Abdomen

Question 1

When should the fetal stomach be documented?

Answer 1

2 + 3 trimesters

Question 2

What is associated with a small or absent fetal stomach?

Answer 2

can be normal (allow to fill- 30 mins)

or can be a/w aneupolidy, tracheoesophageal fistula, and oligohydramnios

Question 3

Esophageal atresia:

Answer 3

absence in segment of esophageal
congenital
a/w tracheoesophageal fistula

Question 4

Whats the most common type of esophageal atresia?

Answer 4

w/ a fistula connecting the distal portion of the esophagus with the trachea (90%)
if stomach doesn’t communicate with trachea, the stomach will be empty/small

Question 5

Esophageal atresia should be suspected when the stomach is empty/absent when there’s __________.

Answer 5

polyhydramnios

Question 6

What are some causes of an absent stomach?

Answer 6

normal empty stomach
herniated into chest
abdo wall defect
EA 
aneuploidy
anhydramnios
microgastria

Question 7

What is an enlarged stomach associated with?

Answer 7

duodenal atresia

persistent enlarged stomach for the duration of the scan-30mins

Question 8

What’s the double bubble sign?

Answer 8

two fluid bubbles:
dilated stomach
dilated prox duodenum
*show the connectiong between duodenum and stomach is important in dx

Question 9

What’s the most common site of intestinal atresia?

Answer 9

duodenum

Question 10

Duodenal atresia is associated with?

Answer 10

polyhydramnios
coexsting anomalies (50%)
Tri-21 (33%)

Question 11

Jejunal-ileal obstruction/atresia:

Answer 11

most common reason for JIO is an isolated vascular compromise
dx is based on dilated loops of bowel w/o dilated stomach
apple peel jejunal atresia

Question 12

What measurement is considered a dilated loop of bowel?

Answer 12

7mm

Question 13

Apple peel jejunal atresia:

Answer 13

subtype of jejunal-ileal obstruction

agenesis of the mesentery and is more often familial

Question 14

What’s an underlying etiology for ileal obstruction?

Answer 14

cystic fibrosis

Question 15

Good photo of the types of jejunal ileal obstruction

Answer 15

on slide 24

Question 16

Anorectal atresia:

Answer 16

most common atresia of large bowel
highest incidence of association w/ other anomalies: chromosomal + genitourinary
part of VACTERL

Question 17

What’s the sonographic dx of anorectal atresia

Answer 17

dilated loops of bowel

absence of polyhydramnios

Question 18

Echogenic bowel:

Answer 18

bowel is same echogenicity of iliac crest or bone (2nd trimester)
considered to be a soft marker and an association w/ tri21, cystic fibrosis, meconium peritonitis, and congenital viral infection

Question 19

Is an echogenic bowel normal later on in the pregnancy (3rd tri)?

Answer 19

Yes bc meconium is echogenic

Question 20

What can be risks for echogenic bowel?

Answer 20

aneuploidy
CF
swallowed fetal blood
infection
GI atresia
IUGR
fetal demise

Question 21

Omphacele:

Answer 21

most common anomaly of the abdo wall
herniation of abdo organs (liver+bowel) into base of umbilical cord
usually isolated

Question 22

What’s the most common anomaly of the abdominal wall?

Answer 22

omphacele

Question 23

Omphacele can be associated with:

Answer 23

pentalogy of Cantrell
Beckwith-Wiedemann syndrome
(CHD, chromo abnormalities)

Question 24

Pentralogy of Cantrell:

Answer 24

association of ectopia cordis, heart defect, diaphragmatic hernia, pericardial defect and omphacele

Question 25

Beckwith-Wiedemann syndrome:

Answer 25

macrosomia, macroglossia, renal neoplasm and omphacele | gigantism

Question 26

Gastroschisis:

Answer 26

abdo organs are pushing out into amniotic cavity usually isolated higher association with morbidity or mortality

Question 27

What lab test is associated with abdo wall defects

Answer 27

inc maternal AFP

Question 28

Gastroschisis can be increased by what factors?

Answer 28

teen moms tobacco illicit drugs (prolly crack) decongestants (pseudoephedrine)

Question 29

What GI anomalies can you have with gastroschisis?

Answer 29

atresias, stenosis, perforations, or volvulus (malrotation of the herniated bowel)

Question 30

The liver increases in echogenicity as the fetal ages. True or false

Answer 30

False--stays the same

Question 31

The spleen is not normally evaluated. What's the texture/echogenicity tho?

Answer 31

similar to liver

Question 32

Splenomegaly is associated with:

Answer 32

severe hemolytic disease due to isoimmunization and infection

Question 33

Asplenia is associated with:

Answer 33

situs inversus | asplenia and polysplenia are associated with heterotaxy syndromes

Question 34

Choledochal cyst:

Answer 34

sacculations of the CBD most often appears as RUQ cyst inferior to umbilical vein and anterior to rt. kidney usually can see dilated ducts location differentiates it from duodenal atresia

Question 35

Adrenal glands:

Answer 35

not usually assessed by easy to visualize after 20wks | medial margin of lt. adrenal gland is lateral wall of aorta and rt. adrenal is posterior to IVC

Question 36

Echogenicity of adrenal gland?

Answer 36

cortex- hypoechoic | medulla- echogenic

Question 37

Neuroblastoma in adrenals:

Answer 37

malignant most common neonatal tumor complex mass, mostly solid w/ cystic spaces + calcifications

Question 38

Hemorrhage of adrenals:

Answer 38

associated w/ fetal distress in older fetuses | similar appearance to renal/adrenal tumors

Question 39

Umbilical arteries can be identified on _____ ____ scans of fetal pelvis lateral to bladder.

Answer 39

oblique axial

Question 40

Single umbilical artery is associated with:

Answer 40

an increase risk of IUGR, congenital anomalies (cardiovascular+genitourinary) and chromosomal abnormalities

Question 41

Ductus venosus:

Answer 41

originates from the pars transversa segment of the LPV and courses in a posterior cranial direction to terminate in the left hepatic vein (LPV) very near IVC

Question 42

Ductus venosus flow:

Answer 42

high velocity, low impedance | forward flow towards rt. atrium

Question 43

Umbilical vein and PV diameter:

Answer 43

have a similar diameter and is usually not possible to differentiate between the two

Question 44

Persistent rt. umbilical vein:

Answer 44

in embryogenessi, 2 umbilical veins form with early regression of the right UV usually an isolated finding, w/o complications, but there can be a small risk of anomalies. But generally fine

Question 45

What does a persistant rt. umbilical vein look like

Answer 45

tubular structure in anterior RUQ lateral to fetal GB normal size to normal UV turns left towards stomach

Question 46

Ascites can be seen with:

Answer 46

``` hydrop fetalis bowel perforation ovarian cyst rupture fetal urinary ascites transudation or rupture of the fetal urinary tract persistant urogenital sinus ```

Question 47

What gastrointestinal anomaly is associated with infection?

Answer 47

echogenic bowel

Question 48

Which GI atresia has the highest incidence of associated anomalies?

Answer 48

anorectal

Question 49

Most common anomaly of the abdo wall?

Answer 49

omphalocele

Question 50

What GI anomaly is associated with drug use?

Answer 50

gastroschisis