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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
In peds, describe the reason for an abscess, as well as the SA.
Trauma, direct invasion of adjacent structures. Appearance is the same as adults - hypoechoic complex masses with poorly defined borders
26
For hydatid/echinococcal cysts, what is the peak incidence occurrence age?
5-15 yrs
27
For peds, what does metabolic liver disease most likely cause?
Most commonly causes fatty infiltration
28
Describe hemochromatosis.
Excessive amount of iron stored in the liver. Not a lot of penetration down to the posterior. Increased parenchymal echogenicity, cirrhosis, hepatomegaly.
29
Primary malignant tumours are more common in adults than children. True or false?
False. They are more common.
30
How do malignant neoplasms generally show themselves in peds?
Generally present as a solitary solid homogenous hyperechoic mass
31
What is the most common pediatric liver mass?
Hepatoblastoma
32
Hepatoblastoma is most common in...
Boys under 5yo.
33
What is a common symptom with hepatoblastoma?
Hepatomegaly or painless palpable abdominal mass. INCREASED AFP.
34
Describe Fibrolamellar Hepatocellular Carcinoma.
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
35
Describe Mesenchymal Sarcoma.
AKA Embryonal Sarcoma. 5-10yrs. Abdo pain and swelling, palpable mass. NO INCREASE IN AFP.
36
What is the sonographic finding of Mesenchymal/Embryonal Sarcoma?
Round hyperechoic solitary mass with well-defined borders and a thick fibrous pedudocapsule, typically in RLL.
37
What does a hepatic infarction look like?
Wedge shaped, hypoechoic.
38
What describes: rare benign vasc condition, dilated sinusoidal blood filled spaces within the liver.
Peliosis Hepatis
39
What is associated with UVC (umbilical vein cath), bowel surgery, neonatal gastroenteritis?
Portal Venous Gas
40
What does portal venous gas look like?
Multiple mobile echogenic foci (no shadowing or reverb)
41
What are the most common congenital anomalies in peds?
Biliary atresia and choledochal cysts
42
Does biliary atresia affect boys or girls more?
Boys
43
What are the SS of peds biliary atresia?
Jaundice in neonates, elevated conjugated/direct bilirubin, pale stools, dark urine, hepatomegaly
44
What are the sonographic features of Biliary Atresia?
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
Choledochal cysts are more common in boys or girls?
Girls
46
What are the three most common causes of jaundice in peds?
Biliary atresia, hepatitis, and choledochal cysts
47
What are the five types of choledochal cysts?
``` Fusiform (MOST COMMON) Diverticulum Choledochocele Dilation of CBD with IHDD Caroli Disease ```
48
What is the most common type of Choledochal Cysts?
Fusiform
49
What is Caroli's disease associated with?
Cystic disease of the kidney
50
What are the SS of Caroli's disease?
Ongoing cramp-like abdo pain, secondary to biliary stasis, ductal stones, cholangitis, hepatic fibrosis
51
What is an abnormal GB size for infants and children?
Anything smaller than: Infants: 1.5-3.0cm Children 3-7cm
52
Small or non-distended GB can be a sign of:
Biliary atresia, congential hypoplasia, AVH, cystic fibrosis, chronic cholecystitis
53
Large GB may indicate:
Prolonged fasting, hydrops, obstruction of cystic duct or CBD
54
Non-visualization of the GB can indicate:
Biliary atresia or viral hepatitis
55
When a GB wall is thicker than 5mm, what does this mean?
Indicative of disease in peds pop.
56
Sickle cell disease raises the risk of:
Cholelithiasis (2x)
57
Pancreatitis is a common complication of:
Cholelithiasis
58
What is Mirizzi Syndrome?
Compression of the extrahepatic ducts due to stones impacted in GB neck or cystic duct causing inflammation and obstruction of CBD
59
What are the signs and symptoms of Mirizzi syndrome? What would be elevated in labs?
Asymptomatic or pain, fatigue, pruritis, jaundice Labs elevated: alk phos, AST, ALT, WBC, direct bilirubin (if jaundice is present)
60
What is the sonographic finding of a hydropic GB?
Big big gallbladder, completely anechoic with thin walls (possible stones or sludge)
61
Where does the vessel dilate during obstruction?
Proximal to the obstruction
62
What is Bile Plug Syndrome?
