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GI 1 > Radiology > Flashcards

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
Q

CT

  • pro
  • con
A

Pro: better contrast than US, high spacial resolution, reproducable

Con: radiation, contrast often needed

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26
Q

CT evaluated on terms of what? Units?

A
  • density (bc xray)

- Hounsfield units

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27
Q

CT planes

A
  • transverse
  • frontal
  • sagittal
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28
Q

Nuclear Medicine

- two common tests

A
  • Cholescintigraphy

- GI bleed scan

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29
Q

Cholescintigraphy

A
  • 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.
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30
Q

GI bleed scan

A
  • used to eval site of suspected or known GI bleeding
  • active bleeding must be occurring…
  • can detect subtle bleeds
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31
Q

HIDA and Gi bleed scan images

A

didn’t go into detail in class, it’s in the slides

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32
Q

Esophagus common GI pathology

A
  • Zenker’s
  • Barrett’s
  • Cancer
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33
Q

Zenker’s Diverticulum

- describe

A
  • posterior esophageal out pouching at level of hypopharynx
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34
Q

Zenker’s Diverticulum

  • sx
  • modality
A
  • halitosis, dysphagia, regurgitation

- esophagram

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35
Q

Zenker’s Diverticulum

- findings

A
  • diverticulum arising midline posterior from esophagus at level of hypopharynx. may be transient
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36
Q

Barrett’s esophagus/esophageal cancer

- describe

A

metaplasia of esophageal squamous cells caused by chronic reflux. Precursor for adenocarcinoma

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37
Q

Barrett’s esophagus/esophageal cancer

  • sx
  • modality
A
  • usually asymptomatic

- esophagram

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38
Q

Barrett’s esophagus/esophageal cancer

- findings

A
  • long segment stricture in mid to lower esophagus, irregular folds, large solid ulcer
  • irregularity and shouldering indicative of cancer
39
Q

Hiatal hernias

- describe

A

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
Q

Hiatal hernia

  • sx
  • modality
A
  • reflux, dysphagia

- esophagram/upper GI

41
Q

Hiatal hernia findings

A
  • look at slides for images :)
42
Q

Peptic ulcer

- describe

A
  • ulcers secondary to gastric acid

- risk: H. pylori, NSAIDS, steroids, ZE syndrome

43
Q

Peptic ulcer

  • sx
  • modality
A
  • epigastric pain

- upper GI, CT for perforation complications

44
Q

peptic ulcer

- findings

A
  • barium out pouching pocket with radiating folds of mucosa towards/away from ucler
  • Hamptom’s line
45
Q

Malignant ulcer

- findings

A
  • 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
Q

Perforated Ulcer

  • modality
  • finding
A
  • CT
  • tiny amt of air in non-dependent peritoneum at midline (free air)
  • ulcer within stomach with air along sight of perforation
47
Q

Pyloric stenosis

  • define
  • sx
A
  • hypertrophy of gastric pylorus musculature

- projectile non-bilious vomitting, usually 4-12 weeks of age

48
Q

pyloric stenosis

  • modality
  • findings
A
  • US

- abnormal msrmnts and non-visualization of gastric content passing through pylorus

49
Q

Malrotation

- define

A

absence of Ligament of Treitz to fix duodenal-jejunal junction in left upper abdomen

50
Q

Malrotation

  • sx
  • modality
A
  • duodenal obstruction or volvulus (twisting of bowel)

- Upper GI

51
Q

Malrotation findings

A
  • duodenal-jejunal junction does not cross midline to left of the left pedicle and does not reach level of duodenal bulb
52
Q

Midgut volvulus

  • define
  • sx
A
  • complication of mal rotation: obstruction and ischemia. Generally in first 6 months of life
  • sudden BILIOUS vomitting
53
Q

midgut volvulus

  • modality
  • findings
A
  • upper GI/SBFT

- corkscrew configuration of small bowel in setting of malrotated small bowel

54
Q

Colonic diverticulosis

  • what
  • sx
A
  • multiple diverticula within colon, usually in older pts or pts with constipation
  • asymptomatic to pain, constipation, bloody stools
55
Q

colonic diverticulosis

  • modality
  • findings
A
  • NECT (non-enhanced CT), barium enema

- many small outpourings, often filled with air/contrast material

56
Q

Diverticulitis

  • describe
  • sx
A
  • complications dt inflammation of colonic diverticular dz

- abd pain, initially LLQ

57
Q

Diverticulitis

  • modality
  • findings
A
  • CECT (contrast enhanced)
  • pericolonic stranding, bowel wall thickening
  • generally on LEFT side
58
Q

Infectious colitis

  • describe
  • sx
A
  • inflammation of colon dt infection, inflammation, ischemia

- abd pain, diarrhea

59
Q

Infectious colitis

  • modality
  • findings
A
  • NECT/CECT

- long segment bowel wall thickening and enhancement (short segment would be more likely neoplasm)

60
Q

Ischemic colitis

  • describe
  • sx
A
  • inflammation fo colon secondary to vascular insufficiency/ischemia
  • abd pain, blood stools, usually older pts with advanced atherosclerosis OR younger pts with coagulopathy
61
Q

