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OB2 > Ch. 63 > Flashcards

Ch. 63 Flashcards

1
Q

Fetal abdominal organs are well formed by

A

The 2nd trimester

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2
Q

In the fetal body, Umbilical arteries & vein are anatomic landmarks for

A

fetal abdominal anatomy & measurements

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3
Q

In the fetus, _ is present

A

Ductus venosus

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4
Q

Fetal liver is

A

Larger and occupies a larger volume of the fetal abdomen

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5
Q

Umbilical hernias form when

A

Intestines return normally to the abdominal cavity & herniate either prenatally or postnatally through an inadequately closed
umbilicus

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6
Q

How does hernia differ from omphalocele?

A

Hernia is covered by skin and subcutaneous tissue

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7
Q

Meckels diverticulum

A

Remnant of the proximal part of the yolk sac that fails to degenerate and disappear during the early fetal period
o Usually a small finger-like sac about 5 cm long projects from the border of the ileum

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8
Q

Most common malformation of the midgut

A

Meckels diverticulum

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9
Q

Most fetuses older than _ should have fluid in their stomach. If the fluid is not seen _

A

16 weeks
Stomach should be reevaluated in 20-30 minutes to rule out possible CNS problems, obstruction, oligohydramnios, and atresia

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10
Q

If fluid is not seen in the stomach after reevaluation

A

Fetus may be reexamined the following day or week to

see if there is a change in stomach size

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11
Q

Fluid within the stomach should be

A

Anechoic

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12
Q

If an echogenic mass is seen in the fetal stomach in a patient with clinical or sonographic evidence that suggests an abruption this could possibly be a

A

hematoma associated w/ intraamniotic hemorrhage

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13
Q

Normal esophagus can be visualized in the thorax during

A

The 2nd and 3rd trimesters

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14
Q

Esophagus appears as

A

2 or more parallel echogenic lines
Multilayered pattern
Occasionally fluid can be seen in the esophagus During fetal swallowing

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15
Q

Umbilical Cord Insertion visualization must be made to rule out

A

Omphalocele
Gastroschisis
Hernia
Mass formation

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16
Q

After birth, umbilical vein

A

Collapses and forms the ligamentum teres

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17
Q

Appearance of bowel varies changes depending on

A

Gestational age

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18
Q

In 1st trimester- Fetus is capable of _, this permits visualization of the stomach by approx.

A

swallowing sufficient amounts of amniotic
fluid

11 menstrual weeks

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19
Q

In the 2nd trimester, Movement & swallowing increase the _

This is where _

A

amniotic fluid volume in the small bowel & colon

Fluid and nutrients are absorbed

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20
Q

Meconium begins to accumulate in the _ after _ weeks

A

Distal part of the small intestines

15-16

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21
Q

Meconium is a combination of

A
  • Desquamated cells
  • Bile pigments
  • Mucoproteins
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22
Q

Until mid-2nd trimester the small bowel lumen is

A

Difficult to demonstrate

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23
Q

Bowel appears as

A

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

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24
Q

Distinction of large bowel from small bowel is possible after

A

20 weeks

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25
Q

Small bowel is slightly _ compared to the liver

A

Hyperechoic

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26
Q

Small bowel may appear

A

“Mass like” in the central abdomen and oelvis

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27
Q

Small bowel appears _ throughout the rest of the pregnancy

A

Hyperechoic

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28
Q

Small bowel: as pregnancy progresses:
_ becomes less prominent.
Small bowel is located _.
After _ weeks, normal peristalsis is increasingly observed

A

Hyperechoic area

more central in the abdomen than colon

27 weeks

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29
Q

Colon can be identified at the end of

A

The second trimester

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30
Q

Colon appears as

A

A long tubular hypoechoic structures w/ well defined walls

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31
Q

What differentiates colon from small bowel

A

Haustral folds

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32
Q

Colon is more _ than small bowel

A

Peripheral

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33
Q

Colon doesn’t have

A

Peristalsis like small bowel

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34
Q

After _ weeks, lipids absorbed from fetal colon & the remaining contents collect as

