Pediatric Upper Abdomen Flashcards
(134 cards)
1
Q
With coarctation of the Ao, >50% also have associated (what pathology)?
A
Renal artery stenosis
2
Q
An interrupted IVC has drainage via?
A
Azygous vein (posterior to Ao)
3
Q
What is the most common reason for AO evaluation in the neonate?
A
Abdominal Ao thrombosis
4
Q
What is the main cause of abdominal Ao thrombosis?
A
UAC - umbilical artery catheter
5
Q
Signs and symptoms of abdominal Ao thrombosis?
A
Absent femoral pulses
Hematuria
Cyanosis
Hypertension
Blanching of lower extremities
Necrotizing enterocolitis (NEC)
6
Q
IVC thrombosis is a complication of what?
A
UVC - umbilical venous catheter
7
Q
IVC tumour invasion can occur in what vessels?
A
- IVC
- Hepatic veins
- Renal artery
8
Q
What is the most common vascular liver tumour in infancy?
A
Hemangiomas
9
Q
What are the two main types of hemangioma’s?
A
- Cavernous
- Hemangioendothelioma’s
10
Q
S/S of cavernous vs hemangioendothelioma’s?
A
- Cavernous - asymptomatic unless large
- Hemangioendothelioma - Hepatomegaly, CHF
11
Q
SF of cavernous vs hemangioendothelioma’s?
A
Cavernous - hyperechoic, vascular, well-defined
Hemangioendothelioma - multiple, potential echogenic foci, hepatomegaly
12
Q
What is the second most common benign hepatic mass seen in children?
A
Mesenchymal hamartoma
13
Q
What population is typically seen with mesenchymal hamartoma?
A
Males < 2yrs
14
Q
S/S of mesenchymal hamartoma?
A
- Painless abdominal swelling
- Anorexia
15
Q
SF of mesenchymal hamartoma?
A
- Complex
- Internal septations
- Avascular
- More common in RT lobe
16
Q
Polycystic liver disease is also seen with what two pathologies?
A
- Polycystic kidney disease
- Von hippel-lindau
17
Q
Hydatid cysts are associated with the exposure to what?
A
Livestock, farming, dogs
18
Q
Peak incidence of hydatid cysts?
A
5-15 yrs
19
Q
What is the second most common site for hydatid infection after the liver?
A
Lungs
20
Q
Urticaria (skin rash) is associated with what pathology?
A
Hydatid cysts
21
Q
SF of hydatid cysts?
A
- Anechoic - complex
- Possible daughter cysts
- Calcifications
- “Water lily” sign
22
Q
What is the most commonly injured abdominal organ in the neonate?
A
Liver - mostly the RT
23
Q
Children and young adults are most often infected by what hepatitis virus?
A
Hep A - fecal oral route of contamination
24
Q
Common symptom of hepatitis?
A
Jaundice - also seen with choledocal cysts and biliary atresia
25
What are the acute vs chronic SF of hepatitis?
Acute:
1. Normal or hepatomegaly
2. Hypoechoic
3. "Starry sky" sign
Chronic:
1. Hyperechoic
2. Cirrhotic
26
What vascular structures may be involved with a hepatic abscess?
1. HA
2. Portal V
3. Umbilical vein (due to cutting the umbilical cord)
27
What pathology may appear as a bulls-eye appearance in the liver?
Abscess
28
What is the main cause of a pyogenic abscess?
Secondary to bowel infection
29
What pathology is typically caused by Candida albicans in immunosuppressed children within the liver?
Fungal abscess
30
SF of fungal abscess?
1. MULTIPLE small lesions with irregular walls
2. Hypoechoic/hyperechoic
3. Target/wheel-within-wheel appearance
31
What liver pathology affects children in areas where drinking water is contaminated and poor sanitation?
Amebic abscess
32
What is the term for the accumulation of fat (triglycerides and lipids) in the hepatocytes?
Steatosis (fatty infiltration)
33
What does NASH stand for?
Non-alcoholic steatohepatitis
34
SF of diffuse fatty liver infiltration?
1. Hyperechoic
2. Reduced penetration (decrease the frequency)
3. Hepatomegaly
35
Which location does focal fatty infiltration and sparing typically occur?
GB fossa/porta hepatis
36
What is the most common type of glycogen storage disease?
Von gierke type 1
37
What pathology is known as an enzyme defect resulting in the accumulation of excessive glycogen
and fat in the liver, intestines & kidneys?
Glycogen storage disease
38
SF of glycogen storage disease?
1. Diffusely increased echogenicity, decreased penetration (fatty liver)
2. Hepatomegaly
3. Possibly solid liver masses (40% of cases of Type 1, typically the masses are adenomas)
39
Parenchymal destruction, scarring, fibrosis and nodular regeneration of the liver is known as?
Cirrhosis
40
Hepatic fibrosis is associated with what other pathology?
