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CD III > Lecture 9- Abd US/CT Imaging > Flashcards

Lecture 9- Abd US/CT Imaging Flashcards

1
Q

blunt vs penetrating trauma

A
  • blunt: MVC, falls (tend to be multi-system and have higher risk mortality than penetrating)
  • penetrating: gunshot, stabbing
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2
Q

roadblocks to good history

A
  • EtOH
  • severe trauma
  • substance abuse
  • developmental delay
  • psychiatric illness
  • overlapping pain symptoms
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3
Q

most common abd imaging modalities

A

US/CT

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4
Q

describe FAST exam

A
  • US done bedside by ED or trauma provider
  • used as initial screening to evaluate for solid organ injury and intra-abd bleeding
  • poorly evaluates hollow viscus injury
  • does not exclude injury in blunt/penetrating traumas if negative
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5
Q

6 places to do FAST exam

A
  • R & L anterior chest
  • RUQ/LUQ
  • sub-xiphoid
  • suprapubic
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6
Q

CT scan types

A
  • Non contrasted: do if contrast allergy, stone, renal insufficiency
  • IV contrast: study of choice, identify devascularized areas, hematomas, active extravasation of blood, extraluminal urine
  • rectal, oral
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7
Q

Sx of contrast dye

A
  • most common sx: itching, warmth, n/v, site irritation, hives, laryngeal irritation
  • Acute tubular necrosis (24-48hrs post injection, fluids to mitigate risk, anuric ESRD ok for contrast)
  • can premedicate w/ 40mg Solumedrol + 50mg Benadryl
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8
Q

contrast complication- extravasation

A
  • toxic to tissues (compartment syndrome, necrosis, ulceration)
  • treat like burn, may require rad and surgical consult
  • elevate + cold compress
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9
Q

considerations for contrast dye w/:
* metformin use
* pregnancy
* breastfeeding

A
  • metform: hold for 48hrs post CT due to risk of lactic acidosis/renal or liver failure
  • pregnancy: crosses placenta, limited data on harm; if emergent do it, if non-emergent US preferred
  • breast feeding: < 0.01% absorbed into milk, can pump & dump for 1d if concerned
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10
Q

describe mild allergic rxn

A
  • typical: limited urticaria, itchy/scratchy throat, nasal congestion, sneezing, rhinorrhea, conjunctivitis
  • additional: mild HTN, HA, dizziness, anxiety, altered taste, flushing/warmth
  • typically is limited/transient
  • vasovagal rxn which resolves spontaneously
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11
Q

describe moderate contrast rxns

A
  • typical: diffuse urticaria/prutitis, erythema w/ stable vitals, facial edema w/out dyspnea, throat thightness or hoarseness, wheezing
  • additional: protracted n/v, hypertensive urgency, isolated CP
  • requires tx to fix
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12
Q

describe severe contrast rxns

A
  • typical sx: diffuse edema, dyspnea, erythema w/ hypotension, laryngeal edema w/ stridor, hypoxia, wheezing, bronchospasm, anaphylactic shock
  • additional: cardaic arrhythmia, seizure, HTN emergency
  • resistance to tx
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13
Q

urticaria tx

A
  • diphenhydramine or fexofenadine
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14
Q

facial or laryngeal edeam tx

A

epinephrine

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15
Q

bronchospasm tx

A
  • beta-2 agonists
  • epinephrine
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16
Q

hypertensive crisis tx

A
  • labetolol
  • nitroglycerin
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17
Q

hypotension unresponsive to fluid tx

A

epinephrine

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18
Q

pulmonary edema tx

A

lasix (furosemide)

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19
Q

seizure tx

A

lorazepam

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20
Q

Liver injuries

A
  • most common site of injury
  • most common cause of death (perhepatic hemorrhage, intraperotneal, extraperitoneal hemorrhage)
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21
Q

splenic injuries

A
  • most often injured in deceleration injuries
  • most vascular organ
  • CT is study of choice for eval of splenic trauma
22
Q

common CT findings in splenic trauma

A
  • Subcapsular hematoma: low attenuation, crescent-shaped collection of fluid in supcapsular space that compresses normal splenic parenchyma
  • Laceration: irregular, low attenuation defect that typically transects spleen
  • Intraparenchymal hematoma: lacerations filled w/ blood; intrasplenic, rounded areas of low attenuation that may have mass effect & enlarge the spleen
  • Contusion: alterations in normal homogenous appearance of spleen (mottled areas of low attenuation)
  • Intraperitoneal fluid/blood: hemoperitoneum occurs w/ almost all splenic injuries also producing small amounts of blood in pelvis
23
Q

kidney injury

A
  • MVC most common cause of blunt trauma
  • most renal injuries will have hematuria
  • contrast enhanced CT is study of choice
24
Q

shock bowel CT findings

A
  • diffuse wall thickening
  • increased bowel wall enhancement
  • IVC/aorta smaller
  • decreased splenic perfusion
  • severe hypovolemia and hypotension
25
Q

bowel perforation injuries

A
  • penetrating or blunt trauma
  • free air w/out surrounding bowel wall
  • fluid in abd cavity
26
Q

bladder injuries

A
  • 70% of bladder ruptures occur w/ pelvic fractures
  • 10% of pts with pelvic fractures have a bladder rupture
  • CT cystogram (foley catheter under gravity) or IV contrast
27
Q

types of bladder rupture

A
  • Extraperitoneal: extraluminal contrast remains around bladder, esp retropubic space; pelvic fracture w/ direct puncture of bladder
  • Intraperitoneal: result of forceful blow to the pelvis w/ distended bladder; usually occurs at dome of the bladder adjacent to peritoneal cavity, contrast runs through peritoneal cavity, surrounds bowel, and extends into paracolic gutters
28
Q

urethral injuries

A
  • more common in males
  • blunt trauma, penetrating around urethra, or straddle fracture
  • hematuria, blood at urethral meatus, inability to void
  • retrograde urethrography (RUG)
29
Q

diaphragm injuries

A
  • 5% of trauma
  • L injuries more common than R
  • herniation of content into thoracic cavity
  • rarely an isolated injury
  • “collar sign”
30
Q

pancreatic injuries

A
  • less common
  • penetrating more common than blunt
  • unlikely to be isolated
  • high likelihood of damage to pancreatic duct
31
Q

