Gastro IV (abd xrays) Flashcards
Indications for abdominal X-ray?
Intraperitoneal free air
Bowel obstruction
Organomegaly
Abnormal masses ( palpatable on exam)
Abnormal calcifications ( gall stones, radiopaque FB, assess tubes ( corpax, catheters)
What is a US better for?
Cholecystitis
Gyn issues
looking for ovarian cysts
What is a CT better for ?
Diverticulitis
Appendicitis
Nephrolithiasis
Abdominal trauma
Abdominal X-ray are useful for what?
Toxic megacolon
SBO
Upright for free air ( pnuenoperitoneum, air under the diaphragm)
KUB for renal tract calculi
FB following ingestion
When is abdominal X-ray not useful?
constipation
**colon loses all costal margins*
** large piece of stool, fecaloma - extreme impaction*
Abdominal X-ray: common views?
AP (supine)
AP (erect)
Lateral decubitus ( w/ arm elevated) - if patient is to sick to stand u, this will displace the free air
Supine lateral (cross-table view) - cutting through laterally
KUB (kidneys, ureter, bladder) - stones , focus more on urinary system
What is part of the acute abdominal series?
PA chest
Supine AP abdomen
Erect AP abdomen
What should an acute abdominal series include?
Just above the diaphragm to the ischial tuberosities
What does an abdominal x-ray: systemic study show?
Vertebrae
Lower ribs
Pelvis
Then soft tissues: LUQ RUQ Both flanks Mid-abdomen Pelvis
how much fluid must be present to show on abd X-ray?
500 ml
Fluid in the abd then we call it?
“gray abdomen” everything looks dull
If fluid in the abdomen then we see what?
“gray abdomen” - everything looks dull
Indistinct margins
Medial displacement of the colon, liver and spleen
“dog’s ears”
**fluid goes into the peritoneum , “bladder ears”*
Pneumoperitoneum: what is most sensitive test for free air - free air under the diaphragm?
CXR
Pneumoperitoneum on X-ray ?
Gas outlying the falciform ligament ( considered lace of the football)
Rigler Sign - air on both sides fo the intestine - luminal side and peritoneal wall
“Football” sign - massive pneumoperitoneum - distending cavity - losing flank stripes
**air within abdominal cavity *
What are examples of abdominal calcifications?
Vascular calcifications Calcified lymph nodes Gallstones Urinary calculi Liver and spleen granulomas Appendicoliths Calcified adrenal glands Pancreatic calcification Bowel contents Soft tissue calcifications Tumor
Small bowel obstruction?
small bowel dilated over 3 cm ( 30 mm)
multiple air/fluid levels in SB
stretch/slit sign
string of pearls sign
coiled spring sign
**usually causes by adhesions - multiple surgeries - multiple scarring also by CA, tumorss, intussesseption
*
Adynamic ileus x-ray?
Diffuse
Symmetric
Gaseous distention
Proportional dilation
** dilation of the large and small bowel - cannot distinguish them - Proportional dilation *
What is the sentinel loop?
Segment of intestine that becomes paralyzed and dilated next to inflamed intra-abdominal organ
**segment of the intestine that basically become enlarged or large air fluid level next to an inflamed organ
*
** pancreatitis , diverticulitis ,*
Toxic megacolon ?
Large bowel loses all tone and contractility
Risk of perforation
Cause is usually fulminant colitis
Toxic megacolon x-ray?
air within the large bowel diffusely all throughout
lose of all costar markings
severe C.diff, colitis, Hypotn, thumb printing?
Indication for colonoscopy?
Unexplained abd pain
Occult or frank GI bleeding
Change in bowel habits
Screening exam for adults
>50 yo
Colonoscopy explanation?
Test goes from anus to cecum ( try to get to the ileal cecal bowel portion
+/- portion of the terminal ileum
Colonoscopy procedure?
Pt given bowel prep to drink the day before the procedure (Colyte, GoLytely)
IV access and pt sedated (Versed/Fentanyl)
Colon is insufflated with air
Air is removed and replaced with CO2 if laser coagulation is going to be used
**bowel prep is important -make sure the is a good mucosa bowel for the doc to look at *
Contraindication for colonoscopy?
Uncooperative/ unstable patients
Profuse rectal bleeding
Suspected colon perforation
Toxic megacolon
Recent colon anastamosis
Colonoscopy results?
Colon CA
Colon polyps
IBD
AV malformations
Hemorrhoids
Diverticulosis
familial adenoma palposis - top rig
Sigmoidoscopy is very similar to ?
colonoscopy
Sigmoidoscopy only examine lower ___ of colon
60 cm
**only viewing part of the descending colon here
*
Is sedation required for Sigmoidoscopy? What is required?
no
Usually only requires enema prep
**less vigorous prep*
Recommendations for Colon CA Screening?
FOBT yearly AND one of the following:
- Colonoscopy Q 10 yrs
- Sigmoidoscopy Q 5 yrs with FOBT Q 3 yrs
DCBE Q 5 yrs
Indication for a barium enema?
Chronic abd pain
Occult/frank blood in stools
IBD
Suspected CA
Any time that visualization of the lumen is needed
Barium Enema procedure?
Bowel prep needed
No sedation needed
Balloon-tip catheter placed
in rectum and balloon blown up to prevent barium from leaking out
Contraindication to Barium Enema?
Bowel perforation
Megacolon
Uncooperative patients/ Unable to hold barium
RUQ US is used to visualize?
liver, GB, extra hepatic ducts and pancreas
RUQ US benefits?
non-invasive
inexpensive
RUQ US of liver looks for ?
Cysts, abscesses, dilated intrahepatic ducts
RUQ US of pancreas looks for?
Tumor, pseudocysts, inflammation, abscess
RUQ US of GB/Ducts looks for?
Stones, dilation, polyps, tumors
HIDA scan aka?
Hepatobiliary hydroxy iminodiacetic acid
HIDA conjoiners are normally excreted by ___________ into the _______ system into the _____.
HIDA conjoiners are normally excreted by hepatocytes into the biliary system into the bowel.
** the acid is taken up by hepatocyte and injected into the bile *
HIDA normal ?
Reflux of the isotope into the cystic duct (GB)
Indications for HIDA?
Biliary colic with normal RUQ US
Abnormal RUQ US without acute cholecystitis
ECRP aka?
Endoscopic Retrograde Cholangiopancreatography (ERCP)
ECRP allow for direct visualization of the _________ and ____ _____.
Allows for direct visualization of the pancreatic and bile ducts
During ____ procedure an incision can be made in the _________ muscle in the _______ __ _____
During ECRP procedure incision can be made in the papillary muscle in the ampulla of Vater
**passing endoscope and we are getting to the sphincter of Odi, look at all the duct systems looking for stones cause pain or abnormal liver function, procedure you can dilated the duct*
Contrindication to ERCP?
Abnl GI anatomy
Esophageal diverticula
Acute pancreatitis
Uncooperative patient
Complication for ECRP?
Perforation
Gram-negative sepsis
Pancreatitis
Aspiration of gastric
contents into the lungs
Oversedation
