In the pediatric population, imaging often plays a critical diagnostic role, especially in diagnosing congenital anomalies. In children, CT scans are avoided if at all possible due to the high risk of radiation exposure. In addition, both CT and (especially) MRI require children to hold still for significant periods of time and often require sedation to complete the study. For these reasons, plain radiography (often with contrast), fluoroscopy, and ultrasound are the imaging modalities of choice for most suspected cases involving GI pathology. Some conditions that can be diagnosed using imaging include hypertrophic pyloric stenosis, necrotizing enterocolitis, midgut malrotation with or without volvulus, intestinal atresia intussusception, appendicitis, Hirschsprung disease, mesenteric lymphadenitis, and obstructions of the biliary tree.
Last updated: 10 May, 2022
Several additional issues must be considered during pediatric imaging, including:
Prior to the interpretation of any image, the physician should take certain preparatory steps. The same systematic approach should always be followed:
Images should always be interpreted using a systematic approach.
Esophagram, upper GI contrast (i.e., “swallow study”), and small bowel follow-through Small Bowel Follow-Through Imaging of the Intestines studies:
Barium esophagram showing a subtle midesophageal narrowing (yellow marker)
Image: “Barium esophagram 1 month after endoscopic submucosal dissection.” By Department of Gastroenterology, Keiyukai Daini Hospital. License: CC BY 4.0A barium enema Barium enema X-ray examination of lower gastrointestinal tract. Imaging is done while a barium compound (e.g., barium sulfate) fills the large intestine via the rectum as a contrast material. Diarrhea study demonstrating colonic atresia Atresia Hypoplastic Left Heart Syndrome (HLHS): A 2-month-old girl exhibits delayed meconium Meconium The thick green-to-black mucilaginous material found in the intestines of a full-term fetus. It consists of secretions of the intestinal glands; bile pigments; fatty acids; amniotic fluid; and intrauterine debris. It constitutes the first stools passed by a newborn. Prenatal and Postnatal Physiology of the Neonate passage, abdominal distension, and vomiting Vomiting The forcible expulsion of the contents of the stomach through the mouth. Hypokalemia starting 10 days after birth. Barium enema Barium enema X-ray examination of lower gastrointestinal tract. Imaging is done while a barium compound (e.g., barium sulfate) fills the large intestine via the rectum as a contrast material. Diarrhea reveals atresia Atresia Hypoplastic Left Heart Syndrome (HLHS) at the splenic side of the colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy (yellow arrow) and distension of the ileum Ileum The distal and narrowest portion of the small intestine, between the jejunum and the ileocecal valve of the large intestine. Small Intestine: Anatomy (red arrow).
Image: “Case 3” by Pediatric Surgery Department of the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. License: CC BY 2.0Hypertrophic pyloric stenosis Hypertrophic pyloric stenosis Hypertrophic pyloric stenosis is hypertrophy and hyperplasia of the pyloric sphincter muscle. The condition is the most common cause of gastrointestinal obstruction in infants. Affected newborns typically present after the third to fifth week of life with progressive non-bilious vomiting and a firm, olive-like mass in the epigastrium. Hypertrophic Pyloric Stenosis refers to congenital Congenital Chorioretinitis thickening of the pyloric musculature that produces severe stenosis Stenosis Hypoplastic Left Heart Syndrome (HLHS) and near obstruction of the gastric outlet. Children present with nonbilious projectile vomiting Vomiting The forcible expulsion of the contents of the stomach through the mouth. Hypokalemia and an olive-sized mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast in the upper abdomen. Hypertrophic pyloric stenosis Hypertrophic pyloric stenosis Hypertrophic pyloric stenosis is hypertrophy and hyperplasia of the pyloric sphincter muscle. The condition is the most common cause of gastrointestinal obstruction in infants. Affected newborns typically present after the third to fifth week of life with progressive non-bilious vomiting and a firm, olive-like mass in the epigastrium. Hypertrophic Pyloric Stenosis can be treated surgically.
