Term
| What is a functional ileus? |
|
Definition
| -A main category in which it is presumed that one or more loops of bowel lose their ability to propagate peristaltic waves of the bowel. Usually due to some local irritation or inflammation, and hence causes a functional type of obstruction proximal to the affected loops. |
|
|
Term
| What are the two types of functional ileus? Describe each type. |
|
Definition
Localized ileus= focus of bowel loses peristalsis; loops of bowel proximal to the abnormally functioning bowel dilate. \
Generalized ileus= the entire bowel loses functionality/ability to peristalse; multiple dilated loops of small bowel |
|
|
Term
| What is a mechanical obstruction? What are the two types? |
|
Definition
-a physical, organic, obstructing lesion prevents the passage of intestinal content past the point of either the small or large bowel blockage. There is dilatation proximal to the obstruction and collapse distal to it.
-two types are SBO and LBO |
|
|
Term
| Describe if there is air seen in the rectum or sigmoid, air in the small bowel, and air in the large bowel in a normal bowel. |
|
Definition
-Yes air in rectum or sigmoid
-Yes, 1-2 loops of air in the SB
-Air in LB in rectum and/or sigmoid |
|
|
Term
| Describe if there is air seen in the rectum or sigmoid, air in the small bowel, and air in the large bowel in a localized ileus. |
|
Definition
-Yes air in rectum or sigmoid
-2-3 distended loops in SB
-Air in LB in rectum and/or sigmoid
**because a functional ileus does not produce the degree of obstruction that a mechanical obstruction does, some gas continues to pass through the defunctionalized bowel past the point of the localized ileus |
|
|
Term
| Describe if there is air seen in the rectum or sigmoid, air in the small bowel, and air in the large bowel in a adynamic/generalized ileus. |
|
Definition
-Yes air in rectum or sigmoid
-Multiple distended loops of SB
-Distended LB |
|
|
Term
| Describe if there is air seen in the rectum or sigmoid, air in the small bowel, and air in the large bowel in a SBO. |
|
Definition
-No air in rectum or sigmoid
-Multiple dilated loops of SB
-no air in LB |
|
|
Term
| Describe if there is air seen in the rectum or sigmoid, air in the small bowel, and air in the large bowel in a LBO. |
|
Definition
-No air in rectum or sigmoid
-No air in SB unless ileocecal valve is incompetent
-LB is dilated |
|
|
Term
| It is difficult to distinguish between a generalized ileus and an SBO- what is a difference? |
|
Definition
| there is no air in the large bowel for an SBO |
|
|
Term
| Loops __________ to the obstruction soon become dilated with air and/or fluid. |
|
Definition
|
|
Term
| Peristalsis will continue in an attempt to propel intestinal contents through the bowel, what is the exception? |
|
Definition
| in the loops of bowel involved in a functional ileus- they will not continue to peristalse |
|
|
Term
| Loops _______ to an obstruction will eventually become decompressed or airless, as their contents are evacuated. |
|
Definition
|
|
Term
| In a mechanical obstruction, the loop(s) that will become the most dilated will either be what two loops? |
|
Definition
| the loop of bowel with the largest resting diameter before the onset of the obstruction (e.g., the cecum in the large bowel), or the loop(s) of bowel just proximal to the obstruction. |
|
|
Term
| Prolonged obstruction with persistently elevated intraluminal pressures can lead to what three things in the affected bowel loop? |
|
Definition
| vascular compromise, necrosis and perforation |
|
|
Term
| In localized ileus there are 2-3 persistently dilated loops of bowel, how can you determine this by imaging? |
|
Definition
| the same loops of bowel will be dilated (>3cm) on multiple views |
|
|
Term
| Is air present in the rectum in localized ileus? |
|
Definition
|
|
Term
| Localized ileus is usually caused by local inflammation, name 4 possible causes according to quadrant. |
|
Definition
