M8: Fetal GI

Question 1

define anasarca

Answer 1

skin edema, sign of hydrops

Question 2

the most sensitive measurement for growth of the fetus

Answer 2

AC

Question 3

when doing an AC, where should the spine be on the screen

Answer 3

L or R,

anterior the spine shadows, posterior its hard to get the landmarks

Question 4

of umbilical Artery and Vein

Answer 4

Artery: 2

Vain: 1

Question 5

describe physiological norm gut herniation

Answer 5

occurs @ 8 wks… gut herniates out of the abdo and rotates 90 degrees, returns back to the abdo by ~12 wks

Question 6

define an omphalocele

does it contain membranes

Answer 6

a defect at the base of the cord, causes abdo contents to herniate into the umbilical cord

yes, contents are covered by membranes - peritoneum and amnion

Question 7

an omphalocele can contain which organs

Answer 7

bowel, stomach, liver

Question 8

which lab value is increased w/ omphalocele

Answer 8

MS AFP

Question 9

which type of omphalocele has a higher association w/ chromo abnormalities

Answer 9

small, containing bowel only

Question 10

a large omphalocele is associated w/ which conditions

Answer 10

beckwith weidemann
pentalogy of cantrell
T18

or can be isolated

Question 11

prognosis of omphalocele

Answer 11

depends on associated anomalies

Question 12

which chromo abnormalities are most commonly associated w/ omphalocele

others

Answer 12

T18, T13

they can also occur w/ T21, Turners (45XO), triploidy

Question 13

US investigation of omphalocele, what do we need to determine

Answer 13

• if there is a surrounding membrane
• if the cord is at the center of the abdo
• contents of the omphalocele/which organs
• if theres any ascities
• other anomalies

Question 14

if a fetus has an omphalocele, how do we measure the AC

w/ omphalocele, which landmark cant we get for our AC

Answer 14

dont include the omphalocele in the measurement

umbilical vein going into portal vein

Question 15

what does the presence of ascities indicate

Answer 15

fetus is going into failure

Question 16

describe gastroschisis

does it contain membranes

Answer 16

a defect in the abdo wall to the RIGHT of the cord insertion, bowel is seen freely floating in the amniotic fluid

no membranes

Question 17

is gastroschisis associated w/ other syndromes

Answer 17

not usually

Question 18

which lab value is increased w/ gastroschisis

Answer 18

MS AFP

Question 19

risk factors for gastroschisis

Answer 19

substance abuse
some medications
young maternal age
smokers

Question 20

which abdo wall defect has a high still birth rate

Answer 20

gastroschisis

Question 21

which fetal assessments are performed regularly if the fetus has gastroschisis

Answer 21

BPP and NST, regardless of BPP results

Question 22

can the abdo wall defect that causes a gastroschisis affect blood supply to the herniated organs

Answer 22

yes

Question 23

severe pulling of a gastroschisis can have what complications

Answer 23

ascities or perforation which can lead to meconium peritonitis

Question 24

a ruptured omphalocele can mimic which other abdo wall pathology

What should you measure with a gastroschisis?

Answer 24

gastroschisis

Bowel wall diameter

Question 25

describe a body stalk anomaly

Answer 25

an abnormality containing 2 of 3 anomalies: myelomeningocele or caudal regression thoracoabdominoschisis or abdominoschisis limb defects

Question 26

another name for body stalk anomaly

Answer 26

limb-body-wall complex

Question 27

US appearance of body stalk anomaly

Answer 27

ectopic cordis or cardiac defects facial clefts low fluid cord short or absent (most important)

Question 28

describe a bladder exstrophy what causes it

Answer 28

failure of closure of the bladder, lower urinary tract, symphysis pubis, rectus muscles and skin defect in development of cloacal membrane

Question 29

which lab value is increased w/ bladder exstrophy

Answer 29

MSAFP

Question 30

US appearance of bladder exstrophy

Answer 30

absent bladder w/ soft tissue mass anteriorly (important) low umbilical cord insertion malformed genitals

Question 31

a bladder exstrophy can be mistaken for which other abdo wall abnormality

Answer 31

omphalocele

Question 32

describe cloacal exstrophy

Answer 32

``` syndrome that includes bladder exstrophy omphalocele imperforate anus spinal bifida ```

Question 33

the rectum and urogenical sinus develops from whic primitive strucutre

Answer 33

cloaca

Question 34

describe a duodenal atresia US appearance

Answer 34

a common sm bowel obstruction ``` 2 stomachs (stomach and duodenum) - double bubble sign polyhydramnios ```

Question 35

what % of duodenal atresia is associated w/ other anomalies what are those anomalies

Answer 35

50% cardiovascular abnorm T21 bowel anomalies

Question 36

do low GI obstructions typically cause polyhydramnios

Answer 36

no, colon is not active, only collecting meconium

Question 37

easy way to tell the sm and lrg bowel apart

Answer 37

sm bowel will peristalsis, larg wont

Question 38

norm colon diameter of fetus at term sm bowel diameter

Answer 38

colon: <18 mm sm b: <12 mm

Question 39

define volvulus

Answer 39

bowel twisting on its own blood supply

Question 40

describe a meconium ileus Us appearance

Answer 40

sm bowel obstruction that occurs almost exclusively w/ cystic fibrosis echogenic bowel

Question 41

how to assess echogenity of bowel

Answer 41

split screen, one w/ bone, one w/ echogenic bowl... turns the gains down until bone goes away. if the bowel is still present than its echogenic.

Question 42

when scanning for echogenic bowel, what probe frequency must we use

Answer 42

Less than or = to 5 MHz, if over this all bowel will look echogenic

Question 43

echogenic bowel is associated w/ which abnormalities

Answer 43

cystic fibrosis choromo abnormalities TORCH infection meconium peritonitis

Question 44

describe meconium peritonitis

Answer 44

a bowel obstruction that can lead to perforation of bowel, leaking meconium into the peritoneum... cause inflammation of the peritoneum

Question 45

US appearance of meconium peritonitis

Answer 45

echogenic reflectors in bowel

Question 46

describe an umbilical vein varix increases risk for what

Answer 46

dilation of umbilical vein after it enters the fetal abdo thrombus in umbilical vein

Question 47

what is a persistent umbilical vein

Answer 47

when the R umbilical vein formed during embryogenesis doesn't disappear and instead travels along the right side of the GB wall and turns towards the stomach

Question 48

3 causes of hepatic calcifications

Answer 48

TORCH Emboli Ischemic damage of liver tissue and necrosis

Question 49

US appearance of hepatic calcification

Answer 49

Echogenic or hyper focus that may have shadowing

Question 50

W/ an abdo cyst what is important to determine

Answer 50

Origin

Question 51

Why is echogenic debris sometimes seen in the stomach

Answer 51

Often idiopathic and not concerning Can be seen after amniocentesis if so blood leaked into the amniotic fluid and is swallowed by the fetus Or w/ intrauterine bleeding