This document discusses various gastrointestinal conditions seen in neonates and infants that may require imaging evaluation. It describes the clinical presentations and key radiographic findings of conditions such as esophageal atresia, pyloric stenosis, intestinal atresias and obstructions, malrotation, intussusception, and Meckel's diverticulum. Imaging modalities discussed include radiography, upper GI studies, ultrasound, CT, and nuclear medicine scans. The document provides an overview of the imaging approach and features that help characterize many common neonatal gastrointestinal pathologies.
Radiology ----Classical Signs in GIT Dr. Muhammad Bin Zulfiqar.
It is very difficult to learn much in the sea of radiology.
This presentation is the way to memorize classical signs in radiology.
Radiology ----Classical Signs in GIT Dr. Muhammad Bin Zulfiqar.
It is very difficult to learn much in the sea of radiology.
This presentation is the way to memorize classical signs in radiology.
Acute abdomen in children
1/Why acute abdomen in children want to present ??!!!
2/Areal case discussion in dibba hospital .
3/Evaluation of acute abdominal pain clinically .
4/Intussusception
5/Cases .
6/Something missed in my topic . ?????
various congenital gastrointestinal diseases manifesting in childhood or even in adults, their radiographic findings on various imaging modalities such as radiograph, barium, ultrasound etc.
Please find the power point on Gastric Outlet Obstruction. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Clinical manifestation
The most common clinical findings
• Inability to pass RT
• Vomiting
• Abdominal distension
• Failure to pass meconium/imperforate
anus
• AN detected
4. Esophageal Atresia &
Tracheoesophageal Fistula
• Developmental disorder
• Fault in formation and separation of
the primitive foregut into the trachea
and esophagus
10. Radiography
• Radiographic evaluation should always
include the abdomen to assess the
presence of air in the GI tract
• Blind pouch of the proximal esophagus
that is distended with air
• Type A and B - Complete absence of gas in
the stomach and intestinal tract
• Type C and D - GIT commonly appears
distended with air.
11. • The type of esophageal atresia is
confirmed by advancing a radiopaque
feeding tube through the nose to the level
of the atresia
• The tube will curl when it approaches the
blind end
• Atelectasis and pneumonia involving the
upper right lobe
• Type E (H-shaped TE fistula without
atresia) - Demonstration of the fistula,
which typically courses forward and
upward from the esophagus
13. Esophageal Atresia and
Tracheoesophageal Fistula
• 25% associated with other GI
malformations
• Imperforate anus
• Pyloric stenosis
• Duodenal atresia
• Annular pancreas
• Less frequently, cardiac, genitourinary, and
vertebral alterations
14. Esophageal Atresia and
Tracheoesophageal Fistula
• The VACTERL complex
• Vertebral
• Anal
• Cardiac
• Tracheal
• Esophageal
• Renal
• Limb anomalies
• The best known grouping of anomalies
associated with tracheoesophageal lesions
17. Gastrointestinal duplications
• Three defining characteristics
• Have well developed coat of smooth
muscle
• Epithelial lining represents some part of
the alimentary tract
• Attached to some part of the alimentary
tract
• Part of the spectrum of mesenteric and
omental cyst
18. • Can occur anywhere along the
alimentary tract
• Duplication cysts are most often
associated with the esophagus and
jejunum/ileum
19. Esophageal duplications
• More often seen on the right side
• More common in the lower half of the
chest
• Contain gastric mucosa in 30%
• Often have associated vertebral
anomalies (neurenteric cyst)
22. HYPERTROPHIC PYLORIC
STENOSIS
• Idiopathic thickening of pyloric muscle
in infancy which creates progressive
gastric outlet obstruction
