tailieunhanh - Radiology for Anaesthesia and Intensive Care - Part 4

Chú ý đặc biệt đã trả cho minh họa phóng xạ có liên quan giải phẫu. Đối với mỗi hệ thống cơ thể (ngực và tim mạch, bụng và xương chậu, và người đứng đầu), giải phẫu học phóng | Imaging the abdomen Question 4 2 64-year-old patient. This patient has a history of diabetes and had reconstructive vascular surgery for peripheral vascular disease 8 days ago. He received intravenous broad spectrum antibiotics for a surgical wound infection and now has bloody diarrhoea. What are the radiological signs Fig. What is the diagnosis Fig. Quiz case. 88 Case illustrations plain films and CT Answer This case demonstrates colonic wall thickening thumb printing and a distended stomach. The diagnosis is pseudomembranous colitis and diabetic gastroparesis. Pseudomembranous colitis In general the radiological findings are adynamic ileus with moderate gaseous distension of the small and large bowel. The haustral folds are frequently shaggy and irregular and thumbprinting is often identified particularly in the transverse colon as in Fig. . Diffuse colonic thickening can be identified on CT. Pseudomembranous colitis is caused by an overgrowth of the commensal anaerobe Clostridium difficile. Commonly it is a complication of antibiotic therapy particularly ampicillin amoxycillin clindamycin and the cephalosporins. Antibiotic disturbance of the normal gut flora appears to allow overgrowth of toxigenic strains of C. difficile. The clinical and pathological effects are the result of toxin production. Further predisposing causes include bowel obstruction and co-existent debilitating disease . leukaemia. The clinical picture is of profuse diarrhoea abdominal cramps and tenderness. A yellow exudative pseudomembrane haemorrhagic areas and mucosal ulcers are seen on colonoscopy. Diabetic gastroparesis is a recognised complication of diabetes mellitus when there is gastric retention in the absence of mechanical obstruction. This can be life threatening. The stomach should be decompressed and emptied with a nasogastric tube. Other causes include electrolyte imbalances diabetic ketoacidosis drugs peritonitis and abdominal trauma. 2 89 Imaging the abdomen .