joins the distal CBD entering the descending portion of the duodenum through the
ampulla of vater
frequently visualized in the body of the pancreas
Duct of Santorini - CORRECT ANSWERS -Secondary secretory duct draining the upper
anterior portion of the pancreas
Enters the duodenum at the minor papilla approx. 2 cm proximal to the ampulla of Vater
Pancreatic Divisum - CORRECT ANSWERS -Failure of the normal fusion of the ducts
of Santorini and Wirsung
Duct of Wirsung is small and and only drains the inferior portion of the pancreatic head
Duct of Santorini drains the majority of the pancreas
Associated with higher incidence of pancreatitis
Annular Pancreas - CORRECT ANSWERS -Rare anomaly caused by failure of normal
regression of the left ventral bud
The head of the pancreas is surrounds the duodenum, resulting in obstruction of the
biliary tree and duodenum
Male prevalence
Cystic fibrosis - CORRECT ANSWERS -Autosomal recessive exocrine gland disorder in
which organs become clogged with mucus secreted by the exocrine glands
,Tail of the pancreas - CORRECT ANSWERS -Most superior portion of the pancreas
lying anterior and parallel to the splenic vein
Lies anterior to the upper pole of the left kidney, posterior to the stomach, and lateral to
the spine
Generally extends toward the splenic hilum
Pancreas becomes hyperechoic as a result of fibrosis or fatty replacement
small cysts may be present
Serum amylase - CORRECT ANSWERS -Increases with acute pancreatitis, pancreatic
pseudocyst, intestinal obstruction, and peptic ucler disease
Decreases with hepatitis and cirrhosis
Remains elevated for approximately 24 hours in epsiodes of acute pancreatitis
Serum lipase - CORRECT ANSWERS -Remains elevated for a longer period of time
Increases with pancreatitis, obstruction of pancreatic duct, pancreatic cancer, acute
cholecystitis, cirrhosis, and severe renal disease
Acute pancreatitis - CORRECT ANSWERS -Most common cause: biliary disease
Abrupt onset of epigastric pain, nausea/vomiting, elevated lipase and amylase, paralytic
ileus
Normal findings (30%)
Decrease in parenchymal echogenicity
Smooth borders
Enlargment
Chronic Pancreatitis - CORRECT ANSWERS -Repeated, prolonged, or persistent
attacks of pancreatitis
Chronic RUQ or epigastric pain, nausea/vomiting, weight loss, abnormal glucose
tolerance test, normal amylase and lipase
Increase in parenchymal echogenicity
Irregular borders
Calcifications
psuedocyst formation
atrophy
prominent pancreatic duct
Pseudocyst - CORRECT ANSWERS -Focal collection of inflammatory necrotic tissue,
blood, and pancreas secretions
Most often located in the lesser sac
Abdominal mass, abdominal pain, elevated amylase
Anechoic or complex mass, well-defined borders, variable shape
Phlegmon - CORRECT ANSWERS -Extension of pancreatic inflammation into the
peripancreatic tissues
Severe abdominal pain, elevated amylase, nausea/vomiting
, Hypoechoic solid mass adjacent to the pancreas
Posterior acoustic enhancement
Left lobe of the liver is divided into medial and lateral segments by what? - CORRECT
ANSWERS -Left hepatic vein
Left lobe of the liver is separated from the caudate lobe by what? - CORRECT
ANSWERS -ligamentum venosum
Right lobe of the liver is divided into anterior and posterior segments by what? -
CORRECT ANSWERS -Right hepatic vein
Main lobar fissure - CORRECT ANSWERS -The main lobar fissure separates the right
and left lobes of the liver.
It is visualized sonographically as an echogenic linear structure extending from the
portal vein to the neck of the gallbladder
**landmark for identifying the gallbladder
Falciform ligament - CORRECT ANSWERS -Attaches the liver to the anterior abdominal
wall
Extends from the diaphragm to the umbilicus
Separate the right and left subphrenic spaces
Ligamentum venosum - CORRECT ANSWERS -The ligamentum venosum is a remnant
of the fetal ductus venosus. It divides the caudate lobe from the left lobe.
Ligamentum teres - CORRECT ANSWERS -Lies within the falciform ligament, remnant
of the fetal umbilical vein***, courses within the left intersegmental fissure, dividing the
left lobe into medial and lateral segments
Main Portal Vein diameter should not exceed: - CORRECT ANSWERS -13 mm or 1.3
cm
Hepatomegaly - CORRECT ANSWERS -Etiology: congestive heart failure, inflammatory
processes, polycystic disease, fatty infiltration, biliary obstruction, neoplasm, budd-chiari
syndrome
Sonographic characteristics: Length exceeding 18 cm, Anterior-posterior diameter
exceeding 15 cm
Alkaline Phosphatase - CORRECT ANSWERS -An enzyme produced primarily by the
liver, bone, and placenta and excreted through the bile ducts
Marked elevation is associated with obstructive jaundice
EXPLANATIONS /GRADE A+ & VERIFIED ANSWERS.
