Fetal gastrointestinal/genitourinary with pathology registry review Flashcards
GI abnormalities
Most often result in polyhydramnios
-If GI obstruction/disturbance where fluid cannot be swallowed or absorbed normally, build up of fluid will take place
-Kidneys continue producing fluid even with GI obstruction
Stomach
Inferior to diaphragm
*should empty and fill every 30 mins
Fetal cord insert
Inferior to level of the kidneys, should be smooth with no herniations or mass
Bowel
Slightly more echogenic than liver
Esophageal atresia
Absence of a section of the esophagus
*associated with VACTERL and T18
Tracheoesophageal fistula
Esophagus and trachea form a connection
Sonographic appearance of esophageal atresia
No visualization of the stomach and polyhydramnios
Duodenal atresia
Fluid filled stomach and fluid filled proximal duodenum
-“double bubble”
-Polyhydramnios
*associated with T21
Anorectal atresia
Most common type of colonic atresia that leads to bowel obstruction
Sonographic appearance of anorectal atresia
Dilated loops of bowel
*look for VACTERL
Hirschsprung disease
Functional bowel obstruction caused by the absence of nerved within bowel wall
Sonographic appearance of hirshsprung disease
Dilated loops of bowel
Echogenic bowel
Bowel bright as bone
*associated with T21 and cystic fibrosis
Neuroblastoma
Adrenal gland tumor, mass superior to kidney
-MOST common malignant abdominal mass in neonates
Hepatomegaly
Most common abnormality of the liver
-Cause ac to be larger than expected GA
*associated with beckwith-wiedemann
Gastroschisis
-Herniation of bowel through an opening on RIGHT side of cord insertion
-Not covered by a membrane or skin
-Larger defects may include stomach and other abdominal organs
-Usually isolated finding
-Requires surgery
*ELEVATED AFP
Omphalocele
-Persistent herniation of bowel and possibly other organs into the BASE of the umbilical cord after 12 weeks
-Bowel and possibly liver
-ALWAYS midline and covered by membrane
-AFP possibly normal due to being covered by membrane
*STRONG association with T18, T13, pentalogy of cantrell
Fetal kidney formation
Form in pelvis and rise to renal fossa by week 9
*if doesn’t rise then = pelvic kidney
Fetal kidney functionality
-Fully functional at 10 weeks
-Produce urine at 12 weeks
Fetal bladder
Seen by week 13 on US
Fetal kidneys seen on US
Week 15
Amniotic fluid
Mostly made of fetal urine AFTER 16 weeks
-As long as one functioning kidney present, normal fluid levels present
*affected heavily by renal function
Most common cause of oligohydramnios
Renal abnormalities
Most common renal anomaly
Duplicate/double collecting system divided into upper and lower moiety/poles
Unilateral renal agenensis
-Failure of one kidney to form
-Most common
-Fluid and bladder will be normal since present kidney is functional
Bilateral renal agenesis
-Failure of BOTH kidneys to form
-NO bladder and NO fluid
*Potters syndrome
Sonographic signs of renal agenesis
-Adrenal gland is flattened and parallel to spine (usually on upper pole of kidney)
-Absence of renal artery branches coming off the aorta in coronal view
Autosomal recessive polycystic kidney disease (ARPKD)
-Infantile
-Bilateral enlarged, echogenic
-NON functional = no fluid, no bladder
-Associated with meckel-gruber
-Oligo/anhydramnios
*FATAL
Autosomal dominant polycystic disease (ADPKD)
-Adult version, doesn’t affect until late adulthood
-Bilateral enlarged, echogenic
-FUNCTIONING
-Normal bladder, normal fluid
-Cyst develop as adults
Sonographic appearance for PKD
Bilaterally enlarged, echogenic kidneys. Cysts are not visualized (microscopic)= echogenic enlarged appearance
Multicystic dysplastic renal disease
Large cysts affecting entire kidney, kidney appears to fill entire abdomen
-Affected kidney is NON functional
-Unilateral = normal fluid/normal bladder
-Bilateral= no fluid/ no bladder
Obstructive cystic dysplasia
Kidney becomes small and echogenic with peripheral renal cyst
-Caused by early renal obstruction
-Unilateral or bilateral
-NON functional
-Bilateral = oligohydramnios
Most common fetal abnormality
Hydronephrosis (AKA pelvocaliectasis, pelviectasis/pyelectasis, caliectasis – depends on dilated area of kidney)
Urinary tract obstruction
Any obstruction to normal succession of urine flow will result in back up and cause dilation proximal to obstruction
Measurement of dilated pelvis
-In transverse and AP
> 4mm in 2nd trimester = pyelectasis
>7mm in 3rd trimester = pyelectasis
Location of ureteropelvic junction obstruction (UPJ)
Most common cause of hydro, pyelectasis only
Location of ureterovesicular junction obstruction (UVJ)
Least common cause of hydro, kidneys and ureter
Urethra obstruction
Bladder outlet obstruction, everything from bladder up is dilated
Bladder outlet obstruction/prune belly syndrome
Posterior urethral valve causes obstruction in male fetus
-Massively dilated bladder
-Key hole sign
-Dilation of ureters and kidneys eventually occurs
Key hole sign in bladder
Dilated bladder (megacystis) and dilated posterior urethra
Triad of prune belly (eagle barret syndrome)
Absent abdominal musculature, undescended testis, urinary tract abnormalities
Bladder extrophy
Bladder located outside the pelvis, lower abdominal mass inferior to umbilicus
-May be included with cloacal extropy and extropy of intestines and genitalia
Cloaca
Everything at the bottom including true pelvis genitalia
Clitoromegaly
Most common cause of ambiguous genitalia in females
Common causes of ambiguous genitalia in males
Micropenis, hypospadias, undescended testis
Hypospadias
Abnormal curvature of penis
