Week 7/8 - E - GI tract imaging - Acute/distended abdo, haematemesis/dysphagia, change in bowel habit/rectal bleeding, jaundice Flashcards
Acute abdomen What is the acute abdomen?
The acute abdomen refers to a sudden severe abdominal pain lasting less than 10 days which is usually a medical emergency
There are many different causes of the acute abdomen (image) Thorough history /examination needed to determine possible pathologies - then complemented by different investigations What are the investigations for suspected cholecystitis/biliary colic?
First line investigation (after bloods / LFTs) = Ultrasound scan Further clarification with MRCP &/or ERCP
What is the most common causative factors of acute pancreatitis? What initial investigations are carried out?
The main causative factors are gallstones or alcohol US can be helpful to confirm gallstones +/- biliary obstruction AXR may see calcified gallstone (very low sensitivity)
The main purpose of imaging in pancreatitis is to evaluate the complications What imaging is carried out and when? What are the different local complictions of pancreatitis?
CT scan is carried out - carried out usuallly from day 5 of onset - assesses severity of the condition as well as assessing complications Local complications include * Pancreatic pseudocyst * Pancreatic abscess * Pancreatic necrosis
A perforated bowel happens when a medical condition, such as diverticulitis, causes a hole or tear in your bowel. An injury or blockage may also perforate your bowel. Bowel contents can leak into your abdomen through the hole. This may cause a life-threatening infection. What is the presentation?
Severe abdominal pain and tenderness Swelling of the abdomen Fever Nausea or vomiting
What is the first line investigation for bowel perforation? - what would be seen What helps delineate the source and show further features such as intra-peritoneal collections?
First line investigation for bowel perforation - Erect CXR Shows pneumoperitoneum which will appear as subphenic gas
Appendicitis What investgations are carried out in the diagnosis of appendicitis?
Typically raised inflammatory markers on bloods (CRP and WCC) with clinical history should be enough to justify appendectomy Urine analysis - exclude pregnancy in women and exclude UTI US may be all that is necessary to diagnose CT has high diagnostic accuracy and is useful if diagnosis is unclear
How does diverticulitis presented?
* Altered bowel habit +/- colicky left sided abdominal pain which is relieved by defecation * Associated diarrhoea +/- Pr bleeding Differs from diverticular disease as features of inflammation are also present * Fever * Raised WCC * Tender colon +/- local peritonism
What investigations are carried out in the diagnosis of diverticular disease?
Erect CXR: may show pneumoperitoneum in cases of perforation AXR: may show dilated bowel loops, obstruction or abscesses CT: this is the best modality in diagnosing diverticulitis/diverticular disease
Distended abdomen What is the most useful first line investigation if suspecting a bowel source as the cause of distended abdomen? - due to obstruction or ileus What may delineate the cause?
Most useful first line investigation is abdominal xray - bowel proximal to obstruction is distended with gas (certain features differ small bowel to large bowel obstruction) CT scan may delineate the cause
Haematemesis What is the main investigation carried out in the diagnosis of Upper GI bleeding? What score allows you to calculate the need for this investigation?
Main investigation is an Upper GI endoscopy Glasgow Blatchford score carried out on patients who present with upper GI bleed to assess the need for intervention - endoscopy Score of 0-1 = no need for intevrention Score of >1 = intervention required
What can be carried out to complement the endoscopy and understand the source of the haematemsis?
CT with IV contrast (no oral contrast) can be carried out WHEN bleeding to complement the endoscopy +/- angiography and intervention SAME protocol for lower GI bleeds
Dysphagia Anywhere in pharynx / oesophagus / stomach - inflammation - tumour - extrinsic compression - benign lesion How is dysphagia often investigated?
Initial first line investigation in patients with dysphagia is usually upper GI endoscopy Barium studies can also often be useful
Change in bowel habit / rectal bleeding What is the essential first investigation carried out in change in bowel habit? What is the initial radiological investigation?
All patients presenting with rectal bleeding require digital rectal examination and procto-sigmoidoscopy as a minimal baseline. - often then full colonoscopy carried out and endoscopy Initial radiological investigation is barium enema (small bowel barium follow through to assess in IBD) or CT virtual colonography
Jaundice Purpose of radiological investigation is to determine hepatic vs post-hepatic cause of jaundice What is the first line investigation? What is used to further investigate if: * Post hepatic cause identifed? * Hepatic cause identified?
First line investigation for anything RUQ really is to carry out an ultrasound scan Post hepatic cause identified - further investigate with MRCP +/- ERCP Hepatic cause identified - CT scan to confirm what is going May need liver biopsy / blood tests