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CLASP > Radiology: Abdomen > Flashcards

Radiology: Abdomen Flashcards

1
Q

what could right upper quadrant pain suggest?

A
  • cholecystitis and biliary colic
  • congestive hepatomegaly
  • hepatitis or hepatic abscess
  • perforated duodenal ulcer
  • retrocecal appendicitis (rarely)
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2
Q

what could right lower quadrant pain suggest?

A
  • appendicitis
  • cecal diverticulitis
  • Meckel’s diverticulitis
  • mesenteric adenitis
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3
Q

what could right or left upper quadrant pain suggest?

A
  • acute pancreatitis
  • herpes zoster
  • lower lobe pneumonia
  • MI
  • radiculitis
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4
Q

what could left upper quadrant pain suggest?

A
  • gastritis
  • splenic disorders (abscess or rupture)
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5
Q

what could left lower quadrant pain suggest?

A
  • sigmoid diverticulitis
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6
Q

what could right or left lower quadrant pain suggest?

A
  • abdominal or psoas abscess
  • abdominal wall herniations
  • cystitis
  • endometriosis
  • incarcerated or strangulated hernia
  • IBD
  • PID
  • renal stone
  • ruptured abdominal aneurysm
  • ruptured ectopic pregnancy
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7
Q

what is a supine AXR good for?

A
  • assessing for bowel obstruction
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8
Q

what is an erect CXR good for in relation to abdomen?

A

assessing for hollow viscus perforation

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9
Q

cons to CT?

A
  • radiation exposure
  • contrast induced nephropathy - i.e. DM risk
  • contrast allergy
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10
Q

MRI good for?

A
  • good for visualising soft tissue
  • used as second line test for hepato-biliary, small bowel and pelvis
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11
Q

MRI cons?

A
  • long time to acquire images as opposed to CT
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12
Q

RIF pain possible diagnoses?

A
  • appendicitis
  • renal colic
  • tubo-ovarian pathology
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13
Q

how does acute appendicitis present?

A
  • challenging diagnosis
  • periumbilical pain, N and V
  • localizes RIF
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14
Q

appendix imaging?

A
  • CT and USS are important tools
  • ideally USS first then CT if this is inconclusive
  • gen speaking when imaging acute abdomen - give IV contast - 60-80 secs after passed in you scan (portal venous phase)
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15
Q

what time do you take an arterial phase scan?

A
  • 20 seconds
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16
Q

CT findings of acute appendicitis?

A
  • periappendiceal inflammation
  • fat stranding (black on CT abd becomes white when oedematous (inflammation)
  • thickening of fascia or mesoappendix
  • extraluminal fluid
  • phlegmon
  • abscess

focal wall nonenhancement representing necrosis

perforation

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17
Q

how does right ureteric calculus present and what test?

A
  • loin to groin pain
  • unenhanced - non-contrast CT (CT KUB) is gold standard for imaging ureteric stones
  • stones >1mm are visualised
  • assoc hydronephrosis/inflammatory change
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18
Q

LIF pain possible diagnoses?

A
  • diverticulitis
  • colitis
  • colorectal cancer
  • tubo-ovarian pathology
  • renal colic
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19
Q

acute diverticulitis presentation?

A
  • left iliac fossa pain
  • unremitting pain w assoc tenderness
  • possibly, ill-defined mass
  • as disease progresses, symptoms become more generalised
  • inflammation of outpouchings
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20
Q

acute diverticulitis imaging?

A
  • no role for AXR or US
  • consider CXR for perforation
  • CT w IV contrast IX of choice
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21
Q
A
  • gas filled diverticuli
  • thickened hypoenhancing bowel
  • hallmark of inflammation: abnormal oedematous fat stranding sitting in adjacent sigmoid mesocolon
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22
Q

complications of acute diverticulitis

A
  • abscess formation
  • fistulation to adjacent structures e.g. bladder
  • CT can help explain symptoms
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23
Q

some other potential causes of LIF pain?

