Radiology

Question 1

You are looking at a plain film of a patient’s abdomen. How will you spot small bowel and large bowel?

Answer 1

Small bowel 1) central position 2) upper limit is 3cm diameter 3) mucosal folds across whole width of bowel (plica semicirculares)

Large bowel 1) peripheral position 2) upper limit is 6cm for large bowel, and 9 cm for caecum 3) haustra (small pouches) - dont Go all the way across width

Question 2

What are the principles of barium radiology?

Answer 2

1) empty bowel If upper Gi tract is to be examined - fasting If lower Gi is to be examined - lower Gi would need to be cleansed 2) Smooth muscle relaxant - eliminates peristalsis and spasms

Question 3

Barium radiology may involve a barium meal, enema or swallow. Which is most appropriate for - oesophagus - stomach/duodenum - small intestine - colon ???

Answer 3

Oesophagus - barium swallow Stomach and duodenum - barium meal Small intestine - barium follow through or enema Colon - barium enema (barium sulfate fills colon, entered via rectum)

Question 4

What are the principles of double contrast barium radiology?

Answer 4

1) barium to coat mucosa 2) gas to distend the bowel lumen

Question 5

What is barium swallow and what is it used for?

Answer 5

• barium swallow - procedure where patient drinks fluid containing barium and undergoes an erect X ray of abdomen - used to look at upper Gi tract FROM PHARYNX TO GASTROESOPHAGEAL JUNCTION

Question 6

What are the three anterior indentations you see at oesophagus during a barium swallow?

Answer 6

From top you see 1) aortic arch 2) left main bronchus 3) left atrium

Question 7

An 81 yo paitent comes in for a barium swallow to assess oesophageal motility. When looking at her radiograph you see that there are 3 waves if contractions. What do the waves correspond to and are they normal?

Answer 7

1) primary contraction - primary swallow induced peristalsis 2) secondary contraction - secondary peristalsis 3) tertiary contraction - ABNORMAL

Question 8

What are the advantages and disadvantages of using a barium meal?

Answer 8

Ad - good for looking at normal anatomy - used if patient refuses endoscopy Disad - limited use for showing pathology (cannot see inflammation well) - requires ionising radiation - does not permit biopsy - patient must be mobile

Question 9

What are the advantages and disadvantages of using Upper GI endoscopy

Answer 9

Ad - MAIN METHOD Can see normal and abnormal mucosal lining Can take a BIOPSY No ionisation radiation Patient needs to be limitedly mobile Disad -

Question 10

What are the advantages and disadvantages of using CT to examine the abdomen?

Answer 10

Ad - staging of cancer (oesophagus and gastric) Disad - limited diagnostic value

Question 11

What are the advantages of plain film in abdomen radiology? Disadvantages?

Answer 11

Ad - easily accessible and very fast Disad- radiation is used

Question 12

What are PET scans?

Answer 12

Positron Emission Tomography

1) Inject radioactive material lagged with glucose
2) Uptake to areas with increased glucose metabolism e.g. tumours

Good for staging and diagnosing cancers

Question 13

CT vs MRI. What is the difference?

Answer 13

CT - Good for initial diagnosis and acute abdomen

MRI - Better for monitoring disease

Question 14

Describe the location and characteristics of the jejunum and ileum when studying small bowel radiologically.

Answer 14

Jejunum

1. Found in Left Upper Quadrant
2. Has a prominent fold pattern (feather-y)
3. Larger lumen

Ileum

1. Found in Right Lower Quadrant
2. Featureless
3. Narrower lumen

Question 15

What are the different ways of imaging the biliary tree?

Answer 15

1) Ultrasound
2) MRCP (Magnetic resonance scanning)
3) ERCP
4) Endoscopic ultrasound (EUP)

Question 16

A patient comes in with a possibility of pathology at her large bowel. What kind of radiological examinations are you considering?

Answer 16

1) Barium enema
2) Colonscopy
3) CT pneumocolon

Question 17

What are the problems with capsule endoscopy or the ‘video pill’?

Answer 17

1) Could get stuck at narrowing of GI tract
2) Not accurate

Question 18

ULTRASOUND OF THE GALL BLADDER AND ASSOCIATED VESSELS: SEE PICTURE

Answer 18