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Digestive > 31 - Radiology > Flashcards

31 - Radiology Flashcards

1
Q

What do I need to know

A
  1. Identify organs
  2. Which imaging is best for which organs
  3. Which imaging best diagnoses some diseases
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2
Q

Air colour in x ray plain film

A

Black

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3
Q

CT

A
  • 300 x the radiation of x ray
  • better contrast of organs
  • expensive
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4
Q

What is contrast determined by in x ray?

A

Different densities
Bones white
Tissue grey (not well contrast/defined unless surrounded by fat which is darker)
Air is grey

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5
Q

intraperitoneal and retroperitoneal

A 
iP -liver and GB
spleen
gut
tail of pancreas
first part of doudenum

RP - kidneys
most of pancreas
adrenal glands
duodenum (2/3/4th part)

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6
Q

3 pathologies you will see in liver

A

trauma
cancer/metastases
cirrhosis

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7
Q

Gallbladder pathologies

A

Gallstones

cancer

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8
Q

Symptoms of liver and GB

A
  • RUQ pain/epigastric (appropriate pain)
  • jaundice (late)
  • abnormal LFTs
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9
Q

Investigations for GB and liver

A
  • Ultrasound
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10
Q

Where duodenal ulcer pain

A

Middle epigastric

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11
Q

What colour are vessels in US

A

BLACK

Helps define structures

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12
Q

How does a fatty liver appear on CT

A

White and speckly
Hepatic steatosis
Fat lobules reflect more sound waves
Ecogenic (whiter)

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13
Q

Target lesions in liver?

A

Hypoechoic rims (less reflection of echoes)
Metastases
Could come in with LFT or screening

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14
Q

What does hep c result in the liver looking like

A

chronic hep resulting the shrunken livers

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15
Q

Hep C curable today

A

Yes but increased risk to hepatocellular carcinoma

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16
Q

Ecogenic nodule in liver?

A

Do CT scan

Shows enhancement pattern that is characteristic of benign

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17
Q

Can you get all of the pancreas on one CT scan

A

No because of the angle it is on; inferior, lateral, posterior

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18
Q

Are all gall stones radio opaque

A

No more are not radio opaque than are

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19
Q

What colour is the GB in US

A

Black as is filled with fluid

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20
Q

Gallstone in US

A

white
dense
shadow as can’t penetrate

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21
Q

What are you likely to see in cholecystitis

A

Thickened wall of GB
Gallstones
Fluid outside of gb
Probe on GB will hurt

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22
Q

How thick should wall of gb be

A

3mm

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23
Q

Can CT be used to see stones

A

Not great
Can be pretty good
Preference to do US first

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24
Q

When would you use CT instead of US for gallstones

A

If you thought a stone was in the CBD or pancreatic duct because US isn’t as good as CT to see pancreas

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25
Q

CT or US for GB/cholecystitis

A

US
can’t put CT and ask if patient has pain
See stones better
See GB well

26
Q

What is better at seeing the pancreas

A

CT not US

27
Q

LI/splenic flexure on CT

A

Bubbly poo
Solid and gas provides natural contrast
If swallows contrast can see some extra contrast

28
Q

SI on CT

A

Fluidfilled fulls gut

29
Q

Spleen problems

A

Trauma
Cancer/lymphoma
Portal hypertension - splenomegaly

30
Q

Does spleen cause pain

A

Not usually

Trauma will bleed

31
Q

How does 2 layers of blood present

A

1 darker than the other in series (fresher)

Can leak into peritoneum

32
Q

What mode of imaging do you use in a trauma setting

A

CT

Time consuming

33
Q

Problems in stomach

A

Cancer and ulcers (ulcers more painful)

34
Q

SI problems

A

Obstruction
Crohns (inflamed)
Cancer
Ischaemic

35
Q

Colon problems

A

cancer
infection
appendicitis
IBD (inflam)

36
Q

Cancer more common is Sior LI

A

LI

37
Q

What are the 2 ways to get free air

A
  1. Trauma
  2. Gut perforation (i.e. ulceration)
    Use to roll patients. Now upright chest xray
38
Q

Imaging if suspect free air

A

Ct

Especially if trauma

39
Q

Symptoms of stomach

A

Pain
Weight loss
Haematemesis (vomiting)

40
Q

Imaging stomach

A
  • abdominal plain film is limited
  • UGI/barium or endoscopy (if gastroenterologist vs hospital)
    > don’t do in ED. Uncommon. Not first line of investigation for most GI problems
  • CT if trauma/severe pain/speeds transit/could be any cause/
41
Q

Imaging SI

A
  • plain film first (looking for obstruction)
  • CT if severe
  • maybe US if dont know
42
Q

Symptoms SI

A
  • bloating pain (obstruction)
  • haematesis (bleeding/ulcer)
  • vomiting (obstruction)
43
Q

SI bowel obstruction

A
  • could be caused by cancer
  • causes vomiting and bloating
  • dilated in plain film
44
Q

How to identify SI bowel obstruction (x ray)

A
  • > 3cm dilated
  • valvulae conniventes transverse entire SI
  • inner abdomen vs picture frame
  • less gas/black in LI (solid stool)
45
Q

SI obstruction on CT

A
  • LI is peripheral and bubbly/natural constrast
  • SI valvulae conniventes
  • location centre
  • and filled with fluid not bubbly/poo
46
Q

CT SI obstruction

A
  • dilated and filled with fluid
47
Q

Pain to direct us to appendicitis and what modality to use

A

Right iliac fossa (starting in epigastric)

X ray USELESS

48
Q

What to use for appendix

A
  • if young try use US (can say is painful)

- older CT

49
Q

What does appendix look like on CT

A
  • Right hand side

- small dilated tube

50
Q

How does Crohns/IBD look like?

A
  • inflamed thickened SI
  • increased enhancement as inflemmed
  • stranding in surrounding fat
  • crohns can cause fistula, perforation, obstruction and dilated downstream
51
Q

LI symptoms

A
  • melaena
  • change in bowel habit
  • PR bleeding
52
Q

LI imaging

A
  • x ray
  • CT if present in hospital
  • endoscopy if present at private
53
Q

Faecal loading

A
  • full of stool in LI

- bit of dilation

54
Q

Colon cancer?

A

‘apple core’ + change in bowel habits

55
Q

Colon cancer in Ct

A
  • concentric thickening of colon wall (CANCER)

- stranding into fat

56
Q

What do you often do for ascites

A

US so can put in needle so don’t burst

57
Q

Relation of pancreas duo and SMA

A

SMA behind pancreas and infront of duo (DONT get confused)

Will see 3/4 parts of the duodenum behind SMA at a lower level to the pancreas

58
Q

What goes wrong in the pancreas

A

Pancreatitis
Cancer
Trauma
Diabetes

59
Q

Features of chronic pancreatitis

A

Calcification
Dilation of duct (scarring)
Irregular side branching

Recurrent acute pain

60
Q

Features of acute pancreatitis

A

PAIN
Serum lipase and amylase
Imaging then often unnecessary

61
Q

Why will you ask for CT for pancreas

A
  • US doesnt show well
  • look for complications of pancreatitis;
    ischaemic pancreas (hardely see pancreas)
    pseudocysts
    gallstones
    stranding into fat (early pancreatitis)

Digestive (24 decks)

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