Week 2 Flashcards
(128 cards)
1
Q
Name the different types of GI fluoroscopic studies
A
Barium Swallow / Meal / Follow Through / Enema & Small Bowel Enema
FMESS
2
Q
Where do most GI problems occur at
A
Lower thoracic esophagus / esophagogastric junction
3
Q
Indications for Barium Swallow
A
DAP: Dysphagia, Anemia, Pain during Swallowing
4
Q
Contraindications for Barium Swallow
A
GIT perforations that leak into peritoneum leading to:
- high morbidity
- hypovolemic shock
- peritoneal adhesions
Intravsation
Constipation
5
Q
Difference between absolute & relative contraindications
A
Absolute means that it is life threatening whereas relative means that it is acceptable if benefits outweigh risks
6
Q
If barium swallow is contraindicated, what is another alternative
A
Contrast swallow using gastrografin
7
Q
Indications for contrast swallow
A
LAS GAS
- Suspected lower GIT perforation
- short period after operation
- acute hemorrhage
- gastrocolic fistula
- localizing FB / tumor before endoscopy
- acute condition which needs surgery
8
Q
Contraindications for gastrografin swallow
A
- Any GI studies involving infant / toddler as it increases risk of dehydration
- tracheoesophageal fistula which can cause pulmonary edema
9
Q
What is the solution to tracheoesophageal fistula
A
Use other water soluble iodinated contrast LOCM to replace gastrografin which is safer but more expensive
10
Q
Barium sulphate is mainly used in __
A
GI tract exams
11
Q
What are the benefits of Barium Sulphate
A
- cheap
- better coating properties than iodinated contrast
- inert & stable without dissociation
12
Q
How to prepare for barium swallow
A
Decap > add 50ml warm water for thicker suspension > recap & shake
13
Q
How to prepare for Barium meal & FT
A
Decap > add 65ml warm water for thinner suspension > recap & shake
14
Q
What are the advantages of thicker Barium
A
Better coating power & assists passage as bolus to distend the tract better
- helps to look for external compression better
15
Q
What are the disadvantages of thick Barium
A
May mask lesions & residues might mimic lesions
16
Q
Describe the swallow study procedure
A
- Patient upright & fed Barium / Gastrografin
- Hold mouthful of contrast till before exposure to demonstrate deglutition
- Swallow contrast in bolus during normal breathing
- Swallow contrast in rapid succession to demonstrate entire esophagus
17
Q
What techniques help to demonstrate esophageal varices
A
- Fully expiration & swallow Ba in bolus while avoiding inspiration till exposure made
- Take deep breath & while holding breath, swallow bolus & perform valsalva maneuver
- Change from upright to recumbent position to demonstrate varicella dissensions of esophagus veins
18
Q
What technique is used to demonstrate esophageal reflux
A
Patient lies supine with head down
19
Q
What spot images are taken by radiologist for Ba Swallow
A
- RAO/LPO or R/L Lateral in upright position
- AP/PA in upright position
- Supine with head down
20
Q
What is the purpose of RAO/LPO position
A
Place patient in RAO to offset esophagus from spine. LPO used if patient cannot tolerate RAO
21
Q
What is the aftercare for Ba swallow
A
Patient warned of white fecal matter for next few days & advised to drink lots of water
22
Q
VFSS
A
Video fluoroscopic swallow study
23
Q
OPMS
A
Oropharyngeal Motility Study
24
Q
What does VFSS examine
A
Simulates habitual swallowing behavior in patients with dysphagia
25
What are focused sites of VFSS
Oral cavity, oro/naso/hypo-pharynx, larynx & cervical part of esophagus
26
VFSS Limitations
- Time constraints
- does not full represent mealtime function as it only samples swallowing function
- Contrast is higher viscosity & different composition from real food
- limited evaluation of fatigue effect on swallowing
- Barium is unnatural food bolus with potential fro refusal by patient
27
Indications for VFSS
- Assess epiglottis closure & integrity of airway protection
