GI Imaging Flashcards
How do patients commonly present with Cholecystitis/Biliary Colic?
- RUQ pain
- often exacerbated by eating
+/- deranged LFTs
What is the first line investigation for Cholecystitis/Biliary Colic?
Ultrasound (US)
What can be visualised on an ultrasound for cholecystitis/ biliary colic?
- gallstones
- dilated common bile duct
What investigation can be used for further classification of cholecystitis/ biliary colic?
- MRCP &/or ERCP
How do patients present with pancreatitis?
- Epigastric/Diffuse abdominal pain
- Elevated serum Amylase
- often caused by gallstones or alcohol, so pt may have symptoms of this
When would an ultrasound be useful in investigating pancreatitis?
- to visualise gallstones +/- biliary obstruction
Why is imaging used in pancreatitis?
- to evaluate how severe any complications are
- Complications could be:
- Necrosis
- Intra-abdominal collections
- Vascular complications
What type of imaging is used to visualise pancreatitis complications and when?
- CT with contrast
- Best performed around 1 week following onset of symptoms
How do patients present with a suspected bowel perforation?
- Pain
- this is dependant on site of perforation
- May be localised or generalised peritonism
What is the first line investigation if you suspect a perforation in a patient, and what does this investigation show?
First line investigation = ERECT chest x-ray
- shows free gas under diaphragm
What other investigation may be used in bowel perforation to look for complications?
CT
- may help show source of perforation
- may show intra-peritoneal collections
How do patients normally present with appendicitis?
- Central abdominal pain
- Later localising in RIF
- May be associated with fever & elevated inflammatory markers
What differential diagnosis should be considered in females presenting with symptoms of appedicitis?
- gynaecological causes
What investigation is first line if you suspect appendicitis?
First line investigation = ultrasound
- this will either confirm diagnosis OR help to find alternative cause
What may be seen on an ultrasound if a patient has appendicitis?
- distended appendix
- Calcified appendicolith
How do patients normally present with diverticulitis?
- Lower abdominal pain (classically LIF)
- Associated diarrhoea +/- PR bleeding
- Elevated inflammatory markers
What investigation is used for diverticulitis and why?
- CT
- shows inflammation and any complications
What symptoms would make you consider urinary causes alongside GI causes?
- associated urinary symptoms (frequency, urgency, dysuria etc.)
- haematuria
What symptoms would make you consider a vascular cause rather than GI?
- sudden onset symptoms
- back pain
- hypotension/ feeling faint
If a patient presents with a distended abdomen suggestive of bowel gas or fluid, what investigation should be done first?
- If thought to be GAS => 1st line = AXR
- If thought to be fluid => 1st line = US`
HOw can you tell the difference on an AXR between dilated loops of small bowel and dilated loops of large bowel?
- small bowel has valvulae conniventes that cross the entire diameter of the wall
- haustra on the large bowel do NOT cross the diameter of the bowel
What are the three types of bowel obstruction that may cause a build up of gas in the bowel?
- Small bowel obstruction
- Ileus
- Large Bowel obstruction
Where can haematemesis arise from? What are the main causes?
- May arise from oesophagus, stomach or duodenum
- Possible causes are:
=> Tumour
=> Inflammation
=> Trauma
=> Vascular causes eg Varices
How is haematemesis investigated? What are the advantages and disadvantages of this procedure?
- Endoscopy
- Adv = allows intervention/ biopsy during procedure
- Disadv = invasive
