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MIDS 227 (module 4) > Ch 7 GIT > Flashcards

Ch 7 GIT Flashcards

1
Q

What does a normal gastric wall measure?

A

2.5-3.5mm

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2
Q

Should normal stomach measurements change when fluid is ingested?

A

Yes

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3
Q

What measurement indicates gastric wall thickening?

A

5-15mm

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4
Q

What causes hypertrophic pyloric stenosis?

A

Idiopathic

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5
Q

What is hypertrophic pyloric stenosis?

A

Abnormal thickening of the antropyloric region of the stomach which results in progressive gastric outlet obstruction

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6
Q

When is hypertrophic pyloric stenosis m/c to occur?

A

In first born males 2-10 weeks old

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7
Q

What is the most common S/S of hypertrophic pyloric stenosis?

A

Dehydration + frequent episodes of non-bilious projectile vomiting

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8
Q

What 2 positions must we scan a pt in with hypertrophic pyloric stenosis?

A

Supine + RPO

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9
Q

When our probe is in SAG, how will the pylorus appear?

A

In TRV (vise versa)

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10
Q

SF’s of hypertrophic pyloric stenosis?

A

-Lack of fluid passing through pylorus!!!

-Filled stomach even when fasting
-Donut/target sign (TRV pylorus)
-Cervix sign (SAG pylorus)
-Antral nipple sign (prolapsed mucosa into gastric antrum)

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11
Q

What is the donut/target sign?

A

Hypoechoic mass with echogenic central lumen seen with hypertrophic pyloric stenosis

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12
Q

List the measurements that indicate pyloric stenosis?

A

Length of channel (pylorus): >1.6cm
Muscle thickness: >3mm

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13
Q

What is a differential for hypertrophic pyloric stenosis?

A

Antritis

(pyloric stenosis = normal stomach wall, antritis = thickened stomach wall)

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14
Q

Does antritis or hypertrophic pyloric stenosis have a thickened stomach wall?

A

Antritis

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15
Q

What is the name of the surgery that can be performed to correct hypertrophic pyloric stenosis?

A

Pyloromyotomy (where the pyloric muscle is split down to the submucosa)

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16
Q

What is pylorospasm?

A

Muscle spasm at/near the pylorus, leading to delayed passage of stomach contents

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17
Q

How can we differentiate pylorospasm from pyloric stenosis?

A

Pylorospasm is transient (lasting short amount of time)

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18
Q

What is bezoar?

A

Undigested material causing gastric or intestinal obstruction

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19
Q

What is the m/c type of bezoar?

A

Lactobezoar

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20
Q

List the 3 types of bezoar?

A

Lactobezoar: inspissated milk/formula (m/c)

Phytobezoar: poorly digested plant/veg fibers

Trichobezoar: ingested hair

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21
Q

What is the appendix?

A

-Blind ending tubular structure attached to cecum
-No peristalsis + compressible when normal
-Target appearance

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22
Q

Normal appendix measurement?

A

<6mm in diameter

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23
Q

What is the m/c condition requiring emergent surgery in children?

A

Appendicitis

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24
Q

S/S of appendicitis?

A

-Pain at mcburney point
-Rebound tenderness
-Fever
-Increased WBCs
-Nausea, vomiting, diarrhea

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25
Q

What is McBurney point?

A

1/3 distance from belly button to right anterior superior iliac spine (location of base of appendix)

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26
Q

What is a positive McBurney sign?

A

Rebound tenderness + pain over McBurney point, indicating appendicitis

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27
Q

___ is the gold standard in children for assessing appendicitis?

A

U/S

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28
Q

An inflamed appendix is m/c seen where?

A

At base of cecal tip during max compression

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29
Q

2 tips for trying to visualize a retrocecal appendix?

A

-Try different pt positions
-EV

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30
Q

Is appendicitis compressible?

A

No!

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31
Q

Abnormal appendix measurement?

A

> 6mm

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32
Q

List the main SF’s of appendicitis?

A

-Non compressible
->6mm
-Free fluid
-Echogenic fat
-Hyperemia on CD
-Target appearance

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33
Q

Are appendicolith’s always associated with appendicitis?

A

No, normal appys can have this (it is an echogenic focus with shadowing)

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34
Q

Why does perforation make diagnosing appendicitis hard?

A

B/c the appendix may no longer be dilated + may not be visualized at all now

35
Q

List 2 complications of perforation?

A

-Abscess or phlegmon formation
-Peritonitis

36
Q

List the 2 m/c SF’s of perforation?

A

-Increased echogenicity of periappendiceal mesentery/fat
-Complex fluid collection (abscess)

37
Q

What is a mucocele?

A

Distention of appendix by mucus (due to benign or malignant causes)

38
Q

A mucocele can result in ileocolic ___?

A

Intussusception

39
Q

A rupture of a mucocele can cause ___?

