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Gastroenterology > GI imaging > Flashcards

GI imaging Flashcards

1
Q

EGD (Esophagogastroduodenoscopy)

A

-Flexible endoscope via the mouth into the esophagus, stomach, duodenum
-Best method for examining the upper gastrointestinal mucosa
-Permits directed biopsy and endoscopic therapy
-Intravenous conscious sedation vs general
anesthesia
-DX AND THERPAUTIC

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2
Q

Contraindications to EGD

A

-Inability of the patient to cooperate despite adequate attempts at sedation/anesthesia
Inability to obtain informed consent
Presence of a known or suspected perforation
-Routine biopsies- pinch bx

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3
Q

bezoar

A

-indigestable foods
-not moving
-cellulose
-forms a mass ins stomach
-bloating
-full quickly
-nausea
-gastric motility disorder, anatomical
-vegetable’s, hair,
-tear it apart with a scope, tap
-coca cola
-chemicals to make it more soluble
-extreme- surgery

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4
Q

colonoscopy

A

-Flexible colonoscope via anal canal into the rectum and colon
-Cecum is reached in >95% of cases
-Terminal ileum can often be examined
-“Gold standard” for diagnosis of colonic mucosal disease
-Greater sensitivity than barium enema or CT for colitis, polyps, cancer
-IV conscious sedation vs general anesthesia

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5
Q

indications for upper gastrointestinal endoscopy (chart from PP)

A

-upper abdominal symptoms that fulfill:
-are unresponsive to empiric therapy (omeprazole, Nexium etc.)
-associated with alarm symptoms
-new onset of symptoms in pt greater than 50 years of age
-dysphagia
-odynophagia- painful swallowing
-persistent or recurrent esophageal reflux despite therapy
-persistent vomiting of unknown cause
-active or recent upper GI bleeding
-presumed chronic blood loss and iron deficiency anemia if any of the following present- there is clinical suspicion of upper GI source, colonoscopy is neg
-lesion seen on upper GI
-acute caustic ingestion
-anemic
-eval for celiac disease

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6
Q

screenings EGD

A

-gastric cancer
-barretts esophagus
-polyposis
-esophageal varices

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7
Q

therapeutic EGD

A

-bleeding GI tract lesions
-variceal banding
-removal of FB
-removal of polypoid lesions*
-dilation of stenotic lesions

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8
Q

indications for colonscopy

A

-abnormal imaging
-lower gi bleeding
-iron deficiency anemia
-lower gi symptoms (chronic diarrhea)

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9
Q

screening colonoscopy

A

-colon polyp
-colon cancer
-inflammatory bowel disease

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10
Q

therapy colonscopy

A

-polypectomy
-localization of lesions
-foreign body removal
-decompression of sigmoid volvulus
-decompression of colonic pseudo obstruction
-balloon dilation of stricutures
-palliative treatment of bleeding or stenosed neoplasms
-placement of percutaneous endoscopy cesostomy tube

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11
Q

colonscopy contraindications

A

-pregnancy
-bowel perforation
-fulminant colitis
-acute diverticulitis
-peritonitis
-cardiopulmonary instability

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12
Q

flexible sigmoidoscopy

A

-Similar to colonoscopy
-Visualizes anus through sigmoid colon
-Primarily used for evaluation of diarrhea, rectal bleeding, and as part of colon cancer screening with other modalities
-quick peak if ulcerative colitis check in

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13
Q

small bowel endoscopy: capsule endoscopy

A

-Swallow disposable capsule that contains chip camera
-Color still images transmitted wirelessly to external receiver
-Visualization: jejunal and ileal mucosa beyond the reach of a conventional endoscope
-It remains purely a diagnostic procedure
-just small intestine not for large
-pictures / movie

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14
Q

indications capsule endoscopy

A

-Evaluation of obscure gastrointestinal bleeding
-Suspicion of small bowel tumors, celiac disease, polyposis syndromes, early Crohn’s

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15
Q

contraindications to capsule endoscopy

A

-Implanted electromagnetic devices
-Severe intestinal motility disorders
-Zenker’s diverticulum
-Swallowing disorders
-Small bowel diverticulosis
-Pregnancy
-Severe Crohn’s enteritis
-Small intestinal strictures
-Obstruction

