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MIDS 187 > Ch 10 Abdomen > Flashcards

Ch 10 Abdomen Flashcards

1
Q

By what trimester have the fetal abdominal organs attained their normal adult position + structure?

A

Early in the 2nd trimester

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2
Q

List the landmarks for the right + left parasagittal views?

A

RT: lung, liver + right kidney
LT: stomach + left kidney

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3
Q

What echogenicity is the fetus’s skin + muscles?

A

Skin: echogenic
Muscles: hypoechoic (can be confused with ascites - pseudoascites)

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4
Q

Which arteries carry most of the fetal aortic blood to the placenta?

A

2 umbilical arteries

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5
Q

The 2 umbilical arteries can be followed caudad from the anterior abdominal wall cord insertion site to which arteries?

A

To the internal iliac arteries (which are just lateral to the bladder)

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6
Q

What 4 structures develop from the embryonic foregut?

A

-Liver
-GB
-Ducts
-Pancreas

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7
Q

In the 4th week, what develops on the caudal portion of the foregut?

A

An outgrowth

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8
Q

When does rapid growth of the liver occur?

A

From 5-10th week - this results in the liver occupying most of the abdominal cavity

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9
Q

What percentage of total weight does the liver make up in the 2nd trimester + at term?

A

2nd trimester: 10%
Term: 5%

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10
Q

Bile secretion begins in what week?

A

12th week

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11
Q

During what week does the liver look bright red due to the start of hematopoiesis?

A

6th week

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12
Q

Is the GB passive or active in fetal life?

A

Passive - it does not respond to fat ingested by the mother

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13
Q

Where is the GB in a fetus?

A

To the right of midline - it separates the right lobe from the medial left lobe (as does the middle HV)

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14
Q

How can we differentiate the GB from the tubular intrahepatic portion of the umbilical vein?

A

CD (the GB should have no color flow)

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15
Q

List 4 ways the GB can be distinguished?

A

-Teardrop shape
-Off midline position (to the right of it)
-Extrahepatic location (posteroinferior to liver)
-Lack of communication b/w GB + vessels of umbilical cord

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16
Q

Does the umbilical vein or GB reach the anterior abdominal wall?

A

Umbilical vein does, GB does not

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17
Q

What is the echogenicity of the pancreas + spleen?

A

Pancreas: hyperechoic
Spleen: hypoechoic

(these are rarely discretely imaged)

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18
Q

What can help aid in the identification of the pancreas?

A

The stomach + the location of the pancreas being anterior to the splenic vein

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19
Q

Is the pancreas echogenicity slightly greater or less than the liver?

A

Greater

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20
Q

List 3 ways we can help identify the spleen?

A

-Is homogeneous, posterior to stomach + superior to LK in left upper abdomen
-Best seen on TRV scans
-Is similar in echogenicity to kidney + slightly less echogenic than liver

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21
Q

Does an absent stomach require a follow up?

A

Yes - the stomach periodically fills + empties but it must be seen throughout the exam

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22
Q

What causes echoes in the stomach?

A

Hyperechoic debris - is a normal finding

(m/c seen in the 2nd trimester + disappears on follow up exams)

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23
Q

Echogenicity within the stomach has been seen in cases of 3rd trimester ____ ____?

A

Placental abruption

(may represent swallowed blood or vernix)

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24
Q

Before fluid enters the small bowel, how will it appear?

A

As a heterogeneous, echogenic pseudomass w/o shadowing (occupies a substantial portion of abdomen)

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25
Q

What is the echogenicity of small bowel?

A

-More echogenic than liver, but less echogenic than bones
-Becomes less echogenic in 3rd trimester + more sharply defined

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26
Q

Where may peristalsis be seen?

A

In small bowel that occupies central abdomen

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27
Q

Does normal small bowel increase or decrease in diameter as gest age increases?

A

Increases

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28
Q

What is the colon?

A

Long, continuous, tubular structure with a hypoechoic lumen at the abdominal periphery

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29
Q

In what trimester is the colon seen?

A

As early as the late 2nd trimester, but more consistently seen in 3rd trimester

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30
Q

Does the colon increase or decrease in diameter throughout the 3rd trimester?

A

Increase

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31
Q

How can we tell if we are looking at the colon or cysts?

A

If it is all linked together than it is bowel

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32
Q

What is meconium composed of?

A

The materials the fetus ingests during gestation (mucous, amniotic fluid, bile, etc)

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33
Q

What is the echogenicity of meconium?

