Ch. 28 The Fetal Gastrointestinal System

Question 1

The fetal gut develops at the end of the ___ menstrual week

Answer 1

5th (foregut, midgut, hindgut)

Question 2

Seen as several parallel echogenic lines within the thorax

Answer 2

esophagus

Question 3

Transvaginally., the fetal stomach can be seen as early ___ weeks but should be seen by ____ weeks.

Answer 3

8, 14

Question 4

Diameter of small bowel is smaller than the colon and should not exceed ____

Answer 4

5mm

Question 5

In early embryologic development, the origin of amniotic fluid is thought to result from an ____.

Answer 5

osmostic preocess.

Question 6

Differentiating small bowel from the colon is achieved late in gestation, because the colon offers larger loops within the periphery of the abdomen and contains hypoechoic material representing ______.

Answer 6

meconium

Question 7

fetal stool that is composed of fetal skin, hair, amniotic fluid, and bile

Answer 7

meconium

Question 8

fetal biometric measurement of the abdomen made in the second and third trimesters; used in conjunction with other measurements to date the pregnancy and size the fetus

Answer 8

abdominal circumference

Question 9

Abdominal circumference electronic calipers are placed around the entire outer perimeter of the abdomen. The abdominal diameter measurement is taken at the same level, with two perpendicular caliper sets. The formula for the abdominal diameter is AC = 1.57 × (____ + ____).

Answer 9

AD1+AD2

Question 10

made in the axial view of the fetus and should include the fetal stomach, transverse thoracic spine, and intrahepatic portion of the umbilical vein and its junction with the left portal vein

Answer 10

abdominal circumference

Question 11

an excessive amount of amniotic fluid for the gestational age

Answer 11

Polyhydramnios

Question 12

Fetal kidneys begin to produce urine by ___ which comprises most of the amniotic fluid.

Answer 12

9 weeks

Question 13

_________contributes greatly to the amount of amniotic fluid.

Answer 13

Fetal urine

Question 14

What should be evaluated when polyhydramnios is detected?

Answer 14

fetal gastrointestinal tract

Question 15

_______ is a substance that contains valuable proteins that are essential for normal fetal development. The fetus ingests amniotic fluid by swallowing. The fluid passes through the esophagus, into the stomach, and travels through the small bowel and into the colon, where absorption takes place. ________results when there is an obstruction or disturbance to the normal flow and absorption of amniotic fluid.

Answer 15

Amniotic fluid; Polyhydramnios

Question 16

When polyhydramnios is detected, the sonographers should evaluate the fetal gastrointestinal tract carefully for signs of abnormalities, such as _____ or ________.

Answer 16

duodenal or esophageal atresia

Question 17

congenital absence of part of the esophagus

Answer 17

esophageal atresia

Question 18

congenital maldevelopment or absence of the duodenum

Answer 18

duodenal atresia

Question 19

Condition associated with esophageal atresia 90% of the time

Answer 19

tracheoesophageal fistuala

Question 20

an abnormal connection between the esophagus and the trachea

Answer 20

tracheoesophageal fistuala

Question 21

acronym for associated anomalies; stands for vertebral anomalies, anal atresia, cardiac anomalies, tracheoesophageal fistula or esophageal atresia, renal anomalies, and limb anomalies

Answer 21

VACTERL

Question 22

a fetus that is below the 10th percentile for gestational age (small for gestational age) and whose growth is impeded for some reason

Answer 22

intrauterine growth restriction

Question 23

Sonographic Findings of ___________

1.Absent or small stomach
2.Polyhydramnios
3.Intrauterine growth restriction

Answer 23

Esophageal Atresia

Question 24

Associated anomalies are often present in esophageal atresia and include duodenal atresia, _______ association, Down syndrome, ____________, and trisomy 18

Answer 24

VACTERL; intrauterine growth restriction

Question 25

The congenital maldevelopment or absence of the proximal portion of the small bowel, the duodenum, is termed _______

Answer 25

duodenal atresia

Question 26

Duodenal atresia classically presents sonographically as a dilated, fluid-filled anechoic stomach and an anechoic fluid-filled proximal duodenum, offering the ___________sign

Answer 26

“double bubble”

Question 27

Duodenal atresia has a known association with

Answer 27

trisomy 21

Question 28

associated anomalies of duodenal atresia include trisomy 21, _________, VACTERL association, ________, and cardiac anomalies.

