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DMST 315 OBGYN 3 > OBGYN: Module 8: Abnormalities of the fetal GI tract > Flashcards

OBGYN: Module 8: Abnormalities of the fetal GI tract Flashcards

1
Q

When we do a ultrasound survey of the Fetal GI tract what do we look for?7

A
  1. Intact abdominal wall
  2. Normal situs
  3. Normal cord insertion
  4. Skin thickness
  5. Fluid collections
  6. Appropriate size for dates
  7. Bowel echogenicity
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2
Q

What does this image represent?

A

2 UA

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3
Q

What are some wall abnormalities?4

A
  1. Omphalocele
  2. Gastroschisis
  3. Body stalk anomaly
  4. Bladder and cloacal exstrophy
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4
Q

What is normal gut herniation during 1st semester?

A

At 8 weeks- gut herniates outside the fetal abdominal cavity and rotates 90 degrees and returns back to abdomen by 12 weeks

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5
Q

What is a omphalocele?

A

Defect at the base of the cord where the abdominal contents herniate into the umbilical cord

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6
Q

What does this image represent?

A

Omphalocele

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7
Q

What is the abdominal contents covered by with omphaloceles?

A

Membrane most likely peritoneum and amnions

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8
Q

What might omphaloceles contain?3

A
  1. Bowel
  2. Stomach
  3. Liver
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9
Q

Omphaloceles lead to an increase in what hormone?

A

MSAFP

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10
Q

A small omphalocele containing bowel only has a higher association of having what?

A

A chromosomal abnormality

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11
Q

A large omphalocele can be associated with what? 3

A
  1. Beckwith - weidmann (1in 7)
  2. Pentalogy of cantrell
  3. Trisomies
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12
Q

In terms of omphaloceles and abnormalities, prognosis depends on what?

A

Associated anomalies

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13
Q

Which two trisomy’s are associated with omphaloceles?

A

T13 and T18

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14
Q

Besides T18 and T13, omphaloceles are reported to appear with what? 3

A
  1. T21
  2. 45XO
  3. Triploidy
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15
Q

What does this image represent?

A

Small omphalocele containing bowel only carry a higher risk of having chromosomal abnormalities

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16
Q

What does the sonographer need to establish in terms of omphalocele sonographically? 5

A
  1. Is there a membrane surrounding contents
  2. Is there a cord at the center of the fetal abdomen
  3. Contents seen within the omphalocele
  4. Presence of ascites
  5. Other associated anomalies
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17
Q

What does these images represent?

A

Omphaloceles

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18
Q

What is gatroschisis?

A

A defect in abdominal wall to the right of the umbilical cord insertion

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19
Q

What does the bowel look like with gastroschisis?

A

Bowel is freely floating in the amniotic fluid

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20
Q

Is there a covering membrane with Gastroschesis?

A

No

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21
Q

Is gastroschisis associated with other syndromes?

A

Typically no

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22
Q

What happens to MSAFP with gastroschisis?

A

Increases

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23
Q

What are some risk factors associated with gastroschisis?4 (what might lead to the disease)

A
  1. Substance abuse
  2. Some medications
  3. Younger women
  4. Smokers
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24
Q

What is the occurrence rate of still birth rate with gastroschisis? What do we do to prevent this?3

A
  1. Up to 12%
  2. Fetal assessments performed regularly
  3. BPP and NST - regardless of the BPP score a NST Is performed (Non stress test)
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25
Q

What does this image represent?

A

Gastroschisis

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26
Q

What does this image represent?

A

Gastroschisis

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27
Q

What does this image represent?

A

Gastroschisis

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28
Q

What does this image represent?

A

Gastroschisis

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29
Q

What does this image represent?

A

Bowel

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30
Q

What are some things a sonographer might do to distinguish gastroschisis from omphalocele? 5

A
  1. Determine contents of the herniated structure
  2. A small hole or defect may affect blood supply to herniated structures
  3. Severe pulling may cause ascites, perforation which can lead to meconium peritonitis
  4. A ruptured omphalocele can mimic a gastroschisis
  5. Measure bowel diameter for further follow up
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31
Q

What does this image represetn?

A

Bowel vs cord

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32
Q

What does this image represent?

A

Gastroschisis

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33
Q

What does this represent?

A

Gastroschisis

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34
Q

What does the silo do for gastroschisis post partum?

A

Water in bag pushes the bowel back into the abdomen

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35
Q

What is a body stalk anomaly?

A

Severe abdominal wall defect which happens with there is a failure of abdominal wall to close

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36
Q

How common is body stalk anomalies?

A

Rare

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37
Q

What happens with body stalk anomalies?