1. RUQ- cholecystitis
2. LUQ- pancreatitis
3. RLQ- appendicitis
4. LLQ- diverticulitis |
|
|
Term
| in an adynamic ileus the entire bowel is aperistaltic, resulting in what? |
|
Definition
| air and fluid filled dilated loops of SB and LB |
|
|
Term
| is air present in the rectum in adynamic ileus |
|
Definition
|
|
Term
| What is almost always the cause of adynamic ileus? |
|
Definition
| recent abdominopelvic surgery |
|
|
Term
|
Definition
| dilated, fluid-filled loops of SB with multiple stacked loops of SB. Many air fluid levels on an upright/decubitus film |
|
|
Term
| Describe the LB in an SBO, is there air in the sigmoid/rectum? |
|
Definition
-decompressed large bowel and distal small bowel
-classically, no air in sigmoid/rectum |
|
|
Term
| What is the #1 cause of SBO? |
|
Definition
| adhesions from previous surg |
|
|
Term
| What are 4 benefits of getting a CT in SBO? |
|
Definition
-bowel ischemia- pneumatosis (air in bowel wall), increased or decreased bowel wall enhancement (with IV contrast)
-perforation/pneumoperitoneum
-identify cause and location of obstruction
-better at differentiating partial from complete obstruction |
|
|
Term
| what is the small bowel feces sign? |
|
Definition
| proximal to the transition point of a SBO, intestinal debris and fluid may accumulate producing the appearance of fecal material in the small bowel |
|
|
Term
| What is a closed loop obstruction? What is the usual shape? What is it at higher risk for? What is the usual cause? |
|
Definition
-two points of the same loop of bowel are obstructed at one point
-usually U or C shaped
-higher risk for strangulation (vascular compromise of bowel loop predisposing to ischemia and infarction)
-usually caused by adhesions |
|
|
Term
| In an LBO, there is usually _______ colon proximal to obstructing lesion and _______ rectum and large bowel distal to obstruction. What part is usually most dilated? What does the SBO look like? |
|
Definition
dilated
decompressed
Cecum- at risk for perforation at 12-15 cm in diameter
No SB dilatation unless ileocecal valve is incompetent |
|
|
Term
| What is the #1 cause of LBO? the following 3? |
|
Definition
1. cancer
2. volvulus
3. hernia
4. diverticulitis |
|
|
Term
| What is a volvulus? what does it look like on radiograph? how is treated/diagnosed? |
|
Definition
-sigmoid colon or cecum twists on itself resulting in obstruction
-large mass with kidney bean shape in LLQ (sigmoid volvulus) or midabdomen (cecal volvulus)
-can be tx and dx with air contrast enema |
|
|
Term
| What is Ogilvie's syndrome? What are 5 causes? |
|
Definition
-loss of peristalsis of LB resulting in massive LB dilatation
-anticholinergics, narcotics, electrolyte imbalances, recent surg, infections |
|
|
Term
| What is the best study for acute onset flank pain- suspicion of stone disease? |
|
Definition
| CT abdomen and pelvis without contrast |
|
|
Term
| What are the 2 best studies for recurrent symptoms of stone dz? |
|
Definition
CT abdomen and pelvis without contrast
US kidneys and bladder retroperitoneal with Doppler and KUB |
|
|
Term
| What is the best study for acute pyelnephritis in an uncomplicated pt? |
|
Definition
| trick question- do nothing, just give abx! |
|
|
Term
| What are the two best studies for acute pyelonephritis in a complicated patient (i.e. DM, IC, hx or stones of prior surg, not responding to therapy)? |
|
Definition
| CT abdomen and pelvis with and w/o contrast |
|
|
Term
| What is the best study for hematuria in all pt's, except those with generalized renal parenchymal dz or young females with hemorrhagic cystitis? |
|
Definition
| CT abdomen and pelvis without and with contrast (CT urography) |
|
|
Term
| What is the best study for a patient with hematuria due to generalized renal parenchymal dz? |
|
Definition
| US kidney and bladder retroperitoneal |
|
|
Term
| What is the best study for indeterminate renal masses? |
|
Definition
| CT abdomen without and with contrast |
|
|
