When do you get an acute abdominal series?
Pt with abdominal pain, distension, diminished or absent bowel sounds with our without guarding or rebound
What are acute abdominal series useful for identifying?
Air under diaphragm, obstruction, fractures, nasogastric tube placements
What are the advantages to AAS?
readily available no prep no need for consent
What is pneumoperitoneum?
Free air under diaphragm on upright chest film suggesting presence of bowel perforation and associated peritonitis
What do solids and liquids look like on US?
Solids are white and liquids are blackc
What is US “all about”?
Size shape inflammation and stones
Advantages to US?
Quick and readily available. Also safe as there is no ionizing radiation
What is the disadvantage to US?
Bowel gas
When do you order US?
- RUQ pain suspected gallstoness or gallbladder disease
- Pancreatitis
- RLQ/appendix
- Ovarian mass via pelvic or transvaginal US
- Testicular mass or torsion
- Pregnancy
- Kidney dysfunction, elevated creatinine, palpable mass, painless hematuria
- Bladder scan especially if incontinence afte voiding (enlarged prostate)
What is a HIDA scan?
- Nuclear tagged material injected IV taken up by hepatocytes and excreted into gallbladder. Evaluates GB function!
- Failure of GB to fill may be caused by acute cholecystitis or cholelithaisis
- avoid in pregnancy
What is HIDA with CCK?
- HIDA scan modified to assess GB function
- inject nuclear tagged material
- watch for filling of GB
- Inject with CCK to stimulate GB to expel bile
- If the ejection fracction is <35-40% it is abnormal
Disadv. is ab cramping and long time
Adv. is ID GB dysfxn with no evidence of sludge or stones
What is Zenker’s diverticula?
- Progressive dysphagia in older adults
- Sx: halitosis, mass in neck, regurgitation of food,
- ROS: unintentional weight loss and malnutrition
- Barium Swallow
What is CT NOT good for?
- mucosal disease
- ulcers
- small neoplasms
What does oral contrast CT allow us to look for?
- Large intraluminal mass
- Tickening of walls of hollow organs
- Evaluation of tumor stages
- Specific locations of obstruction
- ID’s perforation location
Controversy surrounds need for consent secondary to the radiation doses with CT
Adv and disadv to CT?
Adv:
- readily available
- fast
- non invase
- no consent
Disadv.:
- high does radiation
- allergic rxn to contrast (shellfish allergy)
When do you order CT Abd and Pelvis w/o contrast?
- Trauma
- Sudden onsent unilateral flank pain radiating to groin, N/Vm hematuria, pain waxes wanes,
- Test of choicce for renal lithiasis
- unless pregnant, then renal or bladder US w/ or w/o KUB
Prep for EDG?
Nothing to eat after midnight, clear liquids until 2 hrs prior
Indications for EDG?
- dysphagia
- odynophagia
- UGIB
- GERD
- Feeding tube placement
Colonoscopy?
- Clean out colon with laxatives
- start 4-6 hours before bed limit to clear liquids
- light conscious sedation
- endoscope insert via rectum, air to inflate colon so surface is visible
- Cancer screen, rectal bleeding, surveillance
Cystoscopy indications?
- painless hematuria
- kidney or bladder stones
- recurrent UTI and urinary obstruction
