study guide test 2 Flashcards by Heather Sholey

Which anomaly refers to a fetus with a significantly narrow chest diameter?

asphyxiating thoracic dystrophy

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What is the most important determinate for fetal viability?

pulmonary development

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Sonographic evaluation of normal thorax: What should it include?

examined in both trans and coronal or parasagittal planes

thoracic cavity is symmetrically bell-shaped: with the ribs forming the lateral margins, the clavicles forming the upper margins, and the diaphragm forming the lower margins

lungs serve as the lateral borders for the heart and lie superior to the diaphragm

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Chest circumference measurements are made in trans plane at what level?

four chamber view of the heart

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Fetal breathing

most prominent in the 2nd and 3rd trimester

mature fetus spends 1/3 of the time breathing

breathing is present if the fetal chest of abd makes seesaw movements for 20sec

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What are the cardiac access degrees?

normal ranges from 22-75 degrees (average 45 degrees)

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What abnormalities are associated with pulmonary hypoplasia?

renal agenesis

premature rupture of membranes

posterior urethral valve syndrome

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Sonographic findings for CAM:

Type I: single or multiple large cysts 2cm in diameter; good prognosis after resection of affected lung

Type II: multiple small cysts <1cm in diameter, echogenic; high incidence of other congenital anomalies (renal gastrointestinal)

Type III: large, bulky, noncystic lesions producing mediastinal shift; poor prognosis

Ussually 1 lobe is affected; associated with polyhydramnios and anascrea; poor prognosis

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Diaphragmatic hernia: anteriomedial

Foramen of Morgagni

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What lung cyst is the most common?

bronchogenic cyst

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Severity of pulmonary hypoplasia is determined by what?

depends on when pulmonary hypoplasia occurred during pregnancy, its severity, and its duration

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What is the supernumerary of the lung called?

pulmonary sequestration

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What is the normal sonographic appearance of the fetal chest?

majority of the heart is positioned in the midline and left chest

Apex of the heart should be directed toward the spleen

base of the heart lies horizontal to the diaphragm

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What is the appearance of fetal lungs on ultrasound?

homogeneous with moderate echogenicity

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If you see pleural fluid, what should you be looking for?

diaphragm?????

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Pulmonary Sequestration and its sonographic findings:

it is a supernumerary lobe of the lungs, separated from the normal tracheobronchial tree

findings: echogenic solid mass resembling lung tissue; rarely occurs below diaphragm; associated with hydrops and polyhydramnios, diaphragmatic hernia, gastrointestinal anomalies; normal intra-abdominal anatomy

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Where is congenital bronchial atresia most commonly located?

left upper lobe

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What is the most common type of diaphragmatic defect?

foramen of Bochdalek

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What is the mortality rate at birth for a fetus with a diaphragmatic hernia?

high

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What is a diaphragmatic hernia frequently associated with?

cardiac malformations

central nervous system malformations

renal anomalies

vertebral defects

pulmonary hypoplasia

facial clefts

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If there is pleural fluid, what could happen?

a shift

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What is a rupture of amnion that leads to entanglement or entrapment?

amniotic band syndrome

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What is the defect in the lower abdominal wall and lower anterior wall of the bladder?

bladder exstrophy (cloacal exstrophy-rare and more complex)

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An anomaly with large cranial, facial, and body wall defects is called?

limb-body wall complex

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Which abnormality would have visceration of bowel to the right of the umbilical cord?

gastroschisis

If you have an omphalocele and scoliosis is also present, what should you consider?

limb-body wall complex

If an omphalocele is low, what other anomalies should you consider?

bladder or cloacal exstrophy anal atresia spina bifida

What all does Beckwith-Wiedemann Syndrome include?

macroglossia omphalocele visceromegaly

Gastroschisis is a consequence of atrophy of what vessel?

right umbilical vein

What will you see with a lower abdominal wall in bladder exstrophy?

omphalocele inguinal hernia undescended testes anal problems

What abdominal wall defects are the most common?

gastroschisis umbilical hernia omphalocele

Critical part of the process of closing the umbilical wall:

folding

Normal embryonic herniation of the bowel permits what?

midgut grows faster than the abdominal cavity at this stage because of the increased size of the liver and kidneys

What is omphalocele?

omphalocele with only bowel has a higher risk for chromosomal abnormalities and other anomalies

