Pediatric Abdomen Flashcards
1
Q
Symptoms and signs referable to the bowel:
A
- colicky pain
- vomiting
- diarrhea
- abnormal/bloody stools
- absence of bowel sounds
- abdominal mass
2
Q
Appendicitis may mimic what three things?
A
- Mesenteric Adenitis
- Crohn’s Disease
- Meckel’s Diverticulum
3
Q
What is the most common indication for abdominal surgery in children?
A
Appendicitis
4
Q
What causes appendicitis?
A
Luminal obstruction by fecal impaction
5
Q
What can appendicitis lead to? (3)
A
- luminal distention
- bacterial infection
- ischemia
6
Q
Symptoms and signs of appendicitis: (4)
A
- RLQ pain
- N/V
- Fever
- Leukocystosis
7
Q
Acute Appendicitis appearance:
A
- Non-compressible
- > 6mm
- fluid filled
- peripherally hyperemic on Doppler
- appendicolith
- increased periappendiceal echogenicity representing inflammed fat
8
Q
Ultrasound sensitivity for appendicitis
A
85%
9
Q
What should be done to better see a retrocecal appendix?
A
Left Lateral Decubitis
10
Q
What is mesenteric adenitis?
A
inflammation of mesenteric lymph nodes, comes from a variety of infections, usually viral, non-surgical
11
Q
Sonographic findings of mesenteric adenitis: (4)
A
- > 3 lymph nodes
- max short axis diameter of nodes is >5mm
- possible bowel thickening
- nodes tender on compression
12
Q
Symptoms of mesenteric adenitis: (3)
A
- abdominal pain, often near lower right side
- abdominal tenderness
- fever
13
Q
Crohn’s disease usually affects children how old?
A
> 10 years
14
Q
Crohn’s disease AKA
A
Regional enteritis
15
Q
What does Crohn’s disease most commonly affect?
A
Terminal Ileum
16
Q
Sonographic Findings of Crohn’s Diesese : (4)
A
- Loss of bowel wall stratification (later disease)
- Thickened Bowel Wall (>5mm)
- Hypervascular bowel wall
- Creeping fat
17
Q
Complications of Crohn’s Disease? (4)
A
- phlegmon
- abscess formation
- fistula
- stricture
18
Q
What is the most common structural anomaly of the GI tract?
A
Meckel’s Diverticulum
19
Q
What is Meckel’s diverticulum?
A
Remnant of the omphalomesenteric duct- the ileal end of duct remains patent (normally involutes during first trimester…appears as an outpouching or bulge in distal ileum
20
Q
Signs and symptoms of Meckel’s diverticulum: (4)
A
- most are asymptomatic
- gastrointestinal bleeding
- bowel obstruction
- diverticulitis
21
Q
When Meckel’s diverticulum is inflammed, it can resemble:
A
appendicitis
22
Q
What is an intussusception?
A
invagination of a proximal segment of intestine into a more distal segment of bowel “telescoping”
23
Q
What is the most common acute abdominal disorder of EARLY childhood?
A
Intussusception
24
Q
For what age range is intuss most common?
A
3 months-3 years (especially 5-9 months)
25
What percent of intuss occur in the ileocolic region?
90%
26
What are a major cause of intuss?
enlarged nodes in terminal ileum
27
Symptoms of intuss: (4)
- episodic, severe abd pain
- vomiting
- red "currant jelly" stools of blood and mucus
- palpable abd mass
28
How can one exclude intuss sonographically?
show a normal cecum and ileocecal junction in RLQ
29
Ultrasound findings of intuss: (4)
- alternating concentric hypo and hyperechoic rings
- bowel segment diameter >3 cm
- free fluid sometimes
- trapped nodes
30
What is the name of the internal component of an intuss?
intussusceptum (m=middle)
31
Describe small bowel-small bowel intuss:
Small, (
32
What is the incidence of hypertrophic pyloric stenosis?
3 in 1,000 (M>F, 4-5:1)
33
Typical age of presentation of pyloric stenosis:
2-6 weeks old
34
Signs and Symptoms of HPS: (6)
- non-bilious, projectile vomiting
- abd pain
- constant hunger
- wave-like motion of abd shortly after feeding
- dehydration
- weight loss
35
Sonographic measurements of positive HPS:
Thickness: > or = 3 mm **more important**
Length: > or = 16 mm
36
Who are more likely to have borderline wall thickness with HPS?
Premature infants (2.0-2.9mm)
37
The pylorus channel sits between:
The stomach and duodenum
38
What is Henoch-Schonlein Purpura?
systemic vasculitis characterized by deposition of immune complexes in the skin and kidney
39
What can cause small bowel hemorrhage and is a risk factor for intuss?
Henoch-Schonlein Purpura
40
______% of Henoch-Schonlein Purpura affect bowel
50%
41
Symptoms of Henoch-Schonlein Purpura (HSP): (4)
- rash
- joint pain
- abdominal pain due to bowel wall hemorrhage/intuss
- kidney involvement -glomerulonephritis
42
How might Henoch-Schonlein Purpura (HSP) appear sonographically?
edema, inflammation, and hematoma of bowel wall
43
What is Hemolytic Uremic Syndrome (HUS)?
