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GI Tract Flashcards

(73 cards)

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1
Q

What makes up the GI tract?

A

Mouth, pharynx, esophagus, stomach, small intestines/colon

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2
Q

Which areas can be identified with sonography?

A

Distal esophagus attached to stomach (gastroesophageal junction)

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3
Q

What and where is the pyloric sphincter?

A

A muscle controlling emptying of the stomach into the duodenum which lies within the distal stomach

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4
Q

What lies distal to the duodenum?

A

Jejunum and ileum (of the small intestines)

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5
Q

What and where is the ileocecal valve?

A

Ileum connects with cecum (proximal colon) in the right lower quadrant of the abdomen

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6
Q

Where is the vermiform appendix located?

A

Right lower quadrant of abdomen (level of cecum)

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7
Q

What is the ascending colon?

A

The colon traveling toward liver after cecum

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8
Q

Where does the transverse colon begin?

A

A bend in the colon (the splenic flexure marks the start of descending colon)

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9
Q

What is the final section of the colon?

A

The sigmoid as the colon travels inferiorly toward the rectum

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10
Q

Which areas are intraperitoneal?

A

Most GI parts with the exception of duodenum and ascending/descending colon

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11
Q

How many layers are in normal bowel?

A

5 layers

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12
Q

What is the name of the innermost layer and how does it appear?

A

Superficial mucosa / echogenic

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13
Q

What is the second innermost layer and how does it appear?

A

Deep mucosa / hypoechoic

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14
Q

What is the middle layer and how does it appear?

A

Submucosa (muscularis propria interface) / echogenic

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15
Q

What is the 4th layer from innermost and how does it appear?

A

Muscularic propria / hypoechoic

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16
Q

What is the outermost layer and how does it appear?

A

Serosa / echogenic

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17
Q

What conditions indicate a need for sonography?

A

Hypertrophic pyloric stenosis, intussusception, acute appendicitis

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18
Q

What may cause appendix issues?

A

Obstructive process like appendicolith, fecalith, lymph node, tumor, foreign body, seeds, or parasite

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19
Q

What is the laboratory test for appendicitis?

A

Leukocytosis

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20
Q

What may perforated appendix result in?

A

A loculated fluid collection which may represent abscess

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21
Q

Describe the anatomy of a normal appendix.

A

Sausage-like, mobile, compressible, blind-ending structure with a diameter of 7 mm

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22
Q

What can the appendix contain?

A

Air, some fecal matter and rarely a little fluid

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23
Q

What does Power Doppler reveal about the appendix?

A

Little to no vascular with no hyperechoic, non-compressible inflamed fat

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24
Q

What are clinical signs of appendicitis?

