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Abdominal Radiology > Mesenteric small bowel > Flashcards

Mesenteric small bowel Flashcards

1
Q

small bowel disease is usually manifest by four major symptoms

A

colic, diarrhea, malabsorption, bleeding

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2
Q

defined as recurrent and spasmodic abdominal pain with periods of relief every 2 to 3 minutes

A

colic

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3
Q

true or false: diarrhea cause by small bowel disease is less urgent than that caused by colon disease

A

true

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4
Q

size of enteroclysis catheter

A

12 to 14 Fr

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5
Q

single contrast technique in fluoroscopic enteroclysis use how many ml of barium

A

600 cc

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6
Q

double contrast technique in fluoroscopic enteroclysis use how many ml of barium and methylcellulose

A

200 cc barium, 1000 cc of methylcellulose

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7
Q

size of nasojejunal catheter used in CT enteroclysis

A

8 to 13 Fr

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8
Q

high attenuation contrast agents include how many percent of water soluble iodinated contrast with dilute barium

A

4-15%

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9
Q

low attenuation contrast include

A

water and methylcellulose

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10
Q

in CT enteroclysis, 2 liters of enteric agent is infused at what rate

A

100 to 150 cc/min

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11
Q

imaging technique that is particularly important in the study of patients with Crohn disease who are young and undergo many imaging examinations

A

MR enteroclysis and MR enterography

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12
Q

enteric agents use in MR enteroclysis or MR enterography

A

biphasic agents (water, methylcellulose, low-density barium and polyethylene glycol)

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13
Q

agents that may be given during MR to reduce peristalsis and motion artifacts

A

spasmolytics

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14
Q

bowel wall thickening of > 2 cm indicates a benign or malignant process?

A

malignant

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15
Q

length of small bowel

A

7 m

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16
Q

proximal 2/5 of mesenteric intestine

A

jejunum

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17
Q

distal 3/5 of mesenteric intestine

A

ileum

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18
Q

root of small bowel mesentery extends obliquely from the

A

ligament of Treitz, just left of L2 vertebra, to the cecum near the right sacroiliac joint

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19
Q

normal mesenteric lymph nodes may be seen as soft tissue nodules with size of

A

5 mm or less

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20
Q

concave border of mesentery is called

A

mesenteric border

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21
Q

convex border of mesentery is called

A

antimesenteric border

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22
Q

luminal diameter of jejunum

A

< 3 mm

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23
Q

normal fold thickness of jejunum

A

2- 3 mm

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24
Q

diameter of lumen of jejunum on enteroclysis

A

< 4.0 cm

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25
Q

normal fold thickness of jejunum on enteroclysis

A

1-2 mm

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26
Q

number of jejunal folds

A

4-7 per inch

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27
Q

depth of folds of jejunum

A

8 mm

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28
Q

thickness of jejunal bowel wall

A

3 mm

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29
Q

diameter of lumen of ileum

A

< 2 cm

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30
Q

normal fold thickness of ileum

A

< 2.0 cm

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31
Q

diameter of lumen on enteroclysis of ileum

A

< 3.0 cm

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32
Q

normal fold of thickness on enteroclysis of ileum

A

1-1.5 mm

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33
Q

number of ileal folds

A

2-4 per inch

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34
Q

depth of ileal folds

A

8 mm

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35
Q

thickness of ileal wall

A

3 mm

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36
Q

part of small bowel that has numerous lymphoid follicles in submucosa

A

ileum

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37
Q

what structures greatly expands the absorptive surface of small bowel

A

valvulae conniventes and villi

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38
Q

CT and MR enterography findings that suggest malignant small bowel lesions include

A

solitary lesions, nonpedunculated lesions, long-segment lesions, presence of mesenteric fat infiltration and presence of enlarged mesenteric lympn nodes (> 1 cm short axis diameter)

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39
Q

most common neoplasm of the small intesitne, accounting for about 1/3 of all small bowel tumors. they are considered a low-grade malignancy that may recur locally or metastasize to the LN, liver or lung

A

carcinoid

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40
Q

carcinoid arise from what cell type

A

endocrine cells (enterochromaffin or Kulchitsky cells)

