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radiology > abdominal luminal organs > Flashcards

abdominal luminal organs Flashcards

1
Q

complex (imaging) investigation

A
  • plain X-ray, incl. fluoroscopy
  • Ultrasound
  • CT
  • MRI
  • conventional nuclear medicine
  • PET
  • “hybrid imaging”

(+/- contrast)

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2
Q

GI contrast

A
  • barium: insoluble, excellent contrast
  • iodine (Gastrografin): water soluble, suspected leak/perforation
  • single contrast: contours, stenosis, but may be fooled.
    Good for functional studies - peristalsis
  • double contrast: barium coats mucosal surface, air dilates the lumen.
    Better specificity and sensitivity
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3
Q

what to describe about an imaging exam

A
  • what type of examination?
    Is it contrast enhanced? IV or oral? What is the timing of enhancement?
    Orientation (CT/MR) / probe (US)
  • what is being imaged?
  • what is the significant finding?
  • relevant negatives
  • what is the differential diagnosis? (most likely first)
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4
Q

imaging recommendations for abdominal mass

A

CT or MRI of the abdomen, with IV contrast.

In some cases: ultrasound

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5
Q

imaging recommendations in blunt abdominal trauma

A

hemodynamically unstable pt: CXR, AXR, FAST scan

hemodinamically stable pt: CT of the abdomen & pelvis, with IV contrast

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6
Q

imaging recommendations for dysphagia

A

If the cause is known (eg. prior cancer or stroke) -> oropharyngeal motility study

If no known cause -> oropharyngeal motility and esophagography

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7
Q

imaging recommendations for inflammatory bowel disease (esp. Crohn disease)

A

CT of abdomen & pelvis, with IV contrast.
CT enterography.
MR enterography.
fluoroscopic small bowel series.

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8
Q

imaging recommendations for jaundice

A

ultrasound of abdomen

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9
Q

imaging recommendations for staging of GI cancer

A

CT scan of chest, abdomen, and pelvis, with IV contrast

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10
Q

imaging recommendations for suspected small bowel obstruction

A

CT of abdomen and pelvis, with IV contrast.

AXR

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11
Q

luminal digestive tract (anatomy)

A
  • orophraynx
  • esophagous
  • stomach
  • duodenum
  • jejunum
  • ileum
  • colon
  • rectum
  • anal canal
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12
Q

oropharynx: anatomy, imaging, when to use

A

ANATOMY:
third part of pharynx. From soft palate to hyoid bone. Key event: swallowing

IMAGING:
Oropharyngeal motility study & fluoroscopic swallow of iodinated contrast

WHEN TO EXAMINE:

  • elderly with recurrent pneumonia
  • post stroke
  • Head & Neck cancer
  • aspiration (?)
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13
Q

esophagous: anatomy, imaging, when to use

A

ANATOMY:
from pharyngoesophageal junction (C5/C6) to Gastroesophageal junction.
Peristalsis: 5-9 seconds.
- primary (vagus), secondary (intrinsic), and tertiary waves.

IMAGING:

1) contrast swallow -> single or double contrast
* WHEN:
- as part of “upper GI study”
- after normal or impossible or perforated endoscopy
- motility disorders and reflux

2) CT, MRI, endoluminal US
* WHEN:
local staging of esophageal cancer

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14
Q

stomach: anatomy, imaging, when to use

A

ANATOMY:
cardia, fundus, body, antrum, pylorus

IMAGING:

1) contrast swallow -> single or double contrast (CO2 producing crystals)
* WHEN:
- as part of “upper GI study”
- after normal or impossible or perforated endoscopy
- motility disorders & reflux

2) CT
* WHEN:
cancer staging

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15
Q

duodenum: anatomy, imaging, when to use

A

ANATOMY:

  • bulb, second, third, fourth parts (–> 90% peptic ulcers in the bulb)
  • only partly intraperitoneal
  • ampulla of Vater in the second part
  • Ligaentum of Treitz marks boundary with jejunum
  • Blood supply: celiac axis

IMAGING:

  • endoscopy first
  • single contrast swallow: after bariatri surgery - for anastomotic leak
  • CT or MR to stage cancer
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16
Q

small bowel: anatomy

A

Ligamentum of Treitz to ileocecal valve.
7m long.
Mesentery: blood vessels, fat, nerves, lymph nodes. (classified as organ from 2016)
jejunum: proximal 40% -> thicker wall, wider lumen, more folds
ileum: distal 60%
Blood supply: SMA

