The Gastrointestinal Tract and Abdominal Wall CH 10

CLINICAL FINDINGS OF A RECTUS SHEATH НЕМАТОМА

1. Abdominal pain 2. Palpable abdominal mass 3. Discoloration of the skin in the area of the hematoma 4. Decreased hematocrit

SONOGRAPHIC FINDINGS OF PYLORIC STENOSIS

1. Abnormal pylorus appears as a target or dough- nut in the short-axis view 2. Abnormal pylorus appears as a cervix in the long-axis view 3. Wall of pylorus will measure greater than or equal to 3 mm in thickness 4. Length of pyloric channel will measure greater than or equal to 17 mm

SONOGRAPHIC FINDINGS OF A RECTUS SHEATH НЕМАТОМА

1. Blood can appear hypoechoic, hyperechoic, complex, and/or anechoic depending on the stage of development.

SONOGRAPHIC FINDINGS OF CROHN DISEASE

1. Bowel wall thickening 2. Affected bowel will be noncompressible and have a target appearance 3. Hyperemic wall

CLINICAL FINDINGS OF DIVERTICULITIS

1. Constipation or diarrhea 2. Fever 3. Nausea and vomiting 4. Cramping, left lower quadrant pain

SONOGRAPHIC FINDINGS OF AN INTESTINAL OBSTRUCTION

1. Distended fluid-filled loops of bowel 2. An abrupt termination point of the distended bowel may be identified 3. Increased peristaltic motion with to-and-fro motion of intraluminal contents (mechanical ob- struction only)

CLINICAL FINDINGS OF CROHN DISEASE

1. Episodes of diarrhea 2. Abdominal pain 3. Weight loss 4. Rectal bleeding

CLINICAL FINDINGS OF PYLORIC STENOSIS

1. First-born (white) male infant (most often) 2. Nonbilious, projectile vomiting 3. Weight loss 4. Constipation 5. Dehydration 6. Insatiable appetite 7. Palpable olive sign

SONOGRAPHIC FINDINGS OF ACUTE APPENDICITIS

1. Noncompressible, blind-ended tube that mea- sures more than 6 mm in diameter from outer wall to outer wall 2. Echogenic structure within the lumen of the ap- pendix (appendicolith) 3. Hyperemic flow within the wall of the inflamed appendix 4. Periappendiceal fluid collection

SONOGRAPHIC FINDINGS OF INTUSSUSCEPTION

1. Noncompressible, target-shaped or pseudokidney-shaped mass that consists of alter- nating rings of echogenicity (cinnamon bun sign) 2. The diameter of the intussuscepted bowel will exceed 3 cm

CLINICAL FINDINGS OF GASTRIC CARCINOMA

1. Weight loss 2. Abdominal pain 3. Anorexia 4. Vomiting

paralytic ileus

A situation in which bowel is blocked because of the lack of normal peristalsis of a bowel segment or segments; also referred to as non mechanical obstruction

Doughnut sign

A sonographic sign associated with pyloric stenosis in the short axis

Cinnamon bun sign

A sonographic sign associated with the appearance of intussusception

Midgut malrotation

Abnormal rotation of the bowel that leads to a proximal small bowel obstruction

Crohn's disease

An auto immune disease characterized by periods of inflammation of the gastrointestinal tract

Inguinal hernia

Can be further described as direct or indirect Bowel protrudes into the groin

auto immune disorder

Disorder caused when the immune system begins attacking organs in its own body

echogenicities of Serosa (outermost layer)

Echogenic

echogenicities of Submucosa (muscularis propria interface)

Echogenic

Red "currant jelly" stools

Feces that contains a mixture of mucus and blood; a common clinical finding and patient suffering from intussusception

echogenicities of Deep mucosa

Hypoechoic

echogenicities of Muscularis propria

Hypoechoic

What technique is utilized to show movement and the change in size of the hernia.

