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MD3002 Clinical > Imaging of the GI tract > Flashcards

Imaging of the GI tract Flashcards

1
Q

What are the different imaging methods used for the GI tract?

A
  • Conventional: X-ray, fluoroscopy
  • Ultrasound
  • CT
  • MRI
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2
Q

What is the 1st imaging investigation whenever a patient presents with acute abdomen?

A

X-ray

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3
Q

What is to be looked for in a chest x-ray?

A
  • Gas
  • Soft tissue
  • Calcium - bright
  • Foreign object - coins, batteries in children
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4
Q

How is gas seen in a supine x-ray film?

A
  • Blobs of dark or lucent areas

- In erect x-rays the air looks level

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5
Q

What is the normal gas distribution in an x-ray?

A
  • Stomach Lt upper portion
  • Small intestine - 2/3 gas filled loops none larger than 2.5cm cenrally
  • Large intestine mostly in distal portion i.e sigmoid colon and rectum. Peripherally and in lower portion (pelvis). Max diameter 5.5 cm, caecum the beginning of colon can be up to 8 cm
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6
Q

How do you know that gas in present in the small intestine?

A

Central, thin folds going across entire circumference (valvulae conniventis)

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7
Q

How do you know that gas in present in the large intestine?

A

Periphery, thicker and incomplete folds

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8
Q

What does small intestinal obstruction look like on conventioanal x-ray?

A
  • Distended (>2.5 to 3 cm)
  • Multiple central fluid levels
  • Less gas or no gas in large intestine
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9
Q

What does large intestinal obstruction look like on conventional x-ray?

A
  • Distended gas filled loop or air fluid levels at the periphery
  • Caecum over 9 cm, rest over 5/6 cm
  • Look for haustrae to differentiate
  • Less or no gas beyond the level of obstruction
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10
Q

What are haustrae?

A

Incomplete folds of large intestine (obstruction)

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11
Q

What does gas in the wrong place or outside the intestine and stomach mean?

A
  • Intestinal perforation
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12
Q

What can intestinal perforation be due to?

A

Outside injury or operation (emergency)

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13
Q

What is the clinical name given to gas outwith the intestines?

A

Pneumoperitoneum

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14
Q

What does a coffee bean like

sigmoid colon indicate?

A
  • Sigmoid volvulus

- Loop of sigmoid colon wraps around itself

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15
Q

What can abnormal calcifications be due to?

A
  • Stones: gall/ureteric/bladder
  • Calcification in vessel wall (age related atherosclerosis, diabetes, aneurysm)
  • Calcification in organs (pancreas, renal cyst, uterine fibroids)
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16
Q

What can happen as a result of chronic pancreatitis?

A

Pancreatic tissue can become necrosed and calcium can deposit on it

17
Q

What can happen as a result of constipation which can shoe up on x ray

A

Brightness in large intestine as a result of calcium deposits collecting on stool

18
Q

What does severe abdominal pain with history of gall stones and intestinal obstruction?

A

Gallstone ileus

19
Q

When can barium swallow have limited use?

A

After advent CT and MRI

20
Q

What is barium enema?

A
  • X-ray exam that can detect changes or abnormalities in colon
  • The barium is injected into rectum through a small tube
  • Coats walls of LI
  • Gas fills the colon
21
Q

What does barium ehich has all been collected at the lower oesophagus indicate (beak-like appearence)?

A

Achalasia

22
Q

Ultrasound with help of colour doppler helps assess what?

A

Blood supply to an organ

23
Q

What can ultrasound be useful for?

A
  • Gall stones and gall bladder inflammation
  • Quick assessment of abdomen in trauma cases (FAST scan)
  • Serial assessment of foetal well being
  • Complications related to pregnancy
  • 1st line test to assess uterus and ovaries
  • Acute abdomen in children
  • Dynamic assessment (abdominal and inguinal hernia)
24
Q

Round fluid-filled (black) structure in ovary is?

A

Cyst

25
Q

What does a donut sign indicate on ultrasound of bowel?

A

Intussusception (loop enters other loop)

26
Q

What is a second line imaging investigation after x-ray and ultrasound to clarify findings further?

A

CT scan

27
Q

When would CT scans be 1st line?

A

If clinical suspicion is high (cases of trauma, appendicitis)

28
Q

What can CT scans pick up early?

A

Colon cancer

29
Q

When can MRIs be done on pregnant women?

A

After 1st trimester

30
Q

What are the cons of MRIs?

A

Availability, takes more times, not safe for some patients (e.g pacemakers). Some patients may find it difficult (claustrophobia). Safety in pregnancy not proved (noise/heat deposition), so to be avoided in 1st 3 months unless essential

MD3002 Clinical (4 decks)

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