Surgery - Acute Abdomen

Question 1

Best view to detect free air under the diaphragm (indicates perforation of the bowel)?

Answer 1

Upright chest

Question 2

Best imaging to evaluate bowel, organs (liver, spleen, kidney), abdominal aorta, abnormal calcifications in the setting of acute abdomen?

Answer 2

KUB

Question 3

Best imaging to look for fluid levels in the bowel?

Answer 3

Cross lateral or upright abdomen

Question 4

Best imaging to look for air between the liver and abdominal wall?

Answer 4

LL decubitus film

Question 5

Preferred exam to evaluate for acute cholecystitis?

Answer 5

U/S (high sensitivity and specificity)

Question 6

Findings of acute cholecystitis on U/S?

Answer 6

Highly echogenic (white) rounded structures in the gallbladder (gallstones)
Acoustic shadow posterior to the stone
Gallbladder wall thickening of at least 4-5 mm and double wall or tram track sign indicates wall edema or inflammation
Sonographic Murphy's sign

Question 7

If U/S is uncertain, what imaging should be done next?

Answer 7

HIDA scan (non-visualization of the gallbladder is consistent with obstruction of cystic duct)

Question 8

CT is less sensitive than U/S and not used to diagnose cholecystitis - findings?

Answer 8

Cholelithiasis
Pericholecystic fluid and inflammatory fat stranding
Gallbladder wall thickening
Mural or mucosal hyeprenhancement