Chapter 10: The Gastrointestinal Tract
the normal intestine wall should measure less than _____ in thickness
5 cm
_____ is an autoimmune disorder characterized by periods of inflammation of the gastrointestinal tract. Its cause is unknown.
Chrons disease
trichobezoars
a bezoar that consists of matted hair
lactobezoar
a bezoar that consists of powdered milk
melanoma
a malignant form of cancer found most often on the skin
McBurney point
a point halfway between the anterior superior iliac spine and the umbilicus; the area of pain and rebound tenderness in patients suffering from acute appendicitis
mechanical obstruction
a situation in which bowel is physically blocked by something
malrotation of the midgut
a situation in which the small bowel mesentery rotates around the superior mesenteric artery
HPS is most commonly encountered in infants between ____ and ___ weeks old. ____ born ____ infants are more likely to suffer from HPS
2 8 first male
the wall of the pyloric muscle will measure ____ or greater in thickness. While the length of the abnormal pyloric channel will measure _____ or greater
3 mm 17 mm
_______ is most often in the form of adenocarcinoma
Gastric cancer
phytobezoars
a bezoar that consists of vegetable manner
veriform appendix
a blind ended tube that is connected to the cecum of the colon
Meckel diverticulum
a common congenital outpouching of the wall of the small intestine
hypertrophic pyloric stenosis
a defect in the relaxation of the pyloric sphincter that leads to the enlargement of the pyloric muscles and closure of the pyloric sphincter
appendicolith
a dense, calcified stone within the appendix
autoimmune disorder
a disorder in which the immune system attacks normal tissue
volvous
a situation in which a loop of bowel twists upon itself
nonmechanical obstruction
a situation in which bowel is blocked because of the lack of normal peristalsis of a bowel segment or segments; also referred to as a paralytic ileus
fecalith
a stone that consists of feces
phylorospasm
a temporary spasm and thickening of the pyloric sphincter that can replicate the sonographic appearance of pyloric stenosis
leukocytosis
an elevated white blood cell count
____ is inflammation of the appendix, has been cited as the most common cause of acute abdominal pain resulting in surgery. May be the result of an obstructive process.
appendicitis
adenocarcinoma
cancer originating in glandular tissue
what is the sonographic appearance of a bezoar
complex masses with varying degrees of acoustic enhancement and posterior shadowing, depending on their structure
what are the sonographic findings of a pyloric stenosis
abnormal pylorus appears as a target or doughnut in the transverse view abnormal pylorus appears as a cervix in the longitudinal view wall of the pylorus will measure greater than or equal to 3 mm in thickness length of the pyloric channel will measure greater than or equal to 17 mm
treatment for intussusception is by means of an ____ or____ enema. If gangrene is suspected, surgical intervention is warranted.
air contrast
the gastrointestinal tract or _____consists of what?
alimentary canal mouth, pharynx, esophagus, stomach, the small intestines, and colon
gastroesphageal reflux
an abnormality in which fluid is allowed to reflux out of the stomach back into the esophagus
Crohn disease
an autoimmune disease characterized by periods of inflammation of the gastrointestinal tract
_____ or vermiform appendix is a long narrow blind ended tube. It is commonly located within the right lower quadrant, at the level of the cecum.
appendix
after the cecum the colon is termed the ___ ____ as it travels superiorly toward the liver. a bend in the colon the ____ ____ marks the beginning of the transverse colon which travels across the abdomen. Another bend, the ____ ___ located inferior to the spleen marks the beginning of the descedning colon. The colon travels inferiorly and becomes the ___ ___ and subsequntly the ____. the ___ the external opening of the rectum, marks the termination point of the alimentary canal.