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16
Q

double balloon enteroscopy (DBE)

A

-Pan-enteric examination of the small bowel
-Performed via mouth or rectum
-Complimentary to capsule

17
Q

double balloon enteroscopy (DBE) contraindications

A

-Pregnancy
-Serious cardiac or respiratory disease
-Multiple small bowel adhesions
-Anti-coagulants cannot be discontinued

18
Q

ambulatory 24 hour pH monitoring

A

-Test measures reflux of acid from the stomach into the esophagus
-Gold standard for the diagnosis of GERD
-Catheter is placed 5 cm above the upper border of the lower esophageal sphincter and is kept in place for 48 hours
-DO NOT NEED TO DO THIS FOR EVERY GERD PT -> just for ones that arnt responding to treatment

19
Q

ambulatory 24 hr pH monitoring

A

-indications- unresponsive to therapy ****
-contraindications- pacemakers, implantable defibrillators, neurostimulators, bleeding diatheses, varices, strictures, obstructions

20
Q

gastric emptying study

A

-tag foods and see how long it takes to pass it
-indications- evaluations of dumping syndrome, vagotomy, gastric outlet obstruction, effects of meds, and other causes of gastroparesis
-contraindications- pregnancy
-chronic cannabis use

21
Q

barium esophagram

A

-if pt cant swallow down food
-pt drinks or swallows barium or a tablet and x rays or video are taken
-can evaluate swallowing, peristalsis, and lesions
-Haiatal hernia , rings, strictures, Ca, ulcers, abnormal peristalsis, reflux
-diagnostic

22
Q

barium esophagram

A

-indications- dysphagia, odynophagia, esophageal reflux, non cardiac chest pain
-findings- motility disorders, esophagitis, strictures, varices, neoplasm, obstruction, diverticulum, webs, rings
-contraindications- pregnancy and perforation

23
Q

upper GI series

A

-Barium is swallowed and xray images are taken of the esophagus, stomach and duodenum
-Used to evaluate abdominal pain (ulcers, inflammation), structural disorders, motility disorders, weight loss, heme + stool, dysphagia, odynophagia
-Not used much anymore
-not stable enough for endoscopy

24
Q

small bowel series

A

-barium to look at small bowel - x-ray
-indications -> Not used much anymore
-Location of site of intermittent partial small bowel obstruction
-Evaluation of extent of Crohns disease or small bowel disease in patient with normal endoscopy and colonic evaluations
-Evaluation of metastatic disease to the small bowel
-contraindications- Complete bowel obstruction, Perforation, Pregnancy

25
Q

double contrast barium enema (DCBE)

A

-REPLACED BY CT Colonography
-Old Indications:
-Evaluation of colonic mucosa for inflammatory bowel disease, polyps, neoplasm, incomplete colonoscopy
-Contraindications:
-Toxic megacolon
-Immediately after full-thickness colonoscopic biopsy

26
Q

plain film of abdomen

A

-Perforated ulcer or free air in the abdomen- Plain films may demonstrate as little as 1 to 2 mL of air
-small bowel obstruction- Plain films have a sensitivity of 69 to 82 percent for revealing high-grade small bowel obstruction
-Moderate or severe abdominal tenderness, suspicion of bowel obstruction, ingestion of foreign body or penetrating foreign bodies (gunshot wounds)

27
Q

abdominal US

A

-Uses sound waves to create images of organs
-Differentiation of cystic versus solid lesions of the liver and kidneys
-Detection of intra- and extrahepatic biliary ductal dilation, cholelithiasis, gallbladder wall thickness, pericholecystic fluid, peripancreatic fluid and pseudocyst, hydronephrosis, abdominal aortic aneurysm, appendicitis, ascites, primary and metastatic liver carcinoma

28
Q

hepatobiliary iminiodiacetic acid (HIDA) scan

A

-Evaluate the function of the gallbladder and the bile ducts
-Given with CCK to assess gallbladder emptying -> ejection fraction
-Anatomic and functional information
-Used with RUQ pain, nausea, vomiting

