Quiz 5 (GI tract) Flashcards
(112 cards)
1
Q
what are functions of the GI tract?
A
- ingest food
- digest food
- secrete mucus and digestive enzymes
- absorb and breakdown food
- reabsorb fluid to prevent dehydration
- form solid feces
- expel fecal waste
2
Q
what enzymes are secreted by the stomch?
A
hydrochloric acid
pepsin
3
Q
what enzymes are secreted from the small intestines?
A
- secretes mucus
- receives digestive enzymes
4
Q
what enzymes are secreted from the duodenum?
A
large quantities of mucous (protects small intestine from acidic chyme)
5
Q
what enzymes are secreted from the colon?
A
large quantities of mucous-bacteria in colon
-produces vit K and some B-complex vitamins
6
Q
what is the stomach wall thickness?
A
less than 5mm when distended
7
Q
what is the normal bowel wall measurment?
A
less than 4mm thickness
8
Q
where does the small intestine decrease in size?
A
pylorus to ileocecal valve
9
Q
where is the colon the largest?
A
cecum and gradually decreases in size toward the rectum
10
Q
what is seen on ultrasound with the stomach?
A
- GEJ in SAG LL indent
- walls of pylorus in TRV view of pancreas
11
Q
where does much of the digestion and absorption of food take place?
A
valves of Kerckring (valvulae conniventes)
12
Q
how long is the small intestine?
A
6 meters
13
Q
what are the functions of the colon?
A
- absorbs water
- passes useless waste form body
14
Q
how long is the colon?
A
2 meters
15
Q
Teniae coli
A
Longitudinal ribbons of smooth muscle on the outside of the colon
-contract lengthwise
16
Q
Produce haustra
A
-Bulges in the colon
-Caused by contractions
of the teniae coli
17
Q
what are the 4 concentric layers of the gut?
A
- mucosa
- submucosa
- muscularis propria
- serosa or adventita
18
Q
what is the sonographic appearance of gut signiture?
A
echogenic hypoechoic echogenic hypoechoic ........(up to 5 layers)
19
Q
what are indications for scanning the stomach?
A
- abdominal or RLQ pain
- leukocytosis
- vomiting
- weight loss
- fever
- e.t.c
20
Q
what are steps to assess GI tract?
A
- wall thickness
- doppler evaluation
- peristalsis
- inflammed fat surrounding bowel
- lymphadenopathy
21
Q
how do you measure gut wall?
A
measure from outer wall (adventitia) to wall of lumen
22
Q
vascularity of normal gut
A
minimal doppler seen
23
Q
vascularity of inflammation and neoplasia
A
increased vascularity
24
Q
vascularity of ischemia and edematous gut
A
hypovascular
25
where is peristalsis normally seen?
in small bowel and stomach
26
what is the most striking and detectable abnormality on sonography?
mesenteric edema and fibrosis
| -uniform echogenic halo around gut
27
what is a sign of imflammation
Lymphadenopathy
28
why might thickening of the bowel wall occur?
- infiltration
- inflammation
- edema
- neoplastic invasion
29
causes of congenital bowel wall inflammtion?
- meckels Diverticulum
- Malrotation of the bowel
- enteric duplication cysts
30
causes of non congenital or IBD?
- neoplasms (adenocarcinoma most common)
- intussesception
- IBD
- Appendicitis
31
Meckels diverticulum
- remnant of prenatal yolk stalk vitelline duct
| - projects from side of the ileum
32
malrotation of bowel
associated with malposition of SMA and SMV
33
what helps with evaluating malrotation of bowel?
assessed with doppler
- varices may be detected
- ischemia
- necrosis
34
enteric duplication cysts
rare congenital malformations that frequently occur in the small intestine especially the hilum
35
what are the symptoms to enteric duplication cysts?
- abdominal pain
- vomiting
- palpable mass
- hemorrhage
36
what is the most common cancer of the colon?
adenocarcinoma
37
how are esophageal and gastric lesions assessed?
endoscopy
38
is adenocarcinoma of stomach more common in females or males?
males
39
what are differential diagnosis of gastric lesions/neoplasms?
