radiology quiz 2- abdomen

what are the indications for an abdominal xray?

-abdominal pain

-masses

-blockages

-precursor to CT/ MRI

-enteral tube placement

disadvantages of abdominal Xray

-ionizing radiation

-cant see high detail

-2D

-cant use during pregnancy

advantages of abdominal Xray

-painless

-quick

-inexpensive

AP supine Xray

assess bowel obstructions, calcifications, and cancers. includes both halves of diaphragm

KUB Xray

Kidney Ureters Bladder, similar to AP supine but may not include both halves of diaphragm

decubitus xray

ID pneumoperitoneum (laying on pts side)

lateral xray

complements frontal views, can visualize FB and soft tissue masses (facing sideways)

ABDOX

Air and anatomy

Bowel

Dense structures

Organs

Xternal objects

Air

usually in stomach, 2/3 loops in small bowel, and in rectosigmoid colon

what is the 3,6,9 rule used for?

the diameter of the small and large bowel:

- small bowel should be 3cm wide

-large bowel should be 6cm wide

-sigmoid colon should be 9cm wide

small bowel characteristics

lies more central, valvulae conniventes (visible around the full width of the bowel), only seen when it contains gas

large bowel characteristics

lies around the edges of the abdomen, haustral markings (thicker and dont completely traverse the bowel), plicae semilunaris inbetween, contains feces

what is an obstruction?

a GI condition in which digested material is prevented from passing normally through the bowel. can be caused by adhesions from surgery and meds.

Sx: pain, nausea, vomiting, inability to pass gas or stool

small bowel obstruction

Sx: nausea & vomiting (coffee ground), pain, distension, cant pass stoll/gas if complete

high pitched sounds on auscultation, tympanic percussion

what is a step ladder appearance significant for?

small bowel obstruction

fluid filled and dilated small bowel loops in step-wise configuration

how to tell btw an ileus and small bowel obstruction?

an obstruction would have no air distal to it

what can still be seen in a partial small bowel obstruction?

Air can still be seen in the large bowel

whats the most common cause of a large bowel obstruction?

primary colon carcinoma

what is abdominal ileus?

intolerance of oral intake due to inhibition of the gastrointestinal propulsion WITHOUT signs of obstruction

secondary to surgery, meds, trauma, peritonitis, illness

air is ALWAYS in the rectum with ileus

what is cecal volvulus?

torsion of cecum around mesentery leading to obstruction

Sx: distension, constipation, diarrhea, cant pass gas, pain, vomiting

characteristics of cecal volvulus

haustra maintained, distal colon and small bowel distended, air fluid levels can be present

20% are congenital

what is embryo sign significant for?

cecal volvulus

What are predisposing factors for cecal volvulus?

air travel, colon msucle weakness, laxative abuse, Hirschsprungs disease, repeated infxns, pelvic tumors, pregnancy, previous surgeries, violent coughing

what is sigmoid volvulus?

twisted sigmoid colon, ascending transverse and descending colon usually dilated

Sx: constipation, bloating, N/V, pain, distension, fever in cases of perforation, possible ischemia, peritonitis

Tx with colonic decompression

what is coffee bean sign significant for?

sigmoid volvulus - LOSS of haustral markings

what are risk factors for sigmoid volvulus?

age over 50, chronic constipation, megacolon, male

inflammatory bowel disease signs

thumb printing - haustral thickening

lead pipe colon - loss of haustra

toxic megacolon - dilation w/o obstruction

crohns disease mnemonic

C: cobblestone mucosa

R: rosethorn ulcers

O; obstruction

H: hyperplasia of lymph nodes

N: narrowing

S: skip lesions

Xray findings of Crohns

ileum usually affected first, skip lesions and discrete ulcers,

MRI and CT better for Dx

what is ulcerative colitis?

inflammatory bowel disease of rectum, can lead to toxic megacolon

what is applecore sign significant for?

stenosing annular colorectal carcinoma

DDX of ulcerative colitis

lymphoma, crohns, colonic infxns

what is a barium meal?

pts ingests barium contrast to examine the GI tract for abnormalities, GERD, esophagitus, strictures

uses xray and fluoroscopy

indication for barium swallow

high/ low dysphagia, GERD, hiatus hernia, epigastric pain, persistent vomiting, fistula

single versus double contrast barium

single: pt swallows barium only

double: pt swallows barium and air - better mucosal details seen

how is barium swallow recorded

real time video of movements inside the body by passing Xrays through over a period of time

what is birds beak sign significant for?

achalasia- stricture

what does an esophageal web look like?

proximal dilation and jet phenomenon

occurs in cervical esophagus

what is schatzkis ring associated with?

hiatal hernia

what is zenkers diverticulum?

outpouching of pharyngeal muscle. cricopharyngeal muscle fails to relax during swallowing

CREST mnemonic for scleroderma

C: calcinosis

R: Raynauds

E: esophageal dysmotility

S: sclerodactyly

T: telangiectasia

why would we order a barium enema?

lower abdomen pain, occult blood, IBD workup, suspected cancer, abnormal result of volvulus

what is riglers sign?

(double wall sign), sign of pneumoperitoneum

can be caused by perforation

what is an intravenous pyelogram?

contrast injected to see kidneys ureters and bladder

what is a voiding cystourethrogram?

contrast injected into bladder, shows how well the bladder empties

what is a hystersalpingogram?

used to see whether the fallopian tubes are patent and inside of uterus is normal