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MIDS 127 - abdo > Pediatric Abdomen > Flashcards

Pediatric Abdomen Flashcards

1
Q

What is the liver measurement for infants?

A

RLL not greater than 1cm below costal margin

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2
Q

What is the children’s liver measurement?

A

RLL not below costal margin

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3
Q

How large should the CBD be for NEONATES?

A

Less than 1mm

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4
Q

How large should the CBD be for INFANTS?

A

Less than 2mm

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5
Q

How large should the CBD be for CHILDREN?

A

(1-10y/o) Less than 4mm.

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6
Q

How large should the CBD be for ADOLESCENTS?

A

Less than 6-7mm

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7
Q

What should the length of the GB be for infants? (Less than 1 y/o)

A

1.5-3cm

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8
Q

What should the length of the GB be for children?

A

3-7cm

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9
Q

What is the spleen length for INFANTS?

A

6.0-7.0cm

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10
Q

What is the spleen length for CHILDREN?

A

1-4yo: 8.0-9.0cm
4-8yo: 10-12cm
Older than 12yo: 12cm

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11
Q

What has the SS of: infants - failure to thrive, children - severe hypertension, headaches, fatigue?

A

A congenital anomaly: coarctation of descending aorta

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12
Q

What is Coarctation of the descending AO commonly associated with?

A

Renal artery stenosis

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13
Q

What are discoloured limbs a sign of?

A

Possible Coarctation of Abdominal Aorta. Discoloured limbs indicate blood flow issues.

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14
Q

What is the most common reason for AO evaluation in the neonate?

A

Abdominal AO Thrombosis

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15
Q

What can UAC (umbilical artery catheter) cause sometimes?

A

Abdominal AO Thrombosis, IVC thrombosis

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16
Q

What is the most common vascular liver tumour in infancy?

A

Hemangiomas

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17
Q

(Peds) Are hemangiomas more common in girls or boys?

A

Girls (3x)

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18
Q

Do hemangiomas (cavernous) in the younger population look exactly like the adult pop.?

A

Yes

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19
Q

What is a hemangioendothelioma? What age bracket does it occur in? What is it associated with?

A

Most common BENIGN liver tumour, type of hemangioma.

Occurs in infants younger than 6months.

Associated with cutaneous hemangiomas.

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20
Q

What is a Mesenchymal Hamartoma?

A

Arises from the connective tissue or mesenchyme of the portal tracts, is rare.

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21
Q

Are Mesenchymal Hamartomas more common in girls or boys? When does it occur?

A

Boys. Occurs usually within 2 yrs of life with painless abdominal swelling.

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22
Q

In peds, what is the most common injured abdominal organ in blunt abdo trauma?

A

The liver. Most commonly, the right lobe.

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23
Q

Children and young adults are most commonly infected by which Hepatitis?

A

Hepatitis A.

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24
Q

Describe the SA of the 3 types of Hepatitis.

A

ACUTE - hepatomegaly with decreased parenchymal echogenicity and increased echogenicity of the portal walls (starry sky)

CHRONIC - increased parenchymal echogenicity due to fibrosis and nodule regeneration

SEVERE - thickened GB wall with sludge, enlarged nodes in the porta hepatis

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25
Q

In peds, describe the reason for an abscess, as well as the SA.

A

Trauma, direct invasion of adjacent structures. Appearance is the same as adults - hypoechoic complex masses with poorly defined borders

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26
Q

For hydatid/echinococcal cysts, what is the peak incidence occurrence age?

A

5-15 yrs

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27
Q

For peds, what does metabolic liver disease most likely cause?

A

Most commonly causes fatty infiltration

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28
Q

Describe hemochromatosis.

A

Excessive amount of iron stored in the liver. Not a lot of penetration down to the posterior. Increased parenchymal echogenicity, cirrhosis, hepatomegaly.

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29
Q

Primary malignant tumours are more common in adults than children. True or false?

A

False. They are more common.

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30
Q

How do malignant neoplasms generally show themselves in peds?

A

Generally present as a solitary solid homogenous hyperechoic mass

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31
Q

What is the most common pediatric liver mass?

A

Hepatoblastoma

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32
Q

Hepatoblastoma is most common in…

A

Boys under 5yo.

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33
Q

What is a common symptom with hepatoblastoma?

A

Hepatomegaly or painless palpable abdominal mass.

INCREASED AFP.

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34
Q

Describe Fibrolamellar Hepatocellular Carcinoma.

A

Subtype of HCC.

Most commonly affects teenagers and young adults.

Normal labs, mildly elevated AFP. Abdo pain, mass, fever, weight loss, diarrhea, vomiting.

