Beruflich Dokumente
Kultur Dokumente
Small Bowel
Two or three loops of nondistended bowel
Normal diameter = 2.5 cm
Large Bowel
In rectum or sigmoid almost
always
Gas in
stomach
Gas in a
few loops
of small
bowel
Gas in
rectum or
sigmoid
Small Bowel
Two or three levels possible
Large Bowel
None normally
Always
air/fluid
level in
stomach
A few
air/fluid
levels in
small
bowel
Erect Abdomen
Small Bowel
Central
Valvulae extend across
lumen
10
ACUTE ABDOMEN
Perforation
Intestinal obstruction
Paralytic ileus
Acute colitis
Intraperitoneal fluid
Inflammatory conditions
Calcification associated with acute
abdominal conditions
11
Mechanical Obstruction
SBO
LBO
Localized Ileus
Key Features
Supine
Prone
Cholecystitis
Appendicitis
Sentinel
Loops
Pancreatitis
Ulcer
Diverticulitis
Ulcer
Ureteral
calculus
Localized Ileus
Pitfalls
May resemble
early mechanical
SBO
Clinical course
Get follow-up
Generalized Ileus
Key Features
Supine
Erect
Ileus Paralitik
20
Is It An Ileus?
Is the patient immediately postop?
Are the bowel sounds absent or
hypoactive?
If no, then it isnt an ileus
Mechanical SBO
Key Features
SBO
Mechanical SBO
Causes
Adhesions
Hernia*
Volvulus
Gallstone ileus*
Intussusception
Mechanical SBO
Pitfalls
Mechanical LBO
Key Features
27
Ileus Obstruksi
28
Supine
Prone
Mechanical LBO
Causes
Tumor
Volvulus
Hernia
Diverticulitis
Intussusceptio
n
Mechanical LBO
Pitfalls
Supine
Prone
Air in
biliary
tree
SBO
Gallstone
Gallstone Ileus
Sigmoid Volvulus
Extraluminal Air
Free Intraperitoneal Air
Crescent
sign
Riglers Sign
Football
sign
Free Intraperitoneal Air
Free Air
Causes
Post-op 57 days
NOT perforated appendix
Extraperitoneal Air
PERFORATION
PNEUMOPERITONEUM
43
Small pneumoperitoneum
44
Pneumoperitoneum
45
Pneumoperitoneum
46
INTESTINAL OBSTRUCTION
= Dilated loops of bowel proximally
with
non-dilated/collapsed bowel distal to
the presumed point of obstruction.
Gastric Dilatation:
Etiology:
- Mechanical gastric outlet obstruction
- Paralytic ileus
- Gastric volvulus
- Air swallowing
47
Gastric Dilatation
48
Small-Bowel Obstruction:
Etiology:
- Adhesions due to previous surgery
- Strangulated hernias
- Volvulus
- Gallstone ileus
- Intussusception
- Neoplastic, etc.
49
Radiological appearances:
50
Small-Bowel Obstruction
due to adhesion
Small-Bowel Obstruction
due to gallstone ileus
Multiple dilated loops of
small bowel are seen. A band
of
gas
in
the
right
hypochondrium lies within
the common bile duct.
52
Small-Bowel Obstruction
due to Intussusception
Erect film:
- Multiple fluid levels (Stepladder pattern
- String of beads sign
= small bubbles of gas may be trapped
in rows between the valvulae
conniventes.
54
55
Small-Bowel Obstruction:
String of beads sign
56
Ultrasound:
- Dilated fluid-filled loops of small-bowel
obstruction.
- Assessment of the peristaltic activity.
57
CT:
58
LARGE-BOWEL
OBSTRUCTION
Etiology:
- Neoplastic (benign & malignant)
- Volvulus (caecal & sigmoid), etc.