Term
| What is the best study for recurrent lower UTI in women with no underlying risk factors? |
|
Definition
| MANY! all rated as 2. Top three in the list--> CT abdomen and pelvis with and without contrast, Xray abdomen, CT abdomen and pelvis without contrast |
|
|
Term
| What is the best study for renal failure, acute and unspecified? |
|
Definition
| US kidneys and bladder retroperitoneal |
|
|
Term
| What are the 3 best study for incidentally discovered adrenal mall, no hx of malignancy, mass 1-4 cm in diameter, initial eval? |
|
Definition
-CT abdomen without contrast
-CT abdomen with and without contrast
-MIBG |
|
|
Term
| What are the 2 best study for incidentally discovered adrenal mass, no hx of malignancy, 1-4 cm in diam, follow up eval for indeterminate lesion on initial eval |
|
Definition
CT abdomen without contrast
MRI abdomen without contrast |
|
|
Term
| What are the 2 best study for incidentally discovered adrenal mass with no history of malignancy, mass >4cm in diameter |
|
Definition
ct abdomen with contrast
MRI abdomen without and with contrast |
|
|
Term
| what is the best study for pulsatile abdominal mass, suspected AAA |
|
Definition
|
|
Term
| What is the best study for acute (non localized) abdominal pain and fever or suspected abdominal abscess, postoperative patient with fever? |
|
Definition
| CT abdomen and pelvis with contrast |
|
|
Term
| What is the best study for postoperative patient with persistent fever and no abscess seen on CT scan within the last 7 days |
|
Definition
| CT abdomen and pelvis with contrast |
|
|
Term
| What is the best study for acute non localized abd pain and fever or suspected abdominal abscess paitent presenting with fever and no recent operation? |
|
Definition
| CT abd and pelvis with contrast |
|
|
Term
| What are the 2 best study for acute pancreatitis- etiology unknown, first episode of pancreatitis, abd pain, elevated amylase lipase, no fever or evidence of fluid loss at admission, clinical score pending. |
|
Definition
US abd
CT abd with contrast |
|
|
Term
| What are the 2 best study for severe abdominal pain, elevated amylase lipase, 48 hours later assuming no improvement or degradation (assume no prior imaging) |
|
Definition
Ct abd with contrast
MRI abd without and with contrast |
|
|
Term
| What is the best study for acute pancreatitis, severe abd pain, elevated amylase lipase, fever, and elevated WBC count? |
|
Definition
|
|
Term
| What is the best study for acute pancreatitis. severe abd pain, elevated amylase lipase, hemoconcentration, oliguria, tachycardia |
|
Definition
|
|
Term
| What is the best study for dysphagia- oropharyngeal dysphagia with an attributable cause? |
|
Definition
| Xray barium swallow modified |
|
|
Term
| What is the best study for unexplained oropharyngeal dysphagia? |
|
Definition
| Xray pharynx dynamic and static imaging |
|
|
Term
| What is the best study for retrosternal dysphagis in immunocompetent person? |
|
Definition
|
|
Term
| What is the best study for LLQ pain- suspected diverticultiis- typical clinical presentation for diverticulitis, suspected complications or atypical presentations? |
|
Definition
| ct abdomen and pelvis with contrast |
|
|
Term
| What is the best study for suspected SBO (suspected complete or high grade partial sbo) |
|
Definition
| ct abdomen and pelvis with contrast |
|
|
Term
| What are the 2 best study for suspected intermittent or low grade SBO? |
|
Definition
CT abdomen and pevis with contrast
MRI abdomen and pelvis without and with contrast |
|
|
Term
| What are the 2 best study for suspected liver mets (initial imaging test following detection of primary tumor) |
|
Definition
-CT abd with contrast
-MRI abdomen without and with contrast |
|
|
Term
| What is the best study for suspected liver mets- abnormal surveillance US, CT, or MRI in PVP; high suspicion of malignancy |
|
Definition
| mri abdomen without and with contrast |
|
|
Term
