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PEDIATRIC ABDOMEN
PEDIATRIC ABDOMEN
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1
Occurs when an excessive iron is stored within the liver. Genetic, secondary, or transfusional
Hemochromatosis
Hepatoblastoma
Hepatomegaly
Budd–Chiari syndrome
2
Sonographically, a hepatoblastoma appears as __ ___mass with a ___, ___pattern and indistinct boarders
solitary multinodular, heterogeneous, hyperechoic
multiple multinodular, homogenous hypoechoic
multiple multinodular, heterogeneous hypoechoic
solitary multinodular, homogenous hyperechoic
3
LEFT RENAL ARTERY
D
F
C
A
4
RIGHT ILIAC ARTERY
A
C
D
F
5
The walls of the abdominal aorta may appear more echogenic than the walls of the IVC
False
True
6
CONGENITAL ABDOMINAL COARCTATION CAN OCCUR AT
ANY
TIME IN EMBRYONIC DEVELOPMENT
False
True
7
HOW MANY TYPES OF CHOLEDOCHAL CYST ARE THERE
2
3
5
4
8
Atresias-•Sonographically, the duodenum and stomach are seen as large dilated
HYPOECHOIC
structures; esophagus dilation
False
True
9
Hemangioendotheliomas usually affect infants less than
1 year
3 months
8 months
6 months
10
Obstruction at this level include malrotation, duodenal duplication cyst, choledochal cyst, and annular pancreas.
Extrinsic Atresias
Intrinsic Atresias
11
absent femoral pulses, hematuria, cyanosis, hypertension, blanching of lower extremities, and necrotizing enterocolitis
signs of Aortic Thrombus
signs of IVC Thrombosis
12
´
Duplication Cysts will appear
both are correct
true cystic character, w/ hypoechoic muscular rim & hyperechoic inner rim
cyst may appear complex b/c of hemorrhage/debri
13
The hemiazygous continuation lies more ____than the aorta.
ANTERIOR
POSTERIOR
SUPERIOR
LATERAL
14
LEFT ILIAC ARTERY
A
F
D
C
15
Type of Hemangioma-blood-filled spaces lined with a single layer of endothelial cells
Cavernous
hemangioendotheliomas
16
AORTA
B
D
C
E
17
THE PROXIMAL DESCENDING THORACIC AO IS AFFECTED ___ % OF COARCTATIONS
98%
85%
95%
100%
18
Sonographically with Hepatic Fibrosis the liver demonstrates
increased echogenicity & billiary occlusion
increased echogenicty & biliary dilatation
decreased echogenicity & billiary dilatation
decreased echogenicity & billiary stenosis
19
Hemangioendothelioma lesions can appear ___ to adjacent liver tissue
hypoechoic
isoechoic
hyperechoic
all of the above
20
Most common pediatric liver mass
Teratoma
Hepatoblastoma
Hemangioma
Lipoma
21
Acquired cysts are also known as pseudocysts & in kids typically result of prior trauma or to do w/ severe pancreatitis
True
False
22
Phlegmon
•
May resolve spontaneously whenever the necrotic process is not progressive.
False
True
23
Bowel twists on itself and causes bowel obstruction
Intussusception
NONE OF THE ABOVE
Volvulus
Pyloric Stenosis
24
Caused by chronic hepatic injury & results from accumulation of abnormal amount of triglycerides & lipids in hepatocytes
hepatitis
cirrhosis
metabolic liver disease
fatty infiltration
25
´
Duplication Cysts cause
all of the above
rectal bleeding
vomiting
abdominal pain and distention
26
related to variety of conditions, including malignancies, metabolic diseases, cystic fibrosis, & exposure to liver toxin
hepatomegaly
hepatic fibrosis
metabolic liver disease
fatty infiltration
27
group of disorders affecting the liver, due to a defect in an enzyme or transport protein.