A

14

Meconium

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35
Q

After 14 weeks, meconium appears

A

Hypoechoic compared to fetal liver

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36
Q

After 14 weeks, normal colon can be

A

Mistaken form abnormally dilated small bowel or other pathological processes

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37
Q

After 14 weeks, meconium _ in echogenicity closer to term

A

Increases slightly

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38
Q

Liver is involved in

A

several congenital anomalies but rarely affected by an isolated
hepatic lesion

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39
Q

Liver cysts & hemangiomas have

A

Been reported in the fetal liver

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40
Q

Liver enlarges in fetuses with _ due to _

A

Rh isoimmunization

Increased hematopoiesis

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41
Q

Uncommon but may be seen in the liver

A

Tumors
Hamartoma
Hepatoblastoma

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42
Q

Most liver tumors appear as _ masses

A

Solid hypoechoic

Cystic components and solid masses have also been reported

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43
Q

About _% of benign and malignant liver tumors are

A

5

Calcified

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44
Q

Liver calcifications may be seen and appear as

A

Isolated echogenic focus, ususally benign

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45
Q

If multiple liver calcifications are seen

A

Other organs may be affected

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46
Q

Situs inversus

A

Reversal of thoracic and abdominal organs

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47
Q

Total reversal

A

Complete reversal of thoracic & abdominal organs

Prognosis- normal outcome

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48
Q

Partial situs inversus

A

More severe than total

High mortality rate

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49
Q

Partial situs inversus can develop 2 combinations of organ reversal

A

Thoracic viscera usually reversed and abdominal viscera may or may not be reversed

Occasionally, abdominal organs are reversed without reversal of
heart position

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50
Q

Partial situs is divided into

A

Asplenia

Polysplenia

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51
Q

Asplenia partial situs

A

Absence of spleen
Stomach and GB are more midline in position
More centrally located liver
Abnormal positioning of the aorta & IVC on the same side
Mortality rate =95%

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52
Q

Polysplenia

A 
More than one spleen [at least 2 are present]
o Located along the greater curvature of the stomach [Right side]
• Transposition of: 
o Liver
o Spleen
o Stomach
• Absence of GB
• There is an interruption of the IVC
• Heart block is common
• Normal size spleen is NOT seen between stomach and left kidney
on trans abdomen image.
• Mortality rate = 80%
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53
Q

Cause of situs inversus

A

Unclear

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54
Q

Are cardiac malformations common in situs inversus

A

Yes

55
Q

Cardiac malformation in situs w/ asplenia _%, polysplenia _%

A

99

90

56
Q

Cardiac malformations with situs

A

Endocardinal cushion defect
Hypoplastic left heart
Transportation of the great vessels

57
Q

Sonographically

▪ Total situs inversus

A 
Right sided heart axis & aorta
• Transposition of the liver
• Stomach
• Spleen
• Left-sided gallbladder
58
Q

Sono

▪ Partial situs inversus

A

• Right-sided stomach
• Left-sided liver
• Dextrocardia with
o Normal stomach position

59
Q

With situs, other anomalies to check for include

A
  • Gastrointestinal
  • Genitourinary
  • Neural tube
60
Q

• Ascites

o Many causes in the fetus:

A

Gastrointestinal obstruction with bowel perforation
•present as meconium peritonitis & ascites

Nongastrointestinal causes include:
• Immune & nonimmune hydrops
• Urinary tract obstruction
• Congenital infection
• Some abdominal tumors
61
Q

True ascites is seen within the

A

peritoneal recesses and in the spaces between small bowel loops (outlines the falciform ligament)

62
Q

Pseudoascites

A

Sonolucent band near the fetal anterior abdominal wall is commonly seen in routine OB exams over 18 weeks

63
Q

Pseudoascites: band results from

A

normal musculature surrounding the abdominal wall

64
Q

Pseudoascites is always confined to _. Never outline _

A

The anterior fetal abdomen

Falciform ligament

65
Q

Cholelithiasis: _ are seen in the GB

A

Calcifications

66
Q

Gallstones will _ in utero or in childhood

A

Resolve spontaneously

67
Q

Coledochal cyst

A

Dilation of the CBD
▪ Cystic mass adjacent to the fetal stomach & gallbladder
▪ May be confused with malformations of the stomach, bowel or duodenal
atresia

68
Q

Sono

Choledochal cyst

A
  • Close proximity of cyst to neck of gallbladder
  • Ovoid right upper quadrant cyst with entering bile duct
  • Cyst & gallbladder enlarge as pregnancy progresses
  • Absence of peristaltic activity in cyst
69
Q

Agenesis of the gallbladder

occurs in approximate

A

20% of pts with biliary atresia

70
Q

Agenesis of the gallbladder May be associated with

A

Partial situs inversus w/ polysplenia

Rare multiple anomaly syndromes

71
Q

Ability to visualize the GB _ w/ gestational age

A

Increases

72
Q

When asplenia is associated w/ congenital heart disease _ should be considered

A

Polysplenia-asplenia syndrome should be considered

73
Q

Majority of GI malformations can be corrected after birth but it’s important to detect

A

prenatally to prevent complications of dehydration, bowel necrosis and respiratory difficulties that can happen if these lesions are not suspected before delivery.

