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Clinical Medicine LAB - Professor Sample > Gastro IV (abd xrays) > Flashcards

Gastro IV (abd xrays) Flashcards

1
Q

Indications for abdominal X-ray?

A

Intraperitoneal free air

Bowel obstruction

Organomegaly

Abnormal masses ( palpatable on exam)

Abnormal calcifications ( gall stones, radiopaque FB, assess tubes ( corpax, catheters)

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2
Q

What is a US better for?

A

Cholecystitis

Gyn issues

looking for ovarian cysts

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3
Q

What is a CT better for ?

A

Diverticulitis
Appendicitis
Nephrolithiasis
Abdominal trauma

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4
Q

Abdominal X-ray are useful for what?

A

Toxic megacolon

SBO

Upright for free air ( pnuenoperitoneum, air under the diaphragm)

KUB for renal tract calculi
FB following ingestion

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5
Q

When is abdominal X-ray not useful?

A

constipation

**colon loses all costal margins*

** large piece of stool, fecaloma - extreme impaction*

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6
Q

Abdominal X-ray: common views?

A

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

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7
Q

What is part of the acute abdominal series?

A

PA chest

Supine AP abdomen

Erect AP abdomen

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8
Q

What should an acute abdominal series include?

A

Just above the diaphragm to the ischial tuberosities

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9
Q

What does an abdominal x-ray: systemic study show?

A

Vertebrae
Lower ribs
Pelvis

Then soft tissues:
LUQ
RUQ
Both flanks
Mid-abdomen
Pelvis
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10
Q

how much fluid must be present to show on abd X-ray?

A

500 ml

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11
Q

Fluid in the abd then we call it?

A

“gray abdomen” everything looks dull

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12
Q

If fluid in the abdomen then we see what?

A

“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”*

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13
Q

Pneumoperitoneum: what is most sensitive test for free air - free air under the diaphragm?

A

CXR

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14
Q

Pneumoperitoneum on X-ray ?

A

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 *

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15
Q

What are examples of abdominal calcifications?

A 
Vascular calcifications
Calcified lymph nodes
Gallstones
Urinary calculi
Liver and spleen granulomas
Appendicoliths
Calcified adrenal glands
Pancreatic calcification
Bowel contents
Soft tissue calcifications
Tumor
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16
Q

Small bowel obstruction?

A

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
*

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17
Q

Adynamic ileus x-ray?

A

Diffuse
Symmetric
Gaseous distention
Proportional dilation

** dilation of the large and small bowel - cannot distinguish them - Proportional dilation *

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18
Q

What is the sentinel loop?

A

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 ,*

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19
Q

Toxic megacolon ?

A

Large bowel loses all tone and contractility

Risk of perforation

Cause is usually fulminant colitis

20
Q

Toxic megacolon x-ray?

A

air within the large bowel diffusely all throughout

lose of all costar markings

severe C.diff, colitis, Hypotn, thumb printing?

21
Q

Indication for colonoscopy?

A

Unexplained abd pain

Occult or frank GI bleeding

Change in bowel habits

Screening exam for adults
>50 yo

22
Q

Colonoscopy explanation?

A

Test goes from anus to cecum ( try to get to the ileal cecal bowel portion

+/- portion of the terminal ileum

23
Q

Colonoscopy procedure?

A

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 *

24
Q

Contraindication for colonoscopy?

A

Uncooperative/ unstable patients

Profuse rectal bleeding

Suspected colon perforation

Toxic megacolon

Recent colon anastamosis

25
Q

Colonoscopy results?

A

Colon CA

Colon polyps

IBD

AV malformations

Hemorrhoids

Diverticulosis

familial adenoma palposis - top rig

26
Q

Sigmoidoscopy is very similar to ?

A

colonoscopy

27
Q

Sigmoidoscopy only examine lower ___ of colon

A

60 cm

**only viewing part of the descending colon here
*

28
Q

Is sedation required for Sigmoidoscopy? What is required?

A

no

Usually only requires enema prep

**less vigorous prep*

29
Q

Recommendations for Colon CA Screening?

A

FOBT yearly AND one of the following:

  1. Colonoscopy Q 10 yrs
  2. Sigmoidoscopy Q 5 yrs with FOBT Q 3 yrs
    DCBE Q 5 yrs
30
Q

Indication for a barium enema?

A

Chronic abd pain

Occult/frank blood in stools

IBD

Suspected CA

Any time that visualization of the lumen is needed

31
Q

Barium Enema procedure?

A

Bowel prep needed

No sedation needed

Balloon-tip catheter placed
in rectum and balloon blown up to prevent barium from leaking out

32
Q

Contraindication to Barium Enema?

A

Bowel perforation

Megacolon

Uncooperative patients/ Unable to hold barium

33
Q

RUQ US is used to visualize?

A

liver, GB, extra hepatic ducts and pancreas

34
Q

RUQ US benefits?

A

non-invasive

inexpensive

35
Q

RUQ US of liver looks for ?

A

Cysts, abscesses, dilated intrahepatic ducts

36
Q

RUQ US of pancreas looks for?

A

Tumor, pseudocysts, inflammation, abscess

37
Q

RUQ US of GB/Ducts looks for?

A

Stones, dilation, polyps, tumors

38
Q

HIDA scan aka?

A

Hepatobiliary hydroxy iminodiacetic acid

39
Q

HIDA conjoiners are normally excreted by ___________ into the _______ system into the _____.

A

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 *

40
Q

HIDA normal ?

A

Reflux of the isotope into the cystic duct (GB)

41
Q

Indications for HIDA?

A

Biliary colic with normal RUQ US

Abnormal RUQ US without acute cholecystitis

42
Q

ECRP aka?

A

Endoscopic Retrograde Cholangiopancreatography (ERCP)

43
Q

ECRP allow for direct visualization of the _________ and ____ _____.

A

Allows for direct visualization of the pancreatic and bile ducts

44
Q

During ____ procedure an incision can be made in the _________ muscle in the _______ __ _____

A

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*

45
Q

Contrindication to ERCP?

A

Abnl GI anatomy

Esophageal diverticula

Acute pancreatitis

Uncooperative patient

46
Q

Complication for ECRP?

A

Perforation

Gram-negative sepsis

Pancreatitis

Aspiration of gastric
contents into the lungs

Oversedation

Clinical Medicine LAB - Professor Sample (36 decks)

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