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Gastrointestinal > Imaging Of The GI System > Flashcards

Imaging Of The GI System Flashcards

1
Q

What is the ABDO X approach to an abdominal x ray?

A

ABDO X

  • Air
  • Bowel
  • Dense structures + calcifications
  • Organs + soft tissues
  • eXternal objects, lines + tubes
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2
Q

How do you differentiate between the small + large bowel on an abdominal x ray?

A

small bowel: central | valvulae conniventes | contains air or fluid
large bowel: peripheral | haustral folds | contains air or faeces

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3
Q

Reasons for requesting abdominal x ray

A
  • position of iatrogenic items
  • forgein objects
  • confirm ureteric stone identified on CT
  • specialist cases

US or CT preferred as first line

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4
Q

Where should you see air in an abdominal x ray?

A
  • should only be within the bowel (intramural)
  • not within the perioneal space (extramural) | pneumoperitoneum
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5
Q

What is pneumoperitoneum?

A

Air within the peritoneal cavity

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6
Q

investigations of suspected pneumoperitoneum

A

erect CXR
abdominal X ray
abdominal CT

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7
Q

Signs of pneumoperitoneum on erect chest X ray

A

air under the hemidiaphragm

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8
Q

What is Chilaiditi sign?

A

Pseudo-pneumoperitoneum
air under the right hemidiaphragm but within bowel loops

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9
Q

Signs of pneumoperitoneum on abdominal X ray

A
  • Rigler’s sign: bowel wall clearly defined due to air on either side
  • Psoas sign: loss of sharp delineation of psoas muscle border
  • triangle sign: black triangle shapes
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10
Q

What is Rigler’s sign?

A
  • Bowel wall crisply + clearly defined due to gas on both sides
  • Seen in pneumoperitoneum on AXR
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11
Q

What imaging is best to detect pneumoperitoneum?

A

abdominal CT

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12
Q

What is tension pneumoperitoneum?

A

pneumoperitoneum with a one-way valve causing abdominal organs to be compressed centrally

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13
Q

Features of small bowel on AXR

A
  • Central
  • Valvulae conniventes (lines across whole diameter)
  • Contains air or fluid
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14
Q

Features of large bowel on AXR

A
  • peripheral
  • haustral folds
  • contains air or faeces
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15
Q

What is seen in sigmoid volvulus on AXR?

A
  • coffee bean sign
  • large gas filled viscus from pelvis + epigastrium
  • normal positioned caecum
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16
Q

What is seen in sigmoid volvulus in abdominal CT?

A

whirl sign

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17
Q

What is seen in caecal volvulus on AXR?

A
  • Reverse C shaped viscus on right side ‘fetal appearance’
  • Normal sigmoid
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18
Q

How does ascites present on abdominal X ray?

A

fluid on either side of abdomen > central crowding of bowel loops (bowels not fully to the borders of abdomen) (pro-peritoneal fat)

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19
Q

What does oedematous bowel wall indicate on AXR?
What sign shows this?

A

Inflammatory bowel disease
e.g. crohn’s, ulcerative colitis
Thumb printing

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20
Q

What is seen in inflammatory bowel disease on AXR?

A
  • thumb printing sign: mucosa thickening of haustra due to inflammation + oedema
  • lead pipe colon: loss of haustral markings
  • toxic megacolon: colonic dilation, oedema + pseudopolyps
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21
Q

What does a coffee bean sign on AXR indicate?

A

Sigmoid voluvus

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22
Q

What does thumb printing sign on AXR indicate?

A

Irritable bowel disease - colitis
Bowel wall oedema

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23
Q

What do you look for for A on ADBO X?

A

air

  • pneumoperitoneum
  • rigler sign: bowel wall crisply + cleared defined
24
Q

What do you look for on B of ABDO X?

A

Bowel

  • sigmoid volvulus: coffee bean sign
  • caecal volvulus: fetal
25
What is achalasia?
Impaired relaxation of lower oesophageal sphincter
26
Symptoms of achalasia
- weight loss - halitosis (bad breath)
27
What is used to investigate + image achalasia? What sign is seen?
- X ray - Barium swallow + fluoroscopy . - Bird beak structure of distal oesophagus
28
What are the upper limits for the normal diameter of: - small bowel - colon - caecum
- **small bowel**: 3cm - **colon**: 6cm - **caecum** 9cm *3/6/9 rule*
29
What is seen on a AXR in small bowel obstruction?
- dilatation of small bowel >3cm - coiled spring appearance - inspect inguinal region for hernias
30
Standard imaging for colon cancer if patient has been diagnosed already
CT
31
Standard diagnostic imaging for colon cancer
CT colonogram
32
Imaging of rectal cancer
MRI for staging + follow up
33
Imaging for Crohn’s disease
CT for acute abdomen MRI for diagnosis + follow up
34
What is a barium swallow used to test?
Pharynx Oesophagus Proximal stomach
35
Outline a barium enema
- tube is **inserted into rectum** to **visualise large intestines** - barium administered - results are monitored using **fluoroscopy**
36
How can you visualise the vasculature associated with the GI system?
Angiogram
37
Features of toxic mega colon on AXR
- gaseous distension of transverse colon - oedema - featureless transverse + sigmoid colon
38
Pros and cons of abdominal ultrasound
Cheap Portable No radiation . User dependant
39
Pros and cons of abdominal MRI
Detailed No radiation High contrast image . Time consuming Issue with claustrophobia
40
GI features at T12 in CT scan
Liver Stomach Spleen IVC Aorta + coeliac trunk T12 vertebra (Kidneys?)
41
GI features at L1 in CT scan
Liver Stomach Spleen Pancreas IVC Aorta + SMA Both kidneys L1 vertebra
42
GI features at L3 on CT scan
Liver Aorta + IMA IVC Colon Small intestines Psoas major muscles L3 vertebra
43
GI features at L4 on CT scan
Iliac crest Bifurcation of abdominal aorta
44
what densities can be seen on non contrast CT abdomen + what colour they appear
- **air**: black - **SC fat**: dark grey - **soft tissues**: lighter grey - **bones**: white
45
what is used as contrast for contrast CT abdomen? how does the structure with contrast appear on CT?
idione bright white
46
Routes of contrast for imaing
- IV (most common) - oral - rectal - bladder
47
Phases of CTs
- non contrast - systemic arterial - portal venous - delayed
48
What needs to be considered when requesting IV contrast for patient?
allergies eGFR >30 venous access (large cannula needed)
49
When is non contrast CT abdo-pelvis done?
CT KUB to look for ureteric stones IV contrast contraindicated
50
51
Example of water soluble CT contrast
Gastrografin/water soluble
52
Reasons to request AXR
- position of iatrogenic items - forgein items - confirm ureteric stone identified on CT
53
Reasons to request abdominal CT
- first line test for acute abdomen - free air, free fluid, SBO, LBO, inflammation - ureteric stones
54
Reason to request abdominal USS
- first line for RUQ/biliary symptoms - first line for gynaecological organ evaluation
55
56
When is fluoroscopy used?
- Assess oesophagus strictures + motility disorders - for ERCP
57

Gastrointestinal (30 decks)

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