47 - Small intestine Flashcards by anna frykfors von hekkel

In what order should three view rads be taken for vomiting?

Right lateral -> fundic gas; Left lateral -> redistribution to pylorus –> duo/jej; VD - gas retained in duo

HOWEVER -> left, VD, right has been shown to increase gas in duo in left lat and VD views…

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Under what age is serosal detail reduced due to reduced abdo fat?

6 months

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List two radiographic measures of canine SI diameter

List 2 radiographic measures of feline SI diameter

Canine:

<2 rib widths

<1.6x height of L5 at narrowest point

(>1.97 -> 80% probability; 2.07 -> 90% probability)

Feline:

<12mm

<2x L2 vertebral endplate

(>2.5, most likely cause is intestinal obstruction)

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List the two ligamentous attachments of the duodenum

Proximal duodenum: Hepatoduodenal ligament;

Ascending duodenum: Duodenocolic ligament

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What does a pseudoulcer refer to?

Concave depressions at antimesenteric mucosal surface of duodenum -> seen at gas-mucosal surface

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What percentage of non-fasted cats with no GI disease have SI gas?

And fasted dogs?

65% have more than 25% SI with gas in it

RARELY present in fasted cat

In fasted dogs: 30-60% of SI may contain gas

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Which US artifact is seen with intraluminal gas in SI?

Ring-down if static (or reverberation if moving segment)

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What causes focal hyperechogenicity at the equatorial tangents of transverse sections of SI?

Widening of the intervillous space when bowel folds

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Describe features causing hyperechogenicity within the hypoechoic layers of SI loops - CANINE STUDY, EX VIVO

1) All segments, mucosal dual layering: More luminal in position -> villi (increasasing with lacteal dilation); deeper position -> Lamina propria
2) Distal ileum mucosa: Additional hyperechoic line in deepest part of mucosa, and parallel to submucosa -> enlarged lymphoid follicles
3) Muscularis: Hyperechoic line -> fibrous tissue in myenteric plexus

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What animals may have a assymmetrically positioned hypoechoic submucosal layer? Where? What is the significance?

Young entire male cats, healthy: Proximal jejunum (in half of studied cats) and ileum (in all) => likely lymphoid follicles

* has been seen in older cats too*

Unknown significance

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Describe the published characteristics of post prandial mucosal hyperechogenic speckles in the dog

Immediately post prandial:

Echo: High fat MORE compared to fasted in duodenum, but not jejunum
Echogenicity more luminal position
> Likely interface of mucus and ingesta, too soon for lacteals

60 mins post:

Both high and low fat diets increased
Duodenum: echo > than immediately post
More diffuse distribution through mucosa
> Physiological lacteal dilation

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FELINE Wall thickness….

FUCK MY LIFE

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Which small intestinal segment is thickest in the dog and cat respectively?

Dog: Duo; Cat: Ileum

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What are the normal reported sizes for duodenal papillae in dogs and cats?

Dog: L15.2x6.3x4.3mm

Cat? 2.9-5.5mm (4mm in heightin transverse)

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What does “String of pearls” refer to?

Strong duodenal contraction in feline contrast studies

-> 30% of cats!

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What is the rate of peristaltic contractions in the small intestine>?

1-3 per minute

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Which lymph nodes drain the duodenum? Jejunum? Ileum?

Duo: Pancreaticoduodenal and hepatic;

Jej: Jejunal;

Il: Colic

(In the cat, and ileocaecocolic node is also present)

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Normal length of jejunal nodes in adult dog?

5-200mm

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Measurements / features of jejunal LNs of puppies?

Hypo, particularly at periphery.

1.5-12.5mm thick.

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Cats: normal node sized (PD; Jej; ileocol)

PD: L8.4xD4.6mm

Jej: L20.1x5mm

Ileo: L11.8x4.1mm

CT measurements of bowel thickness in dogs….

GI administration of ionic iodinated contrast is not advised in 3 patient groups:

Young, debilitated, dehydrated

Contrast medium doses…

List 3 radiographic characteristics that may help distinguish mechanical and functional ileus

1) > increase in diameter with mechanical;
2) Gas and fluid in mechanical; often just gas in gas in ileus
3) Some normal bowel loops in mechanical (dual population)

Pathological conditions by length and relative distension of affected bowel....

What jejunal US measurement in canines is reported to trigger concern for obstruction?

ser-\>ser: \>15mm, with normal layering and gas / fluid intraluminally

What % of foreign bodies have been reported as linear in dogs?

35%

4 differences of linear FB clinical considerations in dogs and cats

1) Dogs usually older, less dramatic gas pattern; 2) Dogs more prone to secondary intussuception; 3) Dogs \>2x as likely to die 4) Dogs have more evidence of bowel trauma / laceration and peritonitis.