A

Less echogenic than bowel walls

(may be seen in discrete portions of the colon)

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34
Q

Colon with liquid meconium in it is often mistaken for what anomalies?

A

Cysts, dilated bowel, etc.

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35
Q

The 2 m/c types of abdominal wall defects are?

A

-Omphalocele
-Gastroschisis

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36
Q

What type of malformations are one of the sources of elevated AFP levels in the amniotic fluid or maternal serum?

A

Abdominal wall malformations

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37
Q

What is an omphalocele?

A

Midline defect occurring in 1 in 4,000 births

38
Q

A normal migration of bowel into the umbilical cord occurs during which weeks of embryologic development?

A

B/w 8-12 weeks

39
Q

Sometimes bowel does not migrate back into the abdomen + remains in extraembryonic coelom of umbilical cord. Explain what type 1 + type 2 are?

A

Type 1: fusion failure of lateral ectomesodermal folds

Type 2: failure of muscle, fascia + skin to fuse

(omphalocele)

40
Q

List 4 SFs for an omphalocele?

A

-Abdominal viscera
-Bowel protruding into base of cord
-Can range from 2-10cm in size
-Always covered by a membrane + centrally located

41
Q

A definitive 1st trimester diagnosis of an omphalocele is only made when?

A

The omphalocele is larger than the abdomen itself

42
Q

An omphalocele may be suggested in pregnancy if the cord containing the midgut has a max dimension of what?

A

7mm or greater

43
Q

Are omphaloceles associated with other anomalies?

A

Yes 50-70% are, which worsen the prognosis

44
Q

GI anomalies are found in 30-50% of omphaloceles, which anomaly is m/c?

A

Bowel malrotation

45
Q

40-60% of pt’s with omphaloceles have chromosomal abnormalities. Which ones?

A

-Trisomy 13, 18 + 21
-Turner, Klinefelter + triploidy syndromes

46
Q

Is there skin surrounding an omphalocele?

A

No! The abdominal wall has parted. The omphalocele is covered by a thin translucent membrane.

47
Q

Is an umbilical hernia covered by skin?

A

Yes! Completely covered by skin + subcutaneous tissue.

48
Q

What is the distinguishing feature of an umbilical hernia vs an omphalocele?

A

Position of cord insertion:

Hernia = alongside cord
Omphalocele = in cord

49
Q

What is gastroschisis?

A

Smaller abdominal wall defect measuring 2-4cm + m/c occurs to the right of the cord insertion

(is unrelated to the umbilical cord)

50
Q

Do younger or older mothers m/c have fetus’s with gastroschisis?

A

Young - 1 in 3,000 pregnancies

51
Q

The maternal use of what substances cause increased risk of fetal gastroschisis?

A

Vasoactive substances like nicotine + cocaine

52
Q

Except for bowel malrotation + jejunal or ileal atresia, associated anomalies with gastroschisis are m/c related to what?

A

Vascular compromise of the malrotated bowel + are way less common than with an omphalocele

53
Q

Is AFP increased or decreased with gastroschisis?

A

Increased - due to direct contact of bowel with amniotic fluid

54
Q

How early can we detect gastroschisis on u/s?

A

As early as 14-16 weeks, b/c of the free floating loops of bowel within the amniotic fluid

55
Q

Gastroschisis causes what 2 things to occur due to the lack of internal organs?

A

-Right sided cord insertion
-Small AC

(mass is not associated with umbilical cord)

56
Q

Does gastroschisis occur with other anomalies outside of bowel malformations?

A

No, rarely

57
Q

Are the survival rates high or low with gastroschisis?

A

High - 85-95%

58
Q

Differentiate b/w an omphalocele, umbilical hernia + gastroschisis?

A

Hernia: covered by skin + subcutaneous tissue, is located to the side of cord

Omphalocele: covered by translucent membrane, is located in base of cord

Gastroschisis: not covered by any membrane, free floating bowel, m/c to the right of the cord

59
Q

Ascites represents what?

A

Fluid within peritoneum

60
Q

Is true fetal ascites always abnormal?

A

Yes!

-Large amounts can surround + shift intraperitoneal structures superiorly, inferiorly or laterally

61
Q

Urinary ascites results from what?

A

-Bladder outlet obstruction
or
-Renal forniceal rupture

62
Q

List 4 conditions that can cause ascites?

A

-Heart failure
-Infections
-Tumors
-Twin to twin transfusions

63
Q

The liver enlarges in association with what?

