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Pediatric and Superficial Structures > Pediatric Upper Abdomen > Flashcards

Pediatric Upper Abdomen Flashcards

1
Q

With coarctation of the Ao, >50% also have associated (what pathology)?

A

Renal artery stenosis

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2
Q

An interrupted IVC has drainage via?

A

Azygous vein (posterior to Ao)

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3
Q

What is the most common reason for AO evaluation in the neonate?

A

Abdominal Ao thrombosis

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4
Q

What is the main cause of abdominal Ao thrombosis?

A

UAC - umbilical artery catheter

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5
Q

Signs and symptoms of abdominal Ao thrombosis?

A

Absent femoral pulses
Hematuria
Cyanosis
Hypertension
Blanching of lower extremities
Necrotizing enterocolitis (NEC)

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6
Q

IVC thrombosis is a complication of what?

A

UVC - umbilical venous catheter

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7
Q

IVC tumour invasion can occur in what vessels?

A
  1. IVC
  2. Hepatic veins
  3. Renal artery
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8
Q

What is the most common vascular liver tumour in infancy?

A

Hemangiomas

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9
Q

What are the two main types of hemangioma’s?

A
  1. Cavernous
  2. Hemangioendothelioma’s
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10
Q

S/S of cavernous vs hemangioendothelioma’s?

A
  1. Cavernous - asymptomatic unless large
  2. Hemangioendothelioma - Hepatomegaly, CHF
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11
Q

SF of cavernous vs hemangioendothelioma’s?

A

Cavernous - hyperechoic, vascular, well-defined

Hemangioendothelioma - multiple, potential echogenic foci, hepatomegaly

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12
Q

What is the second most common benign hepatic mass seen in children?

A

Mesenchymal hamartoma

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13
Q

What population is typically seen with mesenchymal hamartoma?

A

Males < 2yrs

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14
Q

S/S of mesenchymal hamartoma?

A
  1. Painless abdominal swelling
  2. Anorexia
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15
Q

SF of mesenchymal hamartoma?

A
  1. Complex
  2. Internal septations
  3. Avascular
  4. More common in RT lobe
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16
Q

Polycystic liver disease is also seen with what two pathologies?

A
  1. Polycystic kidney disease
  2. Von hippel-lindau
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17
Q

Hydatid cysts are associated with the exposure to what?

A

Livestock, farming, dogs

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18
Q

Peak incidence of hydatid cysts?

A

5-15 yrs

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19
Q

What is the second most common site for hydatid infection after the liver?

A

Lungs

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20
Q

Urticaria (skin rash) is associated with what pathology?

A

Hydatid cysts

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21
Q

SF of hydatid cysts?

A
  1. Anechoic - complex
  2. Possible daughter cysts
  3. Calcifications
  4. “Water lily” sign
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22
Q

What is the most commonly injured abdominal organ in the neonate?

A

Liver - mostly the RT

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23
Q

Children and young adults are most often infected by what hepatitis virus?

A

Hep A - fecal oral route of contamination

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24
Q

Common symptom of hepatitis?

A

Jaundice - also seen with choledocal cysts and biliary atresia

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25
Q

What are the acute vs chronic SF of hepatitis?

A

Acute:
1. Normal or hepatomegaly
2. Hypoechoic
3. “Starry sky” sign

Chronic:
1. Hyperechoic
2. Cirrhotic

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26
Q

What vascular structures may be involved with a hepatic abscess?

A
  1. HA
  2. Portal V
  3. Umbilical vein (due to cutting the umbilical cord)
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27
Q

What pathology may appear as a bulls-eye appearance in the liver?

A

Abscess

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28
Q

What is the main cause of a pyogenic abscess?

A

Secondary to bowel infection

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29
Q

What pathology is typically caused by Candida albicans in immunosuppressed children within the liver?

A

Fungal abscess

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30
Q

SF of fungal abscess?

A
  1. MULTIPLE small lesions with irregular walls
  2. Hypoechoic/hyperechoic
  3. Target/wheel-within-wheel appearance
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31
Q

What liver pathology affects children in areas where drinking water is contaminated and poor sanitation?

