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Pediatric Sonography > Pediatric Abdomen > Flashcards

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
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2
Q

Appendicitis may mimic what three things?

A
  • Mesenteric Adenitis
  • Crohn’s Disease
  • Meckel’s Diverticulum
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3
Q

What is the most common indication for abdominal surgery in children?

A

Appendicitis

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4
Q

What causes appendicitis?

A

Luminal obstruction by fecal impaction

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5
Q

What can appendicitis lead to? (3)

A
  • luminal distention
  • bacterial infection
  • ischemia
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6
Q

Symptoms and signs of appendicitis: (4)

A
  • RLQ pain
  • N/V
  • Fever
  • Leukocystosis
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7
Q

Acute Appendicitis appearance:

A
  • Non-compressible
  • > 6mm
  • fluid filled
  • peripherally hyperemic on Doppler
  • appendicolith
  • increased periappendiceal echogenicity representing inflammed fat
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8
Q

Ultrasound sensitivity for appendicitis

A

85%

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9
Q

What should be done to better see a retrocecal appendix?

A

Left Lateral Decubitis

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10
Q

What is mesenteric adenitis?

A

inflammation of mesenteric lymph nodes, comes from a variety of infections, usually viral, non-surgical

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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
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12
Q

Symptoms of mesenteric adenitis: (3)

A
  • abdominal pain, often near lower right side
  • abdominal tenderness
  • fever
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13
Q

Crohn’s disease usually affects children how old?

A

> 10 years

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14
Q

Crohn’s disease AKA

A

Regional enteritis

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15
Q

What does Crohn’s disease most commonly affect?

A

Terminal Ileum

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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
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17
Q

Complications of Crohn’s Disease? (4)

A
  • phlegmon
  • abscess formation
  • fistula
  • stricture
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18
Q

What is the most common structural anomaly of the GI tract?

A

Meckel’s Diverticulum

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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

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20
Q

Signs and symptoms of Meckel’s diverticulum: (4)

A
  • most are asymptomatic
  • gastrointestinal bleeding
  • bowel obstruction
  • diverticulitis
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21
Q

When Meckel’s diverticulum is inflammed, it can resemble:

A

appendicitis

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22
Q

What is an intussusception?

A

invagination of a proximal segment of intestine into a more distal segment of bowel “telescoping”

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23
Q

What is the most common acute abdominal disorder of EARLY childhood?

A

Intussusception

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24
Q

For what age range is intuss most common?

A

3 months-3 years (especially 5-9 months)

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25
Q

What percent of intuss occur in the ileocolic region?

A

90%

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26
Q

What are a major cause of intuss?

A

enlarged nodes in terminal ileum

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27
Q

Symptoms of intuss: (4)

A
  • episodic, severe abd pain
  • vomiting
  • red “currant jelly” stools of blood and mucus
  • palpable abd mass
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28
Q

How can one exclude intuss sonographically?

A

show a normal cecum and ileocecal junction in RLQ

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29
Q

Ultrasound findings of intuss: (4)

A
  • alternating concentric hypo and hyperechoic rings
  • bowel segment diameter >3 cm
  • free fluid sometimes
  • trapped nodes
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30
Q

What is the name of the internal component of an intuss?

A

intussusceptum (m=middle)

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31
Q

Describe small bowel-small bowel intuss:

A

Small, (

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32
Q

What is the incidence of hypertrophic pyloric stenosis?

A

3 in 1,000 (M>F, 4-5:1)

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33
Q

Typical age of presentation of pyloric stenosis:

A

2-6 weeks old

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34
Q

Signs and Symptoms of HPS: (6)

A
  • non-bilious, projectile vomiting
  • abd pain
  • constant hunger
  • wave-like motion of abd shortly after feeding
  • dehydration
  • weight loss
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35
Q

Sonographic measurements of positive HPS:

A

Thickness: > or = 3 mm more important
Length: > or = 16 mm

36
Q

Who are more likely to have borderline wall thickness with HPS?

A

Premature infants (2.0-2.9mm)

37
Q

The pylorus channel sits between:

A

The stomach and duodenum

38
Q

What is Henoch-Schonlein Purpura?

A

systemic vasculitis characterized by deposition of immune complexes in the skin and kidney

39
Q

What can cause small bowel hemorrhage and is a risk factor for intuss?

A

Henoch-Schonlein Purpura

40
Q

______% of Henoch-Schonlein Purpura affect bowel

A

50%

41
Q

Symptoms of Henoch-Schonlein Purpura (HSP): (4)

A
  • rash
  • joint pain
  • abdominal pain due to bowel wall hemorrhage/intuss
  • kidney involvement -glomerulonephritis
42
Q

How might Henoch-Schonlein Purpura (HSP) appear sonographically?

A

edema, inflammation, and hematoma of bowel wall

43
Q

What is Hemolytic Uremic Syndrome (HUS)?

A

Diarrhea followed by renal failure, anemia, fever and thrombocytopenia…usually due to infection from E.Coli

44
Q

Symptoms of Hemolytic Uremic Syndrome: (10)

A
  • 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
Q

Sonographic findings of Hemolytic Uremic Syndrome (HUS) : (2)

A
  • marked thickening of large bowel wall

- bilaterally enlarged kidneys with large hyperechoic cortex and increased corticomedullary differentiation

46
Q

How does bowel malrotation occur?