Infantile polycystic kidney disease (ARPKD)
41
S/S of hepatic fibrosis?
1. Hepatomegaly
2. Portal hypertension
42
What is the main cause of hemochromatosis?
Genetic
43
What is the main cause of hemosiderosis?
Repeated blood transfusions
44
T or F? Primary malignant tumours of the liver are more common in children than adults?
TRUE
45
What marker is usually elevated in liver malignancies?
AFP
46
What is the most common pediatric liver mass?
Hepatoblastoma
47
What is the most likely population that presents with a hepatoblastoma?
Boys under 5 yrs
48
S/S for hepatoblastoma?
Painless palpable mass, hepatomegaly
49
SF of hepatoblastoma?
1. Solitary, multinodular mass
2. Heterogeneous ,hyperechoic with indistinct
borders
3. Potentially areas of necrosis or hemorrhage
4. Calcifications
5. Hepatomegaly
50
What population is common with HCC/hepatoma?
Children over 3 yrs
51
SF of HCC?
1. Solid hyperechoic mass
2. Cystic areas of necrosis or hemorrhage
3. Anechoic/hypo halo
4. Tumor thrombi frequently seen in the portal veins, hepatic veins, IVC
52
What veins may be affected by HCC? (3)
1. Hepatic veins
2. Portal veins
3. IVC
53
What is a subtype of HCC that most commonly affects teenagers and young adults?
Fibrolamellar HCC
54
What liver tumour does NOT have an increase in AFP?
Mesenchymal sarcoma
55
What age is typical for mesenchymal sarcoma?
5-10 yrs
56
SF of mesenchymal sarcoma?
1. Round hyperechoic solitary mass (large)
2. Singular mass - fast growing
3. Well-defined borders and a thick fibrous pseudocapsule
57
Metastases to the liver are commonly caused by what tumor?
Neuroblatsoma
58
S/S of portal hypertension?
1. Splenomegaly
2. Ascites
3. Caput medusa
59
SF of portal hypertension?
1. Splenomegaly
2. Portal venous hepatofugal flow
3. Ascites
4. Varices
60
What is a common etiology of portal venous thrombosis in peds?
Improper placement of UVC
61
S/S of PV thrombosis?
1. Abdominal pain
2. Splenomegaly
62
What is Budd Chiari syndrome?
Occlusion of HV's and/or IVC
63
SF of Budd-chiari?
1. Hepatomegaly (back up of blood as the HV's can't drain)
2. Absent flow in HV
3. Echogenic HV lumen
64
Hepatic infarction in Peds can occur due to what?
Occlusion in the HA - typically due to liver transplantation because of thrombus
65
What is a common SF of hepatic infarction?
Wedge shaped, hypoechoic area near capsule periphery
66
What is portal venous gas associated with?
UVC
In neonates - mesenteric ischemia due to NEC
67
Common population of peds seen with portal venous gas?
Premature and low birth weight
68
SF of portal venous gas?
Small echogenic foci seen and are mobile, seen moving with blood flow
69
What pediatric abnormalities present with Jaundice?
1. Hepatitis
2. Biliary atresia
3. Choledocal cysts
70
What abnormality is described as a total absence of biliary tree (80%) to a visibly patent GB, cystic duct and CBD?
Biliary atresia
71
S/S of biliary atresia?
1. Jaundice
2. PALE stool
3. DARK urine
72
What is the leading cause of liver transplantation in peds?
Biliary atresia
73
What procedure is a treatment for biliary atresia?
Kasia procedure
74
A fasting GB of less than what measurement indicates atresia?
<1.5 cm in length
75
What is a pseudoGB?
GB less than 1.5 cm and undefined walls
76
What is the triangular cord sign?
An echogenic area near anterior branch of RPV measuring >4mm in thickness
77
What SF are indicative of biliary atresia?
1. Small GB
2. Triangular cord sign
78
Biliary atresia vs choledocal cysts in commonality of males or females?
Biliary atresia - males
Choledocal cysts - females
79
What is the most common form of choledocal cyst?
Fusiform - found adjacent to GB
80
What is the 2nd m/c form of choledocal cyst?
Diverticulum of CBD
81
What is Type 5 also known as?
Caroli's disease - dilation of CBD and IHD - "string of beads sign"
82
What is Caroli's disease associated with?
Poly cystic kidney disease - medullary sponge kidney
83
Patient presents on ultrasound with multiple cysts near porta hepatis, potentially extending to intrahepatic ductal system. What does this indicate?
Caroli's disease
84
What is known as communicating ectasia of the intrahepatic ducts?
Caroli's disease
85
Non-visualization of the GB is most commonly associated with what? (2)
Biliary atresia or viral hepatitis
86
What GB wall measure indicates thickening?
Suggestive of disease = 2-5mm
Indicative of disease = > 5mm
87
Focal GB wall thickening is associated with what 2 abnormalities?