Answer 28

esophageal atresia ;intrauterine growth restriction;

Question 29

Sonographic Findings of ________ 1.“Double bubble” sign 2.Polyhydramnios 3.Intrauterine growth restriction

Answer 29

Duodenal Atresia

Question 30

What fetal lobe of the liver is larger and why?

Answer 30

left, because fetal circulation provides more oxygen to the left lobe in utero

Question 31

Most common abnormality of the fetal liver

Answer 31

hepatomegaly (seen with intruterine infections, Rh incompatibility (fetal anemia), Beckwith-Wiedmann Syndrome

Question 32

enlargement of the liver

Answer 32

Hepatomegaly

Question 33

a growth disorder syndrome synonymous with enlargement of several organs, including the skull, tongue, and liver

Answer 33

Beckwith–Wiedemann syndrome

Question 34

Enlargement of the fetal _____—_________—can accompany hepatomegaly and may be suggestive of intrauterine infections or Rh incompatibility with hydrops

Answer 34

spleen; splenomegaly

Question 35

Fetal gallstones (cholelithiasis) and sludge within the gallbladder may be noted in utero, most often in the ______ trimester. Gallstones appear sonographically as echogenic foci in the right upper quadrant of the fetus that may or may not produce posterior shadowing

Answer 35

third; (*Gallstones persisting postnatally typically resolve postnatally)

Question 36

the cystic dilatation of the common bile duct

Answer 36

choledochal cyst

Question 37

inflammation of the bile ducts

Answer 37

cholangitis

Question 38

the elevation of blood pressure within the portal venous system

Answer 38

portal hypertension

Question 39

There are 4 different types of choledochal cyst but the most common is

Answer 39

cystic dilation of the CBD

Question 40

Choledochal cysts can lead to ______, _______, pancreatitis, and liver failure

Answer 40

cholangitis,portal hypertension

Question 41

The small intestine should not be ____ to or greater than that of fetal bone.

Answer 41

isoechoic

Question 42

Echogenic bowel is linked to ________, _____, growth restriction, fetal demise, congenital infections such as cytomegalovirus, and gastrointestinal obstructions.

Answer 42

Down syndrome, cystic fibrosis

Question 43

the transducer frequency plays a role in the diagnosis of echogenic bowel. One author suggests that if a ______ frequency transducer suggests echogenic bowel, that the sonographer should ______ the frequency to 5 MHz or less and decrease the overall gain.

Answer 43

higher; decrease

Question 44

an inherited disorder in which mucus-secreting organs such as the lungs, pancreas, and other digestive organs produce thick and sticky secretions instead of normal secretions

Answer 44

cystic fibrosis

Question 45

___________which causes a functional fetal bowel obstruction, is caused by the absence of nerves within the bowel wall

Answer 45

Hirschsprung disease

Question 46

Hirschsprung disease is more common in _____, and there is a strong association with ________.The sonographic finding of dilated loops of bowel within the fetal abdomen is indicative of a fetal bowel obstruction.

Answer 46

males; trisomy 21

Question 47

The sonographic finding of dilated loops of bowel within the fetal abdomen is indicative of a fetal bowel obstruction. These dilated loops of bowel should not exceed ____ mm in diameter or measure greater than ____ mm in length

Answer 47

7; 15

Question 48

Obstruction of the fetal bowel most often occurs when there is a meconium plug causing the barrier, a condition referred to as _______

Answer 48

meconium plug syndrome

Question 49

The most common type of colonic atresia that will lead to a bowel obstruction is ______

Answer 49

anorectal atresia

Question 50

Anorectal atresia will most often lead to the visualization of a __________.