A
  • colorectal carcinoma - less inflam change, usually shorter segment
  • epiploic appendagitis - epiploae twists round
  • ischaemic colitis - is their central obstructing lesion (thrombus)
  • IBD
  • tubo-ovarian pathology
  • pseudomembranous colitis
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24
Q

epigastric and RUQ pain

A
  • biliary colic
  • cholecysitits
  • pancreatitis
  • peforation
25
Q

acute cholecysitits presentation?

A

almost always secondary to gallstones
DX based on
- sign of inflammation RUQ paine tc
- sign of inflammation - fever, WCC, CRP

26
Q

1st line imaging for acute cholecystitis

A
  • US!!! - confirm gallstones, biliary dilatation and inflammation
  • CT can be false for calculi, but good for complications
  • MRI if biliary tree dilatation
27
Q

gallbladder findings of acute cholecystitis?

A
  • gallbladder wall thickening >3mm
  • pericholecystic fluid
28
Q

acute cholecystitis CT findings?

A
  • cholelithiasis - gallstones isodense to bile will be missed on CT
  • gallbladder distention
  • gallladder wall thickening
  • mural or mucosal hyperenhancement
  • pericholecystic fluid and inflammatory fat stranding
  • enhancement of adjacent liver parenchyma due to reactive hyperaemia
29
Q

MRCP used for?

A
  • shows stone in common bile duct, common hepatic duct or cystic duct
  • T2 weighted image - just fluid
30
Q

tx options for biliary stones?

A
  • medical/conservative
  • interventional radiology - percutaneous
  • ERCP if obstructed biliary tree (risk of pancreatitis)
  • surgery
31
Q

pancreatitis presentations?

A

severe central epigastric pain - over 30-60 min
- amylase v elevated
- radiates through to back in 50% of patients
- poorly localised tenderness and pain
- excaerbated by supine positioning

32
Q

role of imaging in pancreatitis?

A
  • confirm dx - if confused…
  • look for reversible causes i.e. biliary dilatation
  • avoid it usually - as many pancreatitis patients need A LOT of imaging

US - identify gallstones, biliary dilataton
CT - hallmarks of inflammation

33
Q

CT findings of pancreatitis?

A
  • focal or diffuse parenchymal enlargement
  • indistinct pancreatic margins owing to inflammation
  • surrounding retroperitoneal fat stranding
  • liquefactive necrosis of pancreatic parenchyma
  • infected necrosis/abscess formation - parts of pancreas that do not enhance
  • vascular complications - portal and splenic vein (thrombosed) and portions of SMA (pseduo-aneurysm - bleeding risk) (as pancreas is retroperitoneal structure)
34
Q

common perforations?

A

common
- perforated ulcer in upper abdo but decreasing w increased use of PPI’s
- diverticular tract (lower GI)

less common
- secondary to cancer
- secondary to ischemia (wall of gut broken down and fallen apart)

35
Q

CT good for for perforation?

A
  • shows free fluid
  • clues to site of origin - ie distribution gas, defect in wall, localised inflammatory change
36
Q

see a large area of free gas in ant abdomen more likely to be what?

A
  • more likely to be lower GI perforation as more gas in large bowel than small bowel
37
Q

why does abdomen become distended?

A
  • physiological mass i.e. pregnancy
  • full of stuff shouldnt be there i.e. loads of gass, lots of faecal loading
  • ascites - lots of fluid in abdomen - i.e. shifting dullness
38
Q

small bowel obstruction signs and symptoms and causes?

A

symptoms - vomiting, pain and distension
signs - hyperactive bowel sounds, tenderness, palpable bowel loops

common causes for small bowel obstruction - adhesions, cancer, herniae, gallstone illeus
imaging - consider abdo XR
basis of concervative tx or surgery

39
Q

initial imaging for potential small bowel obtruction?

A
  • initial IX is abdo XR
40
Q

what are you looking for to identify small bowel and potentially obstruction

A
  • valvulae conniventes are visible (smooth lines one side of bowel to other)
  • loops are central - jejunum and ilium
  • dilatation >2.5cm -3cm = obstruction
  • paucity of gas distally
41
Q

hallmarks of gallstone ileus on CT?

