Recognizing What to Order - Gastrointestinal Imaging

Question 1

Post-op patient with persistent fever?

Answer 1

CT abdomen + pelvis WITH contrast.

Question 2

Acute abdominal pain and fever, pregnant patient?

Answer 2

US abdomen.

Question 3

Acute pancreatitis, 1st episode or no fever?

Answer 3

US abdomen.

Question 4

Acute pancreatitis, worsening, with fever?

Answer 4

CT abdomen WITH or WITHOUT contrast.

Question 5

Trauma, blunt, unstable?

Answer 5

CXR; focused assessment with sonography for trauma (FAST); Abdomen/pelvis x-ray.
- Patient’s condition permitting.

Question 6

Trauma, blunt, stable?

Answer 6

CT chest, abdomen, and pelvis WITH contrast.

Question 7

Blunt trauma with hematuria?

Answer 7

CT chest, abdomen, and pelvis WITH contrast.

Question 8

Dysphagia?

Answer 8

Barium shallow (with dynamic imaging if dysphagia is unexplained).

Question 9

Jaundice, abdominal pain?

Answer 9

US abdomen.

Question 10

Painless jaundice?

Answer 10

CT abdomen WITHOUT and WITH contrast.

Question 11

Jaundice, obstruction unlikely or confusing picture?

Answer 11

US abdomen.

Question 12

RUQ pain +/- fever?

Answer 12

US abdomen.

Question 13

LLQ pain, acute or chronic?

Answer 13

CT abdomen + pelvis WITH contrast - Oral contrast helpful.

Question 14

LLQ pain, woman of childbearing age?

Answer 14

US abdomen to exclude gynecologic abnormality.

Question 15

RLQ pain, acute or chronic?

Answer 15

CT abdomen + pelvis WITH contrast - Oral contrast helpful.

Question 16

RLQ pain, pregnant woman or child?

Answer 16

RLQ abdominal US.

Question 17

Palpable abdominal mass?

Answer 17

CT abdomen WITH or WITHOUT contrast.

Question 18

Suspected liver metastases?

Answer 18

CT abdomen most commonly done WITHOUT + WITH contrast.

–> If negative and suspicion is HIGH –> MRI abdomen WITH contrast.

Question 19

Small bowel obstruction?

Answer 19

CT abdomen + Pelvis with IV contrast.

–> No oral contrast; conventional radiographs still being done first.

Question 20

Acute abdominal pain and fever, possible abscess?

Answer 20

CT abdomen + pelvis WITH contrast.