Term
| Imaging study of choice for RUQ pain or suspected acute pancreatitis: |
|
Definition
|
|
Term
| Study of choice for oropharyngeal dysphagia: |
|
Definition
| Videoflouroscopy (swallowing study) |
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Term
| Study of choice for esophageal dysphagia: |
|
Definition
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Term
| The isotropic voxel transducer ultrasound allows for what? |
|
Definition
volumes of data to be collected at once so 3 D images can be formatted
This will reduce operator dependence of ultrasounds and greatly decrease how long it takes to get an ultrasound |
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Term
| A fatty liver on ultrasound will look __ and ___. |
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Definition
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Term
| Describe a healthy gallbladder on ultrasound: |
|
Definition
- Free of echoes
- Uniform wall thickness < 2 mm
- Margins against the liver or bowel
- Without intervening fluid |
|
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Term
| The common bile duct is measured at what point on ultrasound? |
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Definition
| - next to the portal vein either above or below junction of common hepatic duct with cystic duct |
|
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Term
| In pts less than 60, what should the common bile duct measure on ultrasound? |
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Definition
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|
Term
| In pts over 60, how much should the common bile duct measure on ultrasound? |
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Definition
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Term
| __ is associated with better visualization of the pancreas on ultrasound. |
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Definition
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Term
| A dilated pancreatic duct on u/s suggests: |
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Definition
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Term
| The right kidney is also included in u/s of RUQ b/c can be due to hydronephrosis, a stone, or tumor. |
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Definition
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Term
| What structures does a RUQ ultrasound include? |
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Definition
- Liver
- Gallbladder
- Biliary tree
- Pancreas
- Right kidney |
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Term
| What structures does a complete abdominal ultrasound include? |
|
Definition
- Liver
- Gallbladder
- Biliary tree
- Pancreas
- Right kidney
- Left kidney
- Aorta
- Inferior vena cava |
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Term
| Describe a CT-KUB and its main purpose: |
|
Definition
- Done without oral or IV contrast
- For suspected renal stone disease |
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Term
| Examples of when IV contrast would be needed with GI issues: |
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Definition
- Solid organ tumors
- Vascular abnormalities
- Bowel wall lesions |
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Term
|
Definition
- Barium- do not use if suspect perforation, use if suspect aspiration
- Gastrogaffin- dilute water solube non-ionic contrast, use if suspect perforation, do NOT use if suspect aspiration |
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Term
| If patient is borderline for being a candidate for IV contrast, what can be done? |
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Definition
- Hydration for pts with borderline renal insufficiency
- Premedication with Steroids for those with allergies |
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Term
| when is rectal contrast with CT helpful? |
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Definition
- visualization of large bowel
- diverticulitis
- appendicitis |
|
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Term
| With IV contrast, you can do a multislice CT within seconds of administering the contrast. Routine CT with IV contast are done in 2 phases. Describe them: |
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Definition
- Phase 1: Portal Venous Phase- 60-90 seconds after beginning of IV injection, can see portal venous system and arterial tree
- Phase 2: Urinary tract- delayed, can see renal pelves, ureters, bladder, any contrast enhancing lesions |
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Term
| When should precontrast CT studies be done or just non-contrast CTs done? |
|
Definition
- Renal stones
- Solid tumors like adrenal adenomas- lack of contrast allows for density measurements and histologic specificity
- Assessment of aortic wall density to check for hematoma formation |
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Term
| Symptoms of oropharyngeal dysphagia: |
|
Definition
- Difficulty initiating swallowing
- Choking
- Abnormal feeling in the throat/cervical region |
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Term
| Esophageal dysphagia symptoms: |
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Definition
| - Difficulty swallowing with abnormal sensation in the lower chest occurring several seconds following swallowing |
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Term
| Describe barium swallow for oropharyngeal dysphagia: |
|
Definition
- Done with speech pathologist
- Use variety of substances: thin barium> nectar thickness> honey thickness barium on meat> barium on cracker> finish with 13 mm barium tablet |
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|
Term
| Videoflouroscopy barium swallow observes function of: |
|
Definition
- oropharynx
- hypopharynx
- epiglottis
- proximal esophagus |
|
|
Term
| with a swallowing study, main report and recommmended treatments come from the speech pathologist performing the procedure |
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Definition
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Term
| In addition to gallstones, what other u/s finding may accompany gallstone disease? |
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Definition
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Term