Radiological appearances:
Depends on the state of competence
of the ileocaecal valve:
59
LARGE-BOWEL OBSTRUCTION
due to Sigmoid Volvulus
The hugely dilated ahaustral
loop of sigmoid can be seen
rising out of the pelvis in the
shape of an inverted U.
Haustrated
ascending
&
descending colon separate
from the volved sigmoid loop.
60
LARGE-BOWEL OBSTRUCTION
due to Caecal Volvulus
Distended caecum with its
haustral markings is lying
low in the central abdomen.
There is no significant smallbowel distention.
61
PARALYTIC ILEUS
Generalised paralytic ileus:
Etiology:
- Peritonitis
- Post-operative
- Hypokalaemia
- General debility or infection
- Drugs: morphine
- Congestive cardiac failure, renal colic,
etc.
Radiological appearances:
- Both small & large-bowel dilatation
- Horizontal-ray films: multiple fluid
levels
62
PARALYTIC ILEUS
There
is
generalised
dilatation of both
small
&
large
bowel.
63
Localised ileus:
Etiology:
- Local inflammatory processes:
pancreatitis, cholecystitis, appendicitis, salpingitis
- Trauma:
spine, ribs, hip, retroperitoneum
- Renal colic, etc.
Radiological appearances:
- Non specific (Mimic small/large-bowel obstruction).
- Dilatation of one/two adjacent loops of bowel.
64
Toxic megacolon
A fulminating form of colitis with transmural
inflammation, extensive & deep ulceration &
neuromuscular degeneration.
Involve the transverse colon
Ro. Findings:
Mucosal islands (=pseudopolyps) & dilatation (8
cm)
Common complication:
Perforation in the sigmoid & peritonitis
65
Toxic megacolon
66
INFLAMMATORY
CONDITIONS
Appendicitis
Acute cholecystitis
Emphysematous
cholecystitis
Acute pancreatitis
67
Appendicitis
Signs of acute appendicitis:
68
Appendicitis
- Scoliosis concave to the right
- Dilated caecum
- Right lower quadrant (RLQ) mass
identing
the caecum on its medial border (abscess
formation)
- RLQ haze due to fluid & oedema
- Gas in the appendix-rare, unreliable.
69
abscess
small-bowel
70
71
Acute appendicitis
72
Acute appendicitis
73
Acute cholecystitis
Plain abdominal film:
- Gallstones seen in 20%
- Duodenal ileus
- Ileus of hepatic flexure of colon
- Right hypochondrial mass due to
enlarged
gallbladder
- Gas within the biliary system
- Normal plain films in two-thirds of cases
74
Ultrasound imaging:
- A circumferential halo of low
echogenicity
with thickening of the gallbladder
wall
(8-10mm) in fasting state.
- Indistinct contour to the gallbladder
wall
- Fluid around the fundus of the
gallbladder
- Gallstones casting acoustic shadow
- A distended gallbladder (a stone
obstructing
the cystic duct)
- Echogenic sediment in the lumen
- Positive sonographic Murphy sign
75
Acute cholecystitis
76
CHRONIC CHOLECYSTITIS
Ultrasound imaging:
- A contracted gallbladder
- Sometimes, obliteration of the lumen
- Thickening of the gallbladder wall &
strongly
reflective
- Cholelithiasis
77
CHRONIC CHOLECYSTITIS
78
Acute pancreatitis
Plain chest film:
- A left side pleural effusion
- Basal parenchymal shadowing
- Elevated left hemidiaphragm-unreliable
Plain abdominal film:
- Normal plain films in two-thirds of cases
- Duodenal ileus
Gas in a dilated duodenal loop in the LLD
- A gasless abdomen due to vomiting
cont
79
Acute pancreatitis
- Generalised paralytic ileus
- Dilated loops of bowel (small bowel,
terminal
ileum, ascending & transverse colon)
- Loss of the psoas outline
- Multiple small bubbles within the
pancreas
(pancreatic abscess)
- Pancreatic calcification-unreliable
80
81
ACUTE PANCREATITIS
82
83