Body of the pancreas - CORRECT ANSWERS -largest and most anterior aspect of the
pancreas
lies anterior to the aorta, SMA, SMV, splenic vein, left renal vein, and spine
lies posterior to the antrum of the stomach
Neck of the pancreas - CORRECT ANSWERS -Lies directly anterior to the superior
mesenteric vein and portosplenic confluence
Head of the pancreas - CORRECT ANSWERS -Lies medial to the descending portion
of the duodenum, lateral to the SMV, and anterior to the IVC
Gastroduodenal artery lies in the anterolateral portion of the pancreatic head
CBD lies in the posterolateral portion of the pancreatic head
Uncinate process - CORRECT ANSWERS -portion of the pancreatic head located
directly posterior to the superior mesenteric vein and anterior to the aorta and IVC
Duct of Wirsung - CORRECT ANSWERS -Primary secretory duct extending the entire
length of the pancreas
Joins the distal CBD entering the descending portion of the duodenum through the
ampulla of vater
frequently visualized in the body of the pancreas
Duct of Santorini - CORRECT ANSWERS -Secondary secretory duct draining the upper
anterior portion of the pancreas
Enters the duodenum at the minor papilla approx. 2 cm proximal to the ampulla of Vater
Pancreatic Divisum - CORRECT ANSWERS -Failure of the normal fusion of the ducts
of Santorini and Wirsung
Duct of Wirsung is small and and only drains the inferior portion of the pancreatic head
Duct of Santorini drains the majority of the pancreas
Associated with higher incidence of pancreatitis
Annular Pancreas - CORRECT ANSWERS -Rare anomaly caused by failure of normal
regression of the left ventral bud
The head of the pancreas is surrounds the duodenum, resulting in obstruction of the
biliary tree and duodenum
Male prevalence
Cystic fibrosis - CORRECT ANSWERS -Autosomal recessive exocrine gland disorder in
which organs become clogged with mucus secreted by the exocrine glands
,Tail of the pancreas - CORRECT ANSWERS -Most superior portion of the pancreas
lying anterior and parallel to the splenic vein
Lies anterior to the upper pole of the left kidney, posterior to the stomach, and lateral to
the spine
Generally extends toward the splenic hilum
Pancreas becomes hyperechoic as a result of fibrosis or fatty replacement
small cysts may be present
Serum amylase - CORRECT ANSWERS -Increases with acute pancreatitis, pancreatic
pseudocyst, intestinal obstruction, and peptic ucler disease
Decreases with hepatitis and cirrhosis
Remains elevated for approximately 24 hours in epsiodes of acute pancreatitis
Serum lipase - CORRECT ANSWERS -Remains elevated for a longer period of time
Increases with pancreatitis, obstruction of pancreatic duct, pancreatic cancer, acute
cholecystitis, cirrhosis, and severe renal disease
Acute pancreatitis - CORRECT ANSWERS -Most common cause: biliary disease
Abrupt onset of epigastric pain, nausea/vomiting, elevated lipase and amylase, paralytic
ileus
Normal findings (30%)
Decrease in parenchymal echogenicity
Smooth borders
Enlargment
Chronic Pancreatitis - CORRECT ANSWERS -Repeated, prolonged, or persistent
attacks of pancreatitis
Chronic RUQ or epigastric pain, nausea/vomiting, weight loss, abnormal glucose
tolerance test, normal amylase and lipase
Increase in parenchymal echogenicity
Irregular borders
Calcifications
psuedocyst formation
atrophy
prominent pancreatic duct
Pseudocyst - CORRECT ANSWERS -Focal collection of inflammatory necrotic tissue,
blood, and pancreas secretions
Most often located in the lesser sac
Abdominal mass, abdominal pain, elevated amylase
Anechoic or complex mass, well-defined borders, variable shape
Phlegmon - CORRECT ANSWERS -Extension of pancreatic inflammation into the
peripancreatic tissues
Severe abdominal pain, elevated amylase, nausea/vomiting
, Hypoechoic solid mass adjacent to the pancreas
Posterior acoustic enhancement
Left lobe of the liver is divided into medial and lateral segments by what? - CORRECT
ANSWERS -Left hepatic vein
Left lobe of the liver is separated from the caudate lobe by what? - CORRECT
ANSWERS -ligamentum venosum
Right lobe of the liver is divided into anterior and posterior segments by what? -
CORRECT ANSWERS -Right hepatic vein
Main lobar fissure - CORRECT ANSWERS -The main lobar fissure separates the right
and left lobes of the liver.
It is visualized sonographically as an echogenic linear structure extending from the
portal vein to the neck of the gallbladder
**landmark for identifying the gallbladder
Falciform ligament - CORRECT ANSWERS -Attaches the liver to the anterior abdominal
wall
Extends from the diaphragm to the umbilicus
Separate the right and left subphrenic spaces
Ligamentum venosum - CORRECT ANSWERS -The ligamentum venosum is a remnant
of the fetal ductus venosus. It divides the caudate lobe from the left lobe.
Ligamentum teres - CORRECT ANSWERS -Lies within the falciform ligament, remnant
of the fetal umbilical vein***, courses within the left intersegmental fissure, dividing the
left lobe into medial and lateral segments
Main Portal Vein diameter should not exceed: - CORRECT ANSWERS -13 mm or 1.3
cm
Hepatomegaly - CORRECT ANSWERS -Etiology: congestive heart failure, inflammatory
processes, polycystic disease, fatty infiltration, biliary obstruction, neoplasm, budd-chiari
syndrome
Sonographic characteristics: Length exceeding 18 cm, Anterior-posterior diameter
exceeding 15 cm
Alkaline Phosphatase - CORRECT ANSWERS -An enzyme produced primarily by the
liver, bone, and placenta and excreted through the bile ducts
Marked elevation is associated with obstructive jaundice
