Ch 7 GIT Flashcards
What does a normal gastric wall measure?
2.5-3.5mm
Should normal stomach measurements change when fluid is ingested?
Yes
What measurement indicates gastric wall thickening?
5-15mm
What causes hypertrophic pyloric stenosis?
Idiopathic
What is hypertrophic pyloric stenosis?
Abnormal thickening of the antropyloric region of the stomach which results in progressive gastric outlet obstruction
When is hypertrophic pyloric stenosis m/c to occur?
In first born males 2-10 weeks old
What is the most common S/S of hypertrophic pyloric stenosis?
Dehydration + frequent episodes of non-bilious projectile vomiting
What 2 positions must we scan a pt in with hypertrophic pyloric stenosis?
Supine + RPO
When our probe is in SAG, how will the pylorus appear?
In TRV (vise versa)
SF’s of hypertrophic pyloric stenosis?
-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)
What is the donut/target sign?
Hypoechoic mass with echogenic central lumen seen with hypertrophic pyloric stenosis
List the measurements that indicate pyloric stenosis?
Length of channel (pylorus): >1.6cm
Muscle thickness: >3mm
What is a differential for hypertrophic pyloric stenosis?
Antritis
(pyloric stenosis = normal stomach wall, antritis = thickened stomach wall)
Does antritis or hypertrophic pyloric stenosis have a thickened stomach wall?
Antritis
What is the name of the surgery that can be performed to correct hypertrophic pyloric stenosis?
Pyloromyotomy (where the pyloric muscle is split down to the submucosa)
What is pylorospasm?
Muscle spasm at/near the pylorus, leading to delayed passage of stomach contents
How can we differentiate pylorospasm from pyloric stenosis?
Pylorospasm is transient (lasting short amount of time)
What is bezoar?
Undigested material causing gastric or intestinal obstruction
What is the m/c type of bezoar?
Lactobezoar
List the 3 types of bezoar?
Lactobezoar: inspissated milk/formula (m/c)
Phytobezoar: poorly digested plant/veg fibers
Trichobezoar: ingested hair
What is the appendix?
-Blind ending tubular structure attached to cecum
-No peristalsis + compressible when normal
-Target appearance
Normal appendix measurement?
<6mm in diameter
What is the m/c condition requiring emergent surgery in children?
Appendicitis
S/S of appendicitis?
-Pain at mcburney point
-Rebound tenderness
-Fever
-Increased WBCs
-Nausea, vomiting, diarrhea
What is McBurney point?
1/3 distance from belly button to right anterior superior iliac spine (location of base of appendix)
What is a positive McBurney sign?
Rebound tenderness + pain over McBurney point, indicating appendicitis
___ is the gold standard in children for assessing appendicitis?
U/S
An inflamed appendix is m/c seen where?
At base of cecal tip during max compression
2 tips for trying to visualize a retrocecal appendix?
-Try different pt positions
-EV
Is appendicitis compressible?
No!
Abnormal appendix measurement?
> 6mm
List the main SF’s of appendicitis?
-Non compressible
->6mm
-Free fluid
-Echogenic fat
-Hyperemia on CD
-Target appearance
Are appendicolith’s always associated with appendicitis?
No, normal appys can have this (it is an echogenic focus with shadowing)
Why does perforation make diagnosing appendicitis hard?
B/c the appendix may no longer be dilated + may not be visualized at all now
List 2 complications of perforation?
-Abscess or phlegmon formation
-Peritonitis
List the 2 m/c SF’s of perforation?
-Increased echogenicity of periappendiceal mesentery/fat
-Complex fluid collection (abscess)
What is a mucocele?
Distention of appendix by mucus (due to benign or malignant causes)
A mucocele can result in ileocolic ___?
Intussusception
A rupture of a mucocele can cause ___?
Pseudomyxoma peritonei (accumulation of gelatinous ascites)
SF of a mucocele?
Cystic or complex RLQ mass (<7cm)
What is the m/c cause of obstructive bowel disease of early childhood?
