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radiology > Abdomen > Flashcards

Abdomen Flashcards

1
Q

indications for a KUB

A

i. Bowel gas pattern
ii. Foreign bodies (especially things up the butt)
iii. Calcifications,
iv. Tube placement

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2
Q

KUB stands for

A

kidney abdomen bladder

need to see the entire abdomen and the diaphragm

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3
Q

when would you get a KUB ubright and CXR

A

is you suspect a bowel obstruction
if you suspect a perf
1. Upright film –>look for air-fluid levels &/or free air

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4
Q

if you are looking for air fluid levels with images would you want

A

upright horizontal to the floor or lying down but the beam needs to be placed at the side

this is a sign of obstruction

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5
Q

what muscle should be visible bilaterally in a KUB

A

psoas

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6
Q

Has valvulae conniventes

small or large bowl?

A

small

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7
Q

Has haustra

small or large bowl?

A

large bowel

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8
Q

characteristics of haustra

A
  • Don’t traverse the entire lumen

- Widely spaced

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9
Q

diameter and wall thickness of large bowel

A

< 5 cm diameter

< 3 mm wall thickness

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10
Q

how much air do we usually see in the small bowel

A

Little air in lumen (2-3 loops max)

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11
Q

diameter and wall thickness of small bowel

A

< 2.5 cm diameter

< 3 mm wall thickness

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12
Q

characteristics of valvulae conniventes

A

Traverse the entire lumen

-Spaced closer together compared to haustra

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13
Q

air fluid levels in the colon normal or nah?

A

NO

no air fluid levels in the colon NOT NORMAL

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14
Q

when the bowel stops progressing it is known as a

A

ilieus

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15
Q

can you have air in the rectum with a small bowle obstruction?

A

yes~

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16
Q

what is the difference between a complete and partial small bowel obstruction

A

Complete –>no air distal to obstruction (sigmoid, rectum)

- Partial —> some air distal to obstruction

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17
Q

what is the relationship between obstruction proximity in the small bowel and loops of air seen on film

A

More proximal the obstruction, the fewer bowel loops are seen

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18
Q

what would you expect to see on a supine (KUB)

of a small bowl obstruction

A

Dilated loops, centrally located
- “Stack of coins,”
“bent finger sign”

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19
Q

what would you expect to see on a upright film of a pt with a small bowel obstruction

A

Air-fluid levels, may look like a “step-ladder”

- “String of pearls” (air trapped in successive valvulae conniventes)

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20
Q

types of large bowel obstructions

A

Can be mechanical (mass, twist)

- Can be from fecal impaction or inflammation

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21
Q
  • Few or no air-fluid levels are typical in the BO
A

LBO

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22
Q

Volvulus

A

special type of LBO where it twists like a Jesus fish

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23
Q

Coffee bean sign

A

. Sigmoid volvulus

and axis of bean points to LLQ)

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24
Q
  • “embryo sign”
A

. Cecal volvulus

feet of embryo point to RLQ

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25
Q

. Toxic megacolon aka

A

Ischemic colitis

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26
Q

what is toxic megacolon

what is the sign called on plain film

A

Bowel wall edema (“thumbprinting sign” along lumen of colon)

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27
Q

when bowel twists on itself and dies

A

volvulus

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28
Q

MC valvulus in bedbound seniors who take anticholinergics

A

Ogilive’s syndrome

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29
Q

physiological mechanism behind Ogilive’s syndrome

how does the pt present

A

usually in elderly where they lose peristalsis, colon dilates

pt is usually on anticholinergic medications

come in with an extended abdomen that looks like an obstruction (surgical diagnosis)

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30
Q

thumb-printing casued by

A

colitis

toxic megacolon

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31
Q

sigmoid volvulus goes from which quadrant where

A

LLG–>RLQ

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32
Q

which direction does cecal volvulus run?

A

RLQ upward

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33
Q

highest risk for SBO

A

having had one before

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34
Q

risk factors for SBO

A

Post-surgical adhesions (MCC!)

