B5.016 - GI Imaging Flip

Question 1

for the clinical condition of jaundice with one or more of the following: weight loss, fatigue, anorexia, duration of symptoms >3 months what imaging do you get based on appropriateness criteria

Answer 1

CT with contrast

US abdomen

MRI abdomen

Question 2

which imaging modality has the best imaging

Answer 2

MRI but its expensive

Question 3

Answer 3

salt and pepper liver, should be homogenous, showing micronodular cirrhosis

also see ascites around

Question 4

Answer 4

heterogeneous lesion

not 100% what it is until you add dopler, color changes indicate its vascular

Question 5

what is a definitive way to dx hepatocellular carcinoma

Answer 5

biopsy but high risk

better is another imaging test of MRI

Question 6

Answer 6

look at right aorta, indicates contrast was given

right is delayed post contrast so the contrast is in liver parenchyma and equally distributed

is diagnostic for hepatocellular carcinomas, they get all their blood flow from hepatic artery so the earlier image shows contrast in the are of the carcinoma

Question 7

how do you use contrast to dx hepatocellular carcinoma

Answer 7

hepatocellular carcinomas derive almost all of their blood from the hepatic artery. if you get an MRI with contrast that is taken earlier rather than later so most contrast is still in the arteries and organs that directly get blood supply from them then youll see the hepatocellular carcinoma illucidated more than the rest of the liver bc the liver derives most of its blood from the portal vein

Question 8

what is the most common primary hepatic malignancy

Answer 8

hepatocellular carcinoma

Question 9

what is hepatocellular carcinoma strongly associated with

Answer 9

chronic liver disease

viral hepatitis #1

alcoholism #2

3rd most common cause of cancer death worldwide

Question 10

what is predicted to become th leading cause of cirrhosis in the US in 10-15 years

Answer 10

NASH

Question 11

what is the stepwise process of HCC

Answer 11

regenerative nodule –> dysplastic nodule –> HCC

Question 12

what is used for screening/dx of HCC

Answer 12

US - screening

CT and/or MRI for Dx

will treat without biopsy

Question 13

what do you look for on CT/MRI to diagnose HCC

Answer 13

arterial phase enhancement with rapid washout compared to background parenchyma

Question 14

conventional radiograph use

Answer 14

check for bowel obstruction

cheap

easy

Question 15

what do you order to look for intussusception

Answer 15

abdominal ultrasound

Question 16

Answer 16

intussusception - target sign

outer ring - cecum intussusceptien

inner ring - terminal ileum intussusceptum

Question 17

what is a shiels kit

Answer 17

a thing you can use to reduce an intussusception

blows air or liquid contrast thru rectum and colon to reduce it

Question 18

what is intussusception

Answer 18

occurs when forward peristalsis results in invagination of the more proximal bowel (intussusceptum) into the lumen of the more distal bown (intussusceptien) in a telescope manner

overwhelmingly ileocolic

Question 19

presenting symptoms of intussusception

Answer 19

crampy abdominal pain

bloody currant jelly stool

vomiting

palpable right sided abdominal mass

bowel perforation is an absolute contraindication to attempting image guided reduction

Question 20

treatment of intussusception

Answer 20

therapeutic air/hydrostatic enema or surgery

Question 21

absolute contraindication for performing therapeutic enema procedure

Answer 21

pneumoperitoneum