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Radiology Flashcards

1
Q

Upper GI tract

A

Oropharynx
esophagus
stomach
duodenum

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2
Q

lower GI tract

A 
jejunum
ileum
large bowel
rectum
appendix
liver
gallbladder
pancreas
spleen
mesentery 
peritoneum
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3
Q

Common clinical indications for abdominal xray

A
  • Pain **most common
  • dysphagia
  • change in bowel movement
  • trauma
  • abnormal labs
  • pre/post operative
  • cancer/metastasis work up
  • bloating/abd distention
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4
Q

Emergent clinical indications for abd xray

A
  • hemorrhage
  • perforation
  • infection
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5
Q

GI imaging modalities

A
  • radiograph/plain film
  • fluoroscopy
  • ERCP
  • US
  • CT
  • Nuclear medicine
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6
Q

Two types of intraluminal contrast

A

barium

gastrografin

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7
Q

Intraluminal contrast with barium

- pros and cons

A

Pro

  • better visibility
  • can be given in great quantity
  • use if risk for aspiration

Con
- can cause mediastinitis or peritonitis if perforation exists

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8
Q

Intraluminal contrast with gastrografin

A

Pro

  • water soluble, safe/better to use if perforation is suspected
  • often used post-op bowel sx to evaluate for leak/extravasation
  • therapeutic effect as an enema for constipation

Con
- can cause pneumonitis if aspirated

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9
Q

X-rays

  • interpreted based on what
  • less dense vs. more dense
A
  • relative densities
  • more white = more dense
  • more black = less dense
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10
Q

5 densities in xrays

A
  • air: black
  • fat: gray
  • soft tissue/fluid: white
  • calcium: more white
  • metal: bright white
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11
Q

Common abdominal xray views

A
  • upright and supine: most common
  • KUB (kidney, artery, bladder)
  • Lateral decubitus
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12
Q

When use upright and supine xray view

A

air fluid levels / free air (ex bowel obstruction)

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13
Q

when use KUB xray view

A 
gall stones
kidney stones
masses
perforations
obstruction
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14
Q

when use lateral decubitus xray view

A

free air

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15
Q

Fluoroscopy

- define

A

uses X-rays to evaulate GI tract, usually with intraluminal contrast such as barium

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16
Q

Fluoroscopy common exams/indications

A
  1. Dysphagiagram (swallow study): poor oral intake, aspiration, post-stroke eval
  2. esophagram: difficulty/pain swallowing, post traumatic/post-op perforation
  3. Upper GI: anatomy (ped), reflux, pain, obstruction, perforation
  4. SBFT (small bowel follow-through): obstruction, IBD, post op anatomy
  5. Enema: anatomy, cancer, IBD, post-op, constipation
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17
Q

what see on normal esophagram

A
  • smooth contour

- striations

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18
Q

Anatomical feature that is very important to duodenal placement in body

A

Ligament of Treitz

  • double fold of peritoneum
  • marks boundary between upper/lower GI tract (junction duodenum and jejunum)
  • pathology = malrotation/partial rotation
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19
Q

how to tell difference between jejunum and ileum

A
  • jejunum is feathery

- ileum is longer, smoother

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20
Q

ACBE

A

Air contrast barium enema

  • insert contrast into lrg. bowel to coat lumen, then fill with air.
  • look for strictures, polyp, etc.
  • often orders after “failed” colonoscopy due to anatomic abnormality of transverse colon
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21
Q

ERCP

A

Endoscopic retrograde cholangio-pacreatography

- evaluate biliary and pancreatic ducts

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22
Q

how is an ERCP done

A
  • endoscope is passed through esoph/stomach into the duodenum
  • catheter is inserted into common bile duct, dye is injected in retrograde fashion to opacify the ducts
  • evaluate anatomy and observe for strictures or filling defects caused by stones, cancer, masses
  • an also retrieve stones
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23
Q

US

  • pro & GI anatomy seen well
  • con & GI anatomy not seen well
A

Pro:

  • no radiation, inexpensive, real time images
  • Liver, gallbladder, spleen, pylorus, appendix

Con:

  • tech dependent, sometimes limited visibility
  • not good for bile duct, pancreas, small bowel, appendix

