abdominal and renal imaging lab Flashcards by Lauren M

why order a KUB xray?

– Can be used to evaluate for bowel distention, urinary tract stone/stent, foreign body, and tube placement – cannot be used to rule out free intra- peritoneal gas or detect air-fluid levels

How well did you know this?

Not at all

Perfectly

what is a Acute Abdominal Series (AAS)

• Consists of 3 views: – Upright PA Chest, Upright Abdominal X-ray and Flat plate (supine) Abdomen

How well did you know this?

Not at all

Perfectly

why order a AAS?

– Shows lung pathology, bowel distention, air fluid levels and free air • helpful if you suspect bowel obstruction, ileus, perforated viscus, or a radiopaque foreign body is suspected, but cannot be relied upon to exclude these disorders – Fast to do, relatively low cost and low radiation exposure – Low yield, the majority of AAS are negative or nonspecific • A negative AAS does not exclude pathology

How well did you know this?

Not at all

Perfectly

how do you interpret an AAS?

• Chest (erect, PA or AP) – Look for free air, pneumonia at the bases, pleural effusions • ABD Flat Plate (prone) – Look for gas in rectum, sigmoid, ascending and descending colon, calcifications • Upright Abd (erect) – Look for free air, bowel distention, air-fluid levels, gas pattern, soft tissue masses

How well did you know this?

Not at all

Perfectly

what is an ultrasound the test of choice for and also used for?

– Test of choice for: • Biliary pathology - Cholelithiasis, cholecystitis • Trauma Screen - Screen for intraperitoneal fluid/blood (FAST Scan) • Pregnant pelvic pain – ectopic pregnancy, ovarian cyst • Testiclular pain – Also used for • Assessment of hydronephrosis, soft tissue, procedural guidance

How well did you know this?

Not at all

Perfectly

what are the strengths of an ultrasound?

• Fast to do, relatively low cost and no radiation exposure

How well did you know this?

Not at all

Perfectly

what are the weaknesses of an ultrasound?

• Limited by: operator skill, adipose tissue (fat), air

How well did you know this?

Not at all

Perfectly

what imaging is used for suspected biliary colic?

• US is first line • ERCP and MRCP - if suspect Choledocholithiasis • Ct Abd/pelvis with IV and oral contrast can be helpful • HIDA scan of Liver and GB – Functional test of GB – Done if US is negative and still suspect biliary colic

How well did you know this?

Not at all

Perfectly

what are indirect signs of acute cholecystitis whenever gallstones are identified on a sonogram:

• Gallstone impacted in the GB Neck (stone in the neck that does not move when the patient’s position is changed). • GB distension (transverse diameter > 4 cm) • “Sonographic Murphy’s sign” - pain when the transducer presses directly over the GB. This is THE most specific sign of acute cholecystitis if associated with gallstones, even without GB wall thickening ( > 3 mm) or pericholecystic fluid • Sludge • GB wall thickening > 3mm (suggesting edema of the wall) • Pericholecystic fluid (most commonly due to GB wall edema or rarely indicating GB perforation)

How well did you know this?

Not at all

Perfectly

if you suspect Choledocholithiasis what other tests do you need?

MRCP +/or ERCP – MRCP – diagnostic – ERCP – diagnostic and therapeutic

How well did you know this?

Not at all

Perfectly

when should you suspect Choledocholithiasis

– Patients present with Biliary colic and.. • LFT’s elevated in a “cholestatic” pattern (total bili and alkaline phosphatase are elevated to a greater extent than AST and ALT) • Dilated common duct on ultrasound

How well did you know this?

Not at all

Perfectly

what does a renal US look for?

Quick and easy • Specifically to look for hydronephrosis

How well did you know this?

Not at all

Perfectly

when is US is the imaging modality of choice?

for abdominal and pelvic pain in the pregnant patient/male patients with testicular pain or mass

How well did you know this?

Not at all

Perfectly

when is a US used in women/ pregnant women?

• No ionizing radiation = safe for baby • Used to evaluate fetal well being, and threatened miscarriage • rule out ectopic pregnancy, and ovarian torsion • Also good for diagnosing ovarian cysts

How well did you know this?

Not at all

Perfectly

what is the purpose of a FAST scan?

– a standard set of ultrasound examinations for the evaluation of injured patients – Purpose: Detect free intraperitoneal fluid, pericardial fluid, pleural fluid, Hemothorax and pneumothorax in trauma patients – Limited sensitivity precludes the use of ultrasound as a definitive test to rule out intraabdominal injury • Used as a quick screening test for trauma patients

How well did you know this?

Not at all

Perfectly

Fast Scan – Morrison’s Pouch

• Right flank • Hepatorenal view

How well did you know this?

Not at all

Perfectly

FAST scan Left flank

Perisplenic View

How well did you know this?