ascending colon hepatic flexure splenic flexure sigmoid colon rectum anus
_____ are masses of various ingested material that may cause intestinal obstructions.
bezoars
what are the sonographic findings of chrons disease
bowel wall thickening greater than 5 mm affected bowel will be noncompressible and have a target appearance hyperemic wall
the proximal duodenum is referred to as ___
c-loop of the duodenum
____ must be observed traveling from the pylorus into the duodenum to eliminate the diagnosis of pyloric stenosis
fluid
what are the regions of the stomach
fundus body pyloric region
______ is another cause of nonbilious projectile vomiting in the infant. A transverse section of the gastroesophageal junction can be seen in most persons posterior to the left lobe of the liver and anterior to the abdominal aorta in the sagittal scan plane of the abdomen. After identifying the gastroesophageal junction, the transducer is manipulated to obtain a longitudinal image of the esophagus. Fluid mixed with gas bubbles can be observed traveling retrograde up the esophagus.
gastroesophageal reflux
the ileum meets the cecum or proximal colon at the _____ ____ within the right lower quadrant of the abdomen. at this level a blinded ended tube, the ____ ___, is connected to the cecum
ileocecal valve vermiform appendix
acute appendicitis
inflammation of the appendix
most gastrointestinal tract parts are considered ____, with the exception of the duodenum and ascending/descending colon which are _____ in location
intraperitoneal retroperitoneal
_____ is the telescoping of one segment of bowel into another. Specifically, the proximal portion of the bowel, is allowed to invaginate into the next distal segment, the intussuscipiens.
intussusception
______ has been cited as the most common cause of intestinal obstructions in children less than ____ years of age. It rarely occurs in those under _____ and over _____
intussusception 2 3 months 3 years
intussusception can lead to
ischemia and gangene of the bowel
distal to the duodenum are the ___ and___ of the small intestines
jejunum ileum
pediatric patients may also suffer from _____, which are bezoars that consist of powered milk that has not been adequately mixed with water.
lactobezoars
In patients older than 2 years, a _____ _____ to the mass should be established. This may be an _____ or _____
lead point intestinal polyp meckel diverticulum
The SMA is typically located to the _____of the SMV. With malrotation they will be _____
left reversed
the rectus abdominus muscles are found on both sides of the midline of the anterior abdomen. They are divided by a band of connective tissue called the ___ ___, which is located in the midline of the abdomen.
linea alba
____ or parlytic ileus is when the bowel lacks normal peristalsis
nonmechanical obstruction
nonbilious
not containing bile
the enlarged pyloric muscle may be palpable during physical examination of an infant with pyloric stenosis this is referred to as the ____
olive sign
compression sonography
operator-applied transducer pressure on a structure during a sonographic examination
rebound tenderness
pain encountered after removal of pressures; a common clinical finding in patients suffering from acute appendicitis
the ____ lies distal to the mouth and unites it to the esophagus
pharynx
_____ is a common cause of delayed gastric opening. Measurements tends to be within normal limits and some fluid may be noted.
pylorospasm
what are some additional causes of nonbilious vomiting in an infant
pylorospasm gastroesophageal reflux malrotation of the midgut
the ____ is the distal region of the stomach
pyorus
the ___ ____ forms a covering for the paired rectus abdominus muscles.
rectus sheath
the distal esophagus attaches to the___, which is also known as the _____
stomach gastroesophageal junction
intussuscipiens
the distal segment of the bowel with intussusception
duodenal bulb
the proximal portion of the duodenum closest to the stomach
invaginate
to insert
what are the clinical findings of gastric carcinoma
weight loss abdominal pain anorexia vomiting
peristalsis
contractions that move in a wavelike pattern to propel a substance
what are the sonographic findings of an intestinal obstruction
distended fluid filled loops of bowel an abrupt termination point of the distended bowel may be identified increased peristaltic motion with to and fro motion of intraluminal contents (mechanical obstruction only)
in the longitudinal plane the pylorus will be noted in the ____ slightly right of midline, near the gallbladder. The pylorus is normally positioned ____ in the abdomen. Therefore the abnormal pylorus appears as a ______/____ in the longitudinal plan and as a ____ sign in the transverse plane
epigastrium transversely target/doughnut cervix
what are the clinical findings of chrons disease
episodes of diarrhea abdominal pain weight loss rectal bleeding
the ____ travels inferiorly within the thorax and though an opening in the diaphragm called the esophageal hiatus
esophagus
red currant jelly stool
feces that contains a mixture of mucus and blood; a common clinical finding in patients suffering from intussusception
what are the clinical findings of pyloric stenosis
first born male infant nonbilious projectile vomit dehydration weight loss constipation insatiable appetite palpable olive sign
what should a gastrointestinal ultrasound include
graded-compression or compression sonography to differentiate normal from abnormal bowel
what are the clinical findings of acute appendicitis
history of epigastric pain periumbilical pain general abdominal pain that has moved to the right lower quadrant acute abdominal pain rebound tenderness nausea and vomiting possible leukocytosis high fever (with abscess formation)
inflammatory changes and neoplasms within the gastrointestinal tract will often reveal evidence of _____.