| What is the best study for suspected liver mets- abnormal surveillance US, CT, or MRI in PVP suggests but is not definitive for benign lesions? |
|
Definition
| mri abdomen without and with contrast |
|
|
Term
| What is pneumoperitoneum? pneumotosis intestinalis? pneumobilia? |
|
Definition
-air in peritoneum
-air in bowel wall
-air in biliary system |
|
|
Term
| What are three characteristics of pneumoperitoneum? |
|
Definition
-air under the diaphragm
-air around the falciform ligament
-Rigler's sign- air around both sides of the bowel wall |
|
|
Term
| What are the 9 intraperitoneal abdominal organs? |
|
Definition
-stomach
-1st and 4th part of duodenum
-jejunum
-ileum
-spleen
-liver
-transverse colon
-sigmoid colon |
|
|
Term
| how must the pt be positioned for air beneath the diaphragm in pneumoperitoneum to be seen? |
|
Definition
| -requires pt to be in the upright or left lateral decubitus position and a horizontal x-ray beam unless massive in amount |
|
|
Term
| What must be present for rigler's sign to be seen? |
|
Definition
-usually requires large amounts of free air
will be visible in any position |
|
|
Term
| what must be present for visualization of the falciform ligament to be seen in pneumoperitoneum? pt positioning? |
|
Definition
requires large amounts of free air
patient is usually supine |
|
|
Term
| what is the most common cause of pneumoperitoneum? |
|
Definition
| iatrogenic (surg) persists 5-7 days |
|
|
Term
| what is chliaiditi syndrome? |
|
Definition
| when the colon is interposed between the dome of the liver and the right hemidiaphragm and may be mistaken for free air |
|
|
Term
| describe retroperitoneal air |
|
Definition
-linear hypodensities outlining retroperitoneal structures (psoas, kidneys, bladder, ureteres, aorta, IVC)
-mottled, blotchy appearance usually involving the anterior pararenal space |
|
|
Term
| Give 5 possible causes of pneumoretroperitoneum |
|
Definition
-ruptured appendix
-bowel perforation (A/D colon or rectum)
-trauma
-perforated diverticulitis
-iatrogenic (colonoscopy) |
|
|
Term
| what is seen when air is seen en profile with pneumotosis |
|
Definition
| linear radiolucency paralleling the contour of air in the adjacent bowel lumen |
|
|
Term
| What is the appearance of pneumotosis that may occur in an area of the abdomen not expected to contain colon? |
|
Definition
| mottled appearance that resembles air mixed with fecal matter |
|
|
Term
| In pneumotosis you may see globular, cystlike collections of air that parallel the contour of the bowel- what is this? |
|
Definition
| it is unusual but benign condition that usually affects the left side of the colon |
|
|
Term
| What is the primary form of pneumotosis? what are 3 other causes? |
|
Definition
pneumotosis cystoides intestinalis
-necrotizing enterocolitis, ischemic bowel disease, COPD |
|
|
Term
| what are tubelike, branching lucency's in the RUQ overlying the liver? |
|
Definition
|
|
Term
| differentiate pneumobilia from portal venous air? |
|
Definition
| they are tubular structures that are central in location and few in number. portal venous air is peripheral in location and fills innumerable vessels |
|
|
Term
| gas in the lumen of the ___________ is also a sign of pneumobilia |
|
Definition
|
|
Term
| What are 4 causes of pneumobilia? |
|
Definition
-incompetent sphincter of Oddi
-sphincterotomy used to open sphincter and allow biliary stones to pass into small bowel
-reimplantation of the common bile duct (ex: choledochejejunostomy)
-gallstone ileus - gallstone erodes through the gallbladder and into adjacent small or large bowel; can cause small bowel or colonic obstruction |
|
|
Term
| what did EJ say was the most common cause of pneumobilia during lecture? |
|
Definition
|
|
Term
| What is the biggest cause of portal venous gas that EJ said to know? |
|
Definition
|
|
Term
| What are three characteristics of portal venous gas? |
|
Definition
-extends to within 2 cm of the liver periphery (pneumobilia is more central!)
