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Clin Med III > Dx Tests for GI > Flashcards

Dx Tests for GI Flashcards

1
Q

radiolucent appears

A

dark

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2
Q

radiopaque appears

A

light (white,grey)

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3
Q

3 way views of abdomen x-ray series

A

Anterior/posterior while patient was supine

upright - air-fluid levels

PA chest x-ray - free air underneath hemidiapharagms and check chest pathology

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4
Q

what are three indications for abdominal x-ray

A

abdominal pain, nausea, vomiting, and distention

looking for: intestinal obstruction, perforation, intussusception

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5
Q

what will an obstruction look like on abdominal x-ray

A

dilated bowel proximal to obstruction with collapsed bowel distally

air fluid levels

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6
Q

what will a paralytic ileus (non-mechanical bowel obstruction) look like on abdominal x-ray

A

dilated bowel

gas in both small and large intestines

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7
Q

what will perforation look like on abdominal x-ray

A

free air outside the bowel

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8
Q

what will intussusception look like on abdominal x-ray

A

obstruction signs

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9
Q

2 risks associated with abdominal x-rays

A

contraindicated in pregnancy

radiation exposure

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10
Q

use of reflected sound waves to visualized the abdominal aorta, liver, gallbladder, pancreas, bile ducts, spleen, kidneys, ureters, bladder

A

abdominal ultrasound

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11
Q

doppler ultrasound provides info regarding what

A

blood flow

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12
Q

dark areas on abdominal ultrasound are ______

what are four examples

A

hypoechoic

aorta, bile ducts, abscesses, cysts

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13
Q

white areas are _____ on abdominal ultrasound.

what is one example

A

echogenic (solid)

tumors

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14
Q

when do you consider using an abdominal ultrasound

A

abdominal pain

elevated LFTs

known or suspected liver disease

kidney, pancreas, liver transplant

acute/chronic renal failure

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15
Q

what five things can you visualize on ultrasound of the liver

A

cysts

abscesses

tumors

cirrhosis

dilated bile ducts

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16
Q

what five things can you visualize on gallbladder ultrasound

A

tumors

polyps

stones

sludge

inflammation (wall thickening)

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17
Q

what four things can you visualized on pancreas ultrasound

A

cysts

abscesses

tumors

inflammation

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18
Q

what are the risks/complications of ultrasound

A

ummm… none

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19
Q

When do you not use CT scan with contrast?

A

low GFR

kidney disease

allergy to iodine

renal stone studies

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20
Q

What kind of CT scan do you use for GI bleeds (vomiting blood)

A

CT angiography

embolization procedure

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21
Q

Indications for CT scan A/P view

A

abdominal pain

abdominal distension

N/V

Diarrhea

Constipation

Rectal bleeding

Jaundice

Make sure you use other radiologic studies that have less radiation, fewer complications if possible

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22
Q

CT scan is best for what two things

A

appendicitis and pancreatitis

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23
Q

US is preferred over CT for what

A

cholecystitis, cholelithiasis

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24
Q

When looking at the liver on CT scan, what can you see?

A

cysts, abscesses, tumors, bile duct obstruction

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25
Q

When looking at the pancreas on CT scan, what can you see?

A

cysts, abscess, tumor, calcification, pancreatitis

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26
Q

When looking at GI tract/bowel on CT scan, what can you see

A

tumor, obstruction, perforation, inflammation (appendicitis), bleeding

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27
Q

When looking at spleen on CT scan, what can you see

A

tumor, laceration, hematoma, splenic vein thrombosis

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28
Q

When looking at abdominal aorta on CT scan, what are you looking for

A

visualization for aneurysm

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29
Q

Contraindications for CT scan

A

pregnancy

unstable vitals

morbid obestiy

contraindications to IV contrast (allergy to iodine or shellfish)

elevated creatinine

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30
Q

Complications associated with CT scan

A

reaction to contrast (ranges from itch to anaphylaxis)

acute renal failure from contrast

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31
Q

Metformin precautions with CT scan

A

hold for 48 hours post-contrast administration

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32
Q

Why do you want to avoid unnecessary CTs?

A

radiation risks - 1 CT abdomen = 250-500 CXR

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33
Q

Hepatoiminodiacetic acid scan OR GB nuclear scan OR cholescintigraphy =

A

HIDA scan

34
Q

Explain process of HIDA scan

A

pt receives IV radioactive tracer

technetium labeled hepatic iminodiacetic acid (HIDA) is taken up by liver and excreted into bile

if cystic duct is OPEN (patent), tracer will go to gall bladder where it can be visualized

nuclear scanner tracks flow of tracer

35
Q

what is a positive HIDA scan

A

if gall bladder does not visualized due to cystic duct obstruction in the setting of obstructing stone or edema

36
Q

What test should you combine with HIDA scan to get best information

A

CCK stimulation and ejection fraction

37
Q

primary indication for HIDA scan

A

suspected acalculous cholescystitis

38
Q

What HIDA scan findings will be consistent with cholecystitis?

A

no radionuclide seen in gall bladder within 15-60 minutes

ejection fraction of less than 35%

test reproduces pt’s symptoms

39
Q

When do you not use HIDA scan

A

pregnancy

40
Q

Upper GI series AKA

A

esophagram, barium swallow

41
Q

Upper GI series procedure

A

patient drinks barium sulfate contrast and fluoroscopy is used to visualize esophagus, stomach, and first part of duodenum

42
Q

what is fluoroscopy

A

x-ray movie in real time

43
Q

esophagram/barium swallow shows what

A

throat and esophagus only

can add on small bowel follow-through

44
Q

What are the indications for UGI series?

