Ch 25 Neonatal pediatric abdomen

What is NPO for a 0-2, 3-5, 6+

4 hrs, 5 hrs, 6 hrs

what transducer should be used

highest frequency, smallest footprint

what is most common cause of emergent surgical ab pain in children

Appendicitis

peak age of appendicitis

5-15 YO (more male)

clinical of appendicitis

RLQ pain, vomitting

what is appendicitis

infection from appendiceal lumen becoming obstructed

where can you usually find appendix

anterior and medial to psoas muscle and lateral to iliac vessels

what is normal appendix wall thickness

<1.7 mm

will normal appendix compress?

yes, and lumen may be empty

how is appendix measured

outer to outer wall, using the A/P maximum outer diameter (MOD)

what MOD (max outer diam) is consistent with appendicitis

>= 7 mm w/compression

compression will do what

move small bowel out of way

will compressoin collapse appendix with appendicitis

no

Sonographically - what often accompanies acute appendicitis

echogenic fat adjacent, free fluid

what is a good landmark to find appy

psoas muscle

what is most common acute abdominal disorder in early childhool

intussusception

what is intussusception

when bowel telescopes/prolapses over distal bowel, causing obstruction

what is most common intussusception

prolapse of ilium into cecum or beyond producing ileocolic intussusception

peak age and sex for intussusception

6 mo - 2 years ; male 2:1

patient presentation w/intussusception

colicky ab pain, vomitting, bloody/currant jelly stool, poss palp mass

how do you scan for intussusception

follow bowel beginning at RLQ at cecum

what is cinnamon bun or target sign

trans view of intussusception

what is sandwich sign or pseudokidney

long sono of intussusception w/hypoechoic layers on each side of echogenic center

what is hypertropic pyloric stenosis (HPS)

when pyloric muscle becomes hypertrophied, resulting in obstruction - it is an acquired condition that narrows the pyloric canal

does HPS occur in M or F

male - 4:1 between 3-12 weeks old, peaks at 4 weeks

clinical of HPS

projectile vomiting (without bile), possible olive like mass

what position will help move stomach contents out of the way

right decub

what landmark can be used to visualize pyloric muscle

GB, usually medial to GB

what is normal pyloric muscle canal length measurement

< 15 mm

what is normal pyloric muscle wall thickness

< 3 mm

what is normal pyloric diameter

<10 mm

significant finidings with HPS

active antegrade and reverse gastric peristalsis

what is bagel or donut sign

trans view of hypertrophied pyloric muscle

what is cervix sign

when thickened and elongated muscle extends into the antrum in HPS