Diarrhea followed by renal failure, anemia, fever and thrombocytopenia...usually due to infection from E.Coli
44
Symptoms of Hemolytic Uremic Syndrome: (10)
- bloody diarrhea
- vomiting
- abd pain
- pale skin tone
- lethargy & irritability
- fever
- bruises and/or nose and mouth bleeds
- decreased urination or blood in urine
- swelling
- confusion
45
Sonographic findings of Hemolytic Uremic Syndrome (HUS) : (2)
- marked thickening of large bowel wall
| - bilaterally enlarged kidneys with large hyperechoic cortex and increased corticomedullary differentiation
46
How does bowel malrotation occur?
when intestines fail to rotate normally during development
47
Bowel malrotation increases risk of _______
Volvulus
48
Bowel malrotation affects how many children?
1/500, M:F 1:1
49
Volvulus results in
vascular torsion, requiring emergency surgery to restore blood flow
50
What is the only symptom of volvulus?
bilious (bright green) emesis..otherwise healthy
51
What is the study of choice to ruleout malrotation?
Upper GI study, however, US may be used to assess SMA/SMV relationship
52
What is the normal postioning of SMA and SMV?
SMA is normaly on the left and anterior to the AO, while the SMV is on the right..this is reversed with malrotation
53
What sign represents a volvulus sonographically?
whirlpool sign
54
The most frequent palpable masses in peds patients are ______ in origin.
Renal
55
What is the most common cause of a palpable mass in a pediatric patient?
Hydronephrosis, followed by multicystic dysplastic kidney
56
List masses found in Liver: (5)
- hepatoblastoma
- infantile hepatic hemangioendothelioma
- metastases
- mesenchymal hamartoma
- hepatocellular carcinoma
57
List masses found in pancreas: (4)
- pseudocyst
- pancreatoblastoma
- solid pseudopapillary tumor
- islet cell tumors
58
List masses found in bowel: (2)
- duodenal hematoma
| - duplication cysts
59
What is the most common primary malignant liver lesion in children?
Hepatoblastoma
60
____% of hepatoblastoma cases are in children
90%
| 68%
61
Where are hepatoblastomas usually found?
unifocal, right lobe more often
62
How large are hepatoblastomas?
10-12 cm
63
Clinical presentation of hepatoblastoma: (6)
- painless abd mass
- hepatomegaly
- weight loss/ N/V/ anemia
- **elevated AFP in 90%
- males > females (2:1)
- premature babies
64
Conditions associated with hepatoblastoma include: (6)
- Bechwith-Wiedemann Syndrome
- Isolated hemihypertorphy
- Fetal Alcohol Syndrome
- Familial polyposis coli
- Gardner syndrome
- Wilms tumor
65
Describe hepatoblastoma sonographically (4)
- solitary usually
- heterogeneous with some hyperechoic areas due to hemorrhage/necrosis
- calcification
- hypervascular
66
What pediatric hepatic mass can result in heart failure?
Infantile Hepatic Hemangioendothelioma
67
85% of infantile hemangioendotheliomas present by what age?
6 months
68
Primary characteristic of hepatic mesenchymal hamartoma?
cystic nature
69
Hepatic mets are primarily from what in a young child?
neuroblastomas, but also Wilm's , lymphoma, leukemia
70
Clinical presentations of hepatic mesenchymal hamartomas?
- usually asymptomatic
- respiratory distress
- increasing abd mass size
71
What pediatric abd abnormality may appear like swiss cheese?
hepatic mesenchymal hamartoma
72
What is the second most common primary malignant tumor in children?
hepatocellular carcinoma (4-5 years) and (12-14 years)
73
What abdominal malignancy is associated with pre-existing liver abnormalities?
hepatocellular carcinoma
74
Most common pancreas mass in children:
pseudocyst
75
How does pancreatoblastoma appear sonographically?
LARGE, heterogeneous, multiloculated
76
Is pacreatoblastoma malignant or benign?
malignant
77
Whos is more likely to have solid pseudopapillary tumor?
asian, adolescent girls, med age of diagnosis is 26
78
How does solid psuedopapillary tumor appear sonographically?
large, with solid and cystic components
79
Which islet cell tumor is most common in children?
insulinoma, still rare however
80
What bowel mass results from trauma?
duodenal hematoma
81
How does duodenal hematoma appear sonographically?
hypoechoic mass with thickened duodenal wall, no internal flow
82
What are duplication cysts?
rare congenital malformations where abnormal portions of the intestine are attached to the normal bowel, most commonly at terminal ileum
83
What is the sonographic appearance of duplication cysts?
"gut signature", cysts have layers like the gut in their wall
84
What disorder may be found anywhere in the abdomen on a post-txp pt?
Post-Txp Lymphoproliferative Disorder (PTLD)..affects children who are on immunosuppresants
85
Newly positive EBV titer may signify
PTLD
86
Abdominal involvement of PTLD may cause : (3)
- abd pain and distention
- bloody stool
- intuss
87
PTLD US findings: (4)
- abdomen is most common site
- extra-nodal sites
- solid masses in/near TXP organ
- bowel wall involvement