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41
Q

cells from carcinoid tumor produce

A

vasoactive substances such as serotonin and bradykinins

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42
Q

carcinoid in SI commonly develops in what part

A

ileum

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43
Q

only 7% , those with liver metastases, present with carcinoid syndrome (cutaneous flushing, abdominal cramps, diarrhea) because

A

liver inactivates the vasoactive substances

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44
Q

what substance from carcinoid tumor induces an intense local desmoplastic reaction

A

serotonin

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45
Q

complications from carcinoid tumor

A

stricture, obstruction, bowel infarction

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46
Q

imaging signs of fibrosis and metastases in Carcinoid tumor resemble findings from

A

Crohn disease

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47
Q

barium study shows carcinoid tumor as

A

luminal narrowing, thickened and spiculated folds, separation of bowel loops by mesenteric mass or bowel loops drawn together by fibrosis and primary lesion appearing as small (< 1.5 cm) mural nodule or intraluminal polyp

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48
Q

CT and MR findings that are highly indicative of carcinoid tumor

A

sunburst pattern of radiating soft tissue density in the mesenteric fat due to mesenteric fibrosis, bowel wall thickening, primayr lesion appearing as small, lobulated soft tissue mass, occassionally with central calcifications, usually in the distal ileum, marked contrast enhancement of the primary tumor mass and enlarged mesenteric nodes and liver masses due to metastatic disease

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49
Q

SI mass that is half as common as carcinoid

A

adenocarcinoma

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50
Q

adenocarcinoma of SI is most frequent in what part

A

duodenum, proximal jejunum

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51
Q

complications of SI adenocarcinoma

A

bleeding, obstruction, intussusception

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52
Q

infiltrating type of adenocarcinoma produces strictures and are common in

A

jejunum

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53
Q

polypoid type of adenocarcinoma produces filling defects that are most common in

A

duodenum

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54
Q

20% of all small bowel malignant tumors

A

lymphoma

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55
Q

largest immunologic organ in the body, which is the common site for extranodal origin of lymphoma

A

GI tract

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56
Q

classifcations of lymphoma

A

mature B-cell neoplasms (mantle cell and Burkitt lymphoma), mature T-cell/natural kille cell neoplasms, Hodgkin lymphoma, posttransplant lymphoproliferative disorder, and histiocytic and dendritic cell neoplasms

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57
Q

most of GI lymphomas are

A

B-cell type

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58
Q

GI lymphoma usually involves what SI segment

A

ileum

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59
Q

risk factors for GI lymphoma

A

infections due to H. pylori, HIV, Epstein-Barr virus, Hep B virus

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60
Q

annular constricting lesions of the small bowel

A

small bowel adenocarcinoma, annular metastases, intraperitoneal adhesions, malignant GIST, lymphoma

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61
Q

feature of lymphoma due to replacement of the muscularis and destruction of the autonomic plexus by tumor without inducing fibrosis

A

aneurysmal dilatation

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62
Q

aneurismal dilation of SI in lymphoma is up to what size

A

> 4cm

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63
Q

sign that refers to sparing of rind of fat surrounding mesenteric vessels that are encased by lymphomatous nodes

A

sandwich sign

64
Q

AIDS related lymphoma is of what type

A

High-grade non-Hodgkin lymphoma

65
Q

Burkitt lymphoma usually involve what part of SI in children and young adults

A

ileocecal area

66
Q

imaging findings in SI Burkitt lymphoma

A

bulky ileocecal mass

67
Q

nodular lymphoid hyperplasia is differentiated from lymphona by what characteristics

A

uniform small size of nodules (2 to 4 mm) and even distribution through the area of involvement

68
Q

lymphoid hyperplasia that is confined to the terminal ileum and proximal colon is usually considered incidental and may be related to

