消化系统：读片

消化系统胃肠钡餐检查正常表现胃肠钡餐检查正常表现钡剂灌肠检查正常表现钡剂灌肠检查正常表现小肠导管灌肠正常表现小肠导管灌肠正常表现CT小肠造影DSA检查肠梗阻分型机械性：单纯性、绞窄性动力性：麻痹型、痉挛性血运性：部位分型（小肠）：高位（十二指肠、空肠上段）低位（空肠下段及回肠）SmallBowelObstructionCriteriaforSBOHowSevereIstheObstructionWhereIstheTransitionPointWhatIstheCauseoftheObstructionIstheSBOSimpleorComplicatedclosed-loopsmall-bowelobstructionnosmall-bowelobstructionSupineuprightCTcriteriaforSBOpresenceofdilatedsmallbowelloops(diameter>2.5cmfromouterwalltoouterwall)proximallytonormal-caliberorcollapsedloopsdistallyHowSevereIstheObstructionthereisa50%differenceincaliberbetweentheproximaldilatedbowelandthedistalcollapsedbowelthesmallbowelfecesinthedilatedsmallbowelNocontrastmaterialpassthroughthetransitionpointintothecollapseddistalbowel完全性肠梗阻WhereIstheTransitionPoint

梗阻点acaliberchangebetweenthedilatedproximalandcollapseddistalsmallbowelloopspresenceofthesmallbowelfecessignWhatIstheCauseoftheObstruction

梗阻原因AruleofthumbnevertoforgetisthattheanswerisalmostalwaysinthetransitionpointMostintrinsicbowellesionsareseenatthetransitionpointandmanifestaslocalizedmuralthickeningMostintraluminalcausesmanifestasendoluminal“foreignobjects”withimagingcharacteristicsdifferentfromthoseoftheremainingentericcontentMostextrinsiccausesareseenadjacenttothetransitionpointandusuallyhaveassociatedextraintestinalmanifestations

CauseoftheObstructionHerniasAdhesions

CrohndiseaseMalignancySBOsecondarytoaninguinalherniaSBOsecondarytotheacutepresentationofCrohndiseaseSBOsecondarytoadhesions男性，52岁，腹部手术后2年，腹痛3天CT平扫降结肠肿瘤合并肠梗阻CT增强strangulationcausedbyinternalherniaCT平扫肠套叠

Targetsign

meniscussign肠套叠钡剂灌肠复位SBOcausedbyintussusceptionandanadhesivebandAirenematherapy

atthebeginningofanairenemastudyaftercompletereductionClosed-loopSBOinapatientwithintestinaltorsionSimpleobstruction

单纯性肠梗阻平片阶梯状液平大跨度肠袢鱼肋征碘水造影不完全：3小时以内到达梗阻点且不能通过完全性：6小时不能通过梗阻点StrangulatedObstruction

绞窄性肠梗阻平片假肿瘤征咖啡豆小跨度肠袢：“8”字形、花瓣状、香蕉状、U形orC-形，鸟嘴征碘水造影不完全：3小时以内到达梗阻点且不能通过完全性：6小时不能通过梗阻点定义：发生肠缺血的闭袢性肠梗阻Lackofwallenhancement、asymmetricenhancementorevendelayedenhancementLocalizedfluidandhemorrhageinthemesenteryStrangulatedSBO

绞窄性肠梗阻CT特异性表现ThickeningandincreasedattenuationoftheaffectedbowelwallAhaloor“targetsign”

Pneumatosis

intestinalisGasintheportalveinStrangulatedSBO

绞窄性肠梗阻CT非特异性表现StrangulatedSBO阑尾穿孔、腹膜炎51-year-oldwomanwithperforatedgastriculcer下列穿孔膈下可无游离气体间接征象腹腔脂肪模糊少许渗出性改变、积液其他小肠、阑尾穿孔（正常时一般无气体）胃后壁溃疡穿孔腹膜间位或腹膜后位空腔脏器向腹膜后间隙穿孔（十二指肠、乙状结肠等）消化道出血溃疡性出血55-74%静脉曲张5-14%撕裂伤2-7%血管畸形2-3%肿瘤2-5%胃间质瘤侵犯肝脏消化道活动性出血DSA的不足出血量>1mL/min

有创伤性、耗时、需要一定的专业技能血管开口、分支变异可致阴性结果

难以判定静脉来源所致的病变

平扫增强CTA（MIP)小肠血管畸形左肾包膜下血肿食管平滑肌瘤食管癌食管癌varices

varicoid

carcinoma

downhillesophagealvarices食道静脉曲张贲门失迟缓症achalasiaearlygastriccarcinomaMalignantulcerin32-yearoldwoman溃疡型胃癌胃癌胃充盈不佳出现的假象胃壁增厚？胃良性溃疡ulceroftheduodenalbulb良恶性溃疡的鉴别溃疡本身邻近胃轮廓线粘膜纠集周围粘膜面良性溃疡小弯多见均匀柔软自远而近逐渐变细不中断炎性结节较小恶性溃疡贲门、大弯宽度不均伴僵直粗细不均伴中断癌结节，较大carcinomaofthemajorduodenalpapillaCrohn’sdiseaseCobblestoneappearanceCrohn’sdiseaseCrohn’sdiseasesmallbowellymphomaaden