SA: Solitary and well mariginated with variable echogenicity, potential central scar & focal calcifications

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35
Q

Describe Mesenchymal Sarcoma.

A

AKA Embryonal Sarcoma.

5-10yrs. Abdo pain and swelling, palpable mass. NO INCREASE IN AFP.

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36
Q

What is the sonographic finding of Mesenchymal/Embryonal Sarcoma?

A

Round hyperechoic solitary mass with well-defined borders and a thick fibrous pedudocapsule, typically in RLL.

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37
Q

What does a hepatic infarction look like?

A

Wedge shaped, hypoechoic.

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38
Q

What describes: rare benign vasc condition, dilated sinusoidal blood filled spaces within the liver.

A

Peliosis Hepatis

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39
Q

What is associated with UVC (umbilical vein cath), bowel surgery, neonatal gastroenteritis?

A

Portal Venous Gas

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40
Q

What does portal venous gas look like?

A

Multiple mobile echogenic foci (no shadowing or reverb)

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41
Q

What are the most common congenital anomalies in peds?

A

Biliary atresia and choledochal cysts

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42
Q

Does biliary atresia affect boys or girls more?

A

Boys

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43
Q

What are the SS of peds biliary atresia?

A

Jaundice in neonates, elevated conjugated/direct bilirubin, pale stools, dark urine, hepatomegaly

44
Q

What are the sonographic features of Biliary Atresia?

A

Fasting GB measures less than 1.5cm. Triangular cord sign: echogenic area anterior wall of RPV measuring greater than 4mm in thickness (fibrous remnant of a biliary duct. Liver is enlarged. Increased HA diameter (bigger than 2mm). Splenomegaly.

45
Q

Choledochal cysts are more common in boys or girls?

A

Girls

46
Q

What are the three most common causes of jaundice in peds?

A

Biliary atresia, hepatitis, and choledochal cysts

47
Q

What are the five types of choledochal cysts?

A 
Fusiform (MOST COMMON)
Diverticulum
Choledochocele
Dilation of CBD with IHDD
Caroli Disease
48
Q

What is the most common type of Choledochal Cysts?

A

Fusiform

49
Q

What is Caroli’s disease associated with?

A

Cystic disease of the kidney

50
Q

What are the SS of Caroli’s disease?

A

Ongoing cramp-like abdo pain, secondary to biliary stasis, ductal stones, cholangitis, hepatic fibrosis

51
Q

What is an abnormal GB size for infants and children?

A

Anything smaller than:

Infants: 1.5-3.0cm
Children 3-7cm

52
Q

Small or non-distended GB can be a sign of:

A

Biliary atresia, congential hypoplasia, AVH, cystic fibrosis, chronic cholecystitis

53
Q

Large GB may indicate:

A

Prolonged fasting, hydrops, obstruction of cystic duct or CBD

54
Q

Non-visualization of the GB can indicate:

A

Biliary atresia or viral hepatitis

55
Q

When a GB wall is thicker than 5mm, what does this mean?

A

Indicative of disease in peds pop.

56
Q

Sickle cell disease raises the risk of:

A

Cholelithiasis (2x)

57
Q

Pancreatitis is a common complication of:

A

Cholelithiasis

58
Q

What is Mirizzi Syndrome?

A

Compression of the extrahepatic ducts due to stones impacted in GB neck or cystic duct causing inflammation and obstruction of CBD

59
Q

What are the signs and symptoms of Mirizzi syndrome? What would be elevated in labs?

A

Asymptomatic or pain, fatigue, pruritis, jaundice

Labs elevated: alk phos, AST, ALT, WBC, direct bilirubin (if jaundice is present)

60
Q

What is the sonographic finding of a hydropic GB?

A

Big big gallbladder, completely anechoic with thin walls (possible stones or sludge)

61
Q

Where does the vessel dilate during obstruction?

A

Proximal to the obstruction

62
Q

What is Bile Plug Syndrome?

A

Causes biliary obstruction in full term infants.

63
Q

What is Inspissated Bile Syndrome?

A

Causes biliary obstruction in full-term infants.

64
Q

What is Schlerosing Cholangitis?

A

Inflammatory fibrosis obliterating intrahepatic and extrahepatic ducts

65
Q

Inflammatory bowel disease is often associated with:

A

Sclerosing Cholangitis

66
Q

Are the walls thickened or thinned during Sclerosing Cholangitis?

A

Thickened

67
Q

What is the most common biliary tract findings in children with AIDS?

A

Calculus cholecystitis and cholangitis

68
Q

What is a rare soft tissue tumour that occurs in children?

A

Rhabdomyosarcoma

69
Q

What is the second most common cause of obstructive jaundice?