Answer 50

dilated fetal rectum

Question 51

______this congenital maldevelopment of the rectum and anal opening causes dilation of the bowel.

Answer 51

anorectal atresia

Question 52

Anorectal atresia may be linked with _________association and chromosomal abnormalities; thus, a thorough analysis of the fetus for other abnormalities is vital.

Answer 52

VACTERL

Question 53

Two of the most common ventral abdominal wall defects are

Answer 53

gastroschisis, omphalocele

Question 54

If the fetus has an abdominal wall defect (opening in the abdomen), then a ______ amount of AFP is allowed to pass into the maternal circulation.

Answer 54

greater

Question 55

_____ levels of MSAFP are found in the presence of omphalocele and gastroschisis and thus can be used as a reliable screening test for the early detection of these and other abnormalities. Furthermore, it is important to note that MSAFP levels have been shown to be much higher in _______ than in omphalocele.

Answer 55

Elevated; gastroschisis

Question 56

As a part of normal fetal development during the first trimester, the midgut herniates into the base of the umbilical cord; this is termed __________

Answer 56

physiologic bowel herniation

Question 57

The intestines return to the abdominal cavity by the ____ week of gestation.

Answer 57

12th

Question 58

the normal developmental stage when the midgut migrates into the base of the umbilical cord

Answer 58

physiologic bowel herniation

Question 59

is the herniation of abdominal contents through a right-sided, periumbilical abdominal wall defect

Answer 59

Gastroschisis

Question 60

Thought to be caused by a vascular incident occurring to either the right umbilical vein or omphalomesenteric vein

Answer 60

gastroschisis

Question 61

Prognosis after surgery in a newborn is much better with this abdominal wall defect than those with omphalocele

Answer 61

gastroschisis

Question 62

_______, unlike omphalocele, does ______ have a strong association with chromosomal abnormalities

Answer 62

Gastroschisis; not

Question 63

With Gastroschisis recognizable loops of bowel are often noted outside of the abdomen floating in the amniotic fluid, and ______ Doppler should be used to demonstrate the relationship of the mass to the umbilical cord.

Answer 63

color

Question 64

Clinical Findings of Gastroschisis Elevated _________

Answer 64

MSAFP

Question 65

Sonographic Findings of ________ 1.Normal cord insertion 2.Periumbilical, right-sided mass 3.Recognizable loops of bowel outside the abdomen 4.Intrauterine growth restriction

Answer 65

Gastroschisis

Question 66

an anterior abdominal wall defect where there is herniation of the fetal bowel and other abdominal organs into the base of the umbilical cord

Answer 66

omphalocele

Question 67

An ________ is located within the midline of the abdomen. The ________ will insert into this mass. The entire content is contained and ______ by peritoneum and amnion.

Answer 67

omphalocele; umbilical cord; covered

Question 68

______ is often noted within an omphalocele, as well as within the abdomen of the fetus.

Answer 68

Ascites

Question 69

excessive fluid in the peritoneal cavity

Answer 69

Ascites

Question 70

With an omphalocele a mass that contains liver has what kind of prognosis

Answer 70

poor

Question 71

Clinical Findings of Omphalocele Elevated _______

Answer 71

MSAFP

Question 72

Sonographic Findings of ______ 1.Midline abdominal mass at the base of the umbilical cord that contains bowel, the liver, and/or other abdominal organs 2.Abnormal cord insertion into the midline abdominal mass 3.Multiple associated anomalies

Answer 72

Omphalocele

Question 73

Omphalocele has a more significant risk for _________and _________ than gastroschisis. Trisomy 18, trisomy 13, ______ syndrome, and Beckwith–Wiedemann syndrome have all been linked with omphaloceles.

Answer 73

heart defects; chromosomal anomalies; Turner

Question 74

group of anomalies that include an omphalocele, along with ectopic cordis, cleft sternum, anterior diaphragmatic defect, and pericardial defects

Answer 74

Pentalogy of Cantrell