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Abdominal and GI Images
Clinical Skills Module 3. Not all slides included.
154
Medical
Graduate
07/05/2009

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Cards

Term
Will bone/metal and air appear white or dark on a non-inverted fluoroscopic image?
Definition
bone/metal=very dark. air=white
Term
What are echogenic/hyperechoic areas and what are some examples?
Definition
on US, these are bright areas. Air tissue (not so useful in lung or air-filled bowel) and bone-soft tissue
Term
What are hypoechoic areas and what are some examples?
Definition
dark areas: fluid filled, urinary blader, cysts, blood vessels
Term
What is a plain frontal supine radiograph of the abdomen spanning from the diaphragm to the pubic symphysis?
Definition
KUB
Term
When can air under the diaphragm be assessed?
Definition
KUB + upright PA chest
Term
When can GI air/water levels assess obstruction from ileus?
Definition
KUB+standing abdomen
Term
Is KUB used to assess organ structure of KUB?
Definition
no. used to examine pathologies of organs. to assess those structures via radiograph then an IVP or more correct an IV urogram
Term
What can be used to view hydronephrosis and dilated calyx of the kidney?
Definition
ivu (blunted calices seen in ivu). ivp is inaccurate b/c pyelogram means study of the renal pelvis
Term
For what use is IVP reserved?
Definition
retrograde study only of the renal pelvis
Term
What might be used to view the following: gall and kidney stones. bowel obstruction. constipation. verify position of indwelling catheters (ie ureteric stents/ng tubes) scout film prior to performing barium enema?
Definition
kub
Term
What view might be used for the following purposes: free intraperitoneal gas. acute abdomen. if pt cannot stand or sit it is substitute for erect chest or abdomen?
Definition
left lateral decubitus
Term
What view might be used for the following purposes: pneumoperitoneum. small bowel obstruction. air/fluid levels?
Definition
upright abdomen
Term
What might the following cause: adhesions. neoplasms. hernias. crohns?
Definition
sm bowel obstruction
Term
What chest view is good for seeing free air?
Definition
erect chest
Term
What ab view is good for ab detail: organs, bones, calcifications, fat and gas details?
Definition
supine
Term
What is helpful for remembering what to look for at acute ab film?
Definition
organs bones and stone, masses, fat and gases
Term
What 3 views are included in acute ab series?
Definition
upright chest and ab and ap supine
Term
What is the most common mechanical obstruction of the colon?
Definition
colon cancer
Term
What are the 3 views for an acute ab series in which the pt cannot sit or stand?
Definition
supine chest and ab and lld
Term
What should be ordered for calculus or ab foreign body?
Definition
ap supine ab. single view is ok (radiograph)
Term
When are ct and us performed for acute ab?
Definition
if indicated, are usually performed following plain films
Term
What might be ordered to visualize the following abnormalies: acute appendicitis, diverticulitis, perf peptic ulcer, incarcerated hernia, post-op adhesions, intussusception, malrotation?
Definition
acute ab series
Term
What can be used to view the following: sma/ima arterial thrombois or embolism?
Definition
acute ab series
Term
What can be used to view the following: in peds- malrotation, duodenal atresia, omphalocele, diaphragmatic hernia, TRAUMA>ABUSE->duodenal hematoma?
Definition
acute ab series
Term
What can be used to view the following: trauma or hx/evidence consistent w/causing traumatic abdominal injury, splenic rupture?
Definition
acute ab series
Term
What is a structural or functional abnormality that disrupts the flow of urine from the renal tubule to the urethra?
Definition
obstructive uropathy
Term
What can occur involving the ureteropelvic jct and the posterior urethral valve?
Definition
obstructive uropathy
Term
What is the most common cause of obstructive uropathy in young men?
Definition
nephrolithiasis
Term
What is the most common cause of obstructive uropathy in women?
Definition
pregnancy
Term
What is the most common cause of obstructive uropathy in the elderly?
Definition
tumor- prostatic for men, ovarian for woman
Term
What is the most common complication of obstructive uropathy?
Definition
uti
Term
What noninvasive method can show dilation of the ureters or renal collecting sysem in obstructiver uropathy?
Definition
US
Term
What can ID the presence and location of an obstructive uropathy?
