jaundice, ab, and surgical conditions

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neonate and children require a different ___. gaining the trust of the patient and the patient's family can do much to facilitate the exam. therefore allow suffiecient time to explain the exam to the __ and to the child wo is old enough to comprehend th: scanning approach, parent, required
toys, books, keys, mibiles, and a variety of other ___ devices can be very helpful in quieting the frightened young child; likewise, a ___ may serve well when examining infants.: distracing; pacifier
bottle feeding of formula is not recommended if the child may undergo surgery; some labs offer __ or pedialyte feedings when examining a neonate for pyloric stenosis. parents are encouraged to be present during the exam and can help reassure and quiet th: glucose water
virtually no routine patient prep is prequired. however to image the ___ completely, it is recommended that feeding be withheld for a short time according to the age of the patient. adequate distention of the urinary bladder is most desirable in some si: biliary system; . GI anomalies
the neonatal/pedi ultrasound exam should evaluate the ab and pelvis, with particular concentration on teh ___ (liver, bile duct, and gb, pancreas, spleen, and portal system).: RUQ
in normal US teh size and texture of teh liver should be evaluated; the rigth hepatic lobe should not extend more than __ cm below the costal margin in a young infant without pulmonary hyperaeration and should not extend below the right costal margin in o: 1 cm, portal venous vasculature
in routine US, careful eval of the biliary system should be made to exclude ductal ___. teh common bile duct should measure less than 1 mm in __, less than 2 mm in ___ up to one year old, less then 4 mm in ___, and less than 7 mm in __ and ___.: dilation; neonates; infants up to one year old; older children; adolescents and adults
on routine US the GB size and wall thickness should be assessed. in infants under on the gallbladder length is __ to __ cm and in older children it is __ to __ cm. careful eval of the normal gb should show a smooth-walled anechoic structure without inte: 1.5-3 cm; 3-7 cm; pericholecystic
the pancreas should be examined for size, echotexture, and evidence of dilation of the ___. head is 1-2.2cm; the body is .4-1 cm; tail is .8-1.8 cm. the pancreatic duct should not exceed __ to __ mm: pancreatic duct; 1-2mm
the normal texture of pancreas is ___ compared with the normal liver texture, as little fatty tissue has invaded the islets of langerhans: hypoechoic
the routine US of the spleen the size and texture should be evaluated. the upper limits of normal splenic length ranges from __ cm in infants less than 3 months old to __ cm in children over 12 years of age: 6 cm, 12 cm (>12 is splenomegaly)
the diameter of teh portal vein may be helpful in determining the presence of ___ which can caused by biliary atresia, cirrhosis, or hepatitis. the mean portan vein measurement is 8.5 mm in children less then 10 years of age and 10 mm in patients 10-20 y: portal hypertension
during the first few weeks of life, many neonates experience this which means it comes and goes; lead to increased unconjugated (indirect) bilirubin and follow a self-limiting course. possible causes are breastfeeding or the mobilization or sequestered: transient jaundice
an increased conjugated (direct) bilirubin is ___.: malignant
jaundice greater than 2 weeks is called ___: persistent jaundice
the causes in neonate may be difficult to define because clinical and lab features may be similar in hepatocellular and obstructive jaundice. if bile obstruction, biliary atresia, or metabolic diseases are to be treated early before cirrhosis occurs, the: persistent jaundice
length is measured from proximal to the distal extemes of the echogenic central canal. will be >20 mm in length. thickness is measured from the periphery of the hypoechoic muscle to its juction with the echogenic central canal. diameter is measured bet: pyloric stenosis
may either be intrahepatic or extrahepatic obstruction to bile flow.: jaundice
includes conditions such as choledochal cyst, biliary atresia, or spontaneious perforation of the bile ducts: extrahepatic jaundice
causes include hepatitis and metabolic disease: intrahepatic
if the neonate has jaundice that perists beyond __ weeks after delivery, an ultrasound exam may be ordered to differentiate between teh three most common causes for jaundice: __, __, and ___. in these patients, clinical and lab work-up is needed to ide: 2; hepatitis, biliary atresia, choledochal cyst; TORCH, sweat