```
adenocarcinoma
lymphoma
leukemia
crohn's disease
intussusception
metastases
```
40
intussusception
a proximal segement invaginates into a distal segement and stragulation of vascular supply occurs
41
who is intussusception more commonly seen in?
children
42
what may cause intussusception?
- malignant lesions in adults
| - benign lipomas or polyps
43
examples of IBD
- crohn's
| - colitis
44
what is ulceration of bowel caused by?
inflammation
45
thickened walls of ulceration of bowel look like what?
- pseudo kidney
| - doughnut sign
46
what are bowel problems?
- illeus
| - bowel obstructions
47
ilieus
temporary absence of peristalsis
48
what causes ilieus?
- common after abdominal or pelvic surgery
| - can happen to any part of the bowel
49
bowel obstruction
interference of normal passage of luminal contents
50
what causes bowel obstruction?
-intrinsic or extrinsic factors
| mass, fecal matter
51
what does mechanical bowel obstruction cause?
- adhesions (scar tissue)
- foreign bodies
- gallstones
- hernias
- impacted stool
- intussesception
- tumors-blocking the lumen
- volvulus
52
how does ileus dilate bowel?
- causes paralysis of bowel loops
- peristalsis is absent
- gas accumulates in these loops
- localized ileus may occur near inflammatory process
53
how does obstruced bowel dilate bowel?
- prevent gas from passing through the GI tract
- builds up proximal to obstructed loop
- portion distal to the obstruction becomes decompressed
54
Pneumoperitoneum
presence of air or gas in the abdominal cavity
55
what is the most common cause-perforated peptic ulcer?
Pneumoperitoneum
56
Peritonitis
inflammation of the peritoneum
57
what are signs of peritonitis?
- abdominal pain
- tenderness
- fever
58
Miscellaneous
worm causing thickened bowel seen when we covered Liver/Biliary tree parasites
59
what are signs and symptoms of miscellaneous?
diffuse pain
| vommiting
60
Ascaris
tube within a tube within bowel worm can be seen moving
61
other GI diagnostic tests
- abdominal x-ray plain film
- barium swallow (upper GI)
- barium enema
- CT
62
what is CT good at diagnosing?
gastric carcinoma
63
sonographic appearance of neoplasms
- potential causes of bowel thickening
| - may demonstrate decreased to intermediate echogenicity
64
what are sonographic guidelines for benignancy of appendix??
-long segment
-concentric thickening
-wall preservation
(crohn's disease)
65
what are the sonographic guidelines for malignancy of apendix??
-short segment
-eccentric thickening
-wall layer destruction
(adenocarcinoma)
66
is gut wall thickening malignant or bengin?
malignant and benign
67
gut wall masses location
- intraluminal
- mural
- exophytic
- with or without ulceration
68
neoplasia
- adenocarcinoma
- stromal tumors
- lymphoma
- metastases
69
what is the most common malignant tumor of the GI tract?
adenocarcinoma
70
where does adenocarcinoma occur?
less frequently in the small bowel than in the stomach and large bowel
71
adenocarcinoma appearance
- thicken gut wall in concentric symmetrical or asymmetrical
- target or pseudo kidney may be created
- tumors are usually hypoechoic
- may be lymph node enlargment
- liver mets
72
what are the most common stromal tumors?
smooth muscle origin
73
where are stromal tumors most often seen?
stomach
| small bowel
74
where do colonic tumors occur most often?
in rectum
75
colonic tumors sonographic appearance
- round mass lesions of varying echogenicity
- necrosis or hemorrhage
- air within ulceration
76
lymphoma sonogrpahic appearance
- nodular or polypoid
- carcinoma-like ulcerations
- infiltrating tumor masses
- frequently invade adjacent mesentary and lymph nodes
77
what is the most common IBD?
crohn's disease
78
crohn's disease
- chronic transmural granulomatous inflammatory process
- affects all layers of gut wall
- has skip lesions
79
ulcerative colitis
- mucousal inflammation of the colon
- minimal sonographic change
- begins in anal region and moves upward
80
crohn's disease acute or chronic?
chronic
81
where does crohn's disease most often affect?
terminal ileum
colon
(gut very thick and rigid)
82
what are complications of chronic crohn's disease?