Pancreatitis

A
  • clinical diagnosis w/ CT to find a cause (ex gallstones) or complication
  • most commonly caused by alcoholism and gallstones
32
Q

acute pancreatitis on CT

A
  • enlargement of all or part of pancreas
  • peripancreatic stranding or fluid collections
  • complications: necrosis, pseudocyst
33
Q

chronic pancreatitis CT findings

A
  • continuous and irreversible usually due to alcohol abuse
  • fibrosis, atrophy of gland, ductal dilatation, DM
  • multiple calcifications
34
Q

localized ileus CT findings

A
  • dilated loops
  • usually secondary to inflammation of adjacent organ
  • RUQ: cholecystitis
  • LUQ: pancreatitis
  • RLQ: appendicitis
  • LLQ: diverticulitis
  • mid abdomen: ulcer/kidney/ureteral calculi
35
Q

generalized ileus CT/XRAY

A
  • entire bowel is air containing and dilated
  • absence of peristalsis and continued production of intestinal secretions usually produce many long air-fluid levels in bowel
  • not mechanism obstruction, so there is gas in rectum/sigmoid colon
  • bowel sounds absent/hypoactive
  • post op or electrolyte imbalance
36
Q

causes of small bowel obstructions

A
  • adhesions
  • malignancy
  • hernia
  • gallstone ileus
  • intussusception
  • IBD
37
Q

describe small bowel obstructions

A
  • lesion, either inside or outside small bowel, obstructs lumen
  • from point of obstruction backward, small bowel dilates from continuously swallowed air and intestinal fluid that is still produced by digestive organs
  • peristalsis continues and may increase in an effort to overcome obstruction (leads to hyperactive, high pitched bowel sounds)
  • as time passes, peristaltic waves empty the small bowel along the colon of their contents from point of obstruction forward
38
Q

CT findings SBO

A
  • fluid filled and dilated loops of small bowel (>2.5cm in diameter) proximal to point of obstruction
  • identification of transition point (dotted white arrow) which is where bowel changes caliber from dilated to normal indicating site of obstruction
39
Q

LBO clin med

A
  • colon dilated to point of obstruction (sometimes possible to identify site of obstruction as last air containing segment of colon; regardless of point of obstruction, cecum is often most dilated part)
  • risk of cecal rupture at 12-15cm
  • small bowel not dilated
  • rectum does not contain air
40
Q

LBO CT findings

A
  • dilated to point of obstruction then normal in caliber distal to obstructing lesion
41
Q

Colitis

A
  • inflammation of large bowel
  • clinical history is key
  • segmental thickening of bowel wall w/ irregular narrowing of bowel lumen due to edema
  • accordion sign
42
Q

Diverticulosis

A
  • herniation of mucosa and submucosa through defect in muscular layer
  • generally asx but can become inflammed and bleed (most common cause of massive lower GI bleeding)
43
Q

diverticulitis CT findings

A
  • colon wall thickening
  • pericolonic inflammation
  • can perforate or form abscess
44
Q

Appendicitis

A
  • RLQ pain
  • dilated appendix w/ inflammation around
  • perforation occurs in up to 30% of pts
45
Q

AAA

A
  • aneurysm: localized dilated of artery by 50%+ normal size
  • normal aorta: 3cm
  • most aneurysms occur in abd aorta inferior to the origin of the renal arteries and frequently into one or both iliac arteries
46
Q

AAA- imaging

A
  • US screening test of choice
  • size of an aneurysm is directly related to risk of rupture
  • less than 4cm: less than 10% chance of rupture
  • 4-5cm: 25% chance of rupture
47
Q

Aortic dissection

A
  • convention radiographs not sensitive enough to be diagnostically relaible (widened mediastinum, left pleural effusion)
  • CTA is study of choice
  • left apical pleural cap of fluid/blood
  • loss of normal shadow of aortic knob
  • increased deviation of trachea or esophagus to R
48
Q

type A vs type B dissections

A
  • A: ascending aorta, surgery
  • B: descending aorta, medical management
49
Q

PID

A
  • ovaries are enlarged w/ multiple cysts and periovarian inflammation
  • fallopian tubes may be fluid filled and dilated (pyosalpinx)
  • multi-loculated mass w/ separations
  • US is image of choice; CT for complicated pts or whose HPI doesn’t strongly suggest PID
50
Q

Ovarian cysts

A
  • majority of ovarian cysts in premenopausal women are functional cysts (increase follicular and corpus luteal cysts)
  • dx via XR, CT, US
51
Q

differentiate follicular and corpus luteal cysts

A
  • follicular: forms when non-dominant follicle fills w/ fluid and doesn’t rupture
  • corpus luteal: when corpus luteum fills with fluid (corpus luteum forms after egg is expunged from dominant ovarian follicle)

CD III (12 decks)

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