5- investigation of GI tract with imaging

Question 1

what is symptoms of cholecystitis/biliary colic?

Answer 1

• RUQ pain
• exacerbated by eating
• might have deranged LFTs

Question 2

what is investigations for cholecystitis/biliary colic?

Answer 2

1st line = ultrasound
2nd line = MRCP (MRI imaging)
3rd line = ERCP (endoscopic cholangiography thing)

• potentially then CT to see inflamed gallbladder (sometimes see gallstones)

Question 3

what is regio of pain in pancreatitis and what biochemical change?

Answer 3

• epigastric/diffuse abdominal pain
• elevated serum amylase

Question 4

what are investigations for pancreatitis?

Answer 4

mainly imaging is to evaluate complications (necrosis, intra-abdominal collections, vascular complications, pseudocysts, pseudoaneurysm) as pancreatitis itself is biochemical diagnosis

• 1st line = ultrasound

Question 5

what are investigations for perforation?

Answer 5

• 1st line = erect chest x-ray (looking for air under diaphragm)
• 2nd line = CT may help find source and show further features such as intra-peritoneal colllections

Question 6

what is 1st line investigation for suspected appendicitis?

Answer 6

= ultrasound (can confirm diagnosis or find alternative cause) →might not be able to see on ultrasound

Question 7

what is pain region and biochemical results of diverticulitis?

Answer 7

= inflammation associated with diverticular disease

• lower abdominal pain classically in LIF
• associated with diarrhoea +/- PR bleeding
• elevated inflammatory markers

Question 8

what is investigation for diverticulitis?

Answer 8

CT shows inflammatory change & associated complications - thickened bowel wall & fascial infiltration of mesentery

Question 9

if distended abdomen and suspect bowel source - what is investigations?

Answer 9

1st line = abdominal xray (determine whether small or large bowel)
2nd line = CT to find cause

Question 10

how can you distinguish between large bowel & small bowel on abdominal xray?

Answer 10

• large bowel = peripheral, only a few loops, mucosal folds (haustra) only cross part of the width
• small bowel = centrally placed, narrow angle curvature (tight angles), multiple loops, mucosal folds (valvulae conniventes) cross full width

Question 11

if distended abdomen and suspect fluid, what would investigation be?

Answer 11

ultrasound

Question 12

what is investigations are involved in haematemesis?

Answer 12

• usually managed endoscopically
• after that can do CT with IV contrast, without IV contrast or do angiography intervention if still can’t find cause

Question 13

what investigations are done for dysphagia?

Answer 13

often endoscopy but can also do fluoroscopy (like for functional causes e.g. dysmotility)

Question 14

what investigations are done for changes in bowel habit?

Answer 14

• CT virtual colonoscopy, if can’t visualise whole thing then do flexible sigmoidoscopy
• also barium enema

Question 15

if considering IBD what investigations can be done?

Answer 15

• endoscopy
• fluoroscopic contrast to look for strictures, wall thickening, fistulation

Question 16

what investigations are done for known IBD to see how active disease is?

Answer 16

• small bowel MRI
• CT
• radio-labelled white cell scan

Question 17

what is radio-labelled white cell scan?

Answer 17

take blood and separate white cells, attach radio tracer and reinject cells and see where accumulate (accumulate near inflammation) →normally accumulate near splenic where excreted

Question 18

what investigations are done for jaundice?

Answer 18

1st line = ultrasound →identifies intra or extra hepatic biliary tree, less reliable identifying cause - also identify parenchymal liver disease like cirrhosis, nodules

• also can do MRCP or ERCP
• can do CT to confirm metastases

*jaundice can be pre-hepatic or post hepatic cause - radiology only helps with post-hepatic