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80 Cards in this Set
- Front
- Back
What needs to be included on an esophogram x-ray?
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GI structures of interest & cortical outline of the bony anatomy
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RAO Esophogram
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- Esophagus should be between the spine & heart shadow
- CR 3" lateral of spinous process, 2" below jugular notch |
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How should the lower arm be positioned on a lateral esophogram x-ray?
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90 degrees to the body (similar to Swimmer's)
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If the patient's elevated side is rotated posteriorly on a lateral esophogram...
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Posterior ribs will have more than 1/2" between them
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If the patient's elevated side is rotated anteriorly on a lateral esophogram...
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Posterior ribs are superimposed
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What kVp is usually used for a single contrast UGI?
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> 100 kVp
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What kVp is usually used for a double contrast UGI?
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80-90 kVp
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Patient Prep for UGI
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NPO after midnight (or 8 hours), no gum or tobacco
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RAO UGI
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- air in fundus for double contrast
- barium in pylorus, duodenal bulb, & descending duodenum |
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Normal Sthenic RAO Rotation
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45 degrees
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Normal Hypersthenic RAO Rotation
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As much as 70 degrees
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Normal Asthenic RAO Rotation
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As little as 40 degrees
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What should be seen on RAO UGI?
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- duodenal bulb & descending duodenum in profile
- long axis of stomach is foreshortened w/ closed lesser curvature - pylorus centered, entire stomach & duodenal loop included |
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What should be seen on a hypersthenic right lateral UGI?
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Same things as seen on an RAO UGI
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What should be seen on an asthenic right lateral UGI?
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- duodenal bulb & descending duodenum in profile
- long axis of stomach is not foreshortened, lesser curvature open |
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What should be seen on a LPO UGI?
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- pylorus centered
- stomach & duodenal loop included - air in pylorus, duodenal bulb & descending duodenum - barium in fundus - exactly opposite from RAO |
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Hypersthenic LPO UGI
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- 60 degree rotation
- PYLORUS OVER THE SPINE |
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Sthenic LPO UGI
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- 45 degree rotation
- vertebrae are demonstrated with little if any pyloric superimposition |
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Asthenic LPO UGI
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- 30 degree rotation
- little pyloric superimposition |
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Where is the stomach in a sthenic AP UGI?
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Almost vertical to pyloric section
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Where is the stomach in a sthenic AP UGI?
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Nearly horizontal to pyloric section
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What should be seen on a small intestine AP?
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- spinous processes in middle of image
- no rotation as shown by spine & pelvis |
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How do you know when a small bowel study is finished?
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Barium in the cecum
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Tracheoesophageal Fistula
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- congenital: results from failure of esophagus to completely separate from trachea
- acquired: 50% due to malignancy in mediastinum (80% die within 3 months) - contrast through feeding tube goes into trachea |
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Esophagitis
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- result of GERD, infection, injury from chemical or radiation, medication
- burning chest pain - can cause superficial ulcerations, dilated esophagus, loss of peristalsis |
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Esophageal Reflux
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- lower esophageal sphincter fails to block gastric acid from entering esophagus
- can erode esophagus if untreated |
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Barrett's Esophagus
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- severe reflux that destroys normal squamous lining & replaces it w/ columnar epithelium
- tissue looks ragged - may have hiatal hernia below ulceration |
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Esophageal Cancer
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- difficulty in swallowing over age 40
- symptoms don't appear until late - ulceration of esophageal wall (irregular), annular constrictions - more men than women - Shelf Sign: looks like the esophagus is missing a section |
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Esophageal Diverticulum
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- common
- contains all layers (traction or true diverticula [lower 1/3 of esophagus]) - only mucosa & submucosa herniating through muscular layer (pulsion or false diverticula [middle 1/3 of esophagus]) |
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Zenker's Diverticulum
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- posterior wall of upper cervical esophagus
- may be large enough to block lumen - infection of mediastinal lymph nodes cause adhesions which causes traction diverticulum |
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Esophageal Varices
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- dilated veins due to increased pressure in portal venous system (from cirrhosis of liver)
- blood flow through liver to inferior vena cava is inhibited causing it to go through veins in stomach & esophagus - have wavy borders, thickened folds; looks like rosary beads |
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Hiatal Hernia
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- happens in 50% of population
- small ones only appear when pressure is applied, large ones may cause much of stomach to be above diaphragm - may cause reflux |
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Schatzki's Ring
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- gastroesophageal junction above diaphragm
- result of sliding hiatal hernia - can see when the patient is in Trendelenburg during UGI - symptoms: heartburn, dysphasia |
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Rolling/Paraesophageal Hernia
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- stomach protrudes through another space close to hiatus
- gastroesophageal junction still in normal place |
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Achalasia
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- obstruction of distal esophagus w/ proximal dilation caused by incomplete relaxation of esophageal sphincter
- meds to relax sphincter are taken before meals - esophagus just seems to stop |
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Esophageal Tear
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- caused by esophagitis, neoplasm, ulcer, or external trauma
- symptoms: severe vomiting - large tear can cause free air in mediastinum |
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Corkscrew Esophagus
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- asynchrony of peristalsis (tertiary contractions)
- happens in elderly patients |
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Leiomyomata
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- benign neoplasm
- intraluminal polypoid defect w/ smooth narrowing of lumen |
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Peptic Ulcer
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- caused by inflammation of stomach & duodenum from acid & pepsin in stomach
- most frequently seen = lesser curvature - duodenal ulcer is most common (95% in duodenal bulb) |
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Stomach Cancer
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- infiltrating carcinoma causes narrowing of pyloric canal (most are adenomas)
