Surgical and GI radiology Flashcards
How do you approach the AXR
A - airway
B - bone
C - caclium
D - density
How much air should be in
- small bwoel
- large bowel
- caecum
- small bowel = 3cm for small bowel
- large bowel = 6cm for large bowel
- caecum = 9cm for caecum
3/6/9 rule
what other organ in the abdomen also contains air/fluid
stomach
describe a small bowel on an AXR
- centrally located
- jejnum contains valvulae connivertes
- ileum is normally featureless
- goes the whole way acorss the lumen of the bowel
Describe large bowel on an AXR
- large bowel is generally peripheral
- large bowel contains haustra
What are valvulae conniventes
The valvulae conniventes, also known as Kerckring folds/valves, plicae circulares or just small bowel folds, are the mucosal folds of the small intestine, starting from the second part of the duodenum, they are large and thick at the jejunum and considerably decrease in size distally in the ileum to disappear entirely
What are the causes of small bowel obstruction
- Adynamic ileus (post surgical, sepsis, drugs)
- post surgical adhesions (4-6 weeks)
- malignancy
- volvolus
- intussusception (Iipomas, polyps)
if you have an obstruction of the large bowel everything up to that point is ..
dialted including the small bowel
What are the causes of large bowel obstruction
- Malignancy
- volvolus (sigmoid and caecal)
- post operative adhesions
- ileus (usually also involves small bowel)
What are the radiographic sing of bowels perforation
- Rigler’s sign - looks like a coffee bean
- falciform sign - can now see the ligament
- football sign
- continous hemi-diaphragm sign
What is the first thing you do if you think that the patient has perforation
- erect chest x ray - this is to check for continous hemi-diaphragm sign
What is the thumbprinting sign
if someone was to put there thumbs on either side of the bowel this is thumb printing of the bowel
What are the causes of thumbprinting sign
- ischaemic/inflammatory bowel diease
- pseudomembranous colitis
- diverticulitis
- lymphoma
- amyloid
- typhoid
What does thumb printing represent
diffuse oedema of the bowel
Where should you not have gas
- Within the billary tree
What is pneumobilia
- Gas within the biliary tree
What can normally cause gas within the biliary tree
ERCP
What can cause gas within the biliary tree
- incompetent sphincter of oddi; sphinterectomy (50% at 1 year)
- pancreatitis
- gallstone disease
- Biliary - enteric anastomosis
- biliary entery fistula
- infection: cholangitis
what do you look at when looking at bones in x ray
- Density - metabolic conditions/oesteoporosis
- fractures (trauma/pathological)
- osseous lesions (malignancy)
- joints (sacro-iliac joints, hip)
name signs of osetoarthritis on the x ray
- Subchrondral cysts
- narrowing of joint space
- subchorndal sclerosis
- osteophyte formation
What are the casues of bone metastasis
Cancer from the
- breast
- prostate
- lung
- thyroid
- renal (renal cell carcinoma)
In a male patient what is the most common cause of bone metastasis
Prostate cancer
In a female patient what is the most common cause of bone metastasis
Breast cancer
What is sacral ilietus
- when you cannot see the sacral ileus joint and it increases in whitness
- associated with ankolysing spondylitis and IBD
- fusing of the sacral ileus joint
What are regions of abdnomal calcium
- Vessels (arteries and aneurysm)
- urinary tract (renal calculi)
- gallbladder (gallstones)
- pancreas (pancreatitis chronic)
peripheral calcification is associatied with
abominal aortic aneurysm
in chronic pancreatitis you get
calcification in the pancreas
