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56 Cards in this Set
- Front
- Back
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What do yo ulook for in abdominal xray
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Gas pattern
Extraluminal air Soft tissue masses Calcifications |
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key to bowel identificaiton
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fold pattern:
jejunum: no indented serosa; circular folds (Valvulate conniventes) colon: haustra ileum: no indented serosa |
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Normal gas pattern:
Stomach -- Small Bowel -- -- Large Bowel -- |
Normal gas pattern:
Stomach Always Small Bowel Two or three loops of non-distended bowel Normal diameter = 2.5 cm = 1 US quarter Large Bowel In rectum or sigmoid – almost always |
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When are Fluid Levels Normal
Stomach - Small Bowel -- Large Bowel -- |
When are Fluid Levels Normal
Stomach Always (except supine film) Small Bowel Two or three levels possible Large Bowel None normally |
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Large vs. Small bowel
Large Bowel Peripheral Haustral markings _____ extend from wall to wall Small Bowel Central Valvulae extend ______ lumen Maximum diameter of 2" |
Large Bowel
Peripheral Haustral markings don't extend from wall to wall Small Bowel Central Valvulae extend across lumen Maximum diameter of 2" |
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Complete Abdomen
Acute Abdomen Series What does it include |
Supine Abdomen film (AP)
Erect or left decubitus film Chest - erect or supine film Prone (PA) or lateral rectum film |
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Why get a chest x ray
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easier to see air under diaphragm
pneumonia often presents with abdominal pain |
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Complete Abdomen Supine
What are you looking for? |
Looking for
Scout film for gas pattern Calcifications Soft tissue masses Substitute – none |
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Complete Abdomen Prone
What are you looking for? |
Looking for
Gas in rectum/sigmoid Gas in ascending and descending colon Substitute – lateral rectum |
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Complete Abdomen Erect
What are you looking for? |
Looking for
Free air Air-fluid levels Substitute – left lateral decubitus |
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Erect or Lateral Decubitus film
Patient should lie on side or be upright for at least 10 minutes WHY |
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Complete Abdomen Erect Chest
what are you looking for? |
Looking for
Free air Pneumonia at bases Pleural effusions Substitute – supine chest |
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What does it mean when you see free air under right hemidiaphragm?
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perforated viscus
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Ileus (Abnormal ___ Pattern)
Adynamic Dynamic |
Ileus (Abnormal Gas Pattern)
Adynamic Dynamic |
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Bed ridden patients tend to have _____ ileus (adynamic)
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functional
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Functional Ileus (adynamic)
Localized (________ Loops) Generalized adynamic ileus (paralytic) |
Functional Ileus (adynamic)
Localized (Sentinel Loops) Generalized adynamic ileus (paralytic) |
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Mechanical Obstruction (_______)
SBO LBO |
Mechanical Obstruction (dynamic)
SBO LBO |
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WHEN YOU IDENTIFY AN ABNORMAL AMOUNT OF GAS WITHIN THE BOWEL ALWAYS FOLLOW THE COURSE OF THE GAS UNTIL YOU INDENTIFY IT’S MOST ______ POINT!!
THAT WILL USUALLY BE THE ORIGIN OF THE ___________, IF ONE IS PRESENT |
WHEN YOU IDENTIFY AN ABNORMAL AMOUNT OF GAS WITHIN THE BOWEL ALWAYS FOLLOW THE COURSE OF THE GAS UNTIL YOU INDENTIFY IT’S MOST DISTAL POINT!!
