ABD Board-Gastrointestinal Tract

Question 1

normal intestinal wall is between _ to _ thick depending on the distention of the bowel

Answer 1

3 to 5 mm

Question 2

4 concentric bowel wall layers (layers of the gut wall)

Answer 2

mucosa

submucosa

muscularis externa (external muscle layer)

adventitia or serosa

Question 3

intestical pathology creates a sonographic pattern called

Answer 3

gut signiature known as the target or pseudokidney sign

Question 4

appearance of gut signature

Answer 4

hypoechic external rim corresponding to thickened intestinal wall and hyperehcoic center relating to a residual gut lumen or mucosal ulceration

Question 5

the segment of esophagus between the diaphragm and the stomach

Answer 5

gastroesophageal junction

Question 6

appearance of gastroesophageal junction

Answer 6

on long midline view the of the epigastrum this is seen as a target sign posterior to the left lobe of the liver

Question 7

refers to the presence of air within the peritoneal cavity

Answer 7

pneumoperitoneum

Question 8

most common cause of pneumoperitoneum

Answer 8

perforation of the ABD viscus, most commonly by a perforated ulcer

Question 9

with the patient on the supine position free peritoneal air will float ____

Answer 9

anteriorly

Question 10

placing the transducer on the anterior ABD will result in a ________ ______ or ____ ____ ______

Answer 10

reverberation artifact

total sound reflection (thus absence of an image)

Question 11

most common cause of acutely painful ABD

Answer 11

acute appendicitis

Question 12

patients present with what for acute appendicitis

Answer 12

periumbilical pain shifting to RLQ

anorexia (loss of appetite)

leukocytosis (increased WBC)

rebound tenderness

Question 13

typical location for appendix

Answer 13

posterior to the terminal ileum

anterior to iliac vessels

Question 14

RLQ location of the appendix between the umbilicus and the iliac crest

Answer 14

mcburneys point

Question 15

appendicitis is caused by

Answer 15

the obstrucioin of the appendiceal lumen by a fecalith or hyperplasia of the submucosa.

mucosal secretions increase the intraluminal pressure and compromise venous and lymphatic drainage

bacterial infection leads to gangrenen and perforation

perforation leads to peritonitis

Question 16

used to displace bowel gas and decrease the distance obetween the transducer and the appendix

Answer 16

graded compressioin ultrasound

Question 17

sonographic criteria for diagnosing an inflammatory appendix includes

Answer 17

non compressible

> 6 mm diameter

appendicolith (fecalith)

Question 18

can be observed with an inflammed appendix

Answer 18

color flow hyperiemia (lots of blood flow and color)

Question 19

causes a functional gastric outlet obstruction as a result of hypertrophy and hyperplasia of the muscular layers of the pylorus

Answer 19

hypertrophic pyloric stenosis

Question 20

neonatal patient 3-8 weeks old present with what for hypertrophic pyloric stenosis

Answer 20

vomiting (non bloody, non bilious)

palpable “olive shaped” pylorus

visible peristalsis (wavelike movements that push contents)

Question 21

pyloric wall thickness, channel length, and cross section diameter will all _______ when pyloris is hypertrophic

Answer 21

increase

Question 22

pylorus size criteria

no strong agreement on sizes threshold for diagnosis

Answer 22

muscle thickness > 3 mm (3 to 4 mm)

channel length > 17 mm (14 to 24 mm )

cross section diameter > 15 mm

Question 23

most accurate measurement for hypertrophic pylous

Answer 23

muscle wall thickness

4 mm or more considered positive but between 3 and 4 mm may also be positive especially in premature or younger neonate

Question 24

most common cause of gastric outlet obstruction in neonate 4 weeks or less or in premature babies

Answer 24

pylorospasm

unlike HPS it is treated conservatively

Question 25

inflammation of diverticulum (colonic outpouchings)

Answer 25

diverticulitis

Question 26

symptoms of diverticulitis

Answer 26

LLQ pain

fever

leukocytosis

Question 27

sonographic findings of diverticulitis

Answer 27

thichecning of the bowel wall > 4 mm

abscess formation

inflammed dicerticula (round echogenic structures)

Question 28

bowel obstruction may be caused by

Answer 28

intraluminal (food bolus)

bowel wass lesion (tumor, crohn disease)

extreinsic (adhesions, hernia)

volvulus (twisting of intestines)***

Question 29

most common cause of bowel obstruction

Answer 29

extrinsic (adhesions, hernia)

Question 30

prolonged bowel obstruction can result in

Answer 30

bowel ischemia

bowel necrosis

septicemia

perforation

peritonitis

Question 31

symptoms of bowel obstruction

Answer 31

ABD dstention

pain

vomiting

hypotension (fluid depletion)

leukocytosis

Question 32

ultrasound is used to demonstrate what for bowel obstruction

Answer 32

loops of distended bowel

level of obstruction

peristalsis

Question 33

intussusception details

Answer 33

classically associated with children

most commonly during ages 6months to 4 yrs

present as an ileocolic (90%) intussusception, where ileum invaginates into the proximal colon

Question 34

part of the intestine invaginates (folds into) into another section of intestine, similar to the way the parts of a collapsible telescope retract into one another

Answer 34

intussusception

Question 35

pediatric intussusceptions are usually thought to occur secondary to ______ ______ following viral infection

Answer 35

lymphoid hypertrophy

Question 36

clinical presentation of intussusceptions

Answer 36

may be post viral illness

intermittent ABD pain

right sided ABD mass

vomiting

lethargy and irritability

bloody diarrhea (currant jelly)

Question 37

classical sign of intussusceptions

Answer 37

sausage shaped mass in the right hypochondrium

Question 38

sonographically intussusception appears

Answer 38

as pseudo kidney mass on long plane and in tran a concentric rings of folded bowel (target sign)

Question 39

treatment for intussusception

Answer 39

barium or air enema, pressure from barium or air will unfold the intussusception

refolding occurs as often as 154 to 20 percent of the time

Question 40

lack of perfusion (blood flow) in intussusceptum may indicate

Answer 40

bowel ischemia