Causes of intussceptions Most likely site What has doppler signal been associated with?

Motility disorders, inflammatory wall lesions, neoplastia, Fbs, idiopathic... Ileocolic or caecocolic. But can occur anywhere Doppler signal related to REDUCIBILITY - more likely if signal present

What feature of mechanical obstruction has been defined in CT in people? In CT, what measure of SI dilation has been described for mechanical obstruction? Sns and sp?

"zone of transition" \>2.5x vertebral height ofL5. Sn 79%, Sp 72%

List 3 common diseases that cause functional ileus List 4 less common diseases!

Viral enteritis (particularly parvovirus type 2); peritonitis; and chronic mechanical obstruction. Vascular causes: Strangulation e.g in hernia; mesenteric volvulus (effects cranial mes artery); thrombosis Neurological: Spinal trauma; Dysautonomia; Other: Pseudoobstruction = tunica muscularis atrophy - WEIRD ONE BUT BE AWARE! Biopsy shows changes restricte to tunica muscularis, not involving myenteric plexus. Characterised by fibrosis and atrophy. . POSSIBLE immune mediated aetiology

What 3 comorbidities have been associated with mesenteric volvulus?

Tx for GDV; Tx for intussception; Pancreatic insufficiency

What US features of mesenteric thrombosis have been described in the cat?

Progressive thickening of wall, loss of layering, hypoechoic wall, bright fat.

Reported US features of parvo (in \<6mo dogs)?

Fluid filled SI; Indistinct jej layers; Loss of jej mucosal thickness despite normal wall thickness; Hyperechoic mucosa; Irregular mucosa; absent peristalsis

List 6 common SI tumours; and 5 uncommon Duodenal polyps overrepresented in which breed / animal?

Common: Adenocarcinoma, LSA, GIST, leiomyoma, leiomyosarcoma, Mastocytoma Uncommon: Osteosarcoma, fibrosarcoma, HSA, Neurilemmoma; carcinoid; Polyps: ASIAN cats (Burrners gland adenoma reported in 1 dog)

What US feature in dogs is most predictive for distinguishing neoplasia from enteritis?

Loss of wall layering

Types of feline alimentary lymphoma

Mass- type: Typically loss of layering, up to 22mm, thickening, focal, hypo/mixed. 75% cats have this About 50% have mesenteric LN+ DIffuse: Thickening of muscularis (= or \> than mucosa)

DDx for muscularis thickening in cats?

Lymphoma; IBD; hypertrophy (distal obstruction, idiopathic) SIG MORE LIKELY TO HAPPEN IN LYMPHOMA THAN IBD, however also seen in normal cats Regional LN+ more common in Lymphoma; and being an older cat (\>9)

Differentiation of leiomyosarc and leiomyoma in dogs?

myo = bigger -\> 2-8cm thick; eccentric and mixed echo NB: This was before many recharacterised as GIST More recent research -\> No US features to distinguish GI tumours

Features of Canine schistosomiasis (heterobilharzia americana)?\>

Mineralisationof SI wall, hypercalcaemia

Name 3 breeds and their specific assocaited IBDs

Soft coated Wheaten: Familial PLE / PLN Irish Setter: Gluten-sensitive enteropathy Basenji: Immunoproliferative enteropathy

Focal lipogranulomatous lymphangitis...

Rare and severe canine IBD Distal ileum; thickened wall with retained layers (6-14mm), predominantly muscular thickening, regional LN+; occasional mass up to 4cm from serosa or in mesentry.

3 fungal infections of intestinal tract?

Cryptococcosis, histoplasmosis, pythiosis

DDx for intestinal wall mineralisation

Hypercalcaemia (including toxins: cholecalciferol rodenticides, psoriasis cream); schistosomiasis; renal disease

3 features of GI duplication cyst

1) Intimate association with GIT; 2) Muscular thickening; 3) Epithelial lining Frequently filled with fluid. Reported in all SI segments, Jej most reported. DOgs and cats. 3 LAYER WALL hyper, hypo, hyper, typically mesenteric location (cf. diverticulum on antimesenteric side)

Features of diverticulum

Retains wall layering, outpouching, lumen communicates with bowel, antimesenteric location typically. Young boxers reportedly overrepresented, all in distal flexure of duodenum

PENNINCK PAPER - What does a parallel hyperechoic line in the mucosa of cats with GI disease represent?

Intestinal fibrosis. 68% have concurrent GI disease NOTE DIFFERENCES TO CANINE FEATURES (EX VIVO STUDY), AND SUB MUCOSAL HYPOECHOIC ILEAL JEJUNAL CHANGES IN YOUNG CATS (FOLLICLES)

Dog intestinal thickness US

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47 - Small intestine Flashcards

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