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THRALL - Thom > 47 - Small intestine > Flashcards

47 - Small intestine Flashcards

1
Q

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

A

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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2
Q

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

A

6 months

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3
Q

List two radiographic measures of canine SI diameter

List 2 radiographic measures of feline SI diameter

A

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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4
Q

List the two ligamentous attachments of the duodenum

A

Proximal duodenum: Hepatoduodenal ligament;

Ascending duodenum: Duodenocolic ligament

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5
Q

What does a pseudoulcer refer to?

A

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

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6
Q

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

And fasted dogs?

A

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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7
Q

Which US artifact is seen with intraluminal gas in SI?

A

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

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8
Q

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

A

Widening of the intervillous space when bowel folds

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9
Q

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

A

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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10
Q

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

A

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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11
Q

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

A

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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12
Q

FELINE Wall thickness….

FUCK MY LIFE

A
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13
Q

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

A

Dog: Duo; Cat: Ileum

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14
Q

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

A

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

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

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15
Q

What does “String of pearls” refer to?

A

Strong duodenal contraction in feline contrast studies

-> 30% of cats!

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16
Q

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

A

1-3 per minute

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17
Q

Which lymph nodes drain the duodenum? Jejunum? Ileum?

A

Duo: Pancreaticoduodenal and hepatic;

Jej: Jejunal;

Il: Colic

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

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18
Q

Normal length of jejunal nodes in adult dog?

A

5-200mm

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19
Q

Measurements / features of jejunal LNs of puppies?

A

Hypo, particularly at periphery.

1.5-12.5mm thick.

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20
Q

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

A

PD: L8.4xD4.6mm

Jej: L20.1x5mm

Ileo: L11.8x4.1mm

21
Q

CT measurements of bowel thickness in dogs….

A
22
Q

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

A

Young, debilitated, dehydrated

23
Q

Contrast medium doses…

A
24
Q

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

A

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)

25
Q

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

A
26
Q

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

A

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

27
Q

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

A

35%

28
Q

4 differences of linear FB clinical considerations in dogs and cats

A

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.

29
Q

Causes of intussceptions

Most likely site

What has doppler signal been associated with?

A

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

30
Q

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?

A

“zone of transition”

>2.5x vertebral height ofL5. Sn 79%, Sp 72%

31
Q

List 3 common diseases that cause functional ileus

List 4 less common diseases!

A

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

32
Q

What 3 comorbidities have been associated with mesenteric volvulus?

A

Tx for GDV; Tx for intussception; Pancreatic insufficiency

33
Q

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

A

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

34
Q

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

A

Fluid filled SI;

Indistinct jej layers;

Loss of jej mucosal thickness despite normal wall thickness;

Hyperechoic mucosa;

Irregular mucosa;

absent peristalsis

35
Q

List 6 common SI tumours; and 5 uncommon

Duodenal polyps overrepresented in which breed / animal?

A

Common:

Adenocarcinoma, LSA, GIST, leiomyoma, leiomyosarcoma, Mastocytoma

Uncommon:

Osteosarcoma, fibrosarcoma, HSA, Neurilemmoma; carcinoid;

Polyps: ASIAN cats (Burrners gland adenoma reported in 1 dog)

36
Q

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

A

Loss of wall layering

37
Q

Types of feline alimentary lymphoma

A

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)

38
Q

DDx for muscularis thickening in cats?

A

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)

39
Q

Differentiation of leiomyosarc and leiomyoma in dogs?

A

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

40
Q

Features of Canine schistosomiasis (heterobilharzia americana)?>

A

Mineralisationof SI wall, hypercalcaemia

41
Q

Name 3 breeds and their specific assocaited IBDs

A

Soft coated Wheaten: Familial PLE / PLN

Irish Setter: Gluten-sensitive enteropathy

Basenji: Immunoproliferative enteropathy

42
Q

Focal lipogranulomatous lymphangitis…

A

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.

43
Q

3 fungal infections of intestinal tract?

A

Cryptococcosis, histoplasmosis, pythiosis

44
Q

DDx for intestinal wall mineralisation

A

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

45
Q

3 features of GI duplication cyst

A

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)

46
Q

Features of diverticulum

A

Retains wall layering, outpouching, lumen communicates with bowel, antimesenteric location typically.

Young boxers reportedly overrepresented, all in distal flexure of duodenum

47
Q
A
48
Q

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

A

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)

49
Q

Dog intestinal thickness US

A

THRALL - Thom (40 decks)

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