Intro to GI Imaging

Question 1

GI ordering basics

Answer 1

Start with supine abdomen or acute abdomen series

Question 2

Barium

Answer 2

GI contrast of choice

Except in suspected perforation, high grade obstruction, impending endoscopy

Question 3

Iodine

Answer 3

Alternate GI contrast

Water-soluble contrast

Question 4

CT Uses

Answer 4

Further eval acute abdomen sx –> some ED physicians will pass plain films & go straight to CT

-Bowel obstruction
-Appendicitis
-Renal colic
-Suspected malignancy
-Unexplained infection
-Ischemic bowel
-Unusual abdominal pain

Question 5

CT with IV contrast

Answer 5

Tumor or inflammation/infection

Question 6

CT with oral contrast

Answer 6

Routinely

EXCEPT when seeking calcifications, pt intolerance (vomiting) or CT angiography

Question 7

CTA

Answer 7

visualize vasculature

Question 8

Non-contrast CT

Answer 8

Renal, ureteral stones

Question 9

US uses

Answer 9

FIRST line: gallbladder & biliary imaging –> CT may follow

-Appendicitis (esp children)
-AAA
-Pyloric stenosis
-Renal cyst, obstruction
-Ectopic pregnancy
-Women’s pelvis

Question 10

Normal US echogenicity of solid abdominal organs

Answer 10

PLSK (d/t fat content)

Highest (brightest) –> Lowest (darkest)

Pancreas –> Liver –> Spleen –> Kidney

Question 11

MRI uses

Answer 11

-Delineate biliary ducts (bile duct dilatation)
-Tumor characterization
-Appendicitis in pregnancy
-Hepatic hemangioma
-Other hepatic tumors w/ unclear dx w/ CT/US
-Arterial pathology (MRA)
-Staging in endometrial cancer, prostate cancer
-Complicated cases not resolved by other imaging

Question 12

GI Fluoroscopy

Answer 12

Study of moving body parts, utilizing a continuous XR beam (XR movie) –> much has been replaced by endoscopy/colonoscopy, CT/MRI

Question 13

GI Fluoroscopy uses

Answer 13

• Still used for obstruction of localized site (esophagus)
  -Used in pts refusing endoscopy/colonoscopy

May inhibit further CT scanning d/t barium density

Question 14

Esophagram (aka barium swallow) USES:

Answer 14

-Dysphagia (difficulty swallwing)
-Odynophagia (painful swallowing)
-Foreign body sensation, food or other foreign body
-Chest pain suspected to be related to GERD
-Esophageal CA
-Zenker’s diverticulum
-Hiatal hernia
-Barrett’s esophagus

Question 14

Modified barium swallow

Answer 14

Video fluoroscopic swallowing exam
-done with SLP
-Recorded (disc)
-Determine safety of feedings
-Determines which thickness of feedings are safest
-Aids in direction of exercises
-Demonstrates delay of pharyngeal response time

-Cricopharyngeal hypertrophy; Zenker’s diverticulum

Question 14

Upper GI Series

Answer 14

-Abdominal pain
-Gastric or duodenal ulcer
-Bezoar
-Mass pathology
-Gastric obstruction

Question 15

RUQ Pain

Answer 15

GB US

Question 16

Splenic Trauma

Answer 16

ABD CT

Question 17

Trauma

Answer 17

ABD CT
US (if pt unstable)

Question 18

Gallstone

Answer 18

US

Question 19

Hemangioma (liver)

Answer 19

Hepatic CT (hemangioma protocol)

Nuclear SPECT Imaging

MRI

Question 20

Jaundice

Answer 20

ABD CT
ABD US
Nuclear HIDA scan
Magnetic resonance cholangiogram
ERCP

Question 21

Pain (nonspecific)

Answer 21

Acute ABD series
ABD CT (if persistent)

Question 22

Small bowel study

Answer 22

-Chronic diarrhea
-Gluten sensitivity
-Small bowel lymphoma, suspected malignancy
-WT loss w/ unknown cause
-Steatorrhea
-IBD

Question 23

Mid/Lower ABD ordering schemes

Answer 23

Small Bowel Obstruction LLQ Pain (diverticulitis) intussception Meckel's diverticulitis RLQ Pain (appendicitis)

Question 24

Small Bowel Obstruction

Answer 24

ABD XR ABD/Pelvic CT Small bowel follow-through

Question 25

LLQ Pain (diverticulitis)

Answer 25

ABD-Pelvis CT

Question 26

Intussception

Answer 26

Air-only enema (children) Barium enema (adults)

Question 27

Meckel's diverticulits

Answer 27

ABD-Pelvis CT Pertechnetate sclntlgraphy TC-99

Question 28

RLQ Pain (appendicitis)

Answer 28

US (children) ABD CT (adults)

Question 29

Obstruction Pathology

Answer 29

-Twisting, volvulus, hernias -Internal mass, foreign body, webs, anatomic rings -Inflammation -External scarring/fibrosis (post-op adhesions, congenital bands)

Question 30

Inflammation Pathology

Answer 30

-Mucosal inflammation, GERD, UC -Ulcerations -Regional enteritis/Crohn's -Diverticulitis -Appendicitis

Question 31

Tumor Pathology

Answer 31

-Esophageal --> squamous -Remainder --> adenocarcinomas

Question 32

Perforation Pathology

Answer 32

-Trauma, iatrogenic, ulceration, diverticula

Question 33

Ischemia Pathology

Answer 33

-Obstruction -Vascular compromise/embolius

Question 34

Air/gas in unexpected locations (in absence of penetrating trauma) 1. Abdomen 2. Liver

Answer 34

1. Penumoperitoneum; abscess 2. portal venous gas; biliary gas

Question 35

Signs of PATHOLOGY

Answer 35

* Altering density, signal, echogenicity, activity * Altering the shape * Blurring margins - Disrupting symmetry

Question 36

Barium use EXCEPTIONS

Answer 36

○ Suspected perforation ○ High grade obstruction ○ Impending endoscopy