17
Q

small bowel: when to examine

A
  • investigation of weight loss
  • abdominal pain (after large bowel pathology excluded)
  • follow up of surgery and IBD
  • strictures, ulcers and dysmotility
18
Q

small bowel: possible examinations

A
  • single contrast “follow through”
  • positive contrast & CT
  • negative contrast & MR/CT
  • positive contrast & fluoroscopy
  • double contrast “enteroclysis”
  • NJ tube (NasoJejunal), barium, methylcellulose chaser & fluoroscopy
  • capsule endoscopy
  • US: terminal ileum in IBD
19
Q

large bowel: anatomy

A

1.5 m
caecum, appendix, ascending - transverse - descending - sigmoid colon, rectum, anal canal
arterial supply : SMA (jejunum to splenic flexure) , IMA (beyond)

20
Q

large bowel: when to examine

A
  • rectal bleeding
  • anaemia
  • abdominal pain
  • weight loss
  • colonoscopy: first line unless acute!
21
Q

large bowel: imaging

A

1) CT colonoscopy (“virtual colonscopy”)
- bowel preparation, muscle relaxant, air or CO2 insufflation via rectal tube
- prone and supine CT series
- reconstructed “open” or “fly through”

2) double contrast barium enema
- selected cases only, excellent mucosal detail

3) single contrast enema
- postoperative, fistulas, level of obstruction, frail

4) CT & MR for staging cancer or acute abdomen (CECT)
5) US in appendicitis

22
Q

basic patterns of pathology

A
  • filling defect (in the lumen)
  • mural
  • extraluminal projections
  • compression
  • distension
  • narrowing
23
Q

filling defects

A

1) polyps
- benign or malignant
- sessile or pedunculated
- 1-2 cm

2) masses
- more often malignant (adenocarcinoma below lower esophagous)
- >2cm
- exophytic (into lumen) may bleed and obstruct early
- intramural spread (infiltrate the wall) cause annular constriction

24
Q

intrinsic wall abnormality (mural)

A
  • fold thickening
  • inflammation: gastritis / colitis
  • edema: heart failure, ischemia
  • infiltration: lymphoma, linitis plastica
25
Q

extraluminal projections

A
  • ulcers - mucosal defect
  • benign Vs malignant
  • diverticula - mucosa intact
  • true: all layers of the wall
  • false: mucosa only (colonic)
26
Q

the role of plain film in abdominal imaging

A
  • erect CXR
  • first line of investigation
  • perforation
  • position of NGT (nasogastric tube)
  • AXR:
  • may be helpful in obstruction
  • mechanical obstruction Vs ileus
  • level of pathology

BUT: CECT is the first line!

27
Q

endoscopy

A
  • gastroenterologist / surgeon
  • directly visualise
  • biopsy
  • treat (inject / stent)
  • invasive
  • risk
  • cost
28
Q

radiology

A
  • radiologist
  • no need for sedation
  • fewer complications
  • better at small bowel evaluation
  • may need endoscopy later
29
Q

pathology of the esophagus

A
  1. neoplastic: SCC, adenocarcinoma -> mass or stricture
  2. congenital: atresia or TOF (tetralogy of Fallot)
  3. degenerative: achalasia -> classic beaking / diverticula -> classic pouching - by anatomical region
  4. inflammatory: reflux -> short stricture
  5. traumatic: ingestion of acid -> long stricture
  6. neurological: dysmotility -> “corkscrew esophagus”
  7. vascular: varicies -> smooth indentations
30
Q

pathology of the stomach

A
  1. inflammatory: gastritis -> erosions & thickening / peptic ulcer disease -> ulcers
  2. neoplastic: adenocarcinoma -> mass
  3. iatrogenic: bariatric surgery -> distorted anatomy
31
Q

pathology of the small bowel

A
  1. iatrogenic: adhesions -> obstruction
  2. inflammatory: Crohns -> ulcers & strictures – “string sign of Kantour”
  3. vascular: ischemia from SMA -> edema, pneumatosis
  4. infective: TB -> edema, obstruction
  5. neoplastic: lymphoma & adenocarcinoma (rare)
32
Q

pathology of the large bowel

A
  1. neoplastic: adenocarcinoma -> mass, obstruction
  2. inflammatory: ulcerative colitis -> pseudopolyps, ulcers
  3. vascular: ischemia from SMA/IMA -> edema
  4. congenital: sigmoid volvulus -> obstruction

radiology (13 decks)

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