*appendix depends on the tech

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24
Q

US

  • evaluated in terms of what
  • three results and what they indicate
A
  • echogenicity
  • Hyperechoic: fat, air, calcium (bone, stone), metal
  • iso-echoic: soft tissue
  • hypo-echoic: fluid, vessels
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25
CT - pro - con
Pro: better contrast than US, high spacial resolution, reproducable Con: radiation, contrast often needed
26
CT evaluated on terms of what? Units?
- density (bc xray) | - Hounsfield units
27
CT planes
- transverse - frontal - sagittal
28
Nuclear Medicine | - two common tests
- Cholescintigraphy | - GI bleed scan
29
Cholescintigraphy
- HIDA scan - directly assess biliary system - indirectly assess liver - inject body with agent, body processes it, helps understand if there is liver or gallbladder etc dz.
30
GI bleed scan
- used to eval site of suspected or known GI bleeding - active bleeding must be occurring... - can detect subtle bleeds
31
HIDA and Gi bleed scan images
didn't go into detail in class, it's in the slides
32
Esophagus common GI pathology
- Zenker's - Barrett's - Cancer
33
Zenker's Diverticulum | - describe
- posterior esophageal out pouching at level of hypopharynx
34
Zenker's Diverticulum - sx - modality
- halitosis, dysphagia, regurgitation | - esophagram
35
Zenker's Diverticulum | - findings
- diverticulum arising midline posterior from esophagus at level of hypopharynx. may be transient
36
Barrett's esophagus/esophageal cancer | - describe
metaplasia of esophageal squamous cells caused by chronic reflux. Precursor for adenocarcinoma
37
Barrett's esophagus/esophageal cancer - sx - modality
- usually asymptomatic | - esophagram
38
Barrett's esophagus/esophageal cancer | - findings
- long segment stricture in mid to lower esophagus, irregular folds, large solid ulcer - irregularity and shouldering indicative of cancer
39
Hiatal hernias | - describe
four types I: GE junction above diaphragm II: Ge in normal location, gastric fungus above diaphragm III: mixed I and II IV: gastric volvulus -stomach above diaphragm and twisted on axis
40
Hiatal hernia - sx - modality
- reflux, dysphagia | - esophagram/upper GI
41
Hiatal hernia findings
- look at slides for images :)
42
Peptic ulcer | - describe
- ulcers secondary to gastric acid | - risk: H. pylori, NSAIDS, steroids, ZE syndrome
43
Peptic ulcer - sx - modality
- epigastric pain | - upper GI, CT for perforation complications
44
peptic ulcer | - findings
- barium out pouching pocket with radiating folds of mucosa towards/away from ucler - Hamptom's line
45
Malignant ulcer | - findings
- barium fills ulcer but NO out pouching, does not protrude beyond gastric border - large flat ulcers - Carman Meniscus sign - rolled edges are convex toward the lumen
46
Perforated Ulcer - modality - finding
- CT - tiny amt of air in non-dependent peritoneum at midline (free air) - ulcer within stomach with air along sight of perforation
47
Pyloric stenosis - define - sx
- hypertrophy of gastric pylorus musculature | - projectile non-bilious vomitting, usually 4-12 weeks of age
48
pyloric stenosis - modality - findings
- US | - abnormal msrmnts and non-visualization of gastric content passing through pylorus
49
Malrotation | - define
absence of Ligament of Treitz to fix duodenal-jejunal junction in left upper abdomen
50
Malrotation - sx - modality
- duodenal obstruction or volvulus (twisting of bowel) | - Upper GI
51
Malrotation findings
- duodenal-jejunal junction does not cross midline to left of the left pedicle and does not reach level of duodenal bulb
52
Midgut volvulus - define - sx
- complication of mal rotation: obstruction and ischemia. Generally in first 6 months of life - sudden BILIOUS vomitting
53
midgut volvulus - modality - findings
- upper GI/SBFT | - corkscrew configuration of small bowel in setting of malrotated small bowel
54
Colonic diverticulosis - what - sx
- multiple diverticula within colon, usually in older pts or pts with constipation - asymptomatic to pain, constipation, bloody stools
55
colonic diverticulosis - modality - findings
- NECT (non-enhanced CT), barium enema | - many small outpourings, often filled with air/contrast material
56
Diverticulitis - describe - sx
- complications dt inflammation of colonic diverticular dz | - abd pain, initially LLQ
57
Diverticulitis - modality - findings
- CECT (contrast enhanced) - pericolonic stranding, bowel wall thickening - generally on LEFT side
58
Infectious colitis - describe - sx
- inflammation of colon dt infection, inflammation, ischemia | - abd pain, diarrhea
59
Infectious colitis - modality - findings
- NECT/CECT | - long segment bowel wall thickening and enhancement (short segment would be more likely neoplasm)