Polycystic disease
fatty infiltration
hepatitis
metabolic liver disease
28
Pseudocysts due to complications of acute pancreatitis
cause pain or bowel/billiary obstruction
are single or multiple, many resolve 4-12 weeks
all of the above
often located in or adjacent to pancreas
29
VOLULUS-The whirlpool appearance is a result of the mesentery and SMV wrapped around the SMA
False
True
30
Pseudocysts
hyperechoic, ill defined wall, through transmission
hypoechoic, sharp back wall, through transmission, may have internal echoes
anechoic, sharp back wall, through transmission, may have internal echoes
anechoic, ill defined, may have internal echoes
31
Benign and located along the mesenteric border of the bowel but do not communicate with the bowel; most in ileum
HAMANGIOMA
DUPLICATION CYSTS
LIPOMA
PSUEDOCYSTS
32
´
Pyloric Stenosis often affects 1st-born male infants between _ and _ __of age with most pts presenting at __-__ months
4-15 weeks, 4-6 months
10-15 weeks, 5-6 months
1-5 weeks, 1-3 months
2-10 weeks, 1-2 months
33
´
Choledochal Cyst-
•
concentric dilatations of the CBD with intrahepatic ductal dilatation
TYPE III
TYPE II
TYPE IV
TYPE V
34
Duodenal atresia, duodenal web, and duodenal stenosis are considered what type of atresias
Intrinsic
Extrinsic
35
Acquired cysts include
traumatic cysts
hydatid cysts
all of the above
36
Fatty infiltration may be diffuse or focal
True
False
37
Gallbladder wall presents thickened, irregular, and highly reflective
CHOLEDOCHOLITHIASIS
CHOLELITHIASIS
CHOLECYSTITIS
CHOLANGITIS
38
RIGHT RENAL ARTERY
F
D
C
A
39
Additional blood from the digestive system is carried to the liver via the portal vein, formed by the SMV & splenic v
True
False
40
´
Choledochal Cyst- is Caroli disease in which the peripheral intrahepatic ducts are affected either diffusely or focally
TYPE IV
TYPE III
TYPE V
TYPE II
41
THE NORM SPECTRAL DOPPLER OF THE AO SHOWS
PULSATILE VESSEL, HIGH RESISTANCE FLOW PATTERN
PHASIC VESSEL, LOW RESISTANCE FLOW PATTERN
PULSATILE VESSEL, LOW RESISTANCE FLOW PATTERN
PHASIC VESSEL, HIGH RISISTANCE FLOW PATTERN
42
Hepatoblastoma
Occurs most in __ less than __ years of age
boys, 5
girls, 10
girls, 5
boys, 10
43
___ of the liver are congenital anomalies arising from an AV malformation forming blood-filled spaces
Hemangioendothelioma
all of the above
Hemangioma
Hepatoblastoma
44
Congenital cysts are considered as ___ and have an epithelial lining, whereas ____ or ____ cysts do not
complex, simple or primary
primary, simple or complex
acquired, primary or secondary
primary, acquired or secondary
45
most common vascular liver tumor in infancy
Lipoma
Hepatoblastoma
none of the above
Hemangioma
46
hemangiomas are 3x more common in ___ than ___
children, adults
adults, children
boys, girls
girls, boys
47
Thickening of the GB wall, small GB filled with sludge, & enlarged nodes in the porta hepatitis can be found in cases of
hepatic cell necrosis
acute hepatitis
severe hapatitis
cirrhosis
48
SONOGRAPHIC APPEARANCE OF INTUSSUSCEPTION IS
DOUGHNUT SIGN
TARGET PATTERN
PSEUDOKIDNEY APPEARANCE
ALL OF THE ABOVE
49
A hypoechoic to anechoic halo seen surrounding the gallbladder wall is due to __ of the wall itself or a disease in ___
infection, cbd
calcification, cbd
inflammation, liver tissue
infection, liver tissue
50
A mass presents as a doughnut sign: an anechoic to hypoechoic muscle mass with a central lumen of increased echogenicity
Atresias
pyloric stenosis
51
Most common obstructive bowel disorder of early childhood; more frequent in males
Volvulus
Intussusception
Malrotation
52
´
Choledochal Cyst- SECOND MOST COMMON, PRESENTS AS DIVERTICULUM OF COMMON BILE DUCT
´
TYPE III
TYPE I
TYPE V
TYPE II
53
Type of Hemangioma-
lining or endothelium is multilayered or hypertrophic, with primitive or infantile cells
Hemangioendotheliomas
Cavernous
54
Typical sonographic findings of cavernous hemagioma are
well-defined, hyperechoic area within the liver
ill-defined, hypoechoic area within the liver
ill-defined, hyperechoic area within the liver
well-defined, hypoechoic area within the liver
55
Most commonly injured abdominal organ in blunt trauma in children is ___
liver
spleen
kidney
heart
56
The peak incidence of Hydatid echinococcal cysts occurs in patients __ to __ years of age.
