GI Tract Flashcards
The intestional wall has a layered appearance measuring between ___ to ___ mm thick
3-5mm
How many layers are there in the gastrointestional wall?
5
The 5 ayers of GI wall alternat ____ and ______ lines.
hypoechoic and hyperechoic
What are the 5 layers of the GI wall and their echogenicity?
Mucosa- hyper Mucularis mucosa- hypo Submucosa (thickest)- hyper Muscularis propria- hypo Serosa- hyper
Intestional pathology has a “gut signature” known as
the “target sign” or “pseudokidney sign”
What is the sonographic appearance of the “gut signature” found with intestional pathology?
appears as a hypoechoic external rim corresponding to thickened intestional wall/mucosa
and a
hyperechoic center relating to a residual gut lumen or mucosal ulceration
GE Junction
segment between the diaphragm and stomach, seen as a target sign posterior to the LLL in the long ML view of the epigastrum
presence of air within the peritoneal cavity
pneumoperitoneum
What is the most common cause of a pneumoperitoneum?
perforation viscus, most commonly by a perforated ulcer
What will you see if a patient that has a pneumoperitoneum is position supine and your TDx anterior?
You won;t be able to see anything… the free peritoneal air will float anteriorly and a reverbreration artifact or total sound reflection will result
*trick question on the test… picture of nothing
MC cause of an acutely painful abdomen?
acute appendicitis
Patient with acute appendicitis present will…?
periumbilical pain shifting to RLQ
anorexia - loss of appetitie
leukocytosis - increased WBC
rebound tenderness
What is the typical position of the appendix?
posterior to the terminal ileum (moving TRV toward ML)
anterior to the iliac vessels
Where is McBurney’s Point?
RLQ location of the appendix between the umbilicus and the iliac crest
What causes acute appendicitis?
obstruction of the appendiceal lumen - by a fecalith or hyperplasia of the submucosa
What happens when there is an obstruction of the appendiceal lumen?
muscosal secretions increase the intraluminal pressure and compromise venous and lymphatic drainage,
bacterial infection leads to gangrene and perforation, which leads to peritonitis
Why is graded-compression improtant when looking for the appendix?
displace bowel gas and decrease distance between the TDx and appendix
Sonograohic criteria for appendicitis dx
non-compressible appendix
>6mm diameter
appendicloth (fecalith)
(2 echogenic lines, pus filled, inflammed/dilated)
In female patient of child-bearing age, RLQ pain may be due to pathology involving…?
appendix or gynecological structures
What can mimic appendicitis?
Mesenteris adenitis- self-limmited inflmmatory process that affects the mesenteric lymph nodes in the RLQ
Causes a functional gastric outlet obstruction as result of hypertrophy and hyperplasia of the muscular layers of the pylorus
Hypetrophic pyloric stenosis
What all increases in size with HPS?
pyloric wall thickness, channel length, and cross section diameter
What does the neonatal (3-8wks) present with if Dx with HPS?
vomiting (non-bloody, non0bilious)
palpable “olive-shaped” pylorus
visible peristalsis
Not exact pylorus size criteria but what guidelines are used?
anterior muscle thickness ->3mm to 4mm (most acurate but thickness is age dependent) channel length ->17mm (14-24mm) cross section diameter ->15mm
Measurements of ___mm or greater are considered positive for HPS, but measurements between ____ and ____mm may also be positive, particularly in the premature or younger patient.
4mm
3-4mm
Caution should be taken for the Dx of pylorospasm in neonates younger than ____wks or premature, to avoidpossibly underdiagnosing cases evolving into HPS.
4wks
What is the most common cause of gastric outlet obstruction in neonates <4wks and how is it treated?
pylorospasm
treated conservatively
Most diverticula involve the _____ ______.
sigmoid colon
What is diverticulitis?
inflammation of diverticulum (colonic outpouching)
Symptoms of diverticulitis
LLQ pain
fever
leukocytosis (inc WBCs)
Sonographic appearance of diverticula
thick-walled outpouching with hypoechoic thickening of the adjacent bowel
- segments of thickened bowel may show increased mural vascularity Color Doppler becasue of inflammation
- the surrounding perienteric fat is echogenic and thickened secondary to inflammation or infection
SBO stands for?
mechanical small bowel obstruction
Causes of SBO
intraluminal (food bolus)
bowel wall lesion (tumor, Crohn disease)
extrinsic (adhesions, hernia) - most common
Volvulus (twisting of the intestines)
Sonographic appearance of an acute bowel obstruction
thin gut wall
hyperperistalsis
back and forth movement of intraluminal contents
……. as it progresses…..
bowel becomes thick and edematous
bowel distal to the obstructing lesion is smaller in diameter than the more proximal dilated loops
- small bowel looks like lots of mini polyps
- large bowel/colon looks like long striations paralleled in groups of 2
_____ is a form of bowel obstruction related to adynamic function of the bowel. The bowel lumen is patent, dilated, and fluid filled with minimal peristalsis. There is often poor visibility and poor assessment of the bowel becasue of increased intraluminal gas.
Ileus
Intestional intussusception/telescoping is classically associated with what age group?
children ages 6months to 4years
90% of intussusception typically presents as an _____ intussusception.
ileocolic - the ileum (intussusceptum) invaginates into the prox colon (intussuscipiens)
Pediatric intussusceptions are usually thought to occur secondary to what?
lymphoid hypertrophy following viral infection
Clinical presentation of intussusception
may be post viral upper respiratory infection
intermittent abd pain
palpable sausage-shaped abd mass
vomiting
lethargy and irrability, can sometimes be the only thing
bloody diarrhea (currant jelly)
Sonographic appearance of intussusception
pseudo-kidney mass in LONG
target sign TRV, concentric rings of folded bowel
lack of color perfusion may indicate bowel ischemia
