GI Diagnostics—2

Question 1

Use of reflected sound waves to visualize the abdominal aorta, liver, gallbladder, pancreas, bile ducts, spleen, kidneys, ureters, bladder

What diagnostic test is this?

Answer 1

US

Question 2

In an US, what are the dark areas and what are the white areas?

Answer 2

• Dark areas are echo free = hypoechoic
  
  • Eg. aorta, bile ducts, cysts
• White areas are echogenic = solid
  
  • Eg. tumors

Question 3

Echogenic (solid / white) masses with “shadowing” behind (mobile)

What finding is this describing on an US?

Answer 3

Gallstones

Question 4

US Of what structure?

Answer 4

Gallbladder

Question 5

Patient receives radionuclide injection

Radionuclide extracted by liver & excreted in to bile

Provides visualization of biliary tree

Best info obtained when test is ordered with CCK stimulation and ejection fraction

Which diagnostic tool?

Answer 5

HIDA scan (Hepatoiminodiacetic acid)

Question 6

Indications for a HIDA scan

Answer 6

Primary indication is to diagnose suspected acalculous cholecystitis

US generally ordered 1st, HIDA scan done if US negative & clinical suspicion for cholecystitis persists

Question 7

What 3 findings show a positive test for cholecystitis?

Answer 7

No radionuclide seen in GB within 15 – 60 min.

Ejection fraction < 35% (< 50% is indeterminate)

Test reproduces patient’s symptoms

Question 8

Computerized x-rays that produce cross-sectional images of the body layer by layer

What diagnostic tool?

Answer 8

CT scan aka CAT scan

Question 9

Used to evaluate abdominal & pelvic organs

Imaged enhanced w/ IV iodine-containing contrast (water soluble)

Contrast usu. indicated

Common exception: Renal stone study

Which diagnostic tool?

Answer 9

CT scan

Question 10

T/F: In general CT more accurate than MRI for abd diagnoses

Answer 10

TRUE

Question 11

T/F: When suspected abdominal or bowel disease, CT abdomen & pelvis usu. ordered simultaneously

Answer 11

TRUE

Question 12

What are the 6 indications for abdominal/pelvic CT?

Answer 12

suspected liver disease

Issues of the:

gallbladder

pancreas

GI tract/bowel

spleen

abdominal aorta

Question 13

What type of diagnostic test is shown here?

Answer 13

CT abdomen with contrast

Question 14

What is this image showing?

Answer 14

Pancreatitis

Left image: upper abdominal CT scan shows inflammation and swelling of the pancreas. Consistent with acute pancreatitis.

Right image: CT scan of the upper abdomen showing multiple white-colored calcifications. These occur in chronic pancreatitis.

Question 15

What is this image showing?

Answer 15

CT abdomen-liver laceration

Left image: contrast-enhanced CT of abdomen shows linear low-attenuation defect crossing the posterior aspect of the left lobe of the liver representing a laceration

Right image: Normal contrast-enhanced CT abdomen view for comparison

Question 16

What is this showing?

Answer 16

Right image: CT pelvis without contrast demonstrating renal stone

Left image: normal contrast-enhanced CT abdomen view - for comparison

Question 17

Contraindications to Abd/Pelvic CT

Answer 17

Pregnancy

Unstable vitals

Morbid obesity (weight of patient on table)

Question 18

What are the contraindications to IV contrast?

Answer 18

Allergy to iodine or shellfish

In selected cases, may premedicate with steroids

Elevated Cr, renal failure

Question 19

Precautions for Abd./Pelvic CT

Answer 19

Metformin

Radiation risks

Question 20

direct visualization of the upper GI tract (esophagus, stomach, and first part of duodenum) via a long, flexible, fiberoptic-lighted scope

Usu. performed with conscious sedation

What diagnostic tool?

Answer 20

EGD

Question 21

3 channels of endoscope

Answer 21

1. viewing
2. insufflation of air/aspiration of fluid
3. passing instruments for biopsy/therapy

Question 22

Indications for EGD

Answer 22

Alarm symptoms: dysphagia, weight loss, early satiety, epigastric pain

Dyspepsia

Chronic GERD

Investigate abnormal UGI

There are others but i thought these were the most imp! :)

Question 23

EGD versus UGI:

What makes EGD a better option?

Answer 23

EGD = more sensitive & gold standard bc able to biopsy

EGD = can be used therapeutically to:

• Band esophageal varices
• Dilate esophagus
• Control bleeding

Question 24

What is this showing?

Answer 24

EGD: banding esophageal varices

Question 25

involves use of fiberoptic endoscope to obtain radiographic visualization of bile & pancreatic ducts

Endoscope is passed into the duodenum & a small catheter is inserted into biliary duct

Radiographic dye injected into ducts & x-rays taken

Performed with conscious sedation or anesthesia

Which diagnostic tool?

Answer 25

ERCP

Question 26

Which diagnostic test is this?

Answer 26

ERCP

Question 27

ERCP is indicated for which reasons?

Answer 27

patient with obstructive jaundice

investigation/tx of obstruction of bile & pancreatic ducts

Question 28

What other diagnostic test will you probably order before the ERCP?

Answer 28

_**MRCP may be ordered 1st b/c it is less invasive**_

Question 29

Therapeutic uses of ERCP

Answer 29

Incision in ampulla of Vater for gallstones

Placement of stents through strictured bile ducts

Question 30

CI of ERCP

Answer 30

Previous GI surgery w/ inaccessible ampulla of Vater

Known h/o pancreatitis

Question 31

What is the most important potential complication of ERCP?

Answer 31

Gram-negative sepsis: Introduction of bacteria into biliary & blood system

Question 32

Direct visualization of what 3 structures in a colonoscopy?

Answer 32

rectum

colon

terminal ileum

Question 33

T/F: Flex sig does not require conscious sedation

Answer 33

True

Question 34

What 4 things is a colonoscopy indicated for?

Answer 34

1. colon cancer screen
2. Investigate potential colon cancer symptoms (eg. change in bowel habits, hematochezia, iron deficiency anemia)
3. Investigate signs / symptoms of IBD
4. Investigate abnormal test