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Flashcards in GI Imaging Deck (55):
1

What are the advanatages of abdominal xrays?

5

1. Plain abdominal x-rays are readily available

2. Often used for urgent investigation

3. Does show gas in abnormal places or abnormal amounts

4. Can show stones and metallic foreign bodies well

---Kidney and gall bladder stones

5. Solid organs can be seen but not well

 

2

What kind of xrays may you need for abdominal views?

2

What do you get better imaging with?

2

May need upright and lateral decubitus films as well as flat plates

 

Better imaging with CT or ultrasound

3

Abdominal xray

Indications 5

Not indicated for 3

Indications 

1. Suspected bowel obstruction/Perforation

2. Suspected intussusception

3. Foreign bodies

4. Suspected abdominal mass

5. Blunt abdominal trauma

Not indicated

1. Vague central abdominal pain

2. Gastroenteritis

3. Haematemesis

4

Interpretation

Determine ownership, adequacy, and technical quality of the film

THEN?

3

1. Gases

2. Abdominal findings

3. Solid organs (liver, kidneys, spleen, psoas muscles, bladder)

 

5

What are we looking for with gases in general?

Normal and abnormal gas distribution

6

What are we looking for with gas in the small bowel?

(normal findings 4)

1. Intraluminal gas usually minimal

2. Centrally located

3. Numerous tight loops of small diameter (2.5-3.5cm)

4. Valvulae conniventes (Stack of coins)

7

What are we looking for with gases in the large bowel?

(normal findings 3)

1. Mixture of gas and feces

2. Loops are larger in diameter (3-5cm)

3. Haustra

8

What are abnormal findings in gas patterns?

5

1. Dilated loops

2. Air-fluid levels on erect film

3. Intramural gas

4. Intraperitoneal gas

5. Extraperitoneal gas

9

1. What is the large area in the RUQ of the xray?

2. Its bulk prevents what in this area?

1. liver

2. any bowel occupying this area

10

What is the soft tissue in the LUQ, size of a fist?

spleen

Can be seen, obscured, or not at all

11

Kidney shape?

Which is higher than the other?

What size?

Bean shaped

Left higher than right

About 3 vertebrae in size

12

Explain where you will find the psoas muscles on the xray?

Forms straight lines extending inferolaterally from lumbar spine to lesser trochanter of femur

13

Bladder appears how on the xray?

If full appears as soft tissue density in pelvis

14

Normal Gas Pattern

See picture

15

What is these xrays showing?

What symtpoms does he have from this pathology? 3

SMALL BOWEL OBSTRUCTION

 

TWO PATIENTS WITH

1. ABDOMINAL DISTENSION,  

2. CRAMPY MID-ABDOMINAL PAIN 

3. VOMITING

16

What are these two xrays showing?

What symptoms come with this pathology? 3

LARGE BOWEL OBSTRUCTION

 

TWO PATIENTS WITH

1. ABDOMINAL DISTENSION.

2. LOWER ABDOMINAL PAIN, AND

3. CONSTIPATION

17

What are these two xrays showing?

Often occurs when?

Ileus

After surgery

18

What are these xrays showing?

Constipation (full of stuff/stool)

19

What are these xrays showing

1?

2?

 

1. Calcified gallbladder

2. Kidney stones

20

Abdominal organs

21

Find the Foreign Body!

22

1. Upper GI series aka?

2. Uses what tools?

3. What are the two types?

4. What does it look at? 3

 

1. Also called a barium swallow

2. Uses plain film x-ray and fluoroscopy

3. 2 types

-Standard barium upper GI series

-Double-contrast upper GI series

4. Looks at the

-esophagus,

-stomach, and

-duodenum

23

Indications for an Upper GI series?

4

Indications

1. Dysphagia

2. GERD

3. Assessment of hiatal hernia

4. Strictures

24

Upper GI series contraindications?

4

Risk? 1

 

Contraindications

1. Intestinal obstruction

2. Esophageal perforation or rupture is suspected

3. Pregnant women

4. Individuals with poor swallowing reflex

Risk

1. Constipation

25

Small Bowel Follow Through

Indications

3

1. Chrohn’s

2. Tumors

3. Unexplained abdominal pain

26

1. Lower GI studies aka?

2. What does it evaluate?

3. What kinds? 2

4. Indications? 2

5. Risks? 2

1. Also called Barium Enema

2. Evaluates the colon

3.

-Barium enema

-Air-contrast (double-contrast) enema

4. Indications

-Colon cancer (apple core lesion)

-Diagnose/monitor UC or Crohn’s disease

5. Risk

-Pregnant women

-Colon perforation

27

Lower GI series

28

What is a sensitive method to diagnosis abdominal disease?

CT

29

CT: Frequently used to do what?

(In the picture what does the 3rd pic show?)

stage and follow cancer

(Abdominal aneurysm)

30

Indications for abdominal CT? 3

1. Patients with jaundice

2. Pancreatic disease

3. Hepatic metastases

31

Abdominal CT

1. Shows abdominal wall – localizes_______?

2. What may be used to augment the scan?

3. Downsides? 2

1. Hernias

2. Dilute contrast

3. Expensive, high doses of radiation

32

What is this CT showing?

Gallstone pancreatitis

33

HEPATOBILIARY SCINTIGRAPHY aka?

