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CNIH > peds- UT > Flashcards

peds- UT Flashcards

1
Q

GI tact sonographic technique?

A
  • high frequency linear probe

- grades compression

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2
Q

Normal gastric wall thickeness?

A
  1. 5- 3.5mm

- mucosa and muscle layer combined

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3
Q

abnormal gastric (stomach) wall thickening?

A

5-15mm

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4
Q

gastric wall thickening can be caused by? (3)

A
  • Gastritis
  • Gastric Ulcer
  • Lymphoid hyperplasia
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5
Q

Normal neonatal stomach filled with fluid- layers?

A
  • Hyperechoic submucosa

- Hypoechoic muscle layer

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6
Q

What is Hypertrophic Pyloric Stenosis?

  • what is it?
  • who does it affect?
  • when does it present?
  • cause?
A
  • Abnormal thickening of the antropyloric region of the stomach
  • Mostly affects first-born male infants 2-10 weeks of age
  • most patients present at 1-2 months of age
  • Cause - idiopathic
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7
Q

Hypertrophic Pyloric Stenosis clinical presentation?

A
  • Dehydration
  • Frequent episodes of projectile nonbilious vomiting
  • Failure to thrive
  • Thickening palpated as the “olive-shaped” epigastric mass
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8
Q

HPS what we can visualize? (main 3)

A
  • pyloric muscle
  • lack of passage of fluid through the pylorus
  • stomach often filled with water even when fasting
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9
Q

TRV and SAG plane HPS?

A

TRV- Long axis of pylorus

SAG- trv axis of pylorus

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10
Q

if pylorus is not visualized what should you do?

A
  • give child water to display gastric lumen
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11
Q

how does the mass present in HPS?

A
  • Donut sign

- anechoic/hypoechoic muscle mass with a central echogenic lumen

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12
Q

HPS is diagnosed when? (3)

A
  1. AP of pyloric diameter exceeds 1.5cm
  2. The length of the antrum to the distal end of the channel exceeds 1.8cm
  3. Muscle thickness exceeds 4mm
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13
Q

The stomach wall in children with pyloric stenosis is?

A

always normal

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14
Q

HPS treatment?

A

pyloromyotomy

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15
Q

Small bowel abnormalities? (3)

A
  1. bowel obstruction
  2. meconium ileus
  3. midgut malrotation
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16
Q

small bowel obstruction intrinsic causes?

A
  • Duodenal Atresia (assoc. w. Trisomy 21)
  • Duodenal Stenosis
  • Duodenal Web
  • Jejunal and ileal atresia
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17
Q

small bowel obstruction extrinsic causes?

A

Malrotation
Choledochal Cyst
Duodenal duplication cyst
Annular Pancreas

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18
Q

small bowel obstruction presents with?

A
  • bilious vomiting
  • abdo distention
  • failure to pass meconium
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19
Q

SONO apperance of small Bowel obstruction?

A
  • hyperactive, dilated bowel loops
  • bowel wall thickening in some cases
  • duoden. & stomach seen as large anechoic structures
20
Q

what is Small bowel: Meconium ileus? what is it associated with?

A
  • Abnormally thick meconium in the distal small bowel

- Associated with cystic fibrosis

21
Q

sono apperance of meconium ileus?

A
  • echogenic bowel content
    can be seen on prenatal scans
  • dilated bowel loops
  • decreased peristalsis
22
Q

complications of meconium ileum?

A
  • peritonitis
    (Calcifications develop within 12h, notes as echogenic ascites in fetal scan)
  • pseudocyst
    (A walled-off collection of meconium often with calcifications)
23
Q

Small bowel: midgut malrotation?

A
  • Congenital anomaly that results from an abnormal rotation of the gut as it returns to the abdominal cavity during embryogenesis
24
Q

how does midgut malrotation present? what is it associated with?

A
  • Shortened mesentery, small root
  • SMA / SMV run in the mesentery
  • Associated with omphalocele, gastroschisis, duodenal atresia
25
Q

sono apperance of midgut malrotation?

A
  • demonstrate the relative positions of SMA and SMV
  • Reversed SMA and SMV
  • SMV directly anterior to SMA
  • SMA pulled to right, anterior to IVC
  • SMA right to aorta
  • Whirlpool sign with volvulus
  • SMV and mesentery wrapped around SMA
26
Q

Intussusception?

