5 Diagnostic Imaging Review

What’s that?

Pneumoperitoneum

Does this look like a small bowel or a large bowel obstruction?

small bowel obstruction

Does this look like a small bowel or a large bowel obstruction?

small bowel (string of pearls)

What are we looking at?

cecal volvulus

Small or Large Bowel Obstruction?
(patient is erect)

Large Bowel Obstruction (see pic of same patient, supine)

What’s this?

sigmoid volvulus

Which of the following is contraindicated when bowel perforation is suspected?
a. CT scan with IV contrast (iodine based)

b. CT Scan with PO contrast (barium or iodine)

c. non-contrast CT scan

b. CT scan with PO contrast is contraindicated in cases of bowel perforation.

These studies with PO contrast are routinely recommended when patients have undergone bowel altering surgery

What lab do you want to order prior to ordering a CT scan with contrast?

Cr Clearance.

Also check their meds (some on metformin shouldn’t have contrast, see this article for more details) don’t get in the weeds

https://www.aafp.org/pubs/afp/issues/2013/0901/p312.html#contraindications-to-iv-contrast

What part of the GI tract does a barium swallow evaluate?

upper GI series (esophagus, stomach, first part of duodenum)
evaluate for dysphagia, hernias, esophageal strictures

note: barium enema would be for lower GI series

ERCP is the gold standard for diagnosis of…

biliary obstruction