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Y4 SA - Internal medicine > Approach to abdominal imaging and imaging of parenchymal organs > Flashcards

Approach to abdominal imaging and imaging of parenchymal organs Flashcards

(50 cards)

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1
Q

How is radiography used as an imagine modality for the abdomen, pros and cons

A
  • Good overview
  • Better to assess size and shape
  • Poor at assessing GIT wall changes or internal architecture of organs
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2
Q

How is ultrasound used as an imagine modality for the abdomen, pros and cons

A
  • Excellent to assess internal architecture and luminal spaces (unless gas filled)
  • Operator dependant
  • Poor in presence of extensive gas
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3
Q

Why would we want to image the abdomen?

A

Aid diagnostics
Foreign bodies
Masses
View any abnormalities
Distention/enlargement
Fluid

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4
Q

Which radiography technique is used to avoid scatter and improve contrast resolution?

A

Low kV, high mAs technique

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5
Q

High/long mAs increase susceptibility to…?

A

Motion artefacts

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6
Q

Which radiographic views do you want to take to visualise the abdomen?

A

Right lateral
Ventro-dorsal

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7
Q

When is contrast used?

A
  • Urinary tract studies
  • Less useful in the GIT
  • Essential for abdominal CT
  • Require good preparation and time …and money!
  • Correct contrast medium for the right indication
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8
Q

Describe barium as a contrast medium

A

Used for GI studies only
- If escapes into body cavities: severe granulomatous inflammation, depending on amount: death

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9
Q

Describe iodinated contrast media

A
  • Can be used for GIT, urinary tract, IV and for myelography.
  • Safest: non-ionic and low osmolar iodinated contrast media
  • Anaphylaxis, shock if escapes into body cavities (however of limited duration and considered the best alternative), local irritant, kidney failure for IV
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10
Q

Describe gas/air as a contrast media

A

Limited use, can cause fatal air embolism on rare occasions

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11
Q

What are the main considerations of using ultrasound?

A
  • Great soft tissue contrast shows internal architecture
  • Operator dependent experience necessary
  • Gas is the death of US
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12
Q

How can you maximise the results of ultrasound?

A
  • Perform AFTER radiography (gel artefact)
  • Sedate
  • Well set-up and quiet, dark room
  • Clip widely
  • Use plenty of gel
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13
Q

Describe blind spot considerations on ultrasound

A
  • Organs within the pelvic canal
  • Assessment of surgical accessibility
  • Vascular malformations (e.g. portosystemic shunts)
  • Ectopic ureters
  • Refer for CT
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14
Q

You can feel multiple masses in different locations in the abdomen of a dog, which modality do you choose?

A

Radiography

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15
Q

You diagnosed a dog with anal sac adenocarcinoma. You want to asses for sacral lymph node metastasis, which modality?

A

CT

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16
Q

You have the suspicion of an intraluminal bladder mass, which modality do you choose?

A

Ultrasound

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17
Q

List the Rontgen signs

A

Number
Size
Shape
Margination
Opacity
Location

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18
Q

Fluid has the same opacity as…?

A

Soft tissue

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19
Q

What is the mass effect?

A

Gives clues about the origin of masses/space-occupying lesions or in some cases that there is a mass at all

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20
Q

Describe dystrophic mineralisation

A

Secondary to tissue damage - focal lesion
- Adrenal (cats)
- Fat necrosis
- Tumours, abscesses

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21
Q

Describe metastatic mineralisation

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A

Secondary to hypercalcaemia - mineralisation of gastric mucosa, aortic wall, etc
- Toxic
- Uraemia
- Paraneoplastic

22
Q

Describe the normal peritoneum

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A
  • Space around the organs lined by serous membrane
  • Contains a tiny bit of fluid
23
Q

What is the key role of the omentum in abdominal radiography?

Study These Flashcards
A

Contains fat - key to abdominal contrast and serosal detail

24
Q

What are some causes of a loss of serosal detail in the abdomen?