| The common bile duct is hard to fully examine with ultrasound. What additional studies may be necessary when there is a strong suspicion of choledocolithiasis? |
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Definition
- Nuclear medicine studies (HIDA scan)
- MRCP (magnetic resonance cholangiopancreatography)
- ERCP (endoscopic retrograde cholangiopancreatography) |
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Term
| CHF with hepatic congestion may mimic cholecysitis on ultrasound |
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Definition
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Term
| Gallstone pancreatitis is caused by ___ downstream from the insertion of the __ __ into the __ __ __. |
|
Definition
- choledocolithiasis
- pancreatic duct
- common bile duct |
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Term
| With gallstone pancreatitis what is the test of choice? |
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Definition
| ultrasound is study of choice though CT will better show inflammation of the pancreas |
|
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Term
| what test is best for evaluating peripancreatic fluid and pancreatic perfusion? |
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Definition
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Term
| Visceral nerve fibers react to __ and __, whereas as somatic nerve fibers react to ___. |
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Definition
- distention and inflammation
- inflammation |
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Term
| cutting and tearing don't really cause abdominal pain, its __ and __ that cause abdominal pain. |
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Definition
| distention and inflammation |
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Term
| ___ is typically best test for diseases that cause inflammation, whereas __ is better for diseases that cause obstruction and distention. |
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Definition
- Endoscopy> inflammation
- Imaging> obstruction and distention |
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Term
| Most diverticulae are in the __ colon in the ___. |
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Definition
|
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Term
| "fat stranding" on abdominal CT is associated with: |
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Definition
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Term
| Test of choice for diverticulitis: |
|
Definition
| CT with oral and IV contrast |
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Term
| ___ changes in __ __ adjacent to a diverticulum on a CT establishes the dx of diverticulitis. |
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Definition
| - Inflammatory changes in pericolic fat adjacent to diverticulum |
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Term
| Appendagitis Epiplocicae mimics ___. But this is a self limited condition due to torsion of the __ ___, which results in infarction of the __. These pts nearly always respond to __ and have prompt resolution of symptoms. |
|
Definition
- diverticulitis
- Epiploic appendages (fatty outpuchings along bowel margin)
- fat
- pain relievers |
|
|
Term
| What do you suspect with abdominal pain, distention, nausea, and vomiting? |
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Definition
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|
Term
| When bowel obstruction is suspected, what should the PE focus on? |
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Definition
|
|
Term
| features of abdominal plain film suggestive of bowel obstsruction: |
|
Definition
- air fluid levels
- distended small bowel loops
- paucity of colon contents
but this is not the test of choice |
|
|
Term
| test of choice for bowel obstruction: |
|
Definition
| CT scan with IV contrast and oral contrast if it will be tolerated |
|
|
Term
| normal measurement of healthy small bowel: |
|
Definition
| less than or equal to 25 mm |
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Term
| Key findings of bowel obstruction on CT scan: |
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Definition
- Distended small bowel (normal bowel should be less than or equal to 25mm)
- Transition point (key)- bowel goes abruptly from dilated to collapsed |
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Term
| At the transition point of a bowel obstruction, there may be a hernia, volvulus, or mass. Or there may be inflammatory changes suggestive of a __ from inflammatory bowel disease. |
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Definition
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Term
| If there is a transition point with bowel obstruction, but no cause identified, the most likely cause is __. |
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Definition
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Term
| If there is no transition point with suspected bowel obstruction, and the entire bowel is distended, __ or ___ is more likely. |
|
Definition
- ileus
- pseudoobstruction |
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Term
| Abdominal pain and weight loss make you consider: |
|
Definition
- Intestinal ischemia (especially in those with vascular disease or diabetes)
- occult malignancy (pancreatic, etc) |
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Term
| 2 major causes of colitis resulting in abdominal pain and diarrhea: |
|
Definition
- Pseudomembranous colitis
- Ischemic colitis |
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Term
| Diffuse colon wall thickening and pericolic fat stranging on CT make you think: |
|
Definition
- Pseudomembranous colitis
- Ischemic colitis |
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Term
| Pt was diagnosed with colon cancer via endoscopy, how would you check for mets to the liver? |
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Definition
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Term
| What are the two main reproducible findings on video fluoroscopy barium swallow? |
|
Definition
- Penetration- barium flowing abnormally past the epiglottisand into the supraglottic larynx
- Aspiration- barium flowing past the true vocal cords and into the trachea
Both associated with increased risk for pneumonia and choking |
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Term
