Ch. 10 GI Tract & Abd wall Flashcards
The gastrointestinal tract or alimentary canal consists of:
Mouth, pharynx, esophagus, stomach, the wall intestines, and colon
What organ is the most proximal portion of the gastrointestinal tract?
The mouth
This organ lies distal to the mouth and unites it to the esophagus
Pharynx
The ________ travels inferiorly within the thorax and through an opening in the diaphragm
Esophagus
The __________ _______ can be identified with sonography and will appear as a bulls-eye structure between the left lobe of the liver and abdominal aorta in the sagittal imaging plane
Gastroesophageal function
What are the three parts of the stomach?
fundus, body, pylorus
A muscle that controls the emptying of the contents of the stomach into the duodenum
pyloric sphincter
C-shaped or referred to as the C-loop of the duodenum
Proximal duodenum
Distal to the duodenum are:
Jejunum and ileum of the small intestines
The proximal colon is also called
Cecum
A blinded ended tube that is connected to the cecum of the colon
Vermiform appendix
Most gastrointestinal tract sonographic studies are performed using what probe?
A high frequency linear array transducer. Some may require a curved array transducer
the alternating echogenicities of the bowel wall layers should produce the classic _____/_____ appearance
target, bullseye
A sonographic examination of the gastrointestinal tract should include ________ ______ to differentiate normal from anomalous bowel
Graded compression or compression sonography
Specifically, normal bowel should be _______ and should have observable _________.
Compressible; peristalsis
Generally, the normal intestinal wall should measure less than ___ mm in thickness
5mm
True or false: a normal bowel wall segment produces little to bo color Doppler
True
When examining the gastrointestinal tract, color Doppler can be beneficial for what reasons?
Because of inflammatory changes and neoplasms within the gastrointestinal tract will often reveal hyperemia
Sonography utilizes _________ to analyze bowel.
Compression
When the bowel is compressible, what does it mean?
It means it’s normal bowel
When the bowel is noncompressible, what does it mean?
It means it’s abnormal bowel
The bend in the colon that marks the beginning of the transverse colon is called
hepatic flexure or right colic flexure
Another bend inferior to the spleen that marks the beginning of the descending colon is called
splenic flexure or left colic flexure
What is the termination point of the gastrointestinal tract?
anus, external opening of the rectum
Most GI tract parts are considered
intraperitoneal (exception of duodenum, ascending & descending colon)
The GI tract consists of how many layers?
five
The GI tract layers alternate echogenicity and hypoechoic segments, odd layers are ___, even layers are ____.
echogenic, hypoechoic
The alternating echogenicities of bowel wall layers should produce was sonographic sign
“target” or “bull’s-eye”
- Superficial mucosal layer (echogenic)
- Deep mucosal layer (hypoechoic)
- Submucosal layer (echogenic)
- Muscularis layer (hypoechoic)
- Serosa (echogenic)
Five GI layers
Normal small bowel wall thickness is between
1.5-3mm in thickness
Small bowel distention is defined as a
2.5mm or greater (outer-outer wall)
The colon should measure ___ in the nondistended state
4-9mm
Colon distention is the diameter of a segment that exceed
6mm
Bowel walls should appear ___ in a distended state.
thin
A long, narrow, blinded-ended tube that is commonly located within the right lower quadrant, at the level of cecum
Appendix
The most common cause of acute abdominal pain resulting in surgery
acute appendicitis
This condition may be the result of some form of obstructive process such as appendicolith, fecalith, lymph node, tumor, foreign body, seeds, or parasite.
Acute appendicits
________ ______ is used to sonographically investigate the abdomen for signs of appendicitis.
Graded compression
What will an inflamed appendix looks like in sonography?
