OB Wk 7 Exam

abd wall defects occur in _____ trimester

1st

midgut usually returns into abd cavity by week ______

11-12

a process called _____ helps the embryo transfer into a cylindrical shape

folding

develops when there is a midline defect of the abd muscles, fascia, and skin that results in herniation of intraabdominal structures into the base of the umbilical cord

omphalocele

this herniation is covered by a membrane that consists of the amnion and peritoneum

omphalocele

AFP may be slightly elevated or within normal limits with an

omphalocele

2 types of omphaloceles:

those that contain _____ in the sac

those that contain ______ without liver in the sac

liver

bowel

there is a higher risk for chromosomal abnormalities with this omphalocele

bowel

this omphalocele develops because the intestine fails to return into the abd

bowel

represents a developmental defect in the abd wall closure-- affects the abd wall muscles, fascia, and skin

liver omphalocele

on US:

central abd wall defect with evisceration of bowel or liver into the base of the umbilical cord

ascites may be seen

hydramnios is common

CDH may be present

omphaloceles

bowel omphaloceles appear _______ and must be differentiated from umbilical hernia

echogenic

a normal cord insert suggests an ________ over an omphalocele

umbilical hernia

a periumbilical defect where there is an opening in the layers of the abd wall with herniation of bowel

gastroschisis

gastroschisis is almost always located to the _____ of the umbilical cord

right

gastroschisis infrequently involves the stomach and genitourinary organs --- rarely involves the _____

liver

thought to be a consequence of atrophy of the right umbilical vein or disruption of omphalomesenteric artery (a vascular accident)

gastroschisis

gastroschisis defects are small, measuring _____ in size

2-4cm

gastroschisis is located next to the normal cord insertion (______ side)

right

the umbilical cord insertion is _______ in fetuses with gastroschisis

normal

_________ is always found in the herniation of gastroschisis

small bowel

AFP levels are significantly ______ in gastroschisis vs an omphalocele (bc of exposed bowel)

higher

gastroschisis is more common in _____ and the prognosis with an uncomplicated one is excellent

males

you are able to detect a gastroschisis after _____ weeks

12

with gastroschisis, it is a ____ paraumbilical defect of the abd wall (rarely left sided)

right

to differentiate between omphalocele and gastroschisis:

look for presence of a ________

membrane

gastroschisis will not have a ________

membrane

to differentiate between omphalocele and gastroschisis:

look at the umbilical ____

cord

umbilical cord goes ____ an omphalocele

through

herniation is found to the ____ of the umbilical cord with gastroschisis

right

to differentiate between omphalocele and gastroschisis:

determine which organs are herniated

determine if bowel texture is normal

look for other anomalies because ________ occur with chromosomal abnormalities

omphalocele

beckwith-weidmann syndrome is a rare group of disorders characterized by the common coexistence of (3):

omphalocele, macroglossia, and visceromegaly

a defect in the lower abd wall and anterior wall of the bladder, where the bladder develops outside of the fetus

bladder exstrophy

on US:

normal urinary bladder is not visible

soft tissue mass representing the exposed bladder may be seen on lower abd wall

bladder exstrophy

lower abd wall defect below the cord insertion including exstrophy of bladder and protrusion of intestines

cloacal exstrophy

results in exstrophy of the bladder in which 2 hemibladders are separated by an internal mucosa

cloacal exstrophy

primary finding with cloacal exstrophy is an

anterior abd wall defect

primary finding with pentalogy of Cantrell is

a high/super umbilical omphalocele

AKA ectopic heart; exposed heart presents outside of the chest wall through a cleft defect in the sternum

ectopia cordis

defect that occurs with fusion of the amnion and chorion

limb-body-wall complex

the amnion does not cover the umbilical cord normally, rather it extends as a sheet from the margin of the cord and extends from the body wall and ___________

placenta

_____ sided defects are 3 times more common than right with limb-body-wall complex

left

on US:

defects are large

involve the abdomen and thorax

umbilical cord in short and adherent to placental membranes (or absent)

eviscerated organs seen entangled in the mass

limb-body-wall complex

- complex cardiac disease

- GI anomalies

- GIU anomalies

- neural tube anomalies

associated anomalies w/ omphalocele

- cardiac defects

- facial cleft

- body wall complex

- limb defects

- scoliosis

associated anomalies w/ limb-body-wall

- omphalocele

- cardiovascular malformations

- craniofacial defects

associated anomalies w/ ectopia cordis

fetal abd organs are well formed by what trimester

2nd

the _________ is patent in fetuses

ductus venosus

fetal liver is ______ and occupies a large volume of fetal abdomen

large

most fetuses older than _____ should have fluid in their stomach

16 weeks

stomach should be reevaluated in ______ to rule out possible issues

20 - 30 mins

if an echogenic mass is seen in the stomach it could suggest a placental

abruption

normal esophagus is visualized in _______ trimester(s)

