AB: Ch. 10 Gastrotestinal tract and Abdominal wall

autoimmune disorder

A disease where your immune system attacks your own cells

Crohn's disease

Autoimmune disease causing chronic bowel inflammation

Diverticulitis: clinical & sono findings

C: constipation of diarrhea, fever, nausea, vomiting, cramping LLQ pain S: segmentally thickened bowel with evidence of inflamed perienteric fat; bowel segment hyperemeia; inflamed diverticula appear as echogenic projections (shadowing & ring down)

Gastric carcinoma & metastatic disease of Bowel

M/C adenocarcinoma C: weight loss, abdominal pain, anorexia, vomiting S: hypoechoic, irregular shaped, bulky mass, " target" or "pseudokidney"

Intussusception: clinical & sono findings

M/C ileocolic intussusception; M/C male; M/C cause of intestinal obstruction under 2 yrs C: intermittent, severe abdominal pain, vomiting, palpable mass, red currant jelly stools, leukocytosis S: graded compression, "target" in trv "pseudokidney" sag, alternating rings of echogenicity, cinnabon sign, maintain shape with compression, > 3 cm

Crohn Disease: clinical & sono findings

M/C inflammatory disease of small intestine C: episodes of diarrhea, abdominal pain, weight loss, rectal bleeding S: "target" sign; noncompressible; > 5mm hyperemia w color doppler

Endometriosis of abdominal wall: clinical & sono findings

M/C site for endometriosis outside of pelvic region C: hx of endometriosis, prior C section, pain on C section scar, palpable mass S: linear xducer; well defined, lobulated, or infilitrative; hypoechoic or heterogeneous; possible cystic changes

trichobezoars

a bezoar that consists of matted hair

phytobezoars

a bezoar that consists of vegetable matter

appendicolith

a dense, calcified stone within the appendix

nonmechanical obstruction (paralytic ileus)

a situation in which bowel is blocked because of the lack of normal peristalsis of a bowel segment or segments

mechanical obstruction

a situation in which bowel is physically blocked by something

fecalith

a stone that consists of feces

pylorospasm

a temporary spasm and thickening of the pyloric sphincter that can replicate the sonographic appearance of pyloric stenosis

gastroesophageal reflux

abnormal backward flow of the gastrointestinal contents into the esophagus, causing heartburn and the gradual breakdown of the mucous barrier of the esophagus

midgut malrotation

abnormal rotation of the bowel that leads to proximal small bowel intestine

Pseudomyxoma peritonei

an intraperitoneal extension of mucin-secreting cells that result from the rupture of a malignant mucinous ovarian tumor or possibly a malignant tumor of the appendix

Pseudomyxoma peritonei can result from

appendix cancer

lactovezoar

bezoar that consists of powdered milk

vermiform appendix

blind-ended tube connected to the cecum

adenocarcinoma

cancer originating in glandular tissue

Acute appendicitis: clinical & sono findings

caused by appendicolith, fecalith, lymph node, tumor, foreign body, seeds, or parasite C: HX of epigastric pain, periumbilical pain, or general abdomen pain; rebound tenderness (McBurney's point), leukocytosis, nausea S: graded compression; non-compressible, blind-ended tube > 6 mm; thyroid belly sign

Hypertrophic pyloric stenosis: clinical & sono findings

closing of pyloric sphincter; M/C in infants 6-8 wks C: first born, white male; nonbilious projectile vomiting, dehydration, weight loss, constipation, & instable appetite S: modality of choice; infant in right LD; "target" sign or "doughnut sign" in trv, > 3 mm thickness & >17mm L

