What do abdominal x-rays show? When are they used?
- readily available
- often used for urgent investigation
- shows gas in abnormal places or in abnormal acts: may need upright and lateral decubitus films as well as flat plates
- can show stones and metallic fbs as well: kidney and gall bladder stones
- solid organs can be seen but not as well: can see better CT or US
Indications of abdominal x-ray? Non-indications?
- suspected bowel obstruction/perforation
- suspected intussusception
- fbs
- suspected abdominal mass
- blunt abdominal trauma
non-indications:
- vague central abdominal pain
- gastroenteritis
- haematemesis
Normal distribution of gas in the bowel?
small bowel:
- intraluminal gas usually minimal
- centrally located
- numerous tight loops of small diameter (2.5-3.5 cm)
- valvulae conniventes (stack of coins)
large bowel:
- mix of gas and feces
- loops large in diameter (3-5 cm)
- haustra
abnormal findings of gas and bowel?
- dilated loops
- air fluid levels on erect film
- intramural gas
- intraperitoneal gas
- extraperitoneal gas
When do we see ileus?
- after abdominal surgery
- bowel goes to sleep after surgery
What is an upper GI series?
- barium swallow
- uses plain fim x-ray and fluoroscopy (real time xray)
- 2 types: std barium upper GI series, double contrast upper GI series
- looks at esophagus, stomach and duodenum
Indications and CIs for upper GI series?
- indications: dysphagia GERD assessment of hiatial hernia strictures - CIs: intestinal obstruction esophageal perforation or rupture is suspected pregnant women individuals with poor swallowing reflex (aspiration) - risk: constipation
Indications for small bowel follow through (part of upper GI series)?
- crohns
- tumors
- unexplained abdominal pain
What is lower GI study? Indications, and risks?
- barium enema
- evaluates the colon: barium enema, and air contrast (double contrast) enema
- indications:
colon cancer (apple core)
dx/monitor UC or crohn’s disease
dx blood in stool, megacolon, constipation, diverticulitis, fistulas - risk:
pregnant women
colon perforation
Use of Abdominal CT? Indications?
Downside?
-sensitive method to dx abdominal diseases (also good look at lymph nodes)
- freq used to stage and follow cancer
-indications:
pts with jaundice
pancreatic disease
hepatic metastases
- shows abdominal wall - localize hernias
- dilute contrast may be used to augment the scan
- downside: expensive, high doses of radiation
When is hepatobiliary scintigraphy (HIDA scan/cholescintigraphy) used?
- in dx of problems with liver, gallbladder, or bile ducts
- radio-isotope is taken up in the liver and secreted into bile
- indications:
cholecystitis
bile duct obstruction
assessment for liver transplant
How is an abdominal U/S performed? dependent on?
preferred imaging for what?
- sound waves to visualize internal organs thru abd. wall
- can be combined with endoscopy, visualize structure in hollow organs
- can be performed quickly at bedside, no radiation, inexpensive: imaging occurs real time w/o need for sedation
influence of movements can be assessed quickly - hampered by fat and air
- operator dependent
- limited sensitivity
- preferred imaging for RUQ pain
- useful in eval of unstable trauma pt: FAST - shows intraperitoneal fluid and also hemopericardium
- abdominal and chest CT provides more definitive info
EGD use?
- can visualize esophagus to duodenum
- high def white light endoscope
- minimally invasive with quick recovery: usually done under conscious or moderate sedation, most pts have a sore throat after
Indications and CIs to endoscopy?
indications:
- signs and sxs of upper GI disease
- surveillance for upper GI cancer in high risk settings
- bx
- therapeutic intervention
CIs:
possible perforation
medically unstable/unwilling pts
anticoag
relative CIs:
pharyngeal diverticulum
head or neck surgery
Indications and CIs to capsule endoscopy?
indications:
- obscure GI bleeding
- IBD
- small bowel polyps and tumors
- celiac disease
CIs:
swallowing d/o
SBO/stenosis
problems with this: short batter life (delayed digestion - battery will die)
- pt swallows pill containing camera, able to cover areas of small bowel that are not reachable by endoscopy
Pros and cons to flexible sigmoidoscopy?
Pros:
- may be done in office
- inexpensive, cost-effective
- rduces deaths from rectal cancer
- easier bowel prep, rarely needs sedation
cons:
- detects only half of polyps
- misses 40-50% of cancers located beyond view of sigmoidoscope
- often limited by discomfort, and poor bowel prep
Indications and CIs of flexible sigmoidoscopy?
indications:
- screening test
- blood in stool
- eval of colon
- medical management of colitis
CIs:
- bowel perf
- acute diverticulitis
- active peritonitis
Colonoscopy used to visualize?
- rectum, colon, and distal ileum
- high def white light colonoscopy
- requires bowel prep
- uses, complications similar to upper GI endoscopy:
complications rare in dx colonoscopy - can have bleeding, perforation, with polypectomy
Indications and CIs to colonoscopy?
indications:
- screening
- eval
- f/u colorectal cancer
CIs: - pregnancy - relative contra: colonic perf toxic megacolon IBD with ulceration
What is endoscopic retrograde cholangiopancreatography (ERCP)?
- technique that uses combo of luminal endoscopy and fluoroscopic imaging to dx and tx conditions assoc with pancreatobiliary system
Indications and CIs for ERCP?
indications:
- biliary disease - assessment and tx of biliary obstruction secondary to choledocholithiasis, tx of choledocholithiasis during cholecystectomy after intraop cholangiography, assessment and tx of bile duct strictures
- pancreatic disease: assess and tx acute pancreatitis, strictures, pancreatic duct stones, tx of pseudocyst and malignancies
CIs:
- refusal
- unstable cardiopulmonary, neurologic, or CV status
- existing bowel perf
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Intro to GI49
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Physiology77
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Imaging21
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Esophageal disorders55
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Constipation and Diarrhea40
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GI lab assessment29
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small bowel disorders30
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Anorectal disease65
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GI health maintenance34
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GI pharm: esophagus, stomach, and duodenum34
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GI pharm: antemetics, diarrhea, constipation53
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Stomach and duodenum diseases68
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Pancreatic Disorders23
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IBD and IBS47
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Gallbladder and Biliary tract disorders60
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Bariatric surgery44
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GI bleeding33
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Ischemic bowel disease45
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GI neoplasms73
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Hepatitis and Cirrhosis97
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GI pharm - large bowel56
