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Unit 1 Clin Med III > L1: GI diagnostics > Flashcards

L1: GI diagnostics Flashcards

1
Q

Indications for Xray

A 
Abdominal pain
N/V
Intestinal obstruction
Perforation
Intussusception
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2
Q

3 views for an abdominal xray

A
  1. Anterior/posterior while supine (KUB)
  2. Upright: better visualization of air-fluid levels
  3. PA CXR: see free air under hemidiaphragms, check chest pathology
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3
Q

Appearance of obstruction on xray?

A

Dilated bowel proximal to obstruction with collapsed bowel distally

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4
Q

Appearance of small bowel obstruction on xray?

A

Upright→ multiple air fluid levels arranged in inverted U’s

Supine→ distended small bowel loops, thickened/edematous bowel walls, no air in colon or rectum

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5
Q

Appearance of paralytic ileus on xray?

A

non mechanical bowel obstruction→ dilated bowel, gas in both small and large intestines
→ air mixed with stool
→ haustral fold in apex of sigmoid colon

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6
Q

Appearance of perforation on xray?

A

free air under diaphragm→crescents

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7
Q

Appearance of intussusception on xray?

A

signs of obstruction, swelling, decreased blood flow, obstruction, tissue damage

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8
Q

Hypoechoic means…

A

Dark on echo

Aorta, bile ducts, abscesses, cysts

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9
Q

Echogenic means….

A

White on echo/solid

Tumors

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10
Q

Indications for abdominal ultrasound

A 
Abdominal pain
Elevated LFTs
Known/suspected liver disease
Status post transplant: liver, kidney, pancreas
Renal failure
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11
Q

Liver pathology visible on ultrasound

A 
Cysts (black air)
abscesses
tumors
cirrhosis
Dilated bile ducts
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12
Q

Test of choice for cholecystitis, cholithiasis

A

Abdominal ultrasound

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13
Q

Gallbladder pathology visible on ultrasound

A 
Tumor
polyps
stones
sludge
Inflammation (wall thickening)
Pericholecystic fluid
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14
Q

Pancreas pathology visible on ultrasound

A

Cysts
abscesses
tumors
Inflammation

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15
Q

Indications for CT scan abdomen/pelvis

A 
Abdominal pain
Abdominal distention
N/V/D/C
Rectal bleeding
Jaundice
CT angiography→ GI bleeds, embolization procedures
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16
Q

CT scan abdomen/pelvis uses ___ contrast

A

IV or PO iodine-contrast

Renal stone study→ NO contrast

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17
Q

Liver pathology visible on CT scan abdomen/pelvis

A 
Cysts
abscesses
tumors (metastatic)
bile duct obstruction
hepatomegaly
Laceration→ linear low-attenuation defect (black air)
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18
Q

Gallbladder pathology visible on CT scan abdomen/pelvis

A

Cholcystitis, cholithiasis

→ edematous and hyperemic wall, inflammatory induration of fat surrounding gallbladder. Calcified stones

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19
Q

Pancreas pathology visible on CT scan abdomen/pelvis

A

Cysts
Abscesses
Tumors
calcification
Acute pancreatitis→ inflammation and swelling
Chronic pancreatitis→ white calcifications
GI tract/bowel

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20
Q

GI tract/bowel pathology visible on CT scan abdomen/pelvis

A 
Tumor
obstruction
perforation
inflammation
appendicitis
bleeding
impacted stool
distended colon
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21
Q

Spleen pathology visible on CT scan abdomen/pelvis

A

Tumor
laceration
hematoma
splenic vein thrombosis

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22
Q

Abdominal aorta pathology visible on CT scan abdomen/pelvis

A

Visualize aneurysm

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23
Q

Test of choice for pancreatitis

A

CT scan abdomen/pelvis

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24
Q

HIDA scan definition

A

Patient receives radioactive tracer: Technetium labeled hepatic imilodiacetic acid→ taken up by liver→ excreted into bile
Nuclear scanner tracts flow

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25
Q

HIDA scan aka

A

GB nuclear scan
Cholescintigraphy
Hepatoiminodiacetic Acid scan

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26
Q

HIDA scan indications

A

Acalculous Cholecystitis

Order with CCK stimulation and ejection fraction of the gallbladder

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27
Q

HIDA scan contraindications

A

Pregnancy

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28
Q

Affects the ejection fraction of the gallbladder

A

Morphine

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29
Q

HIDA scan will show ______ if the cystic duct is patent

A

tracer visualized in gallbladder

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30
Q

HIDA scan will show _____ if there is stone or edema causing obstruction

A

tracer not visualized in gallbladder→ (+) test

31
Q

HIDA scan will show _____ in cholecystitis cases

A

no radionuclide seen in gallbladder within 15-60 minutes
ejection fraction <35%
test reproduces patient’s symptoms

32
Q

Upper GI series definiton

A

Drink barium sulfate contrast + fluoroscopy (continous xray)→ visualize esophagus, stomach, duodenum

33
Q

2 different versions of a UGI

A

Esophagram/barium swallow

Small bowel follow through

34
Q

What contrast should be used in case of suspected perforation?

A

water-soluble gastrin

35
Q

Indications for UGI

A 
Dysphagia
GERD symptoms
Early satiety
Suspected peptic ulcer disease
Suspected obstruction/inflammation
36
Q

2 possible complications of UGI

A

Aspiration of barium

Barium can cause constipation

37
Q

Contraindications to UGI

A

Pregnancy
Complete bowel obstruction
Unstable vital signs

38
Q

Can be seen on UGI

A 
Diverticula
Extrinsic compression
Hiatal hernia
Cancer
Filling defects, bezoar
Perforation
Gastric ulcer
39
Q

What does a bezoar look like on UGI?

