peds- UT Flashcards
GI tact sonographic technique?
- high frequency linear probe
- grades compression
Normal gastric wall thickeness?
- 5- 3.5mm
- mucosa and muscle layer combined
abnormal gastric (stomach) wall thickening?
5-15mm
gastric wall thickening can be caused by? (3)
- Gastritis
- Gastric Ulcer
- Lymphoid hyperplasia
Normal neonatal stomach filled with fluid- layers?
- Hyperechoic submucosa
- Hypoechoic muscle layer
What is Hypertrophic Pyloric Stenosis?
- what is it?
- who does it affect?
- when does it present?
- cause?
- 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
Hypertrophic Pyloric Stenosis clinical presentation?
- Dehydration
- Frequent episodes of projectile nonbilious vomiting
- Failure to thrive
- Thickening palpated as the “olive-shaped” epigastric mass
HPS what we can visualize? (main 3)
- pyloric muscle
- lack of passage of fluid through the pylorus
- stomach often filled with water even when fasting
TRV and SAG plane HPS?
TRV- Long axis of pylorus
SAG- trv axis of pylorus
if pylorus is not visualized what should you do?
- give child water to display gastric lumen
how does the mass present in HPS?
- Donut sign
- anechoic/hypoechoic muscle mass with a central echogenic lumen
HPS is diagnosed when? (3)
- AP of pyloric diameter exceeds 1.5cm
- The length of the antrum to the distal end of the channel exceeds 1.8cm
- Muscle thickness exceeds 4mm
The stomach wall in children with pyloric stenosis is?
always normal
HPS treatment?
pyloromyotomy
Small bowel abnormalities? (3)
- bowel obstruction
- meconium ileus
- midgut malrotation
small bowel obstruction intrinsic causes?
- Duodenal Atresia (assoc. w. Trisomy 21)
- Duodenal Stenosis
- Duodenal Web
- Jejunal and ileal atresia
small bowel obstruction extrinsic causes?
Malrotation
Choledochal Cyst
Duodenal duplication cyst
Annular Pancreas
small bowel obstruction presents with?
- bilious vomiting
- abdo distention
- failure to pass meconium
SONO apperance of small Bowel obstruction?
- hyperactive, dilated bowel loops
- bowel wall thickening in some cases
- duoden. & stomach seen as large anechoic structures
what is Small bowel: Meconium ileus? what is it associated with?
- Abnormally thick meconium in the distal small bowel
- Associated with cystic fibrosis
sono apperance of meconium ileus?
- echogenic bowel content
can be seen on prenatal scans - dilated bowel loops
- decreased peristalsis
complications of meconium ileum?
- peritonitis
(Calcifications develop within 12h, notes as echogenic ascites in fetal scan) - pseudocyst
(A walled-off collection of meconium often with calcifications)
Small bowel: midgut malrotation?
- Congenital anomaly that results from an abnormal rotation of the gut as it returns to the abdominal cavity during embryogenesis
how does midgut malrotation present? what is it associated with?
- Shortened mesentery, small root
- SMA / SMV run in the mesentery
- Associated with omphalocele, gastroschisis, duodenal atresia
sono apperance of midgut malrotation?
- 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
Intussusception?
- Telescoping of bowel
- A segment of bowel prolapses into a more distal segment
Intussusception ↑ incidence?
if a child has a lead point:
- Meckel diverticulum
- Enteric duplication cyst
- Intestinal polyps
- Lymphoma
types of intussusception? (4)
ileocolic – most common, 90%
ileoileal
colocolic
ileoileocolic – ileum into ileum into colon
Intussusception clinical presentation?
- 1-3 yo, more freq in boys
- Abdominal pain, intermittent
- Currant-jelly (dark red) stool
- Palpable abdo mass
- Abdo distention
- Vomiting
Intussusception 3 sono apperances?
- target pattern:
- Multiple concentric anechoic rings surrounding a dense echogenic center - Doughnut sign:
- An anechoic ring surrounding echogenic center - Pseudokidney appearance
May be signs of edema and vascular compromise
intussusception complications?
- Bowel obstruction
- Perforation
- Peritonitis
- Vascular compromise which leads to edema of bowel and gangrene
Intussusception treatment?
Enema with:
- Barium
- Other solutions - saline
- Air insufflation
- Surgery
What is Crohn’s Disease and what does it most commonly affect?
- IBD
Most commonly affects:
- terminal ileum
- proximal colon
- age 10 or older
crohn’s disease clinically?
- pain
- diarrhea
- fever
- weight loss
sono appearance of Crohn’s disease?
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
benign bowel masses?
- enteric duplication cyst
- polyps
malignant bowel masses?
- lymphoma
- leiomyosarcoma
location of Enteric Duplication Cyst?
- Located along the mesenteric border of the bowel
- Does not communicate with the bowel
- Tubular cysts may communicate
clinical presentation of enteric duplication cyst?
Abdo pain
Distention
Vomiting, rectal bleeding.
Enteric Duplication Cyst sono features?
- Well defined
- Round
- Fluid-filled mass
- Anechoic
- Acoustic enhancement
- Hypoechoic outer muscular rim and a hyperechoic inner rim of mucosa
Lymphoma clinical presentation?
- Palpable abdo mass
- Abdo pain
- Vomiting (due to obstruction)
Lymphoma sono features?
- Hypoechoic bowel wall thickening
- or a focal hypoechoic or complex mass
- Splenomegaly
- Enlarged retroperitoneal/mesenteric lymph nodes.
Acute Appendicitis clinical presentation?
- Periumbilical pain
- RLQ pain
- Abdominal tenderness
- Fever
- Leukocytosis
actue appendicitis triad?
- RLQ pain
- leukocytosis
- fever
How to ultrasound Acute Appendicitis?
- 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
acute appendicitis sono features?
- 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
acute appendicitis complications?
- 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
