GI Diagnostics—2 Flashcards
Use of reflected sound waves to visualize the abdominal aorta, liver, gallbladder, pancreas, bile ducts, spleen, kidneys, ureters, bladder
What diagnostic test is this?
US
In an US, what are the dark areas and what are the white areas?
- Dark areas are echo free = hypoechoic
- Eg. aorta, bile ducts, cysts
- White areas are echogenic = solid
- Eg. tumors
Echogenic (solid / white) masses with “shadowing” behind (mobile)
What finding is this describing on an US?
Gallstones
US Of what structure?
Gallbladder
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?
HIDA scan (Hepatoiminodiacetic acid)
Indications for a HIDA scan
Primary indication is to diagnose suspected acalculous cholecystitis
US generally ordered 1st, HIDA scan done if US negative & clinical suspicion for cholecystitis persists
What 3 findings show a positive test for cholecystitis?
No radionuclide seen in GB within 15 – 60 min.
Ejection fraction < 35% (< 50% is indeterminate)
Test reproduces patient’s symptoms
Computerized x-rays that produce cross-sectional images of the body layer by layer
What diagnostic tool?
CT scan aka CAT scan
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?
CT scan
T/F: In general CT more accurate than MRI for abd diagnoses
TRUE
T/F: When suspected abdominal or bowel disease, CT abdomen & pelvis usu. ordered simultaneously
TRUE
What are the 6 indications for abdominal/pelvic CT?
suspected liver disease
Issues of the:
gallbladder
pancreas
GI tract/bowel
spleen
abdominal aorta
What type of diagnostic test is shown here?
CT abdomen with contrast
What is this image showing?
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.
What is this image showing?
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
What is this showing?
Right image: CT pelvis without contrast demonstrating renal stone
Left image: normal contrast-enhanced CT abdomen view - for comparison
Contraindications to Abd/Pelvic CT
Pregnancy
Unstable vitals
Morbid obesity (weight of patient on table)
What are the contraindications to IV contrast?
Allergy to iodine or shellfish
In selected cases, may premedicate with steroids
Elevated Cr, renal failure
Precautions for Abd./Pelvic CT
Metformin
Radiation risks
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?
EGD
3 channels of endoscope
- viewing
- insufflation of air/aspiration of fluid
- passing instruments for biopsy/therapy
Indications for EGD
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! :)
EGD versus UGI:
What makes EGD a better option?
EGD = more sensitive & gold standard bc able to biopsy
EGD = can be used therapeutically to:
- Band esophageal varices
- Dilate esophagus
- Control bleeding
What is this showing?
EGD: banding esophageal varices
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?
ERCP
Which diagnostic test is this?
ERCP
ERCP is indicated for which reasons?
patient with obstructive jaundice
investigation/tx of obstruction of bile & pancreatic ducts
What other diagnostic test will you probably order before the ERCP?
_**MRCP may be ordered 1st b/c it is less invasive**_
Therapeutic uses of ERCP
Incision in ampulla of Vater for gallstones
Placement of stents through strictured bile ducts
CI of ERCP
Previous GI surgery w/ inaccessible ampulla of Vater
Known h/o pancreatitis
What is the most important potential complication of ERCP?
Gram-negative sepsis: Introduction of bacteria into biliary & blood system
Direct visualization of what 3 structures in a colonoscopy?
rectum
colon
terminal ileum
T/F: Flex sig does not require conscious sedation
True
What 4 things is a colonoscopy indicated for?
- colon cancer screen
- Investigate potential colon cancer symptoms (eg. change in bowel habits, hematochezia, iron deficiency anemia)
- Investigate signs / symptoms of IBD
- Investigate abnormal test
