Chapter 10: GI Tract (Penny)

Pylorospasm GE reflux Malrotation of the midgut

3 causes of nonbilious vomiting in infants

Duodenum Ascending colon Descending colon

3 parts of the GI tract that are retroperitoneal

body, funds, and pyloric region

3 parts the the stomach

Superficial mucosa-Echogenic Deep mucosa-Hypoechoic Submucosa-Echogenic Muscularis Propria-Hypoechoic Serosa-Echogenic

5 layers of gut (Inner to outer) & appearance

Hypertrophic pyloric stenosis (HPS)

A defect in the relaxation of the pyloric sphincter

As a target or doughnut shape in transverse Cervix sign in long

Abnormal pylorus appears

Acute abdominal pain resulting in surgery

Acute appendicitis is the MCC of

Cecum

After _____ the colon is termed the ascending colon

Ascending colon

After the cecum, the colon is termed _________

Superiorly toward the liver

After the cecum, the colon travels

blind end tube

Appendix AKA vermiform appendix is a long, narrow ______

Cecum Ileocecal valve

Appendix connects to ______ at _______

RLQ at cecum

Appendix is located

Proximal duodenum

C-loop of the duodenum is AKA

Proximal colon

Cecum is AKA

1. 1st born males 2. nonbilious, projectile vomiting 3. weight loss 4. constipation 5. dehydration 6. insatiable appetite 7. palpable olive sign

Clinical finding of pyloric stenosis

1. initial epigastric or general abdomen pain that with time is confined to the RLQ 2. acute abdominal pain 3. Rebound tenderness 4. Nausea/Vomiting 5. possible Leukocytosis (elevated WBC) 6. Fever with abscess formation

Clinical findings of acute appendicitis

Abdominal pain Palpable abdominal mass Vomiting Red currant jelly stools (mix of blood & mucus) Leukocytosis

Clinical findings of intussusception

Inferiorly Sigmoid Rectum

Colon travels _____ and becomes ____ & ______

Little to none

Color flow in normal bowel

Meckel diverticulum

Common congenital outpouching of the wall of the small intestines

perforation peritonitis abscess formation maybe even death

Complications of appendicitis

Bend

Flexure means

Mouth-most proximal to GI tract Pharynx-distal to mouth & connect with Esophagus Esophagus Stomach Small intestines Colon

GI tract consists of

5

GI tract has ___ layers

Alimentary canal

GI tract is AKA

Beginning of the transverse colon

Hepatic flexure marks

outer to outer

How to measure the appendix

2-8wks old infants 1st born males

Hypertrophic pyloric stenosis is MC in

Enlargement of the pyloric muscles which causes closure of the sphincter

Hypertrophic pyloric stenosis leads to

Males

Ileocolic intussusception is MC in

Intestinal obstruction in children less than 2 years old

Ileocolic intussusception is the MCC of

in RLQ at the ileocecal valve

Ileocolic intussusception occurs

In the epigastrum, right of midline, near the GB

In long, the pylorus is noted

Hyperemia

Inflammation and neoplasms will have

Distal

Jejunum and ileum are _____ to the duodenum

Duodenum

Jejunum and ileum are distal to _____

Small intestines

Jejunum and ileum are part of

RLQ

Location of the ileocecal valve

Intraperitoneal Duodenum, Ascending and Descending colon

Most GI parts are ________ in location with the exception of

Compressible Has peristalsis

Normal bowel

<5mm

Normal intestinal wall should measure

Rebound tenderness over the McBurney point in the RLQ

Patients with acute appendicitis suffer from

Cecum

Proximal colon is AKA

C-Loop of the duodenum

Proximal duodenum is AKA

at the distal portion of the pylorus, between the stomach and proximal duodenal bulb

Pyloric channel is located

Emptying of contents of stomach into duodenum

Pyloric sphincter controls

Transversely

Pylorus is positioned ______ in the abdomen

McBurney point

Rebound tenderness and pain occurs over __________ point

Intussusception

Red currant jelly stools are the hallmark sign of?