A

recent viral infection

69
Q

diffuse lymphoid hyperplasia is associated with

A

hypogammaglobulinemia especially low IgA

70
Q

frequent routes of metastases in SI

A

peritoneal seeding and hematogeneous spread

71
Q

peritoneal seeding in SI usually involves the

A

mesenteric border

72
Q

hematogeneous spreading on SI usually involves the

A

antimesenteric border

73
Q

intraperitoneal implantation on the small bowel serosa is most commonly due to

A

ovarian carcinoma in women and colon, gastric or pancreatic carcinoma in men

74
Q

mesenteric border of SI is favored by flow of fluid along the small bowel mesentery from the left upper and right lower abdomen, therefore, implantation is most common along the

A

terminal ileum, cecum and ascending colon

75
Q

direct extension in SI occurs in what malignancies

A

pancreas and colon

76
Q

GIST tumors that exceed ___ cm tend to ulcerate whether they are benign or malignant

A

2 cm

77
Q

malignant GISTs has size of

A

> 5 cm

78
Q

adenoma in SI commonly involves the

A

duodenum and mesenteric small bowel

79
Q

lipomas in SI is most common in

A

ileum

80
Q

rare complication of lipoma in SI

A

bleeding or intussusception

81
Q

hemangioma in SI present as

A

solitary, submucosal, projecting into the lumen as a polyp

82
Q

hemangioma in SI are located predominantly in

A

jejunum

83
Q

autosomal dominant inherited condition consisting of multiple hamartomatous polyps in the SI, colon and stomach associated with melanin freckles on the facial skin, palmar aspects or fingers, toes and mucous membranes

A

Peutz-Jeghers syndrome

84
Q

nonneoplastic, abnormal proliferation of all 3 layers of mucosa, epithelium, lamina propria and muscular mucosae

A

Hamartomatous polyps

85
Q

hamartomatous polyps are most common in ______, usually pedunculated and are variable in size up to 4 cm

A

jejunum

86
Q

involves the small bowel in about half of the case with multiple inflammatory polyps

A

Cronkhite-canada syndrome

87
Q

usually involved in Cronkhite-canada syndrome

A

colon and stomach

88
Q

ascariasis worms mature where in the small bowel

A

jejunum

89
Q

infectious lymphadenopathy is associated with

A

Yersinia enterocolitica, infections of terminal ileum, TB, HIV and Whipple disease

90
Q

most common solid mesenteric mass

A

lymphoma

91
Q

metastases from this tumors produce a prominent desmoplastic reaction in the mesentery

A

carcinoid and small bowel adenocarcinoma

92
Q

benign, locally aggressive, solid, fibrous mesenteric tumor. they ma be solitary or multiple and is associated with Gardner syndrome

A

mesenteric desmoid

93
Q

mesenteric desmoid tumors commonly also occur within what muscles

A

anterior abdominal wall or in the psoas muscles

94
Q

lymphangiomas that arise in the root of small bowel mesentery. most are thin walled and multiloculated with internal fluid that may be chylous, serous or bloody

A

mesenteric cysts

95
Q

congenital, partial, complete replica of the small bowel, most arise from the distal small bowel and may communicate with normal intestinal lumen at one or both ends or not at all. they are lined by intestinal epithelium

A

GI duplication cyst

96
Q

malignancies, primarily _____, may arise within duplication cysts

A

adenocarcinoma

97
Q

heterogeneous with cystic and solid components

A

mesenteric teratoma

98
Q

an uncommon inflammatory condition affecting the root of the mesentery with variable inflammation, fat necrosis and fibrosis

A

mesenteric panniculitis (sclerosing mesenteritis)

99
Q

mesenteric panniculitis is associated with other idiopathic inflammatory disorders including

A

retroperitoneal fibrosis and sclerosing cholangitis

100
Q

this finding has been termed “misty mesentery” and may be caused by mesenteric infiltration by edema, inflammatory cells, neoplastic cells or fibrosis

A

mesenteric panniculitis

101
Q

mesenteric edema may occur with

A

portal hypertension, cardiac or renal failure or hypoproteinemia

102
Q

hemorrhage into mesentery can occur with

A

trauma, ischemia, and anticoagulation therapy

103
Q

dilation of small bowel lumen means

A

small bowel obstruction or dysfunction of small bowel muscle

104
Q

thickening of small bowel folds means

A

infiltration of submucosa

105
Q

uniform, regular, straight thickening meanss

A

infiltration of fluid (edema or blood)