74
Q

GI atresia develops when

A

Portion of bowel grows and infarcts ( doesn’t develop all the way)

75
Q

GI atresia occurs

A

Anywhere in the GI tract

76
Q

With GI atresia _ can occur

A

Obstruction to normal swallowing

77
Q

GI atresia: The membrane covering the lumen & intestinal loops _
Bowel loops below the atresia _
The blockage results in _

A

enlarge above the
obstruction
are narrowed [stenotic]
Polyhydramnios (and backup of amniotic fluid)

78
Q

Esophageal atresia

A

Congenital blockage of the esophagus

79
Q

Esophageal atresia results from

A

faulty separation of the foregut into its respiratory & digestive
components

80
Q

Esophageal atresia in conjunction with a fistula (most commonly)

A

▪ Communication between trachea & esophagus [tracheoesophageal fistula]
▪ Allows passage of amniotic fluid into the stomach

81
Q

Esophageal atresia: sometime there is no fistula so

A

Fluid will not reach the stomach
Although gastric secretions can contribute to stomach fluid
Stomach will not be visualized

82
Q

Combination of polyhydramnios & absent stomach over repeated exams suggest

A

Esophageal atresia

83
Q

Esophageal atresia is not diagnosed in a majority of cases because

A

Tracheoesophageal fistula is usually present

84
Q

Esophageal atresia:

Coexisting anomalies are _

A

Common

85
Q

Esophageal atresia:

Most common anomaly seen

A

Anorectal atresia

86
Q

Esophageal atresia is associated with

A

VACTERL
(Vertebral defect, heart defects, renal, and limb abnormalities)
Growth restriction
Trisomies 18 & 21

87
Q

Duodenal Atresia

A

Blockage of the duodenal lumen by a membrane
Prevents passage of swallowed amniotic fluid
Narrowing of the bowel below the obstruction occurs
Amniotic fluid fails to move past the obstruction
• Amniotic fluid backs up in the duodenum & stomach

88
Q

Sono duodenal atresia

A

Two anechoic communicating structures [stomach & duodenum] seen in the upper fetal abdomen
• double bubble

▪ Polyhydramnios [later in pregnancy]
▪ Often coexist with annular pancreaS

89
Q

What trisomy is associated with duodenal atresia?

A

Trisomy 21

About 30% of fetuses are affected

90
Q

Associated anomalies occur in about % of fetuses with duodenal atresia. Associated anomalies include

A 
50
▪ Cardiovascular anomalies are common
▪ Genitourinary anomalies may coexist
▪ Can find esophageal atresia along with duodenal atresia
▪ Growth restriction
91
Q

Duodenal atresia AFP

A

is elevated due to faulty swallowing

92
Q

Duodenal atresia: _ is required after birth to _

A

Immediate surgery

connect the stomach to the jejunum bypass the obstruction

93
Q

Causes of double bubble

A 
▪ Duodenal atresia (most common)
▪ Duodenal stenosis
▪ Annular pancreas
▪ Ladd’s bands [peritoneal tissue attach to the cecum to the abdominal wall
& create an obstruction of the duodenum]
▪ Proximal jejunal atresia
▪ Malrotation
▪ Diaphragmatic hernia
94
Q

Atresia of the _ slightly more common than duodenal

atresia

A

Jejunum, ileum, or both

95
Q

Bowel atresia is caused by

A 
▪ vascular accident 
▪ sporadic
▪ maternal drug usage
▪ secondary to:
• volvulus
•gastroschesis
96
Q

_ length of bowel is subject to obstruction

A

Entire

97
Q

Blockage of jejunum and ileum bowel segments appear as

A

Multiple cystic structures

Proximal to the site of atresia

98
Q

Bowel atresia:

_ may be present because structures are high in the abdomen

A

Polyhydramnios

99
Q

The more distal the obstruction

A

The less severe the hydramnios

The later it will develop

100
Q

Causes of small bowel obstruction include:

A 
▪ Malrotation
▪ Atresia
▪ Volvulus
▪ Peritoneal bands 
▪ Cystic fibrosis
101
Q