  • Malignancy
  • Hernia
  • Intussusception (bowel telescopes in on itself)
  • Inflammatory Bowel Dz
  • Hx of prior SBO (very strong risk!!)
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35
Q

MCC of LBO

A

Malignancy (MCC!)

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36
Q

Causes of LBO

A
  • Hernia
  • Volvulus
  • Nobody knows precisely why these happen
  • Diverticulitis
  • Intussusception
  • fecal impaction
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37
Q

Single or few dilated loops (usually SB) that stop moving (not due to an obstruction) is known as a

A

Functional Ileus

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38
Q
  • Inflammatory Bowel Dz CC of SBO or LBO
A

SBO

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39
Q

Diverticulitis can cause SBO or LBO

A

LBO

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40
Q

best imaging study for toxic megacolon

A

CT

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41
Q

sentinel loops

A

loop of small bowel cause by inflammation from another process

fix the process–> will act normally

Ileus

caused by renal stone, appy, pancreatitis, diverticulitis

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42
Q

Generalized (‘adynamic”) Ileus

A

Entire bowel dilated (LB and SB loops)

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43
Q

localized Ileus usually occurs in the

A

SB

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44
Q

causes of generalized Ileus

A

Causes: Post surgical, e-lyte problems, DKA, meds

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45
Q

how do you diagnose stones

A

ULS

but can be see on plain film

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46
Q

laminar means

A

stones with a border

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47
Q

tract like calcifications are seen as

A

follow some sort of vasculature or anatomy

vas deferens

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48
Q

amorphous calcifications

A

don’t have a border

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49
Q

Rim like calcification

A

seen as the whole organ

porcelain gallbladder

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50
Q

phlebolith

A

stone in the vessels

“Track-like “

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51
Q

best views for plain films pneumoperitoneum

A

i. Lateral CXR is sensitive for small ones (seen under L hemidiaphragm first!)

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52
Q

gold standard for pneumoperitoneum

A

CT overall best test!!

53
Q

necrotizing infection of the bowel seen in children

A

pneumatosis intestanales

nectrotizing enterocolitis

gas producing bacteria in the bowel

adults get it too it’s is called ischemic bowel
Makes bowel loops appear like loofa sponges

54
Q

Called “double wall sign” on CT

name for it on plain film is

A

Rigler’s sign

pneumoperitoneum sign

55
Q

Air in biliary system

what is it called and what causes it

A

pneumobilia

ii. Cause: gas-forming bacteria

56
Q

pneumobilia seen as

A

Tube-like lucencies in RUQ

57
Q

Retroperitoneal air

A

look for black around retroperitoneal structures (kidneys, aorta, psoas, bladder)

CT is the best but can be visualized on plain film

58
Q

three signs of a pnuemoperitoneum and what type pf plain film you’d see them on

A

free air under the diaphragm on PA CXR

RIGLER’s sign- seen btoh sides of the bowl wall large amt, KUB and upright

visualized falciform ligament on KUB

59
Q

what is the double wall sign

A

seen on CT for pneumoperitoneum

it is the visualization of the falciform ligament (liver to diaphragm)

60
Q

CC of pneumoperitoneum

A

trauma perforation, infxn, surgery (normal for 5-7d)

61
Q

techniques for viewing the esophagus

A

usually use endoscopy (for a thing)

Biphasic Esophagogram (barium studies/fluoroscopy) can also be used

(for a function)

62
Q

indications for a biphasic edophagogram (barium study)

A 
dysphagia, 
perforation (only in small),
 FB, 
stricture
motility problems
 malignancy

will fill the space and ignore the mass

“i feel like i can’t pass food:”

63
Q

normal

A
  1. Aortic arch
  2. Left mainstem bronchus
  3. Esophago-gastric junction
64
Q

specific conditions in which you would want to use a barium study/contrast to view the esophagus