THAT WILL USUALLY BE THE ORIGIN OF THE OBSTRUCTION, IF ONE IS PRESENT |
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Localized Ileus Pitfalls
May resemble early __________ ___ Clinical course Get follow-up |
Localized Ileus Pitfalls
May resemble early mechanical SBO Clinical course Get follow-up |
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Generalized Ileus Key Features
Gas in dilated small bowel and large bowel to rectum ____ air-fluid levels Usually only _______ patients have generalized ileus |
Generalized Ileus Key Features
Gas in dilated small bowel and large bowel to rectum Long air-fluid levels Usually only post-op patients have generalized ileus |
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Functional Ileus (adynamic)
Localized (________ Loops) Generalized adynamic ileus (paralytic) |
Functional Ileus (adynamic)
Localized (Sentinel Loops) Generalized adynamic ileus (paralytic) |
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Mechanical Obstruction (_______)
SBO LBO |
Mechanical Obstruction (dynamic)
SBO LBO |
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WHEN YOU IDENTIFY AN ABNORMAL AMOUNT OF GAS WITHIN THE BOWEL ALWAYS FOLLOW THE COURSE OF THE GAS UNTIL YOU INDENTIFY IT’S MOST ______ POINT!!
THAT WILL USUALLY BE THE ORIGIN OF THE ___________, IF ONE IS PRESENT |
WHEN YOU IDENTIFY AN ABNORMAL AMOUNT OF GAS WITHIN THE BOWEL ALWAYS FOLLOW THE COURSE OF THE GAS UNTIL YOU INDENTIFY IT’S MOST DISTAL POINT!!
THAT WILL USUALLY BE THE ORIGIN OF THE OBSTRUCTION, IF ONE IS PRESENT |
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Localized Ileus Pitfalls
May resemble early __________ ___ Clinical course Get follow-up |
Localized Ileus Pitfalls
May resemble early mechanical SBO Clinical course Get follow-up |
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Generalized Ileus Key Features
Gas in dilated small bowel and large bowel to rectum ____ air-fluid levels Usually only _______ patients have generalized ileus |
Generalized Ileus Key Features
Gas in dilated small bowel and large bowel to rectum Long air-fluid levels Usually only post-op patients have generalized ileus |
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Mechanical SBO Key Features
Dilated small bowel Little gas in colon, especially rectum Key: disproportionate __________ of __ |
Mechanical SBO Key Features
Dilated small bowel Little gas in colon, especially rectum Key: disproportionate dilatation of SB |
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Mechanical SBO Causes
A________ H_____* V_______ _________ ileus* In_____________ *Cause may be visible on plain film (Tumors rare) |
Mechanical SBO Causes
Adhesions Hernia* Volvulus Gallstone ileus* Intussusception *Cause may be visible on plain film (Tumors rare) |
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Mechanical SBO Pitfalls
Early SBO may resemble _________ _____ -get follow up |
Mechanical SBO Pitfalls
Early SBO may resemble localized ileus -get follow up |
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Mechanical LBO Key Features
Dilated colon to point of obstruction ______ or __ air in rectum/sigmoid ______ or __ gas in small bowel, if… _________ valve remains competent |
Mechanical LBO Key Features
Dilated colon to point of obstruction Little or no air in rectum/sigmoid Little or no gas in small bowel, if… Ileocecal valve remains competent |
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Mechanical LBO Causes
T____ Volvulus Hernia Diverticulitis Intussusception |
Mechanical LBO Causes
Tumor Volvulus Hernia Diverticulitis Intussusception |
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Pneumotosis Intestinalis
Air in the bowel ____ Stomach – usually o__________ SB - usually i_______ LB – usually b______ _______osis cyst_____ intestinalis |
Pneumotosis Intestinalis
Air in the bowel wall Stomach – usually obstruction SB - usually ischemia LB – usually benign pneumatosis cystoides intestinalis |
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Signs of Free Air
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Air beneath diaphragm
Both sides of bowel wall Falciform ligament sign |
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Air on both sides of bowel wall – ________ Sign
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Air on both sides of bowel wall – Rigler’s Sign
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Free Air Causes
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Rupture of a hollow viscus
Perforated ulcer Perforated diverticulitis Perforated carcinoma Trauma or instrumentation Post-op 5–7 days NOT perforated appendix |
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Which radiograph position is worst for SENSITIVITY OF IMAGING STUDIES For Free Intraperitoneal Air
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SUPINE ABDOMEN RADIOGRAPH poor
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Are plain films good for imaging Hepatosplenomegaly ?
