Pediatric Pathology Flashcards by Gina VanSteenacker

What is the age of an infant?

one month to 2 years

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What is the age of a neonate?

birth to one month

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What is the age of a child?

two to 12 years of age

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What is the age of an adolescent?

12 -16 years

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What is the most common indication for imaging the biliary tree?

Jaundice

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What is transient jaundice?

it comes and goes during the first few weeks of life

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What are some of the common causes of jaundice?

choledochal cyst

biliary atresia

hepatitis

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What kind of obstruction do you have if you have choledochal cyst, biliary atresia, or perforation of ducts?

extrahepatic obstruction

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If you have hepatitis or metabolic disease what kind of obstruction might you have?

intrahepatic obstruction - hepatocellular

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What are the symptoms of choledochal cyst?

palpable mass

weight loss
jaundice and pain

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What is a choledochal cyst?

abnormal cystic dilation of the biliary tree

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What are the types of choledochal cyst?

fusiform - dilatation of the CBD

Cystic structures communication with the ducts

dilation of the intra nd extra hepatic ducts

CAROLI’S disease with intrahepatic duct dilation

NOT A CYST BUT A DILATION OF DUCTS

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Out pouching of ducts IN the liver is…

Caroli’s disease

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What is neonatal hepatitis?

infection

hepatomegaly

Metabolic, idopathic, via vagina, catherter

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how does hepatitis look on a neonate?

increased in echogenicity

decreased visualization of vessels

(starry night doesn’t work in these cases, already echogenic)

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What is biliary atresia?

narrowing or underdevelopment of biliary ductal system

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What are the symptoms of biliary atresia?

jaundice

acholic (clay like) stools

distended abdomen

absent or small GB

slight decrease in visualization of portal

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What is the sign in histology for biliary atresia?

“triangular cord” sign

US sees a echogenic, thick cord anterior to the PV

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What is polysplenia syndrome?

heart defects and situs abnormalities

spleen abnormalities

biliary atresia

KASI OPERATION

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What is the Kasai operation?

anastomosis of liver ducts to intestine

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What kind of Nuc Med scan do you do if you have a jaundice problem?

Hepatic Scintigraphy

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What is hemangioendothelioma?

most common benign vascular tumor in childhood

hepatomegaly

regresses by 12-18 months

multiple hypoechoic lesions/ heterogeneous

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What is a hepatoblastoma?

**most common* primary malignancy of the liver in children

associated with BECKWITH-WIDEMANN (organs are too big)

single, solid, large

necrosis, hemorrhage, calcification

palpable mass

fever, weight loss

What parasite looks like folded ribbon inside and anechoic structure

hydatid echinococcosis (water lily sign)

see slide 29 for a picture

How do the kidneys appear on peds?

medullary pyramids are large and hypoechoic cortex: thin arcuate arteries: base of medullary pyramids, may appear echogenic fetal lobulation - incomplete fusion

What is PUV?

Posterior Urethral Valve syndrome ** most common** cause of urethral obstruction in BOYS

What is the medical name for the keyhole bladder sign?

PUV

Is PUV congenital or aquired?

congenital surgical fix causes hydronephrosis

WHAT IS A URETEROPELVIC JUNCTION (UPJ) obstruction?

intrinsic narrowing or extrinsic vascular compression pelvocalyceal dilation without ureteral dilation

What disease is described as big, bright and bilateral?

ARPKD (autosomal recessive polycystic kidney disease)

What causes renal vein thrombosis?

severe dehydration or septic infant hematuria, proteinuria and low platelet enlarged kidney - because the vein is not bringing back the blood to be filtered

What is a nephroblastoma

Wilm's Tumor **most common malignant** RENAL tumor in children unilateral large, solid, echogenic mass with calcifications

What hemorrhages with birth trauma?

adrenal hemorrhage as you f/u it should decrease in size see slide43 for pic

What is HPS?

hypertrophic Pyloric stenosis congenital obstruction of pylorus due to hypertrophy of muscles

Who is most likely to get HPS?

Male FIRST BORN infant 2-10 weeks

Where do you find HPS?

pyloric canal - stomach to duodenum

Which disease is described by the Olive sign?

Hypertrophic Pyloric Stenosis (HPS)

How do you surgically fix HPS?

Pyloromyotomy

What are the symptoms of HPS?

bile free vomiting in an otherwise healthy infant dehydration and weight loss

How do you image HPS?

supine and RLD high frequency linear array 5 or 7 MHz

What are the measurements for HPS?

channel length >14-17 mm (must be < 17mm) muscle thickness long axis 4mm diameter 15mm no peristalsis thru pylorus *all measurements are at the top threshold

How do you scan for appendicitis?

Pelvic survey - localize pain right flank with a linear transducer graded compression (lack of compressibility) RLQ pain and vomiting

The outer diameter for appendicitis cannot be greater than _____

6mm slide 63

What is intussusception?

most common ACUTE abdominal disorder in early childhood 6 months -2 years bowels prolapse into distal bowel cause obstruction higher incidence in males

Which pathology do you use a barium enema to determine?

intussusception

What is the sign for intussusecption?

Target or donut sign (transverse) pseudokidney or sandwich sign (long)

What are the symptoms for intussusception?

colicky abdominal pain vomiting bloody stools abdominal distention palpable mass bloody stools vomiting colicky abdominal pain

What transducer do you use for intussuseception?

linear array using graded compression

What is midgut malrotation/volvulus?

failure of rotation of bowel Upper GI - imaging of choice **changes the position of the SMA and SMV*** (reversed)

For what pathology do you need a Ladd operation?

Midgut malrotation/volvulus

What are the congenital uterine anomalies?

slide 73 for pictures hypoplasia/agenesis unicornuate didelphus bicornuate septate arcuate DES drug related

What is the pediatric cause of HTN?

nephroblastoma (aka Wilm's tumor)

If you find a nephroblastoma what other structures do you evaluate?

renal vein IVC

describe an Unicornuate uterus

one Müllerian duct so only half uterus is formed rare

describe uterus didelphys

complete failure of the fusion of the ducts widely separate endometrial cavities

describe bicornuate uterus

most common uterine anomaly two horns indentation at the fundus

describe a septate uterus

endometrial cavities separated by a thin membrane associated with miscarriages treated: hysteroscopic resection * no indentation at fundus otherwise looks like bicornuate)