60
Ischemic colitis - describe - sx
- inflammation fo colon secondary to vascular insufficiency/ischemia - abd pain, blood stools, usually older pts with advanced atherosclerosis OR younger pts with coagulopathy
61
Ischemic colitis - modality - finding
- CECT (contrast bc want to see arteries too) - Findings: inflammation fo colon, esp in watershed area (splenic flexure), thumb printing, submucosal edema (target sign)
62
Mesenteric/intestinal ischemia | describe
- vascular compromise of bowel | - often secondary to arterial or venous occlusion, bowel obstruction, hypotension
63
Mesenteric/intestinal ischemia - sx - modalitiy
- pain out of proportion to PE findings | - CECT w/wo NECT
64
Mesenteric/intestinal ischemia | - findings
Earlier/better to later/worse: - pneumatosis intestinal (air in intestines) - portal venous gas - pneumoperitoneum - submucosal hemorrhage/necrosis
65
Colon cancer - describe - sx
- most common ca of GI tract | - often insidious, altered bowel habits, anemia, obstruction, blood stools
66
Colon cancer - modality - findings
- Fluoro, CT, MRI - polyps under fluoro, apple core lesions - more often on RIGHT side
67
Appendicitis - describe - sx
- inflammation of appendix | - RLQ pain
68
Appendicitis - modality - findings
- US, CECT - thickened and fluid filled. US shows surrounding hypervascularity - complications: abscess and perforation
69
Hepatic steatosis - what - sx
- fatty infiltration of the liver | - usually asymptomatic
70
hepatic steatosis - modality - findings
- US, NECT, MRI - diffuse hyper echoic appearance of liver with loss of detail of periportal fat - darker appearance than spleen tissue, should be the same
71
Cholelithiasis - what - sx
- stones in biliary system | - asymptomatic, can have RUQ following meals
72
Cholelithiasis - modality - findins
- US (or NECT) - shadowing lesions/stones on US - CT shows calcified stones
73
Acute cholelithiasis - what - sx
- inflammation of gallbladder, usually secondary to gallstones - RUQ pain (biliary colic)
74
Acute cholelithiasis - modality - findings
- US (CECT, HIDA) - thickened gallbag wall, pericholecystic fluid, gallstones - HIDA shows non-visualization of gallbladder
75
Omental infarct - what - sx
- vascular compromise of greater omentum | - pain, RLQ tenderness (can mimic appendicitis)
76
Omental infarct - modality - findings
- NECT - focal area fat stranding, sometimes with halo or swirling appearance - on RIGHT side
77
Epiploic appendagitis - what - sx
- non-specific inflammation of colonic epiploid appendage | - pain, usually left
78
Epiploic appendagitis - modality - findings
- CT | - fat density structure with surrounding inflammation, the adjacent bowel is spared/unaffected (unlike diverticulitis!)
79
What are the three common findings on the LEFT side only
1. epiploic appendagitis 2. diverticulosis 3. diverticulitis
80
Pancreatitis - what - sx
- inflammation fo pancreas, usually from ETOH, gallstones, idiopathic - epigastric pain radiating to back
81
Pancreatitis - modality - two types of findings
- CECT | - two forms: edematous and necrotizing
82
Edematous pancreatitis findings
homogenous tissue
83
Complications of pancreatitis
- surrounding fluid collections - pseudoaneurysm - portal/ splenic vein thrombosis - duodenitis
84
Ascites - what - sx
- fluid in peritoneal cavity | - abdominal distention
85
Ascites - modality - findigns
- US, NECT/CECT | - fluid, thickening of peritoneum lining (peritonitis)
86
Cecal volvulus - what - sx
- torsion of cecum around mesentery, leads to obstruction | - obstruction: vomiting, pain, distention
87
Cecal volvulus - modality - findings
- plain film, fluoro, CT - distended loop of large bowel with axis from RLQ to LUQ - haustra preserved - often requires sx
88
Sigmoid volvulus - what - sx
- twisting of sigmoid colon on sigmoid mesocolon | - large bowel obstruction, bloating (no vomiting)
89
Sigmoid volvulus - modality - findings
- plain film, CT - loss of haustra (smooth), coffee bean sign with axis towards LLQ - tx with rectal tube insertion for decompression
90
Small bowel obstruction - what - sx
- most common cause is adhesion from sx (get good hx) | - crampy abd pain, n/v
91
Small bowel obstruction - modality - findings
- plain film, CT | - dilated loops, air fluid levels, gasless abdomen. CT can show transition points
92
Free air - what - sx
- air outside bowel, free in abd cavity - usually from iatrogenic causes (prev sx or perf from ERCP), infection, trauma - sx: pain
93
Free air - modality - findings
- plain film, NECT - upright radiograph show air under diaphragm - left lateral decub shows air between liver and wall - CT shows air outside bowel lumen *investigate cause of free air!!

GI 1 (16 decks)

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