消化系統(tǒng)：讀片

消化系統(tǒng)胃腸鋇餐檢查正常表現(xiàn)胃腸鋇餐檢查正常表現(xiàn)鋇劑灌腸檢查正常表現(xiàn)鋇劑灌腸檢查正常表現(xiàn)小腸導(dǎo)管灌腸正常表現(xiàn)小腸導(dǎo)管灌腸正常表現(xiàn)CT小腸造影DSA檢查腸梗阻分型機(jī)械性：單純性、絞窄性動(dòng)力性：麻痹型、痙攣性血運(yùn)性：部位分型（小腸）：高位（十二指腸、空腸上段）低位（空腸下段及回腸）SmallBowelObstructionCriteriaforSBOHowSevereIstheObstructionWhereIstheTransitionPointWhatIstheCauseoftheObstructionIstheSBOSimpleorComplicatedclosed-loopsmall-bowelobstructionnosmall-bowelobstructionSupineuprightCTcriteriaforSBOpresenceofdilatedsmallbowelloops(diameter>2.5cmfromouterwalltoouterwall)proximallytonormal-caliberorcollapsedloopsdistallyHowSevereIstheObstructionthereisa50%differenceincaliberbetweentheproximaldilatedbowelandthedistalcollapsedbowelthesmallbowelfecesinthedilatedsmallbowelNocontrastmaterialpassthroughthetransitionpointintothecollapseddistalbowel完全性腸梗阻WhereIstheTransitionPoint

梗阻點(diǎn)acaliberchangebetweenthedilatedproximalandcollapseddistalsmallbowelloopspresenceofthesmallbowelfecessignWhatIstheCauseoftheObstruction

梗阻原因AruleofthumbnevertoforgetisthattheanswerisalmostalwaysinthetransitionpointMostintrinsicbowellesionsareseenatthetransitionpointandmanifestaslocalizedmuralthickeningMostintraluminalcausesmanifestasendoluminal“foreignobjects”withimagingcharacteristicsdifferentfromthoseoftheremainingentericcontentMostextrinsiccausesareseenadjacenttothetransitionpointandusuallyhaveassociatedextraintestinalmanifestations

CauseoftheObstructionHerniasAdhesions

CrohndiseaseMalignancySBOsecondarytoaninguinalherniaSBOsecondarytotheacutepresentationofCrohndiseaseSBOsecondarytoadhesions男性，52歲，腹部手術(shù)后2年，腹痛3天CT平掃降結(jié)腸腫瘤合并腸梗阻CT增強(qiáng)strangulationcausedbyinternalherniaCT平掃腸套疊

Targetsign

meniscussign腸套疊鋇劑灌腸復(fù)位SBOcausedbyintussusceptionandanadhesivebandAirenematherapy

atthebeginningofanairenemastudyaftercompletereductionClosed-loopSBOinapatientwithintestinaltorsionSimpleobstruction

單純性腸梗阻平片階梯狀液平大跨度腸袢魚肋征碘水造影不完全：3小時(shí)以內(nèi)到達(dá)梗阻點(diǎn)且不能通過完全性：6小時(shí)不能通過梗阻點(diǎn)StrangulatedObstruction

絞窄性腸梗阻平片假腫瘤征咖啡豆小跨度腸袢：“8”字形、花瓣?duì)睢⑾憬稜?、U形orC-形，鳥嘴征碘水造影不完全：3小時(shí)以內(nèi)到達(dá)梗阻點(diǎn)且不能通過完全性：6小時(shí)不能通過梗阻點(diǎn)定義：發(fā)生腸缺血的閉袢性腸梗阻Lackofwallenhancement、asymmetricenhancementorevendelayedenhancementLocalizedfluidandhemorrhageinthemesenteryStrangulatedSBO

絞窄性腸梗阻CT特異性表現(xiàn)ThickeningandincreasedattenuationoftheaffectedbowelwallAhaloor“targetsign”

Pneumatosis

intestinalisGasintheportalveinStrangulatedSBO

絞窄性腸梗阻CT非特異性表現(xiàn)StrangulatedSBO闌尾穿孔、腹膜炎51-year-oldwomanwithperforatedgastriculcer下列穿孔膈下可無游離氣體間接征象腹腔脂肪模糊少許滲出性改變、積液其他小腸、闌尾穿孔（正常時(shí)一般無氣體）胃后壁潰瘍穿孔腹膜間位或腹膜后位空腔臟器向腹膜后間隙穿孔（十二指腸、乙狀結(jié)腸等）消化道出血潰瘍性出血55-74%靜脈曲張5-14%撕裂傷2-7%血管畸形2-3%腫瘤2-5%胃間質(zhì)瘤侵犯肝臟消化道活動(dòng)性出血DSA的不足出血量>1mL/min

有創(chuàng)傷性、耗時(shí)、需要一定的專業(yè)技能血管開口、分支變異可致陰性結(jié)果

難以判定靜脈來源所致的病變

平掃增強(qiáng)CTA（MIP)小腸血管畸形左腎包膜下血腫食管平滑肌瘤食管癌食管癌varices

varicoid

carcinoma

downhillesophagealvarices食道靜脈曲張賁門失遲緩癥achalasiaearlygastriccarcinomaMalignantulcerin32-yearoldwoman潰瘍型胃癌胃癌胃充盈不佳出現(xiàn)的假象胃壁增厚？胃良性潰瘍ulceroftheduodenalbulb良惡性潰瘍的鑒別潰瘍本身鄰近胃輪廓線粘膜糾集周圍粘膜面良性潰瘍小彎多見均勻柔軟自遠(yuǎn)而近逐漸變細(xì)不中斷炎性結(jié)節(jié)較小惡性潰瘍賁門、大彎寬度不均伴僵直粗細(xì)不均伴中斷癌結(jié)節(jié)，較大carcinomaofthemajorduodenalpapillaCrohn’sdiseaseCobblestoneappearanceCrohn’sdiseaseCrohn’sdiseasesmallbowellymphomaaden