cancer结肠癌课件.pptVIP

* * Norm for comp * Skip lesions * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * NORMAL SMALL BOWEL Early contrast is predominantly in jejunum and later predominately in ileum. (note difference in mucosal fold pattern) ILEUM COLON JEJUNUM ERECT Note dilated small bowel centrally placed with air/fluid levels on upright exam. Ng tube SMALL BOWEL OBSTRUCTION POST – OP ADYNAMIC ILEUS LARGE AND SMALL BOWEL Symmetric dilation of large and small bowel is seen normally as a post operative ileus. COLON SM. BOWEL SUTURES HERNIA SMALL BOWEL BARIUM STUDY CT Note hernia in right lower quadrant on both exams accounting for obstruction. Hernia is likely cause if there is no history of prior surgery. CROHNS DISEASE Narrowed distal ileum due to chronic inflammation is typical for Crohn’s disease. normal SMALL BOWEL DISEASE ULCER OBSTRUCTION POST-OPERATIVE ILEUS CROHN’S DISEASE PAIN HEMATEMESIS DISTENTION DIARRHEA SIGNS / SYMPTOMS HEPATIC FLEXURE SPLENIC FLEXURE TRANSVERSE COLON CECUM ASCENDING COLON DESCENDING COLON TERMINAL ILEUM NORMAL COLON Normal air contrast barium enema (double contrast-air and barium per rectum) shows filling of colon with air and barium retrograde to the cecum with reflux into the terminal ileum. APPENDICITIS / DIVERTICULITIS POLYP / CANCER VOLVULUS GI HEMORRHAGE SIGNS / SYMPTOMS RIGHT / LEFT LOWER QUADRANT PAIN FEVER / ELEVATED WBC’s DISTENSION / OBSTRUCTION WEIGHT LOSS HEMOCULT POSITIVE STOOL / ANEMIA MELENA / HEMATOCHEZIA COLON DISEASE ACUTE APPENDICITIS NORMAL DISTENDED APPENDIX WITH LOCAL INFLAMMATION. DRAINAGE ABSCESS Catheter has been placed by radiologist using CT guidance draining abscess collection. PEDUNCULATED COLON POLYP (DESCENDING COLON) stalk on polyp--pedunculated COLON CANCER Barium enema showing apple-core type constricting lesion with proximal dilation of colon—”APPLE - CORE” constricting lesion Ng tube SMALL BOWEL vs COLON OBSTRUCTION COLON SIGMOID VOLV