If you have a 19wk fetus with an elevated MSAFP, and you see herniated, free floating bowel loops, what should you consider?

gastroschisis

What are the 5 defects of Pentalogy of Cantrell?

cleft distal sternum diaphragmatic defect midline anterior ventral wall defect defect of the apical pericardium with communication into the peritoneum internal cardiac defect

What is gastroschisis?

occurs more frequently in males located to the right of normal cord insertion MSAFP levels are significantly elevated

What is the prognosis with gastroschisis?

excellent

What is the most dramatic finding in ectopia cordis?

heart is outside the thoracic cavity

A high or superumbilical omphalocele is usually the primary finding of what condition?

Pentalogy of Cantrell ## Footnote

Limb body wall defects are more common on which side?

left side

What common anomalies coexist with gastroschisis?

coexisting anomalies are rare

Notably dilated, free floating bowel loops; what might this suggest?

Infarction????

Herniation of an omphalocele is covered in a membrane that consists of what?

amnion and peritoneum

Umbilical vein drains:

placenta body stalk evolving abdominal wall

Hepatic bud enlarges and the right umbilical vein atrophies during what wk of gest?

7-9wks???

Fetus with partial situs inversus demonstrates what?

thoracic viscera are usually reversed abdominal viscera may or may not be reversed

Evidence of a double bubble in a fetus with Tri 21. What is this condition?

duodenal atresia

Fetus with dilated loops of echogenic bowel should be evaluated for what?

meconium peritonitis duodenal atresia bowel obstruction

Where is the spleen visualized in ultrasound?

trans plane posterior and to the left of the fetal stomach

What causes echogenic areas in the fetal abdomen?

calcified: peritoneal calcification-meconium peritonitis, hydrometrocolpos intraluminal meconium calcification-anorectal atresia, small bowel atresia, rarely isolated without bowel obstruction parenchymal-liver, splenic, ovarian cyst cholelithiasis-gallbladder noncalcified: echogenic meconium intraabdominal extrathoracic pulmonary sequestration tumors adrenal hemorrhage

What is a cystic growth of the common bile duct?

choledochal cyst

Haustral folds can be found in what structure?

colon

A remnant of the prox part of the yolk stalk is called?

Meckel's diverticulum

Sonographic demonstration of normal esophagus in 2nd and 3rd tri will appear as what?

2 or more parallel echogenic lines (multilayered pattern)

Most common malformation in the midgut is?

Meckel's diverticulum

How early can you distinguish between large and small bowel?

after 20 menstrual wks

Fetal stomach:

most fetuses older than 14-16wks should have fluid in their stomachs echogenic debris may be visualized along dependent wall of stomach (vernix, protein, or intraamniotic hemorrhage) esophageal anomalies are the least common problem for nonvisualization of the stomach

Transposition of the liver, stomach, absence of the gb, multiple spleens, disruption of the IVC; what is this condition?

polysplenia

Sonolucent band identified near the fetal anterior abdominal wall?

pseudoascites

What is the most reliable criteria for dilated bowel loops?

bowel diameter???

Causes for double bubble:

diaphragmatic hernia annular pancreas Ladd's bands duodenal stenosis duodenal atresia prox jejunal atresia malrotation

What coexisting anomalies are common with esophageal atresia?

anorectal atresia (most common) vertebral defects heart defects renal and limb anomalies

What are the derivatives of the hindgut?

left part of the transverse colon descending colon sigmoid colon rectum superior portion of anal canal epithelium of the urinary bladder most of the urethra

What is the normal diameter of fetal small bowel?

5mm

What is the sonographic appearance for choledochal cyst?

close prox of the cyst to the neck of the gb ovoid RUQ cyst with an entering bile duct cyst and gb that enlarge as gest progresses absence of peristaltic activity in the cyst

Peritoneal calcification at 30wks gest. What is it?

meconium peritonitis

VACTERL is a group of anomalies assc with what anomaly?

anorectal atresia

Fetal liver:

large compared with other intra-abdominal organs hepatic veins and fissures are formed by end of 1st tri occupies most of upper abdomen

What is situs inversus?

total-right side heart axis and aorta, transposistion of liver, stomach, and spleen; left side gb partial-right side stomach; left side liver

Complex disorder of the bowel and genitourinary tract is?

anorectal atresia