GI Tract Pathology Flashcards
intestinal pathology creates a sonographic pattern “gut signature” known as the ____ or ____ sign
“target” or “pseudokidney” sign
ultrasound appearance of the “target” or “pseudokidney” sign (2)
hypoechoic external rim = thickened wall
hyperechoic center = mucosal ulceration
most common cause of an acutely painful abdomen
acute appendicitis
acute appendicitis is caused by the obstruction of the
appendiceal lumen
acute appendicitis criteria (5)
non-compressible
> 6mm diameter
appendicolith
periappendiceal fluid
“thyroid in the belly” sign
what is appendicolith?
echogenic structure within the appendix lumen
signs/symptoms of acute appendicitis (4)
periumbilical pain shifting to the RLQ
anorexia
leukocytosis
rebound tenderness
what is mesenteric adenitis?
inflammation of the mesenteric lymph nodes in the RLQ
clinical presentation mimics acute appendicitis
what is hypertrophic pyloric stenosis (HPS)?
enlargement or hypertrophy of the pyloric sphincter muscles cause gastric outlet obstruction
HPS is most common in
infants 2 to 6 weeks old
signs/symptoms of HPS (3)
nonbilious projectile vomiting
palpable “olive-shaped” pylorus
visible peristalsis
most accurate measurement for HPS
muscle wall thickness
measurements of HPS
muscle wall thickness > 3mm
pyloric channel length > 17mm
most common cause of gastric outlet obstruction in premature infants and neonates younger than 4 weeks
pylorospasm
unlike HPS, pylorospasm measurements tend to be
normal
another cause of nonbilious projectile vomiting in infants where gas bubbles can be observed traveling retrograde up the esophagus
gastroesophageal reflux
clinical presentation is similar to HPS, but with bilious vomiting
midgut malrotation (volvulus)
what is midgut malrotation?
small bowel mesenteric rotate around the SMA
normally the SMA is to the ___ of the SMV
with malrotation the SMA is to the ___ of the SMV
normal = SMA to the LEFT of the SMV
malrotation = SMA to the RIGHT of the SMV
what is intussusception?
telescoping of one segment of bowel into another
intussusceptum = _____ segment, _____ loop
intussiscipiens = _____ segment, ____ loop
intussusceptum = proximal segment, interior loop
intussuscipiens = distal segment, exterior loop
most common type of intussusceptum
ileocolic intussusception
RLQ - ileum to ascending colon
most common cause of intestinal obstruction in children less than 2 years old
intussusception
intussusception rarely occurs in those under ____ and over ____
under 3 months old
over 3 years old
ultrasound appearance of intussusception (4)
target mass in TRV plane
“cinnamon bun sign” in TRV plane
pseudokidney in longitudinal plane
diameter > 3cm
signs/symptoms of intussusception (4)
red currant jelly stool *
acute ABD pain
palpable abdominal mass
vomiting
lab values of intussusception (3)
anemia
dehydration
leukocytosis
what are the two types of bowel obstruction?
mechanical
nonmechanical / paralytic ileus
what is mechanical bowel obstruction?
bowel being blocked by something
what can cause mechanical bowel obstruction? (4)
intraluminal - food bolus
bowel wall lesion - tumor, Crohn disease
extrinsic - adhesions, hernia ** MOST COMMON**
volvulus - twisting of the intestines
what is nonmechanical / paralytic ileus bowel obstruction?
bowel lacks normal peristalsis
what causes nonmechanical / paralytic ileus bowel obstruction? (4)
peritonitis
bowel ischemia
surgery
medications
what are bezoars?
masses of various ingested materials that may cause intestinal obstruction
what do trichobezoars consist of?
ingested hair
what do lactobezoars consist of?
powdered milk
what do phytobezoars consist of?
vegetable material
what types of bezoars are common in pediatric patients?
trichobezoars
lactobezoars
what type of bezoar is common in older patients?
phytobezoars
ultrasound appearance of bowel obstruction (3)
distended fluid-filled loops of bowel
acute = thin walls with hyperperistalsis, back and forth movement of intraluminal contents
progression = aperistaltic with thick, edematous walls
signs/symptoms of bowel obstruction (4)
abdominal distention
intermittent ABD pain
constipation
nausea and vomiting
what is Crohn’s disease?
autoimmune disorder
periods of inflammation of the GI tract, cause is unknown
most common inflammatory disease of the small intestines
crohn’s
crohn’s usually involves the ____ or ____
terminal ileum or proximal colon
ultrasound appearance of Crohn’s (4)
bowel wall thickening
hyperemia
noncompressible > 5 mm
“target” appearance
signs/symptoms of Crohn’s (4)
episodes of diarrhea
ABD pain
weight loss
rectal bleeding
what is diverticulitis?
inflammation of the diverticuli
diverticulitis most often involves the
sigmoid colon
ultrasound appearance of diverticulitis (4)
thick-walled outpouchings
hypoechoic thickening of adjacent bowel (perienteric fat)
projections will produce shadowing or ring-down artifact
hyperemia
signs/symptoms of diverticulitis (4)
LLQ pain
fever
constipation or diarrhea
nausea and vomiting
what is colitis?
inflammation of the colon
4 types of colitis
pseudomembranous
ulcerative
ischemic
infectious
ultrasound appearance of colitis (2)
thickened, hypoechoic colon wall
hyperemia
signs/symptoms of colitis (3)
watery or bloody diarrhea
pain
fever
previous antibiotic therapy that destroys the healthy flora of the intestines leads to subsequent proliferation of _______
Clostridium difficile (C. Diff)
most common benign tumor of the small and large intestines
leiomyomas
leiomyomas appear as
hypoechoic masses continuous with the muscular layer
gastric carcinoma most often is in the form of
adenocarcinoma (80%)
adenocarcinoma of the appendix can lead to ___ with subsequent development of ____
rupture with subsequent development of pseudomyxoma peritonei
what is pseudomyxoma peritonei?
gelatinous ascites that may appear as a multiseptated cystic pelvic mass
most common metastatic tumors to the bowel (3)
malignant melanoma
lungs
breast
ultrasound appearance of gastric carcinoma (3)
hypoechoic, irregular-shaped, bulky mass
up to 10 cm in size
“target” or “pseudokidney”
signs/symptoms of gastric carcinoma (4)
weight loss
ABD pain
anorexia
vomiting
rectus sheath hematoma is the result of
abdominal trauma or may occur spontaneously
signs/symptoms of rectus sheath hematoma (4)
ABD pain
palpable abdominal mass
skin discoloration at the area
decrease hematocrit
most common site for endometriosis of the abdominal wall
anterior abdominal wall
what is scar endometriosis?
endometriosis that is located within the scar of a previous C-section
ultrasound appearance of endometriosis of the abdominal wall (4)
well-defined
lobulated
infiltrative
hypoechoic or heterogenous
signs/symptoms of scar endometriosis (2)
palpable mass
cyclical pain
what is an inguinal hernia?
bowel protrudes into the groin
what is an incisional hernia?
bowel protrudes into a surgical incision site
what is a linea alba hernia?
bowel protrudes through the fascia of the linea alba
what is an umbilical hernia?
bowel protrudes into the umbilicus
what is a spigelian hernia?
bowel protrudes into a weakened area in the lower 1/4th of the rectus muscle
