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OB Gyn class 2 > ch 62 > Flashcards

ch 62 Flashcards

1
Q

foregut

A

Pharynx Lower respiratory system Esophagus Stomach Part of the duodenum Liver and biliary apparatus Pancreas

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2
Q

Esophageal atresia

A

Results from abnormal deviation of tracheoesophageal septum in posterior direction

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3
Q

Stomach

A

Appears as fusiform dilation of caudal part of foregut During fifth and sixth weeks, dorsal border (greater curvature) grows faster than ventral border (lesser curvature)

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4
Q

Duodenum

A

Develops from caudal part of foregut and cranial part of midgut Comes to lie primarily in retroperitoneum

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5
Q

Liver and Biliary System

A

Liver, gallbladder, biliary ducts arise as bud from most caudal part of foregut in fourth week

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6
Q

Hemopoiesis

A

(blood formation) begins during sixth week

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7
Q

bile formation by hepatic cells begin when

A

12 wks

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8
Q

Extrahepatic biliary atresia

A

Blockage of bile ducts results from failure to recanalize following solid stage of development

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9
Q

Pancreas

A

Develops from dorsal and ventral pancreatic buds of endodermal cells that arise from caudal part of foregut

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10
Q

Spleen

A

Lymphatic organ derived from mass of mesenchymal cells located between layers of dorsal mesogastrium

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11
Q

The Midgut

A

Small intestines Cecum and cloaca exstrophy Ascending colon Most of transverse colon

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12
Q

The Midgut

A

All structures supplied by superior mesenteric artery

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13
Q

the midgut is suspended by

A

elongated dorsal mesentery

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14
Q

The Midgut

A

Usually by 10th or 11th week, midgut herniation returns to abdomen

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15
Q

Gastroschisis

A

Is usually located to right of umbilical cord

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16
Q

Umbilical Hernia

A

Forms when: Intestines return normally to abdominal cavity Herniate either prenatally or postnatally through inadequately closed umbilicus

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17
Q

Meckel’s Diverticulum

A

Is the most common malformation of midgut Remnant of proximal part of yolk stalk that fails to degenerate and disappear during early fetal period

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18
Q

The Hindgut

A

Derivatives of hindgut: Left part of transverse colon Descending colon Sigmoid colon Rectum Superior portion of anal canal Epithelium of urinary bladder Most of urethra

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19
Q

The Hindgut is supplied by

A

inferior mesenteric artery

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20
Q

Stomach should be seen by

A

14 to 16 weeks

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21
Q

if stomach is not seen RO

A

Central nervous system problem (swallowing disorders) Obstruction Oligohydramnios Atresia

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22
Q

Echogenic debris may sometimes be seen along dependent wall of stomach

A

Vernix

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23
Q

If stomach seen in right upper quadrant, condition is called

A

situs inversus

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24
Q

If fetus is in vertex presentation with spine up, both aorta and stomach should be seen to left of spine

A

Stomach

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25
Q

can be visualized in thorax during second and third trimesters as two or more parallel echogenic lines (“multilayered” pattern)

A

Normal esophagus

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26
Q

Measured at level of portal sinus and umbilical portion of left portal vein (“hockey stick” appearance on sonogram)

A

Abdominal Circumference

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27
Q

Abdominal circumference should be round, not oval.

A

Abdominal Circumference

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28
Q

Joins umbilical portion of left portal vein at caudal margin of left intersegmental fissure of liver

A

Umbilical Cord Insertion

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29
Q

Visualization of insertion site must be made to rule out presence of omphalocele, gastroschisis, hernia, and mass formation.

A

Umbilical Cord Insertion

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30
Q

Movement of gastric musculature begins in

A

approximately fourth to fifth month of gestation

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31
Q

After 15th to 16th week, meconium begins to accumulate in distal part of small intestine

A

Bowel

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32
Q

Bowel

A

Distinction of large bowel from small bowel possible after 20 menstrual weeks

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33
Q

Appears as ill-defined area of increased echogenicity in mid to lower abdomen

A

Bowel

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34
Q

Hyperechoic appearance could be secondary to reflections from walls of collapsed loops of small bowel or from mesenteric fat between loops

A

Bowel

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35
Q

As pregnancy progresses: Hyperechoic area becomes less prominent Small bowel located more centrally in abdomen than colon

A

Bowel

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36
Q

peristalsis occurs

A

After 27 weeks

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37
Q

Normal diameter of small bowel lumen ≤5 mm, with length of 15 mm near term

A

bowel

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38
Q

Haustral folds of colon help to differentiate it from small bowel

A

Bowel

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39
Q

In early gestation, haustral folds appear as thin linear echoes within lumen of colon Later, colon diameter increases and folds become longer and thicker

A

Bowel

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40
Q

Colon seen near end of second trimester as long tubular hypoechoic structure with well-defined walls

