Abdomen

Question 1

benefits of x-ray

Answer 1

widely available
easy
excludes bowel obstruction/perforation

Question 2

types of abdo X-ray

Answer 2

supine AXR

erect CXR

Question 3

benefits of USS

Answer 3

easy, safe
clear visualisation of solid organs, free fluid, aorta, pelvis
Bowel – occasionally helpful
Correlate imaging with tenderness

Question 4

benefits of CT

Answer 4

quick
accurate
allows better planning of surgery or intervention

Question 5

drawbacks of CT

Answer 5

radiation exposure

renal impairment

Question 6

benefits of MRI

Answer 6

no radiation

good soft tissue delineation esp in pelvis

Question 7

drawbacks of MRI

Answer 7

takes a long time

contraindications/claustrophobia

Question 8

when would you use MRI

Answer 8

use as a second line test in hepatic-biliary, small bowel and pelvis issues

Question 9

key symptoms of acute appendicitis

Answer 9

periumbilical pain

nausea and vomiting

Question 10

where does appendicitis pain localise

Answer 10

RIF

Question 11

imaging in appendicitis

Answer 11

no role for X-ray
CT and USS are diagnostic
USS 1st, CT if this is inconclusive

Question 12

incidence of acute diverticulitis decreases with age

Answer 12

false, increases with age

Question 13

complications of acute diverticulitis

Answer 13

abscess
obstruction
perforation
fistulae

Question 14

imaging acute diverticulitis

Answer 14

xray - exclude obstruction/perforation

CT with IV contrast = gold standard

Question 15

CT findings acute appendicitis

Answer 15

appendiceal dilatation
wall thickening
thickening of the caecal apex

Question 16

ureteric calculus presentation

Answer 16

loin to groin pain

Question 17

imaging for ureteric calculus

Answer 17

non contrast CT - stones >1mm in size are visualised along with assoc changes

Question 18

presentation of acute diverticulitis

Answer 18

left iliac fossa pain
unremitting pain with tenderness
possibly ill-defined mass
symptoms become more generalised with progression

Question 19

what causes acute cholecystitis?

Answer 19

almost always secondary to gallstones

Question 20

diagnosis of cholecystitis

Answer 20

one sign of inflammation (fever, WCC, CRP)
one local sign of inflammation (RUQ pain etc)
confirmatory imaging

Question 21

imaging in acute cholecystitis

Answer 21

USS
CT can be false -ve
MRI if biliary tree dilatation

Question 22

USS in acute cholecystitis

Answer 22

gallstones
GB wall thickening
local fluid

Question 23

MR cholangiopancreatohraphy in cholecystitis

Answer 23

shows stone in common bile duct causing obstruction

stones in GB

Question 24

what is emphysematous cholecystitis

Answer 24

air in gall bladder wall

diabetics

Question 25

treatment options for cholecystitis

Answer 25

medical/conservative interventional radiology (percutaneous) ERCP if obstructed biliary tree surgery

Question 26

causes of small bowel obstruction

Answer 26

adhesions cancer hernia gallstone ileus

Question 27

pancreatitis presentation

Answer 27

acute onset of severe central epigastric pain poorly localised tenderness and pain exacerbated by supine positioning radiates through to the back in some

Question 28

blood test for pancreatitis

Answer 28

elevation of serum amylase

Question 29

pancreatitis imaging

Answer 29

clarify diagnosis assess severity and determine prognosis detect complications determine causes

Question 30

US pancreatitis

Answer 30

identifies gallstones as cause | assess for other aetiologies

Question 31

CT pancreatitis

Answer 31

shows complications but only 7-10 days after diagnosis | should only be taken acutely if patient is very unwell

Question 32

perforation causes

Answer 32

perf ulcer diverticular cancer ischaemia

Question 33

perforation imaging

Answer 33

AP erect xray | CT

Question 34

symptoms of small bowel obstructions

Answer 34

vomiting pain distension

Question 35

signs of small bowel obstruction

Answer 35

increased bowel sounds tenderness palpable loops

Question 36

imaging in bowel obstruction

Answer 36

xray | CT

Question 37

xray S bowel obstruction

Answer 37

``` valvular conniventes loops are central dilatation paucity of gas distally can miss fluid filled loops ```

Question 38

CT S bowel obstruction

Answer 38

``` dilated small bowel loops normal calibre or collapsed loops distally small bowel faeces sign may identify mass rare - gall stone ileum ```

Question 39

causes of L bowel obstruction

Answer 39

colorectal cancer volvulus diverticulitis

Question 40

x ray L bowel obstruction

Answer 40

helpful but may not diagnose underlying cause

Question 41

appearance of L bowel obstruction x ray

Answer 41

``` colonic distention collapsed distal colon small bowel dilatation rectum has no or little air assess for complications such as ischaemia or perforation ```

Question 42

bowel ischaemia

Answer 42

if <10% GI blood flow

Question 43

causes of bowel ischaemia

Answer 43

arterial occlusion venous occlusion non-occlusive hypo perfusion

Question 44

bowel ischaemia presentation

Answer 44

``` severe abdo pain vomiting diarrhoea distension inconsistent borderline amylase, raised WCC, acidotic patient very unwell ```

Question 45

imaging bowel ischaemia

Answer 45

CT

Question 46

CT appearances bowel ischaemia

Answer 46

lack of enhancement of the lumen of the affected vessel mucosal/serosal enhancement reduced or increased ileus/dilated loops of bowel pneumatosis intestinal

Question 47

leaking AAA presentation

Answer 47

pain hypotension pulsatile abdo mass

Question 48

CT leaking AAA

Answer 48

retroperitoneal haemorrhage adjacent to the aneurysm