acute abdo Flashcards
what imaging is used for bowel obstruction
supine AXR
what is used for assessing hollow viscus perforation
erect CXR
cons for CT
radiation exposure
contrast induced nephropathy
contrast allergy
RIF differential diagnosis
appendicitis
renal colic
tubo-ovarian pathology
imaging in appendicitis
ideally USS first
then CT if US is inconclusive
US findings in acute appendicitis
aperistaltic, non-compressible, dilated appendix (>6mm)
appears round when compression is applied
periappendiceal fluid collection
target appearance
CT findings for acute appendicitis
appendiceal dilation (>6mm)
wall thickening and enhancement
thickening of the caecal apex
periappendiceal inflammation
- fat stranding, thickening of fascia, fluid, phlegmon, abscess
what is fat stranding
when the fat becomes inflammed it becomes more white (normally black)
used as a marker for inflammation
first line imaging for ureteric stones
non-contrast CT (CT KUB)
differential diagnoses for LIF pain
diverticulitis
colitis
colorectal cancer
tubo-ovarian pathology
renal colic
presentation of acute diverticulitis
left iliac fossa pain
unremitting pain with associated tenderness
possible, an ill-defined mass
as the disease progresses, symptoms become more generalised
first line imaging for acute diverticulitis
CT with IV contrast
could consider CXR to look for perforation
epipoloic appendagitis
epiploic twists and becomes inflamed
epigastric and RUQ pain differentials
biliary colic
cholecystitis
pancreatitis
perforation
acute cholecystitis diagnosis
almost always secondary to gallstones
diagnosis based on:
- RUQ pain, fever, WCC, CRP
confirmatory imaging
imaging in acute cholecystitis
US first line to assess gall bladder and biliary tree
CT can be false for calculi, but good for complications
MRI if biliary tree dilatation
US findings in acute cholecystitis
gallbladder wall thickening
pericholecystic fluid
treatment of acute cholecystitis
medical/conservative
interventional radiology- percutaneous
ERCP if obstructed biliary tree
surgery
presentation of pancreatitis
acute onset of severe central epigastric pain
poorly localised tenderness and pain
exacerbated by supine position
radiates to the back
elevated serum amylase
role of imaging in pancreatitis
to clarify diagnosis when clinical picture is confusing
detect complications
determine possible cause
when do you use US in pancreatitis
to identify gallstones as a possible cause
pancreatitis on CT
focal or diffuse parenchymal enlargement
indistinct pancreatic margins owing to inflammation
surrounding retroperitoneal fat stranding
looking for vascular complications
causes of perforation
common:
perforated ulcer
diverticular
less common:
secondary to cancer
secondary to ischaemia
first line imaging in perforation
CT- shows free fluid, will show clues to site of origin
- localised inflammatory change
- distribution gas
- defect in wall