A

Immune or nonimmune hydrops

(result of increased hematopoiesis)

64
Q

What would cause fetus to have a small or large liver?

A

Small: IUGR
Large: diabetic mothers + macrosomic fetus’s

65
Q

Why might solitary liver cysts develop?

A

B/c of interruption of the development of the intrahepatic biliary tree

66
Q

Diffuse liver calcifications occur in fetus’s with what?

A

Intrauterine infections

(especially TORCH infections, toxoplasmosis + herpes simplex infection)

67
Q

Will gallstones in fetus’s always have posterior shadowing?

A

No

68
Q

Do fetal gallstones usually resolve?

A

Yes, possibly due to postnatal hydration or from changes in bile metabolism

69
Q

In some cases fetal gallstones are not true gallstones, what are they?

A

Tumefactive sludge or thickened bile

70
Q

Rapid growth/proliferation of the esophageal epithelium during the embryonic period creates an almost complete closure of what structure?

A

The esophageal lumen

71
Q

Esophageal atresia is m/c in male or female infants?

A

Male

72
Q

What is the m/c type of esophageal atresia?

A

-It consists of a proximal esophageal pouch that communicates with the more distal GI tract through a fistula
-The fistula follows a track b/w the tracheobronchial tree (near tracheal bif) + the distal esophagus which allows amniotic fluid to pass into stomach
-Communication with the distal GIT reduces # of fetuses with polyhydramnios b/c of impaired swallowing
-Associated with trisomy 21

73
Q

What 2 factors may cause an absence of stomach fluid?

A

-Oligohydramnios
-Stress of nonimmune hydrops

74
Q

If there is no stomach, or an unusually small stomach, after 18 weeks with normal amniotic fluid levels what is this associated with?

A

A guarded prognosis

(meaning we do not have enough information to know what the outcome will be)

75
Q

If we can’t identify the stomach during the exam, this raises suspicion for what abnormality?

A

Chromosomal abnormalities (however m/c the fetus has a normal karyotype)

76
Q

What is a volvulus?

A

An obstruction caused by bowel twisting upon its blood supply

77
Q

If the sm bowel fails to return to the abdominal cavity + rotate properly, the bowel may twist around the axis of which artery?

A

The SMA - resulting in poor vascular flow distal to the point of obstruction or volvulus

78
Q

When is midgut volvulus usually diagnosed?

A

In first days of life

(infant may present with distention or obstruction, but m/c with bilious vomiting)

79
Q

What is the whirlpool sign?

A

A fluid-filled proximal duodenum with an arrowhead twist at the point of the descending or TRV duodenal obstruction

80
Q

Fluid filling the stomach + duodenum at the site of obstruction creates what classic sign?

A

The double-bubble sign - represents duodenal atresia + is m/c associated with trisomy 21

81
Q

What is duodenal atresia?

A

Failure of duodenum to change from a solid cord of tissue during development to a tube

82
Q

List the 3 types of duodenal recanalization anomalies?

A

-Duodenal diaphragm or web (resulting in stenosis)
-Solid cord with atresia
-Segmental or partial absence of duodenum

83
Q

What type of tissue may surround the 2nd portion of the duodenum, causing obstruction or stenosis?

A

Pancreatic tissue

84
Q

What is the m/c echogenic mass found in the fetal abdomen?

A

Echogenic bowel

(m/c found in 2nd trimester, 50% resolve spontaneously)

85
Q

What trimester is echogenic bowel considered a normal finding?

A

In late 3rd trimester - b/c of presence of meconium in bowel

86
Q

Bowel echogenicity greater than bone indicates greater risk for meconoium ileus/cystic fibrosis + other pathologic processes. What does this cause an increased association with?

A

-Fetal demise
-IUGR

(follow these fetuses closely)

87
Q

List what grade 1, 2 + 3 mean for echogenic bowel?

A

1: bowel is NOT as bright as bone (normal)
2: bowel is AS bright as bone (moderate)
3: bowel is BRIGHTER than bone (worst)

88
Q

How can we differentiate the GB from the umbilical vein?

A

GB has teardrop shape, it does not reach abdominal wall, use CD

89
Q

T/F: An omphalocele is covered by skin + subcutaneous tissue?

A

False: they are covered by a membrane (peritoneum/amnion)

90
Q

When assessing for echogenic bowel, how can you be sure it is truly echogenic?

A

Compare to nearby bone + do split screen image while turning gains down (to compare echogenicity of bowel to bone)

MIDS 187 (19 decks)

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