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Sonographic_Tendencies

Apr 22 • 33 tweets • 12 min read

Inspired by a prev post lets do a thread on G.l. Sonography we'll cover peds where GI ultrasound shines and adults🧵 First up gut signature which is an sono term that corresponds to the layers of bowel from inner to outer: mucosa, submucosa, muscularis propria, and serosa

Lets look at normal bowel first differentiating between the small and large intestine is not hard. Large intestine has huastra and can often be osbcured by fecal matter and gas small bowel lacks haustra and is usually very peristaltic.

Peristalsis

Differentiating between small and large intestine

First up appendicitis the most common pathology you'll encounter, probably second to enteritis.
Parameters:
💢Diameter >6mm (non compressible)
💢Wall thickness >2mm
💢Hyperemia
💢Echogenic fat (equivalent to fat stranding on CT)
💢Appendicolith and free fluid can also be seen.

Here's an appendicitis gallery sonographictendencies.com/2022/02/14/app…

All my youtube videos on the appendix youtube.com/playlist?list=…

Pitfalls Terminal ileitis, fecal filled appendix without any other signs of appendicitis. Appendicolith in a non inflamed appendix.

Appendicolith without appendicitis

Moving on let's go up into the epigastrium and look at pyloric stenosis llink to video on pyloric ultrasound

Hypertrophic Pyloric Stenosis

The duodenum is easily seen on ultrasound some patient may have duodenitis here you can see a normal duodenum and a very thickened one. Always put color doppler to assess for hyperemia or if you suspect mural hemorrhage or ischemia infarct.

On to small bowel #POCUS users are very adept at finding small bowel obstruction
Parameters
💢Fluid-filled bowel, diameter >2.5 cm
💢"To-and-fro" movement (hypoperistalsis)
💢Plicae circulares "keyboard sign"
💢Bowel wall edema
💢Free fluid between loops of bowel tanga sign

Small bowel wall thickening often seen in enteritis Here we have 2 cases of patients with Henoch-Schönlein purpura - inflammatory condition causing inflammation and bleeding of small blood vessels affecting small blood vessels of the skin, joints, intestines, and kidneys.

Intussusception common in toddlers can also be seen in older kids and adults though those my need further workup to look for potential tumors or meckels diverticulum as lead point. Pitfall transient small bowel intussusception, if you see a SB intuss wait for resolution <15 min

Small bowel intussusception in the LUQ (location important as Ileocolic usually in RUQ) also usually <2cm in diameter.

Video on Ileocolic and transient small bowel intussusception.

Intussusception in 11 year old caused by Meckel's Diverticulum

Bowel wall thickening of the Colon can be cause by many issues including Crohn's/IBD, infectious colitis among many others

Bowel wall thickening, ascites and creeping fat in a patient Crohn's.

Panoramic of Descending colitis (ascending colon was normal)

Diverticulitis

Diverticula are characterized as bright bowel outpouching
Echogenic fat suggesting an inflammatory process of the surrounding fat planes
thickened bowel wall (>4 mm)
complicated diverticulitis usually requires further CT assessment

Midgut volvulus - Malrotation of the gut from fetal development which may result in the intestines twisting around the mesenteric artery. Check for normal mesenteric vessel positions (SMA anterior to Aorta, SMV anterior to IVC)