Jejunum

Acute mesenteric ischemia

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Q)  All are  findings in acute mesenteric ischemia findings except?

a) Slow filling intramural vein

b) Spasm of arterial arcade / distal vessels

c) String of sausages/beaded appearance

d) Dilated and ring enhancement of SMV in CT

Answer 

 

SMA syndrome

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Q True in SMA syndrome

  1. Causes Medial Arcuate Ligament syndrome
  2. Causes nut cracker syndrome
  3. Low AM distance and Narrow AM angle <25 degree is sensitive finding
  4. It can be treated by releasing the DJ and keeping duodenum to the right of the artery

Answer 

 

Vascular

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Q  Engorged dilated Riolan arc vessel with retrograde flow suggests

a) SMA occlusion

b) IMA occlusion

c) Normal flow

d) Iliac artery occlusion

Answer

 

Intestinal adaptation

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Q) Bowel segment showing best adaptation

a) Jejunum

b) Ileum

c) Colon

d) Duodenum

Investigations in lower GI Bleed

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Q Least useful investigation in a patient  with recurrent Lower GI bleed, multiple upper and lower GI endoscopies negative? 

a) BMFT

b) Double balloon enteroscopy

c) Capsule endoscopy

d) Push endoscopy

( # Colon Questions  Q 21-30) 

A

Investigations in lower GI bleed should be specific and less time consuming

Small bowel enteroclysis, which uses a tube to infuse barium, methylcellulose, and air directly into the small bowel, yields better images than simple small bowel follow-through. Because the yield has been reported to be very low and the test is poorly tolerated, it is now rarely used.

Capsule endoscopy uses a small capsule with a video camera. capsule endoscopy is an excellent tool for the patient who is hemodynamically stable but continues to bleed, with reported  success  rates  as  high  as  90%  in  identifying  a  small bowel  pathology.

The hemodynamically stable patient should undergo small bowel enteroscopy. Usually performed with a pediatric colonoscope, it is referred to as push endoscopy. It can reach about 50 to 70 cm past the ligament of Treitz  in most cases and permits endoscopic management of some lesions. Overall, push enteroscopy is successful in 40% of patients .

Double-balloon endoscopy is another technique gaining in popularity. Although technically difficult, this approach is capable of providing a complete examination of the small bowel. In expert hands, double-balloon enteroscopy can identify a bleeding source in 77% of cases with occult bleeding, with the yield increasing to over 85% if the endoscopy is per-formed within 1 month of an overt bleeding episode.The advantage of this technique is that as well as visualization,  biopsies can be performed and therapeutic interventions undertaken.

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