CHATTANOOGA STATE COMMUNITY COLLEGE CHATTANOOGA,...

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Rev. 09/10 SACS / jh

CHATTANOOGA STATE COMMUNITY COLLEGE CHATTANOOGA, TENNESSEE

DIVISION OF NURSING & ALLIED HEALTH DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM

COURSE SYLLABUS US 203 – Abdomen & Small Parts I

Class Hours: 4 Credit Hours: 4 Laboratory Hours: 1

Semester: FALL 2010 Dates: 08/30/10-12/17/10, EVERY OTHER Tuesday & 1st Wed. each month Times: Class on Tues. 8:30 a.m.–12:00 p.m. / Lab on designated Weds. 8:30 a.m.–12:00 p.m. Room: OMN-175 Course & Lab Instructor: Lori Robinson, BS, RDCS, RDMS, RVT, RT(R,CT) Voice Mail: (423)697-3262 E-Mail: [email protected] Fax No.: (423)697-3324 Office: Chatt. State HPF Building, Office 180 Office Hours: M-F, 8:30 a.m.-5:00 p.m. (unless clinic travel or class) Additional Lab Instructor: Jody Arnold Hancock, MAEd, RDMS, RVT, RT(R) Voice Mail: (423)697-3341 E-Mail: [email protected] Fax No.: (423)697-3324 Office: Chatt. State HPF Building, Office 177 Office Hours: M-F, 8:30 a.m.-5:00 p.m. (unless clinic travel or class)

CATALOG COURSE DESCRIPTION: The first of a three-course sequence; the student will become familiar with abdominal cross-sectional and sagittal anatomy, including the muscular system and abdominal vascular structures. The organs of the abdomen will be introduced, as they relate to one another and by normal sonographic presentation and physiologic process. The student will learn metabolic functions and the importance of laboratory data and patient clinical history as related to the sonographic scanning procedure. ENTRY LEVEL STANDARDS: Completion of Human Anatomy and Physiology and certification in a patient care field (or recent graduate of a program of such discipline), with a minimum grade of "C" in previous coursework is required for progression to this course. Having had this learning experience, the student should demonstrate knowledge of the structure and function of the human body, medical terminology, positioning terminology, and patient care and management. In addition, the student should demonstrate a responsible attitude toward attendance, independent learning activities, classroom and clinical participation, and course preparation. The student should be computer literate and capable of navigating a Web site. OTHER COURSE REQUIREMENTS: The student should have access to the Internet to gather topic assignments. Networked computers are available for student use on campus, including in the sonography computer laboratory and the library. Students wishing to become proctored on exams between classes may do so with an approved clinical proctor. This process will require access to a computer with an Internet connection at the clinical facility, as well as the ability to download the Respondus Lockdown browser to access the exam through the Chattanooga State Distributed Education Web site. PREREQUISITE: Admission to the Diagnostic Medical Sonography Program. COREQUISITES: US 200, US 201, US 202, US 205.

mailto:[email protected]�

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TEXTBOOKS & RESOURCES FOR COURSE: 1. Curry, Tempkin (2004). Sonography: An Introduction to Normal Structure and Functional Anatomy, 2nd ed.

Philadelphia: W.B. Saunders & Co. 2. Curry, Tempkin (2004). Exercises in Sonographv: An Introduction to Normal Structure and Functional

Anatomv, 2nd ed. Philadelphia: W.B. Saunders & Co. 3. Hagen-Ansert, S. (2006). Textbook of Diagnostic Ultrasonographv., Vol. One & Two, 6th ed. St. Louis: Mosby

Elsevier. 4. Tempkin, B. (1999). Ultrasound Scanning: Principles and Protocols , 2nd ed. Philadelphia: W.B. Saunders & Co. 5. Hickey, Goldberg (1999). Ultrasound Review of the Abdomen, Male Pelvis & Small Parts. Philadelphia:

Lippincott-Raven. COURSE DELIVERY FORMAT:

Standard Format – This format is the traditional format and may use an online format to provide access to “static” materials which include the syllabus, course material, contact information, and presentations. Faculty must make available when requested a copy of syllabus and any other instructor provided course materials, including their contact information. Faculty may require on-line activities and assignments to include online tests and submission of all written and on-line communications. The extent of on-line activities/assignments may vary by course but will be specified on the syllabus.

PRESENTATION METHODS:

♦ PowerPoint Presentations ♦ Reading Assignments ♦ Instructor-Led Reviews ♦ Student-Directed Reviews ♦ Multimedia / Computer-Directed Aids ♦ Textbook & Worksheet Exercises – Both Independent Study & Instructor-Led ♦ Laboratories for Simulations and Practical Clinical Correlation

OUTCOMES & OBJECTIVES

ISLOs – INSTITUTIONAL STUDENT LEVEL OUTCOMES: Specific definitions of each may be found in your Program Handbook. Graduates of the accredited diagnostic medical sonography programs will demonstrate reflective outcomes related to knowledge, skills and attitudes that a community college graduate is expected to develop, to include:

ISLO1. Effective Communication ISLO2. Critical Thinking and Analytical Skills ISLO3. Information Technology Skills ISLO4. Societal & Cultural Awareness ISLO5. Foundational Knowledge in a Specialty ISLO6. Work Ethic

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PSLOs - PROGRAM STUDENT LEVEL OUTCOMES: This course is offered in conjunction with other pre-requisite and/or co-requisite courses as part of the accredited sonography program. At the end of the program year, the student will demonstrate mastery of the following knowledge, skills, attitudes and/or values as related to all program learning.

PSLO1. Obtain, review, and integrate pertinent patient history and supporting clinical data to facilitate optimum diagnostic results. (RELATES TO ISLO 5)

PSLO2. Perform appropriate procedures and record anatomic, pathologic, and/or physiologic data for interpretation by a physician. (RELATES TO ISLO 5)

PSLO3. Record, analyze, and process diagnostic data and other pertinent observations made during the procedure for presentation to the interpreting physician. (RELATES TO ISLO 3)

PSLO4. Exercise discretion and judgment in the performance of sonographic and/or other diagnostic services. (RELATES TO ISLO 2)

PSLO5. Demonstrate appropriate communication skills with patients and colleagues. (RELATES TO ISLO 1)

PSLO6. Act in a professional and ethical manner. (RELATES TO ISLO 6) PSLO7. Provide patient education related to medical ultrasound and/or other diagnostic vascular

techniques, and promote principles of good health. (RELATES TO ISLO 4)

CSLOs - COURSE STUDENT LEVEL OUTCOMES: To be better prepared to interact and function in the sonography department upon course completion, the student will achieve the following course outcomes.

CSLO1. Evaluate patient clinical and laboratory histories in order to properly scan the appropriate anatomic areas for abdominal examination. (RELATES TO PSLO 1)

CSLO2. Obtain a familiarity with physiologic and pathologic processes within the abdomen. (RELATES TO PSLO 2)

CSLO3. Learn to appropriately use sonographic terminology, as related to abdominal sonography for the description of anatomic regions, divisions and sonographic appearance of structures during sonographic examinations. (RELATES TO PSLO 5)

CSLO4. Demonstrate the ability to prepare a patient and provide an appropriate patient care environment for an abdominal ultrasound study. (RELATES TO PSLO 7)

CSLO5. Use the proper basic scanning, documentation, and measurement protocols for performing the various abdominal sonographic examinations. (RELATES TO PSLO 3)

CSLO6. Realize the potential need to expand the scope of the study to include other anatomic areas beyond the basic protocol. (RELATES TO PSLO 4)

CSLO7. Recognize the sonographic appearance and the normal variants of the various abdominal organs and surrounding structures. (RELATES TO PSLO 2)

CSLO8. Identify when to utilize various transducers when scanning abdominal organs, according to frequency, type, footprint size, etc. (RELATES TO PSLO 4)

CSLO9. Demonstrate an understanding of the role of ultrasound in the evaluation of abdominal pathology. (RELATES TO PSLO 6)

LEARNING INDICATORS AND OBJECTIVES: These objectives assist in assuring the student will be better prepared to interact and function with instrumentation in the sonography department upon course completion. These learning indicators have also been included, and sometimes expanded upon, within each of the Topic sections of this syllabus, to correlate with assignments for the purpose of focused student comprehension.