A

Epigastric , periumbilical , abdominal right lower quadrant pain

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25
What is the McBurney point?
An area of rebound tenderness
26
What can be seen in addition to other appendicitis symptoms?
Palpable mass
27
What is the best method for identifying non-compressible inflamed fat?
Slowly applied intermittent compression
28
What indicates perforation in appendix?
Irregular, asymmetrical contour and loss of layer structure
29
How does vascular appear with appendix?
Either increased or absent due to high intramural pressure w/concomitant ischemic necrosis
30
Where is vascular always increased in appendix?
In the surrounding fatty tissue
31
What does the presence of a generalized, dynamic ileus indicate?
Perforated appendix (even if inflamed appendix cannot be visualized)
32
What is the appearance of an inflamed appendix?
Concentrically layered, non-compressible, sausage-like stucture
33
What are the dimensions of an inflamed appendix?
Maximum diameter of 9 mm (variation from 7-17 mm)
34
What is found in 30% of inflamed appendix lumen?
Intraluminal fecoliths obstruction
35
What happens 6-12 hours after initial appendicitis symptoms?
Inflammation progresses to the adjacent fat of the meso-appendix and becomes larger, more hyperechoic and less compressible
36
What happens to fatty tissue around the inflamed appendix?
It will increase in volume representing migrated mesentery/omentum attempting to block any perforation
37
What are physical findings of acute appendicitis?
Non-compressible, blind-ended tube measuring more than 6 mm from each outer wall
38
How will acute appendicitis appear on ultrasound?
Echogenic structure in lumen (appendicolith), hyperemic flow in wall and periappendiceal fluid collection
39
What contributes to a false positive diagnosis of appendicitis?
Normal appendices which are more than 7 mm (children/lymphoid hyperplasia or adults/fecal)
40
What does a generalization of peritonitis cause?
It hampers graded compression which can account for a lower score in patients with free appendiceal perforation
41
What can obstruct a sonographic view of the appendix?
Air-filled dilated bowel loops from adynamic ileus (passage failure) or from air in the lumen
42
What is hypertrophic pyloric stenosis? (HPS)
A genetic and environmentally related condition more common in male/first born over female (4-6:1) seen in 2-8 week olds and occurs in 2-5/1000
43
What age is HPS rarely seen in?
Children more than 6 months old
44
What are clinical findings of pyloric stenosis?
Palpable olive sign (enlarged pyloric muscle) non-bilious, projectile vomiting, weight loss, constipation, dehydration, insatiable appetite,
45
How do you scan for HPS?
Right lateral decubitus, long view of pylorus seen in epigastrium near GB
46
What happens during hypertrophic pyloric stenosis?
Circular muscle layer thickens and narrows/elongates pyloric areas. The mucosa becomes redundant and may appear hypertrophic
47
What happens to the pylorus as a result of elongation/thickening of muscle?
It deviates upward toward GB (marker anteromedial to the right of the kidney)
48
What results from the thickened pylorus?
It narrows the pyloric channel resulting in gastric outlet obstruction, gastric distention, and retrograde peristalsis in the stomach
49
What is the measurement for normal closed pylorus?
Less than 2 mm (2-3 some places)
50
What are sonographic findings of pyloric stenosis?
Target/doughnut sign (trans), cervix-like (long), wall greater/equal to 3mm, pyloric channel > 17 mm
51
How accurate is ultrasound for diagnosing pyloric stenosis?
Close to 100% from sensitivity and specificity
52
How does the muscular layer appear around pyloric stenosis?
Heterogenous echo texture
53
What creates the antral nipple sign?
A redundant mucosa
54
What other problems should be taken into consideration with diagnosing intestinal obstruction/HPS?
Midgut volvulus, malrotation, antral polyps, gastric duplication, pylorospasm (delays gastric opening)
55
What is borderline normal measurement for HPS?
10 mm
56
How does pylorospasm finding differ from HPS?
Pylorospasm measurements tend to be within normal limits, unlike HPS (during exam some fluid goes through pyloric channel)
57
What is intussusception?
Telescoping of one bowel segment into another most common ileocolic in RLQ at the ileocecal valve
58
What are some components of intussusception?
The proximal portion of bowel (intussusceptum) invaginates into the next distal segment (intussuscipiens)
59
What are clinical findings of intussusception?
Severe abdominal pain, vomiting, palpable mass, red currant jelly stool and leukocytosis
60
What happens as a result of intussusception?
As the intestine pulls inward into itself, it can block the passage of food or blood supply and can die
61
What results from pressure between intestinal walls (intussusception)?
Decreased blood flow, irritation and swelling
62
How will intussusception appear on ultrasound?
Target sign (trans) or pseudokidney (long)
63
How will bowel wall appear with intussusception?
Alternating rings of echogenicity representing edematous layers (abnormal bowel non-compressible)
64
What can result from intussusception?
Ischemia and gangrene of bowel (use color to detect any blood flow)
65
What sonographic appearance indicates intussusception in longitude?
Hay fork appearance
66
What are other ultrasound signs for intussusception?
Double ring sign (color doppler), large adenopathies, free fluid, bowel distention
67
What kind of treatment do you give intussusception?
Air/contrast enema not to be used on perforated bowel as there is a risk of bowel tearing
68
Describe a benign lymph node
Ovoid, hypoechoic cortex, thin/invisible with a hyperechogenic hilum from connective tissue trabeculae, lymphatic tissue cords and medullary sinusoids.
69
What are suspicious lymph node characteristics?
Cortical thickening (3 mm cut-off/2.3 metastasis), hilum decrease/absence, shape/vascular changes
70
What is lymph node protocol?
Size (measured), shape, short/long axis ration, nodal borders (sharp/smooth), internal echogenicity (hypo/hyper), echogenic hilum, vascular patterns
71
What are gray scale parameters for lymph node malignancy?
Larger size, round shape (L/T <2), heterogenous echotexture, thinning of hilum, thickened cortex, microcalcification, necrosis, ill defined margins
72
What are Color / Power Doppler features for lymph node malignancy?
Norm-mixed peripheral central blood vessels, high resistant, RI < 0.8, PI < 1.5
73
What other vascular features determine lymph node malignancy?
Abberent/displaced vessels, subcapsular, unperfused areas, non-tapering vessels (necrotic change may show low resistance)

AB VASCULAR (5 decks)

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