- Assess effectiveness of diff postures, manoeuvres, bolus modifications, food viscosity to improve swallowing
28
Contraindications for VFSS
- medically unstable / uncooperative patients
- if info is unlikely to change patient management such as end of life
- patient unable to be adequately positioned
29
When is upright position for VFSS precluded
- low BP
- acute stroke
- spinal cord injury bracing
- skeletal limitations
30
How are patients positioned for VFSS
Side lying / usual eating position
31
Purpose of Ba biscuit
Test strength of tongue base & chewing
32
Reducing viscosity of Ba increases risk of __
Aspiration
33
Where do most elderly fail during VFSS
Thin barium liquid
34
VFSS procedure
1. Patient in true lateral & clear Al wedged shaped filter softens exposure over anterior part of neck
2. Relax both shoulders & apply tight collimation
3. Take fluoroscopy per ST request
35
Generally, there is no aftercare for VFSS except if ___
- CXR if aspiration suspected
- book physiotherapy to do percussion to expel Ba & Food content
36
Indications for barium meal
DAP GUS
- dyspepsia
- sudden weight loss
- upper abdominal mass
- GI hemorrhage
- partial obstruction
- assess perforation site
37
Contraindications of Barium meal
- Complete large bowel obstruction
- suspected bowel perforation
38
Ba Meal Patient Prep includes
- NPO for 8 hours before exam (overnight)
- no smoking & chewing gum
39
Why is smoking & chewing gum not allowed
Reduces gastric motility > stimulates gastric secretion & salivation > excess fluid in stomach on exam day
40
Purpose of buscopan
Inhibits gastric secretion by relaxing stomach smooth muscles
41
what does Ba meal preparation use
double contrast technique which involves:
- EZ-HD
- Gas Producing Agent (Baros 3gm)
42
when should one use single contrast technique
infant/children
- not necessary to demonstrate mucosal fold patterns
DIL adult
- demonstrate gross pathology only
43
Ba meal procedure starts with __
1. patient erect / sitting on couch and given Baros granules with small amounts of Ba
2. After 2-3 bolus of Ba, patient lies supine and roll over on table a few times
44
what is the purpose of asking the patient to lie supine & roll over using Ba meal
coats mucosal lining of stomach as CO2 continues to expand
45
what should one be cautious of when patient lies supine & roll over using Ba meal
- risk of kinking & dislodging of tubing
- patient falling
- patient cannot turn
46
what position is used to demonstrate hiatal hernia & esophageal regurgitation using Ba meal
recumbent position with head down
47
types of hiatal hernia
type 1 sliding
type 2 rolling
type 3 mixed
48
what does RAO supine demonstrate using Ba meal
antrum & greater curve of stomach
49
what does LAO supine demonstrate using Ba meal
lesser curve of stomach
50
what does PA supine demonstrate using Ba meal
antrum + body of stomach
51
what does AP prone demonstrate using Ba meal
duodenal loop
52
what does erect demonstrate using Ba meal
fundus of stomach
53
what does erect RAO/LAO demonstrate using Ba meal
Caps
54
what does swallow RAO demonstrate using Ba meal
oesophagus
55
Ba meal aftercare includes __
1. encouraging fluid intake & warn stool may be white but is normal
2. patient cannot leave till any blurring of vision by buscopan has been resolved
3. instruct patient to go to A&E if still unwell
56
purpose of the contrast/Ba follow through is to __
produce images of small intestine
57
indications of Ba follow through
MAD FAP
- partial obstruction
- abdominal pain/mass
- diarrhea
- anemia
- malabsorption
- failed small bowel enema
58
contraindications of Ba follow through
- complete obstruction
- suspected perforation
- problems related to Ba solution
59
patient prep for Ba follow through
- NPO 8 hrs before exam
- low residue diet for 2 days before exam to reduce gas formation from excess fermentation of intestinal contents
60
procedure for infant Ba follow through
CM injected via feeding tube in-situ at duodenum
61
