Fetal gastrointestinal/genitourinary with pathology registry review

Question 1

GI abnormalities

Answer 1

Most often result in polyhydramnios
-If GI obstruction/disturbance where fluid cannot be swallowed or absorbed normally, build up of fluid will take place
-Kidneys continue producing fluid even with GI obstruction

Question 2

Stomach

Answer 2

Inferior to diaphragm
*should empty and fill every 30 mins

Question 3

Fetal cord insert

Answer 3

Inferior to level of the kidneys, should be smooth with no herniations or mass

Question 4

Bowel

Answer 4

Slightly more echogenic than liver

Question 5

Esophageal atresia

Answer 5

Absence of a section of the esophagus
*associated with VACTERL and T18

Question 6

Tracheoesophageal fistula

Answer 6

Esophagus and trachea form a connection

Question 7

Sonographic appearance of esophageal atresia

Answer 7

No visualization of the stomach and polyhydramnios

Question 8

Duodenal atresia

Answer 8

Fluid filled stomach and fluid filled proximal duodenum
-“double bubble”
-Polyhydramnios
*associated with T21

Question 9

Anorectal atresia

Answer 9

Most common type of colonic atresia that leads to bowel obstruction

Question 10

Sonographic appearance of anorectal atresia

Answer 10

Dilated loops of bowel
*look for VACTERL

Question 11

Hirschsprung disease

Answer 11

Functional bowel obstruction caused by the absence of nerved within bowel wall

Question 12

Sonographic appearance of hirshsprung disease

Answer 12

Dilated loops of bowel

Question 13

Echogenic bowel

Answer 13

Bowel bright as bone
*associated with T21 and cystic fibrosis

Question 14

Neuroblastoma

Answer 14

Adrenal gland tumor, mass superior to kidney
-MOST common malignant abdominal mass in neonates

Question 15

Hepatomegaly

Answer 15

Most common abnormality of the liver
-Cause ac to be larger than expected GA
*associated with beckwith-wiedemann

Question 16

Gastroschisis

Answer 16

-Herniation of bowel through an opening on RIGHT side of cord insertion
-Not covered by a membrane or skin
-Larger defects may include stomach and other abdominal organs
-Usually isolated finding
-Requires surgery
*ELEVATED AFP

Question 17

Omphalocele

Answer 17

-Persistent herniation of bowel and possibly other organs into the BASE of the umbilical cord after 12 weeks
-Bowel and possibly liver
-ALWAYS midline and covered by membrane
-AFP possibly normal due to being covered by membrane
*STRONG association with T18, T13, pentalogy of cantrell

Question 18

Fetal kidney formation

Answer 18

Form in pelvis and rise to renal fossa by week 9
*if doesn’t rise then = pelvic kidney

Question 19

Fetal kidney functionality

Answer 19

-Fully functional at 10 weeks
-Produce urine at 12 weeks

Question 20

Fetal bladder

Answer 20

Seen by week 13 on US

Question 21

Fetal kidneys seen on US

Answer 21

Week 15

Question 22

Amniotic fluid

Answer 22

Mostly made of fetal urine AFTER 16 weeks
-As long as one functioning kidney present, normal fluid levels present
*affected heavily by renal function

Question 23

Most common cause of oligohydramnios

Answer 23

Renal abnormalities

Question 24

Most common renal anomaly

Answer 24

Duplicate/double collecting system divided into upper and lower moiety/poles

Question 25

Unilateral renal agenensis

Answer 25

-Failure of one kidney to form -Most common -Fluid and bladder will be normal since present kidney is functional

Question 26

Bilateral renal agenesis

Answer 26

-Failure of BOTH kidneys to form -NO bladder and NO fluid *Potters syndrome

Question 27

Sonographic signs of renal agenesis

Answer 27

-Adrenal gland is flattened and parallel to spine (usually on upper pole of kidney) -Absence of renal artery branches coming off the aorta in coronal view

Question 28

Autosomal recessive polycystic kidney disease (ARPKD)

Answer 28

-Infantile -Bilateral enlarged, echogenic -NON functional = no fluid, no bladder -Associated with meckel-gruber -Oligo/anhydramnios *FATAL

Question 29

Autosomal dominant polycystic disease (ADPKD)

Answer 29

-Adult version, doesn't affect until late adulthood -Bilateral enlarged, echogenic -FUNCTIONING -Normal bladder, normal fluid -Cyst develop as adults

Question 30

Sonographic appearance for PKD

Answer 30

Bilaterally enlarged, echogenic kidneys. Cysts are not visualized (microscopic)= echogenic enlarged appearance

Question 31

Multicystic dysplastic renal disease

Answer 31

Large cysts affecting entire kidney, kidney appears to fill entire abdomen -Affected kidney is NON functional -Unilateral = normal fluid/normal bladder -Bilateral= no fluid/ no bladder

Question 32

Obstructive cystic dysplasia

Answer 32

Kidney becomes small and echogenic with peripheral renal cyst -Caused by early renal obstruction -Unilateral or bilateral -NON functional -Bilateral = oligohydramnios

Question 33

Most common fetal abnormality

Answer 33

Hydronephrosis (AKA pelvocaliectasis, pelviectasis/pyelectasis, caliectasis -- depends on dilated area of kidney)

Question 34

Urinary tract obstruction

Answer 34

Any obstruction to normal succession of urine flow will result in back up and cause dilation proximal to obstruction

Question 35

Measurement of dilated pelvis

Answer 35

-In transverse and AP > 4mm in 2nd trimester = pyelectasis >7mm in 3rd trimester = pyelectasis

Question 36

Location of ureteropelvic junction obstruction (UPJ)

Answer 36

Most common cause of hydro, pyelectasis only

Question 37

Location of ureterovesicular junction obstruction (UVJ)

Answer 37

Least common cause of hydro, kidneys and ureter

Question 38

Urethra obstruction

Answer 38

Bladder outlet obstruction, everything from bladder up is dilated

Question 39

Bladder outlet obstruction/prune belly syndrome

Answer 39

Posterior urethral valve causes obstruction in male fetus -Massively dilated bladder -Key hole sign -Dilation of ureters and kidneys eventually occurs

Question 40

Key hole sign in bladder

Answer 40

Dilated bladder (megacystis) and dilated posterior urethra

Question 41

Triad of prune belly (eagle barret syndrome)

Answer 41

Absent abdominal musculature, undescended testis, urinary tract abnormalities

Question 42

Bladder extrophy

Answer 42

Bladder located outside the pelvis, lower abdominal mass inferior to umbilicus -May be included with cloacal extropy and extropy of intestines and genitalia

Question 43

Cloaca

Answer 43

Everything at the bottom including true pelvis genitalia

Question 44

Clitoromegaly

Answer 44

Most common cause of ambiguous genitalia in females

Question 45

Common causes of ambiguous genitalia in males

Answer 45

Micropenis, hypospadias, undescended testis

Question 46

Hypospadias

Answer 46

Abnormal curvature of penis