Radiology

Question 1

What radiographic abdominal series variation is indicated given a clinical exam?

Answer 1

KUB - for specific question (tube placement, stone)
KUB supine/upright series - for small or large bowel obstruction
Acute abdominal series - if bowel perf suspected

Question 2

What is the normal size of the small bowel?

Answer 2

<3 cm

Question 3

What are the four common indications for a KUB?

Answer 3

abdominal pain
suspected bowel obstruction
suspected renal stone
suspected swallowed foreign body

Question 4

What is pneumoperitoneum a sign of?

Answer 4

bowel perf

Question 5

What is the test of first choice for suspected pneumoperitoneum?

Answer 5

actute abdominal series

CXR most useful film

Question 6

What are radiographic findings of mechanical small bowel obstruction?

Answer 6

small bowel dilatation (>3cm)
paucity of distal small bowel and colon gas
air-fluid levels on upright view
CT if diagnosis still uncertain

Question 7

What are radiographic findings of paralytic ileus?

Answer 7

mild dilatation of small bowel and colon without paucity of colon gas or with prominent colon gas
gas in rectum

Question 8

What is a difference between the appearance of gallstones and renal stones on KUB?

Answer 8

gallstones are faceted

Question 9

What are three common indications for a barium swallow?

Answer 9

dysphagia
chest pain, non-cardiac
GERD symptoms

Question 10

What are four common diagnoses made by barium swallow?

Answer 10

esophageal carcinoma - irregular stricture w sharp overhanging edges
esophagitis - multiple ulcerations
hiatal hernia - stomach above diaphragm
achalasia - LES dysfunction, dilation of esophagus and narrowing at LES

Question 11

What are four common indications for a UGI?

Answer 11

abdominal pain
suspected duodenal or gastric ulcer
suspected hiatal hernia
suspected gastric mass

Question 12

What UGI findings suggest a duodenal ulcer?

Answer 12

persistent contrast collection, smooth mound of surrounding edema and thickened folds radiating to edge of ulcer crater

Question 13

What UGI findings suggest a benign gastric ulcer?

Answer 13

smooth craters, smooth folds radiating to edge, smooth mounds of surrounding edema

Question 14

What UGI findings suggest a malignant gastric ulcer?

Answer 14

irregular crater and mass around it, irregular edges and folds not radiating to edge

Question 15

What are the five common indications for a small bowel follow through (SBFT)?

Answer 15

small bowel obstruction - intermittent or partial (not acute)
small bowel mass suspected
chronic GI bleed without source
malabsorption syndromes/diarrhea
IBD suspected

Question 16

What are six common indications for a barium enema?

Answer 16

chronic GI bleed/hemoccult positive stools
suspected large bowel obstruction
left lower quadrant pain
suspected diverticulosis/diverticulitis
constipation or diarrhea
suspected IBD

Question 17

What barium enema patterns suggest colon cancer?

Answer 17

polypoid mass or irregular stricture

apple core lesion

Question 18

What barium enema patterns suggest colonic polyp?

Answer 18

filling defect, mass protruding into colon

need laxative prep first

Question 19

What barium enema patterns suggest diverticulosis and what suggest diverticulitis?

Answer 19

osis - smooth round contrast collections protruding from colon
itis - intramural or pericolonic abscesses, bowel wall thickening
most common in sigmoid

Question 20

What barium enema patterns suggest ulcerative colitis?

Answer 20

shallow ulcerations, loss of haustral markings, granular mucosa, collar-button ulcers

Question 21

What are the common indications for an abdominal ultrasound?

Answer 21

RUQ pain (suspected gallstone)
jaundice
increased LFTs
screen for liver masses
evaluate for hepato and splenomegaly

Question 22

What are the two indications for a tagged RBC study?

Answer 22

acute GI bleeding

liver hemangioma

Question 23

When are tagged RBC studies useful with GI bleeding?

Answer 23

only when ACTIVE

Question 24

When are HIDA or DISIDA scans done?

Answer 24

acute cholecystitis - esp if acalculous

biliary leak or biloma

Question 25

How can nuclear imaging confirm ACUTE cholecystitis as opposed to chronic?

Answer 25

cystic duct completely obstructed in acute but not chronic

Question 26

If you see the gallbladder, it is not…

Answer 26

acute cholecystitis

Question 27

What are some common indications for MRI?

Answer 27

other imaging studies done and questions persist
contraindications like IV contrast
liver mass characterization, esp confirmation of hemangiomas
adrenal mass characterization

Question 28

What are four common indications for abdominal angiography?

Answer 28

AAA
mesenteric ischemia
acute or chronic GI bleed - active, brisker than nuclear RBC
abdominal vascular trauma