GI Radiology

Question 1

Zenker’s diverticulum occurs at?

Answer 1

A weakened area at the back of the throat known as Killian’s triangle. It is superior to the cricopharyngeus m. and inferior to the thyropharyngeus m.
It is a false diverticulum.

Question 2

Symptoms of ZD

Answer 2

Trouble swallowing, halitosis, cough.

Question 3

How is ZD diagnosed?

Answer 3

Fluoroscopic barium esophagography.

Question 4

What is the risk of performing an endoscopy in a patient w/ ZD?

Answer 4

The scope may protrude through the diverticulum.

Question 5

What test is best for hiatal hernia?

Answer 5

XR Barium

Question 6

Lead-pipe sign

Answer 6

Suggests long-standing ulcerative colitis due to the loss of haustral markings.

Question 7

XR Barium enema

Answer 7

Used to identify abnormalities of the large intestine (i.e. polyps or inflammatory bowel disease).

Question 8

How to test for achalasia?

Answer 8

Barium swallow.

Question 9

Achalasia pathology

Answer 9

Failure of the LES to relax.

Question 10

Chargas disease

Answer 10

Achalasia from an infection.

Question 11

What is the modality of choice for visualization of the biliary tree?

Answer 11

ERCP

Question 12

What’s unique about ERCP?

Answer 12

It can be used as both a diagnostic tool as well as for treatment for gallstone stone obstructions and stenting.

Question 13

How is ERCP performed?

Answer 13

A tube is passed into the 2nd portion of the duodenum and contrast is injected into the Ampulla of Vater. Then an XR is done for visualization.

Question 14

What is the risk associated with ERCP?

Answer 14

5-10% risk of iatrogenic (physician induced) pancreatitis.

Question 15

What does digital subtraction angiography help to identify?

Answer 15

Compromised arterial flow

Question 16

How is digital subtraction angiography performed?

Answer 16

Catheter is inserted and dye is injected to provide contrast to visualize arterial supply to a specific region.

Question 17

What is the choice diagnostic for cholelithiasis in the US?

Answer 17

Ultrasound, because only about 20% of gallstones are noticed on XR.

Question 18

Symptoms of cholelithiasis

Answer 18

RUQ pain that can radiate to shoulder.

Positive Murphy’s sign.

Question 19

CT facts

Answer 19

Quick
Lots of radiation
Good look at solid organs and fat.
Good for calcification (stones)
Good for overall look at pelvic structures, but with little detail.

Question 20

MRI facts

Answer 20

Longer
Less radiation
Best to visualize tissues.
Excellent for pelvic organs

Question 21

5 steps to visualization of images

Answer 21

1. Solid organs
2. Gb/biliary tree
3. LN chains
4. Somach, duodenum, SI, LI
5. Fat planes, abdominal wall, bones

Question 22

Retroperitoneal organs

Answer 22

Suprarenal gland
Aorta/IVC
Duodenum (2-4 parts)
Pancreas
Ureters
Colon (ascending and descending)
Kidneys
Esophagus
Rectum

Question 23

SMa. syndrome

Answer 23

3rd part of duodenum is compressed between SMa. and aorta.
Can be caused by rapid weight loss, short ligament of Treitz, or anything else that can narrow the angle between SMa. and aorta.

Question 24

Nutcracker syndrome

Answer 24

Left renal v. compressed between SMa. and aorta.