Ans. b (Duodenal atresia) (Ref. Bailey and Love 26th/ 119)Duodenal atresia may take the form of a membrane or the proximal and distal duodenum may be completely separated. Prenatal ultrasound finds a 'double bubble' in the fetal abdo- men with polyhydramnios. There is an association with Down syndrome. Postnatally, there is bilious vomiting if the atresia is distal to the ampulla. A plain abdominal x-ray also shows the double bubble. Repair is by duodenoduodenostomy. Occasionally, there is a duodenal membrane with a modest central perforation, which may delay symptoms until later childhood. Important radiological GI signsX-RAY/Ba sign Diagnosis1. Single Bubble Sign2. Double Bubble Sign # CHPS# Duodenal atresia# Ladd's band# Annular pancreas# Malrotation of gut# Preduodenal vein3. Triple Bubble Sign multiple4. Bubble Signs Jejunal or proximal ileum atresia Ileal atresia5. Rigler's sign6. Football sign7. Dog's cape sign8. Falciform ligament sign}Pneumoperitonium9. Sentinel loop sign10. Colon cut-off sign11. Renal halo sign12. Gasless abdomen}Acute pancreatitis13. Seagull or Mecedes Benz sign14. Rigler's triad Gall stones (Triradiate)Gall stone ileus# Pneumobilia# Ectopic gallstone# Small bowel obstruction15. "Arc-like" calcification in RUQ16. "Tooth-like" calcification in pelvis Liver hydatid cystOvarian dermoid17. Distorted fundic bubble18. Fracture 9-11 ribs19. Loss of splenic outline20 Elevation of left hemidiaphragm}Splenic trauma21. Multiple air-fluid levels with stepladder pattern22. "String of beads" sign (pathognomonic)}Small bowel obstruction23. Liver overlap signFlank overlap signDIO overlap signCoffee-bean signInverted U/V signOmega signBent inner tube sign}Sigmoid volvulus24. Carman's meniscus signCa stomach (malignant ulcer)25. Hampton's lineBenign gastric ulcer26 Ram's horn stomach & 'Pseudo-Billroth' appearanceCrohn's disease (WB 09&SuperSp 11)27. String signCHPS28. String sign of KantorCrohn's disease29. Inverted umbrella signSterling signPulled up/contracted caecumString sign}Ileaocaecal Tb30. Segmentation and flocculation of BariumDiffuse non-specific SB dilatationJejunization of ileumMoulage sign (Loss of mucosal details)}Barium features of Malabsorption31. "Saw-tooth" apperance Diverticulosis32. Thumb print sign Ischemic colitis33. Claw sign andCoiled spring sign}Intussusception34. Hat sign Colonic polyp35. "Apple core" appearance Ca colon36. Mucosal granularity (earliest sign)Loss of haustrationsUlcersPseudoploypsLead pipe or pipe stem colon}Ulcerative Colitis (UC)37. Angiodysplasia of Colon38. Solitary Rectal Ulcer39. Colitis cystic profunda}Generally Ba Studies reveal no abnormality