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GI Tract Physiologic Disturbances

GI Tract Physiologic Disturbances. Intestinal Obstruction. Obstruction to the antegrade flow of intestinal contents Mechanical Blockage within the lumen Blockage from outside of the lumen Ileus – non mechanical Paralysis of the intestine Trauma Neurologic Inflammatory .

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GI Tract Physiologic Disturbances

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  1. GI Tract Physiologic Disturbances

  2. Intestinal Obstruction • Obstruction to the antegrade flow of intestinal contents • Mechanical • Blockage within the lumen • Blockage from outside of the lumen • Ileus – non mechanical • Paralysis of the intestine • Trauma • Neurologic • Inflammatory

  3. Mechanical ObstructionSmall Intestine • Small intestine dilated > 3 cm with gas (swallowed air) and fluid (excreted by digestive glands). Forms multiple air/fluid levels • Plain abdominal films (erect and supine view) to confirm the diagnosis

  4. Mechanical ObstructionSmall Intestine • Observing number, location and mucosal pattern of the dilated bowel may roughly indicate the point of obstruction • Commonly due to post-surgical adhesion or hernia

  5. Mechanical Small Intestine Obstruction • Plain film supine • Distended gas filled loops

  6. Mechanical Small Intestine Obstruction • Upright film • Multiple air-fluid levels • Step laddering (differential air fluid levels) • Prominent mucosal folds - edema

  7. Mechanical ObstructionLarge Intestine • Distended colon from cecum to level of obstruction with air and fluid inside • If you have an “Incompetent” ileocecal valve, gas flow retrograde into small intestine

  8. Mechanical ObstructionLarge Intestine • Barium enema to confirm the diagnosis • Commonly due to • Cancer • Volvulus • Child – midgut volvulus • Adults – cecal volvulus • Elderly – sigmoid volvulus

  9. Distal Colon Obstruction • Supine • Dilated colon in ascending and proximal transverse portions

  10. Distal Colon Obstruction • Upright view • Multiple air fluid levels

  11. Paralytic (Adynamic) Ileus • The intestinal lumen is patent • Functional defect • Decreased propulsion, generalized or localized • Large and small intestine dilatation, occasionally stomach dilated

  12. Paralytic (Adynamic) Ileus • Commonly due to intra-abdominal inflammation, post surgical or post-traumatic reaction, spinal injury • Can be generalized or localized

  13. Paralytic (adynamic) Ileus • Supine film • Dilatation of both large and small intestine • Long tube coiled in stomach

  14. Pneumoperitoneum • Free air in the peritoneal cavity • Commonly due to: • Perforation of gastrointestinal tract – peptic ulcer • Following surgical procedure – laparotomy • Following laparoscopy

  15. Pneumoperitoneum • X-ray signs: • On erect abdominal or chest film, • a curvilinear (small amount) or a crescent (moderate amount) of low density beneath the opacity of the dome of the diaphragm and the liver on the right • Most reliable sign

  16. Pneumoperitoneum • X-ray signs: • Severely ill patient, one who cannot maintain an erect position • Perform a lateral decubitus film. • The air floats to the top of the peritoneal cavity forming a crescentic lucent area between the abdominal wall and adjacent organs

  17. Pneumoperitoneum • X-ray signs: • With no additional gas introduced, or other complicating condition the free air will be absorbed in 7-10 days in adults or much faster 1-2 days in children

  18. Pneumoperitoneum • PA chest upright • Curvilinear area between right diaphragm and the liver (arrows) • Small amount of free air on the left (single arrow)

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