Imaging-GI and Liver Flashcards
A 73 year old man presents with abdominal pain, 10 pound weight loss, malaise and hematochezia. A scout image is shown below. CT is done and reveals fullness in the rectum and stranding fat. What are risk factors for his condition?
Note the presence of air and dilation in the bowel, indicating obstruction from blockade at the rectum. He has colorectal carcinoma. Risk factors include IBD, HNPCC, FAP and family history.
A 73 year old man presents with abdominal pain, 10 pound weight loss, malaise and hematochezia. A scout image is shown below. CT is done and reveals fullness in the rectum and stranding fat. What change in histology has happened in the patient’s colon?
Colorectal carcinoma arises from the adenoma-carcinoma sequence 60% of the time.
How do carcinomas in the right colon typically present?
Polypoid and fungating tumors
How do carcinomas in the transverse and left colon typically present?
Constricting (apple core lesions) and ulcerating
How do carcinomas from IBD commonly present?
Flat adenomatous plaques.
A 23 year old twins present with RLQ pain. Which one of the patients shown below has appendicitis? What would you see on histological examination of their appendices?
Left: not, note air in appendix. Right: appendicitis, note lucency in appendix. In appendicitis you would see infiltrating PMNs.
What is the preferred imaging modality to asses for appendicitis in kids?
Ultrasound. Note that an obstructed appendix will not compress on ultrasound when you push on it.
A 2 week old infant presents to the ED with vomiting. What is the best next step?
Determine if the emesis is bilious or nonbilious. If it is bilious, you’d go on with an upper GI series.
A 2 week old infant presents to the ED with vomiting. Upper GI reveals contrast-filled small bowel spirals with a downward corkscrew appearance. What is your next best step?
Urgent surgical consult. This is a volvulus or malrotation of the small bowel.
What is this condition?
Labb bands. This is how you fix it.
Where do you look on an upper GI series to see if a patient is at risk for malrotation and volvulus?
Ligament of Treitz at the duodenal jejunal junction, this is the normal attachment point of the small bowel near the pedicle of L1
A 9 month old has intermittent abdominal pain. Radiograph reveals lack of air-filled cecum and absence of bowel in the right side when the child is placed in the left lateral decubitus position. You diagnose the kid with intussusception. What would you expect to see on ultrasound?
Target sign in the transverse view. Psuedokidney/sticky bun layered appearance in the longitudinal view.
Aside from achalasia, what else could a beak in the GI tract indicate?
Volvulus. It will show a corkscrew leading to a beak at the volvulus.
A 9 month old has intermittent abdominal pain, bloody stools, lethargy and a palpable RUQ abdominal mass. Radiograph reveals lack of air-filled cecum and absence of bowel in the right side when the child is placed in the left lateral decubitus position. You diagnose the kid with intussusception. How do you treat this child?
Attempt to reduce the intussusception by therapeutic contrast enema or surgery.
Most common location for intussusception?
Ileocecal valve
What is your diagnosis?
Colorectal carcinoma
What is the treatment for this condition?
Surgical resection is used to treat appendicitis. Note the rim enhancement, fluid collection and dirty fat around the appendix.
How do you treat this condition?
Note the feeding tube going into the duodenum. This child needs an urgent Ladd procedure.
How do you treat this condition?
Intussusception is treated with therapeutic enema or surgical therapy.