A

when intestines fail to rotate normally during development

47
Q

Bowel malrotation increases risk of _______

A

Volvulus

48
Q

Bowel malrotation affects how many children?

A

1/500, M:F 1:1

49
Q

Volvulus results in

A

vascular torsion, requiring emergency surgery to restore blood flow

50
Q

What is the only symptom of volvulus?

A

bilious (bright green) emesis..otherwise healthy

51
Q

What is the study of choice to ruleout malrotation?

A

Upper GI study, however, US may be used to assess SMA/SMV relationship

52
Q

What is the normal postioning of SMA and SMV?

A

SMA is normaly on the left and anterior to the AO, while the SMV is on the right..this is reversed with malrotation

53
Q

What sign represents a volvulus sonographically?

A

whirlpool sign

54
Q

The most frequent palpable masses in peds patients are ______ in origin.

A

Renal

55
Q

What is the most common cause of a palpable mass in a pediatric patient?

A

Hydronephrosis, followed by multicystic dysplastic kidney

56
Q

List masses found in Liver: (5)

A
  • hepatoblastoma
  • infantile hepatic hemangioendothelioma
  • metastases
  • mesenchymal hamartoma
  • hepatocellular carcinoma
57
Q

List masses found in pancreas: (4)

A
  • pseudocyst
  • pancreatoblastoma
  • solid pseudopapillary tumor
  • islet cell tumors
58
Q

List masses found in bowel: (2)

A
  • duodenal hematoma

- duplication cysts

59
Q

What is the most common primary malignant liver lesion in children?

A

Hepatoblastoma

60
Q

____% of hepatoblastoma cases are in children

A

90%

68%

61
Q

Where are hepatoblastomas usually found?

A

unifocal, right lobe more often

62
Q

How large are hepatoblastomas?

A

10-12 cm

63
Q

Clinical presentation of hepatoblastoma: (6)

A
  • painless abd mass
  • hepatomegaly
  • weight loss/ N/V/ anemia
  • **elevated AFP in 90%
  • males > females (2:1)
  • premature babies
64
Q

Conditions associated with hepatoblastoma include: (6)

A
  • Bechwith-Wiedemann Syndrome
  • Isolated hemihypertorphy
  • Fetal Alcohol Syndrome
  • Familial polyposis coli
  • Gardner syndrome
  • Wilms tumor
65
Q

Describe hepatoblastoma sonographically (4)

A
  • solitary usually
  • heterogeneous with some hyperechoic areas due to hemorrhage/necrosis
  • calcification
  • hypervascular
66
Q

What pediatric hepatic mass can result in heart failure?

A

Infantile Hepatic Hemangioendothelioma

67
Q

85% of infantile hemangioendotheliomas present by what age?

A

6 months

68
Q

Primary characteristic of hepatic mesenchymal hamartoma?

A

cystic nature

69
Q

Hepatic mets are primarily from what in a young child?

A

neuroblastomas, but also Wilm’s , lymphoma, leukemia

70
Q

Clinical presentations of hepatic mesenchymal hamartomas?

A
  • usually asymptomatic
  • respiratory distress
  • increasing abd mass size
71
Q

What pediatric abd abnormality may appear like swiss cheese?

A

hepatic mesenchymal hamartoma

72
Q

What is the second most common primary malignant tumor in children?

A

hepatocellular carcinoma (4-5 years) and (12-14 years)

73
Q

What abdominal malignancy is associated with pre-existing liver abnormalities?

A

hepatocellular carcinoma

74
Q

Most common pancreas mass in children:

A

pseudocyst

75
Q

How does pancreatoblastoma appear sonographically?

A

LARGE, heterogeneous, multiloculated

76
Q

Is pacreatoblastoma malignant or benign?

A

malignant

77
Q

Whos is more likely to have solid pseudopapillary tumor?

A

asian, adolescent girls, med age of diagnosis is 26

78
Q

How does solid psuedopapillary tumor appear sonographically?

A

large, with solid and cystic components

79
Q

Which islet cell tumor is most common in children?

A

insulinoma, still rare however

80
Q

What bowel mass results from trauma?

A

duodenal hematoma

81
Q

How does duodenal hematoma appear sonographically?

A

hypoechoic mass with thickened duodenal wall, no internal flow

82
Q

What are duplication cysts?

A

rare congenital malformations where abnormal portions of the intestine are attached to the normal bowel, most commonly at terminal ileum

83
Q

What is the sonographic appearance of duplication cysts?

A

“gut signature”, cysts have layers like the gut in their wall

84
Q

What disorder may be found anywhere in the abdomen on a post-txp pt?

A

Post-Txp Lymphoproliferative Disorder (PTLD)..affects children who are on immunosuppresants

85
Q

Newly positive EBV titer may signify

A

PTLD

86
Q

Abdominal involvement of PTLD may cause : (3)

A
  • abd pain and distention
  • bloody stool
  • intuss
87
Q

PTLD US findings: (4)

A
  • abdomen is most common site
  • extra-nodal sites
  • solid masses in/near TXP organ
  • bowel wall involvement

Pediatric Sonography (7 decks)

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