Intussusception (m/c in males)
What is intussusception?
When a bowel segment prolapses into a distal segment
What is the m/c type of intussusception?
Ileocolic
What is the inner portion of bowel called?
Intussusceptum
What is the distal outer portion of bowel called?
Intussuscipiens
What causes intussusception?
Lead point (meckel diverticulum, cysts, polyps, hematomas or bowel masses)
Which pathology has the S/S of bloody stool?
Intussusception
2 main SF’s of intussusception?
-Target pattern or donut sign in TRV
-Pseudo kidney in SAG (kidney shaped mass)
What is the treatment for intussusception?
Hydrostatic pressure under u/s or fluroscopic guidance
Is intussusception recurrence high or low after treatment?
High within first 24 hours after reduction
What is hirschsprung disease (aka aganglionic megacolon)?
-It is aganglionosis (absence of ganglion cells) in segments of the bowel
-The aganglionic segments remain in spasm + produce a functional obstruction
Is there peristaltic action in the denervated portion of the bowel with hirschsprung disease?
No!
What part of the colon is m/c affected with hirschsprung disease?
Rectosigmoid colon
What is the m/c congenital abnormality of the small intestine?
Meckel diverticulum
What is meckel diverticulum?
Incomplete obliteration of the vitelline duct resulting in a blind ending out pouching of the ileum
List the main complication associated with meckel diverticulum?
Bowel obstruction
What is a duplication cyst?
Cysts along the mesenteric border of the bowel that do NOT communicate with the bowel
Where are duplication cysts m/c found?
Ileum
What is a diagnosis differential for duplication cysts?
Meckel diverticulum
What causes malrotation?
Congenital abnormal rotation of the gut during fetal development
Malrotation predisposes to ___ + ___?
Midgut volvulus + internal hernias
Which vessels are associated with malrotation?
SMA + SMV
(reversal of SMA/SMV or SMA gets pulled towards right side + is directly inferior to the SMV)
What side is the SMA + SMV normally on?
SMA: LT
SMV: RT
What is a volvulus a complication of?
Malrotation
What is a volvulus?
-When the bowel twists on itself + causes an obstruction
-Is a surgical emergency or else ischemia can occur!!
What sonographic sign is associated with a volvulus?
Whirlpool sign (when the mesentery + SMV wrap around the SMA)
Duodenal atresia is common in pt’s with ___?
Trisomy 21
Which pathology has the double bubble sign?
Duodenal atresia
What 2 types of bowel atresias are the m/c cause of obstruction in the small bowel?
Jejunal + ileal
What is a meconium ileus?
Bowel obstruction due to abnormally thick meconium
Meconium ileus is commonly associated with ___?
Cystic fibrosis
What is necrotizing enterocolitis (NEC)?
When the bowel undergoes necrosis
NEC is m/c in infants how old?
<32 weeks gestation, aka premature infants
___ is the gold standard for diagnosing NEC?
Radiography
What is the main SF of NEC?
Pneumatosis intestinalis
What is the m/c inflammatory disease of the small bowel?
Crohn’s disease
Crohn’s disease m/c affects which part of the bowel?
Terminal ileum + proximal colon
What is the gold standard for diagnosing Crohn’s disease?
Contrast radiography + endoscopy with biopsy
List the 3 main SF’s of Crohn’s disease?
-Thickened bowel walls (>2.5-3mm)
-Increased vascularity of affected bowel
-Areas of increased echogenicity around inflamed bowel loops
___ is the m/c malignant mass of the small bowel?
Lymphoma (m/c affects ileum)
What is the m/c type of lymphoma?
Non-Hodgkin
A 2 y/o presents with intermittent colicky abdominal pain + bloody stool, what is the diagnosis?
Intussuscpetion (m/c iliocolic)
A 3 week old male presenting with projectile vomiting + a palpable epigastric mass. What pathology are we trying to rule out?
Pylorus stenosis
