GI Imaging Flashcards by Zoe Doak

How do patients commonly present with Cholecystitis/Biliary Colic?

RUQ pain
often exacerbated by eating
+/- deranged LFTs

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What is the first line investigation for Cholecystitis/Biliary Colic?

Ultrasound (US)

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What can be visualised on an ultrasound for cholecystitis/ biliary colic?

gallstones

- dilated common bile duct

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What investigation can be used for further classification of cholecystitis/ biliary colic?

MRCP &/or ERCP

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How do patients present with pancreatitis?

Epigastric/Diffuse abdominal pain
Elevated serum Amylase
often caused by gallstones or alcohol, so pt may have symptoms of this

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When would an ultrasound be useful in investigating pancreatitis?

to visualise gallstones +/- biliary obstruction

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Why is imaging used in pancreatitis?

to evaluate how severe any complications are
Complications could be:
Necrosis
Intra-abdominal collections
Vascular complications

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What type of imaging is used to visualise pancreatitis complications and when?

CT with contrast

- Best performed around 1 week following onset of symptoms

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How do patients present with a suspected bowel perforation?

Pain
this is dependant on site of perforation
May be localised or generalised peritonism

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What is the first line investigation if you suspect a perforation in a patient, and what does this investigation show?

First line investigation = ERECT chest x-ray

- shows free gas under diaphragm

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What other investigation may be used in bowel perforation to look for complications?

may help show source of perforation
may show intra-peritoneal collections

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How do patients normally present with appendicitis?

Central abdominal pain
Later localising in RIF
May be associated with fever & elevated inflammatory markers

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What differential diagnosis should be considered in females presenting with symptoms of appedicitis?

gynaecological causes

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What investigation is first line if you suspect appendicitis?

First line investigation = ultrasound

- this will either confirm diagnosis OR help to find alternative cause

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What may be seen on an ultrasound if a patient has appendicitis?

distended appendix

- Calcified appendicolith

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How do patients normally present with diverticulitis?

Lower abdominal pain (classically LIF)
Associated diarrhoea +/- PR bleeding
Elevated inflammatory markers

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What investigation is used for diverticulitis and why?

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- shows inflammation and any complications

What symptoms would make you consider urinary causes alongside GI causes?

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associated urinary symptoms (frequency, urgency, dysuria etc.)
haematuria

What symptoms would make you consider a vascular cause rather than GI?

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sudden onset symptoms
back pain
hypotension/ feeling faint

If a patient presents with a distended abdomen suggestive of bowel gas or fluid, what investigation should be done first?

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If thought to be GAS => 1st line = AXR

- If thought to be fluid => 1st line = US`

HOw can you tell the difference on an AXR between dilated loops of small bowel and dilated loops of large bowel?

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small bowel has valvulae conniventes that cross the entire diameter of the wall
haustra on the large bowel do NOT cross the diameter of the bowel

What are the three types of bowel obstruction that may cause a build up of gas in the bowel?

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Small bowel obstruction
Ileus
Large Bowel obstruction

Where can haematemesis arise from? What are the main causes?

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May arise from oesophagus, stomach or duodenum
Possible causes are:
=> Tumour
=> Inflammation
=> Trauma
=> Vascular causes eg Varices

How is haematemesis investigated? What are the advantages and disadvantages of this procedure?

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Endoscopy
Adv = allows intervention/ biopsy during procedure
Disadv = invasive

What other investigation can be used for haematemesis (or lower GI bleed) whilst the patient is still bleeding?

- CT with IV contrast (NO oral contrast) | +/- angiography & intervention

Where can dysphagia originate? What is it caused by?

- Originates anywhere in pharynx / oesophagus / stomach - Caused by: - inflammation - tumour - extrinsic compression - benign lesion

How is dysphagia normally investigated?

- endoscopy

What other investigation can be used to assess dysphagia, particularly if patients arent suitable for an endoscopy?

- Fluoroscopic studies to assess oesophagus - Barium or water soluble contrast - Show FUNCTIONAL as well as ANATOMICAL / PATHOLOGICAL information

What symptoms all come under the heading "change in bowel habit"?

- increased/decreased frequency - change in form (Bristol Stool Chart) - PR bleeding - PR mucous

What is the first investigation that should be completed after a history which explains a change in bowel habit?

- PR examination

What radiological investigations can be used in a change of bowel habit?

- Barium enema (cheap and avilable, but misses 1/5 cancers) | - CT virtual Colonography (more expensive and higher radiation dose)

Why are radiological investigations used for a change in bowel habit?

They visualise further along the colon than a flexible sigmoidoscopy

If a patient is thought to potentially have IBD, what investigations are often used?

- Sigmoid/Colonoscopy - If small bowel disease suspected then Fluoroscopic contrast studies => These may show strictures/ wall thickening/ fistulae

Where do strictures commonly occur in the small bowel? I.e. where should you pay extra attention to on the fluoroscopic studies?

Terminal Ileum

What scan can be used to assess if areas of inflammatory bowel disease are active?

Radio-labelled White Cell Scan - localises active inflammation - Liver, Spleen and Bladder normally have high uptake (appear black) whereas bowel appears white with low uptake - If colon appears black/ patchy, this indicates active inflammation

What is the main purpose of using radiological investigations in jaundiced patients?

- to determine HEPATIC vs POST-HEPATIC causes

What is the first line investigation for jaundice?

- US - Easily identifies dilated intra and/or extra-hepatic biliary tree - Less reliable at identifying cause

What is used to further investigate jaundice after a patient has had an ultrasound?

MRCP +/- ERCP

What is the main advantage of an MRCP/ERCP?

- any calculus or obstruction in bile ducts can be removed or stented at the time of ERCP

How do liver metastases appear on US?

- Multiple hypoechoic, but solid liver lesions - Varying sizes - Some with a ‘target’ appearance

If metastases are found in the liver, what radiological investigation is done next and why?

- CT | - to find primary lesion if unknown

GI Imaging Flashcards

(41 cards)