Acute Abdo Pain Imaging Flashcards by Louise Emerson

what are the most common causes of abdo pain

non specific 
appendicitis 
bowel obstruction 
urinary system 
diverticulitis

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what are the imaging tools for the abdomen

primary:
- X-ray (erect for gas under diaphragm)
- CT
- USS

secondary

MRI (take 30-45 mins)
fluoroscopy (not done as much these days

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what conditions can erect abdo c ray exclude

bowel obstruction/ perforation

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what can USS image

solid organs, free
fluid, aorta, pelvis
Bowel – occasionally helpful

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what is more useful for abdo x ray or USS

USS

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what is the most sensitive test in the abdomen

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what are the cautions of CT

radiation exposure 
renal impairment (contrast)

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what is MRI good for

soft tissue delineation, esp in pelvis

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what abdo conditions is MRI used in

used as second line test for:

hepato-biliary
small bowel
pelvis

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what are the presenting features of an acute appendicitis

periunbilical pain
nausea
vomiting
localised to RIF

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what Ix for appendicitis

USS
CT is this is inconclusive
swelling and oedematous fluid surrounding it, will be inflamed and fluid filled on USS

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what are the complications of diverticulitis

abscess
obstruction
perforation
fistulae

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what imaging for acute diverticulitis

plain x ray to exclude obstruction/ perforation
CT
will see soft tissue thickening, inflamed bowel

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what can USS not see through

gas- so if you have a retrocaecal appendix wont be able to see it

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what is acute cholecystitis almost always secondary to

gallstones

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what is the diagnosis of acute cholecystitis based on

one local sign of inflammation (RUQ pain etc)
one sign of inflammation (fever, WCC, CRP)
confirmatory imaging

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what imaging for acute cholecystitis

USS (will see gallstones, CB wall thickening, local fluid. Gall bladder should just be black, in acute cholecystitis will have blood/ pus surrounding the stone, shows up as grey)
CT
MRI if biliary tree dilation
MR cholanfiopancreatography (MRCP) shows stones in GB/ bile ducts

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how is a paracolic abscess treated

needs to be drain (can be caused by perforation)

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should there usually be gas in the urinary bladder

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what do gallstones look like on USS

are echogenic- white, will cast black shadow behind it

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what is the treatment for acute cholecystitis

medical/ conservative
ERCP to clear out bile duct
surgery to remove gall bladder

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what is emphysematous cholecytsitis

when there is air in gallbladder wall

happens in diabetics

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what are the common causes of small bowel obstruction

adhesions, camcer, herniae, gallstone ileus

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what are the symptoms of small bowel obstruction

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vomiting, pain, distention

what are the signs of small bowel obstruction

increased bowel sounds, tenderness, palpable loops

what does imaging do in small bowel obstruction

defines site, cause, severity, complications (perforation/ ischaemia)

what investigations for small bowel obstruction

initial- X ray (good, can miss fluid filled loops) | CT (v sensitive and specific, adhesions not seen)

how can you tell small from large bowel

small bowel have valvulae conniventes lines which go all the way from one side to another large bowel has haustra but these dont go the whole way across

what are the common causes of large bowel obstruction

colorectal cancer volvulus diverticulitis

what imaging for large bowel obstruction

X ray - may not be helpful, may not diagnose underlying disease CT best- shows transition point, underlying mass, state of caecum, distant disease

what are the causes of bowel perforation

common: - ulcer - diverticular less common - cancer - ischaemia

what imaging for peforation

``` x ray -may miss small pockets of gas -doesn't show site origin CT -high sens and spec -shows free fluid -shows clues to site of origin: distribution gas, defect in wall, local inflammation ```

what is riglers sign

when you can see both sides of the bowel wall as the gas outside (happen when perforated) acts as a contrast is a pathological sign

when does bowel ischaemia develop

when it receives less than 10% of cardiac output

what causes bowel ischaemia

arterial occlusion venous occlusion non occlusive hypoperfusion

what are the signs and symptoms of bowel ischaemia

severe abdo pain, very acute onset vomiting, diarrhoea, distention boderline amylase, raised WCC, acidotic

what are the differentials of bowel ischaemia

perforation, pancreatitis, obstruction, diverticulitis

what imaging for bowel ischaemia

biphasic CT - modality of choice - shows site of occlusion and length of bowel affected

when do you gas in portal vein

very bad- happens in bowel ischaemia

what is emergency EVAR

endovascular aortic repair

USS is used first for pain where

RUQ, RIF

summarise the role of CT in the abdomen

primary imaging technique for acute abdo pain except for acute cholecystitis/ appendicitis

what preparation for a gall bladder USS- why

fast them so you can get their gallbladder to distend. | If they are fasted, there is less gas in the duodenum so you are more likely to see the CBD

when is the common bile duct dilated

when more than 5mm

what are the main complications of pancreatitis

necrosis, formation of a pseudocyst

what is seen on CT in pancreatitis

oedema, swelling

what vessels are at risk in pancreatitis

splenic vein- thrombosis | branches of gastroduodenal artery- erosion (haemorrhage due to pseudoaneurysm formation)

what is MRCP

a non invasive way of looking at the billiary tree (magnetic resonance cholangiopancreatography)

what is ERCP

endoscopy retrograde cholangiopancreatography - combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems

how are pancreatic pseudocysts treated

drained percutaneously under CT guidance

what is a pseudocysts

has a non epithelialised cysts

what is the largest branch of the circle of willis

MCA- runs horizontally

what colour is fluid on USS

black

what muscles are activated when you put your hands on your knees to catch your breath

pec minor and serratus anterior (attach to the ribs and scapula, this position allows the accessory muscles of respiration to be used more effectively- not being used to maintain posture)

via what does the ICA enter the skull base

carotid canal

what can be damaged in a supracondylar fracture of the humerus

ulnar nerve | brachial artery

what nerve injury results in anaesthesia of the lateral skin of the forearm

lateral cutaneous nerve of the forearm (is a branch of the musculocutaneous nerve)

what vertebral level does the aortic arch begin and end

T4/5

Acute Abdo Pain Imaging Flashcards

(58 cards)