5-15
5-20
10-20
5-10
57
ACQUIRED
COARCTATION OF THE AO HAS BEEN ASSOCIATED WITH
NEUROFIBROMATOSIS
TUBERIS SCLEROSIS & TURNER SYNDROME
HYPERCALCEMIA & RUBELLA
ALL OF THE ABOVE
58
RARE CONGENITAL DEFECT OF ABDOMINAL AO, NARROWING OF THE VESSEL
TURNER SYNDROME
HYPERCALCEMIA
TUBEROUS SCLEROSIS
HYPOPLASIA/COARCTATION
59
VESSELS SHOULD HAVE ___ ____ & ____ WALLS
ANECHOIC LUMENS, HYPOECHOIC
HYPOECHOIC LUMENS, HYPERECHOIC
HYPOECHOIC LUMENS, HYPOECHOIC
ANECHOIC LUMENS, HYPERECHOIC
60
THE NORM SPECTRAL DOPPLER FLOW PATTERN OF THE IVC IS
MONOPHASIC
PULSATILE
PHASIC
BIPHASIC
61
´
Hepatoblastoma, patients present with hepatomegaly or a painless, palpable abdominal mass 90%.
True
False
62
___ or___ are usually associated with exposure to livestock, farming, & dogs
parasitic cysts
hydatid echinoccal cysts
none of the above
all of the above
63
´
Duplication Cysts May lead to intussusception and pancreatitis if located near the ___
ampulla of vater
tail of the pancreas
pyloric sphinctor
duodenum
64
Pyloric Stenosis > than 1.8cm is abnormal & muscle thickness is equal to or greater than 4 mm.
False
True
65
WHAT TYPE OF CHOLEDOCHAL CYST IS MOST COMMON IS INFANTS AND CHILDREN
TYPE II
TYPE IV
TYPE III
TYPE I
66
Congenital liver cysts are relatively ___. They range in size from ___ to ___.
common, small to large
common, tiny to large
rare, small to large
rare, tiny to medium size
67
´
Choledochal Cyst- CYSTIC DILATATION OF THE INTRADUODENAL CBD
TYPE III
TYPE IV
TYPE II
TYPE V
68
clotting disorders, dehydration, sepsis, nephrotic syndrome, and extension of renal and/or pelvic vein thrombosis.
signs of IVC thrombosis
signs of Aortic Thrombus
69
Liver cysts may be completely
intrahepatic
,
partly intrahepatic
, or
completely extrahepatic
and attached by a stalk
True
False
70
liver receives oxygenated blood from the hepatic
vein
, a branch of the celiac artery
True
False
71
IVC
E
A
C
B
72
AN IVC ON THE PATIENTS LEFT SIDE IS CALLED
ECTOPIC IVC
NONE OF THE ABOVE
SITUS INVERSUS
REVERSE IVC
73
Solid inflammatory mass W/ necrotic tissue & inflammatory exudate and tissue edema
Volvulus
Intussusception
Pancreatic Abscess
Phlegmon
