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：?jiǎn)渭冃浴⒔g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(yú)肋征碘水造影不完全：3小時(shí)以?xún)?nèi)到達(dá)梗阻點(diǎn)且不能通過(guò)完全性：6小時(shí)不能通過(guò)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)?、香蕉狀、U形orC-形，鳥(niǎo)嘴征碘水造影不完全：3小時(shí)以?xún)?nèi)到達(dá)梗阻點(diǎn)且不能通過(guò)完全性：6小時(shí)不能通過(guò)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(wú)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(wú)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(zhuān)業(yè)技能血管開(kāi)口、分支變異可致陰性結(jié)果

難以判定靜脈來(lái)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(mén)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(xiàn)粘膜糾集周?chē)衬っ媪夹詽冃澏嘁?jiàn)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(mén)、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