Acute Abdomen Radiology Flashcards
What are the primary imaging tools in acute abdomen?
X-ray CT USS
What is the secondary imaging tool in acute abdomen?
MRI
What are the drawbacks of using CT?
Increases cancer risk Contrast – renal impairment
USS allows for clear visualisation of…
solid organs, free fluid, aorta, pelvis
MRI is good for…
soft tissue imaging, especially in pelvis
MRI is used as a second-line test for…
hepato-biliary (MRCP), small bowel, pelvis
Which imaging should be used in acute appendicitis?
USS then CT if inconclusive
Diverticulitis may be misdiagnosed as…
appendicitis, colorectal Ca
What do you need to be able to do when doing imaging for suspected diverticulitis?
o Make diagnosis o Look for complications – abscess, obstruction, perforation, fistulae
Give complications of diverticulitis.
abscess, obstruction, perforation, fistulae
Which imaging modalities may be used in diverticulitis?
X-ray CT
How is acute cholecystitis diagnosed?
RUQ pain + fever/raised CRP/WCC + confirmatory imaging
Which imaging modalities are used in Acute cholecystitis?
USS MRCP
What would usually be seen on USS of acute cholecystitis?
Gallstones GB wall thickening
What is emphysematous cholecystitis?
Air in gallbladder wall
Who gets emphysematous cholecystitis?
Diabetics
Give common causes of small bowel obstruction.
adhesions, cancer, herniae & gallstone ileus
What are the main symptoms of small bowel obstruction?
vomiting, pain & distension
What are the main signs of small bowel obstruction?
increased bowel sound, tenderness, palpable loops
Which imaging modalities can be used for small bowel obstruction?
X-ray CT
What is the drawback of x-ray in small bowel obstruction?
may not detect fluid-filled loops
What is gallstone ileus?
Obstruction of the small intestine due to gallstone impaction, usually at the iliocaecal valve
What are the main causes of large bowel obstruction?
colorectal cancer, volvulus, diverticulitis
How can you identify large bowel on x-ray?
Haustra go all the way across
Which imaging modality is best for large bowel obstruction?
CT - can identify cause too
What should you look for in bowel obstruction to assess risk of perforation?
dilation of the caecum suggests high risk of perforation.
What are the common causes of perforation in the GI tract?
Perforated ulcer Diverticulum
Which imaging modalities are useful in perforation?
X-ray CT
What % of CO does the GI tract usually receive?
20%
What % of CO does the GI tract receive in ischaemia?
< 10%
What are the most common causes of bowel ischaemia?
arterial occlusion, venous occlusion & non-occlusive hypoperfusion (combination of factors)
What symptoms may be present in bowel ischaemia?
Severe abdo pain, vomiting, diarrhoea, distention
Give some clinical features of bowel ischaemia.
Borderline amylase, raised WCC, acidotic
Which imaging should be done in suspected bowel ischaemia?
Biphasic CT
Which imaging modality is often used in ureteric colic?
CT
How can haemorrhage control be achieved in leaking AAA?
Aortic balloon
How can AAA be treated?
EVAR
What is the role of USS in acute abdomen?
RUQ/RIF pain
What is the role of CT in acute abdomen?
primary imaging for acute abdo pain apart from acute cholecystitis/appendicitis
What are the main uses of plain film in acute abdomen?
Obstruction or Perforation
Which pathology is seen here?
Acute appendicitis
Which pathology is seen here?
Paracolic abscess
What does this show?
Colovesical fistula
Which pathology does this show?
Acute cholecystitis - GB wall thickening & gallstone
Which pathology is seen here? What type of scan is this?
Gallstone in common bile duct - MRCP scan
Which pathology is seen here?
Small bowel obstruction
Which pathology is seen?
Small bowel obstruction
Which pathology is seen?
Small bowel obstruction due to gallstone ileus
Which pathology is seen?
Large bowel obstruction
Which pathology is seen?
Large bowel obstruction
Also: Caecal tumour & liver mets
Which pathology is seen here?
Perforation
Which pathology is seen here?
Bowel ischaemia
Which pathology is seen here?
Right ureteric calculus
Which pathology is shown here?
Leaking AAA
What does the arrow point to?
Normal gastric bubble
Which imaging would you order in suspected pancreatitis?
USS to look for gallstones
What does the ultrasound show?
Gallstone in the gallbladder
How should you prepare a patient for USS of the bile duct system?
Fast the patient
In the context of a patient with pancreatitis, what does this show?
Oedema - suggestive of pancreatic necrosis
What are the 2 major complications of pancreatitis?
Splenic vein thrombosis. Gastroduodenal artery haemorrhage.
What type of imaging is this?
MRCP
Which procedure can be used to remove gallstones?
ERCP
This patient was treated for pancreatitis 3 months ago. What does the scan show?
Pseudocyst
How are pseudocysts treated?
Percutaneous drainage
What kind of tube is seen here?
Nasojejunal tube
