GI Tract Pathology

Question 1

intestinal pathology creates a sonographic pattern “gut signature” known as the ____ or ____ sign

Answer 1

“target” or “pseudokidney” sign

Question 2

ultrasound appearance of the “target” or “pseudokidney” sign (2)

Answer 2

hypoechoic external rim = thickened wall
hyperechoic center = mucosal ulceration

Question 3

most common cause of an acutely painful abdomen

Answer 3

acute appendicitis

Question 4

acute appendicitis is caused by the obstruction of the

Answer 4

appendiceal lumen

Question 5

acute appendicitis criteria (5)

Answer 5

non-compressible
> 6mm diameter
appendicolith
periappendiceal fluid
“thyroid in the belly” sign

Question 6

what is appendicolith?

Answer 6

echogenic structure within the appendix lumen

Question 7

signs/symptoms of acute appendicitis (4)

Answer 7

periumbilical pain shifting to the RLQ
anorexia
leukocytosis
rebound tenderness

Question 8

what is mesenteric adenitis?

Answer 8

inflammation of the mesenteric lymph nodes in the RLQ
clinical presentation mimics acute appendicitis

Question 9

what is hypertrophic pyloric stenosis (HPS)?

Answer 9

enlargement or hypertrophy of the pyloric sphincter muscles cause gastric outlet obstruction

Question 10

HPS is most common in

Answer 10

infants 2 to 6 weeks old

Question 11

signs/symptoms of HPS (3)

Answer 11

nonbilious projectile vomiting
palpable “olive-shaped” pylorus
visible peristalsis

Question 12

most accurate measurement for HPS

Answer 12

muscle wall thickness

Question 13

measurements of HPS

Answer 13

muscle wall thickness > 3mm
pyloric channel length > 17mm

Question 14

most common cause of gastric outlet obstruction in premature infants and neonates younger than 4 weeks

Answer 14

pylorospasm

Question 15

unlike HPS, pylorospasm measurements tend to be

Answer 15

normal

Question 16

another cause of nonbilious projectile vomiting in infants where gas bubbles can be observed traveling retrograde up the esophagus

Answer 16

gastroesophageal reflux

Question 17

clinical presentation is similar to HPS, but with bilious vomiting

Answer 17

midgut malrotation (volvulus)

Question 18

what is midgut malrotation?

Answer 18

small bowel mesenteric rotate around the SMA

Question 19

normally the SMA is to the ___ of the SMV
with malrotation the SMA is to the ___ of the SMV

Answer 19

normal = SMA to the LEFT of the SMV
malrotation = SMA to the RIGHT of the SMV

Question 20

what is intussusception?

Answer 20

telescoping of one segment of bowel into another

Question 21

intussusceptum = _____ segment, _____ loop
intussiscipiens = _____ segment, ____ loop

Answer 21

intussusceptum = proximal segment, interior loop
intussuscipiens = distal segment, exterior loop

Question 22

most common type of intussusceptum

Answer 22

ileocolic intussusception

RLQ - ileum to ascending colon

Question 23

most common cause of intestinal obstruction in children less than 2 years old

Answer 23

intussusception

Question 24

intussusception rarely occurs in those under ____ and over ____

Answer 24

under 3 months old
over 3 years old

Question 25

ultrasound appearance of intussusception (4)

Answer 25

target mass in TRV plane "cinnamon bun sign" in TRV plane pseudokidney in longitudinal plane diameter > 3cm

Question 26

signs/symptoms of intussusception (4)

Answer 26

red currant jelly stool * acute ABD pain palpable abdominal mass vomiting

Question 27

lab values of intussusception (3)

Answer 27

anemia dehydration leukocytosis

Question 28

what are the two types of bowel obstruction?

Answer 28

mechanical nonmechanical / paralytic ileus

Question 29

what is mechanical bowel obstruction?

Answer 29

bowel being blocked by something

Question 30

what can cause mechanical bowel obstruction? (4)

Answer 30

intraluminal - food bolus bowel wall lesion - tumor, Crohn disease extrinsic - adhesions, hernia ** MOST COMMON** volvulus - twisting of the intestines

Question 31

what is nonmechanical / paralytic ileus bowel obstruction?

Answer 31

bowel lacks normal peristalsis

Question 32

what causes nonmechanical / paralytic ileus bowel obstruction? (4)

Answer 32

peritonitis bowel ischemia surgery medications

Question 33

what are bezoars?

Answer 33

masses of various ingested materials that may cause intestinal obstruction

Question 34

what do trichobezoars consist of?

Answer 34

ingested hair

Question 35

what do lactobezoars consist of?