A

Rhabdomyosarcoma
(neonates - after biliary atresia)
(older children - after choledochal cyst)

70
Q

Is there a raised tumour marker in Rhabdomyosarcoma?

A

No, AFP does not increase

71
Q

Where does Rhabdomyosarcoma usually occur?

A

The hilum of the liver

72
Q

What two masses occur typically at the hilum of the liver?

A

Rhabdomyosarcoma and Klatskins tumour

73
Q

What is the Annular Pancreas and is it more common in boys or girls?

A

Bifurcated pancreatic head that encases the duodenum.

More common in boys. Associated with other congenital anomalies.

74
Q

What affects the exocrine glands in the lungs and GIT?

A

Cystic fibrosis

75
Q

What does cystic fibrosis do?

A

Causes pancreatic exocine dysfuction due to obstruction of small ductules by mucoid secretions leading to tissue destruction, atrophy, and replacement of tissue with fibrosis and fat

76
Q

What is cystic fibrosis commonly mistaken for?

A

Chronic Pancreatitis

77
Q

Insulinomas and gastrinomas are a ______ Cell Tumour.

A

Islet

78
Q

Insulinoma is commonly found in the pancreatic ________.

A

Body/tail

79
Q

Adenoma is most common in the pancreatic ______.

A

Head

80
Q

What is the most common cause of Pancreatits in peds?

A

Blunt abdo trauma

81
Q

What are the SS of acute pancreatitis?

A

Nausea/vomiting, abdo pain, fever, tachycardia, abdominal distention and tenderness

82
Q

What is an Acute Pancreatitis complication?

A

Pseudocysts

83
Q

Where are pseudocysts most commonly found?

A

In pancreas/adjacent to pancreas.

84
Q

How fast do pseudocysts resolve in peds?

A

4-12 wks, typically faster than adults

85
Q

What are the Acute Pancreatitis Complications (peds)?

A

Hemorrhage
Phlegmon
Abscess

86
Q

What is the most common mass in the ped population (of all organs)?

A

Splenic cysts

87
Q

What is the most common fungal infection?

A

Candida; involves liver and spleen

88
Q

What is the sonographic appearance of Candida?

A

Bull’s eye/target

89
Q

What is another name for Bartonella Henselae infection?

A

Cat scratch disease

90
Q

What is another name for Cat Scratch disease?

A

Bartonella Henselae Infection

91
Q

How does Bartonella Henselae (Cat Scratch Disease) show on

A

Multiple hypoechoic microabscesses which may calcify

92
Q

What are the 4 most common splenic tumours?

A

Lymphoma - MOST COMMON MALIGNANT SPLENIC MASS IN CHILDHOOD
Leukemia
Hemangioma (benign) - most common PRIMARY neoplasm of the spleen in children (rare)
Hamartoma (benign) - associated with Beckwidth-Wiedemann and Klippel-Trenaunay Weber syndromes

93
Q

Name all 8 Splenic Tumours (peds)

A

Lymphoma, leukemia, hemangioma, hamartoma, lymphangioma, leiomyoma, angiosarcoma, mets

94
Q

What causes rapid splenic enlargement due to blood pooling the splenic tissue? (while riding a horse)?

A

Splenic Sequestration Syndrome

95
Q

What is the SS of Splenic Sequestration Syndrome?

A

Rapid splenic enlargement, acute drop in hematocrit, extreme LUQ pain

96
Q

What is Sickle Cell Anemia?

A

Formation of abnormal hemoglobin

97
Q

What are the SS of Sickle Cell Anemia?

A

Intense pain, potentially rapid drop in hematocrit and become hypotensive

98
Q

What are the sonographic findings of Sickle Cell Anemia?

A

Splenomegaly with hyperechoic and hypoechoic areas of autoinfarction

In older children, spleen is small and fibrotic from chronic autoinfarction and may calcify

99
Q

What is the most common lysosomal storage disorder?

A

Gaucher Disease

100
Q

What is the sonographic finding of Gaucher Disease?

A

Hepatosplenomegaly, echogenic spleen with small areas of hypoechogenicity or hyperechoic foci

101
Q

What is not a sign and symptom of biliary astrasia?

A

Dark stools

102
Q

Choledochal cysts are the leading cause of liver transplantation in children. True or false.

A

False.

103
Q

True or false: The pancreas is better seen in the peds pop. than the adult pop.?

A

True

104
Q

What is the most common splenic mass in the pediatric population?

A

Cysts

105
Q

True or False: Splenic Sequestrian Syndrome is seen in children who have Sickle Cell Disease?

A

True

MIDS 127 - abdo (14 decks)

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