5) Small & large intestine

Question 1

Imaging modalities (5)

Answer 1

• xray
• CT
• MRI: great for soft tissue
• Endoscopy: small intestines limited because of endoscope issues
• US: can be combined w/ colonoscopy. Can be challenging as colon can be filled with gas (not good for US)

Question 2

small intestine (typically studied with…)

Answer 2

• typically studied with barium, single or double contrast intubated enteroclysis (catheter in nose –> duodenum –> C+ injected. For xray, CT, MRI)
• enteroclysis is when you can see catheter in image
• neutral contrast, easier to analyse walls

Question 3

Inflammation

Answer 3

• enteritis = small intestine
• colitis = large intestine
  »> SI with abscess

Question 4

Crohns disease (pathological features - 5, asc. & trnsv affected… sig & rec affected… )

Answer 4

• can effect whole abdomen
• death can be consequence of rupture
• Pathological features include
  > serositis and wall thickening
  > strictures, mucosal oedema, mucosal ulcer
  > decrease of folds
  > advanced: fat proliferation
  > fistula: body creates new path for disposal
• Ascending and transverse colon affected –> lacking folds. Sigmoid and rectum affected –> normal folds

Question 5

Ulcerative colitis (radiological signs - 3)

Answer 5

• superficial ulcerations, oedema

- Radiological signs: confluent, circumferential, superficial ulcerations, granula mucosa, collar button ulcers

Question 6

Diverticulosis and diverticulitis (4 points)

Answer 6

• saccular outpouching through colon wall
• usually multiple, occuring in clusters
• almost always involved sigmoid, never rectum
• diverticulitis is inflammation of diverticula and complicates 20% of diverticulosis

Question 7

Obstruction (causes, radiographic appearance, distinguishing small from large)

Answer 7

• several causes: mass (most common), volvulus, invagination/intussusception, FB
• Radiographic appearance
  > didstended bowel loops containing air and fluid
  > In erect, can see horizontal line between fluid and air
  > if central, it’s SBO
  > if lateral, its LBO

Question 8

Volvulus

Answer 8

• occurs when bowel twists around its mesentery
• diffuse dilation of bowel containing large amount of air
• “coffee bean” sign

Question 9

Celiac disease (cause, features - 4)

Answer 9

• main cause is loss of villi, leads to small bowel malabsorption
• features: duodenitis, moulage, dilatation, flocculation

Question 10

Tumours (main one and sign, what’s a great way to determine type, texure of types, what do we need for small bowel tumour detection and why, most cancers arise from, common sign, signs for lymphoma)

Answer 10

• Adenocarcinoma is main one: thick walls is a sign
• enhancement is a great way to determine tumour type
• Adenocarcinoma: many grey colours
• lymphoma: homogeneous
• need imaging to detect small bowel tumour as biopsy is difficult –> don’t want to risk perforation
• most cancers arise from pre existing polyps
• apple core constricting lesions
• lymphoma: thickened walled infiltrating mass, with aneurysmal dilation without obstruction

Question 11

Hernia (4 externals)

Answer 11

External hernia

• incisional H
• umbilical H
• Inguinal H
• femoral H

Internal H