• Typically seen in 2-8 week old infants
with worsening projectile vomiting
• Incidence of - 2 per 1,000 live births
25. UGI findings
• Pyloric wall thickness >10 mm
• Elongation and narrowing of pyloric canal
(2-4 cm in length)
• "Double / triple track sign"
• Crowding of mucosal folds in pyloric channel
• "String sign"
• Passing of small barium streak through pyloric
channel
26. • Twining recess = "diamond sign"
• Transient triangular tentlike cleft / niche in
midportion of pyloric canal with apex
pointing inferiorly secondary to mucosal
bulging between two separated hypertrophied
muscle bundles on the greater curvature side
within pyloric channel
• "Pyloric teat"
• Outpouching along lesser curvature due to
disruption of antral peristalsis
• "Antral beaking"
• Mass impression upon antrum with streak of
barium pointing toward pyloric channel
27. • Kirklin sign = "mushroom sign"
• Indentation of base of bulb (in 50%)
• Gastric distension with fluid
• Active gastric hyperperistalsis
• "Caterpillar sign"
30. US findings
• "Target sign"
• Hypoechoic ring of hypertrophied pyloric
muscle around echogenic mucosa centrally
on cross-section
• "Cervix sign"
• Indentation of muscle mass on fluid-filled
antrum on longitudinal section
• "Antral nipple sign"
• Redundant pyloric channel mucosa
protruding into gastric antrum
31. US findings
• Thickened pylorus
Commonly accepted threshold values
• Single wall thickness of pylorus > 3 mm
• Pyloric channel length > 16 mm
• Pyloric diameter > 7 mm
• Exaggerated peristaltic waves
• Delayed gastric emptying of fluid into
duodenum
• Complications: Hypochloremic metabolic
alkalosis
32. US findings
• Pyloric volume >1.4 cm3
[maximum pyloric diameter]2 x pyloric length
4
• Most criteria independent of contracted or
relaxed state
• [Pyloric length (mm) + 3.64] x muscle thickness (mm) > 25
38. GASTRIC VOLVULUS
• Rotation all or part of stomach > 180
degrees, ± closed-loop obstruction,
possible strangulation
• It is the rotation and not the obstruction
which defines the presence of volvulus
39. • Organoaxial volvulus: Rotation around
longitudinal axis (most common)
• Around line extending from cardia to pylorus
• Stomach twists anteriorly or posteriorly
• Antrum moves inferior to superior
40. • Mesenteroaxial volvulus: Rotation about
mesenteric axis
• Axis running across stomach right angles to
lesser & greater curves
• Rotation right to left or left to right about
gastrohepatic omentum
• Mixed volvulus
• Combination of
OAV & MAV
41. Radiography
• Abdominal plain films; patient upright
• Double air-fluid level
• Large, distended stomach; spheric viscus
displaced upward to left
• Elevation of diaphragm
• Small bowel collapsed; paucity distal gas
• Intramural emphysema gastric wall
• Chest X-ray
• Intrathoracic up-side down stomach
• Retrocardiac fluid level
• 2 air-fluid interfaces different heights
• Simultaneous fluid levels above & below
diaphragm
42.
43.
44. Fluoroscopic Findings
• Massively distended stomach left upper
quadrant, may extending into chest
• Inversion of stomach
• Greater curvature above lesser
• Cardia & pylorus at same level
• Downward pointing pylorus & duodenum
• May see "beaking" at point of twist
• OAV: 2 points of twist; luminal obstruction
• Contrast in stomach may not pass beyond
pylorus
• MAV: Antrum & pylorus lie above gastric
fundus
46. CT Findings
• Not generally performed for GV
• CT appearance may be variable
• Depends on extent of gastric herniation,
points of torsion, position of stomach
• May be linear septum within gastric lumen
(area of torsion)
• Large hiatal hernia accompanied by
partial GV
• "Pseudothrombosis" of inferior vena cava
on CT
48. DUODENUM
Duodenal Obstruction
• Complete duodenal obstruction is seen
much more frequently than congenital
gastric obstruction.
