Pediatric GI tract Flashcards
(76 cards)
1
Q
What measurement is classified as gastric wall thickening?
A
5-15mm
2
Q
What population is most affected by hypertrophic pyloric stenosis?
A
Males aged 2-10 weeks
3
Q
What are the signs and symptoms of hypertrophic pyloric stenosis?
A
- Non-bilious projectile vomiting (obstruction occurs before bile duct)
- Dehydration
4
Q
What are the two main SF of hypertrophic pyloric stenosis?
A
- Lack of fluid passing through pylorus
TRV - donut sign
SAG - cervix sign
5
Q
A pyloric stenosis can be diagnosed with what measurements?
A
Channel length: >1.6cm
Muscle thickness: > or = 3mm
6
Q
What is the “antral nipple sign”?
A
Prolapsed pyloric channel mucosa into the gastric antrum - is seen in hypertrophic pyloric stenosis
7
Q
What structure will be NORMAL in patients with pyloric stenosis?
A
Stomach
8
Q
What is the term for a thickened stomach wall?
A
Antritis
9
Q
What is the type of surgery seen with hypertrophic pyloric stenosis?
A
Pyloromyotomy - pyloric muscle split down to the mucosa
10
Q
SF of pylorospasm
A
- TRANSIENT thickening of pyloric canal
- Muscle is not hypertrophied
- Delayed passage of stomach contents
11
Q
What are the 3 types of Bezoar and what do they contain?
A
- Lactobazoar - Insipissated milk (most common)
- Phytobezoar - poorly digested plant material
- Trichobezoar - Ingested hair
12
Q
What are the signs and symptoms of bezoar?
A
- Early satiety
- Poor weight gain
- Vomiting
- Anorexia
- Bloating
13
Q
Normal appearance of the appendix?
A
- Blind-ending structure
- NO peristalsis
- Less than 6mm
- Compressible
14
Q
What is the most common condition requiring emergency surgery in children?
A
Appendicitis
15
Q
Where is an inflamed appendix usually visualized?
A
Base of the cecal tip during max compression
16
Q
What type of appendix placement will need an EV?
A
Retrocecal
17
Q
SF of appendicities
A
- Tubular, non-compressible, blind-ending
- Target appearance (hypoechoic muscular wall with echogenic submucosal layer)
- > 6mm
- Free-fluid adjacent to appendix
- Echogenic fat in peri-appendiceal area
- Hyperemic
- Enlarged surrounding lymph nodes
18
Q
What is a common appendicitis complication?
A
Perforation
19
Q
What three groups are mucoceles classified into?
A
- Focal or diffuse hyperplasia
- Mucinous cystadenoma
- Mucinous cystadenocarcinoma
20
Q
What is the cause of a pseudomyxoma peritonei?
A
Ruptured mucocele
21
Q
What is the most common cause of obstructive bowel disease in early childhood?
A
Intussusception
22
Q
What is the most common population to acquire intussusception?
A
Males aged 1-3
23
Q
What is the most common type of intussusception?
A
Ileocolic
24
Q
Signs and symptoms of intussusception?
A
- Intermittent colicky abdominal pain
- Bloody stool
- Distention
- Vomiting
- Possible palpable abdominal mass
25
What are the SF of intussusception?
TRV - target or donut sign - hypoechoic outer portion with an echogenic center
SAG - pseudokidney sign
26
Treatment for what pathology uses hydrostatic pressure under ultrasound guidance?
Intussusception
27
What are the three main complications of intussusception?
1. Bowel obstruction
2. Perforation/peritonitis
3. Vascular compromise
28
What is the cause of malrotation?
Congenital - a result of malrotation of the gut
29
Malrotation predisposes patients to what 2 other pathologies?
1. Midgut volvulus
2. Internal hernias
30
Signs and symptoms of malrotation?
1. Bilious vomiting
2. Abdominal pain
31
SF of malrotation?
SMA/SMV reversal
32
T or F? The SMA is normally seen to the right of the SMV?
FALSE: this is malrotation
33
Volvulus is a complication of what?
Malrotation - when the SMV wraps around SMA
34
Volvulus occurs when?
The bowel twists on itself and causes an obstruction
35
Why is volvulus a surgical emergency?
The twisted bowel could become ischemic
36
SF of volvulus?
1. “Whirlpool” sign (result of the mesentery and SMV wrapped around the SMA)
2. Inverted SMV / SMA - malrotation
3. Thickened echogenic bowel wall
37
What is another name for Hirschsprung disease?
Aganglionic megacolon
38
What produces a functional obstruction in hirschsprung disease?