Meckel's diverticulum

common congenital outpouching of the wall of small intestine

all of the following are sonographic findings of acute appendicitis except:

compressible, blind ended tube

Normal GI appearance

compressible, peristalsis (pressure will move gas) wall < 5 mm thickness, no color doppler "target" or "bullseye" appearance

sonography exam should include

compression sonography

peristalsis

contractions that move in a wavelike pattern to propel a substance

hypertrophic pyloric stenosis

defect in relaxation of the pyloric sphincter that leads to the enlargement of the pyloric muscles and closure of the pyloric sphincter

diverticulosis

development of small outpouchings termed diverticuli in the digestive tract, most often in sigmoid colon

first part of the small intestine

duodenum

leukocytosis

elevated WBC count

perienteric fat

fat around intestines

red currant jelly stool

feces that contains a mixture of mucus and blood; a common clinical finding in patients with intussuseption

endometriosis

functional endometrial tissue located outside the uterus

stomach consists of

fundus, body, & plyoric region

Which of the followiwng best describes the location of McBurney point?

halfway between anterior superior iliac spine and the umbilicus

Abdominal wall hernias: sono appearance

high frequency transducer; stand-off pad; valsalva technique; examined for bowel content & peristalic motion

third part of the small intestine is

ileum

diverticulitis

inflammation of diverticuli within digestive tract, most often in sigmoid colon

Acute appendicitis

inflammation of the appendix

the sonographic finding of fluid-filled, distended loops of bowel is consistent with:

intestinal obstruction

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

intussusception

second part of the small intestine is

jejunum

melanoma

malignant form of cancer found most often on the skin

bezoars

masses of

Intestinal Obstruction: clinical & sono findings

mechanical or nonmechanical/paralytic ileus C: abdominal distention, intermittent abdominal pain, constipation, nausea & vomiting S: distended fluid-filled loops; peristalic motion increases with mechanical

Order of gastrointestinal tract

mouth, esophagus, stomach, plyoric spintcher, duodenum, jejenum, ileum, cecum, ascending colon, hepatic flexure/right colic flexure, transverse colon, splenic flexure/left colic flexure, descending colon, sigmoid colon, rectum, anus

nonbilious

not containing bile

compression sonography

operator-applied transducer pressure on a structure during a sonographic examination

rebound tenderness

pain encountered after the removal of pressure

valsalva technique

performed by attempting to forcibly exhale while keeping the mouth and nose closed

McBurney's point

point halfway between the anterior iliac spine and the umbilicus; area of pain and rebound tenderness in acute appendicitis

duodenal bulb

proximal portion of the duodenum closet to the stomach

colitis: clinical & sono findings

pseudomembranous, ulcerative, ischemic, infectious C: bloody & watery diarrhea, fever, abdominal pain, previous antibiotic treatment S: thickened, hypoechoic colon wall; hyperemia within colon wall

other causes of nonbilious vomiting

pylorospasm, gastroesophageal reflux, midgut rotation

Rectus Sheath Hematoma: clinical & sono findings

rupture in muscle or associated vasculature; caused by giving birth, sneezing, intercourse, coughing, defecation, urination C: abdominal pain, palpable mass, discoloration, decreased hematocrit S: anechoic, hypoechoic, complex, or hyperechoic

volvulus

situation in which a loop of bowel twists upon itself

thyroid in the belly sign

sonographic appearance of the hyperechoic edematous connective tissue that surrounds the inflamed appendix

cervix sign

sonographic sign associated with appearance of intussusception

cinnamon bun sign

sonographic sign associated with appearance of intussusception

doughnut sign

sonographic sign associated with pyloric stenosis in the short axis

5 histologic layers of GI tract (inner to outer) & their echogenicity

superficial mucosa: echogenic deep mucosa: hypoechoic submucosa: echogenic muscularis propria: hypoechoic serosa: echogenic

intussusception

telescoping of the intestines

intussuscipiens

the distal segment of the bowel with intussusception

gastroesophageal junction

the junction between the stomach and the esophagus

intussusceptum

the proximal segment of the bowel with intussusception

traditionally, treatment for intussusception is by the means of:

therapeutic enema

invaginate

to insert

All of the following are sonographic criteria in the diagnosis of plyoric stenosis except:

wall of the pylorus is usually thin

olive sign

when the pyloric sphincter muscle is enlarged and palpable on physical examination of the abdomen