Lesson 19 (Part 2)

Question 1

What kind of patents history should you have if getting your bowel scanned? (2)

Answer 1

1. Crohn’s disease

2. Ulcerative colitis

Question 2

What are clinical indications for scanning the bowel? (4)

Answer 2

1. Symptoms
2. Acute pain
   - RLQ and/or LLQ
3. Increase WBC
4. Change in Bowel patterns

Question 3

How do you prepare for a bowl ultrasound? (5)

Answer 3

1. Patient fasting
2. 3.5 -5 MHz overall look at bowel
3. Pelvis full bladder
   - to assess sigmoid colon and rectum
4. Empty bladder
5. Areas of interest (pain) receive detailed attention with higher frequency transducer 5 to 9MHz

Question 4

What kind of transducer can you use for areas of interest with the bowel? (4)

Answer 4

1. Linear
2. Convex linear probes
3. Some sector probes
4. Transvaginal for women

Question 5

What is the transvaginal ultrasound good to look at when scanning the bowel?(2)

Answer 5

1. Sigmoid colon

2. Rectum

Question 6

What does a normal bowel do?

Answer 6

Compresses when pushed on

- gas pockets will be displaced

Question 7

How can you tell if a bowl is abnormal?

Answer 7

It will not compress if you push on it

- will remain unchanged

Question 8

Can you see all the layers of the bowl sonographically?

Answer 8

You might be able to

Question 9

What is the gut signature variation sonographically?

Answer 9

Bulls eye in cross section

- echogenic central area and hypoechoic rim

Question 10

What determines the degree you are able to see the layers of the bowel? (2)

Answer 10

1. Quality of scan
   - good patient vs bad patient
2. Resolution of transducer

Question 11

What is the average thickness of the GI track? (2)

Answer 11

Distended = 3mm

Not distended = 5mm

Question 12

How do we tell the difference between the whole GI tract? (2)

Answer 12

1. Know the location
   - know anatomy
2. Look for traits between small and large bowel

Question 13

What is the key difference between large and small bowel appearance?

Answer 13

Peristalsis is normally seen in the small bowel and stomach

- looking for motion

Question 14

Where is peristalsis not typically seen?

Answer 14

In the large bowel

Question 15

What are challenges when scanning the GI tract? (4)

Answer 15

1. Appearance varies depending on the contents on the bowel
   - air, feces or fluid
2. Gas content within gut lumen
   - intraluminal air
3. Intraluminal fluid
   - mimic cystic masses
4. Fecal material can create artifacts and pseudotumors

Question 16

What does the normal gut show with doppler?

Answer 16

Little signal

Question 17

What makes it difficult to interrogate the gut wall with doppler? (2)

Answer 17

1. Normal bowel

2. Mobile bowel

Question 18

What does motion create in the gut wall when using doppler?

Answer 18

An artifact

Question 19

What occurs at abnormal places in the gut wall with doppler?

Answer 19

Hypervascular or hypovascular where tenderness felt

- provides supportive evidence

Question 20

Why are young patients better to scan the appendix?

Answer 20

Better seen typically smaller size

Question 21

Where does the appendix extend from?

Answer 21

The cecum

- long, tubular structure

Question 22

Where is the appendix located?

Answer 22

On the abdominal wall under McBurney’s point

Question 23

What does the small canal of the appendix communicate with?

Answer 23

The cecum by an orifice that is below and behind the ileocecal opening

Question 24

What are the layers of the appendix?

Answer 24

Same layers as the colon

Question 25

How long is a normal appendix length considered to be?

Answer 25

Less than 6mm in AP diameter

- varies in length

Question 26

What does the appendix have with a sonographic appearance?

Answer 26

Blind end or tip