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Unit 1 Clin Med III > L1: GI diagnostics > Flashcards

L1: GI diagnostics Flashcards

1
Q

Indications for Xray

A 
Abdominal pain
N/V
Intestinal obstruction
Perforation
Intussusception
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2
Q

3 views for an abdominal xray

A
  1. Anterior/posterior while supine (KUB)
  2. Upright: better visualization of air-fluid levels
  3. PA CXR: see free air under hemidiaphragms, check chest pathology
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3
Q

Appearance of obstruction on xray?

A

Dilated bowel proximal to obstruction with collapsed bowel distally

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4
Q

Appearance of small bowel obstruction on xray?

A

Upright→ multiple air fluid levels arranged in inverted U’s

Supine→ distended small bowel loops, thickened/edematous bowel walls, no air in colon or rectum

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5
Q

Appearance of paralytic ileus on xray?

A

non mechanical bowel obstruction→ dilated bowel, gas in both small and large intestines
→ air mixed with stool
→ haustral fold in apex of sigmoid colon

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6
Q

Appearance of perforation on xray?

A

free air under diaphragm→crescents

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7
Q

Appearance of intussusception on xray?

A

signs of obstruction, swelling, decreased blood flow, obstruction, tissue damage

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8
Q

Hypoechoic means…

A

Dark on echo

Aorta, bile ducts, abscesses, cysts

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9
Q

Echogenic means….

A

White on echo/solid

Tumors

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10
Q

Indications for abdominal ultrasound

A 
Abdominal pain
Elevated LFTs
Known/suspected liver disease
Status post transplant: liver, kidney, pancreas
Renal failure
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11
Q

Liver pathology visible on ultrasound

A 
Cysts (black air)
abscesses
tumors
cirrhosis
Dilated bile ducts
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12
Q

Test of choice for cholecystitis, cholithiasis

A

Abdominal ultrasound

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13
Q

Gallbladder pathology visible on ultrasound

A 
Tumor
polyps
stones
sludge
Inflammation (wall thickening)
Pericholecystic fluid
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14
Q

Pancreas pathology visible on ultrasound

A

Cysts
abscesses
tumors
Inflammation

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15
Q

Indications for CT scan abdomen/pelvis

A 
Abdominal pain
Abdominal distention
N/V/D/C
Rectal bleeding
Jaundice
CT angiography→ GI bleeds, embolization procedures
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16
Q

CT scan abdomen/pelvis uses ___ contrast

A

IV or PO iodine-contrast

Renal stone study→ NO contrast

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17
Q

Liver pathology visible on CT scan abdomen/pelvis

A 
Cysts
abscesses
tumors (metastatic)
bile duct obstruction
hepatomegaly
Laceration→ linear low-attenuation defect (black air)
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18
Q

Gallbladder pathology visible on CT scan abdomen/pelvis

A

Cholcystitis, cholithiasis

→ edematous and hyperemic wall, inflammatory induration of fat surrounding gallbladder. Calcified stones

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19
Q

Pancreas pathology visible on CT scan abdomen/pelvis

A

Cysts
Abscesses
Tumors
calcification
Acute pancreatitis→ inflammation and swelling
Chronic pancreatitis→ white calcifications
GI tract/bowel

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20
Q

GI tract/bowel pathology visible on CT scan abdomen/pelvis

A 
Tumor
obstruction
perforation
inflammation
appendicitis
bleeding
impacted stool
distended colon
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21
Q

Spleen pathology visible on CT scan abdomen/pelvis

A

Tumor
laceration
hematoma
splenic vein thrombosis

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22
Q

Abdominal aorta pathology visible on CT scan abdomen/pelvis

A

Visualize aneurysm

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23
Q

Test of choice for pancreatitis

A

CT scan abdomen/pelvis

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24
Q

HIDA scan definition

A

Patient receives radioactive tracer: Technetium labeled hepatic imilodiacetic acid→ taken up by liver→ excreted into bile
Nuclear scanner tracts flow