| __ ___ occur proximally in the esophagus and can cause oropharyngeal dysphagia. These can be diagnosed with video fluoroscopy barium swallow. |
|
Definition
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Term
| For lining abnormalities like cystitis, endometritis, colitis, and endometriosis, what studies are done? |
|
Definition
CT, US, and even MR
MR may assist espeically with endometriosis b/c this study can detect blood breakdown products often seen in endometriomas |
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Term
| The __ __ is helpful in distinguishing NASH from alcoholic hepatitis. |
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Definition
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|
Term
| With NASH, the AST/ALT ratio is usually ___ than __. |
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Definition
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|
Term
| With alcoholic hepatitis, the AST/ALT ratio is typically __ than __. |
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Definition
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|
Term
| Non-hepatic causes of elevated LFTs: |
|
Definition
- Muscle disorders (injury and pyomyositis)
- Thyroid disorders
- Celiac disease
- Adrenal insufficiency
- Anorexia Nervosa |
|
|
Term
| What is the cholestatic pattern of liver enzyme abnormalities: |
|
Definition
When Alk Phos elevation exceeds that of aminotranferases
- partial bile duct obstruction
- primary biliary cirrhosis (PBC)
- primary sclerosing cholangitis
- drugs (anabolic steroids)
- metastatic cancer |
|
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Term
| When LFTs are elevated, but alk phosph elevation is greater than aminiotransferase elevation, what test should be ordered first? |
|
Definition
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Term
| Pt has elevated LFTs but alk phos is more elevated than aminotransferases. US shows biliary distention. Now the patient is said to have __ __ and an ___ should be done to determine cause and possibly treat. |
|
Definition
- Extrahepatic cholestasis
- Endoscopic Retrograde Cholangiopancreatography (ERCP) |
|
|
Term
| next step after us in patients with cholestatic pattern of LFT elevation? |
|
Definition
|
|
Term
| next step on patients with hepatocellular pattern of LFT elevation? |
|
Definition
|
|
Term
| Pts with biliary pain and normal or ambiguous enzyme abnormalities, what is the next step? |
|
Definition
| Nuclear medicin hepatbiliary scan (HIDA scan) |
|
|
Term
| Describe the nuclear medicine hepatobiliary scan (HIDA scan) |
|
Definition
Phase 1: Pt is injected with IV dose or radioactively labeled iminodiacetic acid which gets conjugated in the liver and secreted in bile> see liver, biliary tree, gallbladder, and small bowel
- Second phase: performed in pts with chronic pain with suspected sphincter of Oddi dysfunction, performed if gallbladder is visualized in the first hour, provides information about hepatobiliary function, patient is injected with cholecystokinin and imaged for one hour, normal response is ejection fraction of greater than 40%, lower ejection fractions suggest gallbladder dyskinesia and pt is candidate for cholecystectomy |
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Term
| Nuclear medicine hepatobiliary scan is performed and the gallbladder is not visualized in the first hour. What is the dx? |
|
Definition
|
|
Term
| Nuclear medicine scan is performed and the gallbladder is visualized between 1 and 4 hours. What is the dx? |
|
Definition
|
|
Term
| Symptoms of sphincter of oddi dysfunction: |
|
Definition
- RUQ pain
- Elevated aminotransferases
- Elevated bilirubin
- Possibly elevated pancreatic enzymes/pancreatic type pain |
|
|
Term
| Sphincter of Oddi dysfunction is aka: |
|
Definition
- Papillary stenosis
- Sclerosing papillitis
- Biliary spasm
- Biliary dyskinesia |
|
|
Term
| renal abnormalities on US may be followed by: |
|
Definition
| CT and renal excretion studies |
|
|
Term
| Incidentalomas are MC in the: |
|
Definition
|
|
Term
| All patients found to have an incidentaloma of an adrenal gland, needs to undergo __ evaluation. |
|
Definition
|
|
Term
| What are the types of adrenal incidentalomas? |
|
Definition
- Cortisol producing> Cushing's Disease (obesity, HTN, glucose intolerance, Diabetes, hypercholesterolemia)
- Pheochromocytoma- paraoxysmal HTN, flushing, anxiety
- Aldosteronomas- HTN and sodium retention |
|
|
Term
| List 3 types of adrenal incidenalomas: |
|
Definition
- Cortisol producing
- Pheochromocytoma
- Aldosterone producing |
|
|
Term
| What tests should be done if an adrenal incidentaloma is seen on CT scan? |
|
Definition
- Dexamethasone suppression test (cortisol producing)
- 24 hour urine (pheochromocytoma)
- Eval of serum sodium, renin, and aldosterone (for aldosterone producing) |
|
|
Term
| Imaging follow up for pts with an adrenal incidentaloma? |
|
Definition
- return for unenhanced followed by enhanced CT or MRI
- periodically return to make sure incidentaloma does not increase in size |
|
|
Term
| An adrenal incidentaloma less than __ __ is probably a benign adenoma. |
|
Definition
| less than 3cm> benign adenoma |
|
|
Term
| CT without contrast density evaluations: |
|
Definition
<0 HU= benign adenoma
0-10 HU= probably benign adenoma
10-43 HU= Indeterminant
>43 HU= Suspicious for cancer |
|
|
Term
| CT with contrast of adrenal incidentaloma b/w 3 and 5cm with % relative washout greater than __ or enhancement washout greater than __, probably a benign adenoma. |
|
Definition
| %relative washout greater than 40% or enhancement washout greater than 60%> benign |
|
|
Term
| CT with contrast 3-5 cm, indeterminant findings: |
|
Definition
- % relative washout <40%= indeterminant
- % enhancement washout < 60%= indeterminant |
|
|
Term
| Adrenal incidentaloma greater than 5 cm: |
|
Definition
|
|
Term
| If an adrenal incidentaloma is found to be probably benign, what should the follow up be? |
|
Definition
|
|
Term
| If an adrenal incidentaloma is found to be indeterminant, what should follow up be? |
|
Definition
| - f/u CT in 6 to 18 months or biopsy |
|
|
Term
| If an adrenal incidentoma is found to be suspicous for cancer, what should the follow up be? |
|
Definition
|
|
Term
| Describe a CT colonoscopy: |
|
Definition
| - complete large bowel prep> rectally insufflated air> CT scan |
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|