2nd and 3rd

esophagus appears as 2 or more ______________ lines in a multilayered pattern

parallel echogenic

umbilical cord insertion rules out the possibility of (4)

omphalocele, gastroschisis, a hernia, mass

after birth, the umbilical vein collapses to form the

ligamentum teres

movement and swallowing increases the _______ volume in small bowel and colon

amniotic fluid volume

meconium accumulates in the ____ part of small intestine after _____ weeks

distal

15-16

distinction of large bowel from small bowel is possible after

20 weeks

small bowel is slightly ______ compared to liver. Appears as an area of increased echogenicity in the abdomen

hyperechoic

in third trimester, the small bowel becomes less prominent and is located more __________ in the abdomen than colon

central

colon can be identified at the end of ___ trimester

2nd trimester

helps differentiate colon from small bowel

haustra folds

appears as a long tubular structure with well-defined walls. Is located more peripheral

colon

colon does not have _______ like small bowel

peristalsis

meconium appears ______ compared to fetal liver

hypoechoic

meconium will ______ in echogenicity closer to term

increase

larger liver lobe in fetuses

left

liver enlarges with _______ due to increased hematopoiesis

Rh-isoimmunization

most liver tumors appear as solid _____ masses

hypoechoic

if multiple calcifications are seen within liver mass, other organs may be affected such as (2):

brain and spleen

reversal of thoracic and abdominal organs, AKA heterotaxi syndrome

situs inversus

situs inversus can be

partial or total

complete reversal of thoracic and abdominal organs --has a good prognosis

total inversus

more severe form-- thoracic viscera reversed but abdominal is not or vise versa

partial inversus

prognosis is _____ with partial inversus

poor --very high mortality

partial sinus can cause (2):

asplenia or polysplenia

absence of the spleen

asplenia

stomach and GB are more midline

centrally located liver

abnormal position of AO and IVC (on same side)

asplenia

more than one spleen (at least 2)

polysplenia

extra spleens are located on _______ curvature of stomach (right side)

greater

transposition of liver, spleen, stomach

absent GB

interruption to IVC

normal size spleen is not seen between stomach and kidney on trans abdominal image

polysplenia

on US:

right sided heart axis and aorta

transposition of the liver, stomach, spleen, and GB

total sinus

on US:

right sided stomach

left sided liver

right sided heart (dextrocardia) with normal stomach

partial sinus

gastrointestinal obstruction with bowel perforation causes

ascites

seen within the peritoneal recesses and in the spaces between small bowel loops

true ascites

collects between 2 layers of unfused omentum and outlines the falciform ligament

true ascites

sonolucent band (pseudoascites) near the fetal anterior abdominal wall is commonly seen after

18 weeks

results from normal muscles surrounding abdominal wall

pseudoascites

pseudoascites is always confined to the _____ fetal abdomen and is centrally located. It never outlines the ____________ like true ascites

anterior

falciform ligament

calcifications within the GB that will resolve spontaneously in utero or childhood

cholelithiasis

dilation of the CBD ---- appears as a cystic mass adjacent to the fetal stomach and GB

choledochal cyst

choledochal cyst will be in close proximity to GB _____

neck

choledochal cyst is seen as an ovoid RUQ cyst entering the _________

bile duct

with a choledochal cyst, there will be ________ of peristaltic activity

absence

agenesis of GB occurs in patients with biliary atresia and is associated with __________ and multiple anomaly syndromes

polysplenia

spleen may enlarge in fetuses with

Rh isoimmunization

congenital splenic cysts are

rare

develops when a portion of bowel grows and infarcts

atresia

the membrane covering the lumen and intestinal loops enlarges _______ the obstruction

above/proximal