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31 Cards in this Set
- Front
- Back
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Abdominal Radiograph is also known as...
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-"Flat plate"
-"KUB" - Kidney's Ureters bladder |
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Why is Metal/Calcim important for GI radiographs?
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-calcium deposits --> kidney stones
-sometimes gallstones |
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Why is water/soft tissue density important for GI radiographs?
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-can show if pt has ascites, hepatosplenomegaly, or other masses
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***Air on a abdominal radiograph can be which 2 places?
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1. Intraluminal (inside the colon) this is good, and a good way to see if something bad is happening
2. Extraluminal - free air (very very bad) this is always ABNORMAL |
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Intraluminal air: "Bowel Gas Pattern"
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-this is normal
-allows the small and large colon to appear on radigraphs bc the air density is different than the density of soft tissue -allows you to look at 3 things: diameter, fold pattern, and location |
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***Diameter rule of 3s
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1. Small intestine is 3 cm or less
2. Colon should be 6 cm or less 3. Cecum should appear 9 cm or less |
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***What is the Hallmark sign of Obstruction on a radiograph
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-think of a firehose, if there is a kink, there will be dilation proximally and flattening and collapse distally
-this is the same for the intestinal tract: dilation proximal and sudden transition point where the tract collapses |
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Fold patterns
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1. Small bowel looks more like a train track appearance, the folds cross the entire lumen and are visible
2. Colon has haustral folds, these folds should not transect the entire lumen, they appear chunky |
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***What 2 things could Extraluminal air mean (both are abnormal findings, bc extraluminal air is always abnormal)?
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1. Post operative surgery (Ditchek always checks pts history for surgery to rule this out if he sees extraluminal air bc if not it has to be...)
2. Perforation |
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What are examples of localized extraluminal air?
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-abscess
-diverticulitis -pneumobilia -pneumatosis |
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Example #1 of how you can find extraluminal air radiographically
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-2 views: one supine, other lateral decubitus
-if there is free air you will see it float to the top and try to escape in the lateral decubitus view |
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Example #2 of how you can find extraluminal air radiographically
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-have pt sit up and take an xray
-air will push up on the diaphragm -this is a medical emergency and a surgeon needs to be called right away |
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Example #3 of how you can find extraluminal air radiographically
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if you get a flat plate for a pt (1 AP view of the abdomen laying down) there aren't multiple views, you can't reposition the pt to see the gas rise up
-but you can look at the intestines, if you see the actual wall of the intestine as a traceable line you know there is air in there!!! |
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What is the fluid interface rule?***
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-you can only see lines on radiographs when 2 different densities are touching
-if there is air inside the intestine, you have the intestinal wall, you have air outside the intestine--> you can literally trace the wall of the intestine as it snakes through the abdomen |
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What are the 2 types of GI Fluroscopy?
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1. Barium Swallow: Esophagram, video esophagram, upper GI series, small bowel series, enteroclysis
2. Contrast enema: Barium or water soluble (Gastrografin) |
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***To evaluate the lumen what contrast Barium swallow do you give?
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-Single Contrast
-this is simply administering barium and see how it fills the lumen of the GI tract -allows you to see lumen problems such as strictures, obstruction, outpouching, masses |
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***To evaluate the mucosa what contrast Barium swallow do you give?
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-Double contrast
-when you make them swallow gas pills, tell them not to burp, and then give them barium -this distends the lumen and coats the mucosa allowing you to see ulcerations, inflammation and polyps |
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Esophagram Technique
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1. Scout film (before contrast)
2. Double contrast (effervescent granules + thick barium = mucosal coating 3. Single contrast (thin barium = distended lumen) 4. Real time eval: motility, GE reflux, barium pill |
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***What barium test should you use to evaluate esophageal polyps?
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-Double contrast
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***What barium test should you use to evaluate esophageal strictures?
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-single contrast (strictures are a closing off of the lumen, so a single contrast will let you evaluate a narrowed lumne
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What are the major difference for stomach and SB fluroscopy when compare to the esophagus?
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-don't let patient eat or drink after midnight, food will show up as a dark spot and could be confused w/ a patho finding
-may need to spin pt around for the stomach and SB to get barium and air where you want it, may take several hours |
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Contrast enema
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-approaching the GI from the backdoor
-can use the enema to screen for any kind of colon problem (no food for 24 hours before and need to give a laxative to clear pt out) |
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What are the 2 types of contrast
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1. Barium
2. Water soluble: this is what you wanna use if you suspect perforation -having a ton of barium floating around the peritoneal cavity is not ideal |
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***What types of things do find with contrast studies?
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-polyps, diverticula
-***Bird's beak image in an enema isn't achalasia, but is a HALLMARK sign of a VOLVULUS -apple core or napkin ring lesion is likely colon CA |
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What is an Upper GI series?
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-includes esophagram
-plus stomach and duodenum in single and double contrast -Indications: epigastric pain, r/o gastric or duodenal ulcer, gastric outlet obstruction |
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What is a small bowel series?
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-can be done after UGIS ("SB follow-through") or just as a SB series
-2 cups of barium (single contrast), serial overhead and fluroscopic images until contrast in the colon, may take several hours |
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What are the indications for a SBS?
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-abd pain
-r/o IBD (Crohn's) -malabsorption -GI bleed -intestinal obstruction (now CT scan) |
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What are indications for Barium enema?
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-screening for polyps, colon cancer
-evaluate IBD -large bowel obstruction |
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When imaging the intestinal/peritoneal cavity using a CT scan of the abdomen and pelvis you want to make sure you...
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-use contrast
-you can easily pic up the appendix on a CT scan w/ contrast--> see if it's enlarged, inflamed, or blocked by a stone -can also pic up diverticulitis |
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What else can be seen on a CT scan of the abdomen and pelvis?
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-intestinal obstruction
-GI perforation/pneumoperitoneum -enteritis, colitis, tumors -free fluid vs collected fluid -post op complications |
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Ultrasound and the GI tract?
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-isn't great because of the air but it is the imaging modality of choice for gallstones
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