Definition
IVU
Term
What is the procedure of choice in acute obstruction from renal calculi?
Definition
ivu?
Term
What is also very good in determining renal pelvic cysts v. hydronephrosis?
Definition
ivu
Term
What is excellent for urinary tract dilation and useful in ID lesions outside the collecting system?
Definition
ct
Term
What is needed for ct studies of obstructive uropathy that might present a problem?
Definition
iv contrast
Term
What is the specificity and sensitivity of a KUB in ID renal calculi?
Definition
low- 50%
Term
When is diagnostic imaging used for renal calculi?
Definition
1. to confirm dx of 1st time episodes of ureterolithiasis, 2. when dx is unclear, or 3. when associated w/uti
Term
What is the test of choice in dx of calculi?
Definition
unenhanced ct
Term
What are 3 contrast materials?
Definition
1. iodinated contrast media. 2. barium (doesn't dissolve lungs, causes peritonitis), 3. gastrograffin (doesn't cause peritonitis)
Term
Why might you give a pt who is going to have imaging done prednisone, benadryl, or solu-medrol and benadryl?
Definition
allergies to iv contrast
Term
What are the 2 types of adverse rxns caused by contrast media?
Definition
idiosyncratic and non-idiosyncratic
Term
What adverse rxn to contrast media begins 20 min after administration and is not dose dependant?
Definition
idiosyncratic
Term
What adverse rxn to contrast media involves mild symptoms including urticaria, pruritis, rhinorrhea, nausea, retching or emesis, diaphoresis, coughing, and dizziness?
Definition
idiosyncratic
Term
What adverse rxn to contrast media involves moderate sx including persistent emesis, diffuse urticaria, ha, facial edema, laryngeal edema, dyspnea, palpitations, tachycardia or bradycardia, htn, and ab cramping?
Definition
idosyncratic
Term
What adverse rxn to contrast media involves severe sx including life-threatening arrhythmias, hypotension, bronchospasm, laryngeal edema, seizures, syncope, and death?
Definition
idiosyncratic
Term
What adverse rxn to contrast media involves bradycardia, hypotension, vasovagal rxns, neuropathy, extravasation, and delayed rxns?
Definition
non-idiosyncratic rxns
Term
What adverse rxn to contrast media involves sensations of warmth, metallic taste in mouth, n/v?
Definition
non-idiosyncratic rxns
Term
What is live x-ray that provides real time images to study the body sx of interest?
Definition
fluoroscopy
Term
What imaging technique is used to study skeletal, digestive, urinary, respiratory and reproductive systems?
Definition
fluoroscopy
Term
Does a double contrast gi involve the addition of carbonate or bicarbonate?
Definition
bicarbonate, not carbonate
Term
When administering a double contrast gi, what follows bicarbonate (not carbonate)?
Definition
barium
Term
What is the order for administering double contrast enema?
Definition
first enema, then drain, then inflate w/air
Term
What contrast media allows for superior coating of the mucosal surfaces in an upper gi, is used in ages 14 and up, and allows clear visualization of pathologies, ie- gastric ulcers or carcinoma?
Definition
bicarbonate (not carbonate)
Term
Is a UGI used to look for reflux? Is it used to confirm anatomy?
Definition
it is important to note that an ugi is *NOT* used to look for reflux but rather to confirm nml anatomy
Term
How do most infants confir med in ugi?
Definition
emesis aka spit-up
Term
Can infants have reflux and not spit-up?
Definition
yes
Term
What can present w/cough, asthma, breathing issues, pna?
Definition
ugi
Term
Preparation for what may include altering diet to low fiber before test, and note eating anything for 6-12 hrs before test, 2-4 hrs in peds?
Definition
ugi/sb
Term
If a pt cannot/will not swallow (often happens in peds) how do you administer contrast media?
Definition
og/ng or nd tube
Term
The following are limitations for what test: pt has severe vomiting or eats w/o telling you or if barium leaks into peritoneum (via perf ulcer) severe peritonitis can occur?
Definition
ugi/sb
Term
With what test can small details be missed like subtle inflammation or ulcers?
Definition
ugi/sb
Term
What test is lmt b/c it does not test for helicobacter pylori infection (ie stomach ulcers)?