Ultrasound features of hypertrophic pyloric stenosis Hypertrophic pyloric stenosis Hypertrophic pyloric stenosis is hypertrophy and hyperplasia of the pyloric sphincter muscle. The condition is the most common cause of gastrointestinal obstruction in infants. Affected newborns typically present after the third to fifth week of life with progressive non-bilious vomiting and a firm, olive-like mass in the epigastrium. Hypertrophic Pyloric Stenosis: The image shows a cross-section of the pylorus Pylorus The region between the sharp indentation at the lower third of the stomach (incisura angularis) and the junction of the pylorus with the duodenum. Pyloric antral glands contain mucus-secreting cells and gastrin-secreting endocrine cells (g cells). Stomach: Anatomy demonstrating the “ target sign Target sign Pseudomembranous Colitis” (also referred to as the “donut sign”). The calipers mark the thickened musculature, with an inner echogenic ring representing the mucosa.
Image: “Ultrasound features of hypertrophic pyloric stenosis Hypertrophic pyloric stenosis Hypertrophic pyloric stenosis is hypertrophy and hyperplasia of the pyloric sphincter muscle. The condition is the most common cause of gastrointestinal obstruction in infants. Affected newborns typically present after the third to fifth week of life with progressive non-bilious vomiting and a firm, olive-like mass in the epigastrium. Hypertrophic Pyloric Stenosis” by Second University of Naples, Department of Clinical and Experimental Internistic. License: CC BY 2.0Ultrasound image demonstrating a longitudinal view of the pylorus Pylorus The region between the sharp indentation at the lower third of the stomach (incisura angularis) and the junction of the pylorus with the duodenum. Pyloric antral glands contain mucus-secreting cells and gastrin-secreting endocrine cells (g cells). Stomach: Anatomy in a case of hypertrophic pyloric stenosis Hypertrophic pyloric stenosis Hypertrophic pyloric stenosis is hypertrophy and hyperplasia of the pyloric sphincter muscle. The condition is the most common cause of gastrointestinal obstruction in infants. Affected newborns typically present after the third to fifth week of life with progressive non-bilious vomiting and a firm, olive-like mass in the epigastrium. Hypertrophic Pyloric Stenosis: Thickening of the pyloric musculature and elongation Elongation Polymerase Chain Reaction (PCR) of the canal is noted.
Image: “ Hypertrophic pyloric stenosis Hypertrophic pyloric stenosis Hypertrophic pyloric stenosis is hypertrophy and hyperplasia of the pyloric sphincter muscle. The condition is the most common cause of gastrointestinal obstruction in infants. Affected newborns typically present after the third to fifth week of life with progressive non-bilious vomiting and a firm, olive-like mass in the epigastrium. Hypertrophic Pyloric Stenosis” by Herliczek TW. License: CC BY 4.0Necrotizing enterocolitis Enterocolitis Inflammation of the mucosa of both the small intestine and the large intestine. Etiology includes ischemia, infections, allergic, and immune responses. Yersinia spp./Yersiniosis is a relatively common neonatal GI emergency due to infection by gas-forming organisms, which results in ischemic necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage of the intestinal mucosa Intestinal Mucosa Lining of the intestines, consisting of an inner epithelium, a middle lamina propria, and an outer muscularis mucosae. In the small intestine, the mucosa is characterized by a series of folds and abundance of absorptive cells (enterocytes) with microvilli. Small Intestine: Anatomy. Infants typically present with a sudden change in feeding tolerance Tolerance Pharmacokinetics and Pharmacodynamics and abdominal distension in the 1st or 2nd weeks of life.
Necrotizing
enterocolitis
Enterocolitis
Inflammation of the mucosa of both the small intestine and the large intestine. Etiology includes ischemia, infections, allergic, and immune responses.
Yersinia spp./Yersiniosis (
NEC
NEC
Necrotizing enterocolitis (NEC) is an intestinal inflammatory process that can lead to mucosal injury and necrosis. The condition is multifactorial, with underlying risk factors that include prematurity and formula feeding. The clinical presentation varies in severity from feeding intolerance, acute findings on abdominal exam, and systemic symptoms.
