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GI/Liver > Radiology of the Acute Abdomen > Flashcards

Radiology of the Acute Abdomen Flashcards

1
Q

What extra-abdominal conditions can cause an acute abdomen?

A

MI

Pneumonia

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2
Q

What are the broad possible abdominal causes of acute abdomen?

A

Inflammation
Obstruction
Perforation
Ischaemia

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3
Q

What radiological investigations can be used for an acute abdomen?

A

Plain film
Ultrasound
CT

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4
Q

Describe what is meant by the silhouette sign

A

The phenomenon that tissues can be seen on imaging when that tissue is situated next to another tissue/substance of a different density

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5
Q

Fat appears slightly darker than other soft tissues on plain film. T/F?

A

True

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6
Q

If there is an acute abdomen and no psoas muscles can be seen on AXR, what could this indicate?

A

Burst aneurysm

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7
Q

What condition is a porcelain gallbladder (seen on CT) associated with?

A

Gallbladder cancer

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8
Q

What does bowel seen outside of the pelvis on AXR indicate?

A

Herniation

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9
Q

Why is the gallbladder not usually visible on AXR?

A

It cannot be distinguished from the liver

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10
Q

The bladder is always visible on AXR. T/F?

A

False - only if enlarged/full

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11
Q

Describe how the small and large colon can be differentiated on AXR?

A

Large colon - round pockets of gas, not contiguous, gaps between the has bubbles indicate austral contractions, ascending and descending colon exist most laterally
Small colon - exists centrally within the frame of the large bowel, more contiguous, has valvular conniventes

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12
Q

Describe the appearance of gas and faeces in the colon on AXR?

A

Mottled appearance

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13
Q

Why is it important to look for the presence of gas in the rectum on AXR?

A

The absence of gas in the rectum can indicate obstruction

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14
Q

The transverse and sigmoid colons are mobile and can be confused on AXR. T/F?

A

True

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15
Q

What is the name of the anatomical variant where the colon exists above the liver?

A

Chilaiditi’s syndrome

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16
Q

What is the significance of chiladiti’s syndrome?

A

It can be confused for free has beneath the diaphragm.

17
Q

Why might gas be seen within the biliary tree on AXR?

A

Due to previous surgery or gallstone ileus

18
Q

How useful is AXR for investigating Inflammation in the abdomen?

A

It is useful for colitis but is non-specific in other inflammatory conditions

19
Q

What is the pathopneumonic sign of colitis on AXR?

A

Thumb-printing

20
Q

Why is toxic dilatation of the colon dangerous?

A

High morbidity and mortality as it can cause the colon wall to split, become ischaemic and perforate

21
Q

Describe the appearance of ‘burnt out’ colitis on AXR?

A

No haustrations and the colon loss tubular and straight. No longer active inflammation so no thumb-printing seen.

22
Q

AXR should not be requested in suspected appendicitis, but what may be seen in this case?

A

Appendicolith - a calcified deposit in the appendix

23
Q

What is meant by fat stranding?

A

Refers to water within the fat which creates a dark, streaky appearance.

24
Q

What are the different possible presentations of cholecystitis on CT?

A

Thickened gallbladder wall and gallstones
Fat stranding and ill-defined gallbladder wall
Broken down, no longer visible gallbladder wall which is likely to be ischaemic
Gas within the gallbladder wall

25
Q

What imaging test should be used to investigate cholecystitis?

A

Ultrasound

26
Q

Why may CT be used in a patient with pancreatitis?

A

When there is a diagnosis of pancreatitis and the patient is deteriorating to investigate possible pancreatic ischaemia, necrosis and abscess formation.

27
Q

What type of plain film is sensitive fo free gas?

A

CXR

28
Q

Describe the appearance of penumoperitoneum on CXR?

A

Crescent of gas lucency at the hemidiaphragm or an abnormal linear gas line across the central diaphragm (which is not normally visible)

29
Q

Describe the appearance of penumoperitoneum on AXR?

A

Wriggler’s sign - there is gas on both sides of the bowel wall so the thickness of the wall can be easily seen, this indicates pnemoperitoneum

30
Q

Which imaging modality can be used to look for the cause of abdominal obstruction?

A

CT

31
Q

Describe the appearance of small/large colonic obstruction on AXR?

A

Upstream to the obstruction there is distension and downstream to the obstruction there will be less or no gas in the colon

32
Q

What part of the colon will distend if there is colonic obstruction and an open ileo-caecal valve?

A

Small colon

33
Q

What part of the colon will distend if there is colonic obstruction and an closed ileo-caecal valve?

A

Caecum

34
Q

What imaging modality is the first choice to investigate possible abdominal ischaemia?

A

CT

35
Q

What late sign of ischaemia can be seen on AXR?

A

Crescents of gas superimposed over bowel

36
Q

What early signs of ischaemia can be seen on abdominal CT?

A

Bowel does not enhance properly on CT when it is ischaemic

37
Q

Other than looking at the bowel itself, what structures are important to assess on CT when investigating possible ischaemia?

A

Main blood vessels to see whether or not these are occluded.

GI/Liver (8 decks)

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