Noncompressible, blind-ended tube that measures more than 6mm in diameter
An _________ will appear as an echogenic, shadowing structure within the lumen of the appendix
Appendicolith
Patients with appendicitis will suffer from rebound tenderness over Mcburney point in the RLQ is referred to as
McBurney sign
Patients with acute appendicitis that have pain in the RLQ when the LLQ is palpates is referred to as
Rovsing sign
The sonographic appearance of the hyperechoic edematous connective tissue that surrounds the inflamed appendix
thyroid in the belly sign
Clinical findings of______:
1. initial epigastric or general abd pain that with t ime, is confined to the RLQ
2. acute abd pain
3. rebound tenderness
4. nausea and vomiting
5. possible leukocytosis
6. high fever (with abscess formation)
Acute Appendicitis
Sonographic findings of ______:
1. noncompressible, blind-ended tube that measures morethan 6mm in diameter from outer wall to outer wall
2. echogenic structure within the lumen of appendix (appendicolith)
3. hyperemic flow within the wall of inflamed appendix
4. periappendiceal fluid collection
Acute Appendicitis
What is the distal region of the stomach?
pylorus
The _________ _______ controls gastric emptying and prevents undigested food products, or chyme, from refluxing back into the stomach from the duodenum
Pyloric sphincter
This condition is a defect in the relaxation of the pyloric sphincter.
Hypertrophic pyloric stenosis
_______ _______ ______ causes a gastric outlet obstruction
Hypertrophic pyloric stenosis
Hypertrophic pyloric stenosis is most commonly encountered in what age?
Infants between 2 and 6 weeks old
The clinical findings where the enlarged pyloric muscle can be palpated is referred to as
The olive sign
To examine the pyloric region of the stomach, the infant is placed in what position?
Right lateral decubitus position
What can be done to get a better visual of the pylorus?
A small amount of water or glucose solution is given to the patient
What does the pyloric sphincter do?
controls gastric emptying & prevents undigested food products/chyme from refluxing back into the stomach from the duodenum
What infants are most likely to suffer from HPS?
first born, white male infants
In longitudinal plane, what is the position of the pylorus?
It’s within the epigastrium, slightly right of the midline, near the gallbladder
The pylorus is normally positioned ___ in the abdomen.
transverse
Pyloric stenosis yields a ___ appearance when the transducer is placed transverse to the abdomen.
cervix
The abnormal pylorus in short axis appears what on sonography?
A target or doughnut sign
If pyloric stenosis is present, the wall of the pyloric muscle will measure ___mm or greater in thickness, while the length of the abnormal pyloric channel will measure ___mm or greater.
3mm or greater in thickness; 17mm or greater in length
What are the three additional causes of nonbilious vomiting in the infant?
Pylorospasm
Gastroesophageal reflux
Malrotation of the midgut
_________ is a common cause of delayed gastric opening in infants
Pylorospasm
A temporary spasm & thickness of the pyloric sphincter that can replicate the sonographic appearance of pyloric stenosis
pylorospasm
Another cause for nonbilious projectile vomiting other than HPS in an infant
gastroesophageal reflux (reflux out of stomach back into esophagus)
Abnormal rotation of the bowel that leads to a proximal small bowel obstruction, small bowel rotates around the SMA
midgut malrotation
Patients with a midgut malrotation most often suffer from
bilious vomiting
The relationship with the SMA and SMV showing a whirlpool sign is indicative of what
midgut malrotation
What can be observed in sonography in terms of gastroesophageal reflux?
Fluid mixed with gas bubbles can be observed traveling retrograde up the esophagus
Clinical findings of ______:
1. first-born (white) male infant (most often)
2. nonbilious, projectile vomiting
3. weight loss
4. constipation
5. dehydration
6. insatiable appetite
7. palpable olive sign
Pyloric Stenosis
Sonographic findings of ______:
1. abnormal pylorus appears as a target or doughnut sign in transverse view
2. abnormal pylorus appears as a cervic in the longitudinal view
3. wall will measure greater than or equal to 3mm in thickness
4. length of pyloric channel will measure greater than or equal to 17mm
Pyloric Stenosis
The telescoping of one segment of bowel into another, most often the proximal segment of bowel inserts into the distal segment
intussusception
The proximal portion of the bowel with intussusception
Intussuceptum
What does invaginate mean?
To insert
The distal segment of the bowel with intussusception
intussuscipiens
With intussusception, the intussusceptum is allowed to _________ into the next part which is intussuscipiens.
