Dx Tests for GI Flashcards
radiolucent appears
dark
radiopaque appears
light (white,grey)
3 way views of abdomen x-ray series
Anterior/posterior while patient was supine
upright - air-fluid levels
PA chest x-ray - free air underneath hemidiapharagms and check chest pathology
what are three indications for abdominal x-ray
abdominal pain, nausea, vomiting, and distention
looking for: intestinal obstruction, perforation, intussusception
what will an obstruction look like on abdominal x-ray
dilated bowel proximal to obstruction with collapsed bowel distally
air fluid levels
what will a paralytic ileus (non-mechanical bowel obstruction) look like on abdominal x-ray
dilated bowel
gas in both small and large intestines
what will perforation look like on abdominal x-ray
free air outside the bowel
what will intussusception look like on abdominal x-ray
obstruction signs
2 risks associated with abdominal x-rays
contraindicated in pregnancy
radiation exposure
use of reflected sound waves to visualized the abdominal aorta, liver, gallbladder, pancreas, bile ducts, spleen, kidneys, ureters, bladder
abdominal ultrasound
doppler ultrasound provides info regarding what
blood flow
dark areas on abdominal ultrasound are ______
what are four examples
hypoechoic
aorta, bile ducts, abscesses, cysts
white areas are _____ on abdominal ultrasound.
what is one example
echogenic (solid)
tumors
when do you consider using an abdominal ultrasound
abdominal pain
elevated LFTs
known or suspected liver disease
kidney, pancreas, liver transplant
acute/chronic renal failure
what five things can you visualize on ultrasound of the liver
cysts
abscesses
tumors
cirrhosis
dilated bile ducts
what five things can you visualize on gallbladder ultrasound
tumors
polyps
stones
sludge
inflammation (wall thickening)
what four things can you visualized on pancreas ultrasound
cysts
abscesses
tumors
inflammation
what are the risks/complications of ultrasound
ummm… none
When do you not use CT scan with contrast?
low GFR
kidney disease
allergy to iodine
renal stone studies
What kind of CT scan do you use for GI bleeds (vomiting blood)
CT angiography
embolization procedure
Indications for CT scan A/P view
abdominal pain
abdominal distension
N/V
Diarrhea
Constipation
Rectal bleeding
Jaundice
Make sure you use other radiologic studies that have less radiation, fewer complications if possible
CT scan is best for what two things
appendicitis and pancreatitis
US is preferred over CT for what
cholecystitis, cholelithiasis
When looking at the liver on CT scan, what can you see?
cysts, abscesses, tumors, bile duct obstruction
When looking at the pancreas on CT scan, what can you see?
cysts, abscess, tumor, calcification, pancreatitis
When looking at GI tract/bowel on CT scan, what can you see
tumor, obstruction, perforation, inflammation (appendicitis), bleeding
When looking at spleen on CT scan, what can you see
tumor, laceration, hematoma, splenic vein thrombosis
When looking at abdominal aorta on CT scan, what are you looking for
visualization for aneurysm
Contraindications for CT scan
pregnancy
unstable vitals
morbid obestiy
contraindications to IV contrast (allergy to iodine or shellfish)
elevated creatinine
Complications associated with CT scan
reaction to contrast (ranges from itch to anaphylaxis)
acute renal failure from contrast
Metformin precautions with CT scan
hold for 48 hours post-contrast administration
Why do you want to avoid unnecessary CTs?
radiation risks - 1 CT abdomen = 250-500 CXR
Hepatoiminodiacetic acid scan OR GB nuclear scan OR cholescintigraphy =
HIDA scan
Explain process of HIDA scan
pt receives IV radioactive tracer
technetium labeled hepatic iminodiacetic acid (HIDA) is taken up by liver and excreted into bile
if cystic duct is OPEN (patent), tracer will go to gall bladder where it can be visualized
nuclear scanner tracks flow of tracer
what is a positive HIDA scan
if gall bladder does not visualized due to cystic duct obstruction in the setting of obstructing stone or edema
What test should you combine with HIDA scan to get best information
CCK stimulation and ejection fraction
primary indication for HIDA scan
suspected acalculous cholescystitis
What HIDA scan findings will be consistent with cholecystitis?
no radionuclide seen in gall bladder within 15-60 minutes
ejection fraction of less than 35%
test reproduces pt’s symptoms
When do you not use HIDA scan
pregnancy
Upper GI series AKA
esophagram, barium swallow
Upper GI series procedure
patient drinks barium sulfate contrast and fluoroscopy is used to visualize esophagus, stomach, and first part of duodenum
what is fluoroscopy
x-ray movie in real time
esophagram/barium swallow shows what
throat and esophagus only
can add on small bowel follow-through
What are the indications for UGI series?