Valsalva technique

Trichobezoars

a bezoar that consists of matted hair

lactobezoar

a bezoar that consists of powdered milk

Phytobezoars

a bezoar that consists of vegetable matter

the gastroesophageal junction, can be identified with sonography and will appear as

a bulls-eye structure between the left lobe of the liver and abdominal aorta in the sagittal imaging plane

endometriosis

a condition in which patches of endometrial tissue escape the uterus and become attached to other structures in the pelvic cavity

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

The stomach consists of

a fundus, body, and pyloric region.

volvulus

a situation in which a loop of bowel twists upon itself

mechanical obstruction

a situation in which bowel is physically blocked by something

3. Which of the following is not a layer of gut identified with sonography? a. Visceral b. Serosa c. Submucosa d. Mucosa

a. Visceral

6. All of the following are sonographic criteria in the diagnosis of pyloric stenosis except: a. Wall of the pylorus is focally thinned b. Length of the pylorus measures more than 17 mm c. Doughnut appearance in transverse d. Cervix appearance in longitudinal

a. Wall of the pylorus is focally thinned

CLINICAL FINDINGS OF ENDOMETRIOSIS OF THE ABDOMINAL WALL

1. History of endometriosis 2. Prior cesarean section 3. Pain on the area of the cesarean section scar (possible pain that correlates with the menstrual cycle) 4. Palpable mass

CLINICAL FINDINGS OF ACUTE APPENDICITIS

1. Initial epigastric or general abdominal pain that, with time, is eventually restricted to the right lower quadrant 2. Acute abdominal pain 3. Rebound tenderness 4. Nausea and vomiting 5. Possible leukocytosis 6. High fever (with abscess formation)

non-mechanical 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 paralytic ileus

Cervix sign

A sonographic sign associated with pyloric stenosis in the long Axis

Perienteric fat

Fat around intestines

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

Peristalsis

contractions of smooth muscles that provide the force that moves food through the esophagus toward the stomach

13 Other abnormalities that can present much like pyloric stenosis include all of the following except a. Midgut malrotation b. Pylorospasm c. Gastroesophageal reflux disease d. Intussusception

d. Intussusception

10. Pseudomyxoma peritonei can result from: a. Intussusception b. Pyloric stenosis c. Crohn disease d. Appendix cancer

d. Appendix cancer

9. All of the following are common clinical findings in infants who present with pyloric stenosis except: a. Weight loss b. Dehydration c. Olive sign d. First-born female

d. First-born female

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

5. Upon sonographic evaluation of the right lower quadrant in a patient complaining of focal abdominal pain in that area, you visualize a hyperemic blind-ended, tubular structure that contains a shadowing focus. What is the most likely etiology of the shadowing focus? a. Ureteral stone b. Appendicolith c. Gallstone d. Herniated omentum

b. Appendicolith

7. All of the following are sonographic findings of acute appendicitis except: a. Appendicolith b. Compressible, blind-ended tube c. Periappendiceal fluid collection d. Hyperemic flow

b. Compressible, blind-ended tube

CLINICAL FINDINGS OF INTUSSUSCEPTION

1. Intermittent, severe abdominal pain 2. Vomiting 3. Palpable abdominal mass 4. Red currant jelly stools 5. Leukocytosis

SONOGRAPHIC FINDINGS OF DIVERTICULITIS

1. Segmentally thickened bowel with evidence of an inflamed diverticula and inflamed perienteric fat 2. Affected bowel segment will typically reveal hyperemia 3. Inflamed diverticula may appear as echogenic projections from the bowel that produce shad- owing or ring-down artifact

bezoars

Masses of various ingested materials that may cause an intestinal obstruction

thyroid in the belly sign

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

15. Gastric cancer is most often in the form of: a. Cystadenocarcinoma b. Adenocarcinoma c. Rhabdomyocarcinoma d. Angiosarcoma

b. Adenocarcinoma

1. A patient presents to the sonography department with bilious vomiting. While investigating the pediatric patient for pyloric stenosis, you note that while the pyloric sphincter appears normal, the SMA is abnormally located to the right of the SMV. What is the most likely diagnosis? a. Pylorospasm b. Intussusception c. Crohn disease d. Midgut malrotation

d. Midgut malrotation

14. Which of the following would be the most likely clinical feature of colitis? a. Inguinal herniation of the bowel b. Right shoulder pain c. Watery diarrhea d. Midline hematoma

c. Watery diarrhea

Sonography utilizes compression to analyze bowel. In many situations, normal bowel is

compressible,

Valsalva maneuver

forcible exhalation against a closed glottis, resulting in increased intrathoracic pressure