29
Q

endoscopic US

A

-Ultrasound transducers incorporated into the tip of a flexible endoscope
-Ultrasound images are obtained of the gut wall and adjacent organs, vessels, and lymph nodes
-Very high resolution images are obtained
-Provides the most accurate preoperative local staging of esophageal, pancreatic, and rectal malignancies

30
Q

EUS is also highly sensitive for dx of

A

-Bile duct stones
-Gallbladder disease
-Submucosal gastrointestinal lesions
-Chronic pancreatitis
-Can bx exoluminal lesions -> pancreatic cysts via FNA

31
Q

endoscopic retrograde cholangiopancreatogrpahy (ERCP)

A

-Endoscope is passed through the mouth to the duodenum
-Ampulla of Vater is identified and cannulated with a thin plastic catheter
-Radiographic contrast material is injected into the bile duct and pancreatic duct under fluoroscopic guidance
-Sphincter of Oddi can be opened via endoscopic sphincterotomy
-Stones retrieved from ducts
-Biopsies obtained
-Strictures dilated and stented
-Therapeutic and diagnostic procedure especially for ductal strictures and CBD stones

32
Q

CT scan of abdomen and pelvis

A

-With or without contrast agent
-Oral contrast* (usually) agent before abdominal or pelvic scans helps delineate the bowel
-IV contrast is used to obtain vascular and tissue enhancement
-Most helpful in evaluating retroperitoneum (pancreas, kidney, nodes, aorta), liver, appendicitis, bowel disease (inflammation, diverticular disease, masses, hernias, obstruction

33
Q

CT colonography

A

-Indications:
-Evaluation for possible colonic polyps and masses
-Incomplete colonoscopy
-Not stable for colonoscopy-anesthesia
-Contraindications: Pregnancy

34
Q

CT colonography ADVantages

A

-No IV contrast needed or anesthesia
-Has ability to evaluate extracolonic intraabdominal disease (AAA, renal cell cancer, kidney stones).

35
Q

CT colonography Disadvantage

A

-Diagnostic not therapeutic
-Still need prep
-Retained fecal material limits study
-If polyps or masses are found, patient will need to undergo colonoscopy or sigmoidoscopy for tissue diagnosis.
-Can’t asses for AVM or treat them
-$ not covered - need a failed attempt
-full cat scan of everything
-6mm or more

36
Q

MRI of abdomen

A

-MRI provides better soft-tissue contrast than CT
-not covered commonly
-Detection of adrenal lesions, tumor staging, abdominal masses, examination of almost all intraabdominal organs and retroperitoneal structures, and differentiation of benign adenoma from metastasis
-Aids CT in evaluation of liver lesions- Benign from malignant liver tumors

37
Q

magnetic resonance cholangiopancreatography (MRCP)

A

-Evaluation of intra- and extra-hepatic biliary and pancreatic duct dilatation, and the cause of obstruction
-Evaluates choledocholithiasis, retained gallstones, pancreatobiliary neoplasms, strictures, primary sclerosing cholangitis, and chronic pancreatitis
-ERCP may be needed after
-usually ordered with MRI of abdomen

38
Q

CT/MR enterography***

A

-assess small bowel
-this is commonly used
-rule in or out crohns disease
-Indications:
-Assess for extent of IBD, postoperative adhesions, and small bowel tumors
-Contraindications:
-CT: Pregnancy
-MR: cardiac pacemakers, intraocular metallic foreign bodies, intracranial aneurysm clips, cochlear implants, and some artificial heart valves

39
Q

CTE / MRE

A

CTE
-Takes 10 seconds
-More cost effective
-Do not have to hold breath
-No glucogon used
-Iodine based IV contrast
-Radiation exposure
-Obesity and respiratory disease does not limit exam

MRE**
-Takes 30 minutes
-Twice as expensive
-Have to hold breath
-Glucagon +/- nausea/vomiting
-Non iodine based IV contrast
-No radiation exposure
-Obesity or respiratory problems can limit exam

Gastroenterology (20 decks)

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