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Plain films poor for judging liver size
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ASCITES
Uniform ____ness to abdomen _______ placement of bowel loops Separation of adjacent loops Loss of definition of the liver and/or spleen edge Medial displacement of ascending and descending colon Bulging flanks |
ASCITES
Uniform grayness to abdomen Central placement of bowel loops Separation of adjacent loops Loss of definition of the liver and/or spleen edge Medial displacement of ascending and descending colon Bulging flanks |
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Abdominal calcifications produce one of four major patterns:
R__-like Linear or _____-like Lamellar _____like |
Abdominal calcifications produce one of four major patterns:
Rim-like Linear or track-like Lamellar Cloudlike |
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Rim-like
C____ Renal c___ An_______ Aortic an______ Saccular organs e.g. GB Porcelain ___________ |
Rim-like
Cysts Renal cyst Aneurysms Aortic aneurysm Saccular organs e.g. GB Porcelain Gallbladder |
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Linear or Track-like
Walls of a ____ Ureters Arterial _____ |
Linear or Track-like
Walls of a tube Ureters Arterial walls |
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Lamellar or Laminar
Formed in lumen of a hollow viscus Renal s_____ Gall______ Bladder _______ |
Lamellar or Laminar
Formed in lumen of a hollow viscus Renal stones Gallstones Bladder stones |
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Cloudlike, Amorphous, Popcorn
Formed in a _____ organ or tumor Leiomyomas of uterus Ovarian cystadenomas Pancreatic calcifications |
Cloudlike, Amorphous, Popcorn
Formed in a solid organ or tumor Leiomyomas of uterus Ovarian cystadenomas Pancreatic calcifications |
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indentations are from what when imaging the esophagus
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Aorta
Left mainstem bronchus gastroesophageal junction |
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Schatzki ring ?
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Schatzki ring is smooth, symmetric, ringlike constriction in distal esophagus directly above a hiatal hernia
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what are abnormal esophageal contractions
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tertiary
( primary and secondary are normal) |
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Presbyesophagus ?
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As a function of aging, tertiary deep contractions may develop within the esophagus
No specific therapy |
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Hiatal Hernia TYPES
_______ Most common type _____________ Rare |
Hiatal Hernia TYPES
SLIDING Most common type PARAESOPHAGEAL Rare |
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Reflux Esophagitis
About 5% of western population “Causes heartburn” Incompetent ___ ______ _______ _________ |
Reflux Esophagitis
About 5% of western population “Causes heartburn” Incompetent LES (lower esophageal sphincter) |
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Infectious Esophagitis:
H_____________ C______ C__ |
Infectious Esophagitis:
Herpes Simplex Candida CMV |
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Achalasia
Secondary to degeneration of the _________ (__________) plexus causing failure of the ___ to relax |
Achalasia
Secondary to degeneration of the Myenteric (Auerbach’s) plexus causing failure of the LES to relax |
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Causes of Esophageal Ulcers
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Reflux
Infectious (HIV) CMV, Candida Drug induced Barrett’s |
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A metaplastic disorder in which specialized columnar epithelium replaces healthy squamous epithelium.
(more protective from acid) |
Barrett Esophagus (BE)
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___________ the most common cause or precursor of esophageal carcinoma
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Barrett metaplasia is
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BE is an acquired condition, secondary to chronic ________________ ______ (___) damage to the esophageal mucosa
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BE is an acquired condition, secondary to chronic gastroesophageal reflux (GER) damage to the esophageal mucosa
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Imaging Findings of Barrett's
Deep penetrating ulcer, or reticular mucosal surface pattern ________ esophageal stricture Stricture formation usually accompanies the ulceration. At times, no ulceration is evident, and only a smooth, tapered stricture is present. |
Imaging Findings of Barrett's
Deep penetrating ulcer, or reticular mucosal surface pattern Proximal esophageal stricture Stricture formation usually accompanies the ulceration. At times, no ulceration is evident, and only a smooth, tapered stricture is present. |
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What do you worry about with Distal Esophageal Stricture
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Peptic strictures
Barrett’s Carcinoma a. Gastric,esophageal Achalasia |
