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111 Cards in this Set

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