Ischemic colitis

  • modality
  • finding
A
  • 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
Q

Mesenteric/intestinal ischemia

describe

A
  • vascular compromise of bowel

- often secondary to arterial or venous occlusion, bowel obstruction, hypotension

63
Q

Mesenteric/intestinal ischemia

  • sx
  • modalitiy
A
  • pain out of proportion to PE findings

- CECT w/wo NECT

64
Q

Mesenteric/intestinal ischemia

- findings

A

Earlier/better to later/worse:

  • pneumatosis intestinal (air in intestines)
  • portal venous gas
  • pneumoperitoneum
  • submucosal hemorrhage/necrosis
65
Q

Colon cancer

  • describe
  • sx
A
  • most common ca of GI tract

- often insidious, altered bowel habits, anemia, obstruction, blood stools

66
Q

Colon cancer

  • modality
  • findings
A
  • Fluoro, CT, MRI
  • polyps under fluoro, apple core lesions
  • more often on RIGHT side
67
Q

Appendicitis

  • describe
  • sx
A
  • inflammation of appendix

- RLQ pain

68
Q

Appendicitis

  • modality
  • findings
A
  • US, CECT
  • thickened and fluid filled. US shows surrounding hypervascularity
  • complications: abscess and perforation
69
Q

Hepatic steatosis

  • what
  • sx
A
  • fatty infiltration of the liver

- usually asymptomatic

70
Q

hepatic steatosis

  • modality
  • findings
A
  • 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
Q

Cholelithiasis

  • what
  • sx
A
  • stones in biliary system

- asymptomatic, can have RUQ following meals

72
Q

Cholelithiasis

  • modality
  • findins
A
  • US (or NECT)
  • shadowing lesions/stones on US
  • CT shows calcified stones
73
Q

Acute cholelithiasis

  • what
  • sx
A
  • inflammation of gallbladder, usually secondary to gallstones
  • RUQ pain (biliary colic)
74
Q

Acute cholelithiasis

  • modality
  • findings
A
  • US (CECT, HIDA)
  • thickened gallbag wall, pericholecystic fluid, gallstones
  • HIDA shows non-visualization of gallbladder
75
Q

Omental infarct

  • what
  • sx
A
  • vascular compromise of greater omentum

- pain, RLQ tenderness (can mimic appendicitis)

76
Q

Omental infarct

  • modality
  • findings
A
  • NECT
  • focal area fat stranding, sometimes with halo or swirling appearance
  • on RIGHT side
77
Q

Epiploic appendagitis

  • what
  • sx
A
  • non-specific inflammation of colonic epiploid appendage

- pain, usually left

78
Q

Epiploic appendagitis

  • modality
  • findings
A
  • CT

- fat density structure with surrounding inflammation, the adjacent bowel is spared/unaffected (unlike diverticulitis!)

79
Q

What are the three common findings on the LEFT side only

A
  1. epiploic appendagitis
  2. diverticulosis
  3. diverticulitis
80
Q

Pancreatitis

  • what
  • sx
A
  • inflammation fo pancreas, usually from ETOH, gallstones, idiopathic
  • epigastric pain radiating to back
81
Q

Pancreatitis

  • modality
  • two types of findings
A
  • CECT

- two forms: edematous and necrotizing

82
Q

Edematous pancreatitis findings

A

homogenous tissue

83
Q

Complications of pancreatitis

A
  • surrounding fluid collections
  • pseudoaneurysm
  • portal/ splenic vein thrombosis
  • duodenitis
84
Q

Ascites

  • what
  • sx
A
  • fluid in peritoneal cavity

- abdominal distention

85
Q

Ascites

  • modality
  • findigns
A
  • US, NECT/CECT

- fluid, thickening of peritoneum lining (peritonitis)

86
Q

Cecal volvulus

  • what
  • sx
A
  • torsion of cecum around mesentery, leads to obstruction

- obstruction: vomiting, pain, distention

87
Q

Cecal volvulus

  • modality
  • findings
A
  • plain film, fluoro, CT
  • distended loop of large bowel with axis from RLQ to LUQ
  • haustra preserved
  • often requires sx
88
Q

Sigmoid volvulus

  • what
  • sx
A
  • twisting of sigmoid colon on sigmoid mesocolon

- large bowel obstruction, bloating (no vomiting)

89
Q

Sigmoid volvulus

  • modality
  • findings
A
  • plain film, CT
  • loss of haustra (smooth), coffee bean sign with axis towards LLQ
  • tx with rectal tube insertion for decompression
90
Q

Small bowel obstruction

  • what
  • sx
A
  • most common cause is adhesion from sx (get good hx)

- crampy abd pain, n/v

91
Q

Small bowel obstruction

  • modality
  • findings
A
  • plain film, CT

- dilated loops, air fluid levels, gasless abdomen. CT can show transition points

92
Q

Free air

  • what
  • sx
A
  • air outside bowel, free in abd cavity
  • usually from iatrogenic causes (prev sx or perf from ERCP), infection, trauma
  • sx: pain
93
Q

Free air

  • modality
  • findings
A
  • 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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