106
Q

irregular, distorted, nodular thickening means

A

infiltratrion by cells or nonfluid material

107
Q

specific diagnosis of small bowel disease requires

A

matching the small bowel pattern with the clinical data

108
Q

hemorrhage in small bowel manifest as

A

thicker folds with scalloping and “thumbprinting” of some folds

109
Q

nodule size in nodular lymphoid hyperplasia

A

2-4 mm

110
Q

nodule size in lymphoma

A

> 4mm

111
Q

nodule in size in Whipple disease

A

1 to 2 mm

112
Q

nodule size in systemic mastocytosis

A

< 5 mm

113
Q

early crohn disease in SI is characterized by

A

edema and regular folds

114
Q

more advances crohn disease manifest as

A

inflammatory cell infiltrate and irregular folds

115
Q

lymphoma in mesentery manifest as

A

obstruction in lymphatics and causes edema

116
Q

lymphoma in small bowel wall causes

A

nodular, irregular folds

117
Q

two most commonly encountered small bowel diseases

A

lymphoma and crohn disease

118
Q

produces atrophy of the muscularis by the process of progressive collagen deposition resulting in flaccid, atonic often greatly dilated small bowel. excessive contraction of the mesenteric border of small bowel results in formation of mucosal sacculations along the antimesenteric border

A

scleroderma

119
Q

part of SI that is severely involved in scleroderma

A

duodenum and jejunum

120
Q

“hide-bound” appearance of small bowel is seen in this disease with the appearance of thinned folds tethered together which is produced by contraction of the longitudinal muscle layer to a greater extent thatn the circular muscle layer

A

scleroderma

121
Q

diagnosis of scleroderma is confirmed by

A

skin changes and characteristic involvement of esophagus

122
Q

presents with malabsorption, steatorrhea and weight loss

A

adult celiac disease/nontropical sprue

123
Q

in this disease, the mucosa becomes flattened, and absorptive cells decrease in number, vili disappear. the submucosa, muscularis and serosa remain normal

A

celiac disease

124
Q

complications of celiac disease include

A

small bowel intussusception, lymphoma, ulcerative jejunoileitis, cavitating lymphadenopathy syndrome and pneumatosis intestinalis

125
Q

classic radiographic findings of celiac disease include

A

dilated small bowel, normal or thinned folds, a decreased number of folds per inch in jejunum and increased number of folds per inch in the ileum (>5)

126
Q

CT enterography findings in celiac disease include

A

reversed jejunoileal fold pattern with loss of folds in the jejunum and increased number of folds in the ileum, small bowel dilation, increased separation of small bowel folds, mesenteric lymphadenopathy, engorgement of mesenteric vessels

127
Q

it has similar clinical and radiographic findings as nontropical sprue but is confied to india, far east and puerto rico. illness starts with acute diarrhea, fever, malaise, and transitions to chronic steatorrhea, weight loss, malaise, nutrient and vitamin deficiencies

A

tropical sprue

128
Q

enzyme required within the absorptive cells of the jejunum to properly digest dissacharides. several population groups, including chinese, arabs, bantu and eskimos may become totally deficient in this enzyme during adult life

A

lactase

129
Q

secondary lactase deficiency may develop with

A

alcoholism, crohn disease and drugs such as neomycin

130
Q

intestinal ischemia may result from

A

embolism or thrombosis of the SMA or SMV

131
Q

CT findings of acute intestinal ischemia

A

diffuse thickening of bowel wall, usually 8 to 9 mm, rarely exceeding 15 mm, thinning of bowel wall may occur in acute arterial occlusion caused by loss of intestinal muscle tone and tissue volume loss with vessel constriction, bowel edema, intramural hemorrhage, decreased bowel wall enhancement, pneumatosis, adynamic ileus, mesenteric vessels with emboli or thrombi fail to enhance, mesenteric fat stranding and ascites

132
Q

most radiosensitive organ in the abdomen

A

ileum

133
Q

gross dilation of lymphatic vessels in the small bowel mucosa and submucosa. patients present with protein-losing enteropathy, diarrhea, steatorrhea and recurrent infection

