Posted in Gastroenterology on December 05, 2013 by m.khodeer
Small Bowel Dilatation Sprue
Features:
- Jejunal dilitation and wall/ fold thickening leads to ilealization jejunum (<3 folds="" inch="" compensatory="" increase="" number="" of="" in="" ileum="" span="">
- losses of villi leads to Moulage sign (featureless folds). Malabsorption/ excess fluid leads to flocculation of barium.
- Complications: intussusceptions, lymphadenopathy, ascites, hepatic steatosis from malabsorption, malignancy (lymphoma> adenocarcinoma, SCC)
- DDX Small Bowel Dilitation
Malfunction Denervation – gastric surgery, Chagas
Scarring – scleroderma
Infiltration – amyloid, lymphoma, edema (ischemia, infection)
Mechanical – gastroparesis, meds, ileus
Obstruction- mass, adhesions, intussusceptions
Malabsorption – sprue, lactose intolerance, ZE
Duke DDX Dilated SB Loops With Normal Folds
Obstruction
Intrinsic – stricture-> tumor, crohn, XRT, ischemia, infection
- intussusceptions-> tumor, Meckel’s, duplication, adhesions, lymphoid hyperplasia in children
- malrotation with paraduodenal hernia/ volvulus
Extrinsic – adhesions (60%), hernia, closed loop obstruction, masses
Ilues
Sprue
Scleroderma – commonset cause of intestinal pseudo obstruction
On to the Folds
Evaluation of SBFT
You need to ask yourself the following questions when evaluating a SBFT.
- 1-Describe the folds (this is the biggest clue)
Are the folds thickened?
If so, is it focal or diffuse?
Are they regular or irregular?
Regular – hemorrhage and edema
Irregular – inflammatory or neoplastic
Are the folds too close together? “Hidebound”
Are the folds dilated?
Are the folds absent or displaced?
Tags small bowel dilatation