Pediatric Abdomen

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1

What are the scanning considerations of the pediatric abdomen?

use warm gel

keep infant warm

distractions

breaks

diaper/bottle/binky

2

The length of the gallbladder should not exceed the length of the ____.

The length of the gallbladder should not exceed the length of the kidney.

3

What is the CBD measurement in a neonate?

< 1mm

4

What is the CBD measurement in a infant (to 1 year old)?

< 2mm

5

What is the CBD measurement in older children?

< 4mm

6

What is the CBD measurement in a adolesents?

< 7mm

7

What are the measurements of the pancreatic ducts in children?

< 2mm

same as adults

8

The size of the pancreatic duct should _____ in older children.

The size of the pancreatic duct should increase in older children.

9

What is the sonographic appearance of the pediatric pancreas?

hypoechoic compared to liver

little fat invades islets of langerhans at that age

10

What is the measurement of the spleen in infants less than 3 months old?

< 6cm

11

What is the measurement of the portal vein in children less than 10yrs?

8.5mm

12

What is the measurement of the portal vein in children ages 10 - 20 years?

10 mm

13

What is the measurement of the portal vein in adults?

<13mm

14

What is important about the size of the portal vein?

essential in excluding portal hypertension

15

Many neonates experience _____ jaundice in the first few weeks?

transient

16

What are the babies called that experience transient jaundice?

purple light babies

17

What causes transient jaundice in neonates?

spleen hemolysis

liver not ready

18

Persistent jaundice is _________ to diagnose.

more difficult

19

What are some causes of persistent jaundice?

hepatocellular disease

obstruction

20

What are the types of jaundice?

obstructive

nonobstructive

21

What are the types of non obstructive jaundice?

hemolytic

nonhemolytic

22

What causes hemolytic jaundice?

hepatitis

23

What causes nonhemolytic jaundice?

problems with biliruben metabolism

24

What are the causes of intrahepatic jaundice?

hepatitis

metabolic disease

25

What are the causes of extrahepatic jaundice?

choledocal cyst

biliary atresia

perforation of bile ducts

26

What are the 3 most common causes of pediatric jaundice?

neonatal hepatitis

biliary atresia

choledocal cyst

27

What is neonatal hepatitis?

Infection of the liver that occurs in the first 3 months

28

What are some causes of neonatal hepatitis?

complications of vaginal delivery

virus crossing placentia

syphilis

toxoplasmosis

rebella

cytomegalovirus

aids

29

What is the ultrasound appearance of neonatal hepatitis?

normal size

enlargement

increased echogenicity

30

What is pediatric biliary atresiacholedocal cyst?

narrowing or underdevelopment of biliary ductal system

31

What is another name for pediatric biliary atresia?

steatorrhea

32

What is pediatric biliary atresia caused by?

inflammation of system

33

What is absent in most common forms of pediatric biliary atresia?

gallbladder

34

What is the presentation of pediatric biliary atresia?

claylike stools

dark urine

35

What is the sonographic appearance of pediatric biliary atresia?

normal or hyperechoic

enlarged

intrahepatic ducts not dilated

polysplenia

36

What can polyspenia cause problems with?

heart

37

What is pediatric choledochal cyst?

abnormal cystic dilation of the biliary tree

38

What is the presentation of pediatric choledochal cyst?

palpable mass

pain jaundice

fusiform dilation of the CBD

39

What is the sonographic appearance of pediatric choledochal cyst?

multiple cysts

string of pearls

40

What is pediatric hemangioendothelioma?

most common benign vascular lesion of early childhood

rapidly growing

41

When does a pediatric hemangioendothelioma occur?

first 6 months of life

42

What is the presentation of a pediatric hemangioendothelioma?

abdominal distention

hepatomegaly

CHF

elevated AFP

huge mass

congestive heart failure

43

What is the sonographic appearance of pediatric hemangioendothelioma?

hepatomegaly

multiple hypoechoic lesions

hetergeneous

high flow in lesion

AV shunting

44

What is the 3rd most common abdominal malignancy in children after Wilm's disease?

Hepatoblastoma

45

What is Hepatoblastoma?

infantile form of hepatocellular carcinoma

frequently in under 5

46

What is nephoblastoma?

Wilm's tumor

47

What is the most common blastoma?

Wilm's tumor

48

What is neuroblastoma

adrenals

49

What is the presentation of Hepatoblastoma?

palpable mass

elevated AFP

fever

pain

anorexia

weight loss

50

What is the sonographic appearance of Hepatoblastoma?

solid

solitary

heterogeneous

hepatomegaly

51

What is a hypertrophied pyloric stenosis?

the pylorus becomes abnormally enlarged

52

What is hypertrophied pyloric stenosis caused by?

a blockage at the caudad end of the stomach

53

What are the two sphincters in the stomach?

cardiac sphincter

pyloric sphincter

54

What is the presentation of hypertrophied pyloric stenosis?

projectile vomiting

male

3 to 6 weeks

dehydration

failure to thrive

palpable olive

55

What allows the pyloric sphincter to relax?

chemical signal sent

56

What is the chemical signal that relaxes the pyloric sphincter?

nitric oxide

57

Why can't children with hypertrophied pyloric stenosis relax the pyloric sphincter?

they lack the necessary receptors on the pylorus

58

What is the effect of hypertrophied pyloric stenosis?

the pylorus muscle gets bigger due to constant contraction

59

When is ultrasound the modality of choice for a pyloric exam?

when an experienced sonographer is available

60

What transducer should be used during a pylorus exam?

