Fetal Abdomen And Abdominal Wall

Front 1

Diaphragm

Back 1

A muscle that appear sonographically as a hypoechoic curved structure separating the more echogenic lung from the liver and stomach.

Front 2

Liver

Back 2

The Liver is large and occupies most of the upper abdomen in the fetus.
The left lobe is larger than the right lobe

Front 3

Gall Bladder

Back 3

GB is an anechoic fluid fill structure seen in the anterior right abdomen inferior to the liver margin.

Front 4

Spleen

Back 4

Spleen is seen the upper left abdomen posterior to the stomach
The spleen is echogenic and homogenous

Front 5

Gastroschisis

Back 5

Relatively small defect involving all 3 layers of abdominal wall thatcallown the intestines to protrude out in the amniotic cavity.
Occurs lateral to umbilical cord insert , usually to the right.
Is not covered by an membranous sac.
has no associated anomalies

Front 6

Omphalocele

Back 6

Results from faulire of the intestines to return by to the abdomen during the second stage of intestinal rotation.
Occurs at the level of the umbilical cord insertion.
May contain single loops of bowel, or most of abdominal content depending on severity.
herniation is covered by a membranous sac which is layers or amnion and peritoneum.
Has high association with congenital anomalies.

Front 7

Songraphic findings of Gastroschisis

Back 7

-variable amounts of bowel floating in amniotic fluid
-no membranous sac covering herniation
-cord is seen adjacent to defect

Front 8

Songraphic findings of Omphalocele

Back 8

-extra-abdominal mass consisting of a combination of bowel, liver or other abdominal content
-membranous sac covering herniation
-mass at the level of umbilical cord

Front 9

Bladder Extrophy

Back 9

Midline defect that involves the lower abdominal wall and the anterior wall of the urinary bladder.
Isolated defect characterized by the exposure and protrusion of the urinary bladder.
May be associated with genital anomalies.

Front 10

Sonographic findings for Bladder Extrophy

Back 10

-unable to identify the bladder after 30mins of scanning
-mirophallus in male fetuses
separation of pelvic bones
-possible soft tissue protrusion from lower abdominal wall

Front 11

Esophagus

Back 11

Unable to identify unless the fetus is swollen or stenosis is present.

Front 12

Stomach

Back 12

In transverse view the stomach is seen as a oviod fluid collection in the upper left abdomen.
The muscular wall is much thinner in fetuses.
Occasional echoes my be visualized in the stomach.

Front 13

Intestines

Back 13

Diffect to isolate unless fluid is present to provide specific contrast.
Has a cyctic to mixed echogenicity
Peristalsis is seen in the late 2nd trimesters.
Meconium fills the colon and it appears highly echogenic.
The colon is peripheral and small intestines is centrally located in the fetal abdomen.
Colon is most obvious in the 3rd trimester.

Front 14

Esphageal Atresia

Back 14

The discontinuity of the esphagus.
90% are accompanied by a distal traheo-esophageal fistula.
Associated with other congenital malformation most commonly cardiovascular, gastrointestinal, genitourinary, musculoskeletal anomalies.

Front 15

Sonographic findings for Esophageal Atresia

Back 15

-small to absent fetal stomach
-unable to identify the stomach on a serial scan
-may not be sonographically identified if a TE fistal is not present
-polyhydramnios

Front 16

Duodenal Atresia

Back 16

-most common type of perinatal intestinal obstruction
- 65% of fetuses has a karyotypic abnormality at birth, most commonly vertebral and cardiac.
-30% of infant has trisomy 21

Front 17

Songraphic findings for Duodenal Atresia

Back 17

- "double-bubble" sign- dilated stomach with proximal duodenum
-may not be apparent until after 24 weeks
-polyhydramnios

Front 18

Intestinal Atresia

Back 18

Obstruction of the intestines.
Dilated bowel loops may occur at any location along intestinal tract or at the level of the anus.

Front 19

Sonographic findings for Intestinal Atresia

Back 19

-multiple fluid fill bowel loops
-small bowel internal diameter > 7mm
-possible perferation due to calification and ascites
-polyhydramnios
-increased bowel paristalsis

Front 20

Meconium Peritonitis

Back 20

Sterile chemical peritonitis is cause by small bowel perforation in utero.
Perforation is caused by intestinal atresia, volvulus or meconium ileus.
Cystic fibrosis is considered to be the etiology in 35-40% due to thick and sticky meconiun.

Front 21

Songraphic finding for Meconium Peritonitis

Back 21

-presence of a meconium psudocyst
-calcification that may cast a shaddow
-fetal ascites and polyhydramnios

Front 22

Hyperechoic Bowel

Back 22

Bowel that is similar to or greater than that of adjacent bone.
Lower Fz should be used
Located in lower abdomen or pelvic
Diffuse or Focal over a well defined area that does not shaddow.
Can be identified on a 2nd trimesters scan.

Front 23

Common etiology for hyperechoic bowel

Back 23

-normal variant
-trisomy 21
-cystic fibrosis
-swollowed intra - amniotic blood
-CMV infection

Front 24

Abdominal Ascites

Back 24

Ascites is commonly associated with a condition call hydrops fetalis

Front 25

Persistent Right Umbilical Vien

Back 25

When the umbilical vien course toward the left of the fetal abdomen.
umblical vien enters the right portal vien instead of the left portal vien.
Not pathological but can be associated with some anomalous conditions