Definition
ugi/sb
Term
What test is lmt b/c no bx can be done?
Definition
ugi/sb
Term
How prevalent is UGI/sb at chkd?
Definition
9.9/10 order
Term
Why is ugi/sb ordered in peds at chkd?
Definition
rule out sm bowel obstruction, ftt, or crohns dx or follow-up
Term
What is done before ugi/sb?
Definition
scout film-kub
Term
What is a dx tool used to id pathologies of the colon that uses contrast to fill entire colon?
Definition
contrast enema
Term
What is the prep for contrast enema?
Definition
same as ugi/sb protocol for peds and the same as the colonoscopy protocol for adults
Term
What might be used for the following purposes: screen for colon polyps/CA, id inflammation-uc/crohn's, r/o strictures or diverticulum?
Definition
contrast enema
Term
What can help correct ileocolic intussusception, usually done w/air or diluted gstrograffin?
Definition
contrast enema
Term
What should be done as an evaluation for unexplained weight loss or abnormal bowel habits?
Definition
contrast enema
Term
What can skew results of contrast enema if looking for hirschsprung's?
Definition
enema use 24 hrs prior to exam
Term
When might polyps not be visualized in contrast enema?
Definition
if prep is insufficient
Term
What involves denervation of distal coon causing narrowing and spasm w/innervated more proximal colon dilated?
Definition
hirschsprung's
Term
In hirschsprung's, what is the rect-sigmoid ratio on contrast enema?
Definition
<1
Term
How is the ultimate dx of hirschsprung's made?
Definition
ultimate dx made via bx- show lack of enteric ganglion cells
Term
What is excellent for seeing issues not visualized on other studies such as ulcers, tumors, esophageal erosions, eosinophilic esophagitis, gastritis?
Definition
endoscopy
Term
What can detect gi bleeding, detect cause of malabsorption, or confirm any problems seen on radiography or fluoroscopically?
Definition
endoscopy
Term
What can be used to find the cause of the following sx: ab pain, anemia, hematochezia, change in bowel habits, colon ca screening, unexplained weight loss?
Definition
colonoscopy
Term
Preparation for what test includes taking abx if indicated (ie artificial heart valve)? also, this prep is the same for adults prior to contrast enema.
Definition
colonoscopy
Term
What test involves sedation (pts shouldn't drive)? How must pts prepare?
Definition
colonoscopy. elimination of solid foods a few days before exam and take laxatives. enemas may be performed prior to exam.
Term
What can be used to tx bleeding diverticulum, remove and bx polyps (ruling in or out malignancy), and dilate strictures?
Definition
colonoscopy
Term
What uses MRI to take 2 or 3 dimensional images of the interior lining of the colon?
Definition
virtual colonoscopy
Term
What is used as a pre-screening tool for colon or rectal ca, to monitor growth of polyps, to screen for recurrence of colorectal ca, and f/u after abnormal contrast enema?
Definition
virtual colonoscopy
Term
What can be used for appendicitis, diverticulitis, msmt of stones (gu), staging of gi/gu neoplasms?
Definition
ab ct
Term
What can be used to id liver lesions, pancreatitis v. carcinoma, ab blunt trauma, sbo, vascular edge: renal, sma, celiac?
Definition
ab ct
Term
How is the bowel wall better visualized in ab ct?
Definition
w/oral contrast
Term
How are solid organs best visualized w/ab ct?
Definition
w/o oral contrast
Term
What allows for direct visualization of the bowel wall and structures near the bowel wall in diverticulitis?
Definition
ab ct
Term
What is useful for inflammatory bowel disease and appendicitis?
Definition
ab ct
Term
In what population is intussusception commonly seen w/ no cause?
Definition
children
Term
how is intussusception commonly seen in adults?
Definition
w/neoplasm
Term
What is used for active bleeding, cysts, abscesses, infection, tumors, lymph nodes, aneurysm, and foreign objects
Definition
ab ct
Term
What is a fast procedure involving a vascular element that can accurately measure structures, is easier to distinguish fat v. water v. blood, involves high s/s for calcifications and can be 3d?
Definition
ab ct
Term
What is expensive, can involve contrast rxns, and involves high amt of xrt to pts?
Definition
ab ct
Term
What provides a non-invasive means for traumatized pts to determine who can be managed conservatively or who needs surgery, angiography, etc?
