0:00

So continuing our north to south approach,

0:02

we're gonna now talk about the neonatal abdomen.

0:05

Um, primarily focusing on ultrasound applications

0:08

supplemented by, uh, radiographic um, appearance.

0:13

So the normal bowel gas pattern in an infant.

0:15

This is three different infants.

0:17

All three of them have normal abdominal bowel gas patterns.

0:21

So air-filled loops of bowel number one are pretty, uh,

0:26

spaced diffusely throughout the abdomen.

0:28

It looks like almost a tile of mosaic.

0:31

So if you imagine your, um, like it's some Roman chapel

0:34

and you're looking at the floor

0:36

and you have all these tile, beautiful mosaic of tile pieces

0:39

and all of them are about the same distance

0:41

and they're sort of glued together at equal distances.

0:44

That's basically what your bowel gass pattern should

0:46

look like in a newborn.

0:48

Now how do you know, um, if you have a loop of bowel

0:51

that is too large in an infant?

0:53

'cause in older children, adolescents

0:55

and adults, uh, normal caliber of a loop

0:58

of bowel is 2.5 centimeters.

1:01

But in an extremely premature, very low birth weight,

1:04

infant 2.5 centimeters might be like half of the abdomen,

1:07

um, transverse diameter.

1:09

So in newborns we use the inter particular distance as uh,

1:13

an internal control for how large a loop

1:16

of bowel is allowed to be.

1:17

So this is an abnormal, um, patient

1:19

because uh, we have vertebral body anomalies,

1:22

we have malpositioned catheters,

1:24

we have a boot shaped configuration of this heart.

1:27

So this patient had abdominal coarctation

1:29

with vertebral anomalies,

1:30

but check out the inner particular distance here.

1:33

So if you look at the distance of this vertebral body

1:36

between the pedicles, no loops

1:38

of bowel should be bigger than that distance.

1:40

And so here we have some abnormally dilated loops

1:43

of bowel in this right mid and lower abdominal quadrant.

1:46

So this is an abnormal bowel gas pattern

1:48

and we would, um, talk to our clinical colleagues for, uh,

1:51

exactly what else is going on with this infant

1:53

for the explanation for this, uh,

1:56

abnormal bowel dilation in this newborn.

1:59

In general, when we're talking about ultrasound of bowel,

2:02

um, we use the highest frequency we can

2:06

and, uh, use superficial settings.

2:08

So on almost all machines there's going

2:10

to be a musculoskeletal

2:12

or a small parts preset on your ultrasound machine,

2:16

and that's what I want you

2:17

to use when you're looking at neonatal bowel.

2:19

'cause these infants are tiny.

2:20

Um, just like when you're looking at superficial Ms K

2:24

structures with ultrasound, we want you to be able to see,

2:26

uh, tiny detail and adequate, uh, resolution sonographic.

2:31

So I tell my techs that they need

2:33

to mow the lawn when they're doing an ultrasound to look

2:37

for bowel peritoneal content or any sort of fluid.

2:41

You might have to press hard to get bowel gas out

2:43

of the way, but don't forget to number one,

2:46

as you're mowing the lawn or taking your transducer

2:49

and going superior to inferior from right

2:51

to left across the abdominal cavity.

2:53

Every once in a while pause, let up pressure a little bit

2:56

and watch peristalsis without moving your transducer.

2:59

Um, that's gonna help you be, to be able

3:01

to see like is there normal movement.

3:03

Um, is this one loop of bowel, is this two loop of bowels.

3:06

And then don't forget to interrogate any funky looking loops

3:10

bowel with color or power doppler.

3:12

If you have a microvascular imaging setting on your

3:15

transducer or on your machine, rather to be able to look

3:18

for bowel thickening, um, hyper vascularity

3:21

or decreased perfusion.

3:23

Um, also that's important to look

3:25

for when you're looking at bowel in a newborn.