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25
HIDA scan aka
GB nuclear scan Cholescintigraphy Hepatoiminodiacetic Acid scan
26
HIDA scan indications
Acalculous Cholecystitis | Order with CCK stimulation and ejection fraction of the gallbladder
27
HIDA scan contraindications
Pregnancy
28
Affects the ejection fraction of the gallbladder
Morphine
29
HIDA scan will show ______ if the cystic duct is patent
tracer visualized in gallbladder
30
HIDA scan will show _____ if there is stone or edema causing obstruction
tracer not visualized in gallbladder→ (+) test
31
HIDA scan will show _____ in cholecystitis cases
no radionuclide seen in gallbladder within 15-60 minutes ejection fraction <35% test reproduces patient’s symptoms
32
Upper GI series definiton
Drink barium sulfate contrast + fluoroscopy (continous xray)→ visualize esophagus, stomach, duodenum
33
2 different versions of a UGI
Esophagram/barium swallow | Small bowel follow through
34
What contrast should be used in case of suspected perforation?
water-soluble gastrin
35
Indications for UGI
``` Dysphagia GERD symptoms Early satiety Suspected peptic ulcer disease Suspected obstruction/inflammation ```
36
2 possible complications of UGI
Aspiration of barium | Barium can cause constipation
37
Contraindications to UGI
Pregnancy Complete bowel obstruction Unstable vital signs
38
Can be seen on UGI
``` Diverticula Extrinsic compression Hiatal hernia Cancer Filling defects, bezoar Perforation Gastric ulcer ```
39
What does a bezoar look like on UGI?
barium remains in bezoar while exiting the rest of stomach
40
What does perforation look like on UGI?
Leakage of contrast outside of UGI trace
41
What does a gastric ulcer look like on UGI?
Thin, straight line at neck ulcer representing thin rim of undermined gastric mucosa
42
What does a hiatal hernia look like on UGI?
Portion of stomach above diaphragm | Causes increased risk of reflux→ Barrett’s esophagus→ cancer
43
What does cancer look like on UGI?
Strictures, obstructions, tumors, ulcerations
44
What do filling defects look like on UGI?
Displacement of contrast by space-occupying tumor in a hollow viscus
45
Lower GI series aka
Barium enema
46
Risks/complications of a lower GI series
Perforations | Barium→ fecal impaction
47
Why might a barium enema be used?
Alternative to colonoscopy | Reduce non-strangulated ileocolic intussusception
48
Lower GI series contraindications
Pregnancy Megacolon Unstable vitals
49
Can be seen on a lower GI series
``` Ulcers Diverticula Extrinsic compression Perforation Inflammatory bowel disease Cancer ```
50
What does cancer look like on a lower GI series?
``` Strictures obstructions filling defects tumors ulcerations ```
51
Waht does IBS look like on a lower GI series?
Narrowing of barium column due to inflammation of surrounding colon→ “Apple core lesion”
52
What does Ulcerative Colitis look like on a lower GI series?
absent bowel folds (chronic)
53
Esophagogastroduodenoscopy (EGD) definition
Direct visualization of esophagus, stomach, first part of duodenum with long, flexible, fiber optic lighted scope under conscious sedation. Can perform biopsy for histology.
54
Risks/complications of EGD
Perforations Bleeding from biopsy Aspiration of gastric contents Oversedation
55
EGD indications
``` Diagnostic and therapeutic N/V, abdominal pain Dyspepsia Chronic GERD Dysphagia Esophageal varices Hematemesis, melena Iron deficiency anemia Abnormal UGI Suspected enteropathies (celiacs) Foreign body/food bolus Alarm symptoms ```
56
Alarm symptoms are....
Dysphagia, weight loss, early satiety, epigastric pain
57
EGD may show...
``` Hiatal hernia Barrett’s esophagus Tumors Polyps Varices Obstruction Mucosal inflammation Ulcers Web’s rings (Schatzki’s ring) Infection (candida, HSV, H pylori) Arteriovenous (AV) malformations ```
58
Contraindications to EGD
Uncooperative patient Bleeding Esophageal diverticula→ increased risk of perforation Suspected perforation→ can be worsened by insufflation of pressurized air Recent upper GI tract surgery→ weak anastomosis site
59
Endoscopic Retrograde cholangiopancreatography (ERCP) definition
Fiberoptic endoscope + catheter inserted into biliary duct→ radiographic dye injected→ x rays→ visualize bile and pancreatic ducts
60
Risks to ERCP
Pancreatitis, Perforation G- bacteremia/sepsis Aspiration of gastric contents Oversedation
61
Therapeutics uses of ERCP
``` Perform sphincterotomies remove stones place stents obtain brushings/biopsies Remove gallstones via incision to widen ampulla of vater/common bile duct ```
62
Contraindications to ERCP
Uncooperative patient | Previous GI surgery with inaccessible ampulla of Vater
63
What might you order to visualize the biliary tree and pancreatic ducts before doing ERCP?
MRCP cholangiopancreaotgraphy
64
Indications for ERCP
Obstructive jaundice Mass Choledocholithiais Cholangitis
65
Colonoscopy definition
Bowel prep + Long flexible fiberoptic-lighted scope + conscious sedation→ visualize rectum, colon, terminal ileum
66
Flexible sigmoidoscopy is a colonoscopy that only explores the....
rectum and sigmoid colon
67
Indications for colonoscopy
``` Colon cancer screen→ remove, biopsy polyps Potential colon cancer symptoms Diarrhea Prior abnormal test Foreign body removal Decompression of volvulus ```
68
Potential colon cancer symptoms
change in bowel habits hematochezia iron deficiency anemia
69
Possible colonoscopy findings
``` Congestion Ulcers Edema Lack of normal folds Colon cancer Bleeding diverticulum ```
70
How is bleeding diverticulum treated if found on colonoscopy?
Inject with epi cauterize tattoo with india ink
71
Contraindications to colonoscopy
``` Uncooperative patient Severe rectal bleeding Suspected perforation Recent colon surgery Toxic megacolon Active diverticulitis or colitis ```
72
Complications of colonoscopy
Perforation Bleeding due to biopsy or polypectomy Oversedation
73
Cologuard is...
Colon cancer screening test Non-invasive stool test with DNA markers and immunochemical test for hemoglobin in the stool Guidelines recommend every 3 years

Unit 1 Clin Med III (7 decks)

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