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GI (inpt) > Imaging > Flashcards

Imaging Flashcards

1
Q

What are common GI complaints?

A

Pain: abdominal, pelvic, flank, rectal

N/V/D, constipation, heartburn/indigestion, anorexia/weightloss, bleeding, dysphagia/odynophagia, jaundice, and swelling

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2
Q

Abdominal series

A

used for evaluation of perforation, obstruction, FB, gas patterns, soft tissue masses, calcifications

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3
Q

typical views of abdominal series

A

supine (flat plate) and upright of the abdomen

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4
Q

obstruction series of xray

A

lying, upright, CxR portion

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5
Q

What is a Barium enema

A

Single or double contrast barium is introduced trans-anally (entire colon including ileum and appendix); while this occures, plain films are taken and reviewed for abnormal appearance.

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6
Q

what is now replacing barium enemas?

A

Colonoscopy and CT colongraphy

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7
Q

what is contraindicated in poor kidney fxn?

A

Contrast

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8
Q

What does it mean by double contrast?

A

shoot air in then use barium

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9
Q

What is a barium swallow?

A

Barium is ingested and images taken

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10
Q

What does a barium swallow access?

A

esophageal structure and fuction that an EGD may miss; look for hypopharyngeal and cricophyarngeal disorders; delineates strictures, ulcerations, reflux and hiatal hernias

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11
Q

What does an abdominal US assess?

A

solid abdominal organs (Liver, gallbladder, ducts, pancreas, spleen, kidneys)

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12
Q

How does an US work?

A

It emits high frequencey sound waves from a transducer to the organ being studied-which then bounces back and are electronically converted to pictures

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13
Q

What type of imaging can assess blood flow?

A

US

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14
Q

abdominal CT scan uses:

A

retroperitoneal and intra-abdominal organs for masses, abscess, small bowl obstruction, mesenteric ischemia, appendicitis, fluid collection; IV and oral contrast used

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15
Q

Esophagogastricduodenoscopy (EGD)?

A

passage of a flexible endoscope into the esophagus, stomach, and 2cd part of the duodenum

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16
Q

are pts sedated with an EGD?

A

yes-conscious sedation

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17
Q

indications for an EGD?

A

upper GI pathology: bleeding, dysphagia, refractory GERD, dyspepsia, ulcers, anemia, reflux that isn’t responding to tx

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18
Q

risks of EGD?

A

bleeding, perforation, infxn

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19
Q

Capsule Endoscopy?

A

small camera swallowed and color images tranmit wirelessly until the camera “hits the water”

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20
Q

indication of capsule endoscopy?

A

evaluate jejumn and ileum beyond EGD

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21
Q

risk of capsule?

A

only diagnostic, not therapeutic

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22
Q

Small bowel enteroscopy?

A

similar to EGD except able to reach into proximal-mid jejumum IF spiral enteroscopy is used: can be used to perform biopsies

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23
Q

risks of small bowel enteroscopy?

A

bleeding/perforation

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24
Q

colonsocopy?

A

flexible colonoscope is passed through the anuse unto the rectum and colon-reaches cecm and frequently the terminal ileum

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25
Q

gold standard test for GI bleeding?

A

colonoscopy!!

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26
Q

indications for a colonoscopy?

A

diseases of colonic mucosa, colorectal cancer screening, anemia and a lower GIB

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27
Q

risks of a colonoscopy?

A

perforation, bleeding, discomfort

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28
Q

virtual colonoscopy

A

colorectal cancer screening with CT imagain following insufflation of the colon with air “virtual trip”

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29
Q

downside of virtual?

A

cant get a bx! only see

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30
Q

flexible sigmoidoscopy

A

similar to colonoscopy but able to reach the splenic flexure

31
Q

flexible sigmoidoscopy indications?

A

internal hemorrhoids an dlower polyps-used in rural areas w/o access to colonoscopy

32
Q

Endoscopic Retrograde Cholangio Pancreatography (ERCP)

A

A combined endoscopic and fluoroscopic procedure to evaluate the biliary and pancreatic ductal systems and openings.

Initially diagnostic, but evolved to diagnostic and therapeutic

33
Q

Indications of ERCP?

A

sphincter of oddi dysfunction, adenomas, carcinomas, bile duct sontes, cholelithiasis w/ choledocholithiasis, ductal stent placement, gallstone pancreatitis

34
Q

risks of ERCP?

A

7% morbidity, pancreatitis, hemorrhage, cholangitis, perforation and death

35
Q

what is Magnetic Resonance Cholangiopancreatography commonly used for?

A

diagnostic

36
Q

manometery?

A

pressure sensing catheter placed in the esophagus-recorded during swallowing studies

37
Q

what is manometry used for?

A

diagnosis of motility disorders (achalasia, esophageal spasm), and pre-operatively prior to anti-reflux surgery

38
Q

24 hour pH monitoring

A

dx of GERD when dz is in question despite tx or if atypical symptoms

39
Q

what is a positive pH test?