Definition
ct
Term
In a traumatic ab injury, what organ is most affected? what others are affected?
Definition
most affected ->least: spleen, liver, kidney, and urinary bladder
Term
What can be used for pts w/jaundice, to keep track of fetus during pregnancy, access liver or kidney cysts, appendicitis, vascular thrombosis, assessing gyn issues (ectopic, ovarian torsion)?
Definition
ab us
Term
What takes little time to do, is a mobile exam, least expensive, involves no radiation, and can involve motion or doppler?
Definition
ab us
Term
What is dependant on skill of operator, lmt in air distended pts as air interferes w/devise, and has a lmt range in obese pts?
Definition
ab us
Term
What is good for staging uterine and ovarian ca, mrcp, staging prostate ca, fetal issues, vascular: renal, sma, celiac?
Definition
ab mri
Term
What involves no xrt, high visibility of tisues, vascular aspect even w/o contrst, 2d or 3d displays, and intestinal blood flow msmts?
Definition
ab mri
Term
What involves a long time for result, is very expensive, has access issues?
Definition
ab mri
Term
What involves combination of cholesterol and bile forming stones in gall bladder?
Definition
cholelithiasis
Term
What occurs when bile cannot pass via the common bile/cystic bile duct due to stone?
Definition
cholelithiasis
Term
Pt c/o of ruq pain, fever, chills, jaundice, pain after eating at wendy's.
Definition
cholelithiasis
Term
pt is female, fat, forty, fertile
Definition
cholelithiasis
Term
positive murphy's sign.
Definition
cholelithiasis
Term
What should you order in pts w/cholelithiasis?
Definition
kub to visualize calcified stones, ab us for pregnant women
Term
cholelithiasis increases chance of what?
Definition
pancreatitis
Term
what is the bread and butter for surgery?
Definition
cholelithiasis
Term
What are 4 imaging modalities useful for diffuse hepatocellular disease?
Definition
ct, us, mri, angiography
Term
What might you order to help evaluate lesions and surrounding organs w/diffuse hepatocellular disease?
Definition
ct
Term
What can be helpful w/diffuse hepatocellular disease except in fatty liver?
Definition
us
Term
What is the most sensitive in detecting diffuse diseases of liver, hemochromatosis and cirrhosis in w/diffuse hepatocellular disease?
Definition
mr
Term
What helps w/detecting collateral formation in cirrhosis w/diffuse hepatocellular disease?
Definition
angiography
Term
What are 5 imaging modalities useful w/focal hepatic disease?
Definition
us, ct, cta, nm, mr
Term
What can be helpful in exploring for localized lesions except in obese pts or when air is present w/focal hepatic disease?
Definition
us
Term
What is valuable as air and bone do not interfere w/results and is sensitive to disease w/focal hepatic disease?
Definition
ct
Term
What is very effective in depicting vessels w/focal hepatic disease?
Definition
cta
Term
What is helpful in determining a lesion to be a cavernous hemangioma w/focal hepatic disease?
Definition
nm
Term
What is effective in characterizing focal lesions of all types w/focal hepatic disease?
Definition
mr
Term
What is the only modality accepted when analyzing ab trauma?
Definition
ct
Term
What is a good 2nd choice if ct is not available in detecting acute hemorrhage?
Definition
us
Term
What helps embolize bleeding aa in the liver to spleen if surgery is not possible?
Definition
angiography
Term
What is accurate in determining trauma related issues of the liver biliary system or pancreas?
Definition
ct
Term
What involves visualization of gallstones which is the most common cause of cholecystitis?
Definition
us
Term
What is the most common cause of cholecystitis?
Definition
gallstones
Term
What shows gallstones as dense well-defined structures?
Definition
ct
Term
What is useful in detecting calculi of the gallbladder and biliary tree?
Definition
mrcp (Magnetic Resonance Cholangio Pancreatography)
Term
What depict acute cholecystitis as an absence of allbladder filling? To what is this due?
Definition
hepatobiliary nm hida scans (Hepatic 2,6-Dimethyl-Iminodiacetic Acid). due to inflammation of cystic duct all causing obstruction
Term
What is caused by etoh- abuse, trauma, cholelithiasis, peptic ulcer, hypercalcemia, and infection?