A
  • large lamellated gallstone impacted in distal small bowel
  • fistulated from gallbladder into duodenum
  • gas connection between 2 structures
  • gas in biliary tree and small bowel obstruction and density that lookslike a stone in RIF
42
Q

large bowel obstruction is ….. until it is proved not?

A
  • colorectal cancer
    -> affects patients that get diverticular disease, very common
  • other things could be volvulus and diverticulitis
43
Q

large bowel obstruction symptoms

A
  • altered bowel habit, constipation
  • full bowel
  • impaction
  • caecum will perforate and fall apart = faecal peritonitis
44
Q

imaging for large bowel obstruction

A
  • XR
    -> peripheral, >5cm, haustra (big bumps) - colonic distension, collapsed distal colon, rectum has little or no air - then too much gas in large bowel = think large bowel obstruction.
  • CT
    -> confirm dx and localise CT
45
Q

sudden abdominal pain and shock?

A
  • bowel ischaemia
  • perforation
  • pancreatitis
  • leaking AAA
  • ruptured ectopic pregnancy
46
Q

causes of bowel ischaemia

A
  • arterial occlusion - 70-80%
  • venous occlusion - 5-10%
  • non-occlusive hypoperfusion i.e. RTA - 20-30%
  • 20% CO goes straight to your gut - straight down abdominal aorta, coeliac axis, SMA and IMA supplies large bowel
  • <10% - ischaemia develops
47
Q

signs and symptoms of bowel ischaemia

A
  • often unsuspected
  • severe abdominal pain - soft tummy so pain inproportional
  • vomiting, diarrhoea, distension inconsistent
  • borderline amylase, raised WCC, acidotic

broad diff

patient unwell

48
Q

bowel ischaemia imaging of choice?

A
  • CT - vasculature (site of occlusion), length affected vowel, alternative dx
49
Q

CT findings of bowel ischaemia?

A
  • lack of enhance,ent of lumen of affected vessel
  • mucosal/serosal enhancement absent or increased
  • altered wall thickness
  • ileus/dilated loops of bowel >3cm in dm
  • pnematosis intestinalis
    other changes: mesenteric oedema, free fluid, intrahepatic portal venous gas: due to pneumatosis intestinalis
  • intrahepatic portal venous gas: due to pneumatosis intestinalis (v bad sign - mortality)
  • free intra-abdominal gas
50
Q

leaking AAA

A
  • pain
  • hypotension
  • pulsatile abdominal mass
  • MALE
  • PREVIOUS CV problems
  • PREVIOUS ANEURYSM
51
Q

Ix of choice for leaking AAA

A
  • CT
  • will see large distended aorta, two lumens, huge retroperitoneal haematoma
52
Q

46 yr women, acute 48hr period of worsening generalised abdo pain
- absent bowel sounds
- pulse 120
- BP 90/70
- oxygen sats 95%
Ddx?

A
  • shock!!!
  • AAA
  • perforation
  • pancreatitis
  • ischaemic bowel
  • ruptured ectopic pregnancy …
53
Q

first steps in case

A
  • ABCDE
  • IX -> erect chest XR - free gas for perforation and targeted CT - but chest XR good starting point
54
Q

amylase is v increased what is dx?

A
  • pancreatitis
55
Q

next steps for Acute pancreatitis what ix now?

A
  • ultrasound (fast patient)
  • looking for gallstones… then next stop cause idiopathic (alcohol) scorpion bites
56
Q

patient increasingly unwell, tachycardic, inflam markers worse, worseing abdo pain what is going on in scan

A
  • peripancreatic collection
  • also want to look for necrosis, (vascular complications (venous thrombosis and arterial aneurysms)
57
Q

CT bones will be?

A
  • white
    and gas always black
58
Q

MRI bones will be?

A
  • white or black
  • fluid will be white!
59
Q

nasojejunal tube given why?

A

bypass obstruction in stomach - i.e. pseudocyst

CLASP (5 decks)

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