Q True in SMA syndrome
- Causes Medial Arcuate Ligament syndrome
- Causes nut cracker syndrome
- Low AM distance and Narrow AM angle <25 degree is sensitive finding
- It can be treated by releasing the DJ and keeping duodenum to the right of the artery
Q True in SMA syndrome
Q Engorged dilated Riolan arc vessel with retrograde flow suggests
a) SMA occlusion
b) IMA occlusion
c) Normal flow
d) Iliac artery occlusion
Q Meckel’s diverticulum true is
A. Mc congenital anomaly of the intestine
B. Always heterotopic mucosa
D. Located on mesenteric border
Q) Bowel segment showing best adaptation
Q) All are contraindication for strictureplasty in Crohn Disease except
a) Multiple stricture in short segment
b) Colonic stricture
c) Immediate recurrence with obstruction
Q Least useful investigation in a pt with recurrent LGI bleed, multiple upper and lower GI endoscopies negative
b) Double balloon enteroscopy
c) Capsule endoscopy
d) Push endoscopy
Free for all
Investigations in lower GI bleed should be specific and less time consuming
Small bowel enteroclysis, which uses a tube to infuse barium, methylcellulose, and air directly into the small bowel, yields better images than simple small bowel follow-through. Because the yield has been reported to be very low and the test is poorly tolerated, it is now rarely used.
Capsule endoscopy uses a small capsule with a video camera. capsule endoscopy is an excellent tool for the patient who is hemodynamically stable but continues to bleed, with reported success rates as high as 90% in identifying a small bowel pathology.
The hemodynamically stable patient should undergo small bowel enteroscopy. Usually performed with a pediatric colonoscope, it is referred to as push endoscopy. It can reach about 50 to 70 cm past the ligament of Treitz in most cases and permits endoscopic management of some lesions. Overall, push enteroscopy is successful in 40% of patients .
Double-balloon endoscopy is another technique gaining in popularity. Although technically difficult, this approach is capable of providing a complete examination of the small bowel. In expert hands, double-balloon enteroscopy can identify a bleeding source in 77% of cases with occult bleeding, with the yield increasing to over 85% if the endoscopy is per-formed within 1 month of an overt bleeding episode.The advantage of this technique is that as well as visualization, biopsies can be performed and therapeutic interventions undertaken.
To conclude investigations in lower GI bleed have to be specific and have high sensitivity also.