LO1. Describe proper patient preparation required for sonographically evaluating the abdominal organs and related structures. (CSLO 4)

LO2. Using the proper sonographic terms, describe the location, normal echogenicity and echotexture patterns of the psoas and quadratus lumborum muscles. (CSLO 3)

LO3. Assess the diaphragm, including the location, function, and crura. (CSLO 7) LO4. Describe the anterior abdominal muscles, demonstrating the linea alba, rectus abdominus,

external obliques, and rectus sheath. (CSLO 3)

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LO5. Describe the location and sonographic appearance of the muscles visualized in a pelvic sonogram. (CSLO 3)

LO6. Identify the layers of the peritoneum, discussing their function as well as surrounding structures. (CSLO 3)

LO7. Differentiate intraperitoneal from extraperitoneal organs and structures, also defining peritoneal cavity differences from male to female humans. (CSLO 5)

LO8. Describe other body omenta, recesses and spaces associated with potential pathology. (CSLO 2) LO9. Delineate differences between arterial and venous composition, function, echogenicity and

layering of walls and lumen, including blood flow characteristics, with particular emphasis on the abdominal aorta and the inferior vena cava. (CSLO 7)

LO10. Assess the aorta with the major anterior and lateral branches and the organs supplied by those branches. (CSLO 5)

LO11. Assess the inferior vena cava and major tributaries with the organs that are drained by them, also describing the normal location and course of the IVC. (CSLO 5)

LO12. Assess the portal vein and tributaries including location, size and course with associated organs or structures, also describing the echogenicity of the walls and lumen. (CSLO 5)

LO13. List the diagnostic tests associated with the aorta, IVC and portal venous system. (CSLO 1) LO14. Assess the kidney with the internal anatomy including: renal capsule, cortex, medullary

pyramids, major and minor calyces, renal pelvis, hilum, and sinus; as well as the vascular anatomy, including the main renal vein and artery, interlobar artery, arcuate artery, and interlobular artery and show their relationship with the internal anatomy. (CSLO 5)

LO15. Contrast the sonographic appearance of various fluid collections in the renal system. (CSLO 6) LO16. Calculate renal length and renal volume for comparative analysis. (CSLO 5) LO17. Compare the sonographic appearance and size of the adult adrenal with the adrenal of a

neonate. (CSLO 7) LO18. Construct a table of the adrenal cortex zones, the hormones produced in each zone, and the

function of each hormone. (CSLO 2) LO19. Identify the principle functions of the liver and biliary system. (CSLO 2) LO20. Identify the liver function tests, describing their relevance to hepatic disease. (CSLO 1) LO21. Assess the normal anatomical locations, sizes, landmarks and sonographic appearance of the

hepatic and biliary tract structures. (CSLO 5) LO22. Sonographically differentiate the congenital abnormalities and normal variants that affect the

gallbladder and bile ducts. (CSLO 7) LO23. Detail both endocrine and exocrine functions of the pancreas, including the types of cells which

carry out each specific function. (CSLO 2) LO24. Describe the reticuloendothelial system and its structures, most particularly related to the

immune response. (CSLO 9) LO25. Assess the locations, size, shape, and sonographic appearance of a lymph node. (CSLO 5) LO26. Specify the arterial, venous, and lymphatic vessels that supply and drain the spleen. (CSLO 3) LO27. Utilize appropriate ultrasound instrumentation for the assessment of the normal location and

sonographic appearance (size, lobes, echogenicity, texture, borders, vasculature, and other related structures) for the organs of the urinary system, the liver, the pancreas and spleen, including anatomical relationships of adjacent structures. (CSLO 8)

LO28. Identify normal variants of the renals, spleen, pancreas, and liver through their descriptions, sonographic appearances, and associated protocol, when discovered. (CSLO 7)

LO29. Apply Doppler techniques to diagnose a vascular-related problem in the abdomen. (CSLO 9) LO30. Describe hepatopetal and hepatofugal flow patterns in the liver. (CSLO 9) LO31. Compare the characteristics of laminar flow and plug flow. (CSLO 9) LO32. Differentiate the components of a spectral wave form, such as high resistance and low resistance

arterial flow. (CSLO 6)

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REQUIRED ASSESSMENTS

Syllabus Review Submit Syllabus Acknowledgement Statement

ISLO 1

Topic 1 Objectives Part 1 Instructional Objectives in Syllabus + Includes review questions for Ansert text reading

LO 2, 4, 5 LO 3

CSLO 3 CSLO 7

PSLO 5 PSLO 2

ISLO 1 ISLO 5

Topic 2 Objectives Part 2 Instructional Objectives in Syllabus + Includes review questions for Ansert text reading

LO 6 LO 7 LO 8

CSLO 3 CSLO 5 CSLO 2

PSLO 5 PSLO 3 PSLO 2

ISLO 1 ISLO 3 ISLO 5

Scan Planes/ Anatomical Intro.

3-dimensional playdough model built in student pairs for scan planes & anatomical relationships

LO 10,11, & 12

CSLO 5 PSLO 3 ISLO 3

Scan Lab Orientation Hands-on practice to include scan planes & anatomical relationships

LO 27 CSLO 8 PSLO 4 ISLO 2

Topic 3 Objectives

Part 3 Instructional Objectives in Syllabus

LO 1 LO 9

LO 13 LO 10,11,

12

CSLO 4 CSLO 7 CSLO 1 CSLO 5

PSLO 7 PSLO 2 PSLO 1 PSLO 3

ISLO 4 ISLO 5

ISLO 3

Topic 3 Workbook Curry & Tempkin workbook, Ch. 5 LO 9

LO 10 CSLO 7 CSLO 5

PSLO 2 PSLO 3

ISLO 5 ISLO 3

Topic 3 Workbook Curry & Tempkin workbook, Ch. 6 LO 9 LO 11

CSLO 7 CSLO 5

PSLO 2 PSLO 3

ISLO 5 ISLO 3


LO 12 CSLO 7 CSLO 5

PSLO 2 PSLO 3

ISLO 5 ISLO 3

Protocol Assignment

Aorta/Great Vessels Protocol Cards (Follow Instructions provided by instructor; graded based on Protocol Card Assessment Tool)

LO 9 LO 10, 11

CSLO 7 CSLO 5

PSLO 2 PSLO 3

ISLO 5 ISLO 3

Laboratory 1a Activity 1: Abd. Vasc. Scan Lab (Completion of Scan Lab Sheet)

LO 10, 11 LO 27

CSLO 5 CSLO 8

PSLO 3 PSLO 4

ISLO 3 ISLO 2

Laboratory 1a Activity 2: Internet Assignment – GE Basic Abdomen CME (online quiz grade to be submitted to drop box)

LO 27 LO 28

CLSO 8 CLSO 7

PSLO 4 PSLO 2

ISLO 2 ISLO 5

Laboratory 1a Activity 3: CD-Rom-Planes & Vascular Topics (Student to Outline Key Points)

LO 10 LO 11


Laboratory 1b Activity 4: Renal Scan Lab (Completion of Scan Lab Sheet)

LO 14,16 LO 27 LO 28




Laboratory 1b Activity 5: CD-Rom-Kidneys & Urinary Tract Topics (Student to Outline Key Points)

LO 14 LO 15 LO 28




Laboratory 1b Activity 6: (2) Renal Diagrams (Complete & Submit for grade)


Imaging Quiz Image Identification & Anatomical Relationship Quiz: Vasculature & Renal

LO 9 LO 10,11,

12, 14

CSLO 7 CSLO 5

PSLO 2 PSLO 3

ISLO 5 ISLO 3

Exam 1 Covers Topics & Materials on: Topic 1 – Abd. Musculature

LO 2 - 13 CSLO 1

CSLO 2, 7 PSLO 1 PSLO 2

ISLO 5 ISLO 1

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Topic 2 - Peritoneum & Retroperitoneum Topic 3 – Abd. Vasculature

CSLO 3 CSLO 5

PSLO 5 PSLO 3

ISLO 3

Topic 4a Objectives

Part 4 Instructional Objectives in Syllabus (Renals)

LO 1 LO 14, 16

LO 15 LO 28



ISLO 4 ISLO 3 ISLO 2 ISLO 5

Topic 4b Objectives Part 4 Instructional Objectives in Syllabus (Adrenals)

LO 1 LO 17 LO 18




Topic 4 Workbook Curry & Tempkin workbook, Ch. 12

LO 14, 16 LO 15 LO 28




Protocol Assignment Renal Protocol Cards (Follow Instructions provided by instructor; graded based on Protocol Card Assessment Tool)

LO 14 LO 16


Exam 2

Covers Topics & Materials on: Topic 4 – Renals & Suprarenals (Adrenals)

