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Clin D III > Lecture 6- Abdominal & Pelvic Imaging > Flashcards

Lecture 6- Abdominal & Pelvic Imaging Flashcards

1
Q

what are 4 quadrants? what is in each?

A
  • RUQ: Liver, stomach, gallbladder, duodenum, R kidney
  • LUQ: Stomach, pancreas, L kidney, spleen
  • RLQ: appendix, R ovary
  • LLQ: colon, L ovary
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2
Q

9 abdominal divisions

A
  • Superior: R hypochondric; epigastric; L hypochondric
  • Middle: R lumbar; umbilical; L lumbar
  • Inferior: R iliac; hypogastric; L iliac
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3
Q

what is in the 9 regions?

A
  • R Hypochondriac: liver, gallbladder, right kidney, and portions of the small and large intestine
  • Epigastric: portions of the liver, stomach, pancreas, duodenum, spleen.
  • L Hypochondriac: spleen, large/small intestines, L kidney, pancreas, stomach
  • R Lumbar: ascending colon, small intestine, and R kidney
  • Umbilical: duodenum, small intestine, transverse colon.
  • L Lumbar: descending colon, small intestine, L kidney
  • R Iliac: appendix, cecum, ascending colon, small intestine.
  • Hypogastric: bladder, portions of the sigmoid colon, small intestine, reproductive organs
  • L Iliac: sigmoid colon, descending colon, small intestine
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4
Q

three division of the abdomen?

A
  • foregut
  • midgut
  • hindgut
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5
Q

what is the foregut?

A
  • consists of the distal end of the esophagus, stomach, portion of the duodenum
  • includes liver & gallbladder
  • Celiac trunk is the principal artery which supplies the foregut and arises from the abd aorta
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6
Q

what is in the midgut

A
  • distal half of duodenum, jejunum, ileum, cecum, ascending colon, proximal half of transverse colon
  • branches of the sup mesenteric arteries/veins provide primary vascular supply
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7
Q

what is in the hindgut?

A
  • consists of the distal half of transverse colon, descending colon, sigmoid colon, proximal third of rectum
  • supplied by inferior mesenteric artery
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8
Q

what are the 4 lobes of liver? where are they?

A
  • Right lobe: positioned to the R of the IVC and gallbladder
  • Left lobe: positioned to the L ligamentum teres
  • Quadrate lobe: positioned anterior to portal triad
  • Caudate lobe: positioned posterior to the portal triad
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9
Q

retroperitoneal structures

A
  • Suprarenal (adrenal) glands
  • Aorta + IVC
  • duodenum
  • pancreas
  • ureters
  • colon (ascending/descending)
  • kidneys
  • esophagus
  • rectum
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10
Q

what is retroperitoneum

A

an anatomical space located behind the abdominal or peritoneal cavity

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11
Q

what is the mesentary

A

a fold of membrane that attaches the intestine to the wall around the stomach area and holds it in place

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12
Q

what is the peritoneum

A

the serous membrane that lines the abdominal cavity

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13
Q

what muscle is very easy to see on xray? what can it help you find?

A
  • psoas muscle
  • ureters
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14
Q

label the anatomy of the CT slices in the ppt

A

ok

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15
Q

steps to viewing abdomen radiographs

A
  • position it correctly- R marker in right spot, head up
  • view as a whole for abnormalities
  • view systematically (liver/spleen, psoas shadows, renal contours, calcifications, intestinal gas patterns, bones
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16
Q

common indications for requesting conventional abdominal radiographs

A
  • assess bowel gas patterns
  • hx of kidney stones to evaluate positioning
  • screening test for non-localized abd pain
  • look for radiopaque FBs
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17
Q

abd radiograph views

A
  • AP view: most frequent, pt is supine
  • upright: useful for detecting free air/air fluid levels in intestines
  • decubitus: free air if pt can’t stand
  • prone: detects air in rectum/sigmoid
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18
Q

what do abd series include?

A
  • AP view
  • prone or lateral rectal view
  • upright or decubitus view
  • CXR may be included
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19
Q

which kidney is lower? the spleen is the same size as?

A
  • R kidney lower than L kidney
  • spleen= size of L kidney
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20
Q

non pathologic calcifications that can be found on abd xray

A
  • bones
  • mesenteric lymph nodes
  • phleboliths
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21
Q

pathologic calcifications in abd imaging

6

A
  • cholelithiasis
  • nephrolithiasis
  • appendicolith
  • pancreatitis
  • arterial calcifications
  • uterine fibroids
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22
Q

visibility of gallstones vs urinary calcli?

