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Pediatric and Superficial Structures > Pediatric GI tract > Flashcards

Pediatric GI tract Flashcards

1
Q

What measurement is classified as gastric wall thickening?

A

5-15mm

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2
Q

What population is most affected by hypertrophic pyloric stenosis?

A

Males aged 2-10 weeks

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3
Q

What are the signs and symptoms of hypertrophic pyloric stenosis?

A
  1. Non-bilious projectile vomiting (obstruction occurs before bile duct)
  2. Dehydration
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4
Q

What are the two main SF of hypertrophic pyloric stenosis?

A
  1. Lack of fluid passing through pylorus

TRV - donut sign
SAG - cervix sign

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5
Q

A pyloric stenosis can be diagnosed with what measurements?

A

Channel length: >1.6cm
Muscle thickness: > or = 3mm

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6
Q

What is the “antral nipple sign”?

A

Prolapsed pyloric channel mucosa into the gastric antrum - is seen in hypertrophic pyloric stenosis

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7
Q

What structure will be NORMAL in patients with pyloric stenosis?

A

Stomach

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8
Q

What is the term for a thickened stomach wall?

A

Antritis

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9
Q

What is the type of surgery seen with hypertrophic pyloric stenosis?

A

Pyloromyotomy - pyloric muscle split down to the mucosa

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10
Q

SF of pylorospasm

A
  1. TRANSIENT thickening of pyloric canal
  2. Muscle is not hypertrophied
  3. Delayed passage of stomach contents
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11
Q

What are the 3 types of Bezoar and what do they contain?

A
  1. Lactobazoar - Insipissated milk (most common)
  2. Phytobezoar - poorly digested plant material
  3. Trichobezoar - Ingested hair
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12
Q

What are the signs and symptoms of bezoar?

A
  1. Early satiety
  2. Poor weight gain
  3. Vomiting
  4. Anorexia
  5. Bloating
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13
Q

Normal appearance of the appendix?

A
  1. Blind-ending structure
  2. NO peristalsis
  3. Less than 6mm
  4. Compressible
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14
Q

What is the most common condition requiring emergency surgery in children?

A

Appendicitis

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15
Q

Where is an inflamed appendix usually visualized?

A

Base of the cecal tip during max compression

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16
Q

What type of appendix placement will need an EV?

A

Retrocecal

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17
Q

SF of appendicities

A
  1. Tubular, non-compressible, blind-ending
  2. Target appearance (hypoechoic muscular wall with echogenic submucosal layer)
  3. > 6mm
  4. Free-fluid adjacent to appendix
  5. Echogenic fat in peri-appendiceal area
  6. Hyperemic
  7. Enlarged surrounding lymph nodes
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18
Q

What is a common appendicitis complication?

A

Perforation

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19
Q

What three groups are mucoceles classified into?

A
  1. Focal or diffuse hyperplasia
  2. Mucinous cystadenoma
  3. Mucinous cystadenocarcinoma
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20
Q

What is the cause of a pseudomyxoma peritonei?

A

Ruptured mucocele

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21
Q

What is the most common cause of obstructive bowel disease in early childhood?

A

Intussusception

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22
Q

What is the most common population to acquire intussusception?

A

Males aged 1-3

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23
Q

What is the most common type of intussusception?

A

Ileocolic

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24
Q

Signs and symptoms of intussusception?

A
  1. Intermittent colicky abdominal pain
  2. Bloody stool
  3. Distention
  4. Vomiting
  5. Possible palpable abdominal mass
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25
Q

What are the SF of intussusception?

A

TRV - target or donut sign - hypoechoic outer portion with an echogenic center

SAG - pseudokidney sign

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26
Q

Treatment for what pathology uses hydrostatic pressure under ultrasound guidance?

A

Intussusception

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27
Q

What are the three main complications of intussusception?

A
  1. Bowel obstruction
  2. Perforation/peritonitis
  3. Vascular compromise
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28
Q

What is the cause of malrotation?

A

Congenital - a result of malrotation of the gut

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29
Q

Malrotation predisposes patients to what 2 other pathologies?

A
  1. Midgut volvulus
  2. Internal hernias
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30
Q

Signs and symptoms of malrotation?

A
  1. Bilious vomiting
  2. Abdominal pain
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31
Q

SF of malrotation?

A

SMA/SMV reversal

32
Q

T or F? The SMA is normally seen to the right of the SMV?

A

FALSE: this is malrotation

33
Q

Volvulus is a complication of what?

A

Malrotation - when the SMV wraps around SMA

34
Q

Volvulus occurs when?

A

The bowel twists on itself and causes an obstruction

35
Q

Why is volvulus a surgical emergency?

A

The twisted bowel could become ischemic

36
Q

SF of volvulus?

A
  1. “Whirlpool” sign (result of the mesentery and SMV wrapped around the SMA)
  2. Inverted SMV / SMA - malrotation
  3. Thickened echogenic bowel wall
37
Q

What is another name for Hirschsprung disease?

A

Aganglionic megacolon

38
Q

What produces a functional obstruction in hirschsprung disease?

A

Aganglionic segment of the bowel remains in spasm

39
Q

SF of the bowel in Hirschsprung disease?