-smaller individual collections than pneumobilia
-but more collections of air than pneumobilia |
|
|
Term
| what is the best study for RLQ pain- suspected appendicitis; fever, leukocytosis, and classic presentation clinically for appendicitis in adult? |
|
Definition
| CT of abdomen and pelvis with contrast |
|
|
Term
| what is the best study for RLQ pain- suspected appendicitis; fever, leukocytosis, possible appendicitis- atypical presentation in adults and adolescents? |
|
Definition
| ct abdomen and pelvis with contrast |
|
|
Term
| what is the best study for RLQ pain- suspected appendicitis; fever, leukocytosis, pregnant woman? |
|
Definition
|
|
Term
| what is the best study for RLQ pain- suspected appendicitis; fever, leukocytosis, possible appendicitis, atypical presentation in children (less than 14 yrs of age) |
|
Definition
|
|
Term
| what is the best study for RUQ pain- fever elevated WBC, positive murphy's sign? |
|
Definition
|
|
Term
| what is the best study for RUQ pain, suspected acalculus cholecystitis? |
|
Definition
|
|
Term
| what is the best study for a liver lesions >1 cm initially found on US? |
|
Definition
| MRI abdomen without and with contrast |
|
|
Term
| what is the best study for a liver lesions >1 cm initially found on CT? |
|
Definition
| MRI abdomen without and with contrast |
|
|
Term
| what is the best study for a liver lesions >1 cm initially found on MRI without contrast? |
|
Definition
| MRI abdomen without and with contrast |
|
|
Term
| what are rim-like calcifications (describe them)? What are 4 places you may see one. |
|
Definition
-calcification in the wall of a hollow viscus
-Cysts (renal, splenic, mediastinal, popliteal), aneurysms (splenic, renal), GB (increased risk of CA), bladder |
|
|
Term
| What is a linear calcification (describe it)? What are 3 places you may see this? |
|
Definition
-Calcification in the wall of a tubular structure
-arteries (atherosclerosis), fallopian tubes and vas deferens, ureters (rarely linear) |
|
|
Term
| Describe lamellar calcifications. Where are 3 places you may find them? |
|
Definition
-calcification forming around a nidus inside a hollow lumen
-renal and ureteral calculi, gallstones, bladder stones |
|
|
Term
| Describe popcorn calcifications and name 5 places where they may be found. |
|
Definition
-forming the inside of a solid organ or tumor
-pancreatic calcifications associated with chronic pancreatitis, uterine fibroids (leiomyomas), lymph nodes, adenocarcinomas, soft tissue calcification |
|
|
Term
| what is the term for a gallbladder's appearance when it has rimlike calcification? |
|
Definition
|
|
Term
| stones can be easily missed on CT, what is the #1 study for stones/RUQ pain? |
|
Definition
|
|
Term
| What are the three most common types of chest trauma that you may see on film? |
|
Definition
rib fracture
pulmonary contusion
pulmonary laceration |
|
|
Term
Describe the major characteristics of chest trauma associated with the following sets of ribs:
-1st three
-4-9
-10-12 |
|
Definition
-high impact trauma
-common
-may indicate injury to the liver or spleen |
|
|
Term
| What is a flail chest? In what direction does it move? What is it often accompanied by? |
|
Definition
-two fractures in three or more consecutive ribs
-flail segment moves in opposite direction of the remainder of the chest during breathing
-pulm contusions (and PTX) |
|
|
Term
- a pulm contusion is usually secondary to what?