procedure for adult Ba follow through
drinking Ba
feeding tube used if patient cannot swallow Ba/Contrast adequately
62
how much Ba contrast must be fed for Ba follow through
100 - 150mL by spoon / cup / straw using EZ HD & ioparimo/omnipaque 1:1 dilution
63
patient position after contrast ingestion of Ba follow through
patient lies on right side to facilitate CM from stomach to duodenum
64
what series of AXR spot films are used to trace migration of CM in small intestine for follow through
20 mins, 40 mins, 1 hr, 2 hr, 4 hr
65
what positions can be used for better separation of bowel loops for follow through
oblique / tube tilted into pelvis / patient tilted head down
66
why is prone position preferred
patient's own weight acts as a compression
67
during Ba follow through, remember not to reduce kVp setting to ___
- penetrate Ba
- increase further for thicker patients
68
aftercare of follow through includes __
1. patient warned of white poop
2. patient advised to drink adequately
3. laxatives provided
69
indications for SBE
MAD FAP
- Partial obstruction
- Abdominal Pain/mass
- Diarrhea
- Anemia / GI
bleeding
- Mal-absorption
- Failed FT
70
contraindications of SBE
completed obstruction & suspected perforation
71
instrument used for SBE
bilbao dotter tube with guide wire / silk tube
10F 140cm long tube with tungsten filled guide tube
72
what double contrast is used for SBE
Ba & methylcellulose
73
patient prep for SBE
- low residue diet 2 days before exam
- NPO 8 hrs before exam
- pharynx anesthetized using xylocaine immediately before exam
74
advantages of SBE over FT
avoids obscuring small bowel by BA filled upper GI tract & pyloric control over rate of Ba transit
75
prelim film for SBE
supine abdomen
76
where does the tube pass through till for SBE
from nose/mouth > pylorus > duodenal jejunal flexure
77
SBE aftercare includes __
NPO 5 hrs after procedure to avoid risk of choking due to local anesthesia
possible diarrhea due to large volume of fluids given
78
indications of Ba enema
- change in bowel habit
- abdominal pain/mass
- anemia
- obstruction
79
absolute contraindications of Ba enema
- toxic megacolon
- pseudomembranous colitis
- rectal biopsy
80
relative contraindications of Ba enema
- incomplete bowel prep
- recent Ba meal
- patient health is poor
81
patient prep for Ba enema
- low residue diet 3 days before exam
- day prior to exam, take fluids only & laxatives
82
purpose of adhesive tape / hypafix for Ba enema
secures tube in-situ to anus
83
purpose of spare polibar for Ba enema
topping up for large colon
84
drugs kept on standby for Ba enema
buscopan, glucagon
85
advantages of buscopan
- immediate action
- short duration
- cheap
86
side effects of buscopan
* Vision blur
* Dry mouth
* Tachycardia
* Urinary retention
* Acute gastric dilatation
87
contraindications of buscopan
* Glaucoma
* Gravis
* Pyloric stenosis
* Benign Prostate
Hypertrophy
88
advantages of glucagon
* More potent
* Short duration
* Not interfere with bowel transit time
89
side effects of glucagon
* Long onset waiting time (1min)
* Cost
90
contraindications of glucagon
* Pheochromocytoma (too much
epinephrine production)
* Insulinoma (hyperglycemia)
91
Ba enema procedure starts with __
1. patient lying supine in left lateral decubitus
2. insert tip into rectum
3. secure end of catheter using adhesive tape
4. infuse Ba by gravity into patient in prone position
5. intermittent screening using collimated cone view
6. terminate infusion when Ba reaches mid transverse colon / near hepatic flexure then ask patient to lie on their right to collect Ba in hepatic flexure
7. lower down infusion bag & tilt table upright such that excess Ba within rectum & sigmoid colon runs back due to gravity
8. patient blows out Ba gently & pump air into bowel
92
for Ba enema, if the large intestine is very long, where should one terminate infusion of Ba
hepatic flexure
93
what happens if there is too much Ba in hepatic flexure?