A

Bowel

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41
Q

Normal measurements of colon diameter range from 3 to 5 mm at 20 weeks to 23 mm or larger at term

A

Bowel

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42
Q

does not have peristalsis like small bowel

A

Colon

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43
Q

more peripheral than small bowel

A

Colon

44
Q

After 14 weeks of gestation, lipid absorbed from fetal colon and remaining contents collect in colon as meconium

A

Bowel

45
Q

hypoechoic relative to fetal liver and in comparison with bowel wall

A

Meconium within lumen of colon

46
Q

Liver

A

Relatively large compared with other intraabdominal organs Occupies most of upper abdomen in fetus

47
Q

Accounts for 10% of total weight of fetus at 11 weeks and 5% of total weight at term

A

Liver

48
Q

Liver

A

Hepatic veins and fissures formed by end of first trimester

49
Q

Left lobe of liver larger than right in utero secondary to greater supply of oxygenated blood Reverses after birth

A

Liver

50
Q

Gallbladder

A

May be seen sonographically after 20 weeks of gestation

51
Q

Distinguished by location to right of portal-umbilical vein and as oblong, more oval structure than “tubular” intrahepatic umbilical vein

A

Gallbladder

52
Q

Pancreas

A

Normal fetal pancreas has been seen in utero but is more difficult to routinely visualize because of the lack of fatty tissue within the gland

53
Q

Lies in the retroperitoneal cavity anterior to the superior mesenteric vessels, aorta, and inferior vena cava (IVC)

A

Pancreas

54
Q

Normal fetal pancreas has been seen in utero but is more difficult to routinely visualize because of the lack of fatty tissue within the gland

A

Pancreas

55
Q

Homogeneous in texture Similar in echogenicity to kidney Slightly less echogenic than liver Increases in size during gestation Imaged on transverse plane posterior and to left of fetal stomach

A

Spleen

56
Q

Is involved in several congenital anomalies but rarely affected by isolated hepatic lesions

A

Abnormalities of the Hepatobiliary System

57
Q

Liver parenchymal cysts and hemangiomas of liver have been reported. Enlarges in fetuses with Rh-immune disease in response to increased hematopoiesis

A

Abnormalities of the Hepatobiliary System

58
Q

Liver tumors, hamartoma, hepatoblastoma uncommon but may be seen

A

Liver

59
Q

Hemangioendothelioma Most common symptomatic, vascular hepatic tumor of infancy (although rare) May cause nonimmune hydrops in fetus

A

Liver

60
Q

Sonographic Findings of the liver

A

Most liver tumors appear as hypoechoic solid masses; cystic components have also been reported as mixed with solid masses

61
Q

Partial situs inversus

A

Is more severe disorder May develop in two different combinations of organ reversals Thoracic viscera usually reversed Abdominal viscera may or may not be reversed

62
Q

Partial situs divided into asplenia and polysplenia

A

Situs Inversus

63
Q

Situs Inversus

A

Polysplenia represented as transposition of liver, spleen, stomach, and absence of gallbladder

64
Q

Polysplenia

A

At least two spleens present along greater curvature of stomach Heart block common in polysplenia syndrome

65
Q

Situs Inversus

A

Cardiac malformations common (99%) in asplenia syndrome; are seen with less frequency in polysplenia syndrome (90%)

66
Q

Cardiac defects of situs inversus

A

Endocardial cushion defects Hypoplastic left heart Transposition of great vessels

67
Q

total situs inversus

A

usually has normal outcome

68
Q

Mortality rate for partial situs inversus

A

extremely high; death occurs in 90% to 95% with asplenia syndrome and 80% with polysplenia syndrome

69
Q

Total situs inversus

A

right-sided heart axis and aorta; transposition of liver, stomach, spleen; left-sided gallbladder)

70
Q

Partial situs inversus

A

(right-sided stomach, left-sided liver); dextrocardia with normal stomach position (see previous section)

71
Q

Causes of Ascites

A

Genitourinary Gastrointestinal Liver Cardiac Infections Metabolic storage disorders Idiopathic

72
Q

identified in fetus when calcifications are found within gallbladder.

A

Cholelithiasis (gallstones)

73
Q

Choledochal cyst (dilation of CBD) may be diagnosed when

A

cystic mass identified adjacent to fetal stomach and gallbladder

74
Q

Agenesis of gallbladder occurs in approximately

A

20% of patients with biliary atresia

75
Q

Absence of gallbladder can occur in association with

A

polysplenia and rare multiple anomaly syndromes

76
Q

Atresias

A

Develop when portion of bowel grows and infarcts Occurs anywhere in gastrointestinal tract Polyhydramnios evident on ultrasound

77
Q

Blockage results in

A

back-up of amniotic fluid and hydramnios

78
Q

Esophageal Atresia

A

Most common form occurs in conjunction with a fistula, communicating between trachea and esophagus (tracheoesophageal fistula). allows passage of amniotic fluid into stomach

