Fetal Ab

Question 0

The diaphragm separates the more echogenic lungs from the ____________ and the ____________.

Answer 0

Liver; stomach

Question 1

The superior aspect of the abdominopelvic cavity is defined as a thin, dome shaped muscle which appears sonographically as a hypoechoic curved line. This is known as?

Answer 1

Diaphragm

Question 2

You can see the diaphragm on a ____________ or ____________ view of the fetus.

Answer 2

Coronal; Sagittal

Question 3

The _________ is a large organ occupying most of the upper abdomen.

Answer 3

Liver

Question 4

The _________ lobe is larger than the _________ in the fetus.

Answer 4

Left; right

Question 5

The anechoic, fluid-filled gallbladder is seen in the __________ right abdomen, _________ to the liver margin.

Answer 5

Anterior; inferior

Question 6

What organ is difficult to see in the fetus?

Answer 6

Spleen

Question 7

What organ is located in the left upper abdomen, posterior to the stomach and is echogenic and homogeneous?

Answer 7

Spleen

Question 8

The development of anterior abdominal wall involves __________ __________ of the viscera into the base of the ___________ __________ during the first trimester.

Answer 8

Normal herniation

Umbilical cord

Question 9

When does the development of abdominal wall occur?

Answer 9

8th - 12th to 14th week of gestation

Question 10

The evaluation of the anterior abdominal wall should be performed after ______ weeks.

Answer 10

14

Question 11

This is a small defect involving all three layers of the abdominal wall, allowing the intestines to protrude into the amniotic cavity. It usually occurs to the right of the umbilical cord insertion and has no covering or membranous sack.

Answer 11

Gastroschesis

Question 12

What are the possible abdominal wall defects in the fetus?

Answer 12

1. Gastroschesis

2. Omphalocele

Question 13

In order to see gastroschesis, the fetus must be imaged with the fetal abdomen in __________ plane. You must look above and below at the level of the umbilical cord insertion.

Answer 13

Transverse

Question 14

Gastroschesis is a sporadic defect, not associated with ____________ ____________ or other abnormalities.

Answer 14

chromosomal abnormalities

Question 15

This results from failure of the intestines to return to the abdomen during the second stage of intestinal rotation which occurs before the 14th week of life.

Answer 15

Omphalocele

Question 16

With gastroschesis, when and why do complications arise?

Answer 16

Complications arise postnatally with these babies because bowel gets stuck together due to exposure of amniotic fluid. Frequently, bowel obstructions occur in the pediatric and infant years.

Question 17

An omphalocele could contain ___________ or most of the _________ contents, depending how severe

Answer 17

Bowel; abdominal

Question 18

This defect is covered by a membrane which is a layer of amnion and peritoneum, and is present at the level of the umbilical cord insertion.

Answer 18

Omphalocele

Question 19

There is high association between omphalocele and other congenital anomalies, most commonly _________ _________. There’s also associated chromosomal abnormalities, most frequently ________ _______ and _______.

Answer 19

Cardiac defects

Trisomy 13 and 18

Question 20

If the ________ is contained with the omphalocele, there is less risk of associated chromosomal abnormalities.

Answer 20

Liver

• remember liver out is good

Question 21

What are the ultrasound findings of an omphalocele?

Answer 21

• extra abdominal mass consisting of a combination of liver and/or bowel loops and sometimes other organs
• the mass is contiguous with the umbilical cord
• membranous sac covering herniated organs

Question 22

This midline defect involves the lower abdominal wall as well as the anterior wall of urinary bladder. Generally, it is an isolated defect, characterized by exposure and protrusion of the urinary bladder but possibly associated with genital anomalies like cleft clitoris, epispadias, and wide separation of the pubic bones.

Answer 22

Urinary bladder Exstrophy

Question 24

What are the ultrasound findings with urinary bladder exstrophy?

Answer 24

• the bladder will not be identified even over 30 minutes of scanning
• the amniotic fluid volume will be normal
• possible soft tissue protrusion may also be present from lower abdominal wall
• separation of pubic bones
• microphallus in male fetus

Question 24

On transverse images, this structure is seen as an ovoid, fluid collection in the left upper quadrant of the fetal abdomen.