8. Clinical findings of acute appendicitis include all of the following except: ristalsis a. Leukocytosis b. Right lower quadrant pain mm c. Constipation d. Rebound tenderness

c. Constipation

intussuscipiens

the distal segment of the bowel with intussusception

invaginate

to insert

CLINICAL FINDINGS OF AN INTESTINAL OBSTRUCTION

1. Abdominal distention 2. Intermittent abdominal pain 3. Constipation 4. Nausea and vomiting

11. A patient presents to the sonography department with a painful, superficial abdominal mass located within a prior cesarean scar. What clinical feature would be most consistent with scar endometriosis? a. Hematuria b. Chronic headaches c. Cyclical pain d. Bloody diarrhea

c. Cyclical pain

2. What anatomic structure may be noted as a bulls-eye structure anterior to the abdominal aorta and posterior to the left lobe of the liver in the sagittal scan plane? a. Pyloric sphincter b. Duodenal antrum c. Gastroesophageal junction d. Distal jejunum

c. Gastroesophageal junction

12. What abnormality associates red currant jelly stools? a. Diverticulosis b. Appendicitis c. Intussusception d. Pyloric stenosis

c. Intussusception

adenocarcinoma

cancerous tumor of glandular tissue

nonbilious

not containing bile

compression sonography

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

Olive sign

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

CLINICAL FINDINGS OF COLITIS

1. Bloody or watery diarrhea 2. Fever 3. Abdominal pain 4. Previous use of antibiotic therapy

SONOGRAPHIC FINDINGS OF GASTRIC CARCINOMA

1. Hypoechoic, irregular-shaped, bulky mass

SONOGRAPHIC FINDINGS OF COLITIS

1. Thickened, hypoechoic colon wall 2. Hyperemia within the colon wall

SONOGRAPHIC FINDINGS OF ENDOMETRIOSIS OF THE ABDOMINAL WALL

1. Well-defined, lobulated, or infiltrative mass 2. Hypoechoic to the adjacent tissue

McBurney's point

A point on the right side of the abdomen, about two-thirds of the distance between the umbilicus and the anterior bony prominence of the hip

Meckel's diverticulum

common congenital malformation of the GI tract; an outpouching of the bowel located at the ileum of the small intestine near the ileocecal valve; a failure of destruction of the vitelline duct, an embryonic communication between the midgut and the yolk sac

Incisional hernia

Bowel protrudes into a surgical incision site

Spigelian hernia

Bowel protrudes into a weakened area in the lower one-fourth of the rectus muscle; midline of abdomen, between umbilicus and pubis symphysis

Umbilical hernia

Bowel protrudes into the umbilicus; umbilicus

Linea alba hernia

Bowel protrudes through the fascia of the linea alba; midline abdomen

echogenicities of Superficial mucosa (innermost layer)

Echogenic

intussusception

Telescoping of One segment of bowel and to another; most often the proximal segment of the bowel inserts into the distal segment

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

4. All of the following are true of normal intestinal findings with sonography except: a. Normal bowel does not compress b. Normal bowel should have observable peristalsis c. Intestinal wall should measure less than 5 mm d. Normal bowel has little to no color Doppler signals

a. Normal bowel does not compress

vermiform appendix

blind-ended tube connected to the cecum

Complications of abdominal wall hernias include

incarceration, strangulation, and ischemia of the affected bowel.

A key clinical finding of intussusception is

red currant jelly stool.

Gastroesophageal junction

the junction between the stomach and the esophagus

The gastrointestinal tract, or alimentary canal, consists of

the mouth, pharynx, esophagus, stomach, the small intestines, and colon

The clinical finding where the enlarged pyloric muscle can be palpated is referred to as

the olive sign.

duodenal bulb

the proximal portion of the duodenum closest to the stomach

intussusceptum

the proximal segment of the bowel with intussusception

diverticulosis

development of diverticula, pouches in the lining of the colon

Leukocytosis

increase in the number of white blood cells

Appendicitis is indicative when

inflamed appendix is noncompressible and measures greater than 6 mm.

Acute appendicitis

inflammation of the appendix

Diverticulitis

inflammation of the diverticula. Within theDigestive track most often in the sigmoid colon

Melanoma

malignant tumor of pigmented cells in the skin

Sonography utilizes compression to analyze bowel. abnormal bowel is

noncompressible.

rebound tenderness

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