Pediatric Sono - Pylorus, Appendix, Bowel PDF

Common Surgical Conditions Pylorus, Appendix, Bowel Pylorus Chapter 25 Pg 784 Hypertrophic Pyloric Stenosis The pyloric canal is located between the stomach and duodenum. In some infants, the pyloric muscle can become HYPERTROPHIED, resulting in obstruction. Acquired condition, where...

Common Surgical Conditions Pylorus, Appendix, Bowel Pylorus Chapter 25 Pg 784 Hypertrophic Pyloric Stenosis The pyloric canal is located between the stomach and duodenum. In some infants, the pyloric muscle can become HYPERTROPHIED, resulting in obstruction. Acquired condition, where the pyloric canal is narrowed MOST COMMON in male infants (4:1) Occurs between 3 and 12 weeks of age, often peaking at 4 weeks Hypertrophic Pyloric Stenosis Cont'd Bile-free vomiting in an otherwise healthy infant is the MOST frequent clinical symptom. As the pyloric muscle thickens and elongates, the stomach outlet obstruction increases and vomiting is more constant and projectile. Dehydration and weight loss may ensue. Acute onset- Colicky baby Chronic - signs of dehydration and weight loss - baby is too lethartic and too sick to cry Hypertrophic Pyloric Stenosis Cont'd Examination: Ideally, NPO for at least a couple of hours before scanning. Took much fluid or no fluid in the stomach is undesirable. However, it is VERY sonographically obvious in a positive HPS, regardless of NPO status. Supine and RLD for examination Assessment of SMA and SMV to assess for midgut malrotation Pyloric Muscle Thickness diagnosis for HPS Muscle thickness greater than or equal to 3mm is the most diagnostic measurement Thickness is measured from periphery of the hypoechoic muscle to its junction with the echogenic central canal. Channel length greater than 15 to 16mm is also reliable indicator. Appendix Appendicitis is the most common cause of emergent surgical abdominal pain in children Mostly occurs in patients ages 5 to 15 years Male Prevalence Appendicitis occurs when the appendiceal lumen becomes obstructed and subsequently infected and inflamed In infants and young children, the progression of acute appendicitis to perforation more rapid Appendix Cont'd RLQ pain and vomiting are common clinical presentation Pain originates in umbilicus and migrates to McBurney's Point McBurney's Point: This common area of the appendiceal attachment to the cecum is one-third the distance between the right anterior superior iliac spine and the umbilicus. McBurney's Point Appendix Cont'd Supine, curvilinear array transducer Be sure to explain to the patient what you will be doing before performing the compression aspect of the exam. Have the patient point to the exact location of pain The normal appendix appears as a blind-ending, long, tubular structure in the long axis and a BULLSEYE in the transverse plane. Normal appendix appears as the andjacent bowel, no peristalsis visualized, and COMPRESSIBLE Appendix Cont'd The acute INFLAMED appendix is NON-COMPRESSIBLE Measured outer wall to outer wall Maximum outer diameter greater than 7mm Acutely inflamed appendix shows increased "hyperemic" flow (see figure 25.22 in textbook) Appendicolith is a hyperechoic, appears simiilar to a gallstone, will show acoustic shadowing, can be single or multiple Enlarged retroperitoneal lymph nodes may be present Intussusception Most common acute abdominal disorder in early childhood Condition where the bowel prolapses into a more distal bowel and is propelled in an antegrade fashion. Telescoping of the bowel in this manner causes OBSTRUCTION. 90 % of cases includes the prolapse of the ileum into the cecum or beyond, producing an ileocolic intussusception. Children present with colicky abdominal pain, vomiting, and bloody (currant jelly) stools. Abodminal distention or palpable mass Intussusception Cont'd The bowel is followed, starting at the cecum in the RLQ Appears as alternating hypoechoic and hyperechoic rings surrounding an echogenic center, as seen in the short-axis view. Known as the TARGET or Cinnamon bun Sign Pathologically measures larger than 3 cm Pseudo-Kidney or "sandwich" sign - Figure 25.28 in textbook