Imaging Flashcards
Types of GI/Abdominal Imaging
X-rays CT Ultrasound Direct visualization ERCP HIDA Scan
What can Abdominal X-rays show?
Gas in abnormal places or amounts
Stones
Metallic FB
Indications for an Abdominal X-Ray
Suspected bowel obstruction/perforation Suspected intussusception FB Suspected abdominal mass Blunt abdominal trauma (seatbelt from MVA)
When are Abdominal X-rays not Indicated
Vague central abdominal pain
Gastroenteritis
Haematemesis
Gas within the Small Bowel on Abdominal Xray
Intraluminal gas minimal
Centrally located
Tight loops of sm. diameter
Valvulae conniventes
Gas within the Large Bowel on Abdominal X-ray
Mixture of gas & feces
Loops larger in diameter
Haustra
Abnormal Findings on an Abdominal X-ray
Dilated loops Air-fluid levels on erect film Intramural gas Intraperitoneal gas Extraperitoneal gas
Liver on Abdominal X-ray
Large are in RUQ
Spleen on Abdominal X-ray
Soft tissue LUQ
Size of a fist
Can be seen, obscured, or not at all
Kidneys on Abdominal X-ray
Bean shaped
Left higher than right
About 3 vertebrae in size
Psoas Muscles on Abdominal X-ray
Straight lines extending inferolaterally from lumbar spine to lesser trochanter of femur
Bladder on Abdominal X-ray
Only if full
Soft tissue density in pelvis
Define Ileus
Hypo mobility of the GI system in the absence of mechanical bowel obstruction
What is another name for an upper GI series?
Barium swallow
What does an Upper GI Series use for diagnostics?
Plain film x-ray
Fluoroscopy
What are the two types of upper GI series?
Standard barium upper GI series
Double-contrast upper GI series
What does an upper GI series look at?
Esophagus
Stomach
Duodenum
Indications for an Upper GI Series
Dysphagia GERD Assessment of hiatal hernia Strictures Tumors Ulcers Fistulas varices Diverticulum
Contraindications for an Upper GI Series
Intestinal obstruction
Esophageal perforation or rupture is suspected
Pregnant women
Individuals with poor swallowing reflex
Risk of an Upper GI Series
Constipation
Indications for a Small Bowel Follow Through
Crohn's Tumors Unexplained abdominal pain Malabsorption symptoms Small bowel fistulas
What is another name for a lower GI study
Barium Enema
What does a lower GI study evaluate?
The colon
Indications for a Lower GI Study
Colon cancer Diagnose/monitor UC or Crohn's disease Diverticultitis Fistulas Megacolon
Risk of a Lower GI Study
Pregnant women
Colon perforation
What is a sensitive method to diagnose abdominal diseases?
Abdominal CT
What are Abdominal CT Frequently Used for?
Stage
Follow CA
Indications for an Abdominal CT
Patients with jaundice
Pancreatic disease
Hepatic matastases
Contraindications for an Abdominal CT
Expensive
High doses of radiation
Hepatobiliary Scintigraphy (HIDA Scan)
Used in Diagnosis of problems with the liver, gallbladder, or bile ducts
Nuclear-medicine scan
Indications for a Hepatobiliary Scintigraphy (HIDA Scan)
Cholecystitis Bile duct obstruction Assessment for liver transplant Biliary atresia Bile leaks
Abdominal Ultrasonography
Transabdominal ultrasound Can combine with endoscopy Performed quickly at bedside No radiation Inexpensive
What is an abdominal ultrasound hampered by?
Fat
Air
Operator dependent
Limited sensitivity
What is the preferred imaging in RUQ pain?
Abdominal Ultrasound
What is useful in evaluating the unstable trauma patient?
Abdominal Ultrasound
FAST- Focused Assessment with Sonography for Trauma
Types of Endoscopy
EGD- esophagogastroduodenoscopy Colonoscopy ERCP- endoscopic retrograde cholangiopancreatograph Capsule endoscopy Flexible sigmoidoscopy
EGD- esophagogastroduodenoscopy
Visualize esophagus to duodenum
Minimally invasive
Indications of an EGD
Signs/symptoms of upper GI disease
Surveillance for upper GI cancer in high-risk patients
Biopsy
Recurrent emesis
Dysphagia
Dyspepsia
Therapeutic intervention: strictures, placement of G-tub
Contraindications for an EGD
Possible perforation Medically unstable/unwilling patients Anicoagulation (relative) Pharyngeal diverticulum (relative) H&N surgery (relative)
Indications for a Capsule Endoscopy
Obscure GI bleeding
IBD: Crohn’s, UC
Small bowel polyps & tumors
Celiac disease
Contraindications for a Capsule Endoscopy
Swallowing disorder
Small bowel obstruction/stenosis
How does capsule endoscopy work?
Patient swallows camera pill
Takes 60,000 pictures of the bowel
Cons of a Capsule Endoscopy
Short battery life
Can miss part of the bowel
Pros of a Flexible Sigmoidoscopy
May be done in office Inexpensive Reduces deaths from rectal cancer Easier bowel prep Rarely needs sedation
Cons of a Flexible Sigmoidoscopy
Detects only 1/2 of polyps
Misses 40-50% of CA beyond view of sigmoidoscope
Limited by discomfort, poor bowel prep
Indications for a Flexible Sigmoidoscopy
Screening test Blood in stool Evaluation of colon Medical management of colitis Removal of FB Pre-op eval prior to rectal surgery
Contraindications for a Flexible Sigmoidoscopy
Bowel perforation
Acute diverticulitis
Active peritonitis
What is a colonoscopy for?
Visualization of rectum, colon, and distal ileum
Possible Complicaiton
Bleeding, perforation with polypectomy
Indications for a Colonoscopy
Screening Evaluation Follow up colorectal CA Polyps Management of IBD, IBS
Contraindications for a Colonoscopy
Pregnancy
Colonic perforation (relative)
Toxic megacolon (relative)
IBD with ulceration (relative)
What is an Endoscopic Retrograde Cholangiopancreatography (ERCP)?
Technique that uses combination of luminal endoscopy and fluoroscopic imaging to diagnose and treat conditions associated with the pancreatobiliary system
Indications for an ERCP
Biliary disease
Pancreatic disease
Why an ERCP in Biliary Disease?
Assessment & treatment of biliary obstruction due to stones
Treatment of gallstones during a cholecystectomy
Assessment and treatment of bile duct strictures
Why an ERCP in Pancreatic Disease?
Assess & treat acute pancreatitis, strictures, or pancreatic duct stones
Treatment of pseudocyst & malignancies
Contraindications for an ERCP
Refusal
Unstable cardiopulmonary, neurologic, or cardiovascular status
Existing bowel perforation
