Gas Pattens 2 Flashcards
what is max for small bowel size
> 3.5
what is max for large bower bowel
> 5/6
What is max size for volvulus (sigmoid/cecum0
> 9
What is the 3/6/9 rule
max sizes for small bowel/large bowel and volvus obstruction
size of adynamoic ileum vs smo
Adynamic ileus is slightly smaller
<3.5, 5 respectively
obstruction of bowel symptoms
- intermittent cramping and pain around or below umbilicus
- bloating
- vommiting
- constipation
- diarrhea (partial)
obstruction of bowel treatment (complete vs partial)
partial- IV fluids, NG tube no oral food/drink
Complete- usually surgery
Causes of abnormal small bowel air (3)
Small bowel obstruction
Adynamic Ileus
Aerophagia (normal pres of air in small bowel from swallowing air)
What is adynamic ileus
Loss of peristalsis, lumen remain patent
-causes accumulation of gas in the GI tract
Causes of dynamic ileus
Trauma (mc) post op sepsis drugs (opioids) Myocardial infarction CHF peritonitis
Dynamic ileus imaging signs (how to differential bw this and sbo)
Uniform distention in both large and small bowel (air will be all the way down to the rectum)
(can also be local where there is a short segment of involvement near abdominal infmallatory process)
Generalized adynamic/paralytic ileus recovery time
Will resolve within a few days post op
Small bowel obstruction imaging signs
Dilated bowel central
loops may stack on each other or coil around
’string of beads sign’
smaller lumen size
valvule connivente
Little to no large bowel gas (blocked to go into Large)
causes (+mc cause) of sbo
80% of all mechanical bowel obstructions
adhesions (due to surgery mc)
hernia
foreign bodies
gallstones
–3-5 hours after onset of acute obstruction, gas and fluid accumulate above/prox to lesion
when is there too many air/fluid levels in SB
> 2 air/fluid levels in SB= abnormal
average SBO clinical pres
Avg age 64yoa, F>M
Abdominal distension, nausea + vommiting
higher obstructions present earlier
What is the string of beads sign in SBO
row of small air bubbles
-air trapped bw the valvular conniventes in a fluid filled dilated small bowel
(** not typically seen in adynamic ileus**)
How can u see gallstone ileus on xray
air in biliary tree
always check the RLQ-ileocecal valve
key signs of SBO vs Paralytic ileus
SBO
- collicly pain
- abdominal distension is prominent
- increased bowel sounds
- little to no air in large bowel
Paralytic ileus
- pain is not predominant
- abdominal distention may not be as prominent
- absent bowel sounds
- air in large bowel
what is pneumobilia + causes
air in biliary tree
-always abnormal
Causes of pneumobilia (+mc)
Surgery (mc)
Stone ruptured into small bowel
malignant tumor
What is emphysematous cholecytis and what pt is it seen in/what conditions do they have
Gas in gallbladder (rare)
Seen in pts with poorly controlled DM
Also seen w acute inf of GB with gas forming organisms
Large bowel obstruction imaging signs
Dialated bowel peripheral
bowel lumen >6cm (cecum >9cm)
Hausta
multiple air fluid lvls
large bowel obstruction and mc causes
Colon carcinoma (mc) Diverticulitis (mc) Volvus Peritoneal metastases massively distended bladder or other pelvic mass adhesions
Next steps when a large bowel obstruction is present
CT !
What is the main sign you will see with a cecal volvulus + what is it
Coffee bean sign
Twisting of the bowel which leads to intestinal obstruction
mc area for volvus and management
sigmoid/cecum
ER referral
What are the types of herniation of bowel and mc
Inguinal (mc) Femoral Umbilical Epigastric Incisional
Herniation of bowel sign and what can it lead to
painful or painless mass (mc groin/midline abdomen)
Can lead to intestinal obstruction, incarceration and/or strangulation of segment of bowel involved
surgical referral!!
Symptoms of herniation of bowel
Pain, nausea, vommiting, constipation
Imaging signs of toxic megacolon
Large Distention with small amounts of air past it (if obstruction u shouldn’t see any air past the distention)
What is toxic megacolon and what is it associated w
Life threatening complication of other intestinal conditions
-causes rapid and severe widening (dilation) of the large intestine within 1- few days
Often occurs as a complication of inflammatory bowel diseases such as thrones, ulcerative colitis
What is risk and mannagement of toxic megacolon
risk of rupture (immediate referral)
toxic colon clinical symptoms
Abdominal pain distention tenderness fever tachycardia shock
toxic colon imaging signs + mc area
dilated segment of colon >6cm (transverse mc)
- loss of hausfrau on bowel wall
- no signs of obstruction
What is the rigger sign
air outlining the bowel wall on both sides (bowel wall will look kinda white)
causes of pneumoperitoneum (+ mc)
Perforated abdominal viscus (mc, ulcers/carcinoma)
Trauma
Recent laparotomy
What is ascites and causes
accumulation of fluid in the peritoneal cavity
mc causes
- cirrhosis (mc)
- pancreatitis
- chronic renal failure
- congestive heart failure
- bowel obstruction
ascites imaging signs
Increased density of abdomen
soft tissue margins are obscured
centrally located bowel loops w bulging flanks
small bowel loop increased separation
Ascites tx
Find and tx underlying cause
reduce sodium in diet
diuretics
