Small Bowel Duodenum Jejunum Ileum Large Intestine cecum.

Presentation on theme: "Small Bowel Duodenum Jejunum Ileum Large Intestine cecum."— Presentation transcript:

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2 Small Bowel Duodenum Jejunum Ileum Large Intestine cecum

3 Small intestine The small intestine is the portion of the digestive system most responsible for absorption of nutrients from food into the bloodstream. The pyloric sphincter governs the passage of partly digested food from the stomach into the duodenum. This short first portion of the small intestine is followed by the jejunum and the ileum. The ileocecal valve of the ileum passes digested material into the large intestine.

4 Superior (1st) part of duodenum
Descending (2nd) part of duodenum Horizontal (3rd) part of duodenum Duodenojejunal flexure SMA Ascending (4th) part of duodenum

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9 Autopsy-7M Life-4.5~5M Duoodenum Jejunum Ileum
Shortest，widest，25cm，c-shape Jejunum 2/5，coiled spring，feathery Ileum 3/5，smoother

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12 做SBS的目的，主要是要看整個小腸的形狀，結構有無異常功能

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15 Multiple diverticulum over jejunum
這個病人主要在jejunum的部位有明顯的憩室 Multiple diverticulum over jejunum

16 Diverticulum at the 2nd portions of the duodenum.
這個病人可以見到十二指腸在X光片下的投影為一C字型，而憩室主要在descending部分 Diverticulum at the 2nd portions of the duodenum.

17 Duodenal diverticulum, second portion
一樣在這個病人身上可見其憩室在十二指腸 Duodenal diverticulum, second portion

18 Edematous change of mucosal fold & wall thickness;
接下來為介紹一些腸阻塞的case 這個X光片上可以見到藥由胃→十二指腸→jejunum Edematous change of mucosal fold & wall thickness; Partial obstruction over ileum Poor peristasis of small bowel, consistent with adhesion.

19 Obstruction-case 1 但是其藥大部分都聚集在ileum地方，且ileum腸子的管徑變大，腸子黏膜皺折變的很明顯， 即是有obstruction現象

20 Obstruction-case 2 這個case一樣可以看到在jejunum地方，它腸子管徑變大 Disproportional dilatation of jejunum，suggest obstruction

21 The obstruction level should be around distal jejunum
而且在6小時時，其藥仍然未到大腸，so 可以判斷為腸阻塞病人 正常人做SBS時間大約在360分，即6小時時藥會到大腸 但是這個case看來，藥都還在jejunum The obstruction level should be around distal jejunum

22 而且在24hr時，藥才過一點點到colon，且廻腸的藥還很少

23 Obstruction-case 3 20157972 NG placed in duodenum
這個病人為有NG的case，在藥到十二指腸的C型時，可以看到它中間藥有明顯斷掉，有明顯的血管壓跡，所以可以懷疑可能為SMA異常 NG placed in duodenum

24 轉個角度看一下，一樣血管壓跡相當明顯 There is extrinsic compression at distal third portion of duodenum ，probable due to vascular indentation

25 可以看到腸子有被拉扯的感覺 所以比較不像黏連，較可能為惡性腫瘤 Multiple segmental narrowing with mucosal tethering of bowel loops and nodularity outline at ileum. Peritonea carcinomatosis is considered. The barium flow is partially obstructed，but still patent.

26 腸子被拉扯的更嚴重，故考慮為腫瘤可能性較大
After 6 hours，the barium flow passed through the ileum into the right side colon. The opacified right side colon is dilatated with compression to the descending portion of duodenum at hepatic flexure

27 Obstruction-case 4 這一樣是一個近端空腸阻塞的病人 Disproportional dilatation of small intestine, suggestive of intestinal obstruction, more dilated proximal jejunum is found The obstructive level may be at proximal jejunum Collapsed distal bowel loops without opacification by barium

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29 接下來為介紹mass effect腫瘤效應 這個病人在cecum處，有一明顯像tumor壓到的痕跡 Smooth margin filling defect in the cecum. D/D cecal tumor or postappendectomy change

30 Mass effect-case 2 這個病人在左上方處有一明顯density， 胃黏膜被往上頂，腸子被往下推 懷疑有一個mass Soft tissue mass over LUQ area with mass effect to stomach and bowel loops noted

31 Mass effect-case 3 這個X光可以看到它正常十二指腸黏膜看不到，且管徑有明顯狹窄現象 為十二指腸ca病人 An ovoid filling defect within the lumen of the 2nd portion of the duodenum; c/w duodenal tumor.

32 Mass effect-case 4 這個病人可以見到他十二指腸與空腸都廣大的膨脹 . Diffuse dilated duodenum and proximal jejunum

33 時間長一點再照，可以看到jejunum前端部分狹窄，呈一個鳥嘴(beak)形狀(左方這張)，經時間排空後， 就明顯看到有一個mass effect，造成beak形成，像jejunum ca Persistent, long segmental luminal narrowing at the proximal jejunum with "beak" appearance of the proximal small bowel, malignancy like jejunal Ca. is considered

34 Intestinal partial obstruction at jejunum, r/o adhesion.
1.Jejunum有管徑變大現象(左圖) 2.病人骨盆腔有開過刀，但藥雖流下來，卻不像在腸子內 Marked dilatation of small bowel loops (mainly are jejunum) with contrast medium stasis during the procedure. Intestinal partial obstruction at jejunum, r/o adhesion.

35 Fistula formation (vagina and ileum) at RLQ
1.病人藥未流到colon，但卻在rectum有藥溢出(左圖) 2.由右圖可見，原來是ileum與子宮有一個fistula ，所以藥從vagina流出 Fistula formation (vagina and ileum) at RLQ

36 接下來的這個病人可以看到在doudenum處 有一個像息肉狀的不正常顯影 疑似為duodenum ca A large intraluminal round filling defect in 2nd portion of the duodenum, R/O duodenal tumor or polyps. Multiple nodularities of the jejunum, highly suspecting multiple polyps.

37 這個病人的十二指腸球外側有一堆barium，可能為潰瘍導致十二指腸球破裂，造成十二指腸穿孔形成 Extravasation of the contrast material from duodenal bulb into a blind pouch in the right upper abdomen,perforation of duodenal bulb is considered Perforation in the duodenal bulb with a space of contrast pooling in the right upper abdomen.

38 轉個later view一樣可以見到藥明顯由bulb流出 Extravasation of the contrast material from duodenal bulb into a blind pouch in the right upper abdomen,perforation of duodenal bulb is considered Perforation in the duodenal bulb with a space of contrast pooling in the right upper abdomen.

39 Deformed duodenal bulb with a big ulcer.
接下來看到的是ulcer case Ulcer為一火山狀，且可以明顯看到它腸黏膜有腫脹，疑似發炎現象 Deformed duodenal bulb with a big ulcer.

40 Ulcer-case 2 在整個SBS檢查下，在左方這張X光可看到它胃黏膜與肌肉層處有一不正常鋇劑顯影 應該也是ulcer現象 A small ulcer at the lesser curvature of the mid gastric body.

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