A

Abdominal organs lie outside the abdominal cavity, covered by amnion and directly attached to the placenta

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38
Q

What are some major body stalk anomalies?3

A
  1. Spine anomalies
  2. Thoracoabdominoschisis or abdominaoschisis
  3. Limb defects
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39
Q

What is body stalk anomalies sometimes referred to as?

A

Limb- body wall complex

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40
Q

What are some sonographic features of body stock anomalies? 8

A
  1. Abdominal wall defect
  2. Absent umbilical cord
  3. Severe scoliosis
  4. NTD
  5. Ectopic cordis or other cardiac defects
  6. Facial clefts may be present
  7. Missing limbs or club feet
  8. Low fluid
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41
Q

What does this image represent?

A

Limb body wall

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42
Q

What does this image represent?

A

Limb body wall

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43
Q

What is extrophy?

A

The congenital turning inside out of an organ

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44
Q

What is extrophy caused by?

A

Defect in developmental of cloacal membrane

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45
Q

What happens with bladder exstrophy?

A

failure of closure of the bladder, lower urinary tract, overlying symphysis pubis, rectus, muscle and skin

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46
Q

What is seen with bladder exstrophy?

A

Sporadic

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47
Q

What happens with MSAFP with Bladder exstrophy?

A

Increases

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48
Q

What are some sonographic signs of bladder exstrophy?4

A
  1. Absent Bladder with a soft tissue anterior mass
  2. Low umbilical cord insertion
  3. Malformed genitalia
  4. May be mistaken for an omphalocele
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49
Q

What does this image represent?

A

Bladder exstrophy

50
Q

Bladder exstrophy may occur with or without what? What does this mean?

A

Cloacal extrophy and has a better prognosis

51
Q

What does this image represent?

A

Cloacal extrophy

52
Q

Clocal exstrophy includes what syndromes?4

A
  1. Bladder extrophy
  2. Omphalocele
  3. Imperforate anus
  4. Spina bifida
53
Q

With cloacal exstrophy the rectum and the urogenital sinus develop from what?

A

From a primitive structure called the cloaca

54
Q

What does this image represent?

A

Cloacal exstrophy in transverse

55
Q

What does this image represent?

A

Cloacal exstrophy SAG and meningocele

56
Q

What are some abnormalities of the fetal GI Tract?3

A
  1. Atresia or stenosis of the Esophageal and duodenal
  2. Meconium ileus
  3. Meconium peritonitis
57
Q

What is esophageal atresia?

A

Absence of a segment of the esophagus

58
Q

What are two types of esophageal atresia?

A
  1. Isolated esophageal atresia
  2. Atersia with TE fistula
59
Q

What is esophageal atresia usually associated with?

A

Tracheoesophageal fistula

60
Q

What is the etiology of esophageal atresia?

A

Unknown

61
Q

In fetal development esophagus and trachea develop from what?

A

A common primitive pharyngeal cavity

62
Q

What is the appearance of esophageal atresia? 5

A
  1. Small or absent stomach
  2. Polyhydraminos
  3. Dilated proximal esophagus in neck
  4. Fetal vomiting
  5. Associated with other anomalies such as VACTERL, T21, heart defects
63
Q

Esophageal atresia and small or absent stomach depends on what?

A

Whether a fistula is present connecting the esophagus through the trachea

64
Q

What does this image represent?

A

Esophageal atresia and TE fistula

65
Q

What does this image represent?

A

Persistent small stomach and cystic area in neck

66
Q

What does this image represent?

A

Absent fetal stomach

67
Q

What does VACTERAL stand for?

A
68
Q

What is the most common congenital small bowel obstruction?

A

Duodenal atresia

69
Q

What is the sonographic appearance of duodenal atresia?

A

2 stomachs

70
Q

What is a duodenal atresia sign?

A

double bubble

71
Q

Duodenal atresia is 50% associated with what other anomalies?3

A
  1. Cardiovascular
  2. T21
  3. Other bowel abnormalities
72
Q

50% of duodenal atresia cases have what?2

A
  1. Polyhydraminos
  2. Symmetrical IUGR
73
Q

What does this image represent?

A

Duodenal atresia

74
Q

A high GI atresia typically presents with what?

A

Polyhydraminos

75
Q

Lower obstructions do not present with what? What two things happen as a result?

A

Polyhydraminos like
1. Fetal colon is not active in uteri
2. The colon is only collecting meconium

76
Q

Dilated small bowel has what?

A

Peristalsis

77
Q

Dilated large bowel does not have what?

A

Peristalsis

78
Q

What is the colon diameter in a term fetus?

A

<18mm

79
Q

What is the diameter of a small bowel?

A

<12mm

80
Q

Any bowel above what size is abnormal?

A

18mm

81
Q

What does this image represent?

A

Small bowel obstruction

82
Q

What does this image represent?