A

Amebic abscess

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32
Q

What is the term for the accumulation of fat (triglycerides and lipids) in the hepatocytes?

A

Steatosis (fatty infiltration)

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33
Q

What does NASH stand for?

A

Non-alcoholic steatohepatitis

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34
Q

SF of diffuse fatty liver infiltration?

A
  1. Hyperechoic
  2. Reduced penetration (decrease the frequency)
  3. Hepatomegaly
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35
Q

Which location does focal fatty infiltration and sparing typically occur?

A

GB fossa/porta hepatis

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36
Q

What is the most common type of glycogen storage disease?

A

Von gierke type 1

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37
Q

What pathology is known as an enzyme defect resulting in the accumulation of excessive glycogen
and fat in the liver, intestines & kidneys?

A

Glycogen storage disease

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38
Q

SF of glycogen storage disease?

A
  1. Diffusely increased echogenicity, decreased penetration (fatty liver)
  2. Hepatomegaly
  3. Possibly solid liver masses (40% of cases of Type 1, typically the masses are adenomas)
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39
Q

Parenchymal destruction, scarring, fibrosis and nodular regeneration of the liver is known as?

A

Cirrhosis

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40
Q

Hepatic fibrosis is associated with what other pathology?

A

Infantile polycystic kidney disease (ARPKD)

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41
Q

S/S of hepatic fibrosis?

A
  1. Hepatomegaly
  2. Portal hypertension
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42
Q

What is the main cause of hemochromatosis?

A

Genetic

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43
Q

What is the main cause of hemosiderosis?

A

Repeated blood transfusions

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44
Q

T or F? Primary malignant tumours of the liver are more common in children than adults?

A

TRUE

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45
Q

What marker is usually elevated in liver malignancies?

A

AFP

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46
Q

What is the most common pediatric liver mass?

A

Hepatoblastoma

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47
Q

What is the most likely population that presents with a hepatoblastoma?

A

Boys under 5 yrs

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48
Q

S/S for hepatoblastoma?

A

Painless palpable mass, hepatomegaly

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49
Q

SF of hepatoblastoma?

A
  1. Solitary, multinodular mass
  2. Heterogeneous ,hyperechoic with indistinct
    borders
  3. Potentially areas of necrosis or hemorrhage
  4. Calcifications
  5. Hepatomegaly
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50
Q

What population is common with HCC/hepatoma?

A

Children over 3 yrs

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51
Q

SF of HCC?

A
  1. Solid hyperechoic mass
  2. Cystic areas of necrosis or hemorrhage
  3. Anechoic/hypo halo
  4. Tumor thrombi frequently seen in the portal veins, hepatic veins, IVC
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52
Q

What veins may be affected by HCC? (3)

A
  1. Hepatic veins
  2. Portal veins
  3. IVC
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53
Q

What is a subtype of HCC that most commonly affects teenagers and young adults?

A

Fibrolamellar HCC

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54
Q

What liver tumour does NOT have an increase in AFP?

A

Mesenchymal sarcoma

55
Q

What age is typical for mesenchymal sarcoma?

A

5-10 yrs

56
Q

SF of mesenchymal sarcoma?

A
  1. Round hyperechoic solitary mass (large)
  2. Singular mass - fast growing
  3. Well-defined borders and a thick fibrous pseudocapsule
57
Q

Metastases to the liver are commonly caused by what tumor?

A

Neuroblatsoma

58
Q

S/S of portal hypertension?

A
  1. Splenomegaly
  2. Ascites
  3. Caput medusa
59
Q

SF of portal hypertension?

A
  1. Splenomegaly
  2. Portal venous hepatofugal flow
  3. Ascites
  4. Varices
60
Q

What is a common etiology of portal venous thrombosis in peds?

A

Improper placement of UVC

61
Q

S/S of PV thrombosis?

A
  1. Abdominal pain
  2. Splenomegaly
62
Q

What is Budd Chiari syndrome?

A

Occlusion of HV’s and/or IVC

63
Q

SF of Budd-chiari?

A
  1. Hepatomegaly (back up of blood as the HV’s can’t drain)
  2. Absent flow in HV
  3. Echogenic HV lumen
64
Q

Hepatic infarction in Peds can occur due to what?

