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GI > Session 10: Imaging of the Gastrointestinal Tract > Flashcards

Session 10: Imaging of the Gastrointestinal Tract Flashcards

1
Q

Imaging modalities of GI tract.

A

Abdominal x-ray

Erect chest x-ray

Barium swallow

Barium enem

Barium meal

Water soluble contrast

Ultrasound

CT

MRI

PET-CT

Angiography

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2
Q

What gives the highest dose of radiation?

A

CT abdo/pelvis

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3
Q

Risks of imaging of GI tract.

A

Carcinogenesis

Genetics

Developmental risks to foetus

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4
Q

Why would an AXR be requested?

A

Acute abdominal pain

Small or large bowel obstruction

Acute exacerbation of IBD like flare-ups

Renal colic is now done by CT

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5
Q

Systemic approach for an AXR.

A

ABDO X

Air/gas

Bowel

Dense structures (calcifications and bones)

Organs and soft tissue like liver, spleen and kidneys

eXternal objects and artifacts

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6
Q

How will small bowel present on an AXR?

A

Central position and have lines (valvulae conniventes) that cross the entire bowel wall.

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7
Q

How will large bowel present on an AXR?

A

Peripheral position and have incomplete lines (haustra).

Faeces can be visible due to the slow transit time of large bowel.

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8
Q

Give examples of abnormal gas patterns to recognise.

A

Rules of 3s (3,6,9)

Small bowel obstruction (>3 cm)

Large bowel obstruction (>6 cm)

Competent ileocaecal valve (>9 cm)

Incompetent ileocaecal valve (<9 cm)

Paralytic ileus

Volvulus

Toxic megacolon

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9
Q

Causes of small bowel obstrution.

A

Adhesions

Hernias

Tumours

Inflammation

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10
Q

Causes of large bowel obstruction.

A

Colorectal carcinoma

Diverticular stricture

Hernia

Volvulus

Pseudo-obstruction

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11
Q

How might sigmoid volvulus present on AXR?

A

Large coffee bean sign starting in the LIF and pointing towards RUQ.

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12
Q

What is this?

A

Colonic dilation

Oedema

Pseduopolyps

Toxic megacolon

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13
Q

What is this?

A

Called lead pipe colon where there is a featureless colon with the loss of haustra.

It is due to Ulcerative colitis

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14
Q
A

Renal calculi

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15
Q
A

Chronic pancreatitis

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16
Q
A

Vascular calcification

17
Q
A

Abdominal aortic aneurysm

18
Q
A

Foreign bodies

19
Q

Why might an erect chest x-ray be ordered?

A

In case of bowel perforation

20
Q

Give causes of bowel perforation

A

Peptic ulcer

Diverticular

Tumour

Obstruction

Trauma

Iatrogenic

21
Q

How will bowel perforation show up on an erect chest x-ray?

A

It will show free gas right under the diaphragm.

22
Q

What is used to define hollow viscera?

A

Barium contrast and water soluble contrast.

23
Q

Give the common GI contrast studies.

A

Swallow

Meal

Follow through

Enema

24
Q

What does a swallow test show?

A

It can highlight problems and anatomical variances found with the stages of swallowing.

25
Q

What does a follow through show?

A

Allows contrast to pass into the small intestine and can show any variances or pathology in small intestines.

Meal barium shows the stomach

26
Q

What does a contrast enema show?

A

Allows the large intestine to be highlighted

27
Q

Why might a CT be used?

A

To produce a high resolution image of the abdomen that can be further augmented with contrast to show any pathology not visible on x-ray.

However it comes iwth a cost of high dose radiation.

28
Q
A
29
Q
A
30
Q
A
31
Q
A
32
Q
A
33
Q

What is virtual colonoscopy?

A

Individual images from a CT scan that can be reformatted and combined to produce a 3D representation of the scanned anatomy.

34
Q

Why might an MRI be used?

A

To give a detailed and high contrast image of the abdomen without radiation. It can be enhanced by contrast.

It is however very time consuming.

35
Q

Why might abdominal USS be used?

A

Cheap and portable method.

It is user dependant however and you might miss pathology.

36
Q

What is abdominal USS often used for?

A

To visualise the biliary tree to see gallstones and dilated bile ducts.

37
Q

Why are AXRs not used as much any more?

A

Because they are not very sensitive and not very specific.

A lot of radiologist gets it wrong 30-40% of the time.

GI (30 decks)

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