Dilated bowel loops can be _

A

Isolated or associated with other anomalies

102
Q

Anomalies associated with dilated bowel loops

A

Ascites

Meconium peritonitis

103
Q

Sono

Bowel obstruction/ atresia

A

▪ Intestinal obstructions appear as cystic bowel loops not connected to the stomach
▪ Obstruction should be suspected when clear cystic structures are found in the pelvis

104
Q

Meconium Ileus

A

Presence of thick overproduced meconium in the distal ileum

105
Q

Meconium ileum is the earliest manifestation of

A

Cystic fibrosis

106
Q

Cystic fibrosis

A

Genetic disorder that mostly effects the lungs & digestive system

107
Q

Overproduction of meconium is caused by:

A

Increased production of mucus by GI organs & electrolyte imbalance
oCharacteristic of cystic fibrosis

108
Q

3rd most common form of neonatal bowel obstruction (after atresia and malrotation)

A

Meconium ileus

109
Q

Meconium begins to accumulate in the _ because _

A

Fetal bowel in the 2nd trimester.
the colon does not exhibit peristalsis in utero, Meconium
remains suspended at the rectum

110
Q

The anal sphincter prevents the

A

assage of meconium [meconium plug]

into the amniotic fluid unless the fetus is stressed or traumatized

111
Q

Sono meconium ileus

A

▪ Appears as tiny echogenic reflections within the peristaltic small bowel
▪ Impacted meconium causes the ilium to dilate
• Appears echogenic
▪ Normal small bowel appears echogenic during 2nd trimester ▪ Other conditions associated with echogenic bowel:
• Cytomegalovirus • Trisomy 21

112
Q

Anorectal atresia

A

Complex disorder of the bowel & genitourinary tract

113
Q

_ is found in anorectal atresia

A

Imperforate anus

114
Q

Imperforate anus occurs when _

A

A membrane covers the anus prohibiting expulsion of meconium

115
Q

Anorectal atresia may present as part of

A

VACTERL association or in caudal regression

116
Q

Prognosis of anorectal atresia

A

Poor due to associated anomalies

117
Q

Sono

Anorectal atresia

A

▪ Dilated colon & calcified meconium may be seen ▪ Typically, normal amniotic fluid
• May be decreased if there are associated renal problems

118
Q

Hirschsprung’s Disease aka

A

Megacolon

119
Q

Hirschsprungs disease

A

Congenital disorder

Abnormal innervation of large intestines

120
Q

Sono Hischsprung disease

A

▪ Difficult to diagnose prenatally

▪ Dilated bowel loops observed

121
Q

Meconium Peritonitis

A

Arises when fetus has sterile chemical peritonitis secondary to in utero bowel perforation

122
Q

Meconium peritonitis: polyhydramnios is _

A

Common

123
Q

Meconium peritonitis mat result in formation of

A

Meconium pseudocyst

124
Q

Sono meconium peritonitis

A

▪Calcifications seen on peritoneal surfaces or in scrotum
▪ Ascites fluid may be echogenic
• Unusual to see calcification in meconium in fetus with cystic fibrosis
▪ Chronic meconium peritonitis may cause a pseudocyst to develop

125
Q

Hyperechoic Bowel

A

Impression [subjective] of unusually echogenic bowel
o Typically seen in 2nd trimester
o Bowel is compared to the brightness of bone

126
Q

Grade 1 hyperechoic bowel

A

Mildly echogenic typically diffuse

127
Q

Grade 2 hyperechoic bowel

A

Moderate echogenic and typically focal

128
Q

Grade 3 hyperechoic bowel

A

Very echogenic- similar to bone

129
Q

True ascites is always

A

Abnormal

130
Q

Ascites fluid collects between

A

2 leaves of unfused omentum

131
Q

Prognosis of ascites in non- immune hydrops

A

Poor

132
Q

Other conditions that may cause ascites to develop include

A

▪ Bowel perforation
▪ Urinary ascites
• Secondary to bladder rupture

133
Q

Cystic Masses of the Abdomen: important to determine

A 
o Precise location of the mass
o Size of the mass
o Resultant compression of other organ systems
▪Hydronephrosis
▪ Hydroureter
▪ Fetal hydrops
Attempt to determine origin of mass
Determine fetal gender (beneficial when an ovarian mass is suspected
134
Q

Cystic Masses of the Abdomen: important to Describe

A

oEchogenicity

o Presence or absence of septations oCoexisting anomalies

OB2 (7 decks)

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