A

Pseudomyxoma peritonei (accumulation of gelatinous ascites)

40
Q

SF of a mucocele?

A

Cystic or complex RLQ mass (<7cm)

41
Q

What is the m/c cause of obstructive bowel disease of early childhood?

A

Intussusception (m/c in males)

42
Q

What is intussusception?

A

When a bowel segment prolapses into a distal segment

43
Q

What is the m/c type of intussusception?

A

Ileocolic

44
Q

What is the inner portion of bowel called?

A

Intussusceptum

45
Q

What is the distal outer portion of bowel called?

A

Intussuscipiens

46
Q

What causes intussusception?

A

Lead point (meckel diverticulum, cysts, polyps, hematomas or bowel masses)

47
Q

Which pathology has the S/S of bloody stool?

A

Intussusception

48
Q

2 main SF’s of intussusception?

A

-Target pattern or donut sign in TRV
-Pseudo kidney in SAG (kidney shaped mass)

49
Q

What is the treatment for intussusception?

A

Hydrostatic pressure under u/s or fluroscopic guidance

50
Q

Is intussusception recurrence high or low after treatment?

A

High within first 24 hours after reduction

51
Q

What is hirschsprung disease (aka aganglionic megacolon)?

A

-It is aganglionosis (absence of ganglion cells) in segments of the bowel

-The aganglionic segments remain in spasm + produce a functional obstruction

52
Q

Is there peristaltic action in the denervated portion of the bowel with hirschsprung disease?

A

No!

53
Q

What part of the colon is m/c affected with hirschsprung disease?

A

Rectosigmoid colon

54
Q

What is the m/c congenital abnormality of the small intestine?

A

Meckel diverticulum

55
Q

What is meckel diverticulum?

A

Incomplete obliteration of the vitelline duct resulting in a blind ending out pouching of the ileum

56
Q

List the main complication associated with meckel diverticulum?

A

Bowel obstruction

57
Q

What is a duplication cyst?

A

Cysts along the mesenteric border of the bowel that do NOT communicate with the bowel

58
Q

Where are duplication cysts m/c found?

A

Ileum

59
Q

What is a diagnosis differential for duplication cysts?

A

Meckel diverticulum

60
Q

What causes malrotation?

A

Congenital abnormal rotation of the gut during fetal development

61
Q

Malrotation predisposes to ___ + ___?

A

Midgut volvulus + internal hernias

62
Q

Which vessels are associated with malrotation?

A

SMA + SMV

(reversal of SMA/SMV or SMA gets pulled towards right side + is directly inferior to the SMV)

63
Q

What side is the SMA + SMV normally on?

A

SMA: LT
SMV: RT

64
Q

What is a volvulus a complication of?

A

Malrotation

65
Q

What is a volvulus?

A

-When the bowel twists on itself + causes an obstruction
-Is a surgical emergency or else ischemia can occur!!

66
Q

What sonographic sign is associated with a volvulus?

A

Whirlpool sign (when the mesentery + SMV wrap around the SMA)

67
Q

Duodenal atresia is common in pt’s with ___?

A

Trisomy 21

68
Q

Which pathology has the double bubble sign?

A

Duodenal atresia

69
Q

What 2 types of bowel atresias are the m/c cause of obstruction in the small bowel?

A

Jejunal + ileal

70
Q

What is a meconium ileus?

A

Bowel obstruction due to abnormally thick meconium

71
Q

Meconium ileus is commonly associated with ___?

A

Cystic fibrosis

72
Q

What is necrotizing enterocolitis (NEC)?

A

When the bowel undergoes necrosis

73
Q

NEC is m/c in infants how old?

A

<32 weeks gestation, aka premature infants

74
Q

___ is the gold standard for diagnosing NEC?

A

Radiography

75
Q

What is the main SF of NEC?

A

Pneumatosis intestinalis

76
Q

What is the m/c inflammatory disease of the small bowel?

A

Crohn’s disease

77
Q

Crohn’s disease m/c affects which part of the bowel?

A

Terminal ileum + proximal colon

78
Q

What is the gold standard for diagnosing Crohn’s disease?

A

Contrast radiography + endoscopy with biopsy

79
Q

List the 3 main SF’s of Crohn’s disease?

A

-Thickened bowel walls (>2.5-3mm)
-Increased vascularity of affected bowel
-Areas of increased echogenicity around inflamed bowel loops

80
Q

___ is the m/c malignant mass of the small bowel?

A

Lymphoma (m/c affects ileum)

81
Q

What is the m/c type of lymphoma?

A

Non-Hodgkin

82
Q

A 2 y/o presents with intermittent colicky abdominal pain + bloody stool, what is the diagnosis?

A

Intussuscpetion (m/c iliocolic)

83
Q

A 3 week old male presenting with projectile vomiting + a palpable epigastric mass. What pathology are we trying to rule out?

A

Pylorus stenosis

MIDS 227 (module 4) (11 decks)

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