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
