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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
What helps visualize lower GI better
Air Contrast Barium Enema; | Air is put into colon after the barium enema to give air contrast to barium
26
What are indications for a LGI
Alternative to colonoscopy
27
LGI findings include (similar to UGI)
``` IBD (barium narrows 2/2 inflammation) Cancer Ulcers Diverticula Benign tumors Extrinsic compression Perforation (use gastrografin) ```
28
What is a popcorn finding for adenocarcinoma of the colon
Apple core lesion
29
Contraindications to barium enema are
``` Pregnancy Megacolon Suspected perforation (gastrografin) Unstable vitals -always consider radiation risks! ```
30
Complications of a LGI are
Perforation (esp if using ACBE) | Barium fecal impaction
31
What is an abdominal US
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
What are indications for a liver US
Cyst, abscess, tumor measure bile ducts Screen for fatty liver if LFT high screen for cancer if w/ chronic hepatitis
33
What are indications for a gallbladder US
FIRST line for cholelithiasis or cholecystitis! | Tumors, polyps, stones, sludge, inflammation
34
What are indications for a pancreas US
cyst, abscess, tumor, inflammation | Good test but can be hard to see pancreas
35
What do colors mean on an ultrasound
Dark: echo free, hypoechoic. aorta, bile ducts, cysts White: echogenic, solid. tumors
36
What are some US findings
Cyst, abscess Tumor Bile duct stricture, dilation, tumor, stones Acute Inflammation: enlarged organ, edematous Chronic Inflammation: organ small, contracted, echogenic Gallstones
37
What are benefits of an abdominal US
no contrast or radiation- good for patients with CI to other diagnostic tests
38
What is a HIDA scan
Basically a cholescintigraphy- Patient gets a radionuclide injection Radionuclide is extracted by the liver, excreted into bile Allows you to see biliary tree
39
What makes a HIDA scan even better
Order with CCK stimulation and ejection fraction CCK stimulates digestion EF shows you how well you are getting rid of bile
40
What are indications for a HIDA scan
**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
What will you find on HIDA scan that indicates cholecystitis
No radionuclide in GB w/in 15-60 minutes EF <35% Test reproduces pt symptoms
42
What is an abdomal/pelvic CT
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
When is the only time you really don't need contrast
If you suspect renal stones
44
Abd/pelvic CT can help detect
cyst, abscess, tumor, inflammation, bowel perforation, intraabdominal bleeding, intestinal or ureteral obstruction
45
What is a helical CT
continuously obtains imaged, faster and more accurate | abdomen imaged in <30 seconds
46
What test is preferred for abdominal disease
CT (more accurate than MRI)- except some dz, like liver hemangioma, where MRI is better
47
Indications for abdominal/pelvic CT are
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
What do different abd/pelvic CT findings include
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
What is a virtual colonoscopy
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
What is interventional radiology
CT used for visualization during invasive procedures | Ex: aspirate fluid from organ, guide needle biopsy, guide cath placement for abscess drainage
51
Contraindications to abdominal/pelvic CT are
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
If allergic to shellfish, how can you still give contrast with CT
Premedicate with steroids in some cases
53
How much radiation is associated with a CT
250-500 CXR's | so avoid unless necessary- risk is cumulative
54
CT complications are
Reaction to contrast (flushing/itching to anaphylaxis)
55
What is an EGD
Direct visualization of upper GI tract (esophagus, stomach, first part of duodenum) using long, flexible fiber-optic light scope Usually under conscious sedation
56
What are the 3 channels of an endoscope
1. Viewing 2. Insufflation of air/aspiration of fluid 3. Passing instrument for biopsy/therapy
57
What are indications for EGD
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
An EGD can detect
``` hiatal hernia (UGI better) tumor polyps varicies mucosal inflammation ulcer barret's esophagus obstruction webs, rings infection (candida, HSV) AV malformations ```
59
Compare EGD to UGI
EGD is more sensitive bc you can biopsy | EGD can be therapeutic (band esophageal varicies, dilate esophagus, control bleeding)
60
EGD contraindications are
``` Uncooperative patient Severe bleeding (unless you can adequately lavage and aspirate) Esophageal diverticula Suspected perforation Recent upper GI surgery ```
61
Complications of an EGD are
Perforation (VERY serious) Bleeding 2/2 biopsy Aspiration of gastric contents Oversedation
62
What is an ERCP
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
What is the ampulla of vater
the union of pancreatic duct and common bile duct
64
ERCP indications are
Patient with obstructive jaundice | investigate/treat bile or pancreatic obstruction
65
What can you get before an ERCP that is less invasive
MRCP: magnetic resonance cholangiopancreatography
66
Therapeutic uses of an ERCP are
Incision in ampulla of vater widens common bile duct so you can get gallstones out Place stents through strictured bile ducts
67
Contraindications to ERCP are
Uncooperative patient Previous surgery w/ inaccessable ampulla of vater known pancreatitis
68
Complications of ERCP are
Pancreatitis perforation gram neg. sepsis (you introduce bacteria into biliary and blood systems) Aspirate gastric contents oversedation (leading to respiratory arrest)
69
What is a colonoscopy
Direct visualization of rectum, colon, and terminal ileum using a long flexible fiberoptic light scope Conscious sedation
70
What is a flex sigmoidoscopy
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
Indications for a colonoscopy are
``` 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
Colonoscopy can detect
``` tumors (and can Bx) polyps (can remove) Inflammation infection AV malformations -BUT- sensitivity is dependent on endoscopist! ```
73
Contraindications to colonoscopy are
``` Uncooperative patient Severe rectal bleeding Susp perforation recent colon surgery toxic megacolon active diverticulitis ```
74
Complications of colonoscopy are
perforation (serious!) bleeding 2/2 biopsy oversedation

Summer FDTN Exam 5 (12 decks)

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