dysphagia
GERD symptoms
early satiety
suspected peptic ulcer disease
suspected obstruction/inflammation
What are some findings on the upper GI series?
hiatal hernia
potential cancer - strictures, obstructions, filling defects, tumors, ulcerations
ulcers
diverticula
extrinsic compression
perforation - leakage of barium outside the upper GI tract (IF THIS IS THE CASE - USE GASTROGRAFIN)
How will a filling defect look on UGI series?
displacement of contrast medium by a space-occupying lesion in a radiographic study of a contrast-filled hollow viscus
If you suspect an upper GI perforation, what do you do on UGI series?
use water-soluble gastrografin not barium!
complications of UGI series
aspiration if they are throwing up and accidentally aspirate
constipation from barium
contraindications of UGI series?
pregnancy
complete bowel obstruction
suspected upper GI perforation
unstable vital signs
barium enema is used to see what
colon and distal small bowel
what can you use as an alternative to colonoscopy
barium enema
When can a barium enema be therapeutic
reduce a non-strangulated ileocolic intussusception
what will you see with inflammatory bowel disease on a barium enema
narrowing of the barium column due to inflammation of surrounding colon
what will you see that would indicate cancer with a barium enema
strictures
obstructions
filling defects
tumors
ulcerations
what other things can you visualize with barium enema
ulcers, diverticula, benign tumors, extrinsic compression, perforation (leakage of barium outside of colon)
if perforation, what should you do with barium enema
not use barium - use water-soluble gastrografin
four contraindications of barium enema
pregnancy
megacolon
suspected perforation - use gastrografin
unstable vitals
2 complications of barium enema
perforation
fecal impaction due to barium
Esophagogastrodudoenoscopy AKA
EGD
Direct visualization of the upper GI tract via a long flexible fiberoptic lighted scope
EGD
EGD is performed with what type of anesthesia
conscious sedation
___ can be dx and tx
EGD
When do you consider doing an EGD
alarm symptoms - dysphagia, weight loss, early satiety, epigastric pain
N/V, abdominal pain
Dyspepsia
Chronic GERD
Dysphagia
Suspected esophageal varices
Hematemsis or melena
Iron def anemia
abnormal UGI
suspected enteropathies (like celiac)
foreign body/food bolus
EGD findings
hiatal hernia
tumors (cancer)
polyps
varices
mucosal inflammation
ulcers
barret’s esophagus
obstructions
webs, rings (schatzski’s ring)
infection
anteriovenous malformations
complications from EGD
perforation
bleeding from biopsy
aspiration of gastric contents
oversedation
Endoscopic retrograde cholangiopancreatography AKA
ERCP
what is difference between ERCP and EGD
goes into bile and pancreatic ducts - endoscope is passed into duodenum and small catheter inserted into biliary duct where x-rays are taken once dye is injected
MRCP used when
when you don’t want to do a procedure - do this and then see if ERCP is needed
MR visualization of biliary tree and pancreatic ducts
dx not therapeutic
ERCP
indications for ERCP
obstructive jaundice
obstruction of bile and pancreatic ducts - mass, choledocholithiasis, cholangitis
therapeutic uses of ERCP
sphinterotomies, remove stones, place stents, and obtain brushings/biopsies
incision in ampulla of vater to widen common bile duct and gallstones can be removed
contraindications for ERCP
uncooperative pt
previous GI surgery with inaccessible ampulla of Vater
complications of ERCP
pancreatitis, perforation, gram-negative bacteremia or sepsis, aspiration of gastric contents, oversedation
involves direct visualization of rectum, colon, and terminal ileum via long, flexible fiberoptic-lighted scope
dx and therapeutic
req bowel prep
colonoscopy
flexible sigmoidoscopy
limited to rectum and sigmoid colon
indications for colonoscopy
colon cancer screening - remove polyps and biopsy them
signs/symptoms of IBD - Crohn’s and ulcerative colitis
Hematochezia
Diarrhea
Prior abnormal test
Foreign body removal
Decompression of volvulus
what are potential colon cancer symptoms
change in bowel habits, hematochezia, iron def anemia
contraindications of colonoscopy
uncooperative pt
severe rectal bleeding
suspected perforation
recent colon surgery
toxic megacolon
active diverticulitis or colitis
complications of colonoscopy
perforation
bleeding due to biopsy or polypectomy
oversedation
cologuard
colon-cancer screening test
non-invasive stool test with DNA markers and immunochemical test for hemoglobin in stool
do every 3 years