Answer 24

Stomach

Question 25

__________ is not seen unless a stenosis present. Maybe seen in late stage pregnancies as the fetus swallowing.

Answer 25

Esophagus

Question 26

What is gastric pseudo mass?

Answer 26

Swallowed cellular debris

Question 27

Occasionally, you may see echoes within the stomach, particularly in late stage pregnancy which is called the _________ _________ ________.

Answer 27

Gastric pseudo mass *this should not be mistaken for a tumor (see callen's chapter on pitfalls.

Question 28

What structure is difficult to isolate specific segments unless there's fluid to provide contrast and is normally of mixed echotexture to cystic in appearance. You may see peristalsis by late second trimester.

Answer 28

Intestines

Question 30

A mixture of bile and swallowed vernix, desquamated cells and fetal hair which fills the colon and may appear as echogenic. This is most obvious in the late third trimester. The colon is usually in the periphery of the abdomen and the small bowel is central.

Answer 30

Meconium

Question 31

This abnormality can occur 1 in 2000-3000 live births. Defined as the discontinuity of the esophagus. 90% are accompanied by an distal trachea-esophageal fistula. There is 30-70% association with other congenital malformations including cardiac, GI, genitourinary, and musculoskeletal.

Answer 31

Esophageal Atresia

Question 32

What are the ultrasound findings for esophageal atresia?

Answer 32

- small to absent fetal stomach - failure to demonstrate the stomach even on serial ultrasounds - associated polyhydramnios, because fetus is not swallowing the fluid

Question 33

This abnormality is the most common perinatal intestinal obstruction. 65% of fetuses with this have either a chromosomal abnormality or an associated abnormality at birth, most commonly cardiac and vertebral abnormalities.

Answer 33

Duodenal atresia

Question 34

30% of infants with duodenal atresia have ________.

Answer 34

trisomy 21 (downs syndrome)

Question 35

What is the most important ultrasound finding of duodenal atresia?

Answer 35

- double bubble sign equals dilated stomach and dilated proximal duodenum.

Question 36

What are the ultrasound findings of duodenal atresia?

Answer 36

- double bubble - polyhydramnios, because there is limited swallowing of fluid - the double bubble and polyhyramnios may not become apparent until after 24 weeks

Question 37

An abnormality that is obstruction of the intestine with subsequent distentions of bowel loops. It may occur anywhere along the intestinal tract or at the level of the anus. The precise site is often unknown.

Answer 37

Intestinal atresia

Question 38

What are the ultrasound findings of intestinal atresia?

Answer 38

- multiple fluid filled and distended bowel loops - polyhyramnios - possible perforation of the GI tract, indicated by abdominal calcification and ascites.

Question 39

Sterile chemical peritonitis caused by small bowel perforation in utero. It can occur after fetal bowel obstruction caused by intestinal atresia, volvulus, or meconium ileus. Cystic fibrosis is considered to be the cause in 35 to 40% of cases because of thick, sticky meconium.

Answer 39

Meconium peritonitis

Question 40

Meconium ileus and meconium peritonitis are associated with _________ _________.

Answer 40

cystic fibrosis

Question 41

With meconium peritonitis what is seen on ultrasound?

Answer 41

- high specular echoes, corresponding to calcifications within the fetal abdomen. These may shadow. - fetal ascities and polyhydramnios. may seen presence of a meconium pseudocyst.

Question 42

What abnormality is described below: - increased echogenicity of the fetal bowel can be identified on second trimester ultrasound - it can be diffuse or focal, uniform or over a well defined area that does not shadow - located primarily in the lower fetal abdomen and pelvis

Answer 42

Hyperechoeic bowel

Question 43

What is the simplest criteria for diagnosis of hyperechoeic bowel?

Answer 43

more echogenic than adjacent fetal bone *tends to look more echogenic when using higher frequencies and when using harmonics.

Question 44

A __________ frequency should be used to evaluate hyperechoic bowel.

Answer 44

lower

Question 45

What are the common causes for echogenic bowel?

Answer 45

1. normal variant 2. Trisomy 21 3. Cytomegalovirus or CMV infection

Question 46

Abdominal ascites in a fetus, is most commonly seen with __________ _________.

Answer 46

Hydrops Fetalis