A

Zenker’s
Barrett’s (precancerous chronic GERD)
esophagitis
hiatal hernia

65
Q

apple core lesion indicates

A

malignancy

masses on the side of the esophagus

66
Q

a birds beak or rat tail with barium is indicative of

A

achalasia

or seen as the esophagus dilated like a sausage ABOVE the obstruction

67
Q

lights up poop

A

a. CT + oral contrast

i. Less used these days

68
Q

b. CT + IV contrast lights up

A

lights up vessel, kidneys, bladder

i. CONTRAST + CREATININE

69
Q

shaggy-looking, indicate inflammation (often surrounds a sick structure)

A

a. Fat stranding

70
Q

b. Free fluid is seen as

A

seen as black on CT

71
Q

dx of skip lesions

A

Crohn’s

seen in the terminal ileum most commonly

also seen as skip lesions and cobbles-stoning

72
Q

initial test for painless rectal bleeding

A

colonoscopy

73
Q

braium enemas are used for

A 
Crohn's 
UC
diverticular dz
malignancy
and fistula formation
74
Q

if you are looking for a mass inside the bowel

A

Colonoscopy!!!

CT IS NOT THE FIRST TEST

75
Q

what are the indications for a endoscopy of the esophagus

A

same as barium

biopsy possibly during procedure

esophagitis
malignancy
UGI bleeds, mallory, varices, boerhaave’s

76
Q

boerhaave’s

A

transmural perforation of the esophagus to be distinguished from Mallory-Weiss syndrome, a nontransmural esophageal tear also associated with vomiting.

77
Q

why would you do a endoscopy of the stomach

A

gastritis gastric ulcers
gastric tumors
gastic outlet obstruction
post surgical

78
Q

capsule video best for

A

better for small bowel

79
Q

when do you get a colonoscopy

A

after 50 for malignancy

or indications

rectal bleeding
abnormalities
Hx LBO
colitis

80
Q

indications for ABD ULS

A

a. Biliary system (best initial test!)
b. Bladder - urinary retention; post-void residual
c. Kidneys - hydronephrosis; cystic masses; parenchyma
d. Liver & ascites - free fluid in abdomen; liver parenchyma
e. Aorta - aneurysm
f. Trauma - FAST (free abd fluid)

LATBBK

81
Q

best imaging for dx Ulcerative colitis

A

CT (+ oral or IV contrast); colonoscopy

82
Q

best study for dx Duodenal/gastric ulcer

A

b. Duodenal/gastric ulcer –> endoscopy

83
Q

best study for dx diverticular disease

A

CT + oral or IV con

84
Q

Dx appendicitis with what

A

Kids, thin adult, or pregnant person = ultrasound

All other adults = CT + IV con

85
Q

dx appendicitis in a child

A

Edema, inflammation, fat stranding

Dilated appy (>6mm)

86
Q

DX appendicitis in an adult

A

CT

Wall thickness >6mm
Non-compressible appendix

87
Q

best tx for dx pancreatitis

A

CT (+ oral or IV contrast)

88
Q

best tx for dx bowel obstruction (secondary to mass

A

plain film CT + IV con

89
Q

best tx for dx bowel ischemia

A

CT + oral or IV con

90
Q

Ascites/Free fluid in the abdomen (traumatic or non-traumatic)

A

i. Non-traumatic –>CT if it’s their first time with ascites; US otherwise
ii. Traumatic—>FAST exam; follow with CT + IV con if stable

91
Q

best test for biliary dz

A

Ultrasound is best for biliary dz

92
Q

Dx criteria for cholecystitis (4)