A

dysphagia

GERD symptoms

early satiety

suspected peptic ulcer disease

suspected obstruction/inflammation

45
Q

What are some findings on the upper GI series?

A

hiatal hernia

potential cancer - strictures, obstructions, filling defects, tumors, ulcerations

ulcers

diverticula

extrinsic compression

perforation - leakage of barium outside the upper GI tract (IF THIS IS THE CASE - USE GASTROGRAFIN)

46
Q

How will a filling defect look on UGI series?

A

displacement of contrast medium by a space-occupying lesion in a radiographic study of a contrast-filled hollow viscus

47
Q

If you suspect an upper GI perforation, what do you do on UGI series?

A

use water-soluble gastrografin not barium!

48
Q

complications of UGI series

A

aspiration if they are throwing up and accidentally aspirate

constipation from barium

49
Q

contraindications of UGI series?

A

pregnancy

complete bowel obstruction

suspected upper GI perforation

unstable vital signs

50
Q

barium enema is used to see what

A

colon and distal small bowel

51
Q

what can you use as an alternative to colonoscopy

A

barium enema

52
Q

When can a barium enema be therapeutic

A

reduce a non-strangulated ileocolic intussusception

53
Q

what will you see with inflammatory bowel disease on a barium enema

A

narrowing of the barium column due to inflammation of surrounding colon

54
Q

what will you see that would indicate cancer with a barium enema

A

strictures

obstructions

filling defects

tumors

ulcerations

55
Q

what other things can you visualize with barium enema

A

ulcers, diverticula, benign tumors, extrinsic compression, perforation (leakage of barium outside of colon)

56
Q

if perforation, what should you do with barium enema

A

not use barium - use water-soluble gastrografin

57
Q

four contraindications of barium enema

A

pregnancy

megacolon

suspected perforation - use gastrografin

unstable vitals

58
Q

2 complications of barium enema

A

perforation

fecal impaction due to barium

59
Q

Esophagogastrodudoenoscopy AKA

A

EGD

60
Q

Direct visualization of the upper GI tract via a long flexible fiberoptic lighted scope

A

EGD

61
Q

EGD is performed with what type of anesthesia

A

conscious sedation

62
Q

___ can be dx and tx

A

EGD

63
Q

When do you consider doing an EGD

A

alarm symptoms - dysphagia, weight loss, early satiety, epigastric pain

N/V, abdominal pain

Dyspepsia

Chronic GERD

Dysphagia

Suspected esophageal varices

Hematemsis or melena

Iron def anemia

abnormal UGI

suspected enteropathies (like celiac)

foreign body/food bolus

64
Q

EGD findings

A

hiatal hernia

tumors (cancer)

polyps

varices

mucosal inflammation

ulcers

barret’s esophagus

obstructions

webs, rings (schatzski’s ring)

infection

anteriovenous malformations

65
Q

complications from EGD

A

perforation

bleeding from biopsy

aspiration of gastric contents

oversedation

66
Q

Endoscopic retrograde cholangiopancreatography AKA

A

ERCP

67
Q

what is difference between ERCP and EGD

A

goes into bile and pancreatic ducts - endoscope is passed into duodenum and small catheter inserted into biliary duct where x-rays are taken once dye is injected

68
Q

MRCP used when

A

when you don’t want to do a procedure - do this and then see if ERCP is needed

69
Q

MR visualization of biliary tree and pancreatic ducts

dx not therapeutic

A

ERCP

70
Q

indications for ERCP

A

obstructive jaundice

obstruction of bile and pancreatic ducts - mass, choledocholithiasis, cholangitis

71
Q

therapeutic uses of ERCP

A

sphinterotomies, remove stones, place stents, and obtain brushings/biopsies

incision in ampulla of vater to widen common bile duct and gallstones can be removed

72
Q

contraindications for ERCP

A

uncooperative pt

previous GI surgery with inaccessible ampulla of Vater

73
Q

complications of ERCP

A

pancreatitis, perforation, gram-negative bacteremia or sepsis, aspiration of gastric contents, oversedation

74
Q

involves direct visualization of rectum, colon, and terminal ileum via long, flexible fiberoptic-lighted scope

dx and therapeutic

req bowel prep

A

colonoscopy

75
Q

flexible sigmoidoscopy

A

limited to rectum and sigmoid colon

76
Q

indications for colonoscopy

A

colon cancer screening - remove polyps and biopsy them

signs/symptoms of IBD - Crohn’s and ulcerative colitis

Hematochezia

Diarrhea

Prior abnormal test

Foreign body removal

Decompression of volvulus

77
Q

what are potential colon cancer symptoms

A

change in bowel habits, hematochezia, iron def anemia

78
Q

contraindications of colonoscopy

A

uncooperative pt

severe rectal bleeding

suspected perforation

recent colon surgery

toxic megacolon

active diverticulitis or colitis

79
Q

complications of colonoscopy

A

perforation

bleeding due to biopsy or polypectomy

oversedation

80
Q

cologuard

A

colon-cancer screening test

non-invasive stool test with DNA markers and immunochemical test for hemoglobin in stool

do every 3 years

Clin Med III (6 decks)

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