Radiology Class 9

what are sx of mallory weiss tears?

hematemesis, melena, abdominal pain, chest pain from tears

how much blood do you need to get melena?

at least 50 mL

who gets mallory weiss tears?

pregnant women, alcoholics, wt lifters, sick- vomiting

how do we make dx for mallory weiss tears?

endoscopy

how do we tx mallory weiss tears?

PPI

what do we see on imaging for mallory weiss tears?

esophagus shows linear tear of mucosa of distal esophagus due to vomiting with barium tracking into the wall

full thickness tear or rupture (Boerhaave’s syndrome) can lead to mediastinitis and death

what is Boerhaave’s syndrome?

esophageal rupture- distal near GE junction

what are sx of boerhaave’s syndrome?

severe chest pain, hematemesis, SOB

what are risk factors for boerhaave’s syndrome?

trauma, severe vomiting

what are imaging studies to order for boerhaave’s syndrome?

gastrographin or endoscopy

what do we see with localized ileus?

1 or 2 persistently dilated loops of small or large bowel (multiple views)

often air-fluid levels in sentinel loops

local irritation, ileus in same anatomical region as pathology

gas in rectum or sigmoid

may resemble early SBO

what is a sentinel loop on an abdominal xray?

a localized ileus

what are etiologies for localized ileus?

appendicitis, pancreatitis, diverticulitis, cholecystitis

what are sx of localized ileus?

RLQ pain, epigastric RUQ, LLQ, RUQ, distention, tenderness, vomiting since it can’t go anywhere

what do we see for chronic pancreatitis on abdominal xray?

calcifications seen in 30% of pts

do we normally see the pancreas on xray?

no, unless there are calcifications

does every with pancreatitis have calcifications?

no

what is a volvulus?

twist of the bowel about an axis

what percent of all intestinal obstructions are due to volvulus?

15%

what are radiographic findings for voluvulus?

xray- bent inner tube or coffee bean appearance with convexity of loop lying in RUQ (opposite the site of obstruction)

CT- characteristic mesenteric whirl sign

barium swallow/gastrografin enema- narrowing at the site of the volvulus and a pathognomonic bird’s beak

what are rvolvulus risks?

prior episodes (40-60%), elongated mesentery with narrow base, high fiber diet, chronic constipation, institutionalization, laxative use, previous surgery, pregnancy, african-american, hirshprung’s disease

what is toxic megacolon?

inflammatory bowel disease or infectious colitis characterized by total or segmental nonobstructive colonic dilation + systemic toxicity

what are clinical sx used for dx of toxic megacolon?

radiographic evidence of colonic distension plus at least 3 of the following:

fever >38C, HR >120, WBC >10.5, anemia

plus at least 1 of the following:

dehydration, altered sensorium/mental status, electrolyte disturbances, hypotension

what is intussusception?

medical condition, particularly common in infants and young children, where a portion of the intestine folds into itself, like a telescope, causing a blockage

what do we see with intussusception?

current jelly stool- berries

what imaging do we use for intussusception in descending colon?

barium enema