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82 Cards in this Set

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What is the normal diameter of the bowel loops
diameter of the vetebrae at t12
Can you tell the type of bowel based off of postion ino the abdomen
no, not like adults
What is the cause of NEC
idiopathic
What is the mortality of NEC
30%
What is the cause of NEC
unknown, but hypoxia, infection are suspect
Where is the MC location of NEC
RLQ
Is NEC patchy
yes
What are the SS of NEC
abdominal distension, feeding intolerance, vomitting, blood in stool and diarrhea, lethary,
What are some radiographic signs of NEC 3
distendend bowel loops (MC)
pneumotosis (later finding)
PV gas
pneumoperitoneum
What causes of abdominal wall defects
- cephalic fold defect
-lateral fold defect
-caudal fold defect
What is the result of a cephalic fold defect
pentalogy of cantrell
What are the findings in pentalogy of cantrell
CHD
ventral hernia
sternal defect
absent anterior diaphragm
pericardial defect
What type of fold defect causes omphalocele and gastroschisis
lateral
What is the result of a caudal fold defect
cloacal extrophy
What is cloacal extrophy
ophalocele, epispadias, and bladder extrophy
Name 4 characteristics of an omphalocele
midline
covered by peritoneum
cord inserts in to apex
2/3 have additional abnormalities
What is the MC location of a gastroschisis
right side
What is the suspected cause of gastroschisis
vascular insult
Are anomalies frequently assoicated with gastroschisis
no
What are 4 characteristics of gastroschisis
right sided
infrequent anomalies
bowel herniation
no peritoneal covering
What is a common complication of gastroschisis
bowel shortening and atresia from exposure to amniotic fluid
What should be suspected if there is polyhydramnios
obstruction to fetal swallowing (esophageal atresia/trachoesophageal fistula)
What % of patients with esophageal atresia TEF have associated anomalies
50%
What is the syndrome associated with EA
VACTERL
vetebral anomalie
anal atresia
cardiac
TEF or EA
renal
limb

(also hip dislocation)
What do you suspect if there is no bowel gas
EA without TEF
What particular group has a higher incidence of EA without TEF
downs
What is an N type fistula
patency between esophagus and trachea during swallowing (this is very rare)
What is considered a high bowel obstruction
above the jejunum
What is considered a low bowel obstruction
below the jejunum
What are the causes of a proximal obstruction in a neonate
7
gastric atresia or web
pyloric stenosis
doudenal atresia, stenosis or web
doudenal duplication cyst
malrotation
midgut volvulus
jejunal atresia and stenosis
What is the cause of doudenal atresia
failure of the doudenum to recanalize at 3-6 wks gestation
Where do 80% of doudenal atresia occur
distal to ampulla of vater
What is a common association with doudenal atresia
annular pancreas or predoudenal portal vein
What is the MC assoication with doudenal atresia
downs
What are 4 associated findings with doudenal atresia patients
other intestinal atresia
CHD
downs
vaterl
When do you see the double bubble
doudenal atresia
What is more common in downs; web or atresia
web
Explain the normal bowel rotation
returns from the yolk sac at 3-10 wks gestation

3 counter clockwise 90 degree turns results in normal rotation.
What are 3 things to look for if you want to rule out malrotation
the SB goes to the left side
jejunum is on the left
cecum is in the RLQ
What is a common complication of malrotation
midgut volvulus
Why does malrotation occur
there is a short mesentery which is prone to twisting
When do 75% of midgut volvulus present
first 6 wks of life
What is the hallmark of midgut volvulus
bilious vomitting
What is used for diagnosis of midgut volvulus
upper gi
What finding do you expect fo have on UGI in a patient with midgut volvulus
corkscrew
how do differentiate proximal vs distal bowel in children
a few loops vs a lot of loops (in children location of bowel can be misleading)
What are 7 causes of a distal bowel obstruction in a neonate
ileal atresia
meconium ileus
colonic atresia
small left colon
meconium plug
hirschsprung
imperforate anus
What is the study of choice for distal bowel obstruction in the neonate
contrast enema
What are you trying to determine with an enema
if there is a microcolon (if so it means there is a high grade ileal obstruction)
Do almost all patients with CF present with meconium ileus
no 5-10% but all pt with meconium ileus have CF
What are the complications of meconium ileus
2
perforation, volvulus
Can an enema be theraupeutic for meconium ileus
yes and it may take a couple times
How to you tell where a colonic atresia is located
enema (the contrast will stop at the level of atresia)
Are colonic atresias frequently multiple
yes
What demographic typical results in functional immaturity of the colon
diabetic mothers
mothers on magneusium
What is functional immaturity of the colon
Distal colon spastic and narrowed, causes functional obstruction usually at splenic flexure
What are the 2 subgroups of functional immaturity of the colon
small left colon
meconium plug
What typically mimics functional immaturity of the colon
hirschsprungs
What are the imaging findings of functional immaturity fo the colon
-Multiple dilated bowel loops in neonate
-Small left colon to the splenic flexure
-Abrupt zone of transition to dilated proximal colon at the splenic flexure
-Multiple filling defects may fill left colon (meconium), but not required
Best imaging tool: Water-soluble contrast enema
What is the best imaging study when evaluating a lower bowel obstruction in a child
Best imaging tool: Water-soluble contrast enema
What is the pathology of hirschsprungs
arrest of ganglion cells results in abscence distally. The bowel is unable to relax without these cells
What are 2 associations with hirshsprungs
downs
congenital neuroblastoma
What is normaly bigger the rectum or sigmoid
rectum (reversed in hirshsprungs
When does hirschsprungs mimic functional immaturity of the colon
when hirschsprungs is long segment
Can hirschsprungs involve the entire colon
yes
What are the classifications of imperforate anus
high (above the puboretalis sling) and low

important to know because it changes surgical approach
What is a common complication of an imperforate anus
rectourethral fistula
What is the mc age of pyloric stenosis
1wk-3mo
What is the abnormal diameter of the appendix in US
>6 mm non-compressible
What is the MC type of intussusception
ileocolic
What is the intussusceptum
the ileum
what is the intussuscipien
colon
What is the cause of the intussuception
hypertrophy of peyers patches
What is the typical age of intussusception
3 months to 2 years
What should be concerned about if the patient is older than 2 years
lead point
What is the typical presentation
colicky abdominal pain, vomitting, bloody currant jelly stool.
What is the contraindication to reduce an intussusception
free air or pneumotosis
What is required prior to reducing an intussusception
plain film to rule out the contridincations
What does the mucosa and muscularis look like on plain flim
mucosa-echogenic
muscularis-hypoechoic
Where is the 2nd mc location of intussusception
the transverse colon
Beside appendicitis, pyloric stenosis and intussuception what is another emergent abominal finding to look for
incarcerated inguinal hernia
What are some causes of conjugated hyperbilirubinemia
neonatal hepatitis, biliary atresia, choledochal cyst, inborn error of metabolismm