LO 14, 16 LO 15 LO 27

LO 17, 28 LO 18

CSLO 5 CSLO 6 CSLO 8 CSLO 7 CSLO 2

PSLO 3

PSLO 4

PSLO 2

ISLO 3

ISLO 2

ISLO 5

Topic 5 Objectives


LO 1 LO 19 Lo 28 LO 20 LO 21


PSLO 7 PSLO 2

PSLO 1 PSLO 3

ISLO 4

ISLO 5

ISLO 3 Topic 5 Workbook Curry & Tempkin workbook, Ch. 9 LO 21 CSLO 5 PSLO 3 ISLO 3

Protocol Assignment

Hepatic Protocol Cards (Follow Instructions provided by instructor; graded based on Protocol Card Assessment Tool)

LO 21


Laboratory 2 Activity 1:Liver (Hepatic) Scan Lab (Completion of Scan Lab Sheet)

LO 1 LO 21 LO 27




Laboratory 2

Activity 2: Hepatobiliary Video (Student to Outline Key Points)

LO 19 LO 28 LO 21 LO 27


PSLO 2

PSLO 3 PSLO 4

ISLO 5

ISLO 3 ISLO 2

Laboratory 2

Activity 3: CD/Rom – Liver & Peritoneal Cavity Topics (Student to Outline Key Points)

LO 7 LO 21 LO 19 LO 20

CSLO 5

CSLO 2 CSLO 1

PSLO 3

PSLO 2 PSLO 1

ISLO 3

ISLO 5

Exam 3

Covers Topics & Materials on: Topic 5 – Hepatic (Liver)

LO 1 LO 19 LO 28 LO 20 LO 21 LO 27

CSLO 4 CSLO 2 CSLO 7 CSLO 1 CSLO 5 CSLO 8

PSLO 7 PSLO 2


ISLO 4

ISLO 5

ISLO 3 ISLO 2

Topic 6 Objectives


LO 1 LO 19 LO 22 LO 20 LO 21


PSLO 7 PSLO 2

PSLO 1 PSLO 3

ISLO 4

ISLO 5

ISLO 3 Topic 6 Workbook Curry & Tempkin workbook, Ch. 10 LO 21 CSLO 5 PSLO 3 ISLO 3

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Protocol Assignment

Biliary Protocol Cards (Follow Instructions provided by instructor; graded based on Protocol Card Assessment Tool)

LO 21


Exam 4

Covers Topics & Materials on: Topic 6 – Biliary Tract

LO 19 LO 20 LO 21 LO 22


PSLO 2

PSLO 1 PSLO 3

ISLO 5

ISLO 3

Topic 7 Objectives Part 7 Instructional Objectives in Syllabus LO 1

LO 23 LO 28


PSLO 7

PSLO 2

ISLO 4

ISLO 5


LO 28 CSLO 8 CSLO 7

PSLO 4 PSLO 2

ISLO 2 ISLO 5

Protocol Assignment

Pancreas Protocol Cards (Follow Instructions provided by instructor; graded based on Protocol Card Assessment Tool)

LO 27 LO 28

CSLO 8 CSLO 7

PSLO 4 PSLO 2

ISLO 2 ISLO 5

Topic 8 Objectives Part 8 Instructional Objectives in Syllabus LO 24

LO 25 LO 26




Topic 9 Objectives

Part 9 Instructional Objectives in Syllabus LO 24 LO 26 LO 27 LO 28





LO 27 LO 28




Protocol Assignment

Splenic Protocol Cards (Follow Instructions provided by instructor; graded based on Protocol Card Assessment Tool)

LO 26 LO 27 LO 28




Laboratory 3

Activity 1: Internet Assignment – GE Acute Abdomen CME (online quiz grade to be submitted to drop box)

LO 10,12, 14, 21

LO 24,29, & 30 LO 27 LO 28

CSLO 5

CSLO 9

CSLO 8 CSLO 7

PSLO 3

PSLO 6

PSLO 4 PSLO 2

ISLO 3

ISLO 6

ISLO 2 ISLO 5

Laboratory 3a Activity 2:Pancreatic Scan Lab (Completion of Scan Lab Sheet)


Laboratory 3a Activity 3: (2) Pancreatic Diagrams (Complete & Submit for grade)


Laboratory 3b Activity 4:Biliary Scan Lab (Completion of Scan Lab Sheet)

LO 21 LO 27

CSLO 5 CSLO 8

PSLO 3 PSLO 4

ISLO 3 ISLO 2

Laboratory 3c Activity 5:Spleen Scan Lab (Completion of Scan Lab Sheet)

LO 26 LO 27 LO 28




Laboratory 3b/c

Activity 6: CD/Rom – Pancreas & Spleen Topics (Student to Outline Key Points)

LO 23 LO 28 LO 24 LO 26 LO 27


PSLO 2


ISLO 5


Exam 5 Covers Topics & Materials on: LO 23-28 CSLO 2 PSLO 2 ISLO 5

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Topic 7 – Pancreas Topic 8 – Reticuloendothelial System Topic 9 - Spleen

CSLO 3 CSLO 5 CSLO 8 CLSO 9



Topic 10 Objectives Part 10 Instructional Objectives in Syllabus

LO 29,30, & 31 LO 32

CSLO 9

CSLO 6

PSLO 6

PSLO 4

ISLO 6

ISLO 2

Topic 10 Workbook Curry & Tempkin workbook, Ch. 8 LO 29, 31

LO 32 CSLO 9 CSLO 6

PSLO 6 PSLO 4

ISLO 6 ISLO 2

Topic 10 Quiz Abdominal Doppler Quiz

LO 29,30, & 31 LO 32

CSLO 9

CSLO 6

PSLO 6

PSLO 4

ISLO 6

ISLO 2

Final Exam Comprehensive Final Exam Topics 1-10

LO 1-32 CSLO 1-9 PSLO 1-7

ISLO 1-6

EXAMS:

Five(5) Non-Cumulative objective exams – 50% of final course grade The four(4) highest scores will be calculated – 12.5% each of the final grade All exam scores, however, MUST be passing (70% or higher) /or/ remediation will be expected.*

One(1) Quiz – 5% of final course grade One (1) Comprehensive Final exam – 15% of final course grade.

This exam is not eligible for remediation, since it is cumulative. *Remediation of an exam must take place if the student does not pass the exam with a score of 70% or greater. The policy of the CSTCC DMS program is to allow remediation of one (1) non-cumulative exam per course. This means that:

• When a final exam is cumulative/comprehensive, it is not eligible for remediation. (The student must pass with a minimum score of 70% to progress to the next course or to complete the program if the course exists in the final semester.)

• If a student has already remediated an exam during this same course, the student is no longer eligible for additional remediation within the specified course. (Students will continue to be eligible for a one-time remediation within another course during the same semester, however.)

• When sitting for a remediation exam, the student is expected to achieve a minimum score of 80% in order to progress to the next course or to complete the program if the course exists in the final semester.

• Although the student is allowed the opportunity for remediation for the sake of progression, the student’s original exam grade will be posted for final grade calculation purposes.

Students who do not pass the remediation attempt with a minimum score of 80%, or students who have already remediated and do not achieve a minimum score of 70% on a following examination will not be allowed to progress in the course or program. Such students will have the opportunity to apply for readmission to the program during the following program year.

LABORATORY AND HOMEWORK EXPECTATIONS: Completion of assigned reading and homework objectives/exercises between class sessions is required.

1. Demonstrations/Simulations, where applicable. Laboratories will be conducted to correspond with presentations, protocols and homework assignments.

2. Each student will create and maintain a protocol booklet of images for the TAS and TVS pelvic procedures, which will count towards 5% of the final grade.

3. There is an exercise manual that students will complete to correspond to lab and lecture sessions, as part of homework. These are listed in the topic overviews for each section and will count as 5% of the final student grade.

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4. Scanning/simulation and multimedia assignments will be graded for a portion of the laboratory grade, which consists as 10% of the student’s final grade.

FIELD WORK: Clinical correlation should be made to all instructional learning, with clinical assignments often given as or related to homework throughout the program. Students may be asked to present cases or bring case information into the classroom setting. HIPAA Regulations must be adhered to in such instances, with the HIPAA Privacy Statement submitted with the case, and the Case Rubric utilized if a full case is assigned by the instructor. These forms are located in your Syllabus following the Syllabus Acknowledgement Statement.

In many instances, you may use a full case work-up in this course as a required clinical case study assignment AFTER it has been presented in class. However, you must bring the cases for this course to your class session with you, so do NOT expect to turn in the same case for clinical requirements during the same class week, as clinical assignments are due on Monday mornings and students should not expect to have them returned.

