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111 Cards in this Set
- Front
- Back
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Indications of small bowel study
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small bowel obstruction
malabsorption syndrom crohns disease enteritis |
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Contraindications of small bowel study
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perforation
large bowel obstruction |
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name all of the studies that could be done on the small bowel
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small bowel follow through
small bowel series only enteroclysis |
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When is a small bowel follow through finished?
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when the barium reaches the iliocecal valve (2-3 hours)
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How can a small bowel series increase motility?
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lie on right side
glass of ice water saline instead of water add Gastrografin give maxolon/maxeren |
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How many columns of barium are given in a small bowel series?
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one
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How is enteroclysis different from a small bowel series or small bowel follow through?
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barium is injected into the duodenal/jejunal junction (ligament of trutz)
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What is the advantage of enterolysis over other small bowel studies?
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no flocculation
no segmentation visualize defects as injected |
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What is the disadvantage of entereclysis in comparison to other small bowel studies?
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higher dose
more uncomfortable for patient possible perforation |
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What radiographs are necessary for small bowel visualization?
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AP/PA
can also do oblique or erect as necessary |
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What is the patient preparations for a small bowel series?
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NPO after 12am
no smoking no gum food and fluid withheld at least 8 hours prior |
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What is the patient preparations for a barium enema?
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low residual diet for 2-3 days
clear fluid diet the day before laxatives colonic lavage if needed |
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What is the concentration of barium in a single contrast barium enema study?
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15-25% w/v
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What is the concentration of barium in a double contrast barium enema study?
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75-95% w/v
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What is the patient's position for inserting an enema tip, and why?
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Simm's (left lateral with right knee flexed)
relax ab muscles, decrease anal sphincter pressure |
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What is the patient's position for removing an enema tip, and why?
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left lateral (not simms)
increases pressure on the anal sphincter so the patient has more control of their bowel |
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What is a single contrast barium enema used for?
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children
gross pathology |
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What is a double contrast barium enema used for?
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mucosal pattern
small growths polyps diverticula |
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What are the routine studies for barium enema study?
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AP/PA
RAO/LPO LAO/RPO L lat R lat erect AP axial |
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AP/PA large bowel demonstration
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all of the large bowel
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AP/PA axial large bowel demonstration
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30-40* cephalad
retrosigmoid colon |
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RAO/LPO large bowel demonstration
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right colonic/hepatic flexure
ascending colon sigmoid colon |
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LAO/RPO large bowel demonstration
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left colonic/splenic flexure
descending colon |
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Where should the central ray be positioned for a large bowel?
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at the iliac crests
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What is the advantage to virtual CT colonoscopy?
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gentle preparation
less discomfort |
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What is the disadvantage to virtual CT colonoscopy?
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Difficult to differentiate pathologies from fecal material
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right lateral large bowel demonstration
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medial side of ascending colon
lateral side of descending colon left colonic/splenic flexure |
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left lateral large bowel demonstration
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medial side of descending colon
lateral side of ascending colon recto-sigmoid colon |
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Is the air or contrast being visualized when reading a radiograph?
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The air
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When is a barium enema used therapeutically?
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To attempt to reduce intussusception
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What is defecography used to study?
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functional study of the rectum and anus during evacuation and rest
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What are some types of intestinal obstructions?
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mechanical simple small bowel
mechanical closed loop small bowel functional small bowel large bowel |
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causes of a mechanical small bowel obstruction?
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tumour
adhesions volvulus inguinal hernia |
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causes of a functional small bowel obstruction?
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paralytic adynamic ileus
toxic injury traumatic injury |
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symptoms of an intestinal obstruction
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pain
abdominal tenderness vomiting constipation abdominal distension decreased bowel sounds |
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what happens if an obstruction isn't treated?
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fluid will accumulate
continued distension becomes ischemic then necrotic |
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in what age group do small bowel obstructions normally occur?
