E1: GI Diagnostic Studies Flashcards
What imaging would you use to assess for dilated bowel?
Supine abdominal XR (KUB)
What is often the initial test to evaluate abdominal problems?
Supine abdominal XR (KUB)
What kind of imaging allows for good visualization of abdominal air-fluid levels?
Upright abdominal xr
What kind of imaging allows for visualization of free air underneath hemidiaphragms and assesses for perforation?
PA Chest XR
What will you see on XR with a small bowel obstruction?
- Dilated bowel proximal to the obstruction with collapsed bowel distally on supine XR
- air fluid levels on upright XR
What will you see on XR if a patient has an Ileus?
- Dilated bowel but air present in both small bowel and colon
- No air fluid levels
What will you see on XR if a patient has perforation?
Free air outside the bowel
What is the initial diagnostic test of choice in a patient with suspected cholelithiasis?
RUQ US or Gallbladder US
What imaging would you order if you are concerned about pancreatitis or diverticulitis?
CT scan
You see multiple white colored calcifications on the pancreas on the CT scan. What are you concerned about?
Chronic pancreatitis
What scan would you order if you are concerned about kidney stones?
CT abdomen and pelvis without contrast
What are the contraindications to CT scans?
- Pregnanct
- Unstable vitals
- morbid obesity
- Contraindications to IV contrast (shellfish allergy)
What are the possible complications of IV contrast?
- Allergic reaction
- Acute kidney injury (intrinsic and acute tubular necrosis)
What education should you give a patient who recently had a CT with contrast and also takes Metformin?
Hold the Metformin for 48 hours post contrast administration
What does a HIDA scan do?
Assess the bile excreting function of the liver and gallbladder
What is an abnormal HIDA scan?
If the gallbladder is not visualized due to cystic duct obstruction, no radionuclide seen in GB within 15-60 minutes
What two things can an abnormal HIDA scan indicate?
Cholecystitis and acalculous cholecystitis
What are Barium studies used for?
Assessing for luminal GI tract disorders and enhances visibility by coating the mucosa
-evaluates for anatomic and functional abnormalities
What are the 4 types of barium studies?
- Esophagram/Barium swallow
- UGI (upper GI) series
- SBFT (small bowel follow through)
- BE (barium Enema)
What is the esophagram/Barium swallow used for?
Visualizes the esophagus and gastroesophageal junction (GEJ) into the proximal stomach
What are UGI series used for?
To visualize the esophagus, stomach,and first part of the duodenum
What are the contraindications to UGI series?
- Pregnancy
- Complete bowel obstruction
- Suspected upper GI perforation
If there is suspected upper GI perforation, how can a UGI series be performed?
Barium is contraindicated, use water soluble Gastrografin
What is an SBFT used for?
- To visualize the esophagus, stomach, duodenum, jejunum, and ileum
- Can assess peristalsis activity, mucosal abnormalities, diverticula, bowel wall thickening
- evil of crohns and small bowel tumors
What are the indications for a Barium enema?
Change in bowel habits, constipation, diarrhea, assess for tumors/polyps
What are the contraindications for a barium enema?
Pregnancy
Mega colon
Suspected perforation
Unstable vitals
What are the contraindications for an EGD?
- Uncooperative patient
- bleeding
- esophageal diverticula
- suspected perforation
- recent upper GI tract surgery
What is the difference between ERCP and MRCP?
ERCP is diagnostic and therapeutic, MRCP is only diagnostic
What does an ERCP do?
-Involves the use of fiberoptic endoscope o obtain radio graphic visualization of bile and pancreatic ducts
What are the contraindications to ERCP?
- Uncooperative patient
- previous GI surgery with inaccessible ampulla of vater
What are the complications of ERCP?
- PANCREATITIS
- perforation/bleeding
- gram negative bacteremia
- aspiration
- oversedation
What is the gold standard for colon cancer screening?
Colonoscopy
What are the contraindications for colonoscopy?
- ACTIVE DIVERTICULITIS
- toxic megacolon
- severe rectal bleeding
- recent colon surgery