Causes biliary obstruction in full term infants.
63
What is Inspissated Bile Syndrome?
Causes biliary obstruction in full-term infants.
64
What is Schlerosing Cholangitis?
Inflammatory fibrosis obliterating intrahepatic and extrahepatic ducts
65
Inflammatory bowel disease is often associated with:
Sclerosing Cholangitis
66
Are the walls thickened or thinned during Sclerosing Cholangitis?
Thickened
67
What is the most common biliary tract findings in children with AIDS?
Calculus cholecystitis and cholangitis
68
What is a rare soft tissue tumour that occurs in children?
Rhabdomyosarcoma
69
What is the second most common cause of obstructive jaundice?
Rhabdomyosarcoma (neonates - after biliary atresia) (older children - after choledochal cyst)
70
Is there a raised tumour marker in Rhabdomyosarcoma?
No, AFP does not increase
71
Where does Rhabdomyosarcoma usually occur?
The hilum of the liver
72
What two masses occur typically at the hilum of the liver?
Rhabdomyosarcoma and Klatskins tumour
73
What is the Annular Pancreas and is it more common in boys or girls?
Bifurcated pancreatic head that encases the duodenum. More common in boys. Associated with other congenital anomalies.
74
What affects the exocrine glands in the lungs and GIT?
Cystic fibrosis
75
What does cystic fibrosis do?
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
What is cystic fibrosis commonly mistaken for?
Chronic Pancreatitis
77
Insulinomas and gastrinomas are a ______ Cell Tumour.
Islet
78
Insulinoma is commonly found in the pancreatic ________.
Body/tail
79
Adenoma is most common in the pancreatic ______.
Head
80
What is the most common cause of Pancreatits in peds?
Blunt abdo trauma
81
What are the SS of acute pancreatitis?
Nausea/vomiting, abdo pain, fever, tachycardia, abdominal distention and tenderness
82
What is an Acute Pancreatitis complication?
Pseudocysts
83
Where are pseudocysts most commonly found?
In pancreas/adjacent to pancreas.
84
How fast do pseudocysts resolve in peds?
4-12 wks, typically faster than adults
85
What are the Acute Pancreatitis Complications (peds)?
Hemorrhage Phlegmon Abscess
86
What is the most common mass in the ped population (of all organs)?
Splenic cysts
87
What is the most common fungal infection?
Candida; involves liver and spleen
88
What is the sonographic appearance of Candida?
Bull's eye/target
89
What is another name for Bartonella Henselae infection?
Cat scratch disease
90
What is another name for Cat Scratch disease?
Bartonella Henselae Infection
91
How does Bartonella Henselae (Cat Scratch Disease) show on
Multiple hypoechoic microabscesses which may calcify
92
What are the 4 most common splenic tumours?
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
Name all 8 Splenic Tumours (peds)
Lymphoma, leukemia, hemangioma, hamartoma, lymphangioma, leiomyoma, angiosarcoma, mets
94
What causes rapid splenic enlargement due to blood pooling the splenic tissue? (while riding a horse)?
Splenic Sequestration Syndrome
95
What is the SS of Splenic Sequestration Syndrome?
Rapid splenic enlargement, acute drop in hematocrit, extreme LUQ pain
96
What is Sickle Cell Anemia?
Formation of abnormal hemoglobin
97
What are the SS of Sickle Cell Anemia?
Intense pain, potentially rapid drop in hematocrit and become hypotensive
98
What are the sonographic findings of Sickle Cell Anemia?
Splenomegaly with hyperechoic and hypoechoic areas of autoinfarction In older children, spleen is small and fibrotic from chronic autoinfarction and may calcify
99
What is the most common lysosomal storage disorder?
Gaucher Disease
100
What is the sonographic finding of Gaucher Disease?
Hepatosplenomegaly, echogenic spleen with small areas of hypoechogenicity or hyperechoic foci
101
What is not a sign and symptom of biliary astrasia?
Dark stools
102
Choledochal cysts are the leading cause of liver transplantation in children. True or false.
False.
103
True or false: The pancreas is better seen in the peds pop. than the adult pop.?
True
104
What is the most common splenic mass in the pediatric population?
Cysts
105
True or False: Splenic Sequestrian Syndrome is seen in children who have Sickle Cell Disease?
True

MIDS 127 - abdo (14 decks)

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