• Vomiting is usually delayed until after
the first feeding but increases
progressively thereafter
49. Radiographic Appearance of
Duodenal Obstruction
Complete obstruction
Gasless abdomen
Gas in stomach and prox. duodenum
Gas distally if bifid common bile duct
Partial obstruction
Gastric distention
Distended small bowel
“Double bubble”
Scattered gas-filled bowel loops distally
Normal if vomiting decompressed stomach and
duodenum
53. Duodenal atresia
• Most important cause of complete
duodenal obstruction.
• Failure of recanalization of the
duodenum between approximately the
9th and 11th weeks of gestation
54.
55. Jejunal atresia
• Normal or near normal size colon
• Seen in jejunal and proximal ileal atresias
• Colon receives succus entericus from
remaining small bowel
62. Abnormal Gut Rotation
• Nonrotation
• When both limbs return to abdomen without further
rotation
• Small bowel on right and colon on left
• Wide mesentery – less risk of volvulus
• Gastroschisis; Omphalocele; Diaphragmatic Hernia
• Malrotation
• Duodenojejunal limb remains in nonrotation in the
right midabdomen
• Cecocolic limb in partial rotation in the midupper
abdomen fixed to abdominal wall by Ladds bands
63. Malrotation - Radiography
• X ray abdomen : less informative
• Abnormal configuration of gas in right
hypochondrium, the duodenal triangle suggests
diagnosis
• Volvulus :
• Corkscrew sign
• Tapering of beaking of the bowel in complete obstruction
• Malrotated bowel configuration
• Distal obstruction
• Closed loop syndrome features - thick walled
edematous loops with pneumatosis
• Gas less abdomen due to prolonged vomiting
64.
65.
66. • Upper GI series - Modality of choice
• Clearly abnormal position of
duodenum (81%)
Duodenum and Jejunum to right of spine
Corkscrew duodenum and jejunum
DJJ low and in midline
• Unusual abnormal position of
duedenum (16%)
DJJ over right pedicle
DJJ left of spine but low
Duodenal redundency to right of spine
Z shaped configuration of duodenum &
Jejunum
67.
68.
69. USG - Midgut volvulus
• Clockwise whirlpool sign
• Abnormal superior mesenteric vessels
• Inverted SMA/SMV relationship
• Solitary hyperdynamic pulsating SMA
• Truncated SMA
• Inapparent SMV
• Abnormal bowel
• Dilated duodenum proximal to obstruction
• Thickened wall of small bowel distal to
obstruction
• Dilated fluid filled loops of small bowel
• Ascites
70. CT
• SMV to the left of SMA in 80%
• Aplastic or hypoplastic uncinate process
of pancreas
• Chylous mesentric cyst (from interference
of lymphatic drainage)
• Midgut volvulus
• Whirlpool sign of twisted mesentary
• Bowel obstruction
• Free fluid / free gas in advanced cases
73. Angiography
• Barber pole sign – spiralling of SMA
• Tapering or abrupt termination of
mesentric vessels
• Mesentric vasoconstriction
• Prolonged contrast transit time
• Absent venous opacification
• Dilated tortures superior mesentric
vein.
74. INTUSSUSCEPTION
• Invagination of more proximal bowel
(the intussusceptum) into lumen of
more distal bowel (the intussuscipiens)
in a telescope-like manner
• Most common site:
• Terminal ileum/ileocecal valve
• 90% ileocolic
75. Radiography
• Soft tissue mass surrounded by a crescent
of gas
• Evidence of distal small bowel obstruction
• Absence of or decreased gas in the colon
• Pneumoperitoneum
• May be normal
• Left-side-down decubitus/prone views can be
helpful in showing lack of air-filled cecum
76.
