ABD

Question 1

What are indications for supine KUB?

Answer 1

Plain Xray rare: Bowel gas, FB, Calcifications, tubes

Question 2

What is included in ABD series?

Answer 2

KUB, uprdight abdomen, CXR

Question 3

What are indcations for ABD series?

Answer 3

SBO, LBO, perfs, Pneumoperiotoneum, Air fluid level, free air diaphragm, lung patholgy

Question 4

What if pt cannot stand?

Answer 4

LL decubitus- air levels and free air

Question 5

What is adequat for each view?

Answer 5

KUB- lateral walls, CXR- costophrenic angles, Upright- horizontal bean 5-10min. LOOK - white-calcified, black-air- gray- stool organs

Question 6

This xray of ABD shows little air, NO feces, valvulae conninventes w/ narrow space, width <2.5cm, thin wall <3mm?

Answer 6

Small bowel location

Question 7

This xray of ABD shows more air, feces, Haurstra w/ wider space, width <5cm wide, thin wall <3mm?

Answer 7

Large Bowel Locale- peripheral distribution. Transvers colon center and sag

Question 8

T or F. Gas and air fluid level is ABNORMal in the stomach?

Answer 8

FALSE- very normal. Air fluid in UPRIGHT

Question 9

T or F. Gas and air fluid level is ABNORMal in the Large Instestine?

Answer 9

FALSE- gas is NORMAL. NO AIR fluid level

Question 10

T or F. Gas NORMAL and air fluid is ABNORMal in the SMall intestine?

Answer 10

FALSE- VERY little gas and fluid

Question 11

Pt with calcification will ALWAYS have symptoms?

Answer 11

FALSE- calcificaion are abnormal. Pt may or may not have SX

Question 12

What could move the small and large intestine in higher positions?

Answer 12

Organmegaly or MASS- USE CT to DX mass.

Question 13

Gastropareis is common in DM when they stomach is paralyzed. What will be seen?

Answer 13

Air fluid level dialted

Question 14

IF the SBO is mechanicall obstrcuted what is seen?

Answer 14

centered, VCs dilated. Complete, will be no air distal to obstruciton. RECTUM/COLON may have NO Air, collapsed. Proximal= LESS dilated loops. MORE dilated bowels vs. LBO. SBO dilate to >3cm ONLY

Question 15

WHat is stacked coin and bent fiinger sign?

Answer 15

Common in SBO supine view- VCs narrow space. Bent finger look for steps

Question 16

When is upside down U and string pearls seen?

Answer 16

UPright SBO- air w/in VC, U-formed superior and inferior

Question 17

IF SBO is suspected what is PT CP?

Answer 17

Hypotension, TAchy. Risk of perforation.

Question 18

WHat is seen with LBO?

Answer 18

Peripheral, larger haustra. Cecum diated large R. May span 3-4 vertebrae. Few air fluid level in rectum and small bowel.

Question 19

This LBO starts from LLQ-RUQ?

Answer 19

Sigmoid volulus- bowel twisted on itself. Coffe bean shape with long opaque line

Question 20

This LBO starts from RLQ to LUQ

Answer 20

Cecal volvulus- kidney bean shaped

Question 21

Thes LBO type are not volulus and require fluids for treatment?

Answer 21

Toxic megacolon, Ogilvie Syndrome- elderly bedbound, anticholinergics. Entire colon dilated

Question 22

This Pt is post op from tumor removal, that herniated. She also has PMH of IBD?

Answer 22

SBO mechanical risk

Question 23

This Pt has a maligant tumor. What are other DDX?

Answer 23

LBO risk- hernia, volvulus, divertic, intussuception, fecal impaction

Question 24

Ms. V has large bowel dilated adn inflammed, but not obstructed. What is the condition?

Answer 24

Colitis-can see whole bowel. Very sick. DDX- toxic, ischeic, Ulcerative, C. diff.

Question 25

What is risk for Colitis?

Answer 25

Perforation- CT IV w/ CON if not emergent

Question 26

What would inidcated inflammed bowel?

Answer 26

Thicked bowel walls or haustra.Thumb printing

Question 27

What is dilated single or double loop near inflammed area, related to pancreaitis?

Answer 27

Localized illeus (failed bowel)-Sentinel Loop

Question 28

What is DX when both LBO and SBO are dilated, post surgicla. Bowel sound absent?

Answer 28

Generalized Adynmaic ileus

Question 29

Where can air be seen if extraluminal?

