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Summer FDTN Exam 5 > GI diagnostics > Flashcards

GI diagnostics Flashcards

1
Q

What is a 3 way Abd X-Ray

A
  1. Ant/Post while supine
  2. Upright (air-fluid levels)
  3. PA chest XR to see air under hemidiaphragm
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2
Q

When is a 3 way Abd XR indicated

A

Suspected intestinal obstruciton, perforation, or intussusception

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3
Q

What do colors on an XR mean

A

Dark (radiolucent): allow XR to penetrate, so air

White (radiopaque): block penetration of XR, so bone, organ, tissue, etc. (intense white is metallic object)

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4
Q

What are some abdominal XR findings

A 
Obstruction: dilated bowel proximal to obstruction and collapsed distally 
Paralytic ileus (non-mechanical obstruction): dilated bowel, gas in small and large intestine 
Perforation: free air outside bowel 
Intussusception: sign of obstruction
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5
Q

How can you tell small from large intestine

A

Small has valvulae conniventes

Large has haustrations

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6
Q

Multiple air fluid levels of varying size on an upright XR can indicate

A

a complete SBO

But when you do the same but supine, small bowel is distended and no air is in the colon or rectum

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7
Q

What is”ileus”

A

air throughout making small and large bowel “look” the same
Can be seen post op
Likely to see haustral fold in the apex of the sigmoid colon

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8
Q

Classic XR finding for free air is

A

Sickle shaped (half moon) black just inferior to the diaphragm

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9
Q

What is intussusception

A 
one loop of bowel slips into another section of bowel
Leads to swelling, decreased blood flow, obstruction, and tissue damage 
Emergent Tx (barium enema or surgery)!!!
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10
Q

What can cause an obstruction similar to intussusception

A

The ileocecal valve staying shut

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11
Q

What is contraindication to abdominal XR

A

Pregnancy!

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12
Q

What is an upper GI series (UGI)

A

Patient drinks barium sulfate contrast

Fluoroscopy helps visualize esophagus, stomach, and 1st part of duodenum

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13
Q

What are types of UGI series

A

Fluoroscopy: XR movie (continuous XR passed through body part and image is trans. to monitor)
Esophagram: barium swallow, view throat and esophagus only
Small bowel follow through: follow barium through the small intestine

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14
Q

What are indications for a UGI series

A 
Dysphagia, Dyspepsia 
GERD 
Early satiety (gastric cancer?) 
Suspected PUD 
Suspected obstruction/inflammation
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15
Q

UGI series can detect

A

Hiatal hernia (stomach goes superior thru diaphragm)
Cancer (strictures, obstructions, filling defect, tumor, ulcer)
Ulcers
Diverticula (outpouching shows thinner than regular GI)
Benign tumor (filling defect)
Extrinsic compression
Perforation

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16
Q

Why is a scope not preferred to visualize diverticula

A

can perforate because they are thinner!

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17
Q

What is a filling defect

A

Displacement of contrast by a space occupying lesion

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18
Q

What type of study do you do if perforation is suspected

A

Water soluble Gastrografin- do NOT use Barium bc it does not degrade in the body and can lead to ADE

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19
Q

With a hiatal hernia, you are more likely to develop

A

GERD!

You lose the anatomical barrier that keeps everything down

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20
Q

How does an ulcer show up on XR

A

Looks like a loss of GI mucosa with a thin, straight black line at the neck of the ulcer

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21
Q

What is a Bezoar

A

a small stony accumulation in the stomach 2/2 eating random objects (hair, clay, etc.)
Forms a large filling defect

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22
Q

Contraindications to UGI are

A

Pregnancy (unless benefit>risk)
Complete bowel obstruction (where will barium go?)
Susp. GI perforation (use gastrografin)
Unstable vitals (supervise pt)
-Caution: consider radiation risk always!