Necrotizing Enterocolitis) on radiography
(A) Subtle
portal venous gas
Portal Venous Gas
Imaging of the Intestines with
pneumatosis intestinalis
Pneumatosis intestinalis
A condition characterized by the presence of multiple gas-filled cysts in the intestinal wall, the submucosa and/or subserosa of the intestine. The majority of the cysts are found in the jejunum and the ileum.
Necrotizing Enterocolitis
(B)
Pneumoperitoneum
Pneumoperitoneum
A condition with trapped gas or air in the peritoneal cavity, usually secondary to perforation of the internal organs such as the lung and the gastrointestinal tract, or to recent surgery. Pneumoperitoneum may be purposely introduced to aid radiological examination.
Perforated Viscus under the right hemidiaphragm and
pneumatosis intestinalis
Pneumatosis intestinalis
A condition characterized by the presence of multiple gas-filled cysts in the intestinal wall, the submucosa and/or subserosa of the intestine. The majority of the cysts are found in the jejunum and the ileum.
Necrotizing Enterocolitis
(C) Paucity of gas in the abdomen
(D)
Neonate
Neonate
An infant during the first 28 days after birth.
Physical Examination of the Newborn with a distended abdomen
Anteroposterior fluoroscopic image after positive enteric contrast administration demonstrates a “corkscrew” appearance of the duodenum Duodenum The shortest and widest portion of the small intestine adjacent to the pylorus of the stomach. It is named for having the length equal to about the width of 12 fingers. Small Intestine: Anatomy, which does not cross the leftward aspect of the spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy (dashed line). This finding is suggestive of malrotation and midgut Midgut Development of the Abdominal Organs volvulus Volvulus A volvulus is the twisting or axial rotation of a portion of the bowel around its mesentery. The most common site of volvulus in adults is the colon; most frequently the sigmoid volvulus. Patients typically present with symptoms of bowel obstruction such as abdominal pain, distension, vomiting, and constipation/obstipation. Volvulus.
Image: “Upper gastrointestinal study (UGI) demonstrating intestinal malrotation Intestinal malrotation Intestinal malrotation is a congenital anomaly that results from failure of the GI tract to undergo normal rotation around the mesenteric vessels during embryologic development. This condition can result in several anatomic patterns characterized by abnormal location and attachments of the abdominal cavity’s intestines. Intestinal Malrotation and volvulus Volvulus A volvulus is the twisting or axial rotation of a portion of the bowel around its mesentery. The most common site of volvulus in adults is the colon; most frequently the sigmoid volvulus. Patients typically present with symptoms of bowel obstruction such as abdominal pain, distension, vomiting, and constipation/obstipation. Volvulus with abnormal position of the duodenal-jejunal junction to the right of the spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy” by Pediatric Department, Shaare Zedek Medical Center, P.O. Box 3235, 9103102, Jerusalem, Israel. License: CC BY 4.0(A)
Upper GI series
Upper Gi Series
Imaging of the Intestines with barium contrast shows that the
duodenum
Duodenum
The shortest and widest portion of the small intestine adjacent to the pylorus of the stomach. It is named for having the length equal to about the width of 12 fingers.
Small Intestine: Anatomy remains isolated to the right hemiabdomen without crossing the midline, consistent with malrotation.
(B)
Small bowel follow-through
Small Bowel Follow-Through
Imaging of the Intestines shows that the
cecum
Cecum
The blind sac or outpouching area of the large intestine that is below the entrance of the small intestine. It has a worm-like extension, the vermiform appendix.
Colon, Cecum, and Appendix: Anatomy is located in the
left lower quadrant
Left Lower quadrant
Anterior Abdominal Wall: Anatomy.
Intestinal atresia Atresia Hypoplastic Left Heart Syndrome (HLHS) is a condition in which a portion of intestine fails to canalize during development, resulting in bowel obstruction Bowel obstruction Any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anal canal. Ascaris/Ascariasis in newborns. Approximately ½ of all cases constitute duodenal atresia Duodenal atresia Failed recanalization of the duodenum during embryonal development. Congenital Duodenal Obstruction. Infants present with vomiting Vomiting The forcible expulsion of the contents of the stomach through the mouth. Hypokalemia and abdominal distension. Surgery is the definitive treatment.