Invaginate (to insert)
What is the most common type of intussusception?
ileocolic intussusception
_________ ________ occurs within the right lower quadrant at the level of the ileocecal valve.
Ileocolic intussusception
This condition occurs more often in male and has been cited as the most common cause of intestinal obstructions in children less than 2 years old
Intussusception
What is the key to finding intussusception?
Red currant jelly stool
What should be used in sonography to evaluate the pediatric patient who has clinical findings suspicious for intussusception?
Graded compression sonography
Clinical findings of _______:
1. intermittent severe abdominal pain
2. vomiting
3. palpable abdominal mass
4. red currant jelly stools
5. leukocytosis
Intussusception
Sonographic findings of ______:
1. noncompressible, target-shaped or pseudokidney shaped mass that consists of alternating rings of echogenicity (cinnamon bun sign)
2. The diameter of the intussuscepted bowel will exceed 3 cm
Intussusception
Most common cause of of intestinal obstruction in children less than 2 years of age, more common in male patients
intussusception
In adults, intussusception can be caused by a
neoplasm
Hallmark clinical finding of intussusception
red currant jelly stool (mixture of blood and mucus)
Intussusception will appear as what sign sonographically in transverse
“target” (may also resemble “cinnamon-bun sign” because of alternating rings of echogencity representing the edematous layers of the bowel wall)
Intussusception will appear as what sign sonographically in a longitudinal plane
“pseudokidney sign”
Diameter of intussusception will exceed
3mm
Intussusception can lead to
ischemia & gangrene of the bowel
What are the two types of intestinal obstruction?
mechanical and nonmechanical
This type of intestinal obstruction results from the bowel being physically blocked by something
Mechanical obstruction
This type of intestinal obstruction is when the bowel lacks normal peristalsis
Nonmechanical obstruction
When bowel lacks normal peristalsis
nonmechanical obstruction or paralytic ileus
With obstruction small bowel diameter will measure ___ or greater from outer to outer wall
2.5mm
The mucus membrane folds within the inner walls of the small bowel
plicae circulares
Distended fluid filled loops of bowel with intestinal obstruction sonographically will show what sign
keyboard sign
The colon diameter will exceed ___ with intestinal obstruction
6mm
Clinical findings of an______:
1. abdominal distention
2. intermittent abdominal pain
3. constipation
4. nausea and vomiting
Intestinal Obstruction
Sonographic findings of an ______:
1. distended fluid filled loops of bowel
2. an abrupt termination point of the distended bowel may be identified
3. increased peristaltic motion with to-and-fro motion of intraluminal contents (mechanical obstruction only)
Intestinal Obstruction
masses of various ingested material that may cause an intestinal obstruction
Bezoars
A type of bezoars that consists of ingested hair
Trichobezoars
Bezoars that consists of powdered milk that has not been adequately mixed with water
Lactobezoars
bezoars that consist of vegetable material are called ______ and are more often found in older patients.
phytobezoars
An autoimmune disease characterized by periods of inflammation of the gastrointestinal tract
Crohn disease
The most common inflammatory disease of the small intestine
Crohn disease
Crohn’s disease usually involves the terminal ______ or proximal colon.
Ileum
Crohn’s disease won’t be compressible and will show what kind of sign sonographically
“target sign”
Bowel wall will measure greater than ___ with Crohn’s
3mm
Clinical findings of ______:
1. Episodes of diarrhea
2. Abdominal pain
3. Weight loss
4. Rectal bleeding
Crohn Disease
Sonographic findings of ______:
1. bowel wall thickening >5mm
2. affected bowel will be noncompressible and have a target appearance
3. hyperemic wall
Crohn Disease
The development of small outpouchings termed diverticuli in the digestive tract, most often the sigmoid colon
diverticulosis
Inflammation resulting from infection of the small outpouching of the sigmoid colon is termed
Diverticulitis
Clinical findings of _____:
1. constipation or diarrhea
2. fever
3. nausea and vomiting
4. cramping, LLQ pain
Diverticulitis
Sonographic findings of ______:
1. segmentally thickened bowel with evidence of an inflamed diverticula and inflamed perienteric fat
2. affected bowel segment will typically reveal hyperemia
3. inflamed diverticula may appear as echogenic projections from the bowel that produce shadowing or ring-down artifact
Diverticulitis
Inflammation of the colon
colitis
What are the several types of colitis?
