L1: GI diagnostics Flashcards
Indications for Xray
Abdominal pain N/V Intestinal obstruction Perforation Intussusception
3 views for an abdominal xray
- Anterior/posterior while supine (KUB)
- Upright: better visualization of air-fluid levels
- PA CXR: see free air under hemidiaphragms, check chest pathology
Appearance of obstruction on xray?
Dilated bowel proximal to obstruction with collapsed bowel distally
Appearance of small bowel obstruction on xray?
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
Appearance of paralytic ileus on xray?
non mechanical bowel obstruction→ dilated bowel, gas in both small and large intestines
→ air mixed with stool
→ haustral fold in apex of sigmoid colon
Appearance of perforation on xray?
free air under diaphragm→crescents
Appearance of intussusception on xray?
signs of obstruction, swelling, decreased blood flow, obstruction, tissue damage
Hypoechoic means…
Dark on echo
Aorta, bile ducts, abscesses, cysts
Echogenic means….
White on echo/solid
Tumors
Indications for abdominal ultrasound
Abdominal pain Elevated LFTs Known/suspected liver disease Status post transplant: liver, kidney, pancreas Renal failure
Liver pathology visible on ultrasound
Cysts (black air) abscesses tumors cirrhosis Dilated bile ducts
Test of choice for cholecystitis, cholithiasis
Abdominal ultrasound
Gallbladder pathology visible on ultrasound
Tumor polyps stones sludge Inflammation (wall thickening) Pericholecystic fluid
Pancreas pathology visible on ultrasound
Cysts
abscesses
tumors
Inflammation
Indications for CT scan abdomen/pelvis
Abdominal pain Abdominal distention N/V/D/C Rectal bleeding Jaundice CT angiography→ GI bleeds, embolization procedures
CT scan abdomen/pelvis uses ___ contrast
IV or PO iodine-contrast
Renal stone study→ NO contrast
Liver pathology visible on CT scan abdomen/pelvis
Cysts abscesses tumors (metastatic) bile duct obstruction hepatomegaly Laceration→ linear low-attenuation defect (black air)
Gallbladder pathology visible on CT scan abdomen/pelvis
Cholcystitis, cholithiasis
→ edematous and hyperemic wall, inflammatory induration of fat surrounding gallbladder. Calcified stones
Pancreas pathology visible on CT scan abdomen/pelvis
Cysts
Abscesses
Tumors
calcification
Acute pancreatitis→ inflammation and swelling
Chronic pancreatitis→ white calcifications
GI tract/bowel
GI tract/bowel pathology visible on CT scan abdomen/pelvis
Tumor obstruction perforation inflammation appendicitis bleeding impacted stool distended colon
Spleen pathology visible on CT scan abdomen/pelvis
Tumor
laceration
hematoma
splenic vein thrombosis
Abdominal aorta pathology visible on CT scan abdomen/pelvis
Visualize aneurysm
Test of choice for pancreatitis
CT scan abdomen/pelvis
HIDA scan definition
Patient receives radioactive tracer: Technetium labeled hepatic imilodiacetic acid→ taken up by liver→ excreted into bile
Nuclear scanner tracts flow
HIDA scan aka
GB nuclear scan
Cholescintigraphy
Hepatoiminodiacetic Acid scan
HIDA scan indications
Acalculous Cholecystitis
Order with CCK stimulation and ejection fraction of the gallbladder
HIDA scan contraindications
Pregnancy
Affects the ejection fraction of the gallbladder
Morphine
HIDA scan will show ______ if the cystic duct is patent
tracer visualized in gallbladder
HIDA scan will show _____ if there is stone or edema causing obstruction
tracer not visualized in gallbladder→ (+) test
HIDA scan will show _____ in cholecystitis cases
no radionuclide seen in gallbladder within 15-60 minutes
ejection fraction <35%
test reproduces patient’s symptoms
Upper GI series definiton
Drink barium sulfate contrast + fluoroscopy (continous xray)→ visualize esophagus, stomach, duodenum
2 different versions of a UGI
Esophagram/barium swallow
Small bowel follow through
What contrast should be used in case of suspected perforation?
water-soluble gastrin
Indications for UGI
Dysphagia GERD symptoms Early satiety Suspected peptic ulcer disease Suspected obstruction/inflammation
2 possible complications of UGI
Aspiration of barium
Barium can cause constipation
Contraindications to UGI
Pregnancy
Complete bowel obstruction
Unstable vital signs
Can be seen on UGI
Diverticula Extrinsic compression Hiatal hernia Cancer Filling defects, bezoar Perforation Gastric ulcer
What does a bezoar look like on UGI?
barium remains in bezoar while exiting the rest of stomach
What does perforation look like on UGI?
