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GI > Imaging > Flashcards

Imaging Flashcards

1
Q

What do abdominal x-rays show? When are they used?

A
  • readily available
  • often used for urgent investigation
  • shows gas in abnormal places or in abnormal acts: may need upright and lateral decubitus films as well as flat plates
  • can show stones and metallic fbs as well: kidney and gall bladder stones
  • solid organs can be seen but not as well: can see better CT or US
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2
Q

Indications of abdominal x-ray? Non-indications?

A
  • suspected bowel obstruction/perforation
  • suspected intussusception
  • fbs
  • suspected abdominal mass
  • blunt abdominal trauma

non-indications:

  • vague central abdominal pain
  • gastroenteritis
  • haematemesis
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3
Q

Normal distribution of gas in the bowel?

A

small bowel:

  • intraluminal gas usually minimal
  • centrally located
  • numerous tight loops of small diameter (2.5-3.5 cm)
  • valvulae conniventes (stack of coins)

large bowel:

  • mix of gas and feces
  • loops large in diameter (3-5 cm)
  • haustra
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4
Q

abnormal findings of gas and bowel?

A
  • dilated loops
  • air fluid levels on erect film
  • intramural gas
  • intraperitoneal gas
  • extraperitoneal gas
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5
Q

When do we see ileus?

A
  • after abdominal surgery

- bowel goes to sleep after surgery

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6
Q

What is an upper GI series?

A
  • barium swallow
  • uses plain fim x-ray and fluoroscopy (real time xray)
  • 2 types: std barium upper GI series, double contrast upper GI series
  • looks at esophagus, stomach and duodenum
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7
Q

Indications and CIs for upper GI series?

A 
- indications:
dysphagia
GERD
assessment of hiatial hernia
strictures
- CIs:
intestinal obstruction
esophageal perforation or rupture is suspected
pregnant women
individuals with poor swallowing reflex (aspiration)
- risk: constipation
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8
Q

Indications for small bowel follow through (part of upper GI series)?

A
  • crohns
  • tumors
  • unexplained abdominal pain
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9
Q

What is lower GI study? Indications, and risks?

A
  • barium enema
  • evaluates the colon: barium enema, and air contrast (double contrast) enema
  • indications:
    colon cancer (apple core)
    dx/monitor UC or crohn’s disease
    dx blood in stool, megacolon, constipation, diverticulitis, fistulas
  • risk:
    pregnant women
    colon perforation
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10
Q

Use of Abdominal CT? Indications?

Downside?

A

-sensitive method to dx abdominal diseases (also good look at lymph nodes)
- freq used to stage and follow cancer
-indications:
pts with jaundice
pancreatic disease
hepatic metastases
- shows abdominal wall - localize hernias
- dilute contrast may be used to augment the scan
- downside: expensive, high doses of radiation

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11
Q

When is hepatobiliary scintigraphy (HIDA scan/cholescintigraphy) used?

A
  • in dx of problems with liver, gallbladder, or bile ducts
  • radio-isotope is taken up in the liver and secreted into bile
  • indications:
    cholecystitis
    bile duct obstruction
    assessment for liver transplant
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12
Q

How is an abdominal U/S performed? dependent on?

preferred imaging for what?

A
  • sound waves to visualize internal organs thru abd. wall
  • can be combined with endoscopy, visualize structure in hollow organs
  • can be performed quickly at bedside, no radiation, inexpensive: imaging occurs real time w/o need for sedation
    influence of movements can be assessed quickly
  • hampered by fat and air
  • operator dependent
  • limited sensitivity
  • preferred imaging for RUQ pain
  • useful in eval of unstable trauma pt: FAST - shows intraperitoneal fluid and also hemopericardium
  • abdominal and chest CT provides more definitive info
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13
Q

EGD use?

A
  • can visualize esophagus to duodenum
  • high def white light endoscope
  • minimally invasive with quick recovery: usually done under conscious or moderate sedation, most pts have a sore throat after
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14
Q

Indications and CIs to endoscopy?

A

indications:

  • signs and sxs of upper GI disease
  • surveillance for upper GI cancer in high risk settings
  • bx
  • therapeutic intervention

CIs:
possible perforation
medically unstable/unwilling pts
anticoag

relative CIs:
pharyngeal diverticulum
head or neck surgery

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15
Q

Indications and CIs to capsule endoscopy?

A

indications:

  • obscure GI bleeding
  • IBD
  • small bowel polyps and tumors
  • celiac disease

CIs:
swallowing d/o
SBO/stenosis

problems with this: short batter life (delayed digestion - battery will die)

  • pt swallows pill containing camera, able to cover areas of small bowel that are not reachable by endoscopy
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16
Q

Pros and cons to flexible sigmoidoscopy?

A

Pros:

  • may be done in office
  • inexpensive, cost-effective
  • rduces deaths from rectal cancer
  • easier bowel prep, rarely needs sedation

cons:

  • detects only half of polyps
  • misses 40-50% of cancers located beyond view of sigmoidoscope
  • often limited by discomfort, and poor bowel prep
17
Q

Indications and CIs of flexible sigmoidoscopy?

A

indications:

  • screening test
  • blood in stool
  • eval of colon
  • medical management of colitis

CIs:

  • bowel perf
  • acute diverticulitis
  • active peritonitis
18
Q

Colonoscopy used to visualize?

A
  • rectum, colon, and distal ileum
  • high def white light colonoscopy
  • requires bowel prep
  • uses, complications similar to upper GI endoscopy:
    complications rare in dx colonoscopy
  • can have bleeding, perforation, with polypectomy
19
Q

Indications and CIs to colonoscopy?

A

indications:

  • screening
  • eval
  • f/u colorectal cancer
CIs:
- pregnancy
- relative contra:
colonic perf
toxic megacolon
IBD with ulceration
20
Q

What is endoscopic retrograde cholangiopancreatography (ERCP)?

A
  • technique that uses combo of luminal endoscopy and fluoroscopic imaging to dx and tx conditions assoc with pancreatobiliary system
21
Q

Indications and CIs for ERCP?

A

indications:

  • biliary disease - assessment and tx of biliary obstruction secondary to choledocholithiasis, tx of choledocholithiasis during cholecystectomy after intraop cholangiography, assessment and tx of bile duct strictures
  • pancreatic disease: assess and tx acute pancreatitis, strictures, pancreatic duct stones, tx of pseudocyst and malignancies

CIs:

  • refusal
  • unstable cardiopulmonary, neurologic, or CV status
  • existing bowel perf

GI (21 decks)

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