77. Intussusception
• Meniscus sign
Produced by the rounded apex of the
intussusceptum protruding into the column
of contrast
• Coiled spring appearance
Edematous mucosal folds of the returning
limb of the intussusceptum are outlined by
contrast material in the lumen of the colon
84. MECKEL DIVERTICULUM
• Remnant of the omphalomesenteric duct
• Bleeding (when contain ectopic gastric mucosa)
• Intussusception
• Bowel obstruction
• Perforation
• Rule of 2's :
• 2% Incidence of general population
• 2 feet of ileocecal valve
• Before age 2 years
85. Radiography
• Right lower quadrant mass
• Displacement of bowel loops,
• Obstruction
• Enteroliths
• May be normal
87. Ultrasonographic Findings
• Heterogeneous echotexture mass in
RLQ, may mimic appendicitis
• Thick walled tubular structure or
hyperemic bowel loops in RLQ
• Inflamed Meckel diverticulum may
present as a cyst
88. CT Findings
• Findings very similar to appendicitis
• Thick walled blind ending structure near
cecum with surrounding inflammation
• If perforated may see abscess and free air
• CT is more accurate in diagnosing Meckel
diverticulum than arteriography when
presenting symptom is gastrointestinal
bleeding in pediatric patients
89. Nuclear Medicine Findings
Tc-99m pertechnetate scan
• The most specific test for Meckel diverticulum is the
Tc-99m pertechnetate scan: Accuracy -90%
• Pertechnetate accumulates in mucous cells when they
are in an acidic environment, in this case in ectopic
gastric mucosa
• The diverticulum typically does not communicate
with the bowel lumen, so the radiotracer does not
appear to move downstream in bowel unless there is
active bleeding
90.
91. MECONIUM PLUG
SYNDROME
• Small left colon syndrome.
• Transient functional obstruction of the
newborn colon
• Common cause of distal neonatal bowel
obstruction
92. Radiography
• Multiple dilated loops of bowel
• Cannot differentiate dilated large from
small bowel loops in neonates
• Findings nonspecific, cannot
differentiate from other causes of distal
bowel
93. Contrast enema
• R/S ratio usually> 1
• Descending and sigmoid colon small in
caliber
• Abrupt zone of caliber transition in region of
splenic flexure
• Filling defects within colon
• Ascending and transverse colon increased in
caliber
• Difficult to differentiate from long segment
Hirschsprung disease
• Enema often therapeutic; passage of
meconium plugs during or just after enema
94.
95. Small left colon syndrome
• Functional immaturity of colon
• Narrow caliber of the left colon.
• Abrupt transition at the splenic flexure.
• Multiple filling defects in the left colon
are due to meconium plugs
• These infants present at 1-2 days of age
with failure to pass meconium.
96.
97. MECONIUM ILEUS
• Neonatal obstruction of the distal ileum
due to abnormally thick, tenacious
meconium
• Meconium becomes inspissated and
obstructs the distal ileum and is usually
a manifestation of cystic fibrosis
• Presenting illness in approximately 15%
of CF patients
98. Radiography
• Difficult to distinguish neonatal large vs. small
bowel
• Uncomplicated Type
• Multiple dilated bowel loops
• Bubbly lucencies right lower quadrant
• Few air-fluid levels (sticky meconium)
• Complicated Type
• Soft tissue mass or gas less abdomen
• ± Intrauterine perforation and peritonitis
• Curvilinear calcifications on peritoneal surface or lining
pseudocyst
100. Contrast enema
• Smallest of microcolons
• Reflux contrast into terminal ileum
• Meconium pellets in terminal ileum; not
much in colon
• Can be therapeutic in uncomplicated
type
102. MECONIUM PERITONITIS
• Chemical peritonitis from in utero
bowel perforation and peritoneal
leakage of sterile meconium
• At least four types are recognised:
•Fibro-adhesive
•Cystic
•Generalised
•Healed
106. AN - USG
• Highly echogenic linear or clumped foci
(calcifcation )
