Pediatric Sonography- GI Tract

is ultrasound of the GI tract widely used in peds patients?

yes

the normal gastric wall measures ____-____mm

2.5-3.5

what are some causes of gastric thickening? (3)

gastritis

gastric ulcer

lymphoid hyperplasia

the submucosa layer in a neonate will normally be what echogenicity?

hyperechoic

the muscle layer in a neonate will normally be what echogenicity?

hypoechoic

what pathology describes abnormal thickening of the antropyloric region of the stomach?

hypertrophic pyloric stenosis

hypertrophic pyloric stenosis usually affects which patient demographic?

first born male infants that are 2-10 weeks old

what are the clinical presentations of hypertrophic pyloric stenosis? (4)

Dehydration

Frequent episodes of projectile nonbilious vomiting

Failure to thrive

Thickening palpated as the "olive-shaped" epigastric mass

what is the sonographic sign used to diagnose hypertrophic pyloric stenosis?

donut sign

hypertrophic pyloric stenosis is diagnosed when the AP of pyloric diameter exceeds ____cm

1.5

what is the description for the donut sign seen with hypertrophic pyloric stenosis?

An anechoic/hypoechoic muscle mass with a central echogenic lumen

what is the treatment for hypertrophic pyloric stenosis?

Pyloromyotomy

what are the signs/symptoms of a small bowel obstruction? (3)

bilious vomiting

abdo distention

failure to pass meconium

what is the sonographic appearance of a small bowel obstruction?

hyperactive, dilated bowel loops

bowel wall thickening in some cases

duodenum & stomach seen as large anechoic structures

what pathology describes abnormally thick meconium in the distal small bowel?

meconium ileus

meconium ileus is associated with which genetic disease?

cystic fibrosis

what is the sonographic appearance of meconium ileus?

echogenic bowel content (can be seen on prenatal scans)

dilated bowel loops

decreased peristalsis

what are some complications of meconium ileus?

peritonitis

pseudocyst

what is a congenital anomaly that results from an abnormal rotation of the gut as it returns to the abdominal cavity during embryogenesis?

midgut malrotation

patients with midgut malrotation will have shortened ____________

mesentery

what conditions is midgut malrotation associated with?

oomphalocele

gastroschisis

duodenal atresia

what is the sonographic appearance of midgut malrotation?

Reversed SMA and SMV

SMV directly anterior to SMA

SMA pulled to right, anterior to IVC

SMA right to aorta

what is intussusception?

when a telescoping portion of bowel prolapses into a more distal segment

what conditions put a child more at risk for intussusception?

Meckel diverticulum

Enteric duplication cyst

Intestinal polyps

Lymphoma

what is the most common type of intussusception?

iliocolic

what is the most common patient demographic for intussusception?

1-3 year old boys

what are the clinical presentations of intussusception?

Abdominal pain, intermittent

Currant-jelly (dark red) stool

Palpable abdo mass

Abdo distention

Vomiting

what is the sonographic appearance of intussusception?

Target pattern- Multiple concentric anechoic rings surrounding a dense echogenic center

Doughnut sign- An anechoic ring surrounding echogenic center

Pseudokidney appearance

May be signs of edema and vascular compromise

what are possible complications of intussusception? (4)

Bowel obstruction

Perforation

Peritonitis

Vascular compromise which leads to edema of bowel and gangrene

what is the treatment for intussusception?

enema (air, barium or saline)

surgery

which portions of the bowel are most commonly affected in crohn's disease?

terminal ileum & prox colon

crohn's affects peds patients aged ____ and older

10

what are the clinical symptoms of crohn's?

Pain

Diarrhea

Fever

Weight loss

what is the sonographic appearance of crohn's disease?

Symmetrically thickened hypoechoic bowel walls

Non- or partially compressible

Bull's eye or target sign on trv

Pseudo kidney - in sag

↑ vascularity

Secondary appendicitis

Lymphadenopathy

where in the bowel would you find a Enteric Duplication Cyst?

along the mesenteric border of the bowel

do enteric duplication cysts communicate with the bowel?

no

what are the clinical presentations of enteric duplication cysts?

Abdo pain

Distention

Vomiting

rectal bleeding

what is the sonographic appearance of enteric duplication cysts?

Well defined

Round

fluid filled mass

Hypoechoic outer muscular rim and a hyperechoic inner rim of mucosa

what are the clinical presentations of lymphoma?

Palpable abdo mass

Abdo pain

Vomiting (due to obstruction)

what is the sonographic appearance of lymphoma?

Hypoechoic bowel wall thickening

or a focal hypoechoic or complex mass

Splenomegaly

Enlarged retroperitoneal/mesenteric lymph nodes

what is the most common emergency condition requiring emergency surgery in child?

acute appendicitis

what is the triad of symptoms for acute appendicitis?

1. RLQ pain

2. Leukocytosis

3. Fever

acute appendicitis is diagnosed with an appendix AP measuring over ____mm

6

what is the sonographic appearance of acute appendicitis?

Tubular noncompressible structure

Appendix > 6mm AP

Appendicolith may be noted

Enlarged mesenteric lymph nodes

Inflamed fat and free fluid

appendix perforation occurs as a complication of appendicitis in 80-100% of cases in peds patients under the age of ____

3