biliary atresia leads to __ quickly: cirrhosis
infection of the liver that occurs within the first three months; causes include infections, metabolic disorders, familial recurrent cholestasis, metabolism errors, or idiopathic causes: hepatitis
sono a normal or enlarged liver may be seen, the parenchyma pattern is echogenic with decreased visualization of the peripheral portal venous structures; goes from "starry skies" appearance to echogenic in end stage: hepatitis
narrowing or underdevelopment of the biliary ductal system;theis serious disease is seen more commonly in males and may reslt from inflammation of the hepatobiliary system. may affect the intrahepatic or extrahepatic ducts and may or may not involve the: biliary atresia
clinical features include persistent jaundice, acholic stools (no bile in stools), dark urine, and distended ab from hepatomegaly which leads to cirrhosis: biliary atresia
sono it may vary in appearance depending on the type and severity of the disease. extrahepatic is most common forms; absence of gb with intrahepatic ducts which requires cholecystectomy: biliary atresia
an abnormal cystic dilation of the biliary tree that most frequently affects the cbd; five types: fusiform dilation of the cbd, diverticula of the cbd, choledochocele, dilation of the intra and extra hepatic ducts and caroli's disease: choledochal cyst
what is the most common form of choledochal cyst?: fusiform dilation of the cbd
sono there is a fusiform dilation of the cbd with associated intrahepatic ductal dilation: choledochal cyst
there are several causes in the child for __. hemangioendothelioma, hepatoblastoma, cholelithiasis and choledocholithiasis, and cirrhosis: pediatric jaundice
what are the two main causes for pediatric jaundice?: hemangioendothelioma and hepatoblastoma
the most common benign vascular liver tumor of early childhood, occurring usually within the first 6 months after birth; is a vascular tumor so grows rapidly especially in pediatrics: hemangioendothelioma aka infantiel hemangioma
the mass is usually diagnosed in teh first months of life because the mass grows rapidly, causing ab distention; the clinical presentation for infants is hepatomegaly, which may be accompanied by congestive heart failure and cutaneous hemangioma; afp elev: hemangioendothelimoa aka infantile hemangioma
sono it has varied appearance; appears as multiple hypoechoic lesions and hepatomegaly; speckled areas of calcification may be seen within the mass. the tumor may be well circumscribed or poorly marginated. teh mass may be solitary or multicentric. col: hemangioendothelioma
the most common primary malignant disease of the liver and occurs most frequently in children under 5 years of age, with the majority occurring in children under 2 years of age; 3rd most common ab malignancy in children after nephroblastoma; this tumor is: hepatoblastoma
list in order the most common ab tumors in pediatrics: nephroblastoma, neuroblastoma, hepatoblastoma
has been associated with b-w syndrome, hemihypertrophy, familial adenomatous polyposis (polyp tumors on organs), and precocious puberty. clinical findings include a palpable mass and an elevated serum afp. patients may be symptomatic with fever, pain, a: hepatoblastoma
sono it shows hepatomegaly with a solitary mass that may show some calcification. the heterogeneous mass is predominantly solid; however, there may be hypoechoic areas with necrosis and or hemorrhage; portal vein thrombosis may be present. the doppler f: hepatoblastoma
3 common surgical conditions: pyloric stenosis, appendicitis, intussusception
the pyloric canal is located between the stomach and the ___. in some infants the pyloric muscle can become ___, resulting in significantly delayed gastric emptying. the pyloris is not hypertrophied itself but the muscle is. therefore it were as a if t: duodenum, hypertrophied
it presents most commonly in male infants between three and six weeks of age; rarely seen before birth or greater than 5 months of age: pyloric stenosis
bile-free emesis in an otherwise healthy infant is the most frequent clinical presentation. as the muscle thickens and elongates, teh stomach outlet obstruction increases and vomiting is more constant and projectile. dehydration and weight loss may ensu: pyloric stenosis
