Imaging

Question 1

When do you get an acute abdominal series?

Answer 1

Pt with abdominal pain, distension, diminished or absent bowel sounds with our without guarding or rebound

Question 2

What are acute abdominal series useful for identifying?

Answer 2

Air under diaphragm, obstruction, fractures, nasogastric tube placements

Question 3

What are the advantages to AAS?

Answer 3

readily available no prep no need for consent

Question 4

What is pneumoperitoneum?

Answer 4

Free air under diaphragm on upright chest film suggesting presence of bowel perforation and associated peritonitis

Question 5

What do solids and liquids look like on US?

Answer 5

Solids are white and liquids are blackc

Question 6

What is US “all about”?

Answer 6

Size shape inflammation and stones

Question 7

Advantages to US?

Answer 7

Quick and readily available. Also safe as there is no ionizing radiation

Question 8

What is the disadvantage to US?

Answer 8

Bowel gas

Question 9

When do you order US?

Answer 9

• RUQ pain suspected gallstoness or gallbladder disease
• Pancreatitis
• RLQ/appendix
• Ovarian mass via pelvic or transvaginal US
• Testicular mass or torsion
• Pregnancy
• Kidney dysfunction, elevated creatinine, palpable mass, painless hematuria
• Bladder scan especially if incontinence afte voiding (enlarged prostate)

Question 10

What is a HIDA scan?

Answer 10

• Nuclear tagged material injected IV taken up by hepatocytes and excreted into gallbladder. Evaluates GB function!
• Failure of GB to fill may be caused by acute cholecystitis or cholelithaisis
• avoid in pregnancy

Question 11

What is HIDA with CCK?

Answer 11

• HIDA scan modified to assess GB function
• inject nuclear tagged material
• watch for filling of GB
• Inject with CCK to stimulate GB to expel bile
• If the ejection fracction is <35-40% it is abnormal

Disadv. is ab cramping and long time

Adv. is ID GB dysfxn with no evidence of sludge or stones

Question 12

What is Zenker’s diverticula?

Answer 12

• Progressive dysphagia in older adults
• Sx: halitosis, mass in neck, regurgitation of food,
  
  • ROS: unintentional weight loss and malnutrition
• Barium Swallow

Question 13

What is CT NOT good for?

Answer 13

• mucosal disease
• ulcers
• small neoplasms

Question 14

What does oral contrast CT allow us to look for?

Answer 14

• Large intraluminal mass
• Tickening of walls of hollow organs
• Evaluation of tumor stages
• Specific locations of obstruction
• ID’s perforation location

Controversy surrounds need for consent secondary to the radiation doses with CT

Question 15

Adv and disadv to CT?

Answer 15

Adv:

• readily available
• fast
• non invase
• no consent

Disadv.:

• high does radiation
• allergic rxn to contrast (shellfish allergy)

Question 16

When do you order CT Abd and Pelvis w/o contrast?

Answer 16

• Trauma
• Sudden onsent unilateral flank pain radiating to groin, N/Vm hematuria, pain waxes wanes,
• Test of choicce for renal lithiasis
  
  • ​unless pregnant, then renal or bladder US w/ or w/o KUB

Question 17

Prep for EDG?

Answer 17

Nothing to eat after midnight, clear liquids until 2 hrs prior

Question 18

Indications for EDG?

Answer 18

• dysphagia
• odynophagia
• UGIB
• GERD
• Feeding tube placement

Question 19

Colonoscopy?

Answer 19

• Clean out colon with laxatives
• start 4-6 hours before bed limit to clear liquids
• light conscious sedation
• endoscope insert via rectum, air to inflate colon so surface is visible
• Cancer screen, rectal bleeding, surveillance

Question 20

Cystoscopy indications?

Answer 20

• painless hematuria
• kidney or bladder stones
• recurrent UTI and urinary obstruction