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CLASP- radiology + anatomy > imaging of acute abdomen > Flashcards

imaging of acute abdomen Flashcards

1
Q

what imaging is used for bowel obstruction?

A

supine AXR

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2
Q

what imagine is used for assessing a hollow viscus perforation?

A

erect CXR

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3
Q

pros of xray

A

-widely available
-quick
-well tolerated
-inexpensive

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4
Q

cons of xray

A

-overall sensitivity low
-rarely changes management
-ionising radiation

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5
Q

USS pros

A

-easy
-safe (no ionisation)
-clear visualization of solid organs, free fluid, aorta, female pelvic organs
-correlate imaging with tenderness

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6
Q

USS cons

A

-operator and patient dependant
-challenging in obese and/or immobile patients

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7
Q

pros of a CT

A

-quick
-relatively widely available and tolerated
-accurate (sensitivity CT vs USS= 89% vs 70%)
-allows imaging of multiple structures at the same time
-allows better planing for surgical approach or any other intervention

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8
Q

cons of CT

A

-radiation exposure (risk of complications increases as dose increases)
-contrast induced nephropathy (more likely in peeople with pre existing renal impairement)
-contrast allergy

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9
Q

pros mri

A

no radiation and good soft tissue delineation

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10
Q

cons MRI

A

long examination times
not 14/7 in most regions
contraindications/ claustrophobia

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11
Q

what is MRI used second line for?

A

hepato biliary
small bowel
pelvis

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12
Q

RIF- possible diagnosis?

A

-appendicitis
-renal colic
-tubo ovarian pathology

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13
Q

imaging used for appendicitis?

A

1st= USS
CT if USS is inconclusive

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14
Q

USS findings- acute appendicits

A

-Aperistaltic, non compressible, dilated appendix (>6mm outer diameter)
-appears round when compression is applied
-periappendiceal fluid collection
-target appearance (axial section)
-periappendicreal reactive nodal prominence/ enlargement
-wall thickening (3mm or above)

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15
Q

CT findings- acute appendicitis

A

-appendiceal dilatation (>6 mm diameter)
-wall thickening (>3 mm) and enhancement
-thickening of the caecal apex
-periappendiceal inflammation
(fat stranding, thickening of the fascia or mesoappendix, extraluminal fluid, phlegmon , abscess)
-focal wall nonenhancement representing necrosis
-perforation

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16
Q

presentation of right ureteric calculus?

A

loing to groin pain

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17
Q

test or right ureteric calculus (loin to groin pain)

A

non contrast CT KUB= gold standard

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18
Q

LIF pain- differentials

A

Diverticulitis
Colitis
Colorectal cancer
Tubo-ovarian pathology
Renal colic

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19
Q

who is most at risk of acute diverticulitis?

A

-elderly patients

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20
Q

presentation of acute diverticulitis?

A

-left iliac fossa pain
-unremitting pain with associated tenderness
-possibly, an ill-defined mass
-as the disease progresses, symptoms become more generalised

21
Q

investigations for acute diverticulitis?

A

CT with IV contrast

22
Q

epigastric and RUQ pain- differentials

A

Biliary colic
Cholecystitis
Pancreatitis
Perforation

23
Q

what is acute cholecystitis secondary to?

A

always secondary to gallstones

24
Q

what is acute cholecystitis diagnosis based on?

A

-sign of inflammation (RUQ pain etc)
-sign of inflammation (fever ,WCC, CRP)
-Confirmatory imaging

25
Q

first line investigation for acute cholecystitis?

A

USS first line to assess gall bladder and biliary tree

CT can be for false calculi

MRI if biliary tree dilatation

26
Q

US findings- acute cholecystitis?

A

gallbladder wall thickening (>3mm)
pericholecystic fluid

also assess biliary tree

27
Q

CT findings- acute cholecystitis

A

cholelithiasis: gallstones isodense to bile will be missed on CT

gallbladder distension

gallbladder wall thickening

mural or mucosal hyperenhancement

pericholecystic fluid and inflammatory fat stranding

enhancement of the adjacent liver parenchyma due to reactive hyperaemia

28
Q

pancreatitis presentation

A

acute onset of severe central epigastric pain (over 30-60 min)

poorly localised tenderness and pain

exacerbated by supine positioning

radiates through to the back in 50% of patients

Elevation of serumamylase 90-95% specific for the diagnosis

29
Q

role of imaging in pancreatitis?

A

to clarify the diagnosis when the clinical picture is confusing
to assess severity and determine prognosis
to detect complications
to determine possible causes

30
Q

pancreatitis on CT presentation

A

focal or diffuse parenchymal enlargement

indistinct pancreatic margins owing to inflammation

surrounding retroperitoneal fat stranding

liquefactive necrosis of pancreatic parenchyma

infected necrosis/abscess formation

Vascular complications

31
Q

causes of perforation?

A

Common:
Perf. Ulcer (decrease incidence)
Diverticular (1-2% generalized, most localised)

Less common
Secondary to cancer
Secondary to ischaemia

32
Q

first line imaging- perforation?

A

CT

33
Q

if there is a lot of gas- is it more likely to be upper or lower bowel problem

A

high volume of gas- more likely to be lower bowel as theres more gas in large bowel wall

34
Q

abdominal pain + distention differentials

A

Bowel obstruction (small or large)
Masses
Ascites

35
Q

symptoms/ signs of small bowel obstruction

A

Symptoms: vomiting, pain and distension

Signs: Increased bowel sounds, tenderness, palpable loops

36
Q

common causes of small bowel obstuction?

A

adhesions, cancer, herniae and gallstone ileus

37
Q

1st line imaging for small bowel obstruction

A

XRAY

38
Q

what can be seen on Xray of small bowel obstruction?

A

valvulae conniventesare visible

Loops are central

Dilatation > 2.5 - 3 cm

Paucity of gas distally

39
Q

what can be seen on CT of small bowel obstruction?

A

dilated small bowel loops >2.5 cm up from outer wall to outer wall

normal calibre or collapsed loops distally

small bowel faeces sign

may identify a mass

40
Q

causes of large bowel obstruction?

A

Colorectal cancer 60%
Volvulus 15%
Diverticulitis 10%

41
Q

large bowel obstruction presentation on xray?

A

peripheral
>5cm
haustra

-colonic distension
-collapsed distal colon
-small bowel dilatation, which depends on
duration of obstruction and incompetence of theileocaecal valve
-rectum has little or no air
-Caecum can reach upto 10cm

42
Q

what imaging is used for large bowel obstruction

A

Xray and CT

43
Q

sudden abdominal pain and shock- differentials

A

Bowel ischaemia
Perforation
Pancreatitis
Leaking AAA
Ruptured ectopic pregnancy

44
Q

causes of bowel ischaemia?

A

Arterial occlusion – 60-70%
Venous occlusion – 5-10%
Non-occlusive hypoperfusion – 20-30%

45
Q

presentation of bowel ischaemia on CT?

A

Lack of enhancement of the lumen of the affected vessel

mucosal/serosal enhancement reduced or increased

Altered wall thickness

ileus / dilated loops of bowel >3 cm in diameter

Pneumatosis intestinalis

other changes:
mesenteric oedema
free fluid
intrahepatic portal venous gas: due to pneumatosis intestinalis
free intra-abdominal gas

46
Q

imaging of bowel ischaemia?

A

CT

47
Q

imaging for AAA

A

CT

48
Q

what is seen on CT of AAA?

A

Retroperitoneal haemorrhageadjacent to the aneurysm is the most common finding

large aorta

CLASP- radiology + anatomy (2 decks)

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