Questions on Small Intestine
Q31 True in SMA syndrome
a) Causes Medial Arcuate Ligament syndrome
b) Causes nut cracker syndrome
c) Low AM distance and Narrow AM angle <25 degree is sensitive finding
d) It can be treated by releasing the DJ and keeping duodenum to the right of the artery
Q 32) All are findings in acute mesenteric ischemia findings except?
a) Slow filling intramural vein
b) Spasm of arterial arcade / distal vessels
c) String of sausages/beaded appearance
d) Dilated and ring enhancement of SMV in CT
Q33. Least common complication of Meckel's diverticulum (NEET 2018)
Angle less than 10 degree is sensitive.
SMAS typically is due to loss of the mesenteric fat pad
- Strong’s procedure: Where the duodenum is re-positioned to the right of the superior mesenteric artery
- Gastrojejunostomy: Where the jejune (the part of the intestines that continues with the duodenum) is joined directly to the stomach
- Duodenojejunostomy with or without division or resection of the fourth part of the duodenum.
32) c Its string of lakes
- Acute mesenteric ischemia encompasses
- Acute embolism - Plain films (thumb printing, free air)
- NOMI - diagnostic arteriography is the only way to demonstrate the small vessel mesenteric arterial spasm
Classic images include Narrowing of multiple SMA branches, impaired filling of intramural vessels, and “string of lakes” appearance of runoff vessels.
- SMV thrombosis - CT shows a dilated superior mesenteric vein (SMV) . The vessel will not
opacify with contrast. Dilation of the vein is seen with ring enhancement of the vein.
33) c NeoplasmThe most common clinical presentation of Meckel’s diverticulum is gastrointestinal bleeding, which occurs in 25% to 50% of patients who present with complications
intestinal obstruction occur as a result of a volvulus of the small bowel around a diverticulum associated with a fibrotic band attached to the abdominal wall, intussusception, or, rarely, incarceration of the diverticulum in an inguinal hernia (Littre hernia)
Diverticulitis accounts for 10% to 20% of symptomatic presentations.
Neoplasms can also occur in a Meckel’s diverticulum, with NET as the most common malignant neoplasm (77%). Other histologic types include adenocarcinoma (11%), which generally originates from the gastric mucosa, and GIST (10%) and lymphoma (1%).