Imaging Flashcards by Alicia Daum

Types of GI/Abdominal Imaging

X-rays
CT
Ultrasound
Direct visualization
ERCP
HIDA Scan

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What can Abdominal X-rays show?

Gas in abnormal places or amounts
Stones
Metallic FB

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Indications for an Abdominal X-Ray

Suspected bowel obstruction/perforation
Suspected intussusception
FB
Suspected abdominal mass
Blunt abdominal trauma (seatbelt from MVA)

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When are Abdominal X-rays not Indicated

Vague central abdominal pain
Gastroenteritis
Haematemesis

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Gas within the Small Bowel on Abdominal Xray

Intraluminal gas minimal
Centrally located
Tight loops of sm. diameter
Valvulae conniventes

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Gas within the Large Bowel on Abdominal X-ray

Mixture of gas & feces
Loops larger in diameter
Haustra

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Abnormal Findings on an Abdominal X-ray

Dilated loops
Air-fluid levels on erect film
Intramural gas
Intraperitoneal gas
Extraperitoneal gas

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Liver on Abdominal X-ray

Large are in RUQ

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Spleen on Abdominal X-ray

Soft tissue LUQ
Size of a fist
Can be seen, obscured, or not at all

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Kidneys on Abdominal X-ray

Bean shaped
Left higher than right
About 3 vertebrae in size

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Psoas Muscles on Abdominal X-ray

Straight lines extending inferolaterally from lumbar spine to lesser trochanter of femur

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Bladder on Abdominal X-ray

Only if full

Soft tissue density in pelvis

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Define Ileus

Hypo mobility of the GI system in the absence of mechanical bowel obstruction

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What is another name for an upper GI series?

Barium swallow

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What does an Upper GI Series use for diagnostics?

Plain film x-ray

Fluoroscopy

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What are the two types of upper GI series?

Standard barium upper GI series

Double-contrast upper GI series

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What does an upper GI series look at?

Esophagus
Stomach
Duodenum

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Indications for an Upper GI Series

Dysphagia
GERD
Assessment of hiatal hernia
Strictures
Tumors
Ulcers
Fistulas
varices
Diverticulum

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Contraindications for an Upper GI Series

Intestinal obstruction
Esophageal perforation or rupture is suspected
Pregnant women
Individuals with poor swallowing reflex

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Risk of an Upper GI Series

Constipation

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Indications for a Small Bowel Follow Through

Crohn's 
Tumors
Unexplained abdominal pain
Malabsorption symptoms
Small bowel fistulas

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What is another name for a lower GI study

Barium Enema

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What does a lower GI study evaluate?

The colon

Indications for a Lower GI Study

Colon cancer
Diagnose/monitor UC or Crohn's disease
Diverticultitis
Fistulas
Megacolon

Risk of a Lower GI Study

Pregnant women | Colon perforation

What is a sensitive method to diagnose abdominal diseases?

Abdominal CT

What are Abdominal CT Frequently Used for?

Stage | Follow CA

Indications for an Abdominal CT

Patients with jaundice Pancreatic disease Hepatic matastases

Contraindications for an Abdominal CT

Expensive | High doses of radiation

Hepatobiliary Scintigraphy (HIDA Scan)

Used in Diagnosis of problems with the liver, gallbladder, or bile ducts Nuclear-medicine scan

Indications for a Hepatobiliary Scintigraphy (HIDA Scan)

``` Cholecystitis Bile duct obstruction Assessment for liver transplant Biliary atresia Bile leaks ```

Abdominal Ultrasonography

``` Transabdominal ultrasound Can combine with endoscopy Performed quickly at bedside No radiation Inexpensive ```

What is an abdominal ultrasound hampered by?

Fat Air Operator dependent Limited sensitivity

What is the preferred imaging in RUQ pain?

Abdominal Ultrasound

What is useful in evaluating the unstable trauma patient?

Abdominal Ultrasound | FAST- Focused Assessment with Sonography for Trauma

Types of Endoscopy

``` EGD- esophagogastroduodenoscopy Colonoscopy ERCP- endoscopic retrograde cholangiopancreatograph Capsule endoscopy Flexible sigmoidoscopy ```

EGD- esophagogastroduodenoscopy

Visualize esophagus to duodenum | Minimally invasive

Indications of an EGD

Signs/symptoms of upper GI disease Surveillance for upper GI cancer in high-risk patients Biopsy Recurrent emesis Dysphagia Dyspepsia Therapeutic intervention: strictures, placement of G-tub

Contraindications for an EGD

``` Possible perforation Medically unstable/unwilling patients Anicoagulation (relative) Pharyngeal diverticulum (relative) H&N surgery (relative) ```

Indications for a Capsule Endoscopy

Obscure GI bleeding IBD: Crohn's, UC Small bowel polyps & tumors Celiac disease

Contraindications for a Capsule Endoscopy

Swallowing disorder | Small bowel obstruction/stenosis

How does capsule endoscopy work?

Patient swallows camera pill | Takes 60,000 pictures of the bowel

Cons of a Capsule Endoscopy

Short battery life | Can miss part of the bowel

Pros of a Flexible Sigmoidoscopy

``` May be done in office Inexpensive Reduces deaths from rectal cancer Easier bowel prep Rarely needs sedation ```

Cons of a Flexible Sigmoidoscopy

Detects only 1/2 of polyps Misses 40-50% of CA beyond view of sigmoidoscope Limited by discomfort, poor bowel prep

Indications for a Flexible Sigmoidoscopy

``` Screening test Blood in stool Evaluation of colon Medical management of colitis Removal of FB Pre-op eval prior to rectal surgery ```

Contraindications for a Flexible Sigmoidoscopy

Bowel perforation Acute diverticulitis Active peritonitis

What is a colonoscopy for?

Visualization of rectum, colon, and distal ileum

Possible Complicaiton

Bleeding, perforation with polypectomy

Indications for a Colonoscopy

``` Screening Evaluation Follow up colorectal CA Polyps Management of IBD, IBS ```

Contraindications for a Colonoscopy

Pregnancy Colonic perforation (relative) Toxic megacolon (relative) IBD with ulceration (relative)

What is an Endoscopic Retrograde Cholangiopancreatography (ERCP)?

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

Indications for an ERCP

Biliary disease | Pancreatic disease

Why an ERCP in Biliary Disease?

Assessment & treatment of biliary obstruction due to stones Treatment of gallstones during a cholecystectomy Assessment and treatment of bile duct strictures

Why an ERCP in Pancreatic Disease?

Assess & treat acute pancreatitis, strictures, or pancreatic duct stones Treatment of pseudocyst & malignancies

Contraindications for an ERCP

Refusal Unstable cardiopulmonary, neurologic, or cardiovascular status Existing bowel perforation