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Ob/Gyne 2 > Module 8 : Fetal GI Pathology > Flashcards

Module 8 : Fetal GI Pathology Flashcards

1
Q

what 7 things should and ultrasound survey of the GI tract include

A
  • intact abdominal wall
  • normal situs
  • normal cord insertion
  • skin thickness
  • fluid collections
  • appropriate size for dates
  • bowel echogenicity
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2
Q

what is special about the abdominal circumference measurement

A
  • it is the most accurate measurement for dates
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3
Q

4 abdominal wall abnormalities

A
  • omphalocele
  • gastroschisis
  • body stalk anomaly
  • bladder and cloacal exstrophy
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4
Q

what is the normal physiological mid gut herniation and when does it occur

A
  • gut herniates outside fetal abdominal cavity and rotates 90º and returns back into the cavity
  • starts 8 weeks ends 12 weeks
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5
Q

what is an omphalocele

A
  • defect at the base of the cord
  • abdominal contents herniate into the umbilical cord
  • covered by a membrane
    + peritoneum and amnion
  • may contain bowel stomach and liver
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6
Q

what lab value will be increased with an omphalocele

A
  • MSAFP increased
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7
Q

what does a small omphalocele containing only bowel usually have an association with

A
  • a high association with have a chromosomal abnormality
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8
Q

what three things is a large omphalocele associated with

A
  • beckwith Wiedemann
  • pentalogy of cantrell
  • trisomy 18
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9
Q

what is the prognosis of omphalocele

A
  • depends on associated abnormalities

- would need surgery to correct

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10
Q

what trisomy’s are most commonly associated with omphalocele

A
  • trisomy 18 and 13
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11
Q

what three other diseases are seen with omhpalocele

A
  • trisomy 21
  • 45 XO
  • triploidy
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12
Q

what 5 things does the monographer need to establish when scanning omphalocelel

A
  • is there a membrane surrounding contents
  • is the cord at the center of the fetal abdomen
  • contents seen within the omphalocele
  • presence of ascites
  • other associated anomalies
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13
Q

how to measure AC with omphalocele

A
  • exclude herniation
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14
Q

what is gastroschisis

A
  • a defect in the abdominal wall to the RIGHT of the umbilical cord insertion
  • bowel is freely floating in the amniotic fluid
  • NO COVERING MEMBRANE
  • typically no other associated syndromes
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15
Q

what lab value will be increased with gastroschisis

A
  • MSAFP increased
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16
Q

what is more common omphalocele or gastroschisis

A
  • gastroshcisis
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17
Q

what 5 things increase chance of gastroschisis

A
  • substance abuse
  • some medication
  • younger women
  • smokers
  • weed
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18
Q

do gastroschisis have a high stillbirth rate

A
  • yes
  • fetal assessments performed regularly
  • BPP and NST
    + regardless of the BPP score NST is done
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19
Q

gastroschisis and sonography

A
  • determine contents of herniated structures
  • a small hole or defect may affect blood supply to herniated structures
  • severe pulling may cause ascites, perforation which can lead to MECONIUM PERITONITIS
  • a ruptured omphalocele can mimic gastroschisis
  • measure bowel diameter for follow up
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20
Q

how is gastroschisis treated

A
  • silo treatment
    + water in bag pushes the bowel back into the abdomen
  • no surgery required
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21
Q

what is a body stalk anomaly

A
  • consists of 2/3 of these anomalies
    + myelomeningocele or caudal regression
    + thoraabdominoschisis or abdominoschisis
    + limb defects
  • aka limb-body-wall complex
22
Q

7 sonographic features of body stalk anomaly

A
  • missing limbs or club feet
  • abdominal contents may be outside body cavity and free or attached to placenta
  • myelomeningocele with associated Arnold chiari malformation
  • ectopic corgis or other heart defects
  • facial cleft may be present
  • CORD SHORT OR ABSENT
  • low fluid
23
Q

what is bladder exstrophy

A
  • caused by defect in development of cloacal membrane
  • failure of closure of the bladder, lower urinary tract, overlying symphysis pubis, rectus muscles and skin
  • sporadic
24
Q

what lab value will be increased with bladder exstrophy

A
  • MSAFP increased
25
Q

4 sonographic signs

A
  • ABSENT BLADDER WITH A SOFT TISSUE ANTERIOR MASS
  • low umbilical cord insertion
  • malformed genitalia
  • may be mistaken for omphalocele
26
Q

