Gastro Radiology

Question 1

Imaging signs for bowel perf, and which imaging you’d do
Examination symptoms and signs of bowel perforation

Answer 1

Erect cxr - free air under diaphragm, and liver - pneumoperitoneum
CT Abdo and pelvis (correct)
Note- abdo xray would show Rigler’s sign (air on either side of the bowel, normally there should be no black shadowing outside the bowel loops).

Symptoms - sudden and severe abdominal pain, sometimes with localised peritonism or a rigid abdomen on examination

Question 2

Acute appendicitis imaging and what are you trying to exclude

Answer 2

USS TO exclude ovarian cyst, ectopic, PID
Lower Abdo USS - to assess appendix

Question 3

USS findings for acute appendicitis

Answer 3

> 6mm diameter on USS
Hyperemia (vascularity)
Thickness of walls >3mm
Reactive lymph nodes
Free fluid

Question 4

Can you always see appendicitis?

Answer 4

Not if it’s a retrocaecal appenidix

Question 5

When would you do a CT instead for appendicitis type pain

Answer 5

In elderly patients, to exclude diverticulitis or IBD

Question 6

What is fat stranding

Answer 6

When something shows up lighter due to inflammation

Question 7

Acute cholecystitis imaging + signs

Answer 7

On USS- gallstones show up white with shadowing deep to it
Gall bladder wall thickening over 3 cm
Gall bladder distention
Oedema

Sonographic Murphy’s sign

Question 8

What imaging to identify bile duct patency

Answer 8

MRCP - magnetic, resonant, cholangio pancreatography

Question 9

Acute pancreatitis - imaging and signs

Answer 9

CT - the pancreas shows up as indistinct margins of the pancreas due to edema and fat stranding
Necrosis shows up as a hypoenhanced, lower grey areas

USS can be used but only to detect gallstones as potential cause of pancreatitis, and complications such as portal vein thrombosis

Question 10

When would you do an abdominal X-ray?

Answer 10

To exclude obstruction, and diagnose and monitor toxic dilatation such as in IBD

Question 11

What are the be