• Snowstorm appearance
• Abdominal circumference may be increased
• Associated anomalies such as dilated fetal bowel
and/or meconium pseudocysts
• Meconium pseudocyst: Heterogeneous mass
with calcified wall
• Fetal ascites and/or polyhydramnios
107. NECROTIZING
ENTEROCOLITIS
• Idiopathic enterocolitis
• VLBW premature infants
• Combination of infection and ischemia
characterized by coagulative and
hemorrhagic necrosis
• Inflammation of portions of the small
and large intestine
108. Location
• Most common right colon and terminal
ileum
• Can occur anywhere in gastrointestinal
tract
109. Radiography
• Findings range from normal to suggestive
to diagnostic
• Normal
• Suggestive findings
• Asymmetric bowel dilation
• Featureless "unfolded" bowel loops
• Separation of bowel loops
• Fixed configuration of bowel loops over serial
films
114. The football sign / air dome sign
• Right upper quadrant
gas
• Rigler’s (double wall)
sign
• Ligament visualization
• Inverted V sign
• Triangular air
• The cupola sign
• Football or air dome
• Scrotal air
Definitive finding: Free intraperitoneal air
115. Bell classification
• Stage I: Early or suspected NEC
• Nonspecific
• Scalloping/separation/unfolding bowel loops
• Asymmetric bowel distention
• Stage II: Definite NEC
• Pneumatosis intestinalis: Mucosal, serosal; not always
correlating with clinical symptoms/signs
• Stage III:
• Advanced disease (perforation or impending
perforation)
• PVG, free intraperitoneal air, persistent loop sign,
ascites
116. Fluoroscopic Findings
• Enema contraindicated in presumed
acute NEC
• Mucosa permeable to water-soluble
contrast and excreted into kidneys
• Stricture:
• Single or multiple
• Small bowel or colon
• Chronic complication of NEC
118. Differential diagnosis
• In the correct clinical scenario the
presence of gas within bowel wall has
little differential.
•Pneumatosis coli
•Neonatal appendicitis
•Meconium ileus
•Hirschsprung disease
•Infectious enterocolitis
119. HIRSCHSPRUNG DISEASE
• Functional obstruction of the bowel due to
lack of intrinsic enteric ganglion cells
• Morphology
• Denervated colon is small, narrow, spasmodic
• Innervated more proximal bowel is dilated
• Affected portion always includes the anus and
variable length of Rectum
• Continuous disease
• No proximal without distal involvement
120. • Short segment disease : ~ 75% *
• Rectal and distal sigmoid colonic involvement only
• Long segment : ~ 15%
• Typically extends to splenic flexure / transverse colon
• Total colonic aganglionosis : 2 - 13%
• Zuezler-Wilson syndrome
• Occasional extension of aganglionosis into small
bowel
• Ultrashort segment disease
• 3 – 4 cm of internal anal sphincter only
• Controversial entity
121. Associations
• Isolated abnormality in 70% of cases
• Down syndrome : in ~ 10%
• Neurocristopathy syndromes
• Waardenburg-Shah syndrome
• Haddad syndrome
• MEN IIa
• other non-neurocristopathy syndromes
• Aarskog syndrome
• Bardet-Biedl syndrome
• Fryns syndrome
• Pallister-Hall syndrome
• Smith-Lemli-Opitz syndrome
123. Contrast enema
• Rectum smaller than sigmoid (R/S ratio < 1)
• Transition zone from abnormally small distal to
dilated proximal colon
• Fasciculations or sawtooth appearance of mucosa of
involved colon: Spasm
• Thickened, ulcerated colon in patients with
associated colitis
• Microcolon: Total colonic disease
124.
125.
126.
127. Differential diagnosis
• Functional megarectum
• Necrotising enterocolitis
• Microcolon : appears similar to long
segment / whole colon Hirschsprung
disease
128. Megacystis-microcolon-intestinal
hypoperistalsis syndrome
• The duodenum and proximal jejunum
are mildly dilated.
• Small bowel is dilated and shortened,
and the colon is a microcolon
• Abundance of ganglion cells in the
entire gastrointestinal tract.
• Megacystis and megaureters
129.