Pseudomembranous
Ulcerative
Ischemic
Infectious
More often associated with watery diarrhea can result from the use of antibiotic therapy that destroys the healthy flora of the intestine and leads to C. difficile
pseudomembranous colitis
Clinical findings of _____:
1. bloody or watery diarrhea
2. fever
3. abdominal pain
4. previous use of antibiotic therapy
Colitis
Sonographic findings of _____:
1. thickened, hypoechoic colon wall
2. hyperemia within the colon wall
Colitis
Gastric cancer is most often in the form of
adenocarcinoma
Clinical findings of _____:
1. Weight loss
2. Abdominal pain
3. Anorexia
4. Vomiting
Gastric Carcinoma
Sonographic findings of ______:
1. Hypoechoic, irregular-shaped, bulky mass that can measure up to 10cm in size
2. Could appear as a target or have a pseudokidney appearance
Gastric Carcinoma
Third leading cause of death in the western countries after lung and breast, typically found in the rectosigmoid colon
colon cancer
Malignancy of the alimentary tract will appear hypoechoic, irregularly shaped, bulky mass that can measure up to 10cm in size and sonographically may show what kind of signs
“target” and “pseudokidney sign”
An intraperitoneal extension of mucin secreting cells that result from the rupture of a malignant mucinous ovarian/appendix tumor
pseudomyxoma peritonei
Most commonly encountered metastatic tumors of the bowel
malignant melanoma, primary tumors of lung & breast
The rectus abdominis muscles are divided by a band of connective tissue called
linea alba
A rupture in the rectus abdominus muscle or associated vasculature can lead to a
rectus sheath hematoma (discoloration in area of hematoma)
Most common site for endometriosis outside the female pelvis region is the
anterior abdominal wall
List some of the causes of rectus sheath ______:
Abdominal contractions from childbirth
Sneezing
Coughing
Defecation
Urination
Intercourse
hematoma
Clinical findings of a Rectus Sheath ______:
1. Abdominal pain
2. Palpable abdominal mass
3. Discoloration of the skin in the area of the hematoma
4. Decreased hematocrit
Rectus Sheath Hematoma
Sonographic findings of a Rectus Sheath ______:
1. blood can appear hypoechoic, hyperechoic, complex, and/or anechoic depending on the stage of development
Rectus Sheath Hematoma
Clinical findings of ______ of the Abdominal Wall:
1. History of endometriosis
2. Prior cesarean section
3. Pain on the area of the cesarean section scar (possible pain that correlates with
the menstrual cycle)
4. Palpable mass
Endometriosis
Sonographic findings of ______ of the Abdominal Wall:
1. well-defined, lobulated, or infiltrative mass
2. hypoechoic to the adjacent tissue
Endometriosis
Most common type of ventral hernia, referred to as a paraumbilical hernia in adults
umbilical hernia
What is the term that denotes twisting of the bowel?
volvulus
Which of the following is true of a rectus sheath hematoma?
It may occur during defecation
Which of the following is not a layer of gut identified with sonography?
visceral
Pseudomyxoma peritonei can result from
appendix cancer
Which of the following best describes the location of McBurneys point?
halfway between the anterior superior iliac spine and the umbilicus
The most common location of the vermiform appendix is in the area of the
cecum
Which of the following is the development of small outpouchings within the sigmoid colon?
diverticulosis
Treatment for intussusception is by means of
therapeutic enema
The most common cause of intestinal obstruction in children less than 2 years of age is
intussusception
What are the several types of hernias in the abdominal wall?
Inguinal hernia
Incisional hernia
Linea alba hernia
Umbilical hernia
Spigelian hernia
Performed by attempting to forcibly exhale while keeping the mouth and nose closed
Valsalva technique
What technique can be utilized to show movement and change the size of the hernia?
Valsalva technique
accquired inguinal hernia; result from the weakening of the transversalis fascia
direct groin hernia
indirect groin hernia
