Small bowel Flashcards

1
Q

Duodenum anatomy

  1. Does it have a mesentery?
  2. Which portion is intraperitoneal?
    1. Which are retroperitoneal?
  3. What delineates the four parts?
A
  1. Nope.
  2. Segment 1: duodenal bulb.
  3. Segments 2-4 are retroperitoneal.
  4. Segment 1: bulb; it’s intraperitoneal.
    1. Segment 2: descending
    2. Segment 3: horizontal, ends at the SMA impression.
    3. Segment 4: ascending, ending at the ligament of Treitz, which holds the duodenum up at the duodenojejunal flexure.
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2
Q

SB follow-through: trademark features

  1. What is this SB pattern?
  2. What’s the Dx?
  3. In who is this seen?
A
  1. Hidebound bowel: narrow separation of normal folds w/mild bowel dilation.
  2. Scleroderma.
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3
Q

SB follow-through: trademark features

  1. What are these SB pattern?
  2. What’s the Dx?
A
  1. 1st: moulage sign (tube of wax); complete loss of jejunal folds.
    1. 2nd: fold reversal: jejunum loses folds so looks like the normal ileum; ileum gains folds (in the RLQ) to look like jejunum.
  2. Celiac disease.
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4
Q

SB follow-through: trademark features

  1. What is this SB pattern?
  2. What’s the Dx?
A
  1. Thread-like defect in the barium column.
  2. ascariasis: round worm.
    3.
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5
Q

SB follow-through: trademark features

  1. What is this SB pattern?
  2. What’s the Dx?
  3. In who is this seen?
A
  1. Ribbon bowel.
    1. From SB thickening.
  2. Graft vs. host disease.
  3. Pts post stem cell/bone marrow transplant.
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6
Q

Duodenal trauma:

  1. 3 classic findings.
A
  1. Free gas: less than with an ulcer.
  2. Periduodenal free fluid.
  3. Potential duodenal wall thickening.
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7
Q

Duodenal intramural hematoma:

  1. Which portions are most at risk?
  2. What other underlying pathology can cause this?
  3. Which pt group is most susceptible to this?
A
  1. Segments 2 & 3.
  2. Anticoagulation
  3. Kids.
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8
Q

Brunner gland hyperplasia:

  1. Path?
  2. What segments affected?
  3. What’s the appearance?
A
  1. Disproportionate growth of Brunner glands int he duodenum from hyperacidity.
    1. Hyperplasia begins at the pylorus & extends distally to duodenal segments 2/3.
  2. Ix: multiple nodular filling defects, typically in the 1st portion of the duodenum.
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9
Q

Small bowel trauma

  1. Most common location for SB injury w/blunt trauma?
  2. Which CT trauma finding is a strong predictor of significant mesenteric and/or bowel injury?
A
  1. Duodenum & jejunum: they’re closest to the spine.
  2. Seatbelt hematoma + Chance fracture.
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10
Q
  1. Classic finding name?
  2. Dx?
A
  1. balloons on a string
  2. closed loop SBO
    1. Note the blurred margins b/w loops
    2. Fluid-distended SB.
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11
Q

This is the small bowel in a pt w/NHL. What is the name of this sign and what does it represent?

A
  • Pseudokidney sign.
    • Hypoechoic, concentric bowel wall thickening & a central echogenic area w/dirty shadowing corresponding to the air-filled lumen.
    • The peripheral hypoechoic thickened wall simulated the renal cortex.
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