Gas Pattens 2

Question 1

what is max for small bowel size

Answer 1

> 3.5

Question 2

what is max for large bower bowel

Answer 2

> 5/6

Question 3

What is max size for volvulus (sigmoid/cecum0

Answer 3

> 9

Question 4

What is the 3/6/9 rule

Answer 4

max sizes for small bowel/large bowel and volvus obstruction

Question 5

size of adynamoic ileum vs smo

Answer 5

Adynamic ileus is slightly smaller

<3.5, 5 respectively

Question 6

obstruction of bowel symptoms

Answer 6

• intermittent cramping and pain around or below umbilicus
• bloating
• vommiting
• constipation
• diarrhea (partial)

Question 7

obstruction of bowel treatment (complete vs partial)

Answer 7

partial- IV fluids, NG tube no oral food/drink

Complete- usually surgery

Question 8

Causes of abnormal small bowel air (3)

Answer 8

Small bowel obstruction
Adynamic Ileus
Aerophagia (normal pres of air in small bowel from swallowing air)

Question 9

What is adynamic ileus

Answer 9

Loss of peristalsis, lumen remain patent

-causes accumulation of gas in the GI tract

Question 10

Causes of dynamic ileus

Answer 10

Trauma (mc)
post op
sepsis
drugs (opioids)
Myocardial infarction
CHF
peritonitis

Question 11

Dynamic ileus imaging signs (how to differential bw this and sbo)

Answer 11

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)

Question 12

Generalized adynamic/paralytic ileus recovery time

Answer 12

Will resolve within a few days post op

Question 13

Small bowel obstruction imaging signs

Answer 13

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)

Question 14

causes (+mc cause) of sbo

Answer 14

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

Question 15

when is there too many air/fluid levels in SB

Answer 15

> 2 air/fluid levels in SB= abnormal

Question 16

average SBO clinical pres

Answer 16

Avg age 64yoa, F>M
Abdominal distension, nausea + vommiting
higher obstructions present earlier

Question 17

What is the string of beads sign in SBO

Answer 17

row of small air bubbles

-air trapped bw the valvular conniventes in a fluid filled dilated small bowel

(** not typically seen in adynamic ileus**)

Question 18

How can u see gallstone ileus on xray

Answer 18

air in biliary tree

always check the RLQ-ileocecal valve

Question 19

key signs of SBO vs Paralytic ileus

Answer 19

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

Question 20

what is pneumobilia + causes

Answer 20

air in biliary tree

-always abnormal

Question 21

Causes of pneumobilia (+mc)

Answer 21

Surgery (mc)
Stone ruptured into small bowel
malignant tumor

Question 22

What is emphysematous cholecytis and what pt is it seen in/what conditions do they have

Answer 22

Gas in gallbladder (rare)

Seen in pts with poorly controlled DM
Also seen w acute inf of GB with gas forming organisms

Question 23

Large bowel obstruction imaging signs

Answer 23

Dialated bowel peripheral
bowel lumen >6cm (cecum >9cm)
Hausta
multiple air fluid lvls

Question 24

large bowel obstruction and mc causes

Answer 24

Colon carcinoma (mc)
Diverticulitis (mc)
Volvus
Peritoneal metastases
massively distended bladder or other pelvic mass
adhesions

Question 25

Next steps when a large bowel obstruction is present

Answer 25

CT !

Question 26

What is the main sign you will see with a cecal volvulus + what is it

Answer 26

Coffee bean sign Twisting of the bowel which leads to intestinal obstruction

Question 27

mc area for volvus and management

Answer 27

sigmoid/cecum ER referral

Question 28

What are the types of herniation of bowel and mc

Answer 28

``` Inguinal (mc) Femoral Umbilical Epigastric Incisional ```

Question 29

Herniation of bowel sign and what can it lead to

Answer 29

painful or painless mass (mc groin/midline abdomen) Can lead to intestinal obstruction, incarceration and/or strangulation of segment of bowel involved surgical referral!!

Question 30

Symptoms of herniation of bowel

Answer 30

Pain, nausea, vommiting, constipation

Question 31

Imaging signs of toxic megacolon

Answer 31

Large Distention with small amounts of air past it (if obstruction u shouldn’t see any air past the distention)

Question 32

What is toxic megacolon and what is it associated w

Answer 32

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

Question 33

What is risk and mannagement of toxic megacolon

Answer 33

risk of rupture (immediate referral)

Question 34

toxic colon clinical symptoms

Answer 34

``` Abdominal pain distention tenderness fever tachycardia shock ```

Question 35

toxic colon imaging signs + mc area

Answer 35

dilated segment of colon >6cm (transverse mc) - loss of hausfrau on bowel wall - no signs of obstruction

Question 36

What is the rigger sign

Answer 36

air outlining the bowel wall on both sides (bowel wall will look kinda white)

Question 37

causes of pneumoperitoneum (+ mc)

Answer 37

Perforated abdominal viscus (mc, ulcers/carcinoma) Trauma Recent laparotomy

Question 38

What is ascites and causes

Answer 38

accumulation of fluid in the peritoneal cavity mc causes - cirrhosis (mc) - pancreatitis - chronic renal failure - congestive heart failure - bowel obstruction

Question 39

ascites imaging signs

Answer 39

Increased density of abdomen soft tissue margins are obscured centrally located bowel loops w bulging flanks small bowel loop increased separation

Question 40

Ascites tx

Answer 40

Find and tx underlying cause reduce sodium in diet diuretics