Abdomen Flashcards
benefits of x-ray
widely available
easy
excludes bowel obstruction/perforation
types of abdo X-ray
supine AXR
erect CXR
benefits of USS
easy, safe
clear visualisation of solid organs, free fluid, aorta, pelvis
Bowel – occasionally helpful
Correlate imaging with tenderness
benefits of CT
quick
accurate
allows better planning of surgery or intervention
drawbacks of CT
radiation exposure
renal impairment
benefits of MRI
no radiation
good soft tissue delineation esp in pelvis
drawbacks of MRI
takes a long time
contraindications/claustrophobia
when would you use MRI
use as a second line test in hepatic-biliary, small bowel and pelvis issues
key symptoms of acute appendicitis
periumbilical pain
nausea and vomiting
where does appendicitis pain localise
RIF
imaging in appendicitis
no role for X-ray
CT and USS are diagnostic
USS 1st, CT if this is inconclusive
incidence of acute diverticulitis decreases with age
false, increases with age
complications of acute diverticulitis
abscess
obstruction
perforation
fistulae
imaging acute diverticulitis
xray - exclude obstruction/perforation
CT with IV contrast = gold standard
CT findings acute appendicitis
appendiceal dilatation
wall thickening
thickening of the caecal apex
ureteric calculus presentation
loin to groin pain
imaging for ureteric calculus
non contrast CT - stones >1mm in size are visualised along with assoc changes
presentation of acute diverticulitis
left iliac fossa pain
unremitting pain with tenderness
possibly ill-defined mass
symptoms become more generalised with progression
what causes acute cholecystitis?
almost always secondary to gallstones
diagnosis of cholecystitis
one sign of inflammation (fever, WCC, CRP)
one local sign of inflammation (RUQ pain etc)
confirmatory imaging
imaging in acute cholecystitis
USS
CT can be false -ve
MRI if biliary tree dilatation
USS in acute cholecystitis
gallstones
GB wall thickening
local fluid
MR cholangiopancreatohraphy in cholecystitis
shows stone in common bile duct causing obstruction
stones in GB
what is emphysematous cholecystitis
air in gall bladder wall
diabetics
treatment options for cholecystitis
medical/conservative
interventional radiology (percutaneous)
ERCP if obstructed biliary tree
surgery
causes of small bowel obstruction
adhesions
cancer
hernia
gallstone ileus
pancreatitis presentation
acute onset of severe central epigastric pain
poorly localised tenderness and pain
exacerbated by supine positioning
radiates through to the back in some
blood test for pancreatitis
elevation of serum amylase
pancreatitis imaging
clarify diagnosis
assess severity and determine prognosis
detect complications
determine causes
US pancreatitis
identifies gallstones as cause
assess for other aetiologies
CT pancreatitis
shows complications but only 7-10 days after diagnosis
should only be taken acutely if patient is very unwell
perforation causes
perf ulcer
diverticular
cancer
ischaemia
perforation imaging
AP erect xray
CT
symptoms of small bowel obstructions
vomiting
pain
distension
signs of small bowel obstruction
increased bowel sounds
tenderness
palpable loops
imaging in bowel obstruction
xray
CT
xray S bowel obstruction
valvular conniventes loops are central dilatation paucity of gas distally can miss fluid filled loops
CT S bowel obstruction
dilated small bowel loops normal calibre or collapsed loops distally small bowel faeces sign may identify mass rare - gall stone ileum
causes of L bowel obstruction
colorectal cancer
volvulus
diverticulitis
x ray L bowel obstruction
helpful but may not diagnose underlying cause
appearance of L bowel obstruction x ray
colonic distention collapsed distal colon small bowel dilatation rectum has no or little air assess for complications such as ischaemia or perforation
bowel ischaemia
if <10% GI blood flow
causes of bowel ischaemia
arterial occlusion
venous occlusion
non-occlusive hypo perfusion
bowel ischaemia presentation
severe abdo pain vomiting diarrhoea distension inconsistent borderline amylase, raised WCC, acidotic patient very unwell
imaging bowel ischaemia
CT
CT appearances bowel ischaemia
lack of enhancement of the lumen of the affected vessel
mucosal/serosal enhancement reduced or increased
ileus/dilated loops of bowel
pneumatosis intestinal
leaking AAA presentation
pain
hypotension
pulsatile abdo mass
CT leaking AAA
retroperitoneal haemorrhage adjacent to the aneurysm