Aganglionic segment of the bowel remains in spasm
39
SF of the bowel in Hirschsprung disease?
1. Hugely dilated bowel
2. Lack of peristalsis
40
What is the most commonly affected portion in hirschsprung disease?
rectosigmoid colon
41
T or F? Hirschsprung disease can be diagnosed in utero?
TRUE - Dilated bowel
42
Signs and symptoms of hirschsprung disease?
1. Abdominal distention
2. Vomiting
3. Constipation
43
What is the most common congenital anomaly of the small intestine?
Meckel diverticulum - affects ileum
44
Meckel diverticulum is an incomplete obliteration of?
The vitelline duct, which causes an outpouching of the small intestine (ileum)
45
1 year old male presents with painless rectal bleeding, what could be a likely cause?
Meckel diverticulum
46
SF of meckel diverticulum?
1. Blind-ending peristaltic loop connected to the small bowel
2. Fluid filled pouch
3. Hyperemia if infected
47
What may act as a lead point for intussusception?
1. Meckel diverticulum
2. Enteric duplication cyst
3. Intestinal polyps
4. Intramural
5. Hematoma
6. Small bowel mass
48
Where are enteric duplication cysts usually found?
Ileum
49
T or F? Enteric duplication cysts communicate with the bowel?
FASLE - they are located on the inner border of the mesentery along the ileum but DO NOT communicate with the bowel
50
SF of enteric duplication cysts?
1. Well-defined, round, cystic mass
2. Hypoechoic muscular rim (outer) with hyperechoic inner rim
51
What are the two main complications of enteric duplication cysts?
1. Intussusception - lead point
3. Pancreatitis - if near ampulla of vater
52
What is the normal thickness of the small bowel wall?
Less than or equal to 2mm
53
What bowel abnormalities are more common with Down's syndrome?
1. Hirschsprung disease
2. Duodenal atresia
54
What is the most common cause of obstruction in the small bowel?
Jejunal and ileal atresia's
55
What 4 abnormalities are associated with jejunal and ileal atresia?
1. Midgut malrotation
2. Gastroschisis
3. Duodenal atresia
4. Tracheoesophageal fistula
56
Patient presents with bilious vomiting and failure to pass meconium. Upon imaging, you see dilated small bowel with active peristalsis. What is the most likely diagnosis?
Ileal or jejunal atresia
57
What is meconium ileus?
Abnormally thickened meconium in the distal small bowel causes obstruction so the baby can't poop
58
What abnormality is commonly associated with meconium ileus?
Cystic fibrosis
59
SF of meconium ileus?
1. Echogenic bowel contents
2. Dilated bowel loops
3. Decreased peristalsis
60
What does NEC stand for?
Necrotizing enterocolitis
61
What population is NEC most common in?
Premature infants
62
What is NEC?
Bowel undergoes necrosis due to ischemia from hypoxia and infection
63
Signs and symptoms of NEC?
1. Distended abdomen
2. Vomiting
3. Blood in stool
4. Irritability
64
SF of NEC?
1. Thick walled fluid filled bowel loops
2. Pneumatosis intestinalis
3. Portal vein gas
4. Pneumoperitoneum
5. Hyperemia(initially)
6. Ascites
65
What is the most common inflammatory disease of the small bowel?
Chron's disease
66
What portion of the small bowel is mostly affected by chron's?
Terminal ileum and proximal colon
67
At what age does chron's present?
10+
68
Signs and symptoms of chron's?
1. Abdominal pain
2. Diarrhea
3. Fever
4. Weight loss
69
SF of chron's?
1. Thickened bowel walls (>2.5-3mm)
2. Decreased peristalsis
3. Increased vascularity
4. Echogenic fat surrounding bowel loops
5. Enlarged lymph nodes
6. Possible inflamed appendix
70
What does TRD stand for?
Transverse rectal diameter
71
What TRD is suggestive of constipation/fecal impaction?
>2.7-3.8 cm
72
What is the most common malignant mass of the small bowel?
Lymphoma - m/c Non-hodgkin
73
What portion of the bowel is most commonly affected by a lymphoma?
Ileum
74
SF of bowel lymphoma?
1. Hypoechoic bowel wall thickening or focal hypoechoic/complex mass with areas of necrosis
2. Bowel lumen may be narrowed
3. Potential splenomegaly
4. Enlarged retroperitoneal and mesenteric lymph nodes
75
Signs and symptoms of small bowel lymphoma?
1. Palpable abdominal mass
2. Abdominal pain
3. Vomiting
76
Whirlpool sign is associated with what pathology?
Midgut volvulus