Answer 29

Pneumoperitoneum-btwn lever and diaphram.Lateral, R. Retroperitoneal- CT best. Penumatosis intestinales- KIDS severe. Pneumobilia- biliary system, tublie in RUQ (gas from bacteria)

Question 30

Air under diaphragm, Rigler sign (both side of bowel wall), or see the falciform ligament...mean what and is caused by?

Answer 30

Pneumoperitoneum- Cause surgery, perf of hollow organ, periotinitis from organims forming gas

Question 31

WHat is used to study lesion in esophagus, bowel, colon. THe fluid fills space, but avoid masses?

Answer 31

Barioum study- Apple core lesion-mass, Achalasia-complete block. DDX dysphagia, perforation, FB, strcitures, motiliy, malignancy, Zenker diverticululm, Barretts, Hiatal Hernia

Question 32

What are the common indentation of the esophagus, not to be confused with masses?

Answer 32

1. Aortic arch. 2. L main bronchus 3. Esophagastric junction-MC Barrets & GERD

Question 33

What is ideal for SB distal portion to see Chrons, IBD?

Answer 33

Time Oral contrast flouroscopy w/ Barium enema

Question 34

Mr. T has rectal bleeding but is painless. What is inital test for lesion insdie the bowel?

Answer 34

Colonscopy. NOT CT. Bowel prep is key. Screen >50yo. Colitis and malignancy

Question 35

IN order to DX esophagus conditions such as: UGI bleeds, FB, Mallory weiss tear, esophageal varices, boerhaaves, Gastriic: tumors, ulcer, etc.

Answer 35

Endoscopy

Question 36

What is used to see gastric ulcers, tumors, obstuction, postop, w/ biopsy including proximal small bowel?

Answer 36

Endoscopy

Question 37

What is the position of the NG tube indicated for excessive vomiting, decompress bowel (air out SBO), gastric blood lavage?

Answer 37

*10cm below gastric esophageal junction. Confirm w/ Chest xray

Question 38

What is thru skin into stomach, endoscopy and fluroscopy is used to place?

Answer 38

Gastrostomy. PEG

Question 39

What is best initial test for gall blader, gallstones, common bile duct?

Answer 39

*Abdominal US

Question 40

On ABD US what is important to Dx for Bladder, Kidney, Liver, Aorta?

Answer 40

1. Bladder- retention, cysit, mass, post void residual 2. Kidney- hydronephrosis masses, 3. Liver- free fluid Morrison pouch, liver parenchyma 4. Aorta- Aneurysm

Question 41

Can you DX appendiicits with US?

Answer 41

Yes-kids, adults

Question 42

What is preferred to see the biliary tree if available?

Answer 42

MRCP- MR cholangiopancreatogram- NO CONTRAST. USE- bilary stones, pancreas, malignancy, cholangitis. Endoscopic Retrograde- secondary

Question 43

What are the three DX criteria for cholecysitis?

Answer 43

Gallbladder infection- 1. Gallbladder thickening 2. Peri cholesystic fluid (small black strip) 3. Sonographic Murphy's sign- push under live. 4. Bile Duct >6mm dilated. 5. Acalculous cholecysitis is possible

Question 44

What study is used for hepatic biliary tree with nuclear medicine?

Answer 44

HIDA scan- 1. acute cholecysitis. 2 Chronic Biliary tract dz 3. Congenital dz 4. Post op bile leak fistula 5. Liver transplat fx

Question 45

What study is used for renal parenchyma and kidney failure?

Answer 45

US

Question 46

Mr. Kid has painful abdominal pain, w/ h/o dehydration? What is initial study?

Answer 46

CT NO CONTRAST- renal/kidney/ureter stone

Question 47

What is outcome if ureteral stone, kidney stone passing downstream, obstructs ureter. Then urine back up into renal pelvis

Answer 47

US for Hydronephrois- DX of obstructing renal calculi. Hydroureter-CT best

Question 48

What landmarks and probe is used to DX appendicitis on US?

Answer 48

Probe thin linear probe. Obese curvilinear. Landmarks- iliac crest, iliac artery, psoas, cecum.

Question 49

What is DX of pos. Appendiciits?

Answer 49

1. Dilated >6mm 2. Non compressible 3. Thick wall 4. Peri-appendiceal fluid

Question 50

What is used first to dx free fluid in Abdomen?

Answer 50

US- ascites d/t cirrhoiss, cancer. Blood-FAST exam. CT w/ oral & IV contracts for cause?