hyperemia
when would an ultrasound of the gastrointestinal tract be ordered
hypertrophic pyloric stenosis intussusception acute appendicitis
_____ is a defect in the relaxation of the pyloric sphincter. This leads to enlargement or hypertrophy of the pyloric muscles effectively causing a persistent closure of the pyloric sphincter
hypertrophy pyloric stenosis
what are the sonographic findings of gastric carcinoma
hypoechoic irregular shaped bulky mass that can measure up to 10 cm is size. may have target or pseudokidney appearance
the most common type of intussusception, the ______ ______ occurs within the right lower quadrant at the level of the ileocecal valve.
ileocolic intussusception
what are the clinical findings of intussusception
intermittent severe abdominal pain vomiting palpable abdominal mass red currant jelly stools leukocytosis anemia dehydration
intussusception occurs more often in ____ patients
male
_______ is when the small bowel mesentery rotates around the superior mesenteric artery. Can be confirmed by identifying the relationship of the SMA with the superior mesenteric vein.
malrotation of the midgut
bezoars
masses of various ingested material that may cause an intestinal obstruction
there are two types of intestinal obstructions _____ and _____.
mechanical nonmechanical
_____ results from the bowel being physically blocked by something
mechanical obstruction
malignant ____ and primary tumors of the ___ and ___ are the most commonly encountered metastatic tumors
melanoma lung breast
the ____ is the most proximal portion of the gastrointestinal tract.
mouth
what is the sonographic appearance of intussusception
noncompressible target shaped or pseudokidney shaped mass that consists of alternating rings of echogenicity noncompressible bowel
what are the sonographic findings of acute appendicitis
noncompressible, blind ended tube that measure more than 6mm in diameter from outer wall to outer wall echogenic structure within the lumen of the appendix (appendicolith) hyperemic flow within the wall of the inflammed appendix periappendiceal fluid collection
valsalve technique
performed by attempting to forcibly exhale while keeping the mouth and nose closed
bezoars that consist of vegetable material are called ______ and are more often found in older patients.
phytobezoars
the ___ ___ is located at the distal portion of the pylorus, between the stomach and the proximal duodenal bulb
pyloric channel
within the distal stomach lies the _____, a muscle that controls the emptying of the contents of the stomach into the duodenum.
pyloric sphincter
describe the echogenicity of the gut layers superficial mucosa (innermost layer) deep mucosa submucosa (muscularis propria interface) muscularis propria serosa (outermost layer)
superficial mucosa (innermost layer): echogenic deep mucosa: hypoechoic submucosa (muscularis propria interface): echogenic muscularis propria: hypoechoic serosa (outermost layer): echogenic
the alternating echogenicities of the bowel wall layers should produce the classic _____/_____ appearance
target bullseye
Chrons disease usually involves the ___ ____, although it can affect any part of the gastrointestinal tract.
terminal ileum
gastroesophageal junction
the junction between the stomach and the esophagus
intussusceptum
the proximal segement of the bowel with intussusception
intussusception
the telescoping of one segment of bowel into another; most often the proximal segment of the bowel inserts into the distal segment
_____ are bezoars most often found in pediatric patients and consist of ingested hair
trichobezoars
olive sign
when the pyloric sphincter muscle is enlarged and palpable on physical examination of the abdomen; often indicative of pyloric stenosis