79
Q

Esophageal Atresia

A

Gastric secretions may contribute to stomach fluid

80
Q

Combination of polyhydramnios and absent stomach over repeated studies may be suggestive of

A

esophageal atresia

81
Q

In >50% of cases, stomach present because fistula usually present that leads to fluid filling stomach

A

Esophageal Atresia

82
Q

Esophageal Atresia

A

Hydramnios may exist from impaired reabsorption of swallowed fluid and be associated with esophageal atresia; usually does not develop until third trimester

83
Q

Esophageal Atresia

A

Growth restriction present in 40% of cases Chromosomal trisomies (18 and 21) reported Coexisting anomalies common in 50% to 70% of fetuses with esophageal atresia

84
Q

Duodenal Atresia

A

Blockage of duodenal lumen by membrane that prohibits passage of swallowed amniotic fluid

85
Q

Duodenal Atresia Sonographic Findings

A

Two echo-free communicating structures (stomach and duodenum) found in upper fetal abdomen Sonographic appearance termed “double bubble sign” Hydramnios almost always seen with duodenal atresias later in pregnancy

86
Q

Causes of Double Bubble

A

Duodenal atresia Duodenal stenosis Annular pancreas Ladd’s bands Proximal jejunal atresia Malrotation Diaphragmatic hernia

87
Q

About 30% of fetuses with duodenal atresia have

A

trisomy 21 (Down syndrome)

88
Q

Anomalies occur in approximately with duodenal atresia

A

50%

89
Q

Occurs in 1 in 3000 to 5000 live births; thought to be secondary to vascular accident, volvulus or gastroschisis or be sporadic

A

Bowel Intestinal Obstructions

90
Q

Bowel Intestinal Obstructions

A

Atresia or stenosis of jejunum or ileum, or both, and small bowel atresia slightly more common than duodenal atresia

91
Q

Blockage of jejunum and ileal bowel segments

A

(jejunoileal atresia or stenosis) appears as multiple cystic structures (more than two) proximal to site of atresia within fetal abdomen

92
Q

Bowel Intestinal Obstructions

A

General rule: The more distal the obstruction, the less severe the hydramnios, and the later it will develop.

93
Q

Causes of fetal small-bowel obstruction include:

A

Malrotation Atresias Volvulus Peritoneal bands Cystic fibrosis Dilated bowel loops isolated or associated with other anomalies, ascites, or meconium peritonitis

94
Q

Sonographic Findings

A

Intestinal obstructions appear as cystic bowel loops discontinuous with stomach Fetal intestinal obstruction should be suspected when clear cystic structures found in pelvis Vascular restriction may lead to obstruction secondary to gastroschisis

95
Q

Meconium Ileus

A

Is a small-bowel disorder marked by presence of thick meconium in distal ileum

96
Q

Earliest manifestation of cystic fibrosis occurring (%)

A

10% to 15% of patients; is third most common form of neonatal bowel obstruction after atresia and malrotation

97
Q

Meconium begins to accumulate in the fetal bowel in the second trimester, at which time it can be seen sonographically as tiny echogenic reflections within the peristaltic small bowel.

A

Meconium Ileus

98
Q

Meconium Ileus

A

The anal sphincter prevents the passage of meconium (meconium plug) into the amniotic fluid, unless the fetus is stressed or traumatized.

99
Q

Meconium Ileus Sonographic Findings

A

Ileum dilates because of impacted meconium (which appears echogenic) Increased production of mucus by GI organs and electrolyte imbalance explains overproduction of meconium (characteristic of cystic fibrosis)

100
Q

Anorectal Atresia

A

Presents as complex disorder of bowel and genitourinary tract Imperforate anus is disorder that occurs when membrane covers anus, prohibiting expulsion of meconium

101
Q

Hirschsprung’s Disease

A

Megacolon is congenital disorder in which there is abnormal innervation of large intestine

102
Q

Meconium Peritonitis

A

Condition that may arise when fetus has sterile chemical peritonitis secondary to in utero bowel perforation Hydramnios present in 65% of fetuses

103
Q

Sonographic FindingsMeconium Peritonitis

A

Calcifications seen on peritoneal surfaces or in scrotum via processus vaginalis Ascitic fluid may be echogenic. Is unusual to see calcification in meconium ileus in fetus with cystic fibrosis

104
Q

Hyperechoic Bowel

A

Grade 1: Mildly echogenic and typically diffuse Grade 2: Moderately echogenic and typically focal Grade 3: Very echogenic; similar to that of bone structures

105
Q

True ascites in fetal abdomen always

A

abnormal

106
Q

Prognosis is

A

poor in nonimmune hydrops

107
Q

Other conditions that may cause ascites to develop include bowel perforation or urinary ascites secondary to bladder rupture.

A

Ascites

OB Gyn class 2 (20 decks)

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