A

gallbladder wall thickening

peri-cholecystic fluid (black stripe)

sonographic murphy’s sign (probe up there and get slapped)

common bile duct dilation >6mm

93
Q

acalculous cholecystitis

A

no stone cholecystitis seen commonly in the elderly

94
Q

ampulla of vater

A

goes past sphincter of oddi

where you get the die put in

where you light of the biliary tree

looking for things that don’t pick up contrast and they will appear dark

95
Q

infected gallbladder that causes jaundice encephalis

A

cholangitis

96
Q

MRCP

A

no contrast need with MRI

Just flip over to the T2

97
Q

HIDA scan

what are the indications

A

nuclear medicine used to image biliary system

helps look at the integrity of the tree

acute cholecystitis
chronic tract disease
congenital disease
post operative bile leak/fistula 
assess liver transplant
98
Q

best test for a renal stone

A

CT no contrast

DO NOT ORDER A PLANE FILM

99
Q

IVP

A

intravenous pyelogram
plain KUB series after contrast

helps evaluate patency/efficiency

100
Q

Retrograde urethrogram is used for

A

fluoroscopy

urethra strictures trauma

101
Q

Besides ULS what other tests can be use for biliary dx

A

ERCP: endoscopy w/ fluoroscopy

biliary stones
malignancy
cholagitis

MRCP: MRI same indications and lessin

102
Q

indications for a bladder ULS

A

Bladder masses
urinary retention
FAST

103
Q

obstruction in the urethra leads to

A

hydronephrosis

104
Q

how do you confirm hydronephrosis

A

ULS

105
Q

Target sign is seen on what type of imaging

A

a. When an inflamed bowel loop is seen END-ON it looks like a target

106
Q

what is best for finding the exact location of an obstruction

A

CT

107
Q

Target sign ddx

A

Crohn’s
UC
ischemic bowl
intussuception

108
Q

pancreatitis is caused by what?

A

ETOH drugs viruses
gallstones (MC)

CT oral and IV is best test but usually you just see CT with IV contrast

109
Q

alcoholic that comes in with epigastric pain and vomitting

A

get an ULS to look for gallstone pancreatitis

CT to confirm but ULS if suspected

ERCP/MRCP can be done but ERCP precipitate by blocking spincter of ODI

110
Q

if hypotensive with AAA

A

means it is leaking NOT GOOD

elderly person can be seen with first time back pain (retroperitoneal structure)

111
Q

why would you want to do a CT for the biliary system

A

emphysematous cholecystitis

because this is an air around the gallbladder necrotizing and BAD

AIR IS THE ENEMY OF ULS
severe abd pain

112
Q

what imaging is best for hydroureter

A

CT

113
Q

sequele of the stones

A

of a certain size that causes problems

114
Q

when can you see a pregnancy transabdominallys`

A

after 12 weeks

115
Q

which type of ULS do you need a full bladder for

A

transabdominal as a landmark

116
Q

body of the uterus is known as the

A

MYOMETRIUM

117
Q

in most people when can you identify a IUP

A

7 weeks transvaginal

can see 5-6 weeks best for

118
Q

which view do you need in a transabdominal in order to visualize the cervix

A

longitudinal

119
Q

best ULS for ID ectopic pregnancy

A

transvaginal

120
Q

most reliable sign for a viable pregnancy

A

fetal heart beat

in ED we also look for
clear IUP
dates match size

121
Q

4-5 weeks with IUP seen as

A

gestational sac visible

double decidual sac

122
Q

5-6 weeks with IUP seen as

A

gestational sac plus yok sac

possible fetal pole

123
Q

6-8 weeks seen as

A

gestational sac plus yoc and fetal pole

124
Q

7-8 weeks

A

fetal pole and cardiac activity

125
Q

pregnancy in more than one place is known as

A

heterotopic pregnancy

IUP does not rule out an ectopic

126
Q

what length measurement would you take earliest in pregnancy

A

7-13 weeks

CRL

Crown rump length

127
Q

measurements you would make at 13 weeks

A

biparietal diameter BPD and CRL
AND head circumfrance

parietal bones

128
Q

when can you measure the femur of the fetus

A

after 14 weeks

2nd trimester

129
Q

what is the latest measurement you can make for the fetus

A

Late pregnancy use abdominal circumference (AC)

size and weight

radiology (13 decks)

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