-represents _______ into the lung
-can be difficult to distinguish from other airspace processes such as ________
-classically appears within ___ hours of trauma and disappears within ____ hours |
|
Definition
-blunt trauma
-hemorrhage
-PNA
-6, 72 |
|
|
Term
-what are pulmonary lacerations most commonly secondary to?
-where are they usually located in the lung?
-they are usually a ________ lucency, although they may fill with what? |
|
Definition
-penetrating trauma (or displaced rib fractures with severe blunt trauma)
-peripherally based
-linear; may fill with blood/fluid |
|
|
Term
aortic trauma is most commonly secondary to what?
at what part of the aorta do they usually happen? |
|
Definition
-rapid deceleration- car accidents
-in the chest, at the aortic isthmus secondary to it being relatively fixed within the chest |
|
|
Term
| what is the primary clue of aortic trauma on radiograph? |
|
Definition
| widening of the superior mediastinum-- this is low specificity given common limitations in trauma |
|
|
Term
| What is diagnostic on CT of aortic trauma (3)? |
|
Definition
| visualization of an aortic intimal flap, visualization of a contour abnormality (pitfall is the ductus bump), periaortic hematoma (not completely ruptured, but very close to being so-- also may suggest a pseudoaneurysm) |
|
|
Term
| Mediastinal hematoma is less specific for aortic trauma- what are these often secondary to? how to distinguish? |
|
Definition
| sternal fx, look for a fat plan between aorta and hematoma (means the aortia is probs not injured) |
|
|
Term
| what are the 4 most common organs involved in abd trauma? |
|
Definition
liver
spleen
kidneys
shock bowel |
|
|
Term
| Is contrast needed to properly evaluate abdominal trauma?? |
|
Definition
|
|
Term
| Is PO contrast usually given for abd trauma eval? |
|
Definition
|
|
Term
| What is often performed at bedside to evaluate for hemoperitoneum in an abd trauma patient? |
|
Definition
|
|
Term
| It is important to identify secondary findings of abdominal trauma; when looking for free abdominal fluid/hemorrhage you should always look where? Is trace free pelvic fluid normal in pre-menopausal females? |
|
Definition
-adjacent to the spleen/liver and in the paracolic gutters--> fluid layering here can signify underlying trauma that is not obvious
-yes it is normal |
|
|
Term
-what is the most frequently injured abdominal organ?
-what part of this organ is most often injured? |
|
Definition
-liver: accounts for the majority of deaths from abdominal trauma
-posterior aspect of the right hepatic lobe |
|
|
Term
| A wedge shaped defect with liver trauma suggests what? |
|
Definition
| devascularization/infarct |
|
|
Term
| What is active extravasation? |
|
Definition
-very important finding in trauma
-visualization of active bleeding- high rate of bleeding- oftentimes warrants emergent surgery or embolization |
|
|
Term
| What are oftentimes the cause of splenic trauma? since the spleen is highly vascular organ what do we need to worry about? how are most splenic trauma cases usually treated? |
|
Definition
-deceleration or penetrating trauma (especially from 120-12th L rib fx)
-active extravasation
-conservatively |
|
|
Term
| almost all patients with significant renal trauma will have ____________. What is an additional type of injury that we must worry about with renal trauma? |
|
Definition
-hematuria
-injury of the collecting system |
|
|
Term
| What are oftentimes the cause of splenic trauma? since the spleen is highly vascular organ what do we need to worry about? how are most splenic trauma cases usually treated? |
|
Definition
-deceleration or penetrating trauma (especially from 120-12th L rib fx)
-active extravasation
-conservatively |
|
|
Term
| almost all patients with significant renal trauma will have ____________. What is an additional type of injury that we must worry about with renal trauma? |
|
Definition
-hematuria
-injury of the collecting system |
|
|
Term
| when does shock bowel usually occur? what will be seen on CT? |
|
Definition
-with blunt abdominal trauma in which there is severe hypovolemia and profound hypotension
-diffuse thickening of small bowel wall with increased enhancement |
|
|
Term
| What is bladder rupture commonly associated with? how are they evaluated? |
|
Definition
-pelvic fx and soft tissue injury
-delayed CT images following IV contrast OR by retrograde filling of the bladder from contrast infusion through foley catheter |
|
|
Term
| what is the difference in management between an extraperitoneal bladder rupture and an intraperitoneal rupture? |
|
Definition
extra can be just watched
intra probs needs to be operated on |
|
|
Term
| Which type of bladder rupture is more common; extraperitoneal or intraperitoneal? |
|
Definition
|
|
Term
| how do extraperitoneal fx usually occur? what do they look like on film? |
|
Definition
-pelvic fracture with direct puncture of bladder
-extraluminal contrast around the bladder, esp. the retropubic space |
|
|
Term
| how do intraperitoneal bladder ruptures usually occur? at what part of the bladder? whats seen on film? |
|
Definition
-forceful blow to the pelvis with distended bladder
-dome of the bladder
-contrast flows into the peritoneal cavity |
|
|
Term
-urethral injuries are seen almost exclusively in what sex?