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23
Q

Complications of a UGI are

A

Aspiration

Constipation/partial obstruction

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24
Q

What is a lower GI series

A

a Barium enema!
Then fluoroscopy is used to visualize colon, distal small bowel, and occasionally appendix
Can be therapeutic to reduce a NON-strangulated ileocolic intussusception

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25
Q

What helps visualize lower GI better

A

Air Contrast Barium Enema;

Air is put into colon after the barium enema to give air contrast to barium

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26
Q

What are indications for a LGI

A

Alternative to colonoscopy

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27
Q

LGI findings include (similar to UGI)

A 
IBD (barium narrows 2/2 inflammation) 
Cancer 
Ulcers 
Diverticula 
Benign tumors 
Extrinsic compression 
Perforation (use gastrografin)
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28
Q

What is a popcorn finding for adenocarcinoma of the colon

A

Apple core lesion

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29
Q

Contraindications to barium enema are

A 
Pregnancy 
Megacolon 
Suspected perforation (gastrografin) 
Unstable vitals 
-always consider radiation risks!
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30
Q

Complications of a LGI are

A

Perforation (esp if using ACBE)

Barium fecal impaction

31
Q

What is an abdominal US

A

Reflected sound waves are used to visualize abdominal aorta, liver, gallbladder, pancreas, bile ducts, spleen, kidney, ureters, and bladder
Doppler can be used for blood flow
*can order specific areas! RUQ, renal, liver, etc.

32
Q

What are indications for a liver US

A

Cyst, abscess, tumor
measure bile ducts
Screen for fatty liver if LFT high
screen for cancer if w/ chronic hepatitis

33
Q

What are indications for a gallbladder US

A

FIRST line for cholelithiasis or cholecystitis!

Tumors, polyps, stones, sludge, inflammation

34
Q

What are indications for a pancreas US

A

cyst, abscess, tumor, inflammation

Good test but can be hard to see pancreas

35
Q

What do colors mean on an ultrasound

A

Dark: echo free, hypoechoic. aorta, bile ducts, cysts
White: echogenic, solid. tumors

36
Q

What are some US findings

A

Cyst, abscess
Tumor
Bile duct stricture, dilation, tumor, stones
Acute Inflammation: enlarged organ, edematous
Chronic Inflammation: organ small, contracted, echogenic
Gallstones

37
Q

What are benefits of an abdominal US

A

no contrast or radiation- good for patients with CI to other diagnostic tests

38
Q

What is a HIDA scan

A

Basically a cholescintigraphy-
Patient gets a radionuclide injection
Radionuclide is extracted by the liver, excreted into bile
Allows you to see biliary tree

39
Q

What makes a HIDA scan even better

A

Order with CCK stimulation and ejection fraction
CCK stimulates digestion
EF shows you how well you are getting rid of bile

40
Q

What are indications for a HIDA scan

A

**Dx acalculous cholecystitis!
Generally you order an US first, and if negative but you still suspect cholecystitis, get the HIDA
DO NOT use in pregnancy

41
Q

What will you find on HIDA scan that indicates cholecystitis

A

No radionuclide in GB w/in 15-60 minutes
EF <35%
Test reproduces pt symptoms

42
Q

What is an abdomal/pelvic CT

A

computerized X-rays that produce cross sectional images of the body, layer by layer (tomo means slice)
Enhance w/ IV iodine contrast (water soluble)

43
Q

When is the only time you really don’t need contrast

A

If you suspect renal stones

44
Q

Abd/pelvic CT can help detect

A

cyst, abscess, tumor, inflammation, bowel perforation, intraabdominal bleeding, intestinal or ureteral obstruction

45
Q

What is a helical CT

A

continuously obtains imaged, faster and more accurate

abdomen imaged in <30 seconds

46
Q

What test is preferred for abdominal disease

A

CT (more accurate than MRI)- except some dz, like liver hemangioma, where MRI is better

47
Q

Indications for abdominal/pelvic CT are

A

Susp. liver disease (CT>US for fatty liver)
Gallbladder (#1 for cholelithiasis)
Pancreas (best for pancreatic inflammation)
Bowel tumor, perforation, inflammation, appendicitis
Spleen tumor, lac, hematoma, thrombosis
AAA

48
Q

What do different abd/pelvic CT findings include

A

Acute pancreatitis: edema, fluid w/ inflammation
Chronic pancreatitis: calcifications, contracted pancreas
GI tumor: solid mass
GI perf: leak of contrast
GI inflammation: edema, thickened wall, pericolonic fat stranding*
Bile duct obstruction: filling defect

49
Q

What is a virtual colonoscopy

A

3D image done with CT that some people use instead of a colonoscopy 2/2 less prep and discomfort
But not preventive, and kind of sucks if you see something abn bc then you have to do a colonoscopy anyways

50
Q

What is interventional radiology

A

CT used for visualization during invasive procedures

Ex: aspirate fluid from organ, guide needle biopsy, guide cath placement for abscess drainage

