Flx - Small Bowel And Hernias

Front 1

which small bowel border is mesenteric and which is anti-mesenteric

Back 1

concave border is mesenteric
convex border is anti-mesenteric

Front 2

nml appearance of jejunum on SBS

Back 2

feathery mucosa
4-7 folds/inch
folds <2mm

Front 3

nml appearance of ileum on SBS

Back 3

decreased folds, less mucosal features
2-4 folds/inch
folds <2mm

Front 4

ULN size of mesenteric LN

Back 4

5mm

Front 5

describe the abn fold patterns seen in SB

Back 5

thin, straight folds with dilated lumen
thickened straight folds
thick, nodular folds

Front 6

ddx for thin, straight folds with dilated lumen

Back 6

obx
ileus
scleroderma
celiac dz

Front 7

pathophys and appaerance of scleroderma in SBS

Back 7

progressive collagen deposition --> flacid, atonic bowel that is dilated
delayed transit time
sacculations on anti-mesenteric border of bowel
"hidebound appearance"
+/- pneumatosis

Front 8

which portion of small bowel is most commonly affected in scleroderma

Back 8

jejunum, duo > ileum

Front 9

what is theory behind pneumatosis in scleroderma

Back 9

may be related to steroid use

Front 10

classic appearance of celiac dz on SBS

Back 10

thin, straight folds, dilated lumen
reversed fold pattern of jejunum and ileum (jejunal folds become ilielized)
(<3 folds per inch)
excessive intraluminal fluid
moulage sign (tubular featureless appearance of jejunum)
segmentation and flocculation of barium

Front 11

moulage sign

Back 11

tubular featureless appearance of jejunum

Front 12

what is meant by segmentation and flocculation of barium in sbs?
when seen?

Back 12

segmentation - barium separated into clumps
flocculation - barium separated into tiny pieces

seen in celiac disease

Front 13

Why are folds in bowel loops thickened in celiac disease

Back 13

hypoalbuminemia

Front 14

ddx for segmental thickened, straight folds

Back 14

ischemia
radiation enteritis
intramural hemorrhage
adjacent inflamm process

Front 15

pathophys of benign pneumatosis

Back 15

may be from slow healing mucosal ulceration
a/w copd (air dissects from alveoli to mediastinum to retroperitoneum to mesentery and small bowel)

Front 16

when does radiation enteritits occur

Back 16

~6mo

Front 17

pathophys of radiation enteritits

Back 17

end arteritis obliterans

Front 18

appearance of radiation enteritis on SBS

Back 18

fold thickening and separation of bowel loops 2/2 edema

Front 19

how does radiation enteritits present

Back 19

obx >> ischemia

Front 20

intramural hemorrhage "buzzword"

Back 20

stack of coins

Front 21

ddx diffuse thickened straight folds

Back 21

venous congestion
hypoproteinemia
cirrhosis

Front 22

ddx segmental thickened nodular folds of small bowel

Back 22

crohn
infx
lymphoma
mets

Front 23

SBS findings with crohns

Back 23

mucosal ulcers
thick nodular folds
cobblestone mucosal pattern
string sign (long seg of narrowed ileum)
bowel wall separation (from fibrosis)
fibrofatty change in mesentery

Front 24

what is string sign

Back 24

long segment of narrowed ileum

Front 25

ddx string sign

Back 25

crohn
TB
histo
blasto

Front 26

complication of fibrofatty change in mesentary

Back 26

ureteral compression

Front 27

another name for fibrofatty change in mesentary

Back 27

creeping fat

Front 28

what causes whipple dz

Back 28

T whippelii

Front 29

sx of whipple dz

Back 29

malabsorption
arthritis
LAD
abd pain
skin changes

Front 30

apearance of whipple dz on SBS

Back 30

fold thickening and nodularity in prox SB

Front 31

pathophys of eosinophilic gastroenteritis

Back 31

eosinophils and chronic inflammatory cells in SB wall

Front 32

appearance of eosinophilic gastroenteritis

Back 32

areas of thickened nodular folds
luminal narrowing
wide separation btwn loops of bowel

Front 33

pathophys intestinal lymphagiectasia

Back 33

lymphatic channels rupture into gut lumen --> protein loss

lymphatics get dilated in SB mucosa

Front 34

appearance of intestinal lymphangiectasia

Back 34

in jejunum, can have thickened folds with small nodules

Front 35

nodular lymphoid hyperplasia asssoc with

Back 35

IgA, IgG deficiency
very high assoc w gastric and colon CA

Front 36

appearance fo nodular lymphoid hyperplasia

Back 36

innumerable small (<4mm) nodules in involved SB
nodules are uniform in size
infx (if confined only to TI)

Front 37

ddx for innum nodules in SB

Back 37

lymphoma (nodules tend to be less uniform in size)
nodular lymphoid hyperplasia (uniform nodules)
mets (less numerous lesions)

Front 38

appearance of metastatic disease to GI tract

Back 38

nodular changes within bowel wall, nodules are more varied in size than nodular lympyhoid hyperplasia

Front 39

ddx for metastatic disease to GIT
how to distinguish

Back 39

lymphoma, lymphangiectasia (both can look identical)
peutz jeghers - polyps are fewer and larger

Front 40

#1 site fo GIT involvement in amyloidosis

Back 40

small bowel

Front 41

pathophys of GIT involvement in amyloidosis

Back 41

insoluble fibrillar protein deposits within extracellular space of various organs. cna deposit in arterial walls --> ischemia/infarct

Front 42

appearance of amyloid in SBS

Back 42

atrophic, thick folds
bowel dilatation, possible obx
bowel can be featureless

Front 43

what diseases is amyloid assoc with

Back 43

multiple myelopma
chronic infx/inflammation (TB, RA)
idiopathic

Front 44

pathophys of mastocytosis

Back 44

prolif of mastoid cells in skin, bones, LN, GIT
assoc with osteoblastic bone changes

Front 45

appearance fo mastocytosis on SBS

Back 45

mucosal nodules up to 5mm
thickened bowel wall and mucosal folds