sono is emaging method of choice to establish dx. long images of the muscle are obtained by placing the probe transversely across the ruq, just below the xiphoid process and looking in same area as gb. the probe is then rotated obliquely untile the musc: pyloric stenosis
considered partial when you see a small amount of fluid passing through: partial pyloric stenosis
real-time imaging is then performed using a 5-7 mhz linear array transducer. the gb is initially identified, after which the transducer is angled medially until the bull's-eye appearance of the pyloric muscle and echogenic central canal is noted.: pyloric stenosis
pyloric stenosis sono view. in long axis you wil see __ sign. in short-axis you will see __ sign. visualization of a hypertrophied phyloric muscle with a canal measuring __ mm or greater is seen. individual pyloric muscle wall thickness of __ or great: cervix sign, bull's-eye sign, 16 mm, 3.5 mm, 10mm
after ___, appendicitis is the most common acute ab inflammatory process in children. it is common in __ to __ years of age.: gastroenteritis, 7-14 years
occurs when the appendiceal lumen becomes obstructed and subsequently infected. in infants an young children, the progression of acute form to perforation is more rapid than in older children and adults, sometimes occurring within 6-12 hours.: appendicitis
rebound tenderness, rql pain (mcburney's point which is 2 cm from umbilicus) and vomiting are a common clinical presentation.: appendicitis
sonography has proven to be very accurate in confirming this especially in children. the bladder should be emptied to allow gradual graded compression over the area of the appendix with the linear or curved array transducer. the rigth flank and ruq are: appendicitis
the appendix is usually seen __ and __ to the psoas muscle and __ to the iliac vessels. appendicitis is non___. also rule out kidney, bowel, and ovarian problems: anterior, medial, lateral, compressible
it appears as a blind-ending long, tubular structure as seen in teh long plane, and has a bulls-eye appearance in trv. is measured in the trv plane across short-axis using the maximum diameter: appendix/appendicitis
sono it's inflamed appendix an noncompressible. an outer diameter greater than __ mm with compression consisten with appendicitis both in children and adults. the wall thickness is greater than __ mm.: 6 mm, 3mm
other findings may include free peritoneal fluid or a loculated fluid collection in the lower ab, maybe abscess. can dx based on these alone: appendicitis
is densely echogenic, produces a classic acoustic shadow, may be single or multiple, and may be intraluminal or surrounded by a periappendiceal phlegmon (acute inflammatation)or abscess. a localized well defined rlz phlegmon or abscess with or without is: appendicolith
free peritoneal fluid may be th elone abnormal sono finding. on color doppler, hyperperfusion of blood vessels at the periphery of the inflamed area can be demonstrated: appendicitis
is the most common acute ab disorder in early childhood. this condition occurs when bowel prolapses (herniates)into more distal bowel and is propelled in an antegrade fashion.. telescoping of bowel in this manner causes obstruction: intussusception
the ileum may invaginate into mor distal ileum, causing an ____ intussusception. if there is further progression through the ileocecal valve, and ___ intussusception results. prolapse of the ileum into the cecum or beyond produces and ___ intussusceptio: ileoileal, ileocecal, ileocolic
is usally seen in childre between 6 months and 2 years; with a higher incidence in males (2:1) and a seasonal prevalence.: intussusception
children may present with colicky ab pain, vomiting, bloody current-jelly (purplish) stools; ab mass may be palpable. in patients with a classical clinical presentation that have fever and peritoneal signs, surgical intervention is indicated: intussusception
the patient is examined in the supine position. a survey of the entire ab is performed, followed by an ex focusing on the bowel using a 5-7 mhz linear or curved array transducer. sono, alternating hypoechoic and hyperechoic rings surrounding an echogeni: intussusception
in long axis, hypoechoic layers on each side of the echogenic center result in the appearance of pseudokidney or sandwich appearance: intussusception
free peritoneal fluid is not an uncommon finding with uncomplicated versions. color doppler may help to determine the success of an air reduction enema may have for a reduction. if there is good color flow to all areas of the telescoping bowe, the chanc: intussusception

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