-what are three clinical signs?
-what is the most common site of rupture? |
|
Definition
-male
-hematuria, blood at the urethral meatus, and inability to void
-rupture of the posterior urethra through the urogenital diaphragm into the proximal bulbous urethra |
|
|
Term
| What is a pseudodiverticula? How are they differentiated from ulcers, fistulas, or sinuses? |
|
Definition
-herniation of mucosa and submucosa through the muscular layer (does not go through the adventitia or peripheral layer of enteric system)
-they are congenital focal weaknesses in the muscularis
-they change shape wiht the passage of barium |
|
|
Term
| what is a true diverticula? what is the usual cause? |
|
Definition
-outpouching of all three layers
-usually caused by external forces |
|
|
Term
| What are the two areas that pseudodiverticula usually occur in the esophagus? what view is each seen best in? |
|
Definition
-hypopharyngeal region (Zenkers): posterior and seen on lateral view (pretty common, can present with difficulty swallowing or the feeling of something stuck in the throat)
-just above the diaphragm (epiphrenic): seen on frontal view |
|
|
Term
| there is one type of true esophageal diverticula, where is it usually located? |
|
Definition
-traction
-mid-esophageal at the carinal level
-seen best on lateral
-associated with something causing fibrosis in the chest: scarring in one area causes pulling out of the adjacent structure |
|
|
Term
| what percent of esophageal carcinomas have metastases at dx? why is this so? what are the two types of malignancy? |
|
Definition
-50%
-esoph has no serosa and abundant lymphatics
-squamos (smoking/drinking)
-adenocarcinoma (reflux/barretts) |
|
|
Term
| what is the squamo-columnar junction? |
|
Definition
| line of transition from esophageal squamos cells to gastric columnar cells |
|
|
Term
| What are the two ways the esophagus reacts to prolonged, repeated acid reflux. which way is characteristic of barrett's |
|
Definition
-inflammation--> stricture of squamous cells
-inflammation-->change of esophageal squamos epithelium to gastric columnar cells (barrett's) |
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Term
| what causes a sliding hiatal hernia? |
|
Definition
| esophageal scarring and shortening- stomach is pulled up out of abdomen |
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Term
| what are the four forms of esophageal cancer? |
|
Definition
-annular, constricting
-polypoid
-infiltrating
-ulcerating |
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|
Term
| what is a paraesophageal hernia? |
|
Definition
| stomach rotates on itself- less common that sliding and potentially more dangerous bc it can cause ischemia of blood supply and other complications |
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Term
| how is a sliding hiatal hernia identified? is the lack of restriction the cause or the result of herniation? |
|
Definition
rugal folds above diaphragm
cause |
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Term
| what test will look for motility and tell you whether the esophagus is dilated due to the swallowed barium column or due to GERD? |
|
Definition
| fluoroscopy to look for motility (on fluoro the E-G junction dilates to allow swallowed bolus to pass) |
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Term
| what are three characteristics of a benign gastric ulcer? location? |
|
Definition
-extent outside of the lumen of the stomach
-hampton's line
-heaped up inflammatory margin
-lesser curvature |
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Term
| describe the margins and rugae associated with a benign gastric ulcer |
|
Definition
-smooth margins
-rugae oriented towards the ulcer |
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|
Term
| what is the hamptoms line? |
|
Definition
| straight line at the neck of ulcer in profile which represents the thin rim of undermined gastric mucosa |
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|
Term
|
Definition
| a smooth, sharply delineated soft tissue mass surrounding a benign ulcer |
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Term
| what are characteristics of the gastric folds around a gastric ucler? |
