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Radiology and Anatomy > Imaging of Acute Abdominal Pain > Flashcards

Imaging of Acute Abdominal Pain Flashcards

1
Q

What are the primary imaging tools used for abdominal pain?

A

X-ray, CT, US

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2
Q

What are the secondary imaging tools used for abdominal pain?

A

MRI, fluoroscopy

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3
Q

What are the benefits of using x-rays?

A

Used to exclude bowel obstruction and perforation
Overall sensitivity = 30%
Changes management in 4% of cases

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4
Q

What are some features of US?

A

Shows solid organs, free fluid, aorta and pelvis
Can correlate imaging with tenderness
Gives useful info in 56% of patients
Confirms diagnosis in 66%

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5
Q

What are some features of CT?

A

89% sensitivity
Changes management in 46-60%
Allows better planning of surgery or intervention
Contrast may cause renal impairment

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6
Q

How common is acute appendicitis?

A

14% of admissions for abdominal pain

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7
Q

What are the symptoms of acute appendicitis?

A

Periumbilical pain that localises to RIF

Nausea and vomiting

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8
Q

What imaging is done for acute appendicitis?

A

Use US first and then do CT if this isn’t conclusive

CT will show fat stranding and wall thickness >3mm

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9
Q

How does age affect diverticulosis?

A

Incidence increases with age = 10% of population aged <40 compared to 60% of population aged >80

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10
Q

How common is misdiagnosis of acute diverticulitis?

A

Over 1/3 of cases initially misdiagnosed

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11
Q

What are some complications of acute diverticulitis?

A

Abscess, obstruction, perforation, fistulae

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12
Q

What investigations should be done for acute diverticulitis?

A

Do x-ray to exclude obstruction/perforation then do CT

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13
Q

What is acute cholecystitis almost always secondary to?

A

Gallstones

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14
Q

What imaging is done for acute cholecystitis?

A

US = shows gallstones, gallbladder wall thickening and local fluid
MRI if there is biliary tree dilation
MRCP will show stones

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15
Q

What is emphysematous cholecystitis?

A

Air in the gallbladder wall = occurs in diabetics, may need surgery or interventional radiology

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16
Q

What are some common causes of small bowel obstruction?

A

Adhesions, cancer, herniae, gallstone ileus

17
Q

What are the symptoms and signs of small bowel obstruction?

A

Vomiting, pain, distension, increased bowel sounds, tenderness, palpable loops

18
Q

What investigations are done for small bowel obstruction?

A

X-ray is first line = 70% sensitivity, may miss fluid filled loops
CT = sensitivity >95%, transition point is key, adhesions not seen

19
Q

What are the causes of large bowel obstruction?

A

Colorectal cancer (60%), volvulus (15%), diverticulitis (10%)

20
Q

Why are x-rays not used to diagnose large bowel obstruction?

A

May not show the underlying cause

21
Q

Why are CT scans used for large bowel obstruction?

A

Show underlying mass, state of caecum and distant disease

22
Q

What are some causes of perforation?

A 
Common = perforated ulcers, diverticular disease
Uncommon = secondary to cancer to ischaemia
23
Q

What are the disadvantages of using x-ray to image perforation?

A

May miss small gas pockets and doesn’t show site of origin

24
Q

Why are CT scans used to image perforation?

A

Shows free fluid

Can see site of origin in 86% = gas distribution, defect in wall, localised inflammatory change

25
Q

When does bowel ischaemia develop?

A

When normal GI blood flow is <10%

26
Q

What are the causes of bowel ischaemia?

A

Arterial occlusion (60-70%), venous occlusion (5-10%), non-occlusive hypoperfusion (20-30%)

27
Q

What are the symptoms and signs of bowel obstruction?

A

Sever abdominal pain, may have vomiting or diarrhoea, raised WCC, borderline amylase, acidotic

28
Q

What are the differentials of bowel ischaemia?

A

Perforation, pancreatitis, obstruction, diverticulitis

29
Q

What is the first line investigation for bowel ischaemia?

A

Biphasic CT = shows site of occlusion and length of bowel affected

30
Q

What kind of pain is US usually used for?

A

RIF and RUQ pain

31
Q

What is the first line investigation for ureteric obstruction?

A

Non-contrast CT (CT-KUB)

32
Q

What is epiplotic appendagitis?

A

Benign mimic of acute diverticulitis = has target sign appearance

33
Q

How long do you have to wait before doing a CT for acute pancreatitis?

A

8-10 days after symptom onset = allows for complications to be seen

34
Q

What is the imaging modality of choice for a leaking AAA?

A

CT

Radiology and Anatomy (4 decks)

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