130. ANORECTAL
MALFORMATION
• Abnormal separation of genitourinary
system from hindgut
• Spectrum; true imperforate anus (thin
membrane) to atresia distal rectum
• Classification controversial
• Anatomic: Relation of rectal pouch to
pubococcygeal line
• Surgical: Prognostic and therapeutic, "Pena“
classification
131. • Low
• Usually visible perineal orifice; stenotic or
membrane
• No GU tract communication
• Intermediate
• Usually features of high lesion
• High
• Usually rectourinary fistula in males
• Usually rectovaginal or vestibular in females
• Possible vaginal, uterine, or bladder anomalies
132. PUBOCOCCYGEAL LINE:
• Line is drawn between upper and
middle third of pubis to lower border
of S5
• Bowel ends just above this line are
termed high malformation and below
one is termed low malformation.
133.
134. ISCHIAL LINE
• Line drawn below parallel to the
pubococcygeal line at the level of the ossified
ischial bone
• Corresponds to the most proximal level of
bulbous urethra
• Anomalies between this two lines are termed
intermediate
• If fistulas occur, they open in the bulbous
urethra in male or in to vestibule or lower part
of vagina in the female.
135. PIT LINE
• This line is parellal to the ischial line but
one to two centimetre caudal to it.
• This marks the posteroinferior part of
the bulbocavernous muscle.
• If bowel gas ended below this area
Called imperforate anal membrane or
low ARM
136. Radiography
• Distal bowel obstruction, intraluminal
calcification
• ± Gas in bladder in males, vagina in females
• Air in rectal pouch on prone cross table
lateral view: Inaccurate for level
• Bony landmark PCL
• "M" line: Horizontal to pelvis divides lower 1/3,
upper 2/3 ischium
• Low lesions appear high: Meconium-packed
pouch
• High lesions appear low: Straining, crying,
excessive distention pouch
140. Ultrasound
• Hypoechoic rectal pouch-perineal
distance
• < 10 mm: Low lesion;
• > 10-15 mm - high or intermediate
• Reliability similar to radiography with
similar inaccuracies
141. MR Findings
• Pelvic musculature, neorectum, and anal
sphincter position/integrity
• Normal to absent levator muscle
• Normal to absent anal sphincter complex
• Muscle complex malpositioned or atrophic
• Spine
• Tethered cord, spinal dysraphism, sacral
agenesis
142. Urinary tract anomalies associated with ARM
• Renal agenesis
• Renal ectopia
• Megaureter
• HN (PUJ obstruction)
• VUR
• PUV
• Epispadias/Hypo
• Prune belly syn
• VATER anomaly
Multiple Vertebral fusion abnormalities
Congenital heart disease (VSD)
Trache-oEsphageal fistula with oesophageal atresia
plus rib fusion abnormalities and duodenal atresia.
The gas is thought to have passed into the distal bowel by bypassing the duodenal atresia via the accessory pancreatic duct and into the ampulla.
Complete esophageal duplication in a 27-year-old man with a history of dysphagia and
choking. Esophagogram shows the duplicated esophagus (d) located posterior to the normal esophagus. (9)
Duplication cyst in a 2-year-old girl with recurrent episodes of vomiting. (a) Esophagogram shows extrinsic
compression of the left wall of the esophagus (arrows). (b) On a coronal T1-weighted MR image, a sharply defined
low-signal-intensity mass (arrows) is seen adjacent to the left side of the esophagus. The mass had very
high signal intensity on a T2-weighted MR image (not shown).
triple-bubble appearance
Corkscrew sign
Malrotation with midgut volvulus in an infant. Spot film from a single contrast barium study demonstrates a corkscrew appearance of the fourth portion of the duodenum and the proximal jejunum and an abnormal position of the duodenojejunal junction.
triple-bubble appearance
Corkscrew sign
Malrotation with midgut volvulus in an infant. Spot film from a single contrast barium study demonstrates a corkscrew appearance of the fourth portion of the duodenum and the proximal jejunum and an abnormal position of the duodenojejunal junction.