5 - 7 MHz linear array

61

What happens if the pyloric exam comes back non diagnostic?

GI will have to be preformed

62

What are the differential diagnoses of a pyloric exam?

GIT reflex

hiatal hernia

malformation of the gut

63

What images should be taken for a pylorus exam?

long and trans

trans SMV

trans SMA

single long view of each kidney

64

Why are kidney images taken during a pylorus exam?

to exclude

hydronephro

adrenal hemorrhage

65

Why are images of the SMV & SMA taken during a pylorus exam?

to exclude malrotation

66

What method is used to document the pylorus?

line up the transducer transversly by getting the GB and kidney in the same image.

you should be able to see the pylorus

the stomach should have fluid in it

if diagnosis can not be made place the patient in right lateral decubitus

67

How will the pylorus appear is abnormal?

closed

68

How will the pylorus appear is normal?

open

69

What are the measurements of an abnormal pylorus?

16 mm long

10 mm width

3.5 mm thick

70

What is gastritis?

inflammation of the stomach

71

What mimics HPS?

Gastinitis

72

How are gastritis different

HPS - muscle is thick / mucosa is thin

gastritis - muscle is thin / mucosa is thick

73

What are the pitfalls of a hypertrophied pyloric stenosis exam?

mimicking pathology

74

What is the treatment of HPS?

pyloromyotomy

perferred and most sucessful

75

What is the first step of treatment of a child with hypertrophied pyloric stenosis?

intravenous fluids

76

What is the second step of treatment of a child with hypertrophied pyloric stenosis?

corrective surgery

enlarged pylorus is divided in half

stomach is left in tact

Post surgery the muscle shrinks and heals

released 2 to 3 days after surgery

77

How soon after a pyloromyotomy can a baby be fed?

6 hours

slowly

infants may still vomit

78

WHat causes appendicitis?

occurs when lumen of appendix becomes

79

What is a appendicolith?

poo blocking appendix

80

What is a fecalith?

poo blocking appendix

81

What happens when the appendix is blocked after infection sets in?

necrosis

82

What is the most common acute abdominal inflammatory process in children (after gastroenteritis)?

Appendicitis

83

When might a perforation occur in infants and young children with appendicitis?

6 to 12 hours

84

How is appendicitis diagnosed?

diameter greater than 6mm with compression in transverse plane

85

How is rupture of appendix diagnosed?

collection of fluid in RLQ

86

What is the presentation of appendicitis?

RLQ pain

vomiting

87

What are the differentials of appendicitis?

inflammatory bowel disease

ovarian cysts, torsion, neoplasms

88

WHat transducer should be used during an appendicitis exam?

5 - 7 MHz linear array

89

What are the methods in examining for appendicitis?

RLQ & pelvic - females

gradual graded compression over the area of the appendix

graded compression technique

90

How is appendicitis diagnosed with ultrasound?

an outer diameter greater than 6 mm with compression is consistent with appendicitis in children and adults in a transverse plane

rebound pain is consistent with appendicitis

an appendicolith is virtually diagnostic

91

What is the most common acute abdominal disorder in early childhood?

Intussusception

92

What is Intussusception?

when bowel prolapses into more distal bowel and it propelled in an antegrade fashion

telescoping of bowel in this manner causes obstruction

93

What is the sonographic appearance of Intussusception?

long - Pseudokidney or sandwich

trans - target sign

94

What is the presentation of Intussusception?

pain

vomiting

bloody stool

95

What transducer should be used to check for Intussusception?

5 - 7 linear array

96

What is the length of the kidneys?

9-12 cm

97

what is the width of the kidneys?

5 cm

98

What is the thickness of the kidneys?

2.5 cm

99

Explain the protective covering of the kidneys?

true capsule

pararenal fat - adrenals & kidneys

gerota's fascia

ribs

100

How do the pyramids remain relative to the cortical rim?

large even after birth

101

What happens to the glomerular filtration rate after birth?

increases rapidly

102

What happens to the pyramids throughout childhood?

cortex continues to grow so pyramids appear smaller

103

What is the echotexture of the kidneys at birth compared to the liver?

similar or hyperechoic

104

What is the echotexture of the kidneys at 4 to 6 months compared to the liver?

cortical echogenicity decreases

hypoechoic

105

Where are the arcuate arteries?

lie at the base of the medullary pyramids

intensely echogenic structures

106

What is the sonographic appearance of the neonate adrenals?

large - easy to identify

inverted V or Y in longitudinal plane

107

Where do the adrenals lie?

superior to the upper pole of the kidneys

108

What is Cross-fused renal ectopia

anomaly where the kidneys are fused medially and located on the same side of the midline

109

What is Cake kidney?

anomaly where the kidneys are fused laterally and located on the same side of the midline

upper & lower poles fused

110

What are sigmoid kidneys?

