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SMALL BOWEL
Normal Small Bowel
Submucosal Infiltration
\u2022
Edema
\u2022
Inflammatory exudates
\u2022
Blood
\u2022
Lymph tissue
\u2022
Tumor
Two patterns
\u2022
depends upon the amount of submucosal
infiltration
o
small amount = \u201cstack of coins\u201d
\ue000
little separation of the
normal folds
o
large amount = \u201cpicket fence\u201d
\ue000
greater separation of the
normal folds
Stack of Coins
Picket Fence
Sprue
\u2022
Celiac disease of the children
\u2022
Non-tropical sprue
o
Improve on gluten free diet
\u2022
Tropical sprue
o
Improves with antibiotic and folic
acid
X-ray Findings
\u2022
Hallmark features
o
Dilatation
o
Dilution- jejunum
\u2022
Segmentation \u2013 masses of barium
separated from the adjacent clumps
\u2022

Fragmentation \u2013 exaggerated example of
irregular stippling of residual barium in the
proximal bowel

Non-infiltrated (Stack of Coins)
Dilatation
Dilution
No Dilution
Sprue
Scleroderma
Infiltrated (Picket Fence)
+/- Dilated
Non-dilated
Whipple\u2019s Disease
(nodularity)

Amyloid
Edema
Ischemia
Hemorrhage
Radiation
Lymphoma

X-ray Features
\u2022
Intusussception
\u2022
Increase risk of carcinoma and lymphoma
\u2022
Moulage sign
o
caused by dilated loops with
effaced folds
o
Looking like tube into which wax
has been poured
Dilatation + Dilution
Intusussception
Moulage Sign
Scleroderma
\u2022
Affects: esophagus, small bowel and colon
\u2022
Atrophy of the muscular layer and
replacement of fibrous tissue
\u2022
Associated with malabsorption
X-Ray features
\u2022
Entire small bowel is usually dilated
\u2022
\u201chide-bound appearance\u201d
\u2022
Close approximation of the valvulae
\u2022
Does not have increase secretions
\u2022
May be associated with pneumatosis
intestinalis
\u201cHide-Bound appearance\u201d
Scleroderma
Whipple\u2019s Disease
\u2022
Very rare disease
\u2022
Glycoprotein in lamina propria of small
bowel
o
Sudan-negative
o
PAS-negative
o
Gram (+) rods are also present
\u2022
Clinically
o
Abdominal pain, diarrhea, weight
loss
\u2022
Treated with long term antibiotics
X-ray Features
\u2022
Hallmarks
o
Nodules
o
Picket fence(markedly thickened
mucosal wall)
\u2022
Small bowel may or may not be dilated
\u2022
Affects jejunum mostly
Amyloidosis
\u2022
RARe
\u2022
GI involvement is common
\u2022
Associated with malabsorption
\u2022
Radiologic features
o
Picket fence \u2013 markedly thickening
of the valvulae
o
No dilation or dilution
o
Affects the entire small bowel
Hypoproteinemia
\u2022
Resulting from liver or kidney disease
\u2022
Usually asymptomatic from intestinal
edema
\u2022
X-ray findings
o
Changes are present throughout
the small bowel
o
Loops are separated due to edema
of walls
o
Folds are quite thick (picket fence)
Ishemic Bowel Disease
\u2022
Thickening of the wall due to edema and
hemorrhage
\u2022

Localized perforation can produce: air in
bowel wall and air in portal venous
system.

X-ray Findings
\u2022
Spasm and irritability
\u2022
Narrowed lumen
\u2022
Thickened folds \u2013 \u201cthumb printing\u201d
\u2022
Healing may result in stricture formation
Ischemic Bowel Disease
Intramural Bleeding
\u2022
Suggestive if there is a duodenal
obstruction secondary to trauma
\u2022
Localized lesion occur with trauma
\u2022
Diffuse lesion seen with anticoagulants
of 00

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