03.01 Radiology: Imaging of Common GI Disorders Flashcards by Karla Guntayon

Accumulation of modified opacities throughout the segments of the colon which represent fecal material

Mottled densities

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Abundant mottled densities

Presents with constipation

Fecal retention/stasis

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Abundance of gas in small and large bowels
Generalized gas-filled distention
Impaired propulsion of GI contents > hypomotility of GI tract in the absence of mechanical bowel obstruction > accumulation of gas in the bowels > distention

Ileus/hypomotility

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Bowel gas has not resolved after more than 3 days

Paralytic ileus

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Collection of gas in one area
Focal inflammation in a given region
Inflammation at the epigastric region or RLQ

Sentinel loop

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in large bowel obstruction, the colon is gas filled and dilated down to the level of sigmoid colon
Maybe diverticular stricture

Cut-off sign

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Intra-abdominal inflammation, such as with pancreatitis, can lead to a localized ileus

Sentinel loop

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Closed loop obstructions
Abundance of gas-filled bowel loops in the center of the abdomen
Valvulae conniventes/plicae circulares are evident
Intermittent abdominal pain, vomiting, RUQ mass

Coiled spring

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Coiled spring pattern: without contrast

May represent obstruction

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Coiled spring pattern with contrast

Intussusception

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Small-bowel obstruction

Demonstrated only in upright position

Air-fluid leveling

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Small bowel obstruction
Represents small pockets of trapped air within the superior walls of the bowel in the valvulae conniventes
Increased peristaltic activity
Ovoid appearance due to meniscal effect of fluid between the valvulae conniventes

String of pearls

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Small bowel obstruction
Lucent areas that appear like vertical lines
Secondary to increased peristaltic activity

Stretch/slit sign

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Obstruction at the duodenum

Stomach distention

Single bubble sign

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Maximum normal diameter of SI

30mm

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Maximum normal diameter of LI

50-60mm

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Maximum normal diameter of cecum

90mm

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Most common pathology presenting with a single bubble sign
Palpable lesion in the epigastric area among newborns
Non-bilous vomiting

Hypertrophic pyloric stenosis

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Encountered when 2 bowel loops are involved
Obstuction beyond the stomach but probably at/around the area of the duodenum
Possible etiologies: atresia, obstuction, extrinsic compression by the region adjacent to the duodenum, periduodenal anomaly, anything that involves the distal portion of the duodenum
Presents with bilious vomiting

Double bubble sign

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Jejunal obstruction
Encountered when there are 3 loops involved
Signify a possible obstruction on the jejunum

Triple bubble sign

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Volvulus (twisting of loop of intestine around its mesenteric attachment)
Vomiting, alternating diarrhea and constipation

Coffee bean sign

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Volvulus at right apex

Sigmoid volvulus

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Volvulus at left apex

Cecal volvulus

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Complication of intestinal malrotation
Present with bilious vomiting
Common among newborns

Midgut volvulus

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Inflammatory focus Secondary to a collection of abscess or an inflammatory focus Normal, not distended gas filled bubble loops except at sudden interruption of air Cancer, inflammation

Colon cut-off sign

Bowel loops in R hemiabdomen Prominent liver shadow Splenic flexuer is much more superior to hepatic flexure

Hematomegaly

Chest films are sometimes needed to confirm the possibility of a perforated gas-containing organ Crescent shaped Trauma, iatrogenic perforation, GI tract disease, inflammatory conditions

Pneumoperitoneum

Normal air under left hemidiaphragm (stomach air or gastric bubble)

Magenblase

Collection of air follows the configuration of bowel loops | Presence of haustrations, usually present with no symptoms, incidental finding

Chilaiditi's sign

Chilaiditi's sign + pain One of the causes of pseudoperitoneum and occurs when bowel gas is interposed between the liver and the hemidiaphragm resulting in pain

