Objective Enhance anatomical physiological and clinical education of secondyear medical students with respect to the hepatobiliary and renal systems Adaptation of basic ultrasonography knowledge and techniques will be used to interrogate the organ systems in order to achieve this objective ID: 1043207
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1. Hepatobiliary and Renal Ultrasound
2. ObjectiveEnhance anatomical, physiological, and clinical education of second-year medical students with respect to the hepatobiliary and renal systems.Adaptation of basic ultrasonography knowledge and techniques will be used to interrogate the organ systems in order to achieve this objective.Stay focused, learn through repetition, ask questions, and have fun!
3. The Knobs (Knobology)On ButtonDepth/GainFreeze/scrollModes2DColorDopplerM modeExam Familiarize with knobology
4. TransducersSelect probe and identify leading edge
5. Principles of UltrasoundBasic physics Image anatomyLearn the languageAnechoicHypoechoicHyperechoicI – AIMDefine anechoic, hypo/hyperechoic
6. I-AIMI for IndicationA for AcquisitionI for InterpretationM for Medical Management
7. I-AIM: Indication - HPBRUQ pain (usually)Suspect biliary pathology, fluid filled structuresFour acute biliary conditions:Symptomatic Cholelithiasis: stones in gallbladderCholedocholithiasis: stones migrate to biliary tractCholecystitis: inflammation of the gallbladderStone pancreatitis: stones migrate to obstruct pancreatic enzyme excretion inflamed pancreasAscending cholangitis: infection of biliary tree(ps – teaching point; know the difference between cholelithiasis, cholecystitis, choledochochalithiasis, cholangitis)
8. I-AIM: Indication – Renal/bladderFlank pain/renal colicEspecially with history of nephrolithiasisAn- or oliguriaAcute renal failure Concern for ureteral injuryMeasuring post-void residual urine
9. I-AIM: Acquisition: 3 P’sPatient: positioningFor these scans, supine or LLDProbe: curvilinear for this scanLow frequency = penetration but resolutionHigh Frequency = penetration but resolutionPicture: make it shinePhysical: gel and pressureTechnique: probe motions (sweep, slide, rock, fan)Mechanics: depth and gainPlace patient in correct position; select probe, optimize picture
10. I-AIM: Interpretation - NormalPattern recognition requires repetition
11. The Antler SignDefine “Antler sign” Identify liver, anatomic relationships
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13. The Antler SignDefine “Antler sign” Identify liver, anatomic relationships
14. I-AIM: Interpretation - NormalIdentify gallbladder and relationships
15. I-AIM: Interpretation - NormalIdentify gallbladder and relationships
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17. The Mickey MouseDefine “Mickey Mouse”Identify hepatic veins vs. portal veins Identify components of portal triad
18. I-AIM: Interpretation - NormalIdentify right kidney and relationships
19. I-AIM: Interpretation - NormalIdentify left kidney and relationships
20. I-AIM: Interpretation - NormalIdentify bladder and relationships