Radiograph showing the double bubble sign in an infant with duodenal atresia Duodenal atresia Failed recanalization of the duodenum during embryonal development. Congenital Duodenal Obstruction
Image: “Invertogram showing high ARM Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy and AP view showing duodenal atresia Duodenal atresia Failed recanalization of the duodenum during embryonal development. Congenital Duodenal Obstruction” by Manoj Saha, Department of Pediatric Surgery, Gauhati Medical College. License: CC BY 3.0Upper GI contrast study taken at 5 and 15 minutes showing a dilated stomach Stomach The stomach is a muscular sac in the upper left portion of the abdomen that plays a critical role in digestion. The stomach develops from the foregut and connects the esophagus with the duodenum. Structurally, the stomach is C-shaped and forms a greater and lesser curvature and is divided grossly into regions: the cardia, fundus, body, and pylorus. Stomach: Anatomy (red arrows) and marked distension of the duodenum Duodenum The shortest and widest portion of the small intestine adjacent to the pylorus of the stomach. It is named for having the length equal to about the width of 12 fingers. Small Intestine: Anatomy (yellow arrows) all the way to the duodenojejunal junction (green arrow). The findings suggest jejunal atresia Atresia Hypoplastic Left Heart Syndrome (HLHS). Gastroesophageal reflux is also noted in the esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus: Anatomy, but the rest of the distal bowel appears normal.
Image: “Upper gastrointestinal contrast study” by Rahul Gupta, Praveen Mathur, Sharanabasappa Gubbi, Pradeep Kumar Gupta, Ramendra Shukla, and Anu Bhandari. License: CC BY 3.0Intussusception Intussusception Intussusception occurs when a part of the intestine (intussusceptum) telescopes into another part (intussuscipiens) of the intestine. The condition can cause obstruction and, if untreated, progress to bowel ischemia. Intussusception is most common in the pediatric population, but is occasionally encountered in adults. Intussusception: telescoping of a distal segment of the bowel into a more proximal segment, most often in the ileocolic region. Intussusception Intussusception Intussusception occurs when a part of the intestine (intussusceptum) telescopes into another part (intussuscipiens) of the intestine. The condition can cause obstruction and, if untreated, progress to bowel ischemia. Intussusception is most common in the pediatric population, but is occasionally encountered in adults. Intussusception is the most common abdominal emergency in children < 2 years of age, which presents with the “classic triad” of sudden onset crampy abdominal pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways, a palpable sausage-shaped mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast, and currant jelly stools.
Ultrasonography of the right abdomen shows the typical ultrasonographic “target” sign of ileocolic intussusception Intussusception Intussusception occurs when a part of the intestine (intussusceptum) telescopes into another part (intussuscipiens) of the intestine. The condition can cause obstruction and, if untreated, progress to bowel ischemia. Intussusception is most common in the pediatric population, but is occasionally encountered in adults. Intussusception.
Image: “Ultrasonography of the right upper abdominal quadrant” by Department of Pediatric Surgery and Pediatric Urology, Johann Wolfgang Goethe University of Frankfurt. License: CC BY 4.0Ultrasound (A) and CT (B) radiographic evidence of
intussusception
Intussusception
Intussusception occurs when a part of the intestine (intussusceptum) telescopes into another part (intussuscipiens) of the intestine. The condition can cause obstruction and, if untreated, progress to bowel ischemia. Intussusception is most common in the pediatric population, but is occasionally encountered in adults.
Intussusception
(A) Ultrasound showing the appearance of bowel within a bowel, consistent with
intussusception
Intussusception
Intussusception occurs when a part of the intestine (intussusceptum) telescopes into another part (intussuscipiens) of the intestine. The condition can cause obstruction and, if untreated, progress to bowel ischemia. Intussusception is most common in the pediatric population, but is occasionally encountered in adults.
Intussusception
(B)
Axial
Axial
Computed Tomography (CT) CT with IV contrast showing
intussusception
Intussusception
Intussusception occurs when a part of the intestine (intussusceptum) telescopes into another part (intussuscipiens) of the intestine. The condition can cause obstruction and, if untreated, progress to bowel ischemia. Intussusception is most common in the pediatric population, but is occasionally encountered in adults.
