GI Tract

Question 1

The normal intestinal wall is between ___ thick when non-distended.

Answer 1

3 and 5 mm

Question 2

Intestinal pathology creates a sonographic pattern known as the…

Answer 2

‘target’ or ‘pseudo-kidney’ sign.

Question 3

A pseudokidney sign may be seen in a case of…

Answer 3

gastric carcinoma.

Question 4

Name two things that can produce a thick bowel wall.

Answer 4

inflammation and neoplasm

Question 5

How does bowel wall thickening effect peristalsis?

Answer 5

It may be diminished or absent.

Question 6

Sonographically, bowel wall thickening appears as a ___echoic rim and a ___echoic center.

Answer 6

hypo-, hyper-

Question 7

The segment of esophagus between the diaphragm and the stomach is called the…

Answer 7

gastroesophageal junction.

Question 8

On a sagittal midline view of the epigastrum, this is seen as a target sign to the left lobe of the liver.

Answer 8

GE junction

Question 9

This is the most common cause of an acutely painful abdomen.

Answer 9

acute appendicitis

Question 10

This is the most common condition that necessitates emergency surgery.

Answer 10

acute appendicitis

Question 11

Patient’s with acute appendicitis present with…

Answer 11

1) peri-umbilical pain shifting to the RLQ
2) leukocytosis
3) nausea, vomitting, low-grade fever
4) rebound tenderness

Question 12

This is the RLQ location of the tender area in the early stages of appendicitis.

Answer 12

McBurney’s point

Question 13

This is caused by the obstruction of the appendiceal lumen by a fecalith or hyperplasia of the submucosa.

Answer 13

appendicitis

Question 14

In appendicitis, mucosal secretions increase the intraluminal pressure which…

Answer 14

compromises venous and lymphatic drainage.

Question 15

A bacterial infection of the appendix leads to…

Answer 15

gangrene and perforation, which leads to peritonitis.

Question 16

This is used to displace bowel gas and decrease the distance between the transducer and the appendix.

Answer 16

graded-compression u/s

Question 17

What is the transducer of choice for eval of acute appendicitis?

Answer 17

5.0 MHz linear array with a short focus

Question 18

What is the sonographic criteria for diagnosing an inflammatory appendix?

Answer 18

1) non-compressable appendix
2) 6 mm or more in diameter
3) appendicolith/fecalith

Question 19

In female patients of child-bearing age, RLQ pain may be due to…

Answer 19

pathology of the appendix OR gyn structures.

Question 20

What do we suspect if there is a fluid collection next to the inflamed appendix?

Answer 20

appendiceal abscess

Question 21

T/F? Hypertrophic pyloric stenosis is more common in girls than boys.

Answer 21

FALSE, HPS has a 4:1 male to female ratio.

Question 22

This is characterized by hypertrophy of the circular muscle resulting in elongation of the pylorus and constriction of the canal.

Answer 22

hypertrophic pyloric stenosis

Question 23

What age patient presents with HPS?

Answer 23

neonatal, 3-6 weeks old

Question 24

What symptoms does a patient with HPS present with?

Answer 24

1) projectile vomitting

2) palpable olive-shaped abd mass

Question 25

T/F? Ultrasound is the method of choice for diagnosing HPS.

Answer 25

true

Question 26

What are the diagnostic criteria for HPS?

Answer 26

1) pyloric muscle thickness > 3mm 2) pyloric channel length >12mm 3) *pyloric cross-section > 15mm*

Question 27

With HPS there is an ___ in the pyloric diameter and length.

Answer 27

increase

Question 28

With ___ there is an increase in the pyloric diameter and length.

Answer 28

HPS

Question 29

This is the inflammation of the diverticulum.

Answer 29

diverticulitis

Question 30

Patient with diverticulitis present with...

Answer 30

1) fever 2) leukocytosis 3) LLQ pain 4) thickening of the bowel wall (>4m) 5) abscess formation 6) inflammed diverticula (round echogenic structure

Question 31

What three things cause mechanical small bowel obstruction (SBO)?

Answer 31

1. intraluminal food bolus 2. bowel wall lesion (tumor, Crohn's disease) 3. extrinsic (adhesions, hernia)

Question 32

What is the most common cause of mechanical SBO?

Answer 32

Extrinsic (adhesions, hernia)

Question 33

Prolonged bowel obstruction can result in...

Answer 33

``` bowel ischemia bowel necrosis septicemia perforation peritonitis ```

Question 34

Patients with SBO caused by diverticula present with symptoms of...

Answer 34

1. abd distention 2. pain 3. vomitting 4. hypotension (fluid depletion) 5. leukocytosis

Question 35

How is u/s used in cases of bowel obstruction?

Answer 35

to demonstrate loops of distended bowel, the level of obstruction, and peristalsis

Question 36

This is a process in which a segment of intestine invaginates or telescopes into the adjoining intestinal lumen.

Answer 36

intussusception

Question 37

This is the most common cause of obstruction in infants (<1 yr old).

Answer 37

intussusception

Question 38

Classic symptoms of intussusception include:

Answer 38

1. palpable abd mass 2. abd pain w/ vomitting 3. rectal bleeding

Question 39

Although difficult to detect, what is a classic sign of an intussusception?

Answer 39

a palpable sausage-shaped mass

Question 40

Sonographically, an instussusception usually presents as what kind of mass?

Answer 40

sag: oval, pseudo-kidney-esque trv: concentric rings (bullseye)