OBJECTIVES: Students will be expected to perform instructional objectives located within the topic overviews for each section independently, in addition to other chapter objectives that may also be assigned. These objectives will be turned in prior to each exam that correlates to this material in the student’s dropbox (either online or on campus). The student’s completion of instructional objectives directly assists in preparing the student for the assessment on related material, so a grade is assigned for their completion. The student should consider these as the “Entrance Ticket” to the exam. The instructor reserves the right to refuse the student entry to the exam without first submitting these objectives. Note that the student should preferably use the online dropbox and ONLY use the on-campus one if online submission is not available or achievable. (The student should choose only one means or the other of submission; do not duplicate assignment submission into both places, please.) In this course, additional credit may be assigned to a specific topic portion of instructional objectives when a student completes and presents a voluntary case study. Mandatory case studies receive their own grades. OTHER EVALUATION METHODS: Attendance and Participation will be taken into consideration when assigning the final grade, with points being deducted for unexcused absenteeism or tardiness. The instructor reserves the right to adjust grades according to these or other considerations (i.e. participation, disruption, etc.). Attendance and other relevant classroom policies are specifically addressed in the DMS Student Handbook, where the student has previously given signature to an understanding and acceptance of these policies.

COURSE GRADING & GRADING SCALE: EXAM 1 12.5%* EXAM 2 12.5%* EXAM 3 12.5%* EXAM 4 12.5%* EXAM 5 12.5%* QUIZ 1 5% LABORATORIES 10% PROTOCOL CARDS 5% HOMEWORK ASSIGNMENTS 5% OBJECTIVES COMPLETION 10%

*Top 4 Exam Grades will be included in the Final Grade.

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The final grades of A, B, C, D, or F will be assigned on the basis of the numerical average determined by the assignments listed above with the following point ranges: A (90-100) B (80-89) C (70-79) D (65-69) F (64 or less) In the event that a student fails an exam and has exhausted all remediation attempts, the student will NOT be awarded a grade higher than a D, regardless of how the numeric grade would otherwise calculate. Students must successfully complete all work with passing competency grades for each assignment to achieve a minimum of a C in the course, thereby maintaining eligibility for program progression.

SYLLABUS STATEMENTS

STUDENT-INSTRUCTOR COMMUNICATION

All sonography program students are required to set up a TigerMail account and supply this official college email address to the program director at the beginning of the program year. Your director and/or instructor will use your TigerMail account to relay any program-specific information to you. The link to set up this account can be found on the campus TigerWeb home page, which will first require input of your Student campus ID (your “A” number) and setting up your own password.

Any email communications that are course-specific will be addressed by your instructor through the e-Learn (online course platform) email system. Your instructor(s) will demonstrate the use of this tool during your sonography orientation. Please utilize the e-Learn email system within your course when asking a course-specific question or submitting course-specific information to your instructor.

You may email your instructor at his/her Chattanooga State email address (rather than the e-Learn site) or call and leave a message on your instructor’s voice mail when your question or information is either program-specific or your course-specific question has not been answered according to the procedure established in the following paragraph.

It is my goal, as your sonography course instructor, to answer your emails and voice mails within 48 hours during the regular program week (Mon-Fri) and within 72 hours when a weekend is involved. However, please understand that the sonography program requires faculty to travel to clinic sites and other professional events (often for multiple consecutive days) as part of my program duties. I will continue to make reasonable attempts to check my email and/or voice mail within the stipulated timeframe above. However, in an emergency where you have not received an adequate response in a timely manner, please leave a message with our secretary at 423-697-3360, specifically explaining your need, so that she may attempt to reach me or someone else who can assist you immediately. Thank you.

ASSIGNMENT GRADING

Students are asked to submit graded documents either within their Dropbox (online) or Inbox (on campus) by the designated due date. Your instructor will have submitted items graded no later than the following class week, where you will either receive confirmation of a grade in your Dropbox Comments (online) or your graded materials will be located in your Outbox (on campus). Your instructor will notify you of any grading delays beyond this standard, along with the anticipated time you may expect to receive your returned graded assignment.

Where instructor dates are provided (on the course online calendar, syllabus, lesson plans and/or in each topic segment), late work will be accepted only under extenuating circumstances and upon completion and submission

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of the Extension Request Form together with explanation and proof of need for an extension (i.e. doctors certificate, etc.). All accepted late assessment, regardless of cause, may be penalized.

If the course is not completed prior to the end of the term, the student will receive an Incomplete and will have two additional weeks into the following semester to complete the course work (unless the instructor has approved a later date in advance, due to approval of the extension request form). After such time, an Incomplete will be changed to a Failure of the course.

EXTENSION POLICY

Assignments will not be accepted after 2 weeks from the end of the assigned course week. Late assignments can only receive a maximum of 75% of the grade assigned. (Extreme extenuating circumstances, such as a health issue, may receive special consideration.)

ADA STATEMENT Students who have educational, psychological, and/or physical disabilities may be eligible for accommodations that provide equal access to educational programs and activities at Chattanooga State. These students should notify the instructor immediately, and should contact Disabilities Support Services within the first two weeks of the semester in order to discuss individual needs. The student must provide documentation of the disability so that reasonable accommodations can be requested in a timely manner. All students are expected to fulfill essential course requirements in order to receive a passing grade in a class, with or without reasonable accommodations. DISRUPTIVE STUDENTS The term “classroom disruption” means – student behavior that a reasonable person would view as substantially or repeatedly interfering with the activities of a class. A student who persists in disrupting a class will be directed by the faculty member to leave the classroom for the remainder of the class period. The student will be told the reason(s) for such action and given an opportunity to discuss the matter with the faculty member as soon as practical. The faculty member will promptly consult with the division dean and the college judicial officer. If a disruption is serious, and other reasonable measures have failed, the class may be adjourned, and the campus police summoned. Unauthorized use of any electronic device constitutes a disturbance. Also, if a student is concerned about the conduct of another student, he or she should please see the teacher, department head, or division dean. AFFIRMATIVE ACTION Students who feel that he or she has not received equal access to educational programming should contact the college affirmative action officer. ACADEMIC INTEGRITY/ACADEMIC HONESTY In their academic activities, students are expected to maintain high standards of honesty and integrity. Academic dishonesty is prohibited. Such conduct includes, but is not limited to, an attempt by one or more students to use unauthorized information in the taking of an exam, to submit as one's own work, themes, reports, drawings, laboratory notes, computer programs, or other products prepared by another person, or to knowingly assist another student in obtaining or using unauthorized materials. Plagiarism, cheating, and other forms of academic dishonesty are prohibited. Students guilty of academic misconduct, either directly or indirectly through participation or assistance, are immediately responsible to the instructor of the class. In addition to other possible disciplinary sanctions, which may be imposed through the regular institutional procedures as a result of academic misconduct, the instructor has the authority to assign an "F" or zero for an activity or to assign an "F" for the course.

12


SYLLABUS GUIDELINES STATEMENT

The instructor reserves the right to modify this syllabus in writing anytime during the course of the semester. This course is governed by the policies and procedures as stated in the current: • Chattanooga State Student Handbook • CSTCC Nursing/Allied Health Student Handbook • CSTCC Diagnostic Medical Sonography Student Handbook.

Additional or more specific guidelines may apply. PROGRAM POLICIES: This class is governed by the policies and procedures stated in the current Chattanooga State Diagnostic Medical Sonography Student Handbook. Additional or more specific guidelines may apply. COLLEGE POLICIES: This class is governed by the policies and procedures stated in the current Chattanooga State Student Handbook. Additional or more specific guidelines may apply.

STUDENT ACKNOWLEDGEMENT STATEMENT

By my signature below, I attest that I have received and reviewed the US 203 course syllabus for Fall ___________ . course no. Semester Year I understand the course requirements with regard to attendance, grading, objectives, course policies and procedures, including those regarding my conduct in this course. I agree to be held accountable for my performance and actions according to such requirements and also agree to the provisions of the Syllabus Guidelines Statement as written within the course syllabus. Student Name (Please Print): Student Signature: Date:

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Chattanooga State Community College Diagnostic Medical Sonography Program HIPAA Privacy Statement Related to Sharing of Case Study Information for Educational Purposes

Course #: Semester/Year: Case Study Title: Case Study #: Instructor: The submitted archived images/reports associated with this case study are to be used only by the ChSCC DMS/CVS Programs for case study information, according to the current HIPAA agreement that has been signed by all relevant parties. No portion is to be shared for any other purpose outside of the agreed upon scope to pursue academic knowledge for professional necessity. Any parties viewing such information are within this same instructional scope and also agree that no information about this patient or case will be discussed or used outside of this environment. Any cases remaining with the instructor will be stored in a case file that is either physically locked in the digital imaging room or file room storage facility or digitally stored on a password protected computer that will only be accessed by parties covered within the designated instructional scope OR will be disposed of in the same manner as all privacy records on campus. Any case study records returned to the student MUST be immediately returned to the clinical site from which they were released for use. The Student submitting this case should designate one of the following options, related to the extent of privacy information included:

� Submitted documents and/or images DO NOT contain any recognizable patient identification.