Definition
pancreatitis ( diuretics))
Term
What is the first choice for pancreatic inflammation v. neoplasm? What could disrupt images? How do you confirm lesion?
Definition
us. however, if ileus is present, air will disrupt images, also, if lesion is present, then ct will confirm
Term
What can help w/pancreasic and biliary duct evaluation in pancratic inflamation v. neoplasm?
Definition
mrcp
Term
Which of the following tests would you order for dysphagia: endoscopy, ugi, ugi/sb, be, colonoscopy, us, mri, ct?
Definition
ugi, endoscopy
Term
Which of the following would you order for esophageal stricture: endoscopy, ugi, ugi/sb, be, colonoscopy, us, mri, ct?
Definition
contrast swallow: barium or gastrograffin, ugi
Term
Which of the following would you order for hiatal hernia: endoscopy, ugi, ugi/sb, be, colonoscopy, us, mri, ct?
Definition
ugi
Term
Which of the following tests should you order for gstric or duodenal ulcer: endoscopy, ugi, ugi/sb, be, colonoscopy, us, mri, ct?
Definition
ugi- difficult to detect at the lower thresholds, endoscopy- gives clear visualization
Term
Which of the following tests should you order for crohn's disease: endoscopy, ugi, ugi/sb, be, colonoscopy, us, mri, ct?
Definition
ugi/sb, endoscopy, colonoscopy, ct
Term
What should you order for ulcerative colitis?
Definition
plain supine ab film may show colonic dilation in severe cases -> toxic megacolon. be- can be done in mild cases; however, may ppt toxic megacolon. colonoscopy- confirms uc via bx. helical ct.
Term
Why might you order plain supine film for ulcerative colitis?
Definition
may show colonic dilation in severe cases -> toxic megacolon
Term
When can you order be for ulcerative colitis?
Definition
in mild cases, however, may ppt toxic megacolon
Term
What confirms uc via bx?
Definition
colonoscopy
Term
Which of the following tests should you order for colon polyps/neoplasm: endoscopy, ugi, ugi/sb, be, colonoscopy, us, mri, ct?
Definition
be, colonoscopy, ct for staging
Term
Which of the following tests should you order for sigmoid volvulus: endoscopy, ugi, ugi/sb, be, colonoscopy, us, mri, ct?
Definition
plain supine ab film and upright, be shows "bird beaking" of stenosis, ct
Term
Pt presents w/mother to pediatric ed ashen w/h/o billous emesis, feeding difficulty, and ab pain x 1 week. upon exam you notice several areas over the rib cage that are tender to touch in addition to midline epigastric tenderness. all of your blood chemistry is nml except an elevated amylase. What imaging study should you order 1st?
Definition
xrt, us
Term
What can be tx conservatively w/ng decompression and tpn, w/somatostatin in severe cases?
Definition
intramural duodenal hematoma. hematoma is followed w/us. on day2, the ng can be closed and duodenal transit can be tested. usually hematoma is resolved in 2 weeks, if not sx is recommended
Term
38yo f w/severe epigastric pain (radiating to her back) and loose, foul smelling yellow-green stools. serum amylase and lipae are elevated. What imaging do you order?
Definition
ab us shows pancreatic head enlargement
Term
What involves a pancreas decreased in size secondary to fibrosis?
Definition
chronic pancreatitis
Term
What involves increased echogenicity b/c of fatty infiltrates, nad calcifications and ductal dilation?
Definition
acute pancreaitis
Term
18yo anxious f has been intensely studying for her exams past 2 weeks now presents to the ed w/rlq pain diarrhea, fever and 20lb weight loss past mo. increased wbc and elevated esr. stool - for blood. What imaging do you order?
Definition
ugi/sb shows narrowing at ti
Term
3 wk f arrives w/mother at pediatric practice w/h/o spitting up, stops breathing, turns blue. baby progressing in all other milestones, but barely maintaining weight. mother anxious and says sx center around feeding.
Definition
pt had nasopharyngeal reflux and episode of reflux past thoracic esophagus into nasopharyngeal region. infants are obligate nose breathers up to 6 mos. otherwise, nml anatomy, no aspiration, pyloric stenosis, or malrotation
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