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Flashcards in Imaging Deck (21):
1

What do abdominal x-rays show? When are they used?

- readily available
- often used for urgent investigation
- shows gas in abnormal places or in abnormal acts: may need upright and lateral decubitus films as well as flat plates
- can show stones and metallic fbs as well: kidney and gall bladder stones
- solid organs can be seen but not as well: can see better CT or US

2

Indications of abdominal x-ray? Non-indications?

- suspected bowel obstruction/perforation
- suspected intussusception
- fbs
- suspected abdominal mass
- blunt abdominal trauma

non-indications:
-vague central abdominal pain
- gastroenteritis
- haematemesis

3

Normal distribution of gas in the bowel?

small bowel:
- intraluminal gas usually minimal
- centrally located
- numerous tight loops of small diameter (2.5-3.5 cm)
- valvulae conniventes (stack of coins)

large bowel:
- mix of gas and feces
- loops large in diameter (3-5 cm)
- haustra

4

abnormal findings of gas and bowel?

- dilated loops
- air fluid levels on erect film
- intramural gas
- intraperitoneal gas
- extraperitoneal gas

5

When do we see ileus?

- after abdominal surgery
- bowel goes to sleep after surgery

6

What is an upper GI series?

- barium swallow
- uses plain fim x-ray and fluoroscopy (real time xray)
- 2 types: std barium upper GI series, double contrast upper GI series
- looks at esophagus, stomach and duodenum

7

Indications and CIs for upper GI series?

- indications:
dysphagia
GERD
assessment of hiatial hernia
strictures
- CIs:
intestinal obstruction
esophageal perforation or rupture is suspected
pregnant women
individuals with poor swallowing reflex (aspiration)
- risk: constipation

8

Indications for small bowel follow through (part of upper GI series)?

- crohns
- tumors
- unexplained abdominal pain

9

What is lower GI study? Indications, and risks?

- barium enema
- evaluates the colon: barium enema, and air contrast (double contrast) enema
- indications:
colon cancer (apple core)
dx/monitor UC or crohn's disease
dx blood in stool, megacolon, constipation, diverticulitis, fistulas
- risk:
pregnant women
colon perforation

10

Use of Abdominal CT? Indications?
Downside?

-sensitive method to dx abdominal diseases (also good look at lymph nodes)
- freq used to stage and follow cancer
-indications:
pts with jaundice
pancreatic disease
hepatic metastases
- shows abdominal wall - localize hernias
- dilute contrast may be used to augment the scan
- downside: expensive, high doses of radiation

11

When is hepatobiliary scintigraphy (HIDA scan/cholescintigraphy) used?

- in dx of problems with liver, gallbladder, or bile ducts
- radio-isotope is taken up in the liver and secreted into bile
- indications:
cholecystitis
bile duct obstruction
assessment for liver transplant

12

How is an abdominal U/S performed? dependent on?
preferred imaging for what?

- sound waves to visualize internal organs thru abd. wall
- can be combined with endoscopy, visualize structure in hollow organs
- can be performed quickly at bedside, no radiation, inexpensive: imaging occurs real time w/o need for sedation
influence of movements can be assessed quickly
- hampered by fat and air
- operator dependent
- limited sensitivity
- preferred imaging for RUQ pain
- useful in eval of unstable trauma pt: FAST - shows intraperitoneal fluid and also hemopericardium
- abdominal and chest CT provides more definitive info

13

EGD use?

- can visualize esophagus to duodenum
- high def white light endoscope
- minimally invasive with quick recovery: usually done under conscious or moderate sedation, most pts have a sore throat after

14

Indications and CIs to endoscopy?

indications:
- signs and sxs of upper GI disease
- surveillance for upper GI cancer in high risk settings
- bx
- therapeutic intervention

CIs:
possible perforation
medically unstable/unwilling pts
anticoag

relative CIs:
pharyngeal diverticulum
head or neck surgery

15

Indications and CIs to capsule endoscopy?

indications:
- obscure GI bleeding
- IBD
- small bowel polyps and tumors
- celiac disease

CIs:
swallowing d/o
SBO/stenosis

problems with this: short batter life (delayed digestion - battery will die)

- pt swallows pill containing camera, able to cover areas of small bowel that are not reachable by endoscopy

16

Pros and cons to flexible sigmoidoscopy?

Pros:
- may be done in office
- inexpensive, cost-effective
- rduces deaths from rectal cancer
- easier bowel prep, rarely needs sedation

cons:
-detects only half of polyps
-misses 40-50% of cancers located beyond view of sigmoidoscope
- often limited by discomfort, and poor bowel prep

17

Indications and CIs of flexible sigmoidoscopy?

indications:
-screening test
- blood in stool
- eval of colon
- medical management of colitis

CIs:
- bowel perf
- acute diverticulitis
- active peritonitis

18

Colonoscopy used to visualize?

- rectum, colon, and distal ileum
- high def white light colonoscopy
- requires bowel prep
- uses, complications similar to upper GI endoscopy:
complications rare in dx colonoscopy
- can have bleeding, perforation, with polypectomy

19

Indications and CIs to colonoscopy?

indications:
- screening
- eval
- f/u colorectal cancer

CIs:
- pregnancy
- relative contra:
colonic perf
toxic megacolon
IBD with ulceration

20

What is endoscopic retrograde cholangiopancreatography (ERCP)?

- technique that uses combo of luminal endoscopy and fluoroscopic imaging to dx and tx conditions assoc with pancreatobiliary system

21

Indications and CIs for ERCP?

indications:
- biliary disease - assessment and tx of biliary obstruction secondary to choledocholithiasis, tx of choledocholithiasis during cholecystectomy after intraop cholangiography, assessment and tx of bile duct strictures
- pancreatic disease: assess and tx acute pancreatitis, strictures, pancreatic duct stones, tx of pseudocyst and malignancies

CIs:
- refusal
- unstable cardiopulmonary, neurologic, or CV status
- existing bowel perf