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AB VASCULAR > GI Tract > Flashcards

GI Tract Flashcards

1
Q

What makes up the GI tract?

A

Mouth, pharynx, esophagus, stomach, small intestines/colon

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2
Q

Which areas can be identified with sonography?

A

Distal esophagus attached to stomach (gastroesophageal junction)

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3
Q

What and where is the pyloric sphincter?

A

A muscle controlling emptying of the stomach into the duodenum which lies within the distal stomach

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4
Q

What lies distal to the duodenum?

A

Jejunum and ileum (of the small intestines)

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5
Q

What and where is the ileocecal valve?

A

Ileum connects with cecum (proximal colon) in the right lower quadrant of the abdomen

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6
Q

Where is the vermiform appendix located?

A

Right lower quadrant of abdomen (level of cecum)

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7
Q

What is the ascending colon?

A

The colon traveling toward liver after cecum

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8
Q

Where does the transverse colon begin?

A

A bend in the colon (the splenic flexure marks the start of descending colon)

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9
Q

What is the final section of the colon?

A

The sigmoid as the colon travels inferiorly toward the rectum

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10
Q

Which areas are intraperitoneal?

A

Most GI parts with the exception of duodenum and ascending/descending colon

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11
Q

How many layers are in normal bowel?

A

5 layers

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12
Q

What is the name of the innermost layer and how does it appear?

A

Superficial mucosa / echogenic

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13
Q

What is the second innermost layer and how does it appear?

A

Deep mucosa / hypoechoic

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14
Q

What is the middle layer and how does it appear?

A

Submucosa (muscularis propria interface) / echogenic

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15
Q

What is the 4th layer from innermost and how does it appear?

A

Muscularic propria / hypoechoic

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16
Q

What is the outermost layer and how does it appear?

A

Serosa / echogenic

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17
Q

What conditions indicate a need for sonography?

A

Hypertrophic pyloric stenosis, intussusception, acute appendicitis

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18
Q

What may cause appendix issues?

A

Obstructive process like appendicolith, fecalith, lymph node, tumor, foreign body, seeds, or parasite

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19
Q

What is the laboratory test for appendicitis?

A

Leukocytosis

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20
Q

What may perforated appendix result in?

A

A loculated fluid collection which may represent abscess

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21
Q

Describe the anatomy of a normal appendix.

A

Sausage-like, mobile, compressible, blind-ending structure with a diameter of 7 mm

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22
Q

What can the appendix contain?

A

Air, some fecal matter and rarely a little fluid

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23
Q

What does Power Doppler reveal about the appendix?

A

Little to no vascular with no hyperechoic, non-compressible inflamed fat

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24
Q

What are clinical signs of appendicitis?

A

Epigastric , periumbilical , abdominal right lower quadrant pain

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25
Q

What is the McBurney point?

A

An area of rebound tenderness

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26
Q

What can be seen in addition to other appendicitis symptoms?

A

Palpable mass

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27
Q

What is the best method for identifying non-compressible inflamed fat?

A

Slowly applied intermittent compression

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28
Q

What indicates perforation in appendix?

A

Irregular, asymmetrical contour and loss of layer structure

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29
Q

How does vascular appear with appendix?

A

Either increased or absent due to high intramural pressure w/concomitant ischemic necrosis

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30
Q

Where is vascular always increased in appendix?

A

In the surrounding fatty tissue

31
Q

What does the presence of a generalized, dynamic ileus indicate?

A

Perforated appendix (even if inflamed appendix cannot be visualized)

32
Q

What is the appearance of an inflamed appendix?

A

Concentrically layered, non-compressible, sausage-like stucture

33
Q

What are the dimensions of an inflamed appendix?

A

Maximum diameter of 9 mm (variation from 7-17 mm)

34
Q

What is found in 30% of inflamed appendix lumen?

A

Intraluminal fecoliths obstruction

35
Q

What happens 6-12 hours after initial appendicitis symptoms?

A

Inflammation progresses to the adjacent fat of the meso-appendix and becomes larger, more hyperechoic and less compressible

36
Q

What happens to fatty tissue around the inflamed appendix?

A

It will increase in volume representing migrated mesentery/omentum attempting to block any perforation

37
Q

What are physical findings of acute appendicitis?

A

Non-compressible, blind-ended tube measuring more than 6 mm from each outer wall

38
Q

How will acute appendicitis appear on ultrasound?

A

Echogenic structure in lumen (appendicolith), hyperemic flow in wall and periappendiceal fluid collection

39
Q

What contributes to a false positive diagnosis of appendicitis?

A

Normal appendices which are more than 7 mm (children/lymphoid hyperplasia or adults/fecal)

40
Q

What does a generalization of peritonitis cause?

A

It hampers graded compression which can account for a lower score in patients with free appendiceal perforation

41
Q

What can obstruct a sonographic view of the appendix?