Chilaiditi's syndrome

``` Lucent foci within the left hemithorax Hernias represent gas containing bowel loops in the chest Presence of borborygmi Tachypnea US ```

Congenital diaphragmatic hernia

More common congenital diaphragmatic hernia Left hemithorax Defect in lateral and posterior sides

Bochdalek

Less common congenital diaphragmatic hernia Right hemithorax Defect in anterior (at sternocostal angle)

Morgagnie

Collection of calcifications in the mid-epigastric region at the level of L2 Further confirm by other imaging modalities Round, hyperdense, middle portion of abdomen Chronic pancreatitis, neoplasm, sub-intraparenchymal hemorrhage, hyperparathyroidism, cystic fibrosis

Pancreatic calcifications

Fat, forty, fecund, female | (+) Murphy's sign and Collin's sign

Cholelithiasis

Cholelithiasis: gold standard, cheap and readily available

Cholelithiasis: gives good accuracy and can detect different types of stones at different locations compared to ultrasound

CT sonogram

Created by stones in the gallbladder that are right beside each other

Mercedes Benz sign

Press the inferior portion of the liver, and if there is inspiratory arrest, this is positive

Murphy's sign

Ask the patient to place their hand on back, thumbs up | Radiation of pain to inferior scapula

Collin's sign

Filling defects at the distal segments of the esophagus > represents erosion secondary to reflux X-ray with contrast Caused by corrosion, infection, radiation therapy

Esophageal atresia

EA is confirmed by

Barium enema

Achalasia Abnormal distension of entire esophagus then abrupt tapering distally Failure of lower esophageal sphincter to relax Possible defect: auerbach's plexus, vagus nerve, dorsal motor nucleus of the vagus nerve

Bird's beak/rat's tail sign

Complication of achalasia | Secondary to chronic esophageal irritation

Esophageal cancer

Diagnosing using esophagogram | Outpouching containing contrast

Diverticulum

Proximal | Between cricopharyngeus and inferior pharyngeal sphincter muscles

Zenker's diverticulum

Distal | Above the lower esophageal sphincter, more frequently on the right

Epiphrenic diverticulum

Linitis plastica Persistently narrow, not distensible bowel walls May indicate serous adenocarcinoma

Old leather water bottle

Intramural hemorrhage Secondary to scleroderma, malabsorptive gastroenteropathies, vasculitis, trauma, coagulation defects, ischemia Asymmetric atrophic longitudinal layer

Stack of coins

Colon constriction Abnormally constricted segment of sigmoid colon Not distensible despite inflation with air Demonstrated with air May be due to mechanical small bowel obstruction, foreign bodies, tumors, chrohn's disease, ulcerative colitits, adhesions, herniais, volvulus

Apple core deformity

Contrast containing segment of the bowel loop that appears narrow or stenotic Caused by Crohn's disease, radiation enteritis, lymphoma, endometriosis, eosinophilic gastroenteritis, drug-induced, ulcerative colitis

Bowel stenosis

Intermittent abdominal pain, previous travel to a developing country Coral look > valvulae conniventes Commonly at the jejunal segment

Ascariasis

Gas-filled distension of bowels Distal portion of intestinal tract Absence of ganglionic cells in the distal colon or functional obstruction

Hirschprung disease/aganglionic megacolon

Seemingly normal Cecum is not in its normal position Normal embryological process of bowel fixation and development is interrupted

Malrotation

Acquired herniations of the mucosa and portions of the submucosa through the muscularis propria Round opacities outline the colon walls

Diverticulosis

Iodinated contrast

Hepatobiliary tree

Abnormally distended commno bile duct + dilated radicles | 5 types

Choledochal cyst

Most common type | Fusiform dilatation of extrahepatic duct

Type 1

Diverticulum along the common bile duct

Type 2

Choledochocele | Outpouching inside the duodenum

Type 3

Intrahepatic and extrahepatic ducts are dilated | Second most common