aggregation of Ba occurs
94
the purpose of pumping air into the bowel is used to __
1. help force Ba towards caecum
2. double contrast effect
3. inflate large intestine
95
when should muscle relaxants be used for Ba enema
inhibits intestinal motility (Ba enema) & gastric secretion (Ba meal)
relieves pain / spasm due to gas inflation
96
Ba enema film series for upright position
erect AP / LPO / RPO AXR
97
Ba enema film series for supine position
- supine AXR
- prone KUB
- prone caudal rectum
98
purpose of prone KUB for supine patients Ba enema
better disperses bowel to focus on KUB
99
purpose of caudal rectum for supine patients Ba enema
elongates / separates overlapping sigmoid colon
100
Ba enema film series for tabletop with grid
- right lateral decubitus AXR
- left lateral decubitus AXR
- horizontal lateral rectum
101
Ba enema film series for post evacuation KUB
functional study
102
Ba enema aftercare includes __
1. patient warned of white poop
2. encourage drinking more water
3. must not leave department till blurring of vision by buscopan resolved
103
complications of Ba enema
TOPICS
* Perforation
* Obstruction (impacted Barium)
* Intramural barium
* Cardiac arrhythmia
* Transient bacteraemia
* Side effects of pharmacological agents used
104
FNAC
fine needle aspiration cytology
105
biopsy includes __
FNAC & Tru Cut Core
106
drainage includes __
abscess, cyst, pleural effusion, pus, ascites
107
indications for FNAC & Tru Cut Core Biopsy
- sampling for disease
- gold standard for cell differentiation such as nature & extent of disease
108
contraindications for FNAC & Tru Cut Core Biopsy
abnormal coagulation profile such as
- elevated PT
- elevated APTT
- reduced platelet count
- low PC
109
PT
prothrombin time
110
APTT
activated partial thromboplastin time
111
PC
prothrombin concentration
112
common sites for FNAC & biopsy are
Neck, kidney, liver, lungs
- adrenal mass
- breast lesion
- liver mass
- pulmonary mass
- renal mass
- thyroid nodule
- neck mass
- neck lymph node
113
FNAC uses ___ spinal needles for __
20 - 22G; cell types & structure
114
TruCut Core Biopsy uses ___ biopsy needles for ___
16 - 18G; cell differentiation
115
patient prep for FNAC & TruCut Core Biopsy
normal bleeding profile & biopsy done to sterilize puncture site & drape surrounding area
116
what is the risk of FNAC
risk of seeding tumors / spreading tumor tissue
117
aftercare for FNAC & biopsy
compress puncture site for 10 mins
118
complications of FNAC & biopsy
- pain & discomfort
- hemorrhage
- pneumothorax
119
what can be used to help small abscesses / fluid collections besides percutaneous drainage
antibiotics but not effective against larger collections
120
purpose of percutaneous drainage
obviate / delay major operation
121
indications of percutaneous drainage
presence of abscess / cyst / pleural effusion
122
contraindications of percutaneous drainage
abnormal coagulation profile such as
- elevated PT
- elevated APTT
- reduced platelet count
- low PC
123
patient prep for percutaneous drainage
- normal bleeding profile
- fasting 6 hours before
- sterilize puncture site & drape surrounding area
124
what local anesthesia is given for percutaneous drainage
subcutaneous lidocaine (lignocaine/xylocaine) 1% injection
125
aftercare for percutaneous drainage
- remove catheter
- repeated imaging such as CXR for perforation for pleural effusion & chest drainage, liver biopsy
126
major complications of percutaneous drainage
* severe bleeding
* peritonitis
* bowel obstruction
* bowel fluid draining from the catheter
* septicemic shock
127
minor complications of percutaneous drainage
* Include local pain, bleeding, infection and leakage along the catheter track
* Catheters may also be dislodged, kinked or blocked. In such cases, a new catheter may
have to be inserted
128