51
Q

Contraindications to abdominal/pelvic CT are

A

pregnancy
unstable vitals
morbid obesity
IV contraindication: allergy to iodine or shellfish, elevated Cr, renal failure
-Caution if on metformin (stop 1 day prior), radiation risk

52
Q

If allergic to shellfish, how can you still give contrast with CT

A

Premedicate with steroids in some cases

53
Q

How much radiation is associated with a CT

A

250-500 CXR’s

so avoid unless necessary- risk is cumulative

54
Q

CT complications are

A

Reaction to contrast (flushing/itching to anaphylaxis)

55
Q

What is an EGD

A

Direct visualization of upper GI tract (esophagus, stomach, first part of duodenum) using long, flexible fiber-optic light scope
Usually under conscious sedation

56
Q

What are the 3 channels of an endoscope

A
  1. Viewing
  2. Insufflation of air/aspiration of fluid
  3. Passing instrument for biopsy/therapy
57
Q

What are indications for EGD

A

Alarm Sx: dysphagia, wt loss, early satiety, epigastric pain
Upper abdominal pain
dyspepsia
chronic GERD
suspected esophageal varicies (portal HTN, alcoholism)
investigate abnormal UGI
investigate susp enteropathies (celiac dz)

58
Q

An EGD can detect

A 
hiatal hernia (UGI better) 
tumor 
polyps
varicies
mucosal inflammation
ulcer
barret's esophagus
obstruction
webs, rings 
infection (candida, HSV) 
AV malformations
59
Q

Compare EGD to UGI

A

EGD is more sensitive bc you can biopsy

EGD can be therapeutic (band esophageal varicies, dilate esophagus, control bleeding)

60
Q

EGD contraindications are

A 
Uncooperative patient 
Severe bleeding (unless you can adequately lavage and aspirate) 
Esophageal diverticula 
Suspected perforation 
Recent upper GI surgery
61
Q

Complications of an EGD are

A

Perforation (VERY serious)
Bleeding 2/2 biopsy
Aspiration of gastric contents
Oversedation

62
Q

What is an ERCP

A

Use fiber-optic endoscope to get radiographic view of bile and pancreatic ducts (biliary tree)
-Endoscope passed into duodenum, and small catheter sent into biliary duct
-Radiographic dye injected into ducts
-Take XR
conscious sedation or anesthesia obvi

63
Q

What is the ampulla of vater

A

the union of pancreatic duct and common bile duct

64
Q

ERCP indications are

A

Patient with obstructive jaundice

investigate/treat bile or pancreatic obstruction

65
Q

What can you get before an ERCP that is less invasive

A

MRCP: magnetic resonance cholangiopancreatography

66
Q

Therapeutic uses of an ERCP are

A

Incision in ampulla of vater widens common bile duct so you can get gallstones out
Place stents through strictured bile ducts

67
Q

Contraindications to ERCP are

A

Uncooperative patient
Previous surgery w/ inaccessable ampulla of vater
known pancreatitis

68
Q

Complications of ERCP are

A

Pancreatitis
perforation
gram neg. sepsis (you introduce bacteria into biliary and blood systems)
Aspirate gastric contents
oversedation (leading to respiratory arrest)

69
Q

What is a colonoscopy

A

Direct visualization of rectum, colon, and terminal ileum using a long flexible fiberoptic light scope
Conscious sedation

70
Q

What is a flex sigmoidoscopy

A

Same as colonoscopy but only for rectum and sigmoid colon- way less prep, just enema instead of drinking the bowel prep
Does not require conscious sedation!

71
Q

Indications for a colonoscopy are

A 
Colon cancer screen (remove polyps, biopsy) 
Bleeding (but not severe)
Investigate potential colon cancer Sx 
Investigate S/Sx of IBD 
Investigate abn barium enema, CT, etc.
72
Q

Colonoscopy can detect

A 
tumors (and can Bx) 
polyps (can remove) 
Inflammation 
infection 
AV malformations 
-BUT- sensitivity is dependent on endoscopist!
73
Q

Contraindications to colonoscopy are

A 
Uncooperative patient 
Severe rectal bleeding 
Susp perforation 
recent colon surgery 
toxic megacolon 
active diverticulitis
74
Q

Complications of colonoscopy are

A

perforation (serious!)
bleeding 2/2 biopsy
oversedation

Summer FDTN Exam 5 (12 decks)

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