A

Occlusion in the HA - typically due to liver transplantation because of thrombus

65
Q

What is a common SF of hepatic infarction?

A

Wedge shaped, hypoechoic area near capsule periphery

66
Q

What is portal venous gas associated with?

A

UVC
In neonates - mesenteric ischemia due to NEC

67
Q

Common population of peds seen with portal venous gas?

A

Premature and low birth weight

68
Q

SF of portal venous gas?

A

Small echogenic foci seen and are mobile, seen moving with blood flow

69
Q

What pediatric abnormalities present with Jaundice?

A
  1. Hepatitis
  2. Biliary atresia
  3. Choledocal cysts
70
Q

What abnormality is described as a total absence of biliary tree (80%) to a visibly patent GB, cystic duct and CBD?

A

Biliary atresia

71
Q

S/S of biliary atresia?

A
  1. Jaundice
  2. PALE stool
  3. DARK urine
72
Q

What is the leading cause of liver transplantation in peds?

A

Biliary atresia

73
Q

What procedure is a treatment for biliary atresia?

A

Kasia procedure

74
Q

A fasting GB of less than what measurement indicates atresia?

A

<1.5 cm in length

75
Q

What is a pseudoGB?

A

GB less than 1.5 cm and undefined walls

76
Q

What is the triangular cord sign?

A

An echogenic area near anterior branch of RPV measuring >4mm in thickness

77
Q

What SF are indicative of biliary atresia?

A
  1. Small GB
  2. Triangular cord sign
78
Q

Biliary atresia vs choledocal cysts in commonality of males or females?

A

Biliary atresia - males

Choledocal cysts - females

79
Q

What is the most common form of choledocal cyst?

A

Fusiform - found adjacent to GB

80
Q

What is the 2nd m/c form of choledocal cyst?

A

Diverticulum of CBD

81
Q

What is Type 5 also known as?

A

Caroli’s disease - dilation of CBD and IHD - “string of beads sign”

82
Q

What is Caroli’s disease associated with?

A

Poly cystic kidney disease - medullary sponge kidney

83
Q

Patient presents on ultrasound with multiple cysts near porta hepatis, potentially extending to intrahepatic ductal system. What does this indicate?

A

Caroli’s disease

84
Q

What is known as communicating ectasia of the intrahepatic ducts?

A

Caroli’s disease

85
Q

Non-visualization of the GB is most commonly associated with what? (2)

A

Biliary atresia or viral hepatitis

86
Q

What GB wall measure indicates thickening?

A

Suggestive of disease = 2-5mm
Indicative of disease = > 5mm

87
Q

Focal GB wall thickening is associated with what 2 abnormalities?

A
  1. Cholecystitis
  2. Adenomyomatosis (hyperplasia of GB)
88
Q

Symptoms of cholelithiasis/cholecystitis in peds versus children?

A

Peds - irritability and jaundice

Children - intolerance to fatty foods, nausea, vomiting

89
Q

What is Mirizzi syndrome?

A

Stone impacted in GB neck or cystic duct

90
Q

What abnormality causes jaundice and pruritis?

A

Mirizzi syndrome

91
Q

What may cause a hydropic GB?

A

Ill children receiving TPN

92
Q

What are both intrinsic and extrinsic causes of biliary obstruction?

A
  1. Stones
  2. Masses
  3. Strictures
93
Q

What is known as inflammatory fibrosis of the intrahepatic and extrahepatic ducts causing narrowing or obliteration of the ducts?

A

Sclerosing cholangitis

94
Q

What is sclerosing cholangitis associated with?

A

Concurrent inflammatory bowel disease - very thickened duct walls will be seen

95
Q

What is the SECOND most common cause of obstructive jaundice in peds?

A

Rhabdomyosarcoma - biliary neoplasm

96
Q

What is the most common location of a rhabdomyosarcoma?

A

Porta hepatis - extends into IHD and EHD

97
Q

SF of rhabdomyosarcoma?

A
  1. Solid lobular mass
  2. Duct dilation adjacent to mass
  3. Possible areas of necrosis
98
Q

What is the most common congenital anomaly of the pancreas in peds?