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A
  • Lack of fat: no contrast in the animal e.g. emaciated animals
  • Brown fat/young animal
  • Peritoneal fluid
  • Perintonitis
  • Carcinoma-tosis/sarcoma-tosis
  • Visceral crowding
25
Why is there a loss of serosal detail in brown fat/younger animals?
Has a higher water content so has a soft tissue opacity on radiograph so young animals will have a lack of detail
26
How does peritonitis cause a loss of serosal detail?
Due to inflammatory cell infiltration of fat
27
How does a carcinoma-tosis/sarcoma-tosis lead to a loss of serosal detail?
Metastases of lots of small nodules within the mesentery which are displacing the normal fat content – too small to be appreciated as nodules
28
How does visceral crowding lead to a loss of serosal detail?
If you have a large mass everything will be displaced
29
What is a pneumoperitoneum?
Gas within the peritoneal space
30
What are the 3 DDx of a pneumoperitoneum?
1. Most common = ruptured GIT = septic abdomen - Emergency – need to be treated immediately 2. Post surgery (up to 4 weeks) 3. Penetrating trauma
31
How does a pneumoperitoneum appear on radiography?
- Increased contrast between gas and soft tissue - Highlighting of the serosal surface of organ - Gas bubbles that do not conform to GIT - Usually in conjunction with loss of serosal detail (peritonitis/fluid)
32
Describe the normal appearance of the liver on radiography
Most cranial organ in the abdomen Acute ventrocaudal angle Just poking past the costal arch
33
Describe why you would assess the gastric axis on radiography
- Fix a point in the middle of the fundus - Draw a line to the middle of the pylorus - Axis should be parallel to the last rib or roughly perpendicular to the spine
34
Describe the features of a generalised hepatomegaly on radiography
Rounded margins Extending further caudal to the costal arch Caudally displaced gastric axis
35
List the potential causes of a generalised hepatomegaly
Nodular hyperplasia Lymphoma Diffuse mets Acute hepatitis Metabolic hepatopathy (e.g. diabetes, steroid therapy)
36
Describe the features of a focal hepatomegaly on radiography
Mass effect depending on which part is affected
37
List the potential causes of a focal hepatomegaly
Neoplasia Other mass (e.g. abscess)
38
What are the major DDx of Microhepatia
Vascular: - Portosystemic shunt - Primary portal vein hypoplasia Inflammatory: - Chronic hepatitis with fibrosis/cirrhosis
39
What are the major DDx of Microhepatia
Vascular: - Portosystemic shunt - Primary portal vein hypoplasia Inflammatory: - Chronic hepatitis with fibrosis/cirrhosis
40
Describe how Microhepatia presents on radiography
Contained within the costal arch Little soft tissue cranial to the stomach Cranially displaced gastric axis
41
Describe the normal appearance of the spleen on radiography
Tail: Flat triangle just caudal to the liver ventrally - mobile Head: Flat triangle on the left, ‘superimposing’ the right kidney - fixed to stomach Body: connecting both, left, often not clearly visible
42
Describe the appearance of splenomegaly on radiography
Subjective assessment of size Often rounding of the margins Tail caudally displaced (?) In cats: Tail visible ventrally! Mass effect
43
Describe the causes of splenomegaly due to a splenic mass
Neoplasia: dogs - haemangiosarcoma, cats - mast cell tumour Haematoma Nodular hyperplasia
44
List some causes of generalised splenomegaly
- Sedation/GA - Infiltration (lymphoma) - Inflammation (hyperplasia, splenitis)
45
Describe the features of the normal retroperitoneum
- Dorsal to the peritoneal cavity - Contains kidneys and ureters, bladder neck, great vessels, adrenal glands and lymph nodes, prostate etc. - Continuous with mediastinum cranially - Normal fat opacity (often streaky)
46
Describe the features of the normal retroperitoneum
- Dorsal to the peritoneal cavity - Contains kidneys and ureters, bladder neck, great vessels, adrenal glands and lymph nodes, prostate etc. - Continuous with mediastinum cranially - Normal fat opacity (often streaky)
47
Describe the features of retroperitoneal masses
- Can arise from any retroperitoneal organ (common kidneys and lymph nodes) - Or can be fluid (effusion/haemorrhage) - Mass effect: Displacing peritoneal organs ventrally - Abnormal soft tissue opacity
48
Describe the features of the adrenal glands on radiography
Normally not visible on radiographs Retroperitoneal May mineralised in old cats (incidental)
49
How to adrenal masses appear on radiography?
- Mineralisation in dogs is associated with neoplasia (but not all tumour mineralise) - Mass effect: displace kidney laterally and/or ventrally - Common neoplasia: adenoma/-carcinoma and phaeochromocytoma
50
Describe the normal and abnormal appearance of abdominal LNs on radiography
- Normally not visible on radiographs - Mass effect when enlarged - Soft tissue mass

Y4 SA - Internal medicine (7 decks)

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