A

Air-filled dilated bowel loops from adynamic ileus (passage failure) or from air in the lumen

42
Q

What is hypertrophic pyloric stenosis? (HPS)

A

A genetic and environmentally related condition more common in male/first born over female (4-6:1) seen in 2-8 week olds and occurs in 2-5/1000

43
Q

What age is HPS rarely seen in?

A

Children more than 6 months old

44
Q

What are clinical findings of pyloric stenosis?

A

Palpable olive sign (enlarged pyloric muscle) non-bilious, projectile vomiting, weight loss, constipation, dehydration, insatiable appetite,

45
Q

How do you scan for HPS?

A

Right lateral decubitus, long view of pylorus seen in epigastrium near GB

46
Q

What happens during hypertrophic pyloric stenosis?

A

Circular muscle layer thickens and narrows/elongates pyloric areas. The mucosa becomes redundant and may appear hypertrophic

47
Q

What happens to the pylorus as a result of elongation/thickening of muscle?

A

It deviates upward toward GB (marker anteromedial to the right of the kidney)

48
Q

What results from the thickened pylorus?

A

It narrows the pyloric channel resulting in gastric outlet obstruction, gastric distention, and retrograde peristalsis in the stomach

49
Q

What is the measurement for normal closed pylorus?

A

Less than 2 mm (2-3 some places)

50
Q

What are sonographic findings of pyloric stenosis?

A

Target/doughnut sign (trans), cervix-like (long), wall greater/equal to 3mm, pyloric channel > 17 mm

51
Q

How accurate is ultrasound for diagnosing pyloric stenosis?

A

Close to 100% from sensitivity and specificity

52
Q

How does the muscular layer appear around pyloric stenosis?

A

Heterogenous echo texture

53
Q

What creates the antral nipple sign?

A

A redundant mucosa

54
Q

What other problems should be taken into consideration with diagnosing intestinal obstruction/HPS?

A

Midgut volvulus, malrotation, antral polyps, gastric duplication, pylorospasm (delays gastric opening)

55
Q

What is borderline normal measurement for HPS?

A

10 mm

56
Q

How does pylorospasm finding differ from HPS?

A

Pylorospasm measurements tend to be within normal limits, unlike HPS (during exam some fluid goes through pyloric channel)

57
Q

What is intussusception?

A

Telescoping of one bowel segment into another most common ileocolic in RLQ at the ileocecal valve

58
Q

What are some components of intussusception?

A

The proximal portion of bowel (intussusceptum) invaginates into the next distal segment (intussuscipiens)

59
Q

What are clinical findings of intussusception?

A

Severe abdominal pain, vomiting, palpable mass, red currant jelly stool and leukocytosis

60
Q

What happens as a result of intussusception?

A

As the intestine pulls inward into itself, it can block the passage of food or blood supply and can die

61
Q

What results from pressure between intestinal walls (intussusception)?

A

Decreased blood flow, irritation and swelling

62
Q

How will intussusception appear on ultrasound?

A

Target sign (trans) or pseudokidney (long)

63
Q

How will bowel wall appear with intussusception?

A

Alternating rings of echogenicity representing edematous layers (abnormal bowel non-compressible)

64
Q

What can result from intussusception?

A

Ischemia and gangrene of bowel (use color to detect any blood flow)

65
Q

What sonographic appearance indicates intussusception in longitude?

A

Hay fork appearance

66
Q

What are other ultrasound signs for intussusception?

A

Double ring sign (color doppler), large adenopathies, free fluid, bowel distention

67
Q

What kind of treatment do you give intussusception?

A

Air/contrast enema not to be used on perforated bowel as there is a risk of bowel tearing

68
Q

Describe a benign lymph node

A

Ovoid, hypoechoic cortex, thin/invisible with a hyperechogenic hilum from connective tissue trabeculae, lymphatic tissue cords and medullary sinusoids.

69
Q

What are suspicious lymph node characteristics?

A

Cortical thickening (3 mm cut-off/2.3 metastasis), hilum decrease/absence, shape/vascular changes

70
Q

What is lymph node protocol?

A

Size (measured), shape, short/long axis ration, nodal borders (sharp/smooth), internal echogenicity (hypo/hyper), echogenic hilum, vascular patterns

71
Q

What are gray scale parameters for lymph node malignancy?

A

Larger size, round shape (L/T <2), heterogenous echotexture, thinning of hilum, thickened cortex, microcalcification, necrosis, ill defined margins

72
Q

What are Color / Power Doppler features for lymph node malignancy?

A

Norm-mixed peripheral central blood vessels, high resistant, RI < 0.8, PI < 1.5

73
Q

What other vascular features determine lymph node malignancy?

A

Abberent/displaced vessels, subcapsular, unperfused areas, non-tapering vessels (necrotic change may show low resistance)

AB VASCULAR (5 decks)

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