A

lymphangiectasia

134
Q

refers to lymphatic obstruction due to radiation, CHF or mesenteric node involvement by malignancy or inflammation

A

secondary lymphangiectasia

135
Q

pattern of small bowel lymphangiectasia closely resembles what disease

A

Whipple disease

136
Q

most common site of GI amyloidosis

A

small bowel

137
Q

a myeloproliferative neoplasm characterized by infiltration of mast cells in the skin, bones, lymph nodes, liver and spleen and GI tract

A

systemic mastocytosis

138
Q

characteristic skin manifestation of systemic mastocytosis

A

urticaria pigmentosa

139
Q

disease that present with arthritis, neurologic symptoms or steatorrhea, generalized lymphadenopathy. demonstration of tiny (1 mm) sand-like nodules spread diffusely over the mucosa or in small groups is strong evidence of the disease. low density or fat density nodes in mesentery are characteristic

A

Whipple disease

140
Q

protozoans that may infest the proximal intestine and cause a cholera-like diarrhea with life threatening fluid loss

A

cryptosporidium and Isospora belli

141
Q

common systemic infection in AIDS, involving lung, liver, spleen, bone marrow, lymph nodes and intestinal tract

A

mycobacterium avium intracellulare

142
Q

common inflammatory disease of uncertain etiology that may involve the GI tract from esophagus to anus

A

crohn disease

143
Q

this disease is characterized by erosions, ulcerations, full-thickness bowel wall inflammation, and formation of noncaseating granulomas

A

crohn disease

144
Q

patterns of colon involvement in crohn disease include

A

colon and terminal ileum (55%), small bowel alone (30%), colon alone (15%), and proximal small bowel without terminal ileum (3%)

145
Q

imaging hallmarks of crohn disease

A

aphthous erosions, confluent deep ulcerations, thickened distorted folds, fibrosis with thickened walls, contractures and stenosis, involvement of mesentery, asymmetric involvement both longitudinally and around the lumen, skip areas of normal intervening bowel between disease segments

146
Q

“cobblestone pattern”, which are deep ulcerations that are large and often linear, forming fissures between nodules of elevated edematous mucosa is seen in

A

crohn disease

147
Q

abnormal communications between two epithelial-lined organs

A

fistula

148
Q

most frequent fistulas in crohn disease

A

ileocolonic and ileocecal

149
Q

this infection causes acute enteritis with abdominal pain, fever and often bloody diarrhea taht mimics acute appendicitis or acute Crohn disease. infection is self limited with course of 8 to 12 weeks, most pronounced in the distal 20 cm of ileum

A

yersinia enterocolitis

150
Q

clinically and radiographically similar to Yersinia enterocolitis that usually lasts 1 to 2 weeks but relapses are common

A

Campylobacter fetus jejuni

151
Q

small vessel vasculitis that affects eyes, joints, skin, central nervous system and intestinal tract. prominent clinical features include relapsing iridocyclitis, mucocutaneous ulcerations, vesicles, pustules and mild arthritis. intestinal disease most commonly involves the ileocecal region, where crohn disease is closely mimicked

A

Behcet disease

152
Q

GITB most commonly involve the

A

ileocecal area

153
Q

small bowel diverticula are common in

A

jejunum along the mesenteric border

154
Q

megaloblastic anemia due to malabsorption of Vit B12 may be seen in what SI diseases

A

crohn, diverticula

155
Q

most common congenital anomaly of the GI tract, present in 2 to 3 % of population. the diverticulum varies from 2 to 8 cm in length, and is located on the antimesenteric border of ileum up to 2 m from ileocecal valce

A

Meckel diverticulum

156
Q

tip of Meckel diverticulum may be attached to the umbilicus by a

A

remnant of the vitelline duct

157
Q

outpouchings along the antimesenteric border of the small bowel that result from the diseases of the small bowel. they occur most commonly in association with crohn disease or scleroderma

A

pseudodiverticula or sacculations

Abdominal Radiology (14 decks)

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