...

111

What is hydronephrosis?

dilatation of the urinary collecting system

112

What is the cause of hydronephrosis?

obstruction

urinary reflux

abnormal muscle development

113

What is the presentation of hydronephrosis?

flank pain

114

What is the sonographic appearance of hydronephrosis?

dilated pelvis

dilated calyces

maybe dilated ureters

115

What is UPS?

Ureteropelvic junction obstruction

116

What is UPS caused by?

extrinsic vascular compression at the UPJ

intrinsic narrowing of the ureter at the UPJ

117

What happens when there is bilateral involvement of UPS?

increased risk of renal abnormalities

118

What is the most common type of obstruction of the upper urinary tract?

UPS

119

What is the sonographic appearance of UPS?

dilated pelvis

dilated calyces

ureters normal

120

What is the best way to demonstrate the ureters at the UPJ?

coronally

121

When may a megaureter be present with UPS?

if there is vesicoureteral reflux

122

What is posterior urethral valves?

congenital anomaly causing bladder outlet obstruction

123

What causes posterior urethral valves?

congenital folds in urethra

bladder dilates

ureters dilate

124

Besides posterior urethral valves, what can cause a bladder obstruction?

pelvic mass

neurogenic bladder

125

What is the most common cause of bladder outlet obstruction in the male neonate?

posterior urethral valves

126

What is the sonographic appearance of posterior urethral valves?

thick bladder wall

hydronephrosis

hydroureter

keyhole sign

127

What is prune belly syndrome?

urethral obstruction dilate bladder

28 weeks testicles can not descend due to dilated bladder

bladder continues to grow and pushes on abdominal wall

abdominal muscles grow abnormally

baby is born and urine is released

stomach looks like a prune

128

What is the cause of prune belly syndrome?

28 weeks testicles can not descend due to dilated bladder

bladder continues to grow and pushes on abdominal wall

abdominal muscles grow abnormally

baby is born and urine is released

stomach looks like a prune

129

What is hypoplastic anterior abdominal musculature

abdominal muscles grow abnormally

130

How do you correct prune belly syndrome?

surgically

131

What is MCDK?

multicystic dysplastic kidney

potter type 2

132

What is the sonographic appearance of MCDK?

unilateral

enlarged multiple cysts

133

What is IPKD?

infantile polycystic kidney disease (recessive)

Potter type 1

134

What is the sonographic appearance of IPKD?

enlarged

hyperechoic

135

Renal vein thrombosis is prevalent in ______?

infants of diabetics

136

Renal vein thrombosis may occur in what type of infant?

dehydrated

septic infant

137

Is a renal vein thrombosis, unilateral or bilateral?

either

138

What is the presentation of renal vein thrombosis?

renal enlargement

hematuria

proteinuria

low platelet count

139

What is the sonographic appearance of renal vein thrombosis?

thrombus may be visualized within the renal vein or IVC

hyperechoic thrombosis

enlarged kidneys

patchy areas of increased echogenicity

140

What is the most common solid kidney mass in neonates?

Congenital Mesoblastic Nephroma

141

What is Congenital Mesoblastic Nephroma?

highly invasive

benign counterpart of Wilm's tumor

Large flank mass more common in males

children under 1 year

142

What is fetal renal hamartoma?

AKA Congenital Mesoblastic Nephroma

143

What is congenital Wilm's tumor?

AKA Congenital Mesoblastic Nephroma

144

What is always indicated with Congenital Mesoblastic Nephroma?

Nephectomy

145

What is the most common solid renal mass of childhood?

Wilm's Tumor

146

What is a Nephroblastoma?

AKA Wilm's Tumor

147

What is Wilm's tumor?

invasive malignant tumor normally before 3rd birthday

tends to go in vessels

metastatic potential

148

What is the presentation of Wilm's tumor?

nausea and vomiting

palpable abdominal mass

149

What is a Neuroblastoma?

malignant tumor of the the adrenal medulla

150

When does Neuroblastoma usually occur?

between 2 months and 2 years

151

What is the sonographic appearance of Neuroblastoma?

highly echogenic

increased vascularity

152

What is the second most common abdominal tumor of childhood?

Neuroblastoma

153

What can cause an adrenal hemorrhage?

difficult delivery

large baby

diabetic mother

stress / hypoxia at delivery

septicemia

may be present when ther is none of the above

154

When is an adrenal hemorrhage usually found?

secondary to other complications