A

pH below 4 for >5% of the time

40
Q

LFTs?

A

how well the liver is fxn

41
Q

test for the liver’s SYNTHETIC FXN?

A

serum albumin and globulin, cooags

42
Q

Albumin?

A

maintains colloidal oncotic pressure, impt in blood transport of enzymes, hormones and drugs, measure of nutritional status, also indicates hepatoctye damage (damage decreases albumin synthesis)

makes of 60% of total protein

43
Q

globulin?

A

antibody building blocks

less important to oncotic pressure, categorized as alpah1-2 and Beta 1-2 globulins

marker of nutrional status

44
Q

what is the best acute measure of synthetic liver function?

A

Coags, bc of short half life and rapid turn over (such as PT/aPTT) PT is very useful though

45
Q

what test the livers excretory and detoxifying function?

A

Serum Bilirubin

46
Q

What is bilirubin derived from?

A

breakdown of RBCs where by HgB is released and broken into heme and globuin. hem–> bilirubin in splin

47
Q

What is unconjugated bilirubin?

A

initial form of bili from the spleen (before it goes to liver-usually elevated by of hemolytic disorders)

48
Q

What is conjugated bilirubin?

A

in liver, conjugated with glucoronide.

49
Q

What does elevated bilirubin mean?

A

liver or biliary dz- bile excretion problem!!

50
Q

What does urine bilirubin indicate?

A

obstructive problem that causes hyperbilirubinemia– (conjuaged bilirubin is water soluble) makes pee orange!!

51
Q

Blood ammonia?

A

produced during protein metabolism and colonic flora–means that pts w/ liver dz may have muscle wasting and increased ammonia levels

52
Q

What does elevated blood ammonia indicate?

A

encephalopathy or occule hepatic dz w/ mental status changes

53
Q

Liver Serum enzymes

A

AST, ALT

54
Q

Where is AST found?

A

skeletal and cardiac muscle, brain, kidneys , lungs

55
Q

ALT found?

A

liver and is a specific marker of liver injury

56
Q

what do extremely elevated liver enzymes indicate?

A

damage– hepatitis!

57
Q

what does increased levels of Alkaline phosphate indicate?

A

secreted by Kupffer cells; indicates either intra or extra hepatic obstruction and cirrhosis

58
Q

What is the most sensitive test for tumor liver metastasis?

A

Alkaline phosphatase

59
Q

What is the most sensitive enzyme for detecting biliary obstruction, cholangitis, or cholecysitis?

A

gamma-glutamyl transferase (also detect chronic EtOH use)

60
Q

What is 5’nucleotidase?

A

similar to alk. phosphatase, but specific to liver?

61
Q

What is the main cause of duodenal ulcers

A

H. pylori (and Nsaids)

62
Q

How do you detect H pylori?

A

Antibody tests! IgG anti-H.pylori antibody is most used- elevates2 mnths after infx and stays elevated for 1 yr after tx

63
Q

What is the urea breath test?

A

-non-invasive test of choice for diagnosing H. pylori infection.
-Indicated for chronic or recurrent gastric or duodenal ulcers/inflammation.
H. pylori metabolize urea to CO2 via produced urease.
- The patient ingests carbon labeled urea which the gastric mucosa absorbs. If H. pylori are present, urea is converted to CO2 which stomach capillaries uptake and circulate to the lungs. The labeled carbon is measureable through exhalation by gas chromatography.
Samples are collected before and 30 minutes after carbon/urea ingestion.

64
Q

Why do you test for amylase?

A

helps detect and monitor course of pancreatitis. damage to cells/blockage leads to increased amylase and excess enzyme picked up by peritoneal vessels

elevates in 12 hours from dz onset, normalizes in 48-72.

sensitive but not specific!

65
Q

Why do you test for lipase?

A

evaluating pancreatic dz-most commonly acute pancreatitis

levels rise later compared to amylase and stay elevated longer

more useful in late dz of pancreatisi

**ordered more frequently than amylase

66
Q

HAV testing?

A

IgG and IgM, but most infxns not severe enough for medical tx

67
Q

HBV testing?

A

incubation 5wks to 6 mnths

**core and surface!

HbcAB and HBsAB

68
Q

What is most common and easiest HBV ab to test for?

A

HBsAG- first test to be abnormal before symptom onset=active infxn!!

69
Q

HBcAB?

A

marker of chronic infection

70
Q

HBV-DNA?

A

RT-PCR method of quantifying viral load- antiviral tx

71
Q

Hep C?

A

more commonly transmitted through blood transfusions!!

Incubation 2-12 wks after exposure (much more chronic and slowly progressive)

72
Q

how do you check for HCV?

A

screening test anti-HCV antibodies to HCV recombinant core antigen

detected w/ in 4 weeks

RNA-viral load

73
Q

HDV?

A

HDV antigen in first days

IgM and total HDV antibodes also detectable

GI (inpt) (16 decks)

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