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CLASP Radiology > Acute Abdo Pain Imaging > Flashcards

Acute Abdo Pain Imaging Flashcards

1
Q

what are the most common causes of abdo pain

A 
non specific 
appendicitis 
bowel obstruction 
urinary system 
diverticulitis
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2
Q

what are the imaging tools for the abdomen

A

primary:
- X-ray (erect for gas under diaphragm)
- CT
- USS

secondary

  • MRI (take 30-45 mins)
  • fluoroscopy (not done as much these days
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3
Q

what conditions can erect abdo c ray exclude

A

bowel obstruction/ perforation

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4
Q

what can USS image

A

solid organs, free
fluid, aorta, pelvis
Bowel – occasionally helpful

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5
Q

what is more useful for abdo x ray or USS

A

USS

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6
Q

what is the most sensitive test in the abdomen

A

CT

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7
Q

what are the cautions of CT

A 
radiation exposure 
renal impairment (contrast)
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8
Q

what is MRI good for

A

soft tissue delineation, esp in pelvis

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9
Q

what abdo conditions is MRI used in

A

used as second line test for:

  • hepato-biliary
  • small bowel
  • pelvis
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10
Q

what are the presenting features of an acute appendicitis

A

periunbilical pain
nausea
vomiting
localised to RIF

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11
Q

what Ix for appendicitis

A

USS
CT is this is inconclusive
swelling and oedematous fluid surrounding it, will be inflamed and fluid filled on USS

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12
Q

what are the complications of diverticulitis

A

abscess
obstruction
perforation
fistulae

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13
Q

what imaging for acute diverticulitis

A

plain x ray to exclude obstruction/ perforation
CT
will see soft tissue thickening, inflamed bowel

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14
Q

what can USS not see through

A

gas- so if you have a retrocaecal appendix wont be able to see it

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15
Q

what is acute cholecystitis almost always secondary to

A

gallstones

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16
Q

what is the diagnosis of acute cholecystitis based on

A

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

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17
Q

what imaging for acute cholecystitis

A

USS (will see gallstones, CB wall thickening, local fluid. Gall bladder should just be black, in acute cholecystitis will have blood/ pus surrounding the stone, shows up as grey)
CT
MRI if biliary tree dilation
MR cholanfiopancreatography (MRCP) shows stones in GB/ bile ducts

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18
Q

how is a paracolic abscess treated

A

needs to be drain (can be caused by perforation)

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19
Q

should there usually be gas in the urinary bladder

A

no

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20
Q

what do gallstones look like on USS

A

are echogenic- white, will cast black shadow behind it

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21
Q

what is the treatment for acute cholecystitis

A

medical/ conservative
ERCP to clear out bile duct
surgery to remove gall bladder

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22
Q

what is emphysematous cholecytsitis

A

when there is air in gallbladder wall

happens in diabetics

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23
Q

what are the common causes of small bowel obstruction

A

adhesions, camcer, herniae, gallstone ileus

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24
Q

what are the symptoms of small bowel obstruction

A

vomiting, pain, distention

25
Q

what are the signs of small bowel obstruction

A

increased bowel sounds, tenderness, palpable loops

26
Q

what does imaging do in small bowel obstruction

A

defines site, cause, severity, complications (perforation/ ischaemia)

27
Q

what investigations for small bowel obstruction

A

initial- X ray (good, can miss fluid filled loops)

CT (v sensitive and specific, adhesions not seen)

28
Q

how can you tell small from large bowel

A

small bowel have valvulae conniventes lines which go all the way from one side to another

large bowel has haustra but these dont go the whole way across

29
Q

what are the common causes of large bowel obstruction

A

colorectal cancer
volvulus
diverticulitis

30
Q

what imaging for large bowel obstruction

A

X ray - may not be helpful, may not diagnose underlying disease
CT best- shows transition point, underlying mass, state of caecum, distant disease

31
Q

what are the causes of bowel perforation

A

common:
- ulcer
- diverticular

less common

  • cancer
  • ischaemia
32
Q

what imaging for peforation

A 
x ray 
-may miss small pockets of gas
-doesn't show site origin 
CT 
-high sens and spec 
-shows free fluid
-shows clues to site of origin: distribution gas, defect in wall, local inflammation
33
Q

what is riglers sign

A

when you can see both sides of the bowel wall as the gas outside (happen when perforated) acts as a contrast
is a pathological sign

34
Q

when does bowel ischaemia develop

A

when it receives less than 10% of cardiac output

35
Q

what causes bowel ischaemia

A

arterial occlusion
venous occlusion
non occlusive hypoperfusion

36
Q

what are the signs and symptoms of bowel ischaemia

A

severe abdo pain, very acute onset
vomiting, diarrhoea, distention
boderline amylase, raised WCC, acidotic

37
Q

what are the differentials of bowel ischaemia

A

perforation, pancreatitis, obstruction, diverticulitis

38
Q

what imaging for bowel ischaemia

A

biphasic CT

  • modality of choice
  • shows site of occlusion and length of bowel affected
39
Q

when do you gas in portal vein

A

very bad- happens in bowel ischaemia

40
Q

what is emergency EVAR

A

endovascular aortic repair

41
Q

USS is used first for pain where

A

RUQ, RIF

42
Q

summarise the role of CT in the abdomen

A

primary imaging technique for acute abdo pain except for acute cholecystitis/ appendicitis

43
Q

what preparation for a gall bladder USS- why

A

fast them so you can get their gallbladder to distend.

If they are fasted, there is less gas in the duodenum so you are more likely to see the CBD

44
Q

when is the common bile duct dilated

A

when more than 5mm

45
Q

what are the main complications of pancreatitis

A

necrosis, formation of a pseudocyst

46
Q

what is seen on CT in pancreatitis

A

oedema, swelling

47
Q

what vessels are at risk in pancreatitis

A

splenic vein- thrombosis

branches of gastroduodenal artery- erosion (haemorrhage due to pseudoaneurysm formation)

48
Q

what is MRCP

A

a non invasive way of looking at the billiary tree (magnetic resonance cholangiopancreatography)

49
Q

what is ERCP

A

endoscopy retrograde cholangiopancreatography - combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems

50
Q

how are pancreatic pseudocysts treated

A

drained percutaneously under CT guidance

51
Q

what is a pseudocysts

A

has a non epithelialised cysts

52
Q

what is the largest branch of the circle of willis

A

MCA- runs horizontally

53
Q

what colour is fluid on USS

A

black

54
Q

what muscles are activated when you put your hands on your knees to catch your breath

A

pec minor and serratus anterior (attach to the ribs and scapula, this position allows the accessory muscles of respiration to be used more effectively- not being used to maintain posture)

55
Q

via what does the ICA enter the skull base

A

carotid canal

56
Q

what can be damaged in a supracondylar fracture of the humerus

A

ulnar nerve

brachial artery

57
Q

what nerve injury results in anaesthesia of the lateral skin of the forearm

A

lateral cutaneous nerve of the forearm (is a branch of the musculocutaneous nerve)

58
Q

what vertebral level does the aortic arch begin and end

A

T4/5

CLASP Radiology (6 decks)

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