(HIDA SCAN/Cholescintigraphy)

 

34

HEPATOBILIARY SCINTIGRAPHY (HIDA SCAN/Cholescintigraphy)

1. used for what?

2. How does it work?

3. Indications? 3

1. Used in diagnosis of problems with the liver, gallbladder, or bile ducts

2. Radio-isotope is taken up in the liver and secreted into the bile

3. Indications

-Cholecystitis

-Bile duct obstruction

-Assessment for liver transplant

35

Label the following letters?

A: liver parenchyma

B: gallbladder

C: small bowel

D: common bile duct

E: intrahepatic bile duct

36

Nuclear Imaging of the Gall Bladder

37

ABDOMINAL ULTRASONOGRAPHY

1. How does it work?

2. what is it also known as?

3. Can be combined with what to visualize hollow structures?

1. Sound waves to visualize internal organs thru abdominal wall

2. Known as transabdominal ultrasound

3. Can be combined with endoscopy, visualize structures in hollow organs*

38

Abdominal US:

 

Advantages? 5

Can be performed

1. quickly at bedside;

2. no radiation;

3. inexpensive

4. Imaging occurs real time without need for sedation

5. Influence of movements can be assessed quickly

39

1. Disadvantages of Ab US? 3

2. Preferred imaging for what?

3. Useful in evaluation of what patient?

4. What does FAST mean?

-What does it show?

5. What provides more definitive information? 2

1.

-Hampered by fat and air

-operator dependent;  

-limited sensitivity**

2. Preferred imaging for right upper quadrant pain

3. unstable trauma patient

4. Focused Assessment with Sonography for Trauma

-shows intraperitoneal fluid and also hemopericardium

5. Abdominal and chest CT provides more definitive information

 

40

ABDOMINAL ULTRASOUNDS

-Needs skilled technician and able interpreter

41

1. Endoscopy aka?

2. Can visualize what area?

3. Advantages? 2

4. Most pts have what afterwords?

1. EGD – esophagogastroduodenoscopy

2. Can visualize the esophagus to the duodenum

--High-definition white light endoscope

3.

-Minimally invasive with quick recovery

-Usually done under conscious or moderate sedation

4. Most patients have a sore throat afterwards

42

Endoscopy?

Indications? 4

Contraindications? 3

Indications

1. Signs and symptoms of upper GI disease

2. Surveillance for upper GI cancer in high-risk settings

3. Biopsy

4. Therapeutic intervention    

Contraindications

1. Possible perforation

2. Medically unstable/unwilling patients

3. anticoagulation             

43

Capsule Endoscopy 

Indications? 4

Contraindications? 2

Indications

1. Obscure gastrointestinal bleeding

2. Inflammatory bowel disease

3. Small bowel polyps and tumors

4. Celiac disease

Contraindications

1. Swallowing d/o

2. Small bowel obstruction/stenosis

 

44

Why do we use capsule endoscopy?

Patient swallows pill containing a camera

Parts of small bowel not reachable by other endoscopy

45

FLEXIBLE SIGMOIDOSCOPY

Pros? 4

Cons? 3

Pros

1. May be done in office

2. Inexpensive, cost-effective

3. Reduces deaths from rectal cancer

4. Easier bowel preparation, rarely needs sedation

 

Cons

1. Detects only half of polyps

2. Misses 40-50% of cancers located beyond the view of the sigmoidoscope

3. Often limited by discomfort, poor bowel preparation

46

FLEXIBLE SIGMOIDOSCOPY

Indications? 4

Contraindications? 3

Indications

1. Screening test

2. Blood in stool

3. Evaluation of colon

4. Medical management of colitis

Contraindications

1. Bowel perforation

2. Acute diverticulitis

3. Active peritonitis

47

1. Colonoscopy visualizes what? 3

2. White kind of light?

3. Requires what?

1. Visualization of

-rectum,

-colon

-distal ileum

2. High definition white light colonoscope

3. Requires bowel prep

48

Uses, complications similar to upper GI endoscopy

Complications rare in diagnostic colonoscopy But can be what? 2

 

Can have

-bleeding,

-perforation with polypectomy

49

Colonoscopy

Indications: 3

Contraindications: 4

Indications

1. Screening

2. Evaluation

3. Follow-up colorectal cancer

Contraindications

1. Pregnancy

Relative contra:

2. Colonic perforation

3. Toxic megacolon

4. IBD with ulceration

50

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) is what?

Technique that uses combination of luminal endoscopy and fluoroscopic imaging to diagnose and treat conditions associated with the pancreatobiliary system

51

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)

Indications?

2

Biliary disease

Pancreatic disease

52

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)

What reasons would we use this for biliary diseases? 3

1. Assessment and treatment of biliary obstruction secondary to choledocholithiasis

2. Treatment of choledocholithiasis during cholecystectomy after intraoperative cholangiography

3. Assessment and treatment of bile duct strictures

53

ERCP

What reasons would we use this for pancreatic disease? 2

1. Assess and treat acute pancreatitis, strictures, pancreatic duct stones

2. Treatment of pseudocyst and malignancies

54

ERCP Contraindications? 3

1. Refusal

2. Unstable cardiopulmonary, neurologic, or cardiovascular status

3. Existing bowel perforation

 

55

Strucutures of the Abdomen