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Intestinal diseases

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Such as

Intestinal ascariasis （ worm infestation） Hirschsprung disease （ megacolon） Congenital anorectal anomalies Crohn's disease (segmental enteritis) ulcerative colitis colonic carcinoma

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Intestinal ascariasis

Barrium study---- earthworm-like filling defect,in the center, a barium line which is parallel to the lumen can be seen.

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ascariasis

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ascariasis

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ascariasis

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Hirschsprung's disease is an abnormality in which

certain nerve fibers are absent in segments of the

bowel, resulting in severe bowel obstruction.

It was first identified in 1886 by a physician named

Harold Hirschsprung.

Hirschsprung disease or megacolon or aganglionosis of the colon

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Diagnosis-1

Hirschsprung's disease in the newborn must be distinguished from other causes of intestinal obstruction.

The diagnosis is suspected by the child's medical history and physical examination, especially the rectal exam.

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Diagnosis-2

The diagnosis is confirmed by a barium enema x ray, which shows a picture of the bowel. The x ray will indicate if a segment of bowel is constricted, causing dilation and obstruction.

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先天性巨结肠

Hirschsprung's disease

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congenital anal stenosis anal membrane not break imperforate anus Anus and anal canal are good ,but rectum

has a dead end

Congenital anorectal anomalies---4 types

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Take Photographs 20hours after be borned

Put a metal mark in the anal region, upside

down the baby for 1~2 min

eg: Congenital imperforate anus

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Congenital imperforate anus

Gas in the colon

Surface between fluid

and gas

Measure the length

between the dead end

and the mark

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Crohn's disease (segmental enteritis)

Crohn's disease is a type of inflammatory bowel disease (IBD), resulting in swelling and dysfunction of the intestinal tract.

Occurs in all age groups

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Sites

The inflammation of Crohn's disease most commonly affects the last part of the ileum, and often includes the large intestine (the colon).

However, inflammation may also occur in other areas of the gastrointestinal tract, affecting the mouth, esophagus, or stomach.

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Causes

The cause of Crohn's disease is unknown. No infectious agent (virus, bacteria, or fungi) has been identified as the cause of Crohn's disease.

Evidences show it’s a disorder of the immune system

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Symptoms

Diarrhea(腹泻 ), fever, abdominal pain, inability to eat, weight loss, and fatigue(疲劳 ).

severe pain that mimics appendicitis. Malnutrition serious complications, including obstruction,

abscess formation, and fistula formation

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X rays Techniques

Barium meal Barium enema. Barium helps to "light up" the intestine,

allowing more detail to be seen on the resulting x rays.

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X rays Diagnosis

Strictures of the intestinal canal Ulcers Mucosal abnormalites sinus tract or syrinx(瘘管 )

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Strictures

extremely variable in length. “the string sign”----Sometimes a loop of bowel is so

narrow, either from spasm in an extensively ulcerated loop of bowel or edema and fibrosis in the bowel wall, that its appearance has been called “the string sign”.

The bowel proximal to a stricture is often dilated.

When there is obvious disease in the terminal ileum, the cecum may be contracted.

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Ulcers

Ulcers are seen sometimes quite deep. Cobblestone appearance-fine ulceration

combined with mucosal edema.

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Mucosal abnormalities

the mucosal folds may become thickened ,distorted ,or even disappear owing to thickening of the bowel wall

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The string sign

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Cobblestone appearance

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Treatment

Treatments for Crohn's disease try to reduce the underlying inflammation, the resulting malabsorption/malnutrition, the uncomfortable symptoms of crampy abdominal pain and diarrhea, and the possible complications (obstructions, abscesses, and fistulas).

Inflammation can be treated with a drug called sulfasalazine(柳氮磺吡啶 ).

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Prognosis

Crohn's disease is a life-long illness. The severity of the disease can vary.

Well over 60% of all patients with Crohn's disease will require surgery, and about half of these patients will require more than one operation over time. About 5-10% of all Crohn's patients will die of their disease, primarily due to massive infection.

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Ulcerative colitis

Ulcerative colitis is a inflammatory bowel disease of unknown origin belonging to the same group of chronic inflammatory bowel disease (IBD) as Crohn’s disease (CD).

The prevalence of the disease is estimated at about 6-8 cases per 100,000 population with an equal distribution between men and women.

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Causes

There is a possible genetic aetiology but autoimmune mechanisms and "psychological" factors also play an aetiological role.

Extraintestinal manifestations such as arthritis and cholangitis( 胆管炎 ) are frequently associated with ulcerative colitis (UC).

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Sites

In ulcerative colitis, the inflammation affects the lining of the rectum and large intestine.

It is thought that the inflammation begins in the sigmoid colon.

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UC VS CD

Ulcerative colitis differs from Crohn's disease, which is a form of IBD that affects both the small and large intestines.

The inflammation of ulcerative colitis occurs only in the lining of the intestine (unlike Crohn's disease which affects all of the layers of the intestinal wall).