� Submitted documents and/or images DO NOT contain any recognizable facility identification.

� Submitted documents and/or images DO contain information that is recognizable but CANNOT be removed. The Data archiving/PACS system does NOT allow the removal of data or I am NOT provided with any alternate capability to hide patent information.

� The recognizable data is related to patient identification.

� The recognizable data is related to facility identification.

� Students are not permitted to remove Images/reports associated with case studies from this facility. Relevant Data pertaining to this case study must be reviewed on site by ChSCC faculty.

Student Signature: __________________________________Date of Signature:

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Chattanooga State Community College Diagnostic Medical Sonography Program

Case Study Assessment Guide

Criteria 17 15 13 11 Points

Indications/ Presenting Symptoms

Completeness of case history to include:

Age, gender, presentation of

symptoms/indications, and prior diagnosis or

problems.

Case history is

complete except one criterion is omitted.

Case history partially complete, two criteria

are omitted.

Limited Case history

included.

Sonographic

Findings

Excellent description of a specific US exam

(with submitted images) to include; US

appearance using appropriate medical

terminology to describe pathology/findings in students’ own words.

Very Good description of US findings and use

of terminology, however, one

abnormality is omitted. Appropriate images are

submitted.

Good description of US findings, however, one abnormality is omitted and/or inappropriate terminology is used.

Only a limited number of images are included.

US findings are limited to a copied radiology report. No images/few images are submitted.

Scanning Problems/ Caveats

Involved and How These

Were overcome

Scanning

caveats/problems are thoroughly discussed

along with a description of how these were

overcome.

Scanning

caveats/problems are discussed along with a limited description of

how these were overcome.

Scanning

caveats/problems are discussed along with no

description of how these were overcome.

Scanning caveats/ problems and a

description of how these were overcome were not discussed,

only limited entry, such as “no problems”

Applicability to

Present Didactical Studies

Student relates in

excellent detail how this case applies to their

present didactic studies.

Student relates in very good detail how this case applies to their


Student relates in good

detail how this case applies to their present

didactic studies.

Student relates in very limited detail how this case applies to their


New Clinical Applicability

Student relates in

excellent detail how new technology,

instrumentation or other procedures were used to obtain diagnosis for

this case.

Student relates in good

detail how new technology,


this case.

Student relates in

limited detail how new technology,


this case.

Student relates in very limited or no detail how

new technology, instrumentation or other procedures were used to obtain diagnosis for

this case.

Additional

Information

Excellent additional

information is gathered concerning this specific

case or pathology including (if available):

lab results, imaging reports and /or images from other modalities,

surgical notes, pathology reports, and research information

concerning the abnormality/pathology.

Good additional


case or pathology to including (if available):

lab results, imaging reports and /or images from other modalities,

surgical notes, pathology reports, and research information

concerning the abnormality/pathology.

Additional information is

gathered concerning this specific case or

pathology including (if available): lab results,

imaging reports and /or images from other modalities, surgical

notes, pathology reports, and research

information concerning the abnormality

/pathology.

Only limited additional


case or pathology.

Total →

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CSTCC DMS PROGRAM

US 203 - Abdominal & Small Parts I

Instructional Activities and Objectives

MODULE 1: Abdominal Musculature, Abdominal Wall, and Diaphragm

ASSIGNMENTS

READING ASSIGNMENT:

Hagen-Ansert, Chapter 3, pages 49-67

Hickey & Goldberg, pages 191-193

HOMEWORK ASSIGNMENT:

Instructional Objectives

PLUS Additional

Review Questions to correlate with Hagen-Ansert, Chapter 3 (for Topics 1-2)

(Review Questions will be included after Objectives for Part 2)

INSTRUCTIONAL OBJECTIVES - Due on Exam Date

Instructional Objectives for this module are to be completed as part of your topic review and exam preparation.

You should submit answers for these objectives prior to your first exam. To do this, download an electronic version directly into the Dropbox for Objectives 1. (You may use this direct link to accomplish this or go to the dropbox tab above and select the correct objectives link.)

You may use the Rich Text File of this topic's OBJECTIVES to save and complete them on your own computer for sending your assignment to the dropbox. (These are included in your Module materials.)

1. Using the proper sonographic terms, describe the normal echogenicity and echotexture patterns of the psoas and quadratus lumborum muscles. 2. Describe the location of the psoas and quadratus lumborum muscles. 3. Describe the diaphragm, including the location, function, and crura. 4. List the structures that make up the anterior abdominal wall. 5. Describe the linea alba and the rectus abdominus muscle. 6. Draw and label a diagram of the anterior abdominal muscles demonstrating the linea alba, rectus abdominus muscle, ext. oblique muscle, and rectus sheath. 7. Describe the location and sonographic appearance of the iliopsoas muscle.

https://elearn.chattanoogastate.edu/d2l/tools/LMS/quicklink.asp?ou=10820&type=dropbox&rCode=TBRTrainin-19788�

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8. List the skeletal muscles that line the pelvic floor and describe their function. 9. Name the pelvic muscle can mimic an ovary. 10. Describe the location and sonographic appearance of the obturator internus muscles. 11. Discuss the term levator ani and its function. Topic Outline:

I. Abdominal Musculature and Abdominal Wall a. Sonographic terminology b. Sonographic appearance of muscles in the abdomen and pelvis c. Intra-abdominal muscles 1. Quadratus lumborum 2. Psoas major 3. Iliacus 4. Iliopsoas

II. Abdominal wall a. Anterior structures b. Posterior structures c. Lateral structures d. External oblique muscles e. Internal oblique muscles f. Linea alba g. Rectus abdominus

III. Ghost image artifact a. Rectus abdominus muscle IV Diaphragm a. Crura of the diaphragm

1. Right crus 2. Left crus

b. Ultrasound appearance of the diaphragm V. Subphrenic spaces a. Liver/diaphragm b. Spleen/diaphragm

VI. Pelvic muscles a. Pelvic diaphragm

1. Pubococcygeus muscles 2. Ileococcygeus muscles 3. Coccygeus muscles

b. Piriformis muscles c. Obturator internus muscles d. Levator ani muscles

1. Pubococcygeus muscles 2. Iliococcygeus muscles

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MODULE 2: Peritoneal Cavity, Mesenteries, and Retroperitoneum

ASSIGNMENTS

READING ASSIGNMENT:

S. Hagen-Ansert, Chapter 3

Hickey & Goldberg Ch. 10, Pg. 185-191,197, & 203



PLUS Additional

Review Questions to correlate with Hagen-Ansert, Chapter 3 (for Topics 1-2)

(Review Questions will be included after Objectives for Part 2)





1. Identify the layers of the peritoneum and discuss their function. 2. List the structures found posterior to the peritoneum. 3. Name the intraperitoneal organs. 4. Discuss the pattern that fluid accumulation (ascites) takes within the peritoneum (example: where does it start and where does it go next). 5. Define the term intraperitoneal. 6. Describe the difference(s) of the peritoneal cavity in the male versus the female. 7. Describe the greater omentum and its functions. 8. Give a detailed description of the location of the lesser sac and name the pathology that is commonly found in this location. 9. Describe the location of the hepatorenal recess, identify another name for this space, and tell why the sonographer should examine this area carefully. 10. List the types of fluid that may communicate throughout the peritoneum. 11. Describe the locations of the subphrenic spaces. 12. Draw a diagram of the midline sagittal plane of the female pelvis and label the structures (to include: uterus, urinary bladder, rectum, pubic symphysis, anterior cul-de-sac and poster cul-de-sac).


