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Clin Med III Unit I > 1 GI Diagnostics > Flashcards

1 GI Diagnostics Flashcards

1
Q

What different views can you order for abdominal xrays?

A

AP projection while patient supine

Upright

PA chest xray

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2
Q

When would you want an AP abdominal view xray?

A

Aka KUB (kidney ureter bladder)

Done while patient is supine

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3
Q

Upright abdominal xrays are better for …

A

Visualization of air-fluid levels

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4
Q

PA chest X-rays can be used to visualize…

A

Free air underneath hemidiaphragm and check chest pathology

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5
Q

Indications for abdominal xray

A

Abdominal pain, N/V, distention (can see on CT too but xray is faster, cheaper, less radiation)

Intestinal obstruction

Perforation (will see air in places it shouldn’t be)

Intussusception (peds usually)

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6
Q

Dilated bowel proximally with collapsed bowel distally indicates…

A

Obstruction

Will also see air fluid levels

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7
Q

Abdominal xray showing generalized dilated bowel and gas in both small and large intestines indicates…

A

Paralytic ileum (non-mechanical bowel obstruction) - frozen bowel, common after surgery, but NO clear obstruction

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8
Q

Abdominal xray shows free air outside the bowel. You suspect…

A

Perforation

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9
Q

Thickened and edematous bowel wall on xray is indicative of…

A

Small bowel obstruction

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10
Q

A loop of bowel slipped into another section of bowel, creating swelling, decreased blood flow, obstruction, and tissue damage

A

Intussusception

Requires emergency treatment

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11
Q

Risks/complications of abdominal xrays

A

Contraindicated in pregnancy

Radiation exposure

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12
Q

Use of reflected sound waves to visualize the abdominal aorta, liver, gallbladder, pancreas, bile ducts, spleen, kidneys, ureters, bladder

A

Abdominal ultrasound

Doppler US provides additional info re: blood flow

Can be ordered for specific location/organ

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13
Q

Dark areas on U/S are…

A

Hypoechoic

Examples: aorta, bile ducts, abscesses, cysts

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14
Q

White areas on U/S are …

A

Echogenic (solid)

Examples: tumors

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15
Q

When is an abdominal U/S indicated?

A

Abdominal pain

Elevated LFTs

Known/suspected liver disease

S/p kidney, pancreas, or liver transplant

Acute/chronic renal failure

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16
Q

What kind of abnormalities can you see on a liver u/s?

A

Cysts, abscesses, tumors, cirrhosis

Dilated bile ducts

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17
Q

What kind of abnormalities can you see on a gallbladder u/s?

A

Tumors, polyps, stones, sludge, inflammation (wall thickening)

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18
Q

What kind of abnormalities can you see on a pancreatic u/s?

A

Cysts, abscesses, tumors, inflammation

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19
Q

Risks/complications of U/S?

A

There aren’t really any - No contrast, no radiation

Useful study in patients with contraindications to other diagnostic tests

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20
Q

Computerized xrays that produce cross-sectional images of the body layer by layer

A

CT scan

Used to evaluate abdominal and pelvic organs

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21
Q

CT images can be enhanced with …

A

IV or PO iodine contrast

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22
Q

What is the exception to using contrast for abdominal CTs?

A

Renal stone study - because calcium stones are radiopaque, you won’t see them if you have contrast added

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23
Q

Indications for abdominal CT

A 
Abdominal pain
Abdominal distention
N/V
Diarrhea
Constipation
Rectal bleeding
Jaundice
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24
Q

Can you use CT to diagnose cholecystitis or cholelithiasis?