1. Cholecystitis
2. Adenomyomatosis (hyperplasia of GB)
88
Symptoms of cholelithiasis/cholecystitis in peds versus children?
Peds - irritability and jaundice
Children - intolerance to fatty foods, nausea, vomiting
89
What is Mirizzi syndrome?
Stone impacted in GB neck or cystic duct
90
What abnormality causes jaundice and pruritis?
Mirizzi syndrome
91
What may cause a hydropic GB?
Ill children receiving TPN
92
What are both intrinsic and extrinsic causes of biliary obstruction?
1. Stones
2. Masses
3. Strictures
93
What is known as inflammatory fibrosis of the intrahepatic and extrahepatic ducts causing narrowing or obliteration of the ducts?
Sclerosing cholangitis
94
What is sclerosing cholangitis associated with?
Concurrent inflammatory bowel disease - very thickened duct walls will be seen
95
What is the SECOND most common cause of obstructive jaundice in peds?
Rhabdomyosarcoma - biliary neoplasm
96
What is the most common location of a rhabdomyosarcoma?
Porta hepatis - extends into IHD and EHD
97
SF of rhabdomyosarcoma?
1. Solid lobular mass
2. Duct dilation adjacent to mass
3. Possible areas of necrosis
98
What is the most common congenital anomaly of the pancreas in peds?
Pancreas divisum - failure of the anterior and dorsal panc buds to fuse
99
What is a small pancreas associated with?
Polysplenia
100
What is annular pancreas associated with?
Duodenal atresia since the pancreas is wrapping around duodenum
101
What can cause congenital pancreatic cysts?
Von-hippel lindau and polycystic kidney disease
102
What is cystic fibrosis?
EXOCRINE disorder affecting lungs and GI tract - abnormally thick mucous production
103
What does cystic fibrosis result in within the pancreas?
Pancreatic exocrine function
104
Are pancreatic carcinomas functioning or non-functioning?
Non-functioning
105
What organs does pancreatic cancer metastasize to?
1. Liver
2. Lungs
3. Lymph nodes
106
Are pan cancer tumors hyper or hypoechoic?
Hypoechoic
107
T or F? 2/3rds of islet cell tumors are functioning?
TRUE
108
What are the two types of islet cell tumors?
Insulinoma - more common
Gastrinoma
109
Symptoms of an insulinoma?
Fasting HYPERinsulinemia = hypoglycemia
110
SF of insulinoma?
Well-defined anechoic mass
111
What is the most common cause of pancreatitis in paediatrics and children?
Blunt trauma
112
What is NOT a symptom of acute pancreatitis?
A) nausea
B) bradycardia
C) abdominal pain
D) abdominal distention
B - tachycardia
113
Will acute pancreatitis be more or less echogenic than the liver?
Less
114
What is an abnormal measurement for the pancreatic duct?
>1.5mm
115
What are the common pancreatitis complications?
1. Pseudocyst - most common
2. hemorrhage - disrupted blood vessels
3. Phlegmon - solid mass composed of necrotic tissue and puss/edema
4. Abscess - Severe cases with extensive necrosis
116
What pathology is due to
repeated attacks of acute pancreatitis causing fibrosis and destruction of pancreatic cells?
Chronic pancreatitis
117
What is chronic pancreatitis due to?
Hereditary pancreatitis
118
The inferior margin of the spleen should NOT extend?
Past the lower pole of the Lt kidney
119
What splenic abnormality is associated with interrupted IVC with azygous or hemiazygous continuation?
Polysplenia
120
Acquired splenic cysts are also known as what?
Pseudocysts - usually the result of trauma
121
What are the common pathologies of the spleen with immunocompromised vs non-immunocompromised children?
Immunocompromised - Candida - fungal
Non-immunocompromised - Bartonella henselae -
"cat scratch disease"
122
SF of candida in the spleen?
Bulls-eye appearance / wheel within a wheel
123
SF of cat scratch disease?
Hypoechoic micro-abscesses
124
What pathology results from occlusion of splenic artery?
Splenic infarct
125
In what pathology frequently causes splenic infarction?
Sickle cell anemia
126
SF of splenic infarction?
Wedge shaped (triangular) hypoechoic region in the periphery of spleen
127
Splenic rupture can result from what?
Mono
128
What can occur with splenic rupture?
1. Hemoperitoneum
2. Splenosis - remnants of spleen in peritoneum
129
Most common malignant splenic mass in childhood?
Lymphoma
130
Most common primary neoplasm of the spleen in children?
Hamartoma
131
What splenic tumor does not create a focal mass and is diffuse?
Leukemia
132
What is an autosomal recessive disease of the spleen resulting in the formation of abnormal hemoglobin?
Sickle-cell anemia
133
What is a complication of sickle-cell?
Acute splenic sequestration
134
Patient presents with intense pain and a drop in hematocrit. Ultrasound shows an enlarged spleen with areas of infarction. What is the most likely diagnosis?
Sickle-cell anemia