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Hagen-Ansert Chapter 3 Review Questions:

1. Define the following anatomic terms: median, sagittal, coronal, and transverse. 2. Define anterior, posterior, medial, lateral, proximal and distal as each relates to anatomic structures. 3. Name the nine regions of the abdomen. 4. List the four quadrants of the abdomen. 5. List the composition of the anterior abdominal wall. 6. Name and describe the two layers of the peritoneum. 7. What is the significance of the epiploic foramen? 8. What is the difference between the mesentery and the omentum? 9. Define the area of the peritoneal fossae. 10. Describe the falciform, ligamentum teres, lienorenal and gastrosplenic ligaments. 11. Name the four muscle groups of the anterior abdominal wall. 12. What muscles make up the muscular “sling” in the inferior boundary of the true pelvis? 13. Name the muscles in the true pelvis that form the posterior pelvic wall and the muscle that lines the

lateral pelvic wall. Topic Outline:

I. Abdominal Peritoneum a. Description b. Function c. Layers II. Peritoneal cavity a. Fluid accumulation b. Intraperitoneal structures c. Retroperitoneal structures d. Mesentery e. Omentum

1. Greater omentum 2. Lesser omentum

f. Lesser sac g. Epiploic foramen h. Subphrenic space i. Hepatorenal recess j. Paracolic gutters

III. Pelvic peritoneal Cavity a. Description b. Female pelvis

1. Anterior cul-de-sac 2. Posterior cul-de-sac

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MODULE 3: Abdominal Vasculature

ASSIGNMENTS

READING ASSIGNMENT:

Curry & Tempkin, Chapters 5, 6, & 7



Curry & Tempkin Workbook, Chapters 5, 6, & 7





1. Name the three layers of an artery. 2. Draw a table delineating the differences between an artery and a vein. 3. Describe the normal location, course and size of the abdominal aorta. 4. Draw a diagram of the aorta with the major anterior and lateral branches and the organs supplied by those branches and label. 5. Describe the echogenicity of the walls and lumen of the aorta and its branches using sonographic terminology. 6. List the diagnostic tests associated with the aorta. 7. Describe the normal location and course of the inferior vena cava. 8. Draw a diagram of the IVC and major tributaries with the organs that are drained by them and label. 9. Discuss the function of the IVC. 10. Contrast the sonographic appearance of the aorta and its branches with that of the IVC and its tributaries. 11. List the diagnostic tests associated with the IVC. 12. Describe the normal location, size, and course of the portal vein. 13. Draw a diagram of the portal vein and tributaries including location and the associated organs and label. 14. Describe the function of the portal venous system. 15. Describe the echogenicity of the walls and lumen of the portal vein and its tributaries using sonographic terminology. 16. Discuss diagnostic tests associated with the portal venous system.


20


Topic Outline:

I. Vascular Anatomy a. Principle wall layers b. Vein and artery differences

1. Thickness of wall layers 2. Rate of blood flow 3. Valves 4. Anatomical Relationships 5. Flow characteristics 6. Changes with respiration 7. Exceptions

II. Normal Sonographic Appearance a. Long-axis b. Short axis c. Proper measurements

1. AP most accurate 2. Lumen vs. outer wall measurement

d. Reference to Doppler 1. 2-D imaging vs. Doppler flow/color

III. Normal Abdominal Aorta a. Anatomical course b. Size c. Physiology d. Major branches

1. Celiac trunk • left gastric artery • splenic artery • common hepatic artery

2. Superior mesenteric artery 3. Inferior mesenteric artery 4. Renal arteries 5. Gonadal arteries 6. Common iliac arteries

• external • internal

IV. Normal Inferior Vena Cava a. Physiology b. Major tributaries

1. Common iliac veins • external • internal

2. Gonadal veins 3. Renal veins 4. Suprarenal veins 5. Hepatic veins

c. Anatomical course d. Size

V. Normal Portal Venous System a. Definition b. Physiology c. Main portal vein

1. Confluence 2. Main tributaries

• Splenic vein

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• Superior mesenteric vein • Inferior mesenteric vein

3. Branches • Left portal vein • Right portal vein

4. Anatomical course 5. Size

VI. Sonographic images and imaging techniques

MODULE 4a: Renals

ASSIGNMENTS

READING ASSIGNMENT:

Curry & Tempkin, Chapter 12

Hagen-Ansert, Chapter 10, pages 290-318



Curry & Tempkin Workbook, Chapter 12



You should submit answers for these objectives prior to your first exam. To do this, download an electronic version directly into the Dropbox for Objectives 4a. (You may use this direct link to accomplish this or go to the dropbox tab above and select the correct objectives link.)


1. List the organs in the urinary system and describe their principle functions. 2. Draw a diagram of the kidney with the internal anatomy including: renal capsule, cortex, medullary pyramids, major and minor calyces, renal pelvis, hilum, and sinus. 3. Using proper sonographic terms, describe the sonographic appearance of the adult kidneys, ureters, and bladder (include echogenicity, texture, contour or shape, and size). 4. Describe the normal location for the organs of the urinary system (include anatomical relationships of adjacent structures, such as the kidneys lie lateral to the psoas muscles). 5. Draw a diagram of the kidney showing the renal vasculature including the main renal vein and artery, interlobar artery, arcuate artery, and interlobular artery and show their relationship with the internal anatomy. 6. Describe the following normal renal variants and their sonographic appearance: dromedary hump,


22


hypertrophied column of Bertin, junctional parenchymal defect, duplex collecting system, horseshoe kidney, and extra renal pelvis. 7. List the laboratory tests used to evaluate the urinary system and discuss the clinical indications associated with abnormal values. 8. Identify the locations that should be evaluated when an ectopic kidney is suspected. 9. Compare the appearance and size of the adult kidney with the kidney of a neonate or child. 10. Contrast the sonographic appearance of a simple cyst, parapelvic cyst, and hydronephrosis. 11. Describe how to obtain and calculate a renal volume. 12. List the three sonographic criteria used to diagnose a simple cyst with ultrasound. Topic Outline:

I. Retroperitoneal Spaces a. Anterior pararenal space b. Posterior pararenal space c. Perirenal spaces

1. Left 2. Right

II. Urinary System a. Relational anatomy b. Location, shape, and size

1. Right kidney 2. Left kidney 3. Ureters 4. Urinary bladder

III. Renal Structure a. Parenchyma

1. Cortex 2. Medulla

• Medullary pyramids b. Sinus

1. Renal pelvis 2. Minor Calyces 3. Major Calyces or infundibulum 4. Renal vessels 5. Fat, nerves, and lymphatics

c. Capsules 1. Renal capsule 2. Gerota’s fascia 3. Adipose tissue

IV. Renal Function a. Maintain body’s chemical equilibrium

1. Homeostasis b. Dispose of metabolic waste products by excreting urine c. Blood pressure regulation

1. rennin secretion d. Maintenance and balance of blood levels

V. Renal Laboratory Data a. Urinalysis b. Serum Creatinine c. Blood urea nitrogen

VI. Renal Vascular Supply a. Arteries b. Veins c. Doppler waveform patterns

23


VII. Sonographic Applications VIII. Normal Sonographic Appearance

a. Kidney 1. Adult

• Shape • Size • Echogenicity

2. Pediatric/neonate • Shape • Size • Echogenicity

b. Ureter c. Bladder

IX. Required protocol images X. Renal Variants of Normal and Congenital Anomalies

a. Dromedary hump b. Hypertrophied column of Bertin c. Duplex Collecting System d. Horseshoe kidney e. Ectopic kidneys f. Crossed renal ectopia g. Cross fused renal ectopia h. Extrarenal pelvis i. Renal Agenesis j. Hypoplastic Kidneys k. Renal sinus lipomatosis l. Persistent fetal lobulations m. Renal Dysplasia

1. Multicystic Dysplastic Kidney Disease (MCDK) 2. Polycystic Renal Disease, (Infantile type) IPKD 3. Polycystic Renal Disease (Adult type) APKD

XI. Renal Pathologies Specific to Sonographic Findings a. Simple Cyst b. Parapelvic Cyst c. Hydronephrosis d. Ureteropelvic Junction Obstruction (UPJ)

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MODULE 4b: Suprarenals (Adrenals)

ASSIGNMENTS

READING ASSIGNMENT:

Curry & Tempkin, Chapter 12, pg. 196-203

Hickey & Goldberg, Chapter 1






You should submit answers for these objectives prior to your first exam. To do this, download an electronic version directly into the Dropbox for Objectives 4b. (You may use this direct link to accomplish this or go to the dropbox tab above and select the correct objectives link.)


