ABD Flashcards
What are indications for supine KUB?
Plain Xray rare: Bowel gas, FB, Calcifications, tubes
What is included in ABD series?
KUB, uprdight abdomen, CXR
What are indcations for ABD series?
SBO, LBO, perfs, Pneumoperiotoneum, Air fluid level, free air diaphragm, lung patholgy
What if pt cannot stand?
LL decubitus- air levels and free air
What is adequat for each view?
KUB- lateral walls, CXR- costophrenic angles, Upright- horizontal bean 5-10min. LOOK - white-calcified, black-air- gray- stool organs
This xray of ABD shows little air, NO feces, valvulae conninventes w/ narrow space, width <2.5cm, thin wall <3mm?
Small bowel location
This xray of ABD shows more air, feces, Haurstra w/ wider space, width <5cm wide, thin wall <3mm?
Large Bowel Locale- peripheral distribution. Transvers colon center and sag
T or F. Gas and air fluid level is ABNORMal in the stomach?
FALSE- very normal. Air fluid in UPRIGHT
T or F. Gas and air fluid level is ABNORMal in the Large Instestine?
FALSE- gas is NORMAL. NO AIR fluid level
T or F. Gas NORMAL and air fluid is ABNORMal in the SMall intestine?
FALSE- VERY little gas and fluid
Pt with calcification will ALWAYS have symptoms?
FALSE- calcificaion are abnormal. Pt may or may not have SX
What could move the small and large intestine in higher positions?
Organmegaly or MASS- USE CT to DX mass.
Gastropareis is common in DM when they stomach is paralyzed. What will be seen?
Air fluid level dialted
IF the SBO is mechanicall obstrcuted what is seen?
centered, VCs dilated. Complete, will be no air distal to obstruciton. RECTUM/COLON may have NO Air, collapsed. Proximal= LESS dilated loops. MORE dilated bowels vs. LBO. SBO dilate to >3cm ONLY
WHat is stacked coin and bent fiinger sign?
Common in SBO supine view- VCs narrow space. Bent finger look for steps
When is upside down U and string pearls seen?
UPright SBO- air w/in VC, U-formed superior and inferior
IF SBO is suspected what is PT CP?
Hypotension, TAchy. Risk of perforation.
WHat is seen with LBO?
Peripheral, larger haustra. Cecum diated large R. May span 3-4 vertebrae. Few air fluid level in rectum and small bowel.
This LBO starts from LLQ-RUQ?
Sigmoid volulus- bowel twisted on itself. Coffe bean shape with long opaque line
This LBO starts from RLQ to LUQ
Cecal volvulus- kidney bean shaped
Thes LBO type are not volulus and require fluids for treatment?
Toxic megacolon, Ogilvie Syndrome- elderly bedbound, anticholinergics. Entire colon dilated
This Pt is post op from tumor removal, that herniated. She also has PMH of IBD?
SBO mechanical risk
This Pt has a maligant tumor. What are other DDX?
LBO risk- hernia, volvulus, divertic, intussuception, fecal impaction
Ms. V has large bowel dilated adn inflammed, but not obstructed. What is the condition?
Colitis-can see whole bowel. Very sick. DDX- toxic, ischeic, Ulcerative, C. diff.
What is risk for Colitis?
Perforation- CT IV w/ CON if not emergent
What would inidcated inflammed bowel?
Thicked bowel walls or haustra.Thumb printing
What is dilated single or double loop near inflammed area, related to pancreaitis?
Localized illeus (failed bowel)-Sentinel Loop
What is DX when both LBO and SBO are dilated, post surgicla. Bowel sound absent?
Generalized Adynmaic ileus
Where can air be seen if extraluminal?
Pneumoperitoneum-btwn lever and diaphram.Lateral, R. Retroperitoneal- CT best. Penumatosis intestinales- KIDS severe. Pneumobilia- biliary system, tublie in RUQ (gas from bacteria)
Air under diaphragm, Rigler sign (both side of bowel wall), or see the falciform ligament…mean what and is caused by?
Pneumoperitoneum- Cause surgery, perf of hollow organ, periotinitis from organims forming gas
WHat is used to study lesion in esophagus, bowel, colon. THe fluid fills space, but avoid masses?
Barioum study- Apple core lesion-mass, Achalasia-complete block. DDX dysphagia, perforation, FB, strcitures, motiliy, malignancy, Zenker diverticululm, Barretts, Hiatal Hernia
What are the common indentation of the esophagus, not to be confused with masses?
- Aortic arch. 2. L main bronchus 3. Esophagastric junction-MC Barrets & GERD
What is ideal for SB distal portion to see Chrons, IBD?
Time Oral contrast flouroscopy w/ Barium enema
Mr. T has rectal bleeding but is painless. What is inital test for lesion insdie the bowel?
Colonscopy. NOT CT. Bowel prep is key. Screen >50yo. Colitis and malignancy
IN order to DX esophagus conditions such as: UGI bleeds, FB, Mallory weiss tear, esophageal varices, boerhaaves, Gastriic: tumors, ulcer, etc.
Endoscopy
What is used to see gastric ulcers, tumors, obstuction, postop, w/ biopsy including proximal small bowel?
Endoscopy
What is the position of the NG tube indicated for excessive vomiting, decompress bowel (air out SBO), gastric blood lavage?
*10cm below gastric esophageal junction. Confirm w/ Chest xray
What is thru skin into stomach, endoscopy and fluroscopy is used to place?
Gastrostomy. PEG
What is best initial test for gall blader, gallstones, common bile duct?
*Abdominal US
On ABD US what is important to Dx for Bladder, Kidney, Liver, Aorta?
- Bladder- retention, cysit, mass, post void residual 2. Kidney- hydronephrosis masses, 3. Liver- free fluid Morrison pouch, liver parenchyma 4. Aorta- Aneurysm
Can you DX appendiicits with US?
Yes-kids, adults
What is preferred to see the biliary tree if available?
MRCP- MR cholangiopancreatogram- NO CONTRAST. USE- bilary stones, pancreas, malignancy, cholangitis. Endoscopic Retrograde- secondary
What are the three DX criteria for cholecysitis?
Gallbladder infection- 1. Gallbladder thickening 2. Peri cholesystic fluid (small black strip) 3. Sonographic Murphy’s sign- push under live. 4. Bile Duct >6mm dilated. 5. Acalculous cholecysitis is possible
What study is used for hepatic biliary tree with nuclear medicine?
HIDA scan- 1. acute cholecysitis. 2 Chronic Biliary tract dz 3. Congenital dz 4. Post op bile leak fistula 5. Liver transplat fx
What study is used for renal parenchyma and kidney failure?
US
Mr. Kid has painful abdominal pain, w/ h/o dehydration? What is initial study?
CT NO CONTRAST- renal/kidney/ureter stone
What is outcome if ureteral stone, kidney stone passing downstream, obstructs ureter. Then urine back up into renal pelvis
US for Hydronephrois- DX of obstructing renal calculi. Hydroureter-CT best
What landmarks and probe is used to DX appendicitis on US?
Probe thin linear probe. Obese curvilinear. Landmarks- iliac crest, iliac artery, psoas, cecum.
What is DX of pos. Appendiciits?
- Dilated >6mm 2. Non compressible 3. Thick wall 4. Peri-appendiceal fluid
What is used first to dx free fluid in Abdomen?
US- ascites d/t cirrhoiss, cancer. Blood-FAST exam. CT w/ oral & IV contracts for cause?
