Ex 1 - Small Bowel

Question 1

Standard Views - intestines

Answer 1

Lateral recumbent

VD

Question 2

Patient prep - Intestinal rads

Answer 2

• Stable patient with chronic GI signs
• NPO 12-24 hrs
• Cleansing enema 2-4 hrs prior (if possible)
• Pt with acute abdomen, vomiting, or palpably enlarged bowel
• NO specific prep necessary
• abnormal pattern of fluid and gas can help make dx

Question 3

Fundamentals of radiographic evaluation - small intestine

Answer 3

1. size and shape
2. position
3. margination
4. opacity
5. motility

Question 4

Distended bowel is seen with…

Answer 4

inflammatory conditions, partial and total obstructions

Question 5

Two causes of obstruction - need to differentiate (sm intestine)

Answer 5

Mechanical

Functional

Question 6

Repeatability

Answer 6

Want to see a suspicious area on MULTIPLE rads over time to increase significance of the finding

Question 7

Ileus

Answer 7

Disruption of normal propulsive ability of the GI tract

• Mechanical or Functional
• occur in dogs and cats
• should be differentiated prior to sx

Question 8

Functional ileum

Answer 8

“paralytic ileus”

• Peristaltic contractions of the bowel cease
• lumen remains patent
• usually gas filled loops
• stress, electrolyte imbalances, pain, etc - causes

Question 9

Mechanical ileum

Answer 9

“Two populations of bowels”

• caused by PHYSICAL obstruction
• non-uniform distention of the bowel
• over time, will become paralytic –> resulting in uniform distention
• FB, intussusception, neoplasia and strictures - causes

Question 10

Mechanically obstructed bowel differs from functionally obstructed bowel

Answer 10

• usually of larger diameter than functional
• usually has mixture of gas and fluid; functional has more gas or may be completely gas-filled
• usually has some normal sized bowel present; functional may have generalized involvement

Question 11

Patterns of enlargement - small intestine

Answer 11

• Focal involvement, mild distention
• Focal involvement, severe distention
• General involvement, mild distention
• General involvement, severe distention

Question 12

Focal involvement, mild distention

Answer 12

mild increase in size of the small bowel

regional enteritis, regional peritonitis, partial mechanical obstruction, early functional ileus

Question 13

Focal involvement, severe distention

Answer 13

think mechanical obstruction

FB, intussusception, neoplasia, stenosis, stricture, dysautonomia, parvo

Question 14

General involvement, mild distention

Answer 14

functional ileus, enteritis, drugs rxn, malabsorption

Question 15

General involvement, severe distention

Answer 15

Functional: loops will be uniformly distended (mesenteric torsion)

Mechanical: loops not uniform, some may be normal
(complete obstruction of distal bowel, intestinal volvulus, intussusception, FB, neoplasia, recent abdominal sx)

Question 16

Normal position of small intestine

Answer 16

evenly distributed throughout the abdomen

Question 17

Position of small intestine - obese cats

Answer 17

the right ventral abdomen

Question 18

Where do hernias occur? (7)

Answer 18

Diaphragmatic 
Peritoneo-pericardial 
Body wall 
Inguinal 
Scrotal 
Umbilical 
Perineal

Question 19

Some reasons for decreased serosal detail? (5)

Answer 19

Juveniles 
Emaciated patients 
Ascites 
Peritonitis
Carcinomatosis

Question 20

Can you determine intestinal wall thickness on survey rad?

Answer 20

No! its unreliable

Question 21

Gravel sign

Answer 21

Opaque granular material

Caused by chronic partial obstruction –> desiccation of the ingest that is trapped proximal to the obstruction

Question 22

Rad Findings - Focal Neoplasia (7)

Answer 22

Straightened border 
Thickened wall 
Peristalsis will be decreased 
Lumen is narrowed 
Mucosa can be irregular (ulceration) 
\+/- Distended on the oral sign 
"Apple core" sign

Question 23

Rad Findings - Infiltrative Neoplasia (2)

Answer 23

• Often affect a large section of bowel (e.g. lymphoma)
• narrowed lumen
• irregular mucosa

*Biopsy is necessary to differentiate LSA from IBD

Question 24

Rad Findings - FB (2)

Answer 24

*Total or partial obstructions

• Total obstructions
• greater distention of the bowel orally
• no passage of +contrast past the FB
• contrast medium should be seen to outline the FB which will create a filling effect

Question 25

Why would you see plication? (accordion shape)

Answer 25

With a Linear Foreign Body

*Also see abnormal “C-shaped” discontinuous gas bubbles (dogs > cats)