1. Describe the normal location of the left and right adrenal glands. 2. Compare the sonographic appearance and size of the adult adrenal with the adrenal of a neonate. 3. Draw a diagram of the adrenal showing the medulla and the cortex with zones. 4. Draw a table listing the adrenal cortex zones, the hormones produced in each zone, and the function of each hormone. 5. Describe the function of the adrenal medulla. 6. Discuss the difficulties a sonographer might encounter while trying to image the adult adrenal. Topic Outline:

I. Adrenal Anatomy a. Location

1. Right adrenal 2. Left adrenal 3. Relational anatomy

b. Size c. Shape

II. Vascular supply a. Arterial

1. Suprarenal branch of the inferior phrenic 2. Suprarenal branch of the aorta


25


3. Suprarenal branch of the renal b. Venous

4. Drained by one vein: • Right suprarenal vein empties into the IVC • Left suprarenal vein empties into the left renal vein

III. Physiology a. Two layers with independent functions

1. Cortex • Three zones

o Zona glomerulosa o Zona fasciculate o Zona reticularis

• Hypofunction o Addison’s disease

• Hyperfunction o Cushing’s disease

2. Medulla IV. Sonographic evaluation

a. Adults 1. Normal ultrasound characteristics

• Echogenicity b. Neonates

6. Nrmal ultrasound characteristics • Echogenicity

V. Pathology a. Cysts b. Hemorrhage c. Syndromes d. Tumors

MODULE 5: Hepatic A & P

ASSIGNMENTS

READING ASSIGNMENT:


Hickey & Goldberg, Chapter 7, pg. 115-129

S. Hagen-Ansert, Chapter 6, pg. 142-168





26





1. Describe the normal location, size and shape of the liver. 2. Describe the sonographic appearance (echogenicity, texture, and borders) of the liver and compare it to the surrounding organs. 3. Discuss the relational landmarks of the liver (tell what organs lie anterior, posterior, medial, superior, and inferior to the liver). 4. Identify the principle functions of the liver. 5. Discuss the vascular supply to the liver and describe the sonographic appearance of each vessel. 6. Name the lobes of the liver and tell which vessel(s) supply each lobe. 7. List the normal variants of the liver and describe their sonographic appearance. 8. Create a table listing the liver function tests and describe their relevance to hepatic disease. 9. Identify the ligaments, segments, and fissures of the liver and describe their location. 10. The illustration provided below demonstrates portions of the surface and internal anatomy of the liver. Identify the labeled anatomy (numbers 1-16).

Topic Outline: I. Prenatal development a. Primitive gut b. Liver parenchymal cells 1. Hepatocytes 2. Küpffer cells c. Fetal liver functions

1. Hemopoiesis 2. Lymphocyte formation 3. Coagulative factor formation 4. Bile production

d. Fetal circulation 1. Ductus venosus 2. Ligamentum venosum 3. Ligamentum teres


27


II. Liver Anatomy a. Size and shape b. Echogenicity ladder of normal tissues c. Location d. Lobes of liver 1. Left 2. Right 3. Caudate e. Relational Anatomy f. Abdominal ligaments

1. Main lobar fissure 2. Falciform ligament 3. Right triangular ligament 4. Ligament of Teres 5. Ligamentum Venosum g. Segmental Anatomy of the Liver 1. Major lobes 2. Intersegmental lobes 3. Intrasegmental lobes 4. Main lobar fissure 5. Diagrams and images 6. Right intersegmental fissure 7. Left intersegmental fissure h. Porta Hepatis 1. Porta hepatis 2. Portal triad

• Main portal vein o Branches

• Proper Hepatic artery • Common Hepatic duct

3. Sonographic appearance • Portal veins

o Doppler wave form • Hepatic arteries

o Doppler waveform • Bile ducts

i. Other Liver Vasculature j. Normal Variants 1. Reidel’s lobe

2. Papillary process III. Related Anatomy a. Respiratory diaphragm 1. Crura of the diaphragm IV. Liver Functions a. Metabolism 1. Carbohydrates 2. Fats 3. Proteins 4. Heparin synthesis 5. Albumin synthesis 6. Bilirubin b. Storage c. Detoxification d. Reticuloendothelial functions e. Bile production

28


V. Clinical Laboratory Tests VI. Hepatic Imaging Parameters

a. Transducer b. Scan planes

c. Patient positions d. Gain settings e. Size, texture, echogenicity, and contour f. Presence, direction and flow velocities of vascular structures

VII. Sonographic Liver Evaluation a. Sonographic Appearance VIII. Common Diagnostic Tests a. Computerized Tomography b. Magnetic Resonance Imaging c. Nuclear Medicine IX. Hepatic Pathology Overview a. Diffuse Hepatocellular Disease

1. Fatty Infiltration 2. Focal Sparing

b. Focal Hepatic Abnormalities 1. Cystic Lesions

• Simple cyst • Congenital cyst • Polycystic disease

2. Hemangioma

MODULE 6: Biliary Tract A & P

ASSIGNMENTS

READING ASSIGNMENT:









29




1. Describe the normal locations and size of the biliary system structures. 2. Describe the normal anatomy and sonographic appearance of the biliary tract. 3. Discuss the relational landmarks of the bilary tract (tell what structures lie anterior, posterior, medial, superior, and inferior to the gallbladder and bile ducts). 4. Identify the principle functions of the biliary system. 5. Explain the arterial supply to the gallbladder and the venous drainage of the gallbladder. 6. List the specific sonographic applications used during an examination of the biliary system. 7. List the congenital abnormalities and normal variants that affect the gallbladder and bile ducts and describe their sonographic appearance. 8. Describe the different imaging modalities used to examine the biliary tract. 9. Define the following key words and describe the sonographic appearance of the terms with an asterisk (*): *Adenomyomatosis Alkaline phosphatate Ampulla of Vater Bilirubin Cholecystokinin *Cholecystitis *Cholelithiasis *Choledocholithiasis Duct of Wirsung *Hydrops *Porcelain Gallbladder Porta Hepatis *Sludge Sphincter of Oddi *Spiral valves of Heister Topic Outline: I. Introduction a. Anatomical relationships II. Prenatal development a. Formed by the ventral diverticulum III. Anatomy a. Gallbladder 1. Size 2. Location 3. Function 4. Divisions of the gallbladder 5. Gallbladder wall

• Measurement • Layers

6. Normal sonographic appearance • Gallbladder

b. Normal Variants of gallbladder 1. Gallbladder variants

• Bilobed • Septated • Partial • Complete • Duplicated GB • Phrygian cap • Hartman’s pouch


30


• Folds • Intrahepatic GB • Congenital absence

2. Sonographic appearance of gallbladder variants c. Cystic duct 1. Size

2. Location 3. spiral valves of Heister

d. Hepatic ducts 1. Size

2. Location 3. Sonographic appearance

e. Common bile duct 1. Size

2. Location 3. Sonographic appearance

f. Anatomical relationships g. Portal triad IV. Physiology a. Functions of the biliary tract 1. Concentration of bile 2. Storage of bile 3. Transportation of bile

• Location • Cholecystokinin

b. Bile composition V. Surgical Procedures VI. Laboratory tests a. BIlirubin b. Alkaline phosphatase VII. Sonographic evaluation a. Overview b. Patient Preparation Technique c. Imaging Techniques for the Biliary Tract 1. Gallbladder 2. Common bile duct 3. Intrahepatic ducts

• “double-channel sign” or “double barrel shotgun” sign d. Sonographic characteristics of the biliary system

e. Clinical Signs of Gallbladder Disease f. Non-visualization of the gallbladder

g. Courvoisier gallbladder h. Contracted gallbladder

VIII. Imaging common abnormalities of the biliary tract a. Cholelithiasis

1. Criteria used for diagnosing gallstones 2. Why Do Gallstones Cause Pain?

• Clinical symptoms 3. Incidence of Gallstones 4. Formation of Gallstones 5. Gallstone Composition 6. Sonographic appearance of cholelithiasis 7. WES triad 8. Porcelain Gallbladder

31


b. Choledocholithiasis 1. Cystic duct stone 2. Sonographic appearance

c. Sludge 1. Sonographic appearance d. Cholecystitis 1. Acute and chronic types

2. Clinical symptoms 3. Sonographic appearance e. Gallbladder Polyps

1. Clinical symptoms 2. Sonographic appearance

f. Benign papillomas 1. Clinical symptoms

2. Sonographic appearance g. Adenomyomatosis

1. Clinical symptoms 2. Sonographic appearance

IX. Other imaging modalities for the biliary system a. Nuclear medicine b. other

MODULE 7: Pancreas A & P

ASSIGNMENTS

READING ASSIGNMENT:









32




1. Using the proper sonographic terms, describe the normal echogenicity, contour, and echotexture patterns of the pancreas. 2. Describe the normal location and size of the pancreas. 3. Identify the normal anatomy and relational landmarks of the pancreas. 4. Draw a detailed diagram of the pancreas (including the ducts) and related anatomy (vessels and organs) and label the structures. 5. Create a table detailing the endocrine and exocrine functions of the pancreas (make sure to include the type of cell which carries out each specific function). 6. Discuss the vascular supply of the pancreas. 7. Name the main and accessory pancreatic ducts and describe their location, size, sonographic appearance and function. 8. List the normal variants of the pancreas and describe their appearance. 9. Identify the pancreatic enzymes and their functions. 10. Discuss how the sonographic appearance of the pancreas changes as a person ages. 11. Define the following key words: Ampulla of Vater Amylase Chyme Diabetes Mellitus Gastrin Glucagon Glucose Insulin Lipase Pancreatic juice Sodium bicarbonate Somatostatin Topic Outline: I. Introduction II. Review of the Digestive Tract a. Role of the liver as an accessory organ of the digestive tract 1. Bile production 2. Excretion of waste b. Role of the biliary system as an accessory organ of the digestive tract

