Radiographs of the GI

Question 1

What are some main modalities used in radiology for imaging of the abdomen?

Answer 1

• Radiographs
• fluoroscopy
• Ultrasound
• CT
• MRI

Question 2

A patient comes in complaining of abdominal pain, what is the first work up in visualizing the abdomen.

Answer 2

Abdominal radiographs

Question 3

What is the normal location of air as seen in radiographs.

Answer 3

Stomach, 2-3 levels of small intestinal, sigmoid and rectum.

Question 4

Where are you likely to find free air on the abdominal cavity in a radiographs?

Answer 4

Free air rises to the most superior portion of the cavity. best seen on a upright radiograph

Question 5

In radiographs, if the images were taken with patient left side down decubitus, where are you likely to find free air?

Answer 5

Air is detected between the liver and right lower ribs.

Question 6

Under the diaphragm where you likely to see free air?

Answer 6

Best seen on the right side because the liver offers a distinct outline between the free air and the soft tissue.

Question 7

What is Rigler’s sign?

Answer 7

Is produced when both sides of the bowel wall become outlined by air. Typically seen on supine radiographs.

Question 8

Normally air is seen on the inside of the bowel but, sometimes air can be seen on both sides of the bowel. What are some conditions/situations that can give rise to Rigler’s sign?

Answer 8

• Surgery
• Perforated viscus ( peptic ulcer, penetrating trauma, diverticulitis, bowel obstruction)
• Inflammatory conditions (toxic megacolon, TB, peritoneal inflammation)
  -intrathoracic causes
  -pneumoatosis intestinalis
  -

Question 9

What are some abnormal calcification/ossification that can be visible on radiographs?

Answer 9

• Renal stones
• appendicolith
• gallstones
• renal cyst wall
• gallbladder wall
• atherosclerotic calcification of the aorta
• urinary bladder stones
• fibroids

Question 10

Where are you likely to see normal air-fluid levels?

Answer 10

Stomach (unless on a supine film)
Small bowel (2-3 levels) 
large bowel (not typically seen)

Question 11

What is ileus?

Answer 11

bowel (small or large) dilation without mechanical obstruction.

Question 12

What are some causes of Ileus?

Answer 12

• metabolic disorders,
• medications
• ischemia
• recent surgery
• localized abdominal pain caused by appendicitis, pancreatitis, etc, may causes focal small bowel dilatation with air-fluid levels (sentinel loops)
• neuromsucular and motitlity abnormalities
• sprue.

Question 13

How does Mechanical SBO present?

Answer 13

Dilated small bowel loops, with differential air-fluid levels = difference in air-fluid levels in a single loop of bowel; little gas in colon, absent in rectum. There’s disproportionate air in the small bowel.

Question 14

How does LBO present?

Answer 14

• Air seen to the point of obstruction
• little to no air in the rectum and/or sigmoid colon
• little to no gas in the small bowel, unless the ileocecal valve is incompetent

Question 15

What are some causes of small bowel obstruction?

Answer 15

Adhesions, hernias, cancer-intrinsic and extrinsic; volvulus.

Question 16

Which imaging technique is test to evaluate specific complaints localized to the esophagus, and to work up gastric diseases, including peptic ulcer disease, in small bowel pathology like Crohn’s disease; and in colon pathology, including diverticular disease or polyps; and to evaluate ureters and urinary bladder in cases of trauma or in newborns to asses for vesciuoreteral reflux?

Answer 16

Fluoroscopy

Question 17

A patient presents with pain on the upper right quadrant, what imaging technique would be best to use?

Answer 17

Upper right quadrant sounds like gallbladder issues and so you can use Ultrasound to evaluate for cholelithiasis.

Question 18

If a patient presents with nonspecific abdominal pain with sudden onset, what imaging technique is best for this type of situation?

Answer 18

CT scans.

Question 19

On physical exam you palpate the liver and notice a small hard nodule. You perform a CT of the abdomen and notice a nodule but isn’t so clear. What imaging can you use to get a more localized and descriptive image?

Answer 19

MRI. it’s often used to evaluate a specific issue seen on prior imaging studies. usually for soft tissue like liver mass or renal mass.