- as tumor advances towards fundus, stomach becomes narrower & stiffer - survival rate = 10% - high in Japan, Chile, & Eastern Europe - sign -- absence of hydrochloric acid (achlorhydria) |
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Pyloric Stenosis
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- congential abnormality
- STRING SIGN: narrowing of lumen of pylorus caused by hypertrophy of muscle (stomach becomes distended) - symptom: projectile vomiting after feeding 2-4 weeks after birth |
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Duodenal Diverticula
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- incidental findings in 1-5% of UGIs
- "BAYONET" STOMACH - small outpouching of bowel lumen filled with contrast around the junction of 1st & 2nd portions of duodenum |
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Menetrier's Disease
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- giant hypertrophic gastritis (giant folds of tissues within stomach)
- rare chronic disease seen in men aged 30-60 - symptoms: pain, loss of appetite, vomiting w/ blood, ulcer-like pain after eating |
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Bezoar
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- foreign body reaction
- Phytobezoar: vegetable material - Trichobezoar: hair & fingernails |
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Regional Enteritis
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- chronic inflammatory disorder (unknown cause)
- most common area: terminal ileum - young adults most common (stress & emotional upsets related to onset or relapse) - *cobblestone pattern* |
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Crohn's Disease (Regional Enteritis)
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- irregular thickening of mucosal folds caused by submucosal inflammation & edema
- transverse & longitudinal ulcerations separate islands of thickened mucosa - may have normal sections of bowel in between inflamed sections |
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Celiac Disease
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- genetic disease caused by gluten
- damages small intestine - barium looks clumped together & broken up |
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Meckel's Diverticulum
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- found in ileum
- rounded persistent yolk sac - rapidly empties so it's difficult to image - shown best in nuclear med |
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What filters the blood in a nephron?
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Glomerulus
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Where are the ureters located when looking laterally?
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Medially between kidney & spine
Enter bladder posteriorly & laterally |
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How much urine can the bladder hold?
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800 mL
"Need to go" when there's 300 mL |
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What will be seen on a 5 min KUB film of an IVP?
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Kidneys, most of ureters, & contrast starting to fill bladder
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What does a retrograde IVP show?
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The form of the kidneys, not the function
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Renal Agenesis
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- only 1 kidney
- congenital |
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Hypoplastic Kidney
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- smaller than normal, but not atrophic
- still functions properly |
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Ectopic Kidney
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- left kidney low in pelvis
- renal ectopia (misplaced kidney) - crossed ectopic kidneys (1 kidney is lower, & fused w/ lower pole of other kidney) |
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Horseshoe Kidney
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- congenital fusion anomaly
- both kidneys malrotated, lower poles joined by a band of normal parenchyma - renal pelvis may be large & flabby; ureters anterior not medial |
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Bifid Collecting System
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Multiple ureters and/or kidneys (no symptoms)
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Ureterocele
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Cystic dilation of distal ureter at or near insertion into bladder
Cobra head sign |
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Bright's Disease (Glomerulonephritis)
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- inflammatory disease
- glomerulus becomes permeable which causes blood & albumin leak into urine - small, smooth underdeveloped kidneys |
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Pyelonephritis
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- occurs b/c of obstruction of urinary tract due to enlarged prostate, kidney stone, or congenital defect
- may not see acute on x-ray |
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Emphysematous Pyelonephritis
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- only occurs in diabetics
- gas-forming bacteria - will cause necrosis of entire kidney |
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Papillary Necrosis
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- destructive process involving the medullary papillae & the terminal portion of the renal pyramids
- cavitation occurs - looks like white oval spots on kidney |
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Kidney Stones
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- abnormal accumulation of mineral salts within urinary system
- 80% radiopaque, can be seen on plain x-ray (CT at 95%) |
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Staghorn Kidney Stones
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- large stone takes the shape of the renal pelvis, which blocks the flow of urine
- have to drain kidney with a tube |
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Renal Diverticulum
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- abnormal pouches, variable size
- stagnant urine causes stones & infections - best seen on a retrograde exam |
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Polycystic Kidney
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Multiple cysts replace the normal parenchyma of the kidney, which causes obstruction
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Renal Cell Carcinoma
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- occurs in over 40 year olds
- symptoms: painless hematuria, localized bulging or general enlargement |
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Wilm's Tumor (Nephroblastoma)
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- most common renal malignancy in children under 5
- malignant |
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Grawitz Tumor (Adenocarcinoma, Hypernephroma)
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- malignant
- destroys kidney & invades vascular system, particularly the renal vein & inferior vena cava |
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Hydronephrosis
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Distention of renal pelvis & calices caused by obstruction
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Patient Prep for Lower GI Exams
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- NPO after midnight
- low residue diet 2-4 days before - may take laxative, cleansing enema day before |
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What would you be looking for in a double contrast lower GI study?
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Polyp
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Intussusception
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- most common cause of bowel obstruction in babies & young children
- part of bowel telescopes in on itself, restricts blood flow - due to some kind of mass in adults |
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Hirschsprung's Disease
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- typically seen in children
- Aganglionic megacolon - absence of peristalsis |
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Diverticulosis
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- development of pouches on colon which balloon outward
- can cause swelling & partial stenosis - fecal matter hangs out in pouches, causes infection |
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Volvulus
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- occurs when part of the intestine twists on itself
- looks like lines across abdomen area |
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Polyps
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- malignant: sessile (no stalk), large & flat
- benign: pedunculated (have a stalk), mushroom shaped |
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Colon Cancer
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- rectosigmoid cancer can spread to liver if not treated early, then metastasizes
- no early symptoms - often results from untreated polyp |
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Where does ulcerative colitis usually begin?
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Recto-sigmoid end of colon
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