Type 4

Intrahepatic ducts are dilated | Caroli's disease

Type 5

Modality of choice for the imaging of the hepatobiliary tree For viewing of the intestines Confirm disease of the intestinal tract Appendicitis

UTZ

Distension of small bowels Fluid-filled bowel loops Presence of anechoic areas in affected bowel segments

Ileus

Blind ended tubular structure Trilaminated wall with targetoid appearance Appendicolith

Acute appendicitis

Hyperchoic focus at the tip of the appendix | Calcified deposit of material within the appendix

Appendicolith

Abnormal telescoping of one segment into another | Palpable sausage-like mass lesion

Intussusception

Intussusception signs on transverse cut

Target sign Bull's eye Crescent-in-doughnut

Intussusception signs on longitudinal cut

Pseudokidney Hayfork sign Bull's eye

Most common location of intussusception in pedia

Ileocecal

Protrusion of contents of the abdominal cavity through the inguinal canal

Inuinal hernia

In CT scan, the landmarks of hernia

Hesselbach's triangle - base: inguinal ligament - lateral: epigastric artery - medial: rectus sheath

Landmarks of direct hernia

Enters within Hesselbach's triangle

Landmarks of indirect hernia

Enters at the deep ring > inguinal canal > upper pole of testis

Echogenic structure same as surrounding tissues Antenatal ultrasound can diagnosis this Anterior abdominal wall defect through which abdominal contents freely protrude

Gastrochisis

Organs remain enclosed in visceral peritoneum

Omphalocele

Increased echogenicity of the liver | Reversible, multifactorial disease, due to improper diet/alcoholism

Fatty liver

Accumulation of fluid in the peritoneum Secondary to many etiologies Appears as anechoic areas in spaces between organs

Ascites

Ascites in hepatorenal space

Morrison's pouch

Well-circumscribed anechoic focus in the liver parenchyma | Can't determine if benign or malignant on UTZ

Livery cyst/nodule

Upper limits of normal size on UTZ

Length: 12 cm Width: 7 cm Height: 5 cm

Anechoic | Splenic vein, aorta, IVC, celiac artery

Pancreas/ pancreatic cyst

Distendeded gall bladder (> 10 x 5 x o,3)

Cholecystitis

Types of cholecystitis

Calculous (with stones) | Acalculous (no stone)

Stones in the gallbladder appear hyperechoic on an anechoic background Stones are round, well-circumscribed foci with posterior shadowing

Cholelithiasis

Can demonstrate exact site of obstruction To check for abnormal gas pattern To determine the cause of obstruction Abnormal fluid collection

CT Scan

On CT, thickened bowels hyperdensities | On XR, apple core deformity

Colon constriction

Round structure with contrast outside: diameter is thickened, air and inflammation, appendicitis

Soft tissue lesions

Stone enters intestinal tract

Gallbladder ileus

Heterogenous pancreas | Hypodensities which enhance with contrast

Acute pancreatitis

Using CT for prognostication

Balthazar score

Abnormal fluid collection at tail of pancrease | Creates colon cut-off sign

Abscess formation

Better demonstrates the cause of the obstruction

CT scan

On lateral side of abdominal wall

Spigelian hernia

Similar to standard/rigid colonoscopy but invasive | Bowel preparation and lying down are rquired

Virtual colonoscopy/CT colonoscopy

Confirmatory examination in pregnancy, history of allergic reaction to contrast material Equivocal findings in CT

MRI

Pattern of contrast would make one lesion more unique than the other Liver nodules

Mass lesions in liver

Plaques | Filling defects

Gallbladder stone

Isolate the biliary tract and reconstruct the image Filling defects = stones Static fluid = bright against low signal Requires no contrast

MR cholangiopancreatography

Indicated in pregnant | Hyperintense signal surrounded by hypointense backgound on T2

Appendicitis

Indicated in those who have allergic reactions to contrast, renal failure Hyperintense

Pancreatitis

03.01 Radiology: Imaging of Common GI Disorders Flashcards

(101 cards)