Intussusception in the
left lower quadrant
Left Lower quadrant
Anterior Abdominal Wall: Anatomy
Abdominal radiograph after air enema demonstrates a “crescent” (meniscus) sign demonstrating intussusception Intussusception Intussusception occurs when a part of the intestine (intussusceptum) telescopes into another part (intussuscipiens) of the intestine. The condition can cause obstruction and, if untreated, progress to bowel ischemia. Intussusception is most common in the pediatric population, but is occasionally encountered in adults. Intussusception.
Image: “Abdominal radiograph after subsequent air enema” by Jaclyn Otero, Molly R. Posa, and Maria N. Kelly. License: CC BY 4.0Obstruction of the terminal ileum Ileum The distal and narrowest portion of the small intestine, between the jejunum and the ileocecal valve of the large intestine. Small Intestine: Anatomy by abnormally thick and sticky meconium Meconium The thick green-to-black mucilaginous material found in the intestines of a full-term fetus. It consists of secretions of the intestinal glands; bile pigments; fatty acids; amniotic fluid; and intrauterine debris. It constitutes the first stools passed by a newborn. Prenatal and Postnatal Physiology of the Neonate. Meconium Meconium The thick green-to-black mucilaginous material found in the intestines of a full-term fetus. It consists of secretions of the intestinal glands; bile pigments; fatty acids; amniotic fluid; and intrauterine debris. It constitutes the first stools passed by a newborn. Prenatal and Postnatal Physiology of the Neonate ileus Ileus A condition caused by the lack of intestinal peristalsis or intestinal motility without any mechanical obstruction. This interference of the flow of intestinal contents often leads to intestinal obstruction. Ileus may be classified into postoperative, inflammatory, metabolic, neurogenic, and drug-induced. Small Bowel Obstruction is often seen in neonates with cystic Cystic Fibrocystic Change fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans and Hirschsprung disease Hirschsprung Disease Hirschsprung disease (HD), also known as congenital aganglionosis or congenital megacolon, is a congenital anomaly of the colon caused by the failure of neural crest-derived ganglion cells to migrate into the distal colon. The lack of innervation always involves the rectum and extends proximally and contiguously over variable distances. M Hirschsprung Disease. Affected neonates usually present with vomiting Vomiting The forcible expulsion of the contents of the stomach through the mouth. Hypokalemia, failure to pass meconium Meconium The thick green-to-black mucilaginous material found in the intestines of a full-term fetus. It consists of secretions of the intestinal glands; bile pigments; fatty acids; amniotic fluid; and intrauterine debris. It constitutes the first stools passed by a newborn. Prenatal and Postnatal Physiology of the Neonate within 12‒24 hours, and abdominal distension.
Also known as congenital Congenital Chorioretinitis aganglionic megacolon Megacolon Megacolon is a severe, abnormal dilatation of the colon, and is classified as acute or chronic. There are many etiologies of megacolon, including neuropathic and dysmotility conditions, severe infections, ischemia, and inflammatory bowel disease. Megacolon, Hirschsprung disease Hirschsprung Disease Hirschsprung disease (HD), also known as congenital aganglionosis or congenital megacolon, is a congenital anomaly of the colon caused by the failure of neural crest-derived ganglion cells to migrate into the distal colon. The lack of innervation always involves the rectum and extends proximally and contiguously over variable distances. M Hirschsprung Disease is characterized by the absence of nerve cells in the distal colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy, resulting in failure of the affected segment to relax, leading to functional obstruction. Affected neonates present with bilious emesis, abdominal distension, and failure to pass meconium Meconium The thick green-to-black mucilaginous material found in the intestines of a full-term fetus. It consists of secretions of the intestinal glands; bile pigments; fatty acids; amniotic fluid; and intrauterine debris. It constitutes the first stools passed by a newborn. Prenatal and Postnatal Physiology of the Neonate. Associated enterocolitis Enterocolitis Inflammation of the mucosa of both the small intestine and the large intestine. Etiology includes ischemia, infections, allergic, and immune responses. Yersinia spp./Yersiniosis is common.