what 4 anomalies does cloacal exstrophy include

A
  • bladder exstrophy
  • omphalocele
  • imperforate anus
  • spina bifida
27
Q

what two structures develop from the cloaca

A
  • the urogenital sinus

- rectum

28
Q

three fetal GI obstructions

A 
- atresia or stenosis
  \+ esophageal 
  \+ duodenal
- meconium ileus
- meconium peritonitis
29
Q

what is esophageal atresia

A
  • absence of a segment of the esophagus
  • usually associated with tracheoesophageal fistula
  • unknown etiology
  • ESOPHAGUS ACTUALLY STOPS
30
Q

sonographic features of esophageal atresia

A 
- small or absent stomach 
  \+ depends on if the fistula connects back to stomach
- polyhydramnios
- dilated proximal esophagus in neck
- fetal vomitting
31
Q

what 3 other anomalies are associated with esophageal atresia

A
  • VACTERL
  • trisomy
  • heart defects
32
Q

what is duodenal atresia

A
  • common small bowel obstruction
33
Q

ultrasound appearance of duodenal atresia

A
  • 2 stomach
    + stomach and first portion of duodenum
  • double bubble
  • polyhradmnios
34
Q

what 3 other anomalies is 50% duodenal atresia associated with

A
  • cardiovascular
  • trisomy 21
  • other bowel abnormalities
35
Q

does dilated small bowel have peristalsis or no

A
  • yes it does
36
Q

does dilated large bowel have peristalsis or no

A
  • does not have peristalsis
37
Q

colon diameter in a term fetus

A

< 18mm

38
Q

small bowel diameter in a term fetus

A

< 12mm

39
Q

what is a Volvos

A
  • bowel twisting on its own blood supply
40
Q

what is meconium ileus

A
  • obstruction of small bowel with meconium

- almost exclusively due to cystic fibrosis

41
Q

what is the sonographic appearance of meconium ileus

A
  • echogenic bowel
42
Q

how do we asses echogenic bowel on ultrasound

A
  • echogenic bowel should be as echogenic as bone
  • decrease gains to see which disappears first bowel or bone
  • if bowel still visible after bone disappears then diagnosis is made
  • WATCH TRANSDUCER FREQUENCY IS OVER 5MHZ THEN NORMAL BOWEL WILL BE HYPERECHOIC
  • USE SPLIT SCREEN FOR COMPARISON
43
Q

what 4 things is echogenic bowel associated with

A
  • cystic fibrosis
  • chromosomal abnormalities
  • TORCH infection from mother
  • meconium peritonitis
44
Q

what is meconium peritonitis

A
  • a bowel obstruction can lead to perforation of bowel
  • perforation leads to contents of fetal bowel (meconium) leaking out into the peritoneum
  • this causes inflammation o the peritoneum
  • appears as echogenic reflectors throughout the bowel
45
Q

what is an umbilical vein vary

A
  • dilation of umbilical vein after it enters the fetal abdomen
  • increase risk of thrombus in umbilical vein
46
Q

what is a persistent right umbilical vein

A
  • during early embyrogenisis there are 2 umbilical veins

- right umbilical vein travels along the right side of the gallbladder and turns toward the stomach instead of away

47
Q

what three things may cause hepatic calcification

A
  • TORCH (maternal infection)
  • emboli
  • ischemic damage of liver tissue and necrosis
48
Q

sonographic appearance of hepatic calcification

A
  • echogenic or hyperechoic focus that may have a shadow as well
49
Q

4 origins of abdominal cysts

A
  • mesenteric or omental
  • ovarian if fetus is female
  • choledochal cyst on the fetal CBD
  • hepatic
50
Q

sonographic appearance of abdominal cysts

A
  • anechoic structure with through transmission and thin walls
51
Q

3 other abdominal abnormalities

A
  • echogenic debris within the stomach
  • gallstones
  • hepatic calcifications
52
Q

echogenic debris within the stomach characteristics

A
  • usually idiopathic and not ominous sign
  • can be seen after amniocentesis (fetus swallowing blood)
  • also seen when intrauterine bleeding has occurred

Ob/Gyne 2 (19 decks)

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