Left

SMA is typically to the _____ of the SMV

Right

SMV is typically to the _____ of the SMA

C-Shaped

Shape of proximal duodenum

1. Noncompressible blind end tube measuring >6mm in diameter from outer wall to outer wall 2. Appendicolith-echogenic structure within the lumen of the appendix 3. Hyperemic flow within wall of inflamed appendix 4. Periappendiceal fluid collection

Sono findings of acute appendicitis

Identifying the relationship of the SMA & SMV

Sonographic diagnosis of malrotation of the midgut is confirmed by

1. abnormal pylorius appears as target or doughnut in trans 2. abnormal pylorus appears as a cervix in long view 3. wall of the pylorus measures > 3mm in thickness 4. length of pyloric channel will measure > 17mm

Sonographic findings of pyloric stenosis:

Beginning of the descending colon

Splenic flexure marks _______

Intussusception

Telescoping of 1 segment of bowel into another

esophageal hiatus

The esophagus travels inferiorly within the thorax and through an opening called the

Across the abdomen

Transverse colon travels

small amount of water or glucose solution

What can be given to the child to better visualize the pylorus?

pyloric sphincter

What group of muscles called the ___________ controls gastric emptying and prevents undigested food products or chyme from refluxing back into the stomach from the duodenum

Ileocolic intussusception

What is the MC type of intussusception?

Appendicitis

What is the MCC of acute abdominal pain resulting in surgery?

Pylorus

What is the distal region of the stomach?

Red currant jelly stools

What is the hallmark sign of intussusception?

anus

What marks the end of the alimentary canal

duodenum ascending colon descending colon

What parts of the GI tract are considered retroperitoneal in location?

Right lateral decubitus

What position is used to examine the pyloric region?

"gut signature"

What should be noted with ultrasound of the GI?

High frequency linear

What type of transducer is used for GI tract studies?

hypertrophic pyloric stenosis intussusception acute appendicitis

When is ultrasound used for the GI tract?

Intussusceptum (Proximal portion) Intussuscipiens

With intussusception, _________ invaginates into the ________

Right

With malrotation of the midgut, SMA is to the ____ of the SMA

Small bowel mesentery SMA

With malrotation of the midgut, with or without volvulus, _____ rotates around ______

3mm or > thick 17mm or > long

With pyloric stenosis, the wall of the pyloric muscle will measure

Upper GI radiography

_____ is used to verify the diagnosis of malrotation of the midgut

Thickness

______ measurement in pyloric stenosis is more specific

Splenic flexure

_______ marks the beginning of the descending colon

Hepatic flexure

_______ marks the beginning of the transverse colon

Fluid traveling from the pylorus to the duodenum

________ must be observed to eliminate the diagnosis of pyloric stenosis

Graded compression sonography

________ should be used if there is suspicion for intussusception

Ileocolic intussusception

_________ is the MCC of intestinal obstruction in children less than 2 years old

1. appendicolith 2. fecalith (stone consisting of feces) 3. lymph node 4. tumpr 5. foreign body 6. seeds 7. parasite

acute appendicitis may be the result of:

vermiform appendix

blind ended tube that is connected to the cecum of the colon

pylorospasm

common cause of delayed gastric opening

peristalsis

contractions that move in a wavelike pattern to propel a substance

intussuscipiens

distal segment of the bowel with intussusception

non-bilious

not containing bile

compression sonography

operator applied transducer pressure on a structure during a sonographic exam

rebound tenderness

pain encountered after the removal of pressure; common clinical finding in patients suffering from acute appendicitis

Mcburney point

point halfway between the anterior superior iliac spine and the umbilicus

duodenal bulb

proximal portion of the duodenum closest to the stomach

intussusceptum

proximal segment of the bowel with intussusception

gastroesophageal

the distal esophagus attaches to the stomach at an area known as the ____________ junction

Olive sign

when the pyloric sphincter muscle is enlarged and palpable on physical exam of the abdomen it is known as ______ sign

posterier, anterior

with GE reflux, a transverse section of the GE junction can be seen in most persons ______ to the left lobe of the liver and ______ to the abdominal aorta in the sagittal scan plane