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Case 3 > Imaging the Upper GI Tract and Hepatobiliary System > Flashcards

Imaging the Upper GI Tract and Hepatobiliary System Flashcards

1
Q

What are imaging methods used on the gastrointestinal tract

A

Alimentary tube: plain film, barium studies, computed tomography, MRI, fibre-optic endoscopy

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2
Q

What length should the small bowel be in plain film

A

3cm

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3
Q

What barium radiology do you use to look at the oesophagus

A

Barium swallow

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4
Q

What barium radiology do you use to look at the stomach/ duodenum

A

Barium meal

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5
Q

What barium radiology do you use to look at the small intestine

A

Barium follow through and small bowel enema

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6
Q

What barium radiology do you use to look at the colon

A

Barium enema

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7
Q

What do you need for upper GI tract barium radiology

A

Fasting and smooth muscle relaxant

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8
Q

Why do you use a smooth muscle relaxant in barium radiology and what would you use

A

Use buscopan. Smooth muscle relaxant eliminates peristalsis and spasm

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9
Q

What do you need for lower GI tract barium radiology

A

Bowel cleaning and muscle relaxant

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10
Q

Why do you need an empty bowel for barium radiology

A

So that you can see the mucosal lining of the bowel (prevents food from sticking)

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11
Q

How do you distend the upper bowel

A

Patient drinks a drink with specific fizzy granules

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12
Q

How do you distend the lower bowel

A

CO2 is put up the back passage

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13
Q

Describe the principles of double contrast barium radiology

A

Barium coats the mucosa, gas (air or CO2) distends the bowel lumen

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14
Q

What are the two types of single contrast techniques in barium radiology

A

Contrast swallow and gastrografin enema

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15
Q

Describe contrast swallow

A

Emergency examination; no prep; look for gross abnormality e.g. leak, perforation, bolus obstruction; no mucosal detail; water soluble contrast used (NOT gastrografin)

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16
Q

Describe gastrografin enema

A

emergency examination; no prep; look for gross abnormality e.g. complete obstruction, perforation, fistula; no mucosal detail; no muscle relaxant of gas used

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17
Q

What is normal oesophageal peristalsis

A

Primary peristalsis followed by secondary peristalsis

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18
Q

What does abnormal oesophageal motility show

A

Tertiary contractions

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19
Q

What does a prone motility study require

A

Primary peristalsis followed by secondary peristalsis

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20
Q

What is the function of secondary peristalsis

A

To clear anything left over from the primary swallow to the stomach

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21
Q

Describe a barium meal

A

Requires ionising radiation, relatively insensitive, does not permit biopsy

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22
Q

Describe endoscopy

A

No ionising radiation, direct inspection of mucosa, allows biopsy, limited mobility required

23
Q

Why is endoscopy preferred

A

No ionising radiation, allows direct inspection of mucosa, allows biopsy and limited mobility is required

24
Q

Describe upper gastrointestinal CT

A

Limited diagnostic value; mainly used for staging known oesophageal or gastric cancers, post-operative complications; needs gastric distention so IV buscopan and drink water or omnipaque

25
Q

Describe small bowel follow through studies

A

Patient drinks barium, barium followed through small bowel

26
Q

Describe small bowel enema

A

Enteroclysis- tube examination, contrast infused into small bowel, better distention of small bowel

27
Q

What show the small bowel better than plain film

A

Barium studies

28
Q

What is ultrasound used for

A

To evaluate terminal ileum and appendix and to look for collections. Limited value in examining rest of bowel. Operator and patient dependent

29
Q

Describe CT or MRI enterography

A

fairly new techniques. Give larger volumes of oral bulking agent e.g. kleenprep (a laxative which draws fluid into the bowel). Bulking agent distends small bowel and acts as negative/ positive contrast

30
Q

Why use CT or MRI

A

CT good for initial diagnosis and acute abdomen, MRI better for monitoring disease. CT is very quick but there is quite a lot of radiation. For MRI you lie still for 20-30 minutes for good pictures. MRI shows normal and abnormal thickening of the bowel wall

31
Q

Describe capsule endoscopy

A

If you want lumenal views of the small bowel then you need to use capsule endoscopy. However capsule endoscopy is hard to interpret. It is used mainly in difficult cases when you are unsure of the pathology

32
Q

What is used in large bowel imaging

A

Barium enema, CT pneumocolon and colonoscopy

33
Q

What is T1 MRI good for

A

Anatomy, the fluid is dark

34
Q

What is T2 MRI good for

A

Pathology, the fluid appears bright

35
Q

Describe MRCP

A

Sequence imaging which is heavily T2 weighted

36
Q

What does erect barium swallow allow you to see

A

Demonstration of the anatomy from pharynx to gastro-oesophageal junction (cardia)

37
Q

What does prone barium swallow allow you to see

A

Allows assessment of oesophageal peristalsis i.e. physiology

38
Q

What are 3 the anterior indentations of the oesophagus caused by

A

1st indentation- aortic arch. 2nd indentation- left main bronchus. 3rd indentation- left atrium

39
Q

What are the indentations in the oesophagus at risk of being

A

A stricture

40
Q

What does a barium meal allow good demonstration of

A

Fundus, body, antrum, pylorus, duodenum

41
Q

Describe small bowel anatomy

A

Jejunum- left upper quadrant, prominent fold pattern, larger calibre lumen. Ileum- right lower quadrant, more featureless, narrower lumen, terminates at ileo-caecal valve

42
Q

What can be used to image the biliary tract

A

Ultrasound, magnetic resonance scanning (MRCP), endoscopic retrograde cholangio-pancreatography (ERCP), endoscopic ultrasound (EUS)

43
Q

What do you mainly use to look at the biliary tree

A

Ultrasounds

44
Q

What is odynophagia

A

Pain when swallowing due to disorganised contraction and corkscrewing of the oesophagus

45
Q

What is the best way of locally staging cancer

A

Endoscopic cancer

46
Q

What does PET show

A

Metastases

47
Q

What is the colon commonly affected by

A

Chrome’s disease or inflammatory conditions

48
Q

What does fat wrapping show

A

The small bowel is inflamed

49
Q

What does a positive Murphy’s sign mean

A

Tender gall bladder

50
Q

What are inflammatory markers

A

WBCs CRP (c-reactive protein)

51
Q

What are possible causes of strictures of the biliary tree

A

Neoplasms- cholangiocarcinoma, gallbladder adenocarcinoma, pancreatic adenocarcinoma, metastasis; Post-inflammatory- pancreatitis, post radiation or chemotherapy; Inflammatory- AIDS cholangiopathy, biliary parasites, primary sclerosing cholangitis. No obstruction: caroli disease, choledochal cyst, recurrent pyogenic cholangitis, primary sclerosing cholangitis

52
Q

What can obstruction of the biliary tree be caused by

A

Stones or strictures

53
Q

What are symptoms of a Klatskin tumour

A

Painless jaundice, itching, weight loss

Case 3 (9 decks)

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