Imaging: First Line investigations

Question 1

first line imaging technique for cholecystitis / biliary colic?

Answer 1

US

Question 2

first line imaging technique for pancreatitis? (Also, when should this be performed?)

Answer 2

CT

Best performed around 1 week following symptom onset (can see changes)

Question 3

first line imaging technique for perforation?

Answer 3

ERECT CXR
(if patient standing up - the free air rises to the top and can be seen under the diaphragm)
A CT may help delineate the source of free air and show further features e.g. intra-peritoneal collections

Question 4

first line imaging technique for appendicitis?

Answer 4

US

Question 5

first line imaging technique for distended abdomen (suspected bowel source)?

Answer 5

AXR (allows you to determine whether the cause is small bowel obstruction/ large bowel obstruction/ ileus) - CT may help delineate the cause

Question 6

first line imaging technique for distended abdomen (suspected fluid source)?

Answer 6

US - this may also determine the cause e.g. liver disease, metastases, peritoneal masses, ascites

Question 7

first line imaging technique for haematemesis?

The protocol is the same for lower GI bleeding

Answer 7

endoscopy (has advantage of allowing intervention/ biopsy at same time). However, this can be complemented by radiological investigation. Image WHEN bleeding: CT with IV contrast +/- angiography and intervention

Question 8

first line imaging technique for dysphagia?

Answer 8

endoscopy. Can also do Ba studies

Question 9

first line imaging technique for change in bowel habit?

Answer 9

Ba enema or CT virtual colonography

Question 10

first line imaging technique for change in bowel habit if IDB is suspected?

Answer 10

endoscopy (fluoroscopic contrast studies if small bowel disease suspected). Also, a small bowel MRI could be used in known cases of Crohn’s or large bowel Crohn’s with suspected small bowel involvement

Question 11

first line imaging technique for checking is known IBD is active?

Answer 11

radio-labelled white cell scan (can localise active inflammation)

Question 12

first line imaging technique for jaundice? (to distinguish between hepatic and post-hepatic jaundice)

Answer 12

US (easily identifies dilated intra and / or extra-hepatic biliary tree). Less reliable at identifying cause. May require US guided liver biopsy. MRCP +/- ERCP (can stent/ remove stones too) for further investigations