A

You can but US is preferred over CT

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25
What is the preferred test for evaluating the pancreas?
CT preferred over US for pancreatitis Can also use CT to evaluate pancreatic cysts, abscesses, tumors, or calcification
26
US is preferred over CT for ________, but CT is preferred over US for __________
US for cholecystitis/cholelithiasis CT for pancreatitis
27
If you do use CT to evaluate cholecystitis, what will you see?
Distended gallbladder with an edematous and hyperemic wall and inflammatory induration in the fat surrounding the gallbladder Calcified stones can also be visualized on CT
28
Contraindications for abdominal CT
Pregnancy Unstable vitals Morbid obesity IV contrast - allergy to iodine or SHELLFISH (in some cases, can premedicate) Elevated creatinine
29
Complications of CT scans
Reaction to contrast (ranges from flush/itch —> anaphylaxis) Acute renal failure from contrast
30
What precautions are important to remember with CT scans
Hold metformin for 48 hours post-contrast administration Radiation risks - 1 abdominal CT = 250-500 CXRs (avoid unnecessary CTs)
31
What is a HIDA scan?
Hepatoiminodiacetic Acid Scan aka GB nuclear scan aka cholescintigraphy Patient receives IV technetium labeled hepatic iminodiacetic acid —> taken up by liver and excreted in bile Nuclear scanner tracks flow of tracer If cystic duct is patent, tracer will go to GB, where it can be visualized
32
A HIDA scan is considered positive if...
Gallbladder does not visualize due to cystic duct obstruction in the setting of obstructing stone or edema
33
HIDA scans provide best information when ordered concurrently with...
CCK stimulation and ejection fraction (tests pumping ability of the gallbladder)
34
What is the primary indication for HIDA scans?
To diagnose suspected acalculous cholecystitis (though you would start with U/S)
35
What findings would you expect on a HIDA scan in the case of cholecystitis?
No radionuclide seen in gallbladder within 15-60 min Ejection fraction <35% Test reproduces patient’s symptoms
36
When is a HIDA scan contraindicated?
Pregnancy
37
If you want to do a HIDA scan, what do you need to remember to do?
DO NOT give pain meds! Morphine will effect results
38
How is an Upper GI series performed?
Patient drinks barium sulfate contrast (or gastrografin) and fluoroscopy is used to visualize esophagus, stomach, and first part of the duodenum Esophageal/barium swallow is a variation that shows throat and esophagus only AKA esophageal, barium swallow
39
When is an upper GI indicated?
Dysphagia GERD symptoms Early satiety Suspected PUD Suspected obstruction/inflammation
40
Portion of stomach above diaphragm on UGI?
Hiatal hernia
41
What UGI findings suggest potential cancer?
Strictures, obstructions, filling defects, tumors, ulcerations Filling defect = displacement of contrast medium by a space-occupying lesion in a radiographic study of a contrast-filled hollow viscous
42
Leakage of barium outside of UGI tract indicates...
Perforation USE WATER-SOLUBLE GASTROGRAFIN
43
If you suspect perforation, UGI should be performed with...
Water soluble gastrografin rather than barium contrast
44
If you suspect a gastric ulcer, or see one on UGI, what else do you need to order?
EGD!!!!
45
Contraindications for UGI series
Pregnancy Complete bowel obstruction Suspected upper GI perforation (use gastrografin not barium!!!) Unstable vital signs
46
Possible complications for UGI series
Aspiration (esp if dysphagia) | Constipation from the barium
47
Barium enemas are AKA...
Lower GI series Patient receives a barium enema and fluoroscopy is used to visualize the colon and distal SB Can be an alternative to colonoscopy
48
When would a barium enema be therapeutic?
To reduce a non-strangulated ileocolic intussusception
49
Contraindications for barium enemas
Pregnancy MEGACOLON Suspected perforation (must use GASTROGRAFIN) Unstable vitals
50
Complications of barium enemas
Perforation | Fecal impaction due to barium
51
Direct visualization of the upper GI tract via a long, flexible, fiber optic lighted scope
EGD (esophagogastroduodenoscopy) Performed under conscious sedation (not full anesthesia) Can be both diagnostic and therapeutic
52
Indications for EGD
``` Alarm Sx (DYSPHAGIA, WEIGHT LOSS, EARLY SATIETY, EPIGASTRIC PAIN)******* N/V, abdominal pain Dyspepsia Chronic GERD Suspected esophageal varies Hematemesis or melena Fe deficiency anemia Abnormal UGI Suspected enteropathies (ie celiac) Foreign body/food bolus ```
53
Contraindications for EGD
Uncooperative patient Bleeding Esophageal diverticula (b/c inc risk of perforation)****** Suspected perforation (b/c can be worsened)****** Recent upper GI tract surgery (weak anastomoses site)****
54
Complications of EGD
Perforation Bleeding from biopsy Aspiration of gastric contents Oversedation
55
What is an ERCP?
Endoscopic retrograde cholangiopancreatography Involves use of fiber optic endoscope to obtain radiographic visualization of BILE AND PANCREATIC DUCTS Similar to MRCP (Magnetic Resonance Cholangiopancreatography)
56
Indications for ERCP
Obstructive jaundice | Investigation/treatment of obstruction of bile and pancreatic ducts (mass, choledocholithiasis, cholangitis)
57
Therapeutic uses for ERCP
Can perform sphicterotomies, remove stones, place stents, and obtain brushings/biopsies Incision in ampulla of vater to widen common bile duct and gallstones can be removed
58
Contraindications for ERCP
Uncooperative patient | Previous GI surgery with inaccessible ampulla of vater
59
Complications of ERCP
``` Pancreatitis Perforation Gram-negative bacteremia/sepsis (from translocation of bacteria into Biliary —> blood system) Aspiration of gastric contents Oversedation ```
60
Procedure that allows for direct visualization of the rectum, colon, and terminal ileum via a long, flexible, fiber optic-lighted scope
Colonoscopy Usually performed with conscious sedation Both diagnostic and therapeutic Requires bowel prep
61
Procedure with visualization limited to rectum and sigmoid colon
Flexible sigmoidoscopy
62
Indications for colonoscopy
Colon cancer screen (remove polyps, biopsy) Potential colon cancer symptoms (change in BMs, hematochezia, iron deficiency anemia) SSx of IBD Hematochezia Diarrhea Prior abnormal test (BE, CT) Foreign body removal Decrompression of volvulus
63
Contraindications for colonoscopy
``` Uncooperative patient Severe rectal bleeding Suspected perforation Recent colon surgery Toxic MEGACOLON Active diverticulitis or colitis ```
64
Complications of colonoscopy
Perforation Bleeding Oversedation
65
Non-invasive stool test with DNA markers and immunochemical test for hemoglobin in the stool
Cologuard Alternative to colonoscopy for colon cancer screening Frequency of testing not yet established (Q3years?)

Clin Med III Unit I (6 decks)

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