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older individuals
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same symptoms as small bowel obstruction, but more likely in children
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appendicitis
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define simple mechanical obstruction
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one point of obstruction
no blood flow interference gas and fluid accumulates |
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radiographic appearance of an incomplete simple mechanical obstruction
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stepladder sign
stacked coin |
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radiographic appearance of a complete simple mechanical obstruction
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no gas in the large bowel
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define closed loop mechanical obstruction
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2 part obstruction
blood supply cut off |
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complication of closed loop mechanical obstruction
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blood supply cut off
infarction - necrotic - gangrene |
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radiographic appearance of a closed loop mechanical obstruction
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inverted u shape
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define functional obstruction
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peristalsis of the small bowel isn't working properly
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radiographic appearance of functional obstruction
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distended loops in the central abdomen
gas and fluid levels gas in the small and large bowel no specific point of obstruction |
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main cause of functional obstruction
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surgery
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radiographic difference between functional and mechanical obstruction
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functional-gas in the large bowel
mechanical-no gas in the large bowel |
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radiographic difference between small and large bowel obstruction
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small- distended loops in the central abdomen
large- distended loops in the peripheral abdomen |
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define volvulus
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complete twisting of a loop of bowel about its mesenteric base of attachment
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common sites for volvulus
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sigmoid
cecum |
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radiographic appearance of volvulus
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sigmoid: inverted u
cecum: kidney shaped air filled mass |
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types of inflammatory bowel disease
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crohn's disease (regional enteritis)
ulcerative colitis |
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crohn's disease location
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terminal ileum commonly
is regional, so can happen anywhere |
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crohn's disease symptoms
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RLQ pain
blood in stool possible clubbed nailbeds transmural |
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radiographic appearance of crohn's disease
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skip lesions
string sign (ulcers or edema) cobblestones fistula formation |
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treatment of crohn's disease
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medication (steroids)
diet (less bulk) surgery if required |
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ulcerative colitis symptoms
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abdominal pain
weight loss fever superficial (not transmural) |
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ulcerative colitis location
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rectosigmoid colon
LLQ |
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radiographic appearance of ulcerative colitis
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pipestem sign (fibrosis)
loss of haustra toxic megacolon grainy and gritty |
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ulcerative colitis complications
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toxic megacolon
hemorrhage perforation obstruction |
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define malabsorption syndrome
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inadequate absorption of nutrients from intestinal mucosa
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malabsorption syndrom causes
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GI surgery
pancreatic disorder hepato-biliary disease small bowel disease hereditary disorder |
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malabsorption radiographic appearance
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irregular distorted small bowel folds
OR distension with regular folds |
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define meckels diverticulum
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congenital small intestine sac/appendage of fluid in/near ileum
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cause of meckels diverticulum
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failure of the vitelline duct to close during embryological development
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complications of meckels diverticulum
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ulcer
perforation hemorrhage |
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treatment of meckels diverticulum
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surgery if needed
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radiographic appearance of meckels diverticulum
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finger of a glove near the terminal ileum
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define intussusception
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segment of the bowel telescope into the segment just distal to it
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age group of intussusception
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3 months - 6 years
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location of intussusception
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ileocecal valve (usually)
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most common cause of bowel obstruction in young children
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intussusception
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signs/symptoms of intussusception
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abrupt onset of abdominal pain
blood in stool palpable RLQ |
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special case of intussusception
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adults with tumour, pedunculated polyps, or inflammatory mass
causes nausea and vomiting |
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radiographic appearance of intussusception
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coiled spring
CT: 3 concentric rings US: doughnut shape |
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differentiate between diverticulosis and diverticulitis
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diverticulosis is mucosa herniating through the muscular layer
diverticulitis is inflamed diverticula |
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diverticulosis cause
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weak muscular wall
low fibre diet constipation/straining low exercise |
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diverticulitis cause
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retained fecal material
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diverticular disease age
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very common over 60
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early, middle, and late symptoms of diverticular disease
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(early) flatulence
(middle) intermittent diarrhea or constipation (late) hemorrhoids, LLQ pain |
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complications of diverticular disease
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perforation
abscess strictures suppuration |
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symptoms similar to diverticular disease
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hemorrhoids
carcinoma inflammatory bowel disease |
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radiographic appearance of diverticular disease
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outpouchings of colon wall
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treatment of diverticular disease
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anti-inflammatory drugs
surgery diet (no seeds, nuts, popcorn) |
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types of polyp
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pedunculated
sessile familial |
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location of polyps
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pedunculated- ascending, transverse, rectosigmoid
sessile- sigoid, rectum familial- throughout colon |
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symptoms of polyps
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rectal bleeding
diarrhea constipation |
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causes of peritonitis
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1) spread from other abdominal infections
2) rupture of GI tract 3) penetrating abdominal wound |
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define polyp
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growth that projects from the mucosa of the colon into the lumen
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symptoms of peritonitis
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continuous abdomen pain
tense, rigid abdomen vomiting fever |
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complications of peritonitis
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abscesses
adhesions that lead to obstruction toxic shock |
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treatment of peritonitis
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antibiotics early
surgery late |
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prognosis of peritonitis
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good if localized
poor if generalized |
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colon cancer locations
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colorectal
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age of people who get colon cancer
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50-70
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causes of colon cancer
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ulcerative colitis
familial polyps |
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radiographic appearance of colon cancer
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apple core sign
progressive constriction of lumen |
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preventative measures against colon cancer
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less red meat, fat, sugar, smoking
more fibre, chicken, fish, fruits, vegetables |
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common site of secondary cancer to colon cancer
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liver cancer
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second most common site for cancer
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colon
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define hirschsprungs disease
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congenital absense of nerve ganglia in the proximal rectum that always involves the anal sphincter
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symptoms of hirschprungs disease from birth
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no bowel signs
no passage of meconium abdominal distension |
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symptoms of hirschprungs disease in an infant
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abdominal distension
constipation small stool |
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radiographic appearance of hirschprungs disease
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huge dilated colon with sudden narrowed segment of colon
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treatment of hirschprungs disease
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surgically remove narrowed segment (astamosis)
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define imperforate anus
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congenital absence of normal communication between rectum and exterior of the body
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cause of imperforate anus
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embryological accident
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modality of choice for imperforate anus
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ultrasound
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radiographic procedure for imperforate anus
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1) hold infant upside down for 5 minutes (air to tip of blind pouch)
2) 72" SID, AP, Lat with marker at anal opening 3) measure distance from pouch to opening |
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complications after surgery for imperforate anus
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may have difficulties going to the bathroom
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