Gastro IV (abd xrays) Flashcards
(46 cards)
Indications for abdominal X-ray?
Intraperitoneal free air
Bowel obstruction
Organomegaly
Abnormal masses ( palpatable on exam)
Abnormal calcifications ( gall stones, radiopaque FB, assess tubes ( corpax, catheters)
What is a US better for?
Cholecystitis
Gyn issues
looking for ovarian cysts
What is a CT better for ?
Diverticulitis
Appendicitis
Nephrolithiasis
Abdominal trauma
Abdominal X-ray are useful for what?
Toxic megacolon
SBO
Upright for free air ( pnuenoperitoneum, air under the diaphragm)
KUB for renal tract calculi
FB following ingestion
When is abdominal X-ray not useful?
constipation
**colon loses all costal margins*
** large piece of stool, fecaloma - extreme impaction*
Abdominal X-ray: common views?
AP (supine)
AP (erect)
Lateral decubitus ( w/ arm elevated) - if patient is to sick to stand u, this will displace the free air
Supine lateral (cross-table view) - cutting through laterally
KUB (kidneys, ureter, bladder) - stones , focus more on urinary system
What is part of the acute abdominal series?
PA chest
Supine AP abdomen
Erect AP abdomen
What should an acute abdominal series include?
Just above the diaphragm to the ischial tuberosities
What does an abdominal x-ray: systemic study show?
Vertebrae
Lower ribs
Pelvis
Then soft tissues: LUQ RUQ Both flanks Mid-abdomen Pelvis
how much fluid must be present to show on abd X-ray?
500 ml
Fluid in the abd then we call it?
“gray abdomen” everything looks dull
If fluid in the abdomen then we see what?
“gray abdomen” - everything looks dull
Indistinct margins
Medial displacement of the colon, liver and spleen
“dog’s ears”
**fluid goes into the peritoneum , “bladder ears”*
Pneumoperitoneum: what is most sensitive test for free air - free air under the diaphragm?
CXR
Pneumoperitoneum on X-ray ?
Gas outlying the falciform ligament ( considered lace of the football)
Rigler Sign - air on both sides fo the intestine - luminal side and peritoneal wall
“Football” sign - massive pneumoperitoneum - distending cavity - losing flank stripes
**air within abdominal cavity *
What are examples of abdominal calcifications?
Vascular calcifications Calcified lymph nodes Gallstones Urinary calculi Liver and spleen granulomas Appendicoliths Calcified adrenal glands Pancreatic calcification Bowel contents Soft tissue calcifications Tumor
Small bowel obstruction?
small bowel dilated over 3 cm ( 30 mm)
multiple air/fluid levels in SB
stretch/slit sign
string of pearls sign
coiled spring sign
**usually causes by adhesions - multiple surgeries - multiple scarring also by CA, tumorss, intussesseption
*
Adynamic ileus x-ray?
Diffuse
Symmetric
Gaseous distention
Proportional dilation
** dilation of the large and small bowel - cannot distinguish them - Proportional dilation *
What is the sentinel loop?
Segment of intestine that becomes paralyzed and dilated next to inflamed intra-abdominal organ
**segment of the intestine that basically become enlarged or large air fluid level next to an inflamed organ
*
** pancreatitis , diverticulitis ,*
Toxic megacolon ?
Large bowel loses all tone and contractility
Risk of perforation
Cause is usually fulminant colitis
Toxic megacolon x-ray?
air within the large bowel diffusely all throughout
lose of all costar markings
severe C.diff, colitis, Hypotn, thumb printing?
Indication for colonoscopy?
Unexplained abd pain
Occult or frank GI bleeding
Change in bowel habits
Screening exam for adults
>50 yo
Colonoscopy explanation?
Test goes from anus to cecum ( try to get to the ileal cecal bowel portion
+/- portion of the terminal ileum
Colonoscopy procedure?
Pt given bowel prep to drink the day before the procedure (Colyte, GoLytely)
IV access and pt sedated (Versed/Fentanyl)
Colon is insufflated with air
Air is removed and replaced with CO2 if laser coagulation is going to be used
**bowel prep is important -make sure the is a good mucosa bowel for the doc to look at *
Contraindication for colonoscopy?
Uncooperative/ unstable patients
Profuse rectal bleeding
Suspected colon perforation
Toxic megacolon
Recent colon anastamosis