1. Bile storage 2. Bile concentration 3. Bile transportation

4. Bile function • Fat emulsifier • Excretion of waste products from the liver

III. Prenatal development a. The pancreas arises from two duodenal buds 1. Dorsal bud 2. Ventral bud IV. Anatomy a. Location of pancreas 1. Epigastrium and left hypochondrium

2. Retroperitoneal b. Divisions of the pancreas 1. Uncinate


33


2. Head 3. Neck 4. Body 5. Tail c. Size d. Contour and shape

V. Sonographic assessment of the pancreas a. Transverse and sagittal scan plane survey b. Using the liver as an acoustic window c. Variable location 1. Retroperitoneal fat 2. Body habitus d. Sonographic appearance 1. Echogenicity and contour

• Echogenicity ladder 2. Vascular landmarks 3. Imaging order

VI. Pancreatic ductal system a. Duct of Wirsung

1. Size and location VII. Patient preparation techniques a. Fasting VIII. Improved imaging techniques a. Using the liver as an acoustic window b. Image pancreas first c. Utilize various breathing techniques d. Utilize various patient positions e. Fluid filled stomach IX. Pancreatic scanning caveats X. Pancreatic physiology with aging characteristics a. Fatty replacement of the pancreas b. Size c. Echotexture d. Echogenicity XI. Pancreas Physiology a. Functions 1. Exocrine

• Acinar cells • Pancreatic ducts • Produces Pancreatic juice/enzymes

o Components of pancreatic juice o Functions of enzymes

2. Endocrine • Islets of Langerhans cells • Composed of three different cell types:

o Alpha cells o Beta cells o Delta cells

• Production of insulin, glucagon, and somatostatin • Diabetes Mellitus • Hypoglycemia

XII. Laboratory tests a. Serum amylase b. urine amylase

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c. serum lipase d. Glucose tolerance test

MODULE 8: Reticuloendothelial Physiology

ASSIGNMENTS

READING ASSIGNMENT:











1. Describe the reticuloendothelial system. 2. List the reticuloendothelial system organs. 3. Explain the “immune response”. 4. Create a table listing the types of leukocytes and their functions. 5. List the components of the lymphatic system. 6. Describe the locations, size, shape, and sonographic appearance of a lymph node. 7. Discuss the functions of the lymphatic system. 8. Identify the two main functions of blood. 9. Define the following key words:

Lymphocytes Immunity Lymph Leukocytosis Leukopenia Hematocrit Sepsis Thrombocytopenia T-lymphocytes B-lymphocytes Antigen


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Topic Outline: I. Introduction of the Reticuloendothelial system II. Functional cells of the RE system:

a. Phagocytes 1. Macrophages 2. Monocytes 3. Neutrophils 4. Eosinophils

b. Non-phagocytes 1. Lymphocytes

III. RE system cell locations a. Circulatory system b. Liver c. Spleen d. Bone marrow e. Lymph nodes

IV. Blood Composition a. Plasma b. Leukocytes c. Platelets d. Erythrocytes

V. Blood functions a. Transportation of substances b. Body’s Defense

VI. Laboratory Data VII. Types of Leukocytes

a. Neutrophil b. Eosinophil c. Basophil d. Lymphocyte e. Monocyte

VIII. Immune Cells a. B-Lymphocytes b. T-Lymphocytes IX. Lymphatic system introduction X. Lymphatic system components a. Lymph b. Lymph vessels c. Lymph nodes

• Lymph node functions • Lymph node locations

XI. Sonographic appearance a. Lymph nodes b. Lymphadenopathy

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MODULE 9: Splenic A & P

ASSIGNMENTS

READING ASSIGNMENT:



S. Hagen-Ansert, Chapter 11, pages 357-365








1. Describe the normal location, size, and shape of the spleen. 2. Using the proper sonographic terms, describe the normal echogenicity, contour, and echotexture pattern of the spleen. 3. Identify the normal anatomy and relational landmarks of the spleen. 4. Create a table detailing the functions of the spleen (make sure to include if the function is part of the Reticuloendothelial system or a function of the spleen). 5. Describe the arterial, venous, and lymph vessels that supply and drain the spleen. 6. List the normal variants of the spleen and describe their sonographic appearance. 7. Define the following key words:

Culling Erythrocyte Hemotopoiesis Hemosiderin Leukocyte Malpigian corpuscles Pitting Phagocytosis Red pulp Splenomegaly Wandering spleen White pulp


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Topic Outline: I. Introduction II. Prenatal development III. Anatomy of the spleen a. Location b. Anatomical relationships c. Ligaments d. Size and shape IV. Blood supply V. Functional divisions a. White pulp

1. Lymphatic system • Primary component - malpigian corpuscles

2. Manufacturers lymphocytes b. Red pulp 1. Reticuloendothelial system 2. Produces phagocytic cells

• Engulfs and destroys foreign particles (bacteria) VI. Broad Physiology a. Not essential for life

b. Principle organ to break down worn out RBC’s c. Produces cells capable of making antibodies

1. Lymphocytes 2. Plasma

d. Main component of the RES e. Stores small amounts of blood which it liberates in an emergency f. Storage of iron in the phagocytes

VII. Sonographic imaging techniques a. Patient Prep b. Scanning considerations

1. Patient positions 2. Scan planes 3. Transducer types 4. Breathing techniques 5. Measurement of spleen

VIII. Sonographic appearance IX. Echogenicity ladder of normal tissues review X. Splenic variants a. Asplenia b. Accessory spleen c. Polysplenia d. Wandering spleen XI. Common Splenic Pathologies

a. Granulomatous disease b. Splenomegaly c. Splenic cysts d. Splenic rupture

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MODULE 10: Abdominal Doppler

ASSIGNMENTS

READING ASSIGNMENT:


Hickey & Goldberg, pages 267-269 & 274-281

S. Hagen-Ansert, pages 25-28, 99-100, & 132-140








1. Describe the Doppler Effect 2. List ways that Doppler/color Doppler can help diagnose a vascular problem 3. Doppler/color Doppler ultrasound is a clinically useful tool in diagnosing many disease processes of the abdomen. Identify at least two specific disease processes or pathologies and tell how Doppler/color Doppler can be utilized 4. Describe hepatopetal and hepatofugal flow patterns in the liver 5. Compare the characteristics of laminar flow and plug flow. 6. Discuss color flow Doppler and its applications. 7. Describe how an arterial stenosis would appear on pulsed and color flow Doppler. 8. Explain the flow pattern changes in the SMA from a fasting state to postprandial. 9. Draw an example of a spectral wave form and label the individual components (window, velocity, baseline, peak systole, end diastole, dicrotic notch, and envelope). 10. Draw examples of a venous wave form and an arterial wave form. 11. Draw examples of a high resistance and low resistance arterial waveform and explain their differences. Topic Outline: I. Introduction II. Doppler Effect


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a. Definition b. Medical Applications

1. Doppler imaging • Presence and direction of blood flow • Flow velocities/variance or range of velocities within the vessel • Flow disturbances

III. Doppler a. Doppler angle b. Pulsed wave Doppler versus color Doppler c. Spectral analysis

1. Components of spectral display 2. Display of normal vascular flow

• Laminar flow • Plug flow • High resistance versus low resistance flow patterns

3. Display of a stenosis • Spectral broadening

4. Systole 5. Diastole

IV. Aorta wave forms compared to other abdominal vessels a. Aorta versus renal artery b. Aorta versus IVC and portal vein V. Blood flow direction a. Flow towards the transducer - traditionally shown above the baseline

b. Flow away from the transducer - traditionally shown below the baseline

VI. Normal Doppler waveform examples of abdominal vessels a. Aorta b. Renal artery c. Interlobar artery d. Renal vein e. Superior mesenteric artery

1. Before eating/high resistance waveform 2. Postprandial (after eating)/low resistance waveform

f. IVC g. Hepatic veins h. Main portal vein

VII. General Doppler Applications VIII. Doppler Applications specific to the abdominal disease processes IX. Color Flow Scanning

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