Answer 35

powdered milk

Question 36

what do phytobezoars consist of?

Answer 36

vegetable material

Question 37

what types of bezoars are common in pediatric patients?

Answer 37

trichobezoars lactobezoars

Question 38

what type of bezoar is common in older patients?

Answer 38

phytobezoars

Question 39

ultrasound appearance of bowel obstruction (3)

Answer 39

distended fluid-filled loops of bowel acute = thin walls with hyperperistalsis, back and forth movement of intraluminal contents progression = aperistaltic with thick, edematous walls

Question 40

signs/symptoms of bowel obstruction (4)

Answer 40

abdominal distention intermittent ABD pain constipation nausea and vomiting

Question 41

what is Crohn's disease?

Answer 41

autoimmune disorder periods of inflammation of the GI tract, cause is unknown

Question 42

most common inflammatory disease of the small intestines

Answer 42

crohn's

Question 43

crohn's usually involves the ____ or ____

Answer 43

terminal ileum or proximal colon

Question 44

ultrasound appearance of Crohn's (4)

Answer 44

bowel wall thickening hyperemia noncompressible > 5 mm "target" appearance

Question 45

signs/symptoms of Crohn's (4)

Answer 45

episodes of diarrhea ABD pain weight loss rectal bleeding

Question 46

what is diverticulitis?

Answer 46

inflammation of the diverticuli

Question 47

diverticulitis most often involves the

Answer 47

sigmoid colon

Question 48

ultrasound appearance of diverticulitis (4)

Answer 48

thick-walled outpouchings hypoechoic thickening of adjacent bowel (perienteric fat) projections will produce shadowing or ring-down artifact hyperemia

Question 49

signs/symptoms of diverticulitis (4)

Answer 49

LLQ pain fever constipation or diarrhea nausea and vomiting

Question 50

what is colitis?

Answer 50

inflammation of the colon

Question 51

4 types of colitis

Answer 51

pseudomembranous ulcerative ischemic infectious

Question 52

ultrasound appearance of colitis (2)

Answer 52

thickened, hypoechoic colon wall hyperemia

Question 53

signs/symptoms of colitis (3)

Answer 53

watery or bloody diarrhea pain fever

Question 54

previous antibiotic therapy that destroys the healthy flora of the intestines leads to subsequent proliferation of _______

Answer 54

Clostridium difficile (C. Diff)

Question 55

most common benign tumor of the small and large intestines

Answer 55

leiomyomas

Question 56

leiomyomas appear as

Answer 56

hypoechoic masses continuous with the muscular layer

Question 57

gastric carcinoma most often is in the form of

Answer 57

adenocarcinoma (80%)

Question 58

adenocarcinoma of the appendix can lead to ___ with subsequent development of ____

Answer 58

rupture with subsequent development of pseudomyxoma peritonei

Question 59

what is pseudomyxoma peritonei?

Answer 59

gelatinous ascites that may appear as a multiseptated cystic pelvic mass

Question 60

most common metastatic tumors to the bowel (3)

Answer 60

malignant melanoma lungs breast

Question 61

ultrasound appearance of gastric carcinoma (3)

Answer 61

hypoechoic, irregular-shaped, bulky mass up to 10 cm in size "target" or "pseudokidney"

Question 62

signs/symptoms of gastric carcinoma (4)

Answer 62

weight loss ABD pain anorexia vomiting

Question 63

rectus sheath hematoma is the result of

Answer 63

abdominal trauma or may occur spontaneously

Question 64

signs/symptoms of rectus sheath hematoma (4)

Answer 64

ABD pain palpable abdominal mass skin discoloration at the area decrease hematocrit

Question 65

most common site for endometriosis of the abdominal wall

Answer 65

anterior abdominal wall

Question 66

what is scar endometriosis?

Answer 66

endometriosis that is located within the scar of a previous C-section

Question 67

ultrasound appearance of endometriosis of the abdominal wall (4)

Answer 67

well-defined lobulated infiltrative hypoechoic or heterogenous

Question 68

signs/symptoms of scar endometriosis (2)

Answer 68

palpable mass cyclical pain

Question 69

what is an inguinal hernia?

Answer 69

bowel protrudes into the groin

Question 70

what is an incisional hernia?

Answer 70

bowel protrudes into a surgical incision site

Question 71

what is a linea alba hernia?

Answer 71

bowel protrudes through the fascia of the linea alba

Question 72

what is an umbilical hernia?

Answer 72

bowel protrudes into the umbilicus

Question 73

what is a spigelian hernia?

Answer 73

bowel protrudes into a weakened area in the lower 1/4th of the rectus muscle