A

Pancreas divisum - failure of the anterior and dorsal panc buds to fuse

99
Q

What is a small pancreas associated with?

A

Polysplenia

100
Q

What is annular pancreas associated with?

A

Duodenal atresia since the pancreas is wrapping around duodenum

101
Q

What can cause congenital pancreatic cysts?

A

Von-hippel lindau and polycystic kidney disease

102
Q

What is cystic fibrosis?

A

EXOCRINE disorder affecting lungs and GI tract - abnormally thick mucous production

103
Q

What does cystic fibrosis result in within the pancreas?

A

Pancreatic exocrine function

104
Q

Are pancreatic carcinomas functioning or non-functioning?

A

Non-functioning

105
Q

What organs does pancreatic cancer metastasize to?

A
  1. Liver
  2. Lungs
  3. Lymph nodes
106
Q

Are pan cancer tumors hyper or hypoechoic?

A

Hypoechoic

107
Q

T or F? 2/3rds of islet cell tumors are functioning?

A

TRUE

108
Q

What are the two types of islet cell tumors?

A

Insulinoma - more common

Gastrinoma

109
Q

Symptoms of an insulinoma?

A

Fasting HYPERinsulinemia = hypoglycemia

110
Q

SF of insulinoma?

A

Well-defined anechoic mass

111
Q

What is the most common cause of pancreatitis in paediatrics and children?

A

Blunt trauma

112
Q

What is NOT a symptom of acute pancreatitis?
A) nausea
B) bradycardia
C) abdominal pain
D) abdominal distention

A

B - tachycardia

113
Q

Will acute pancreatitis be more or less echogenic than the liver?

A

Less

114
Q

What is an abnormal measurement for the pancreatic duct?

A

> 1.5mm

115
Q

What are the common pancreatitis complications?

A
  1. Pseudocyst - most common
  2. hemorrhage - disrupted blood vessels
  3. Phlegmon - solid mass composed of necrotic tissue and puss/edema
  4. Abscess - Severe cases with extensive necrosis
116
Q

What pathology is due to
repeated attacks of acute pancreatitis causing fibrosis and destruction of pancreatic cells?

A

Chronic pancreatitis

117
Q

What is chronic pancreatitis due to?

A

Hereditary pancreatitis

118
Q

The inferior margin of the spleen should NOT extend?

A

Past the lower pole of the Lt kidney

119
Q

What splenic abnormality is associated with interrupted IVC with azygous or hemiazygous continuation?

A

Polysplenia

120
Q

Acquired splenic cysts are also known as what?

A

Pseudocysts - usually the result of trauma

121
Q

What are the common pathologies of the spleen with immunocompromised vs non-immunocompromised children?

A

Immunocompromised - Candida - fungal

Non-immunocompromised - Bartonella henselae -
“cat scratch disease”

122
Q

SF of candida in the spleen?

A

Bulls-eye appearance / wheel within a wheel

123
Q

SF of cat scratch disease?

A

Hypoechoic micro-abscesses

124
Q

What pathology results from occlusion of splenic artery?

A

Splenic infarct

125
Q

In what pathology frequently causes splenic infarction?

A

Sickle cell anemia

126
Q

SF of splenic infarction?

A

Wedge shaped (triangular) hypoechoic region in the periphery of spleen

127
Q

Splenic rupture can result from what?

A

Mono

128
Q

What can occur with splenic rupture?

A
  1. Hemoperitoneum
  2. Splenosis - remnants of spleen in peritoneum
129
Q

Most common malignant splenic mass in childhood?

A

Lymphoma

130
Q

Most common primary neoplasm of the spleen in children?

A

Hamartoma

131
Q

What splenic tumor does not create a focal mass and is diffuse?

A

Leukemia

132
Q

What is an autosomal recessive disease of the spleen resulting in the formation of abnormal hemoglobin?

A

Sickle-cell anemia

133
Q

What is a complication of sickle-cell?

A

Acute splenic sequestration

134
Q

Patient presents with intense pain and a drop in hematocrit. Ultrasound shows an enlarged spleen with areas of infarction. What is the most likely diagnosis?

A

Sickle-cell anemia

Pediatric and Superficial Structures (23 decks)

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