A
  • Telescoping of bowel

- A segment of bowel prolapses into a more distal segment

27
Q

Intussusception ↑ incidence?

A

if a child has a lead point:

  • Meckel diverticulum
  • Enteric duplication cyst
  • Intestinal polyps
  • Lymphoma
28
Q

types of intussusception? (4)

A

ileocolic – most common, 90%
ileoileal
colocolic
ileoileocolic – ileum into ileum into colon

29
Q

Intussusception clinical presentation?

A
  • 1-3 yo, more freq in boys
  • Abdominal pain, intermittent
  • Currant-jelly (dark red) stool
  • Palpable abdo mass
  • Abdo distention
  • Vomiting
30
Q

Intussusception 3 sono apperances?

A
  1. target pattern:
    - Multiple concentric anechoic rings surrounding a dense echogenic center
  2. Doughnut sign:
    - An anechoic ring surrounding echogenic center
  3. Pseudokidney appearance

May be signs of edema and vascular compromise

31
Q

intussusception complications?

A
  • Bowel obstruction
  • Perforation
  • Peritonitis
  • Vascular compromise which leads to edema of bowel and gangrene
32
Q

Intussusception treatment?

A

Enema with:

  • Barium
  • Other solutions - saline
  • Air insufflation
  • Surgery
33
Q

What is Crohn’s Disease and what does it most commonly affect?

A
  • IBD

Most commonly affects:

  • terminal ileum
  • proximal colon
  • age 10 or older
34
Q

crohn’s disease clinically?

A
  • pain
  • diarrhea
  • fever
  • weight loss
35
Q

sono appearance of Crohn’s disease?

A

Use graded compression:

  • Symmetrically thickened hypoechoic bowel walls
  • Non- or partially compressible
  • Bull’s eye or target sign on trv
  • Pseudo kidney – in sag
  • ↑ vascularity
  • Secondary appendicitis
  • Lymphadenopathy
36
Q

benign bowel masses?

A
  • enteric duplication cyst

- polyps

37
Q

malignant bowel masses?

A
  • lymphoma

- leiomyosarcoma

38
Q

location of Enteric Duplication Cyst?

A
  • Located along the mesenteric border of the bowel
  • Does not communicate with the bowel
  • Tubular cysts may communicate
39
Q

clinical presentation of enteric duplication cyst?

A

Abdo pain
Distention
Vomiting, rectal bleeding.

40
Q

Enteric Duplication Cyst sono features?

A
  • Well defined
  • Round
  • Fluid-filled mass
  • Anechoic
  • Acoustic enhancement
  • Hypoechoic outer muscular rim and a hyperechoic inner rim of mucosa
41
Q

Lymphoma clinical presentation?

A
  • Palpable abdo mass
  • Abdo pain
  • Vomiting (due to obstruction)
42
Q

Lymphoma sono features?

A
  • Hypoechoic bowel wall thickening
  • or a focal hypoechoic or complex mass
  • Splenomegaly
  • Enlarged retroperitoneal/mesenteric lymph nodes.
43
Q

Acute Appendicitis clinical presentation?

A
  • Periumbilical pain
  • RLQ pain
  • Abdominal tenderness
  • Fever
  • Leukocytosis
44
Q

actue appendicitis triad?

A
  1. RLQ pain
  2. leukocytosis
  3. fever
45
Q

How to ultrasound Acute Appendicitis?

A
  • Ultrasound – primary method of imaging

Graded compression:

  • to displace the bowel gas
  • to demonstrate compressibility of the appendix
  • The appendix is visualized near the cecum and terminal ileum
  • Doppler
46
Q

acute appendicitis sono features?

A
  • Tubular noncompressible structure
  • with a target appearance of an outer hypoechoic muscular layer and echogenic submucosa layer surrounded by a fluid-filled center
  • Appendix > 6mm AP
  • Appendicolith may be noted
  • Enlarged mesenteric lymph nodes
  • Inflamed fat and free fluid
47
Q

acute appendicitis complications?

A
  • Perforation occurs in 80-100% of children under the age of 3
  • 10-20% perforate in children 10-17yrs

Perforated appendix appears as a fluid-filled collection that can lead to:

  • Abscess formation
  • Peritonitis

CNIH (69 decks)

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