Abdomen Flashcards
When should the fetal stomach be documented?
2 + 3 trimesters
What is associated with a small or absent fetal stomach?
can be normal (allow to fill- 30 mins)
or can be a/w aneupolidy, tracheoesophageal fistula, and oligohydramnios
Esophageal atresia:
absence in segment of esophageal
congenital
a/w tracheoesophageal fistula
Whats the most common type of esophageal atresia?
w/ a fistula connecting the distal portion of the esophagus with the trachea (90%)
if stomach doesn’t communicate with trachea, the stomach will be empty/small
Esophageal atresia should be suspected when the stomach is empty/absent when there’s __________.
polyhydramnios
What are some causes of an absent stomach?
normal empty stomach herniated into chest abdo wall defect EA aneuploidy anhydramnios microgastria
What is an enlarged stomach associated with?
duodenal atresia
persistent enlarged stomach for the duration of the scan-30mins
What’s the double bubble sign?
two fluid bubbles:
dilated stomach
dilated prox duodenum
*show the connectiong between duodenum and stomach is important in dx
What’s the most common site of intestinal atresia?
duodenum
Duodenal atresia is associated with?
polyhydramnios
coexsting anomalies (50%)
Tri-21 (33%)
Jejunal-ileal obstruction/atresia:
most common reason for JIO is an isolated vascular compromise
dx is based on dilated loops of bowel w/o dilated stomach
apple peel jejunal atresia
What measurement is considered a dilated loop of bowel?
7mm
Apple peel jejunal atresia:
subtype of jejunal-ileal obstruction
agenesis of the mesentery and is more often familial
What’s an underlying etiology for ileal obstruction?
cystic fibrosis
Good photo of the types of jejunal ileal obstruction
on slide 24
Anorectal atresia:
most common atresia of large bowel
highest incidence of association w/ other anomalies: chromosomal + genitourinary
part of VACTERL
What’s the sonographic dx of anorectal atresia
dilated loops of bowel
absence of polyhydramnios
Echogenic bowel:
bowel is same echogenicity of iliac crest or bone (2nd trimester)
considered to be a soft marker and an association w/ tri21, cystic fibrosis, meconium peritonitis, and congenital viral infection
Is an echogenic bowel normal later on in the pregnancy (3rd tri)?
Yes bc meconium is echogenic
What can be risks for echogenic bowel?
aneuploidy CF swallowed fetal blood infection GI atresia IUGR fetal demise
Omphacele:
most common anomaly of the abdo wall
herniation of abdo organs (liver+bowel) into base of umbilical cord
usually isolated
What’s the most common anomaly of the abdominal wall?
omphacele
Omphacele can be associated with:
pentalogy of Cantrell
Beckwith-Wiedemann syndrome
(CHD, chromo abnormalities)
Pentralogy of Cantrell:
association of ectopia cordis, heart defect, diaphragmatic hernia, pericardial defect and omphacele
Beckwith-Wiedemann syndrome:
macrosomia, macroglossia, renal neoplasm and omphacele
gigantism
Gastroschisis:
abdo organs are pushing out into amniotic cavity
usually isolated
higher association with morbidity or mortality
What lab test is associated with abdo wall defects
inc maternal AFP
Gastroschisis can be increased by what factors?
teen moms
tobacco
illicit drugs (prolly crack)
decongestants (pseudoephedrine)
What GI anomalies can you have with gastroschisis?
atresias, stenosis, perforations, or volvulus (malrotation of the herniated bowel)
The liver increases in echogenicity as the fetal ages. True or false
False–stays the same
The spleen is not normally evaluated. What’s the texture/echogenicity tho?
similar to liver
Splenomegaly is associated with:
severe hemolytic disease due to isoimmunization and infection
Asplenia is associated with:
situs inversus
asplenia and polysplenia are associated with heterotaxy syndromes
Choledochal cyst:
sacculations of the CBD
most often appears as RUQ cyst inferior to umbilical vein and anterior to rt. kidney
usually can see dilated ducts
location differentiates it from duodenal atresia
Adrenal glands:
not usually assessed by easy to visualize after 20wks
medial margin of lt. adrenal gland is lateral wall of aorta and rt. adrenal is posterior to IVC
Echogenicity of adrenal gland?
cortex- hypoechoic
medulla- echogenic
Neuroblastoma in adrenals:
malignant
most common neonatal tumor
complex mass, mostly solid w/ cystic spaces + calcifications
Hemorrhage of adrenals:
associated w/ fetal distress in older fetuses
similar appearance to renal/adrenal tumors
Umbilical arteries can be identified on _____ ____ scans of fetal pelvis lateral to bladder.
oblique axial
Single umbilical artery is associated with:
an increase risk of IUGR, congenital anomalies (cardiovascular+genitourinary) and chromosomal abnormalities
Ductus venosus:
originates from the pars transversa segment of the LPV and courses in a posterior cranial direction to terminate in the left hepatic vein (LPV) very near IVC
Ductus venosus flow:
high velocity, low impedance
forward flow towards rt. atrium
Umbilical vein and PV diameter:
have a similar diameter and is usually not possible to differentiate between the two
Persistent rt. umbilical vein:
in embryogenessi, 2 umbilical veins form with early regression of the right UV
usually an isolated finding, w/o complications, but there can be a small risk of anomalies. But generally fine
What does a persistant rt. umbilical vein look like
tubular structure in anterior RUQ lateral to fetal GB
normal size to normal UV
turns left towards stomach
Ascites can be seen with:
hydrop fetalis bowel perforation ovarian cyst rupture fetal urinary ascites transudation or rupture of the fetal urinary tract persistant urogenital sinus
What gastrointestinal anomaly is associated with infection?
echogenic bowel
Which GI atresia has the highest incidence of associated anomalies?
anorectal
Most common anomaly of the abdo wall?
omphalocele
What GI anomaly is associated with drug use?
gastroschisis