Abdominal anteroposterior radiograph of a neonate Neonate An infant during the first 28 days after birth. Physical Examination of the Newborn with Hirschsprung disease Hirschsprung Disease Hirschsprung disease (HD), also known as congenital aganglionosis or congenital megacolon, is a congenital anomaly of the colon caused by the failure of neural crest-derived ganglion cells to migrate into the distal colon. The lack of innervation always involves the rectum and extends proximally and contiguously over variable distances. M Hirschsprung Disease showing air-filled distended loops of the large intestine Large intestine The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy: No part of the descending or sigmoid colon Sigmoid colon A segment of the colon between the rectum and the descending colon. Colon, Cecum, and Appendix: Anatomy can be identified.
Image: “Abdominal plain X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests shows a generalized distention of the loops of the large intestine Large intestine The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy” by Nusrat et al AL Amyloidosis. License: CC BY 4.0Appendicitis Appendicitis Appendicitis is the acute inflammation of the vermiform appendix and the most common abdominal surgical emergency globally. The condition has a lifetime risk of 8%. Characteristic features include periumbilical abdominal pain that migrates to the right lower quadrant, fever, anorexia, nausea, and vomiting. Appendicitis is the inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation of the appendix Appendix A worm-like blind tube extension from the cecum. Colon, Cecum, and Appendix: Anatomy, which characteristically presents with periumbilical pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways migrating to the RLQ with guarding, nausea Nausea An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. Antiemetics/ vomiting Vomiting The forcible expulsion of the contents of the stomach through the mouth. Hypokalemia, and fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever. In children, the diagnosis is usually clinical with/without the use of ultrasound. Management is usually surgical.
Sonographic views in appendicitis Appendicitis Appendicitis is the acute inflammation of the vermiform appendix and the most common abdominal surgical emergency globally. The condition has a lifetime risk of 8%. Characteristic features include periumbilical abdominal pain that migrates to the right lower quadrant, fever, anorexia, nausea, and vomiting. Appendicitis: axial Axial Computed Tomography (CT) (left) and transverse (right). The overall diameter between the calipers is shown.
Image: “Sonographic views of appendix Appendix A worm-like blind tube extension from the cecum. Colon, Cecum, and Appendix: Anatomy.” by Ebrahim Karimi, Mohammad Aminianfar, Keivan Zarafshani, and Arash Safaie. License: CC BY 3.0Mesenteric lymphadenitis Lymphadenitis Inflammation of the lymph nodes. Peritonsillar Abscess refers to inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation in the mesenteric lymph Lymph The interstitial fluid that is in the lymphatic system. Secondary Lymphatic Organs nodes (usually in the RLQ) that often occurs when the enteric immune system Immune system The body’s defense mechanism against foreign organisms or substances and deviant native cells. It includes the humoral immune response and the cell-mediated response and consists of a complex of interrelated cellular, molecular, and genetic components. Primary Lymphatic Organs reacts strongly to an infection (e.g., viral infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease, Yersinia enterocolitica Yersinia enterocolitica A species of the genus yersinia, isolated from both man and animal. It is a frequent cause of bacterial gastroenteritis in children. Yersinia spp./Yersiniosis infection). Stretching of the lymph Lymph The interstitial fluid that is in the lymphatic system. Secondary Lymphatic Organs node capsules can result in pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways similar to that experienced in appendicitis Appendicitis Appendicitis is the acute inflammation of the vermiform appendix and the most common abdominal surgical emergency globally. The condition has a lifetime risk of 8%. Characteristic features include periumbilical abdominal pain that migrates to the right lower quadrant, fever, anorexia, nausea, and vomiting. Appendicitis; however, mesenteric lymphadenitis Lymphadenitis Inflammation of the lymph nodes. Peritonsillar Abscess is self-limiting Self-Limiting Meningitis in Children.