A

barium remains in bezoar while exiting the rest of stomach

40
Q

What does perforation look like on UGI?

A

Leakage of contrast outside of UGI trace

41
Q

What does a gastric ulcer look like on UGI?

A

Thin, straight line at neck ulcer representing thin rim of undermined gastric mucosa

42
Q

What does a hiatal hernia look like on UGI?

A

Portion of stomach above diaphragm

Causes increased risk of reflux→ Barrett’s esophagus→ cancer

43
Q

What does cancer look like on UGI?

A

Strictures, obstructions, tumors, ulcerations

44
Q

What do filling defects look like on UGI?

A

Displacement of contrast by space-occupying tumor in a hollow viscus

45
Q

Lower GI series aka

A

Barium enema

46
Q

Risks/complications of a lower GI series

A

Perforations

Barium→ fecal impaction

47
Q

Why might a barium enema be used?

A

Alternative to colonoscopy

Reduce non-strangulated ileocolic intussusception

48
Q

Lower GI series contraindications

A

Pregnancy
Megacolon
Unstable vitals

49
Q

Can be seen on a lower GI series

A 
Ulcers
Diverticula
Extrinsic compression
Perforation
Inflammatory bowel disease
Cancer
50
Q

What does cancer look like on a lower GI series?

A 
Strictures
obstructions
filling defects
tumors
ulcerations
51
Q

Waht does IBS look like on a lower GI series?

A

Narrowing of barium column due to inflammation of surrounding colon→ “Apple core lesion”

52
Q

What does Ulcerative Colitis look like on a lower GI series?

A

absent bowel folds (chronic)

53
Q

Esophagogastroduodenoscopy (EGD) definition

A

Direct visualization of esophagus, stomach, first part of duodenum with long, flexible, fiber optic lighted scope under conscious sedation. Can perform biopsy for histology.

54
Q

Risks/complications of EGD

A

Perforations
Bleeding from biopsy
Aspiration of gastric contents
Oversedation

55
Q

EGD indications

A 
Diagnostic and therapeutic
N/V, abdominal pain
Dyspepsia
Chronic GERD
Dysphagia
Esophageal varices
Hematemesis, melena
Iron deficiency anemia
Abnormal UGI
Suspected enteropathies (celiacs)
Foreign body/food bolus
Alarm symptoms
56
Q

Alarm symptoms are….

A

Dysphagia, weight loss, early satiety, epigastric pain

57
Q

EGD may show…

A 
Hiatal hernia
Barrett’s esophagus
Tumors
Polyps
Varices
Obstruction
Mucosal inflammation
Ulcers
Web’s 
rings (Schatzki’s ring)
Infection (candida, HSV, H pylori)
Arteriovenous (AV) malformations
58
Q

Contraindications to EGD

A

Uncooperative patient
Bleeding

Esophageal diverticula→ increased risk of perforation

Suspected perforation→ can be worsened by insufflation of pressurized air

Recent upper GI tract surgery→ weak anastomosis site

59
Q

Endoscopic Retrograde cholangiopancreatography (ERCP) definition

A

Fiberoptic endoscope + catheter inserted into biliary duct→ radiographic dye injected→ x rays→ visualize bile and pancreatic ducts

60
Q

Risks to ERCP

A

Pancreatitis, Perforation
G- bacteremia/sepsis
Aspiration of gastric contents
Oversedation

61
Q

Therapeutics uses of ERCP

A 
Perform sphincterotomies
remove stones
place stents
obtain brushings/biopsies
Remove gallstones via incision to widen ampulla of vater/common bile duct
62
Q

Contraindications to ERCP

A

Uncooperative patient

Previous GI surgery with inaccessible ampulla of Vater

63
Q

What might you order to visualize the biliary tree and pancreatic ducts before doing ERCP?

A

MRCP cholangiopancreaotgraphy

64
Q

Indications for ERCP

A

Obstructive jaundice
Mass
Choledocholithiais
Cholangitis

65
Q

Colonoscopy definition

A

Bowel prep + Long flexible fiberoptic-lighted scope + conscious sedation→ visualize rectum, colon, terminal ileum

66
Q

Flexible sigmoidoscopy is a colonoscopy that only explores the….

A

rectum and sigmoid colon

67
Q

Indications for colonoscopy

A 
Colon cancer screen→ remove, biopsy polyps
Potential colon cancer symptoms
Diarrhea
Prior abnormal test
Foreign body removal
Decompression of volvulus
68
Q

Potential colon cancer symptoms

A

change in bowel habits
hematochezia
iron deficiency anemia

69
Q

Possible colonoscopy findings

A 
Congestion
Ulcers
Edema
Lack of normal folds
Colon cancer
Bleeding diverticulum
70
Q

How is bleeding diverticulum treated if found on colonoscopy?

A

Inject with epi
cauterize
tattoo with india ink

71
Q

Contraindications to colonoscopy

A 
Uncooperative patient
Severe rectal bleeding
Suspected perforation
Recent colon surgery
Toxic megacolon
Active diverticulitis or colitis
72
Q

Complications of colonoscopy

A

Perforation
Bleeding due to biopsy or polypectomy
Oversedation

73
Q

Cologuard is…

A

Colon cancer screening test
Non-invasive stool test with DNA markers and immunochemical test for hemoglobin in the stool
Guidelines recommend every 3 years

Unit 1 Clin Med III (7 decks)

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