A
  1. Hugely dilated bowel
  2. Lack of peristalsis
40
Q

What is the most commonly affected portion in hirschsprung disease?

A

rectosigmoid colon

41
Q

T or F? Hirschsprung disease can be diagnosed in utero?

A

TRUE - Dilated bowel

42
Q

Signs and symptoms of hirschsprung disease?

A
  1. Abdominal distention
  2. Vomiting
  3. Constipation
43
Q

What is the most common congenital anomaly of the small intestine?

A

Meckel diverticulum - affects ileum

44
Q

Meckel diverticulum is an incomplete obliteration of?

A

The vitelline duct, which causes an outpouching of the small intestine (ileum)

45
Q

1 year old male presents with painless rectal bleeding, what could be a likely cause?

A

Meckel diverticulum

46
Q

SF of meckel diverticulum?

A
  1. Blind-ending peristaltic loop connected to the small bowel
  2. Fluid filled pouch
  3. Hyperemia if infected
47
Q

What may act as a lead point for intussusception?

A
  1. Meckel diverticulum
  2. Enteric duplication cyst
  3. Intestinal polyps
  4. Intramural
  5. Hematoma
  6. Small bowel mass
48
Q

Where are enteric duplication cysts usually found?

A

Ileum

49
Q

T or F? Enteric duplication cysts communicate with the bowel?

A

FASLE - they are located on the inner border of the mesentery along the ileum but DO NOT communicate with the bowel

50
Q

SF of enteric duplication cysts?

A
  1. Well-defined, round, cystic mass
  2. Hypoechoic muscular rim (outer) with hyperechoic inner rim
51
Q

What are the two main complications of enteric duplication cysts?

A
  1. Intussusception - lead point
  2. Pancreatitis - if near ampulla of vater
52
Q

What is the normal thickness of the small bowel wall?

A

Less than or equal to 2mm

53
Q

What bowel abnormalities are more common with Down’s syndrome?

A
  1. Hirschsprung disease
  2. Duodenal atresia
54
Q

What is the most common cause of obstruction in the small bowel?

A

Jejunal and ileal atresia’s

55
Q

What 4 abnormalities are associated with jejunal and ileal atresia?

A
  1. Midgut malrotation
  2. Gastroschisis
  3. Duodenal atresia
  4. Tracheoesophageal fistula
56
Q

Patient presents with bilious vomiting and failure to pass meconium. Upon imaging, you see dilated small bowel with active peristalsis. What is the most likely diagnosis?

A

Ileal or jejunal atresia

57
Q

What is meconium ileus?

A

Abnormally thickened meconium in the distal small bowel causes obstruction so the baby can’t poop

58
Q

What abnormality is commonly associated with meconium ileus?

A

Cystic fibrosis

59
Q

SF of meconium ileus?

A
  1. Echogenic bowel contents
  2. Dilated bowel loops
  3. Decreased peristalsis
60
Q

What does NEC stand for?

A

Necrotizing enterocolitis

61
Q

What population is NEC most common in?

A

Premature infants

62
Q

What is NEC?

A

Bowel undergoes necrosis due to ischemia from hypoxia and infection

63
Q

Signs and symptoms of NEC?

A
  1. Distended abdomen
  2. Vomiting
  3. Blood in stool
  4. Irritability
64
Q

SF of NEC?

A
  1. Thick walled fluid filled bowel loops
  2. Pneumatosis intestinalis
  3. Portal vein gas
  4. Pneumoperitoneum
  5. Hyperemia(initially)
  6. Ascites
65
Q

What is the most common inflammatory disease of the small bowel?

A

Chron’s disease

66
Q

What portion of the small bowel is mostly affected by chron’s?

A

Terminal ileum and proximal colon

67
Q

At what age does chron’s present?

A

10+

68
Q

Signs and symptoms of chron’s?

A
  1. Abdominal pain
  2. Diarrhea
  3. Fever
  4. Weight loss
69
Q

SF of chron’s?

A
  1. Thickened bowel walls (>2.5-3mm)
  2. Decreased peristalsis
  3. Increased vascularity
  4. Echogenic fat surrounding bowel loops
  5. Enlarged lymph nodes
  6. Possible inflamed appendix
70
Q

What does TRD stand for?

A

Transverse rectal diameter

71
Q

What TRD is suggestive of constipation/fecal impaction?

A

> 2.7-3.8 cm

72
Q

What is the most common malignant mass of the small bowel?

A

Lymphoma - m/c Non-hodgkin

73
Q

What portion of the bowel is most commonly affected by a lymphoma?

A

Ileum

74
Q

SF of bowel lymphoma?

A
  1. Hypoechoic bowel wall thickening or focal hypoechoic/complex mass with areas of necrosis
  2. Bowel lumen may be narrowed
  3. Potential splenomegaly
  4. Enlarged retroperitoneal and mesenteric lymph nodes
75
Q

Signs and symptoms of small bowel lymphoma?

A
  1. Palpable abdominal mass
  2. Abdominal pain
  3. Vomiting
76
Q

Whirlpool sign is associated with what pathology?

A

Midgut volvulus

Pediatric and Superficial Structures (23 decks)

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