Not at all

Perfectly

FAST scan subxiphoid view

How well did you know this?

Not at all

Perfectly

FAST scan pericardial tamponade

How well did you know this?

Not at all

Perfectly

FAST scan Pelvic (retrovesicular views)

Ct Scan of the Abdomen and
Pelvis

• Multiple cross sectional images
• Multiple planes
– Sagittal
– Axial
– Coronal
• Allows for reconstructed images
• Usually gives the most information
• Significant radiation exposure

CT planes

Ct Scan of the Abd and Pelvis
• Without contrast (stone protocol)

– test of choice for ureterolithiasis

Ct Scan of the Abd and Pelvis with IV contrast only

– Radiographic test of choice if suspected abdominal trauma

CT scan of abd and pelvic With IV and oral contrast

– Test of choice for suspected • Bowel pathology • Solid organ (parenchymal) pathology • Vascular pathology • Best test for undifferentiated abd pain - Gives you the most information

what most you confirm before giving IV dye?

good kidney function • Check BUN, Creatinine, and GFR

when is CT Scan Abdomen/Pelvis with IV and Oral Contrast the test of choice?

• Imaging modality of choice for bowel inflammation/ infection, solid organ injury/infection, vascular problems and cancer • Both abdomen and pelvis are scanned (because the bowel is variable in location with portions in the Abd and pelvis

what does the IV contrast do in CT Scan Abdomen/Pelvis with IV and Oral Contrast

– enhances the bowel wall – optimizes detection of bowel inflammation and extra-luminal complications such as perforation, abscesses and fistulae – Shows vasculature

what does the oral contrast do in CT Scan Abdomen/Pelvis with IV and Oral Contrast

provides better imaging of the bowel – distends the bowel and highlights the bowel wall.

CT Abd/Pelvis without Constrast (stone protocol)

• the imaging modality of choice for suspected ureterolithiasis • Both abdomen and pelvis are scanned (because the stone, hydronephrosis and structure could be anywhere from the kidnety to the bladder) • No IV or oral contrast – might obscure identification of the stone

what are CT Findings of Ureterolithiasis

• Hydronephrosis • Hydroureter • Perinephric stranding • Note – Location of stone – Size of the stone

what is the Imaging for Suspected Acute Appendicitis

• CT Abd/Pelvis with IV and oral contrast is first line. • US or MR can be performed if concerned about radiation exposure. • In children and pregnant patients, US of the RLQ should be first line imaging.

what are CT Scan Findings of Acute Appendicitis

* Appendiceal wall thickening and enhancement - diameter \> 6 mm * Pericolonic fat inflammatory changes (also called "fat stranding") * Pericolonic fluid - free or loculated * Free intraperitoneal gas if perforated * +/- appendicolith

when is EGD the test of choice?

– Imaging test of choice for gastritis, PUD, GERD

what is EGD diagnostic and therapeutic for?

* Upper GI Bleed * Choledocholithiasis * Esophageal narrowing or foreign body

when is Flexible sigmoidoscopy used?

screening test for colon cancer

what is Flexible sigmoidoscopy diagnostic and therapeutic for?

• lower GI bleed

what imaging would you use for • Bowel (infection, inflammation, obstruction, cancer)

– Ct Abd/Pelvis with IV and oral contrast

what imaging would you use for Solid organs (injury, infection, cancer)

– Ct Abd/Pelvis with IV contrast

what imaging would you use for Gallbladder

Ultrasound; If suspect Choledocholithiasis then MRCP or ERCP

what imaging would you use for GYN

– US if pregnant or suspect torsion or cyst – Ct with contrast if suspect cancer or abscess

what imaging would you use for Male GU

– US for torsion, Ct with contrast if suspect cancer or infection (Fournier’s, abcess)

what imaging would you use for • Kidney/Ureter/Bladder

– Ct without contrast if suspect stone, with if suspect cancer, infection then IV contrast

what imaging would you use for • Abdominal Vasculature (aorta, mesenteric arteries)

– Ct Abd/Pelvis with IV contrast

what imaging would you use for • Appendicitis

CT abd/pelvis with IV and Oral contrast – US first if child or pregnant

what imaging would you use for • Biliary Colic/Gallbladder pathology

– US RUQ

what imaging would you use for • Renal Colic (Kidney stone/ureterolithiasis)

– CT abd/pelvis without contrast (stone protocol) – US if chronic kidney stones, pregnant or child

what imaging would you use for • Abd Trauma

– FAST scan initial screen for interperitoneal blood – Ct Abd Pelvis with IV contrast only is gold standard

what imaging would you use for • Vasculature (AAA, Aortic Disection, Mesenteric Ischemia)

– Ct Abd/Pelvis with IV contrast • If uncertain etiology then CT Abd/Pelvis with IV and Oral Contrast – Gives you the most overall information