Leakage of contrast outside of UGI trace
What does a gastric ulcer look like on UGI?
Thin, straight line at neck ulcer representing thin rim of undermined gastric mucosa
What does a hiatal hernia look like on UGI?
Portion of stomach above diaphragm
Causes increased risk of reflux→ Barrett’s esophagus→ cancer
What does cancer look like on UGI?
Strictures, obstructions, tumors, ulcerations
What do filling defects look like on UGI?
Displacement of contrast by space-occupying tumor in a hollow viscus
Lower GI series aka
Barium enema
Risks/complications of a lower GI series
Perforations
Barium→ fecal impaction
Why might a barium enema be used?
Alternative to colonoscopy
Reduce non-strangulated ileocolic intussusception
Lower GI series contraindications
Pregnancy
Megacolon
Unstable vitals
Can be seen on a lower GI series
Ulcers Diverticula Extrinsic compression Perforation Inflammatory bowel disease Cancer
What does cancer look like on a lower GI series?
Strictures obstructions filling defects tumors ulcerations
Waht does IBS look like on a lower GI series?
Narrowing of barium column due to inflammation of surrounding colon→ “Apple core lesion”
What does Ulcerative Colitis look like on a lower GI series?
absent bowel folds (chronic)
Esophagogastroduodenoscopy (EGD) definition
Direct visualization of esophagus, stomach, first part of duodenum with long, flexible, fiber optic lighted scope under conscious sedation. Can perform biopsy for histology.
Risks/complications of EGD
Perforations
Bleeding from biopsy
Aspiration of gastric contents
Oversedation
EGD indications
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
Alarm symptoms are….
Dysphagia, weight loss, early satiety, epigastric pain
EGD may show…
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
Contraindications to EGD
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
Endoscopic Retrograde cholangiopancreatography (ERCP) definition
Fiberoptic endoscope + catheter inserted into biliary duct→ radiographic dye injected→ x rays→ visualize bile and pancreatic ducts
Risks to ERCP
Pancreatitis, Perforation
G- bacteremia/sepsis
Aspiration of gastric contents
Oversedation
Therapeutics uses of ERCP
Perform sphincterotomies remove stones place stents obtain brushings/biopsies Remove gallstones via incision to widen ampulla of vater/common bile duct
Contraindications to ERCP
Uncooperative patient
Previous GI surgery with inaccessible ampulla of Vater
What might you order to visualize the biliary tree and pancreatic ducts before doing ERCP?
MRCP cholangiopancreaotgraphy
Indications for ERCP
Obstructive jaundice
Mass
Choledocholithiais
Cholangitis
Colonoscopy definition
Bowel prep + Long flexible fiberoptic-lighted scope + conscious sedation→ visualize rectum, colon, terminal ileum
Flexible sigmoidoscopy is a colonoscopy that only explores the….
rectum and sigmoid colon
Indications for colonoscopy
Colon cancer screen→ remove, biopsy polyps Potential colon cancer symptoms Diarrhea Prior abnormal test Foreign body removal Decompression of volvulus
Potential colon cancer symptoms
change in bowel habits
hematochezia
iron deficiency anemia
Possible colonoscopy findings
Congestion Ulcers Edema Lack of normal folds Colon cancer Bleeding diverticulum
How is bleeding diverticulum treated if found on colonoscopy?
Inject with epi
cauterize
tattoo with india ink
Contraindications to colonoscopy
Uncooperative patient Severe rectal bleeding Suspected perforation Recent colon surgery Toxic megacolon Active diverticulitis or colitis
Complications of colonoscopy
Perforation
Bleeding due to biopsy or polypectomy
Oversedation
Cologuard is…
Colon cancer screening test
Non-invasive stool test with DNA markers and immunochemical test for hemoglobin in the stool
Guidelines recommend every 3 years