A

Small bowel obstruction

83
Q

What does each three of these bowels represent?

A

a. Normal
b. Malrotation
c. Malrotation with volvulus

84
Q

What is volvulus?

A

Bowel twisting on its own blood supply

85
Q

What is meconium ileus? What does the fetus do with this?

A
  1. Obstruction of small bowel with meconium
  2. Typically liquid material the fetus ingests
86
Q

Meconium ileus is almost exclusively due to what?

A

Cystic fibrosis which is a dysfunction of exocrine and mucus producing gland

87
Q

How does the meconium appear with cystic fibrosis? How is bowel mobility with this?What does this result in? 3

A
  1. Thickened and sticky
  2. Bowel motility is poor
  3. Resulting in obstruction
88
Q

What is the sonographic appearance of meconium ileus?

A

Echogenic bowel

89
Q

On ultrasound echogenic bowel should be as echogenic as what?

A

Bone

90
Q

If we suspect echogenic bowel what should we do?

A

Turn down gains to see which disappears first, bone or bowel

91
Q

What do we need to watch out for with echogenic bowel DDX? What do we need to do?

A
  1. Watch transducer frequency, >5MHz bowel will appear hyperechoic in a normal fetus
  2. Use split screen for comparison
92
Q

Echogenic bowel is associated with what? 4

A
  1. Cystic fibrosis
  2. Chromosomal abnormalities
  3. TORCH infections from the mother
  4. Risk of meconium peritonitis
93
Q

What does this image represent?

A

Meconium Ileus

94
Q

What does this image represent?

A

Echogenic bowel

95
Q

Any bowel obstruction can lead to what?

A

Dilated bowel proximal and perforation of the bowel

96
Q

Perforation of the bowel leads to what?

A

The contents of the fetal bowel, meconium, leaking into the peritoneum

97
Q

Meconium is sterile, what does this mean?

A

No bacterial contamination occurs

98
Q

Leaking meconium causes what?

A

An inflammation of the peritoneum, which reacts by forming calcium deposits

99
Q

What is the sonographic appearence of meconium peritonitis?3

A
  1. Appears as echogenic reflectors throughout the bowel2
  2. Polyhdraminious
  3. Ascites and hydrops as obx progresses
100
Q

What is umbilical vein varix?

A

Dilation of the umbilical vein after it enters the fetal ambdomen

101
Q

Umbilical vein varix results in what kind of risk?

A

Increase risk of thrombus in umbilical vein as blood slows down through dilation

102
Q

What does this image represent?

A

Varix

103
Q

When do we see perisistent right umbilical vein?

A

During early embryogenesis there are 2 umbilical veins

104
Q

With persistent right umbilical veins, normally the right and left do what?

A

The right regresses and the left remains

105
Q

What does a persistent right umbilical vein look like?

A

Typical hocky stick appearance of UV

106
Q

If persistent right umbilical vein doesn’t travel normally, what happens?

A

The right umbilical vein travels along the right side of the gall bladder and turns towards the stomach instead of away

107
Q

What does this image represent?

A

Normal vs Persistent right umbilical vein

108
Q

Persistent right umbilical vein results in what?

A

Increased risk of heart defects

109
Q

With persistent right umbilical vein, what is indicated?

A

Fetal echo is indicated

110
Q

Hepatic calcifications may be due to what?4

A
  1. TORCH
  2. Emboli
  3. Ischemic damage of liver tissue and necrosis
  4. If on periphery, meconium peritonitis
111
Q

What is the sonographic appearance of hepatic calcification?2

A
  1. Echogenic or hyperechoic focus
  2. May shadow
112
Q

What does this image represent?

A

Hepatic calcification

113
Q

Hepatic calcification is due to what?

A

Maternal CMV infection passed on to the fetus

114
Q

What is the origin of abdominal cysts?4

A
  1. Mesenteric or omental
  2. Ovarian if fetus is female
  3. Choledochal cyst on the fetal CBD
  4. Hepatic
115
Q

What is the sonographic appearance of abdominal cysts?

A

Anechoic structure with through transmission and thin walls

116
Q

With abdominal cysts what must we try to figure out?

A

The origin

117
Q

What kind of abdominal abnormalities are seen in the stomach?

A

Echogenic debris within the stomach

118
Q

In terms of echogenic debris seen in the stomach, when will se see it? 2

A
  1. After an amniocentesis
  2. When intrauterine bleeding has occurred
119
Q

Why do we see echogenic debris in stomach post amniocentesis?

A

Caused by blood leaking into the amniotic cavity after an amniocentesis. The fetus swallows the blood resulting in echogenic debris in stomach

120
Q

What does each of these images represent?

A
  1. Debris in stomach
  2. Fetal gallstones

DMST 315 OBGYN 3 (21 decks)

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