A
  • gall: only 10% of all stones
  • 90% of urinary calculi are visible due to high calcium content
23
Q

what are phleboliths

A
  • found in lower half of pelvis
  • 1 cm of less in diameter
  • more common in women
  • small blood clots in a vein that harden over time due to calcification
24
Q

describe normal gas pattern in bowels

A
  • small amount of gas in stomach & small intestine
  • always air in rectum or sigmoid colon w/ varying amounts of air in rest of colon
  • CT most sensitive for identifying gas patterns
25
Q

what is generalized adynamic ileus

A
  • loss of intestinal motility
  • increased gas throughout GI tract
  • gas in rectum
  • # 1 cause is post-op
26
Q

clinical picture of generalized adynamic ileus

4

A
  • hypoactive bowel sounds
  • bowel distention
  • +/- tendernes
  • no cramping
27
Q

describe small bowel obstruction

A
  • mechanical obstruction of the small bowel
  • “stacked coin”, dilated loops of small bowel
  • little to no gas in colon, depends on timing
  • # 1 cause is adhesions
28
Q

describe large bowel obstruction

A
  • mechanical obstruction of large bowel
  • dilated colon proximal to the obstruction w/ no air distally
  • absence of gas in rectum
29
Q

clinical picture of LBO

3

A
  • abd distension
  • severe cramping
  • pain
30
Q

differentiate distended bowel and dilated bowel

A
  • distended: air filled but still normal size
  • dilated: air filled beyond normal size
31
Q

how can large bowel be identified?

A

haustra- irregulary spaced soft tissue folds that do not usually transverse the width of the colon

32
Q

describe sigmoid volvulus

A
  • type of LBO
  • occurs mostly in elderly pts w/ hx of constipation
  • redundant mesentery twists on itself which causes obstruction
  • classic appearance: inverted “U” projecting out of the pelvis
33
Q

causes of pneumoperitoneum

3

free intraperitoneal air

A
  • caused by rupture of hollow viscus
  • perforated ulcer, diverticulum, carcinoma, appendix
  • trauma or abd surgery
34
Q

how to evaluate for pneumoperitoneum

A

upright or decubitus view

Air under the diaphragm on upright view (most sensitive) - usually the r

35
Q

radiographic signs of pneumoperitoneum

A
  • air under diaphragm on upright view
  • air on both sides of bowel wall (Rigler sign)
  • falciform ligament visible on supine view
36
Q

barium contrast studies visualize what in upper GI?

A
  • esophagus
  • stomach
  • small intestine
37
Q

barium contrast studies visualize what in enema?

A

colon, not widely used

38
Q

abd ct what contrast?

A
  • oral contrast used for most except:
  • trauma, vascular, stone search
39
Q

when is barium contraindicated?

A

within a week before or after biopsy surgery/trauma

40
Q

what does double contrast mean?

A
  • use of pos and negative contrast agents to increase sensitivity of exam
  • pos contrast: barium
  • neg contrast: air, CO2
41
Q

what can double contrast studies help with?

A
  • detection of polyps and colorectal cancer
  • f/u screening for post-op colorectal cancer
  • evalulation of diverticular disease
  • failed colonoscopy
  • investigation of non-specific abd pain
42
Q

when is double contrast study contraindicated?

A
  • toxic megacolon
  • pseudomembranous colitis
  • imminent recatal bx +/- 7d
43
Q

RUQ pain

1st choice dx, imaging modality, other causes

A
  • cholecystitis
  • other: peptic ulcer disease, choledocholithiasis, acute hepatitis, liver abscess, RLL pneumonia
  • Imaging: first choice is US, CT second, CXR PRN
44
Q

LUQ Pain

ddx, imaging modalitis

A
  • least common quadrant to report pain in
  • ddx includes splenic infarct (CT), splenic hemorrhage (US, CT), LLL pneumonia (CXR), PUD (endoscopy)
45
Q

RLQ pain

1st choice dx, imaging modality, other causes

A
  • most common: appendicitis
  • ddx: diverticulutis, urinary calculi, IBD, gynecologic dx
  • imagine: CT first choice, US in children, women of child-bearing age, preg women
46
Q

signs of appendicitis on imaging

A
  • thickened appendix (>10mm goes to OR; < 6mm r/o)
  • appendicieal wall hyperenhancement
  • focal cecal thickening
  • periappendiceal inflammation
  • appendicolith (10% of pts)
47
Q

LLQ Pain

1st choice dx, imaging modality, other causes

A
  • top cause is diverticulitis
  • ddx: perforated colon CA, urinary calculi, gynecologic diseases
  • Imaginge: CT best overall; US for children, women of child-bearing age, preg women
48
Q

Flank Pain

1st choice dx, imaging modality, other causes

A
  • most common cause is urinary calculi
  • ddx: pyelonephritis, renal infarct, diverticulitis, appendicitis, pancreatitis, cholecystitis, ovarian masses
  • imagine: CT, US can be used as initial test
49
Q

Midepigastric/Back Pain

ddx, imaging

A
  • ddx: pancreatitis, aoritc dissection, aortic aneurysm rupture, urinary calculi, bowel obstruction
  • imaging: CT, if suspecting PUD do upper GI
50
Q

gynecologic causes of lower quadrant/pelvic pain

ddx, imgaing

A
  • ddx: PID, ruptured ovarian cyst, ectopic pregnancy
  • imaging: US
51
Q

what does apple core appearance mean?

A

some type of colon cancer is “eating” away at the lumen of the bowel leaving on the “core” of the bowel intact

52
Q

what does lead pipe interpretation mean?

A

loss of haustra and narrowing of the colon which progresses proximally

suspect ulcerative colitis

53
Q

go to ppt and fill out chart

A

ok

54
Q
A

RIGLER SIGN

Clin D III (11 decks)

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