- inflammatory masses
- obstruction
- strictures
- perforation
- appendicitis
83
what are classic sonographic findings for crohn's disease?
- gut wall thickening
- creeping fat
- hyperemia
- mesenteric lymphandenopathy
- strictures
- mucosal abnormalities
- skip lesion
84
strictures
rigid narrowing of gut lumen
85
what do structures look like?
lumen appears as a linear echogenic central area within a thickened gut loop
(US is accurate technique for detecting small bowel)
86
fistula formation
characteristic complication at the proximal end of a thickened segment of Crohn's loop
87
SUMMARY chron's classic features
- gut wall thickening greater than 4mm
- creeping fat
- hyperemia
- strictures
- lymphadenopathy
- mucosal abnormalities
88
SUMMARY chron's complications
- inflammatory masses
- fistula
- obstruction
- perforation
- appendicitis
89
what is the treatment for crohn's?
no cure
medication
- anti-inflam.
- corticosteroids
- antibiotics
surgery
- removal of colon or sm intes.
- ileostomy-small bowel
- colostomy-large bowel
90
sonographic features of ulcerative colitis
- minimal sonographic change even with acute or long standing disease
- starts in anus and proceeds up
- no skip lesion
91
RLQ pain
- appendicitis
| - diverticulitis
92
LLQ pain
-acute diverticulitis
93
other abdomen abnormalities
- mechanical bowel obstruction
- ileus
- colitis
94
appendicitis
inflammatory process of the appendix that may indent or displace the cecum
95
what may be see with appensicitis?
- will not exhibit peristalsis
- will not compress
- appendicoliths and periappendiceal abscess
96
what is the most common cause of RLQ pain?
acute appendicitis
97
what is the triad of symptoms for acute appendicitis?
-RLQ pain
-tenderness
-leukocytosis
(mass could also be palpable)
98
what further symptoms could occur with acute appendicitis?
- transient visceral or referrer crampy pain in periumbilical area
- nausea and vomiting
- pain shifts to RLQ-peritoneal irritation
99
who does acute appendicitis most occur in?
- younger patients
- 10-30
- but can affect all ages
100
what is the graded compression technique in appendicitis?
-used to assess for non-compressible bowel
-use a linear, broad, footprint, high frequency transducer (7MHz)
-displace the bowel loops while applying moderate compression
REBOUND PAIN will occur as probe is lifted off quickly
101
what are good indications of appendicitis?
- non compression
| - rebound pain
102
what helps to locate origin of appendix?
ileocecal
103
what are the sonographic appearances of the appendix?
- blind ended
- non compressible
- aperistaltic tube
- gut signature
- arising from base of cecum
- AP diameter greater than 6mm
104
what are supportive features of appendix?
- inflammed perienteric fat
- pericecal collections
- appendicoltih
105
what are complications of appendicitis?
- perforation
- abscess
- gangrene
106
where is the appendix located?
behind the cecum which makes visualization difficult
107
diverticulitis "LLQ pain"
- cause in an overwhelming number of cases
| - pouches within the bowel wall become inflammed
108
what are diverticuli?
acquired deformities of large bowel
| -muscular dysfunction and hypertrophy
109
where is diverticuli often seen?
- western urban population
| - sigmoid and left colon
110
what is the classic triad of symptoms for acute diverticulitis?
- LLQ pain
- Fever
- Leukocytosis
111
sonographic features of acute diverticulitis?
- segmental thickened gut
- inflammed diverticula
- inflammed perienteric fat
112
what is the treatment to diverticulitis?
- simple uncomplicated diverticulitis responds well to antibiotics
- recurring acute attacks or complications such as peritonitis, abscess or fistula require surgery
- low fiber diet rests bowel-heals
