GI Section I: Luminal (3 steps of the SB follow through) Flashcards
What are the 3 step method of the SB follow through?
Step 1 - Evaluate the folds
Step 2a - Evaluate the Loop separation with or withouth Tethering
Step 2b - If Nodules are Present Evaluate the Distribution and Secondary Findings To Help Narrow the Differential.
Step 3 - Trademark Features
DDx
Thin (<3mm) Straight Folds with Dilation
Mechanical Obstruction
Paralytic Ileus
Scleroderma
Sprue
DDx
Thick Straight Folds >3mm + Segmental distribution
Ischemia
Radiation
Hemorrhage
Adjacent Inflammation
Ddx Thick straight folds >3mm + Diffuse distribution
Low protein
Venous congestion
Cirrhosis
Thick folds with nodularity + Segmental
Crohns
Infection
Lymphoma
Mets
Thick folds with nodularity + Diffuse
Whipples
Lymphoid hyperplasia (nodules 2-4mm, uniform size)
Lymphoma
Mets (nodules >4 mm, variable size)
Intestinal lymphangietasia
Loop separation + NO tethering
Ascites
Wall thickening (Crohns, Lymphoma)
Adenopathy
Mesenteric Tumors
Loop separation + Tethering
Tethering looks like someone is pinching and pulling the loops towards the displacing mass.
Carcinoid
“Sand Like Nodules”
Diffuse micronodules in the jejunum.
Whipples (Tropheryma whipplei)
Pseudo-Whipples (MAC infection)
Uniform 2-4mm Nodules
Lymphoid hyperplasia
Nodules of Larger or Varying Sizes
Cancer - think Mets (Melanoma)
“Cobblestoning”
Raised islands of mucosa separated by linear streaks running perpendicular to the lumen of the bowel. - ulceration
think of Crohns
Ribbon Bowel
Graft vs Host
Bowel is featxireless, atrophic, and has fold thickening (ribbon-like).
Hidebound sign
Scleroderma
Narrow separation of normal folds with mild bowel dilation.
Moulage sign (tube of wax)
Celiac
Dilated jejunal loop with complete loss of jejunal folds - opacified like a “tube of wax”
Fold reversal
