31 - Radiology

Question 1

What do I need to know

Answer 1

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

Question 2

Air colour in x ray plain film

Answer 2

Black

Question 3

CT

Answer 3

• 300 x the radiation of x ray
• better contrast of organs
• expensive

Question 4

What is contrast determined by in x ray?

Answer 4

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

Question 5

intraperitoneal and retroperitoneal

Answer 5

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)

Question 6

3 pathologies you will see in liver

Answer 6

trauma
cancer/metastases
cirrhosis

Question 7

Gallbladder pathologies

Answer 7

Gallstones

cancer

Question 8

Symptoms of liver and GB

Answer 8

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

Question 9

Investigations for GB and liver

Answer 9

• Ultrasound

Question 10

Where duodenal ulcer pain

Answer 10

Middle epigastric

Question 11

What colour are vessels in US

Answer 11

BLACK

Helps define structures

Question 12

How does a fatty liver appear on CT

Answer 12

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

Question 13

Target lesions in liver?

Answer 13

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

Question 14

What does hep c result in the liver looking like

Answer 14

chronic hep resulting the shrunken livers

Question 15

Hep C curable today

Answer 15

Yes but increased risk to hepatocellular carcinoma

Question 16

Ecogenic nodule in liver?

Answer 16

Do CT scan

Shows enhancement pattern that is characteristic of benign

Question 17

Can you get all of the pancreas on one CT scan

Answer 17

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

Question 18

Are all gall stones radio opaque

Answer 18

No more are not radio opaque than are

Question 19

What colour is the GB in US

Answer 19

Black as is filled with fluid

Question 20

Gallstone in US

Answer 20

white
dense
shadow as can’t penetrate

Question 21

What are you likely to see in cholecystitis

Answer 21

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

Question 22

How thick should wall of gb be

Answer 22

3mm

Question 23

Can CT be used to see stones

Answer 23

Not great
Can be pretty good
Preference to do US first

Question 24

When would you use CT instead of US for gallstones

Answer 24

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

Question 25

CT or US for GB/cholecystitis

Answer 25

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

Question 26

What is better at seeing the pancreas

Answer 26

CT not US

Question 27

LI/splenic flexure on CT

Answer 27

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

Question 28

SI on CT

Answer 28

Fluidfilled fulls gut

Question 29

Spleen problems

Answer 29

Trauma Cancer/lymphoma Portal hypertension - splenomegaly

Question 30

Does spleen cause pain

Answer 30

Not usually | Trauma will bleed

Question 31

How does 2 layers of blood present

Answer 31

1 darker than the other in series (fresher) | Can leak into peritoneum

Question 32

What mode of imaging do you use in a trauma setting

Answer 32

CT | Time consuming

Question 33

Problems in stomach

Answer 33

Cancer and ulcers (ulcers more painful)

Question 34

SI problems

Answer 34

Obstruction Crohns (inflamed) Cancer Ischaemic

Question 35

Colon problems

Answer 35

cancer infection appendicitis IBD (inflam)

Question 36

Cancer more common is Sior LI

Answer 36

LI

Question 37

What are the 2 ways to get free air

Answer 37

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

Question 38

Imaging if suspect free air

Answer 38

Ct | Especially if trauma

Question 39

Symptoms of stomach

Answer 39

Pain Weight loss Haematemesis (vomiting)

Question 40

Imaging stomach

Answer 40

- 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/

Question 41

Imaging SI

Answer 41

- plain film first (looking for obstruction) - CT if severe - maybe US if dont know

Question 42

Symptoms SI

Answer 42

- bloating pain (obstruction) - haematesis (bleeding/ulcer) - vomiting (obstruction)

Question 43

SI bowel obstruction

Answer 43

- could be caused by cancer - causes vomiting and bloating - dilated in plain film

Question 44

How to identify SI bowel obstruction (x ray)

Answer 44

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

Question 45

SI obstruction on CT

Answer 45

- LI is peripheral and bubbly/natural constrast - SI valvulae conniventes - location centre - and filled with fluid not bubbly/poo

Question 46

CT SI obstruction

Answer 46

- dilated and filled with fluid

Question 47

Pain to direct us to appendicitis and what modality to use

Answer 47

Right iliac fossa (starting in epigastric) | X ray USELESS

Question 48

What to use for appendix

Answer 48

- if young try use US (can say is painful) | - older CT

Question 49

What does appendix look like on CT

Answer 49

- Right hand side | - small dilated tube

Question 50

How does Crohns/IBD look like?

Answer 50

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

Question 51

LI symptoms

Answer 51

- melaena - change in bowel habit - PR bleeding

Question 52

LI imaging

Answer 52

- x ray - CT if present in hospital - endoscopy if present at private

Question 53

Faecal loading

Answer 53

- full of stool in LI | - bit of dilation

Question 54

Colon cancer?

Answer 54

'apple core' + change in bowel habits

Question 55

Colon cancer in Ct

Answer 55

- concentric thickening of colon wall (CANCER) | - stranding into fat

Question 56

What do you often do for ascites

Answer 56

US so can put in needle so don't burst

Question 57

Relation of pancreas duo and SMA

Answer 57

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

Question 58

What goes wrong in the pancreas

Answer 58

Pancreatitis Cancer Trauma Diabetes

Question 59

Features of chronic pancreatitis

Answer 59

Calcification Dilation of duct (scarring) Irregular side branching Recurrent acute pain

Question 60

Features of acute pancreatitis

Answer 60

PAIN Serum lipase and amylase Imaging then often unnecessary

Question 61

Why will you ask for CT for pancreas

Answer 61

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