Like Crohn's disease, ulcerative colitis occurs in all age groups, with the most common age of diagnosis being 15-35 years of age.

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Symptoms

Abdominal cramping(痉挛 ,绞痛 ) and pain Blood and pus(脓液 ) in the stools(粪便 )

Diarrhea, fever, and weight loss. diarrhea -> dehydration -> low blood

pressure, fast heart rate, and dizziness(眩晕 ). Perforation of the intestine

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X-ray examinations

X-ray examinations requiring the use of barium should be delayed until treatment has begun.

Because of the risk of intestinal perforation in ulcerative colitis, most doctors begin treatment before stressing the wall of the intestine with the barium solution.

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X rays Diagnosis

Widespread ulceration — The cardinal (main) sign; The ulcers are usually shallow but in severe cases may be quite deep.

Loss of the haustra( 袋 ) in the affected portions of the colon — In all but the milder cases

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X rays Diagnosis

Rigid tube —owing to narrowing and shortening of the colon

Pseudopolyps—small filling defects projecting into the lumen of the bowel formed by swollen(肿胀 ) mucosa

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Ulcerative colitis

Barium enema, revealing numerous superficial and deep ulcerations of the rectosigmoid, visible as barium outpouchings of various size and shape.

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Ulcerative colitis

Ulcerative colitis, pseudopolyps. Barium double contrast enema. There are several sessile and pedunculated polyps (arrows) and an absence of normal mucosal pattern.

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Ulcerative colitis

Chronic stage. Barium double contrast

enema demonstrates a global retraction of the whole colon with reduction of the lumen and decreased prominence(隆

凸 ) of the hepatic and the splenic flexure.

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Ulcerative colitis

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Ulcerative colitis

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Ulcerative colitis

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Treatment

Inflammation can be treated with a drug called sulfasalazine.

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Prognosis

The rate of remission of ulcerative colitis (after a first attack) is nearly 90%.

Those individuals whose colitis is confined primarily to the left side of the large intestine have the best prognosis.

Those individuals with extensive colitis, involving most or all of the large intestine, have a much poorer prognosis.

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Colorectal carcinoma/ cancers

Colorectal carcinoma is a malignant tumor arising from the colorectal epithelium and accounting for two-thirds of all gastrointestinal malignant tumors

The large majority of colorectal carcinomas are adenocarcinomas.

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Causes

Many colorectal cancers are thought to arise from adenomatous polyps in the colon.

These mushroom-like growths are usually benign, but some may develop into cancer over time.

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Presentations

Change in bowel habits change in frequency (constipation and/or diarrhea), change in the quality of stools change in consistency of stools Bloody stools or rectal bleeding Stools with mucus Tarry(柏油样 ) stools (melena) (more likely related to upper

gastrointestinal eg stomach or duodenal disease) Feeling of incomplete defecation(排便 ) (tenesmus 里急后重 )

(usually associated with rectal cancer) Reduction in diameter of feces Bowel obstruction (rare)

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Radiology

Polypoid carcinomas Annular tumors

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plain films

very rarely fine stippled calcifications(斑点状钙化 ) either in the tumor itself or in liver and lymph node metastasis

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Barium contrast studies- polypoid carcinomas

a lobulated filling defect of variable size with a contour deformity along one margin of the bowel .

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Barium contrast studies- Annular tumors

Deformation of both margins with lumen narrowing

There is an abrupt transition(急剧转变 ) between the tumor, where the mucosa is no longer visible, and the normal aspect of the adjacent mucosa. This leads to a typical appearance of an "apple core" or an overhanging edge, called "the tumor shoulder".

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Carcinoma of the transverse colon. Double contrast barium study, demonstrates a lacunar filling defect along the cranial border (arrow) of the right portion of the transverse colon, extending over a distance of about 3 cm.

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Rectal carcinoma Barium study. There is an annular tumor with ulcerated surface in the distal portion of the rectum. Note the abrupt transition between the narrowed tumoral segment and the normal proximal and distal rectum.

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typical appearance of an "apple core"

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colon carcinoma

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colon carcinoma

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Colonic polyposis

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Colonic polyposis

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Diverticulum of the colon

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Diverticulum of the colon

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Bowel obstruction

Bowel obstruction is a failure of onward passage of intestinal content due to mechanical obstruction.

In children, the site of the obstruction is almost always in the small bowel.

The symptoms are those of bile stained vomiting, abdominal distension, the extent of which depends on the level of the obstruction, and absence of bowel gas distal to the level of the obstruction. The child frequently also presents with failure of opening of the bowels.

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Radiology

The typical pattern of a bowel obstruction is that of distended loops of bowel proximal to the obstruction, absence of gas distally and multiple short fluid levels, often referred to as a ladder pattern.

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Supine(仰卧 ) abdominal radiograph showing small bowel obstruction and multiple distended small bowel loops and absent colonic gas.

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ladder pattern