Ultrasound of the right lower quadrant Right lower quadrant Anterior Abdominal Wall: Anatomy showing prominent mesenteric lymph Lymph The interstitial fluid that is in the lymphatic system. Secondary Lymphatic Organs nodes measuring up to 9 mm MM Multiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies. Multiple Myeloma, suggestive of mesenteric lymphadenitis Lymphadenitis Inflammation of the lymph nodes. Peritonsillar Abscess
Image: “Abdominal ultrasound showing large hypoechoic Hypoechoic A structure that produces a low-amplitude echo (darker grays) Ultrasound (Sonography) mesenteric lymph Lymph The interstitial fluid that is in the lymphatic system. Secondary Lymphatic Organs nodes in a 6-year-old girl with acute nonspecific mesenteric lymphadenitis Lymphadenitis Inflammation of the lymph nodes. Peritonsillar Abscess” by Rossana Helbling, Elisa ELISA An immunoassay utilizing an antibody labeled with an enzyme marker such as horseradish peroxidase. While either the enzyme or the antibody is bound to an immunosorbent substrate, they both retain their biologic activity; the change in enzyme activity as a result of the enzyme-antibody-antigen reaction is proportional to the concentration of the antigen and can be measured spectrophotometrically or with the naked eye. Many variations of the method have been developed. St. Louis Encephalitis Virus Conficconi, Marina Wyttenbach, Cecilia Benetti, Giacomo D. Simonetti, Mario G. Bianchetti, Flurim Hamitaga, Sebastiano A.G. Lava, Emilio F. Fossali, and Gregorio P. Milani. License: CC BY 4.0Two significant biliary tract Biliary tract Bile is secreted by hepatocytes into thin channels called canaliculi. These canaliculi lead into slightly larger interlobular bile ductules, which are part of the portal triads at the “corners” of hepatic lobules. The bile leaves the liver via the right and left hepatic ducts, which join together to form the common hepatic duct. Gallbladder and Biliary Tract: Anatomy disorders that can cause obstruction include biliary atresia Atresia Hypoplastic Left Heart Syndrome (HLHS) and choledochal cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change. Both present with obstructive jaundice Jaundice Jaundice is the abnormal yellowing of the skin and/or sclera caused by the accumulation of bilirubin. Hyperbilirubinemia is caused by either an increase in bilirubin production or a decrease in the hepatic uptake, conjugation, or excretion of bilirubin. Jaundice and acholic stools. Treatment is surgical.
Biliary atresia Atresia Hypoplastic Left Heart Syndrome (HLHS)
Image by Lecturio.Biliary atresia Atresia Hypoplastic Left Heart Syndrome (HLHS) in a 65-day-old girl: (A) Ultrasound in the transverse plane Transverse plane Anterior Abdominal Wall: Anatomy shows a negative triangular cord sign (arrow). (B) Ultrasound image in the oblique subcostal plane Subcostal Plane Anterior Abdominal Wall: Anatomy shows an atretic gallbladder Gallbladder The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile. Gallbladder and Biliary Tract: Anatomy measuring 0.8 cm (asterisk) and enlarged hepatic artery Hepatic artery A branch of the celiac artery that distributes to the stomach, pancreas, duodenum, liver, gallbladder, and greater omentum. Liver: Anatomy measuring 1.5 mm MM Multiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies. Multiple Myeloma (arrow). (C) A 3D MRCP MRCP Non-invasive diagnostic technique for visualizing the pancreatic ducts and bile ducts without the use of injected contrast media or x-ray. Mri scans provide excellent sensitivity for duct dilatation, biliary stricture, and intraductal abnormalities. Primary Sclerosing Cholangitis shows no visible extrahepatic biliary tree Biliary tree The bile ducts and the gallbladder. Gallbladder and Biliary Tract: Anatomy and the presence of a small gallbladder Gallbladder The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile. Gallbladder and Biliary Tract: Anatomy (asterisk). (D) Surgical cholangiography shows a small gallbladder Gallbladder The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile. Gallbladder and Biliary Tract: Anatomy (asterisk) and a patent but extremely hypoplastic common bile duct common bile duct The largest bile duct. It is formed by the junction of the cystic duct and the common hepatic duct. Gallbladder and Biliary Tract: Anatomy.
Image: “Biliary atresia Atresia Hypoplastic Left Heart Syndrome (HLHS) in a 65-day-old girl” by Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine. License: CC BY 4.0