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Definition
| folds are thick and they stop well short of the ulcer margin |
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Term
| what two areas do gastric carcinomas usually occur in? what is the usual cell type? what are the 3 gross forms? |
|
Definition
-antral region, lesser curve
-adenocarcinoma
-polypoid, infiltrating (linitis plastica), ulcerated |
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Term
-what is more common: gastric or duodenal ulcer?
-what area of the duodenum are the most common, what side of the wall (ant/post)
-they fill with contrast when pt is in what position?
-complications include what three things? |
|
Definition
-duodenal
-in the bulb or 1st part, on the anterior wall
-prone
-obstruction, perforation, hemorrhage |
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Term
-are duodenal diverticulum usually solitary or multiple?
-what structure are they close to, if not incorporating?
-may extend into what? |
|
Definition
-usually solitary, may be multiple
-sphincter of oddi
-pancreatic head |
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|
Term
-what is a meckel's diverticulum?
-location?
-5 sx? |
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Definition
-true congenital diverticulum
-distal ileum
-painless bleeding, volvulus, intussusception, diverticulitis, peptic ulcer |
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Term
| what is the rule of 2's for a meckels diverticulum? |
|
Definition
-2% of pop
-2 feet from ileocecal valve
-2 inches in length
-2% are asymptomatic
-2 types of tissue (gastric and pancreatic)
-2 yoa is most common age presenting
-2:1 male:female |
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Term
| 50% of symptomatic Meckel's diverticula have ______ muscoa and symptoms of _______ ulcer |
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Definition
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Term
| two ways to detect meckels? tx? |
|
Definition
UGI exam
Nuclear medicine scan
surgical tx |
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|
Term
| Unlike all other divertiucla, what is unique about the location of a meckels? |
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Definition
| on the anti-mesenteric border |
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Term
| what is a spigelian hernia? |
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Definition
| -hernia through the spigelian fascia (lateral ventral hernia) which is the aponeurotic layer between the rectus abdominis muscle medially and the semilunar line laterally. |
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Term
| spigelian hernias are small, so the risk of ________ high. most develop on what side? what age? compared to other types of hernias they are (rare/common)? |
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Definition
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Term
| what 2 changes often seen in the bowel of a pt with crohn's? |
|
Definition
multiple entero-enteric fistulas
thickened omentum and bowel wall (normal is < 3 mm) |
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Term
| whats the difference between a sessile and pedunculated polyp? |
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Definition
sessile are attached directly to wall
pedunculated attached to wall by a stalk |
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|
Term
|
Definition
-familial disorder with multiple hamartomatous polyps from stomach to colon
-also melantotic macules of skin (esp vermillion border) |
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Term
| What may lead to intussusception? what does it look like on BE? tx in kids? |
|
Definition
polyps
produces coiled spring appearance on BE
judicious low pressure water soluble contrast enema |
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|
Term
| an apple core lesion is characteristic of? |
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Definition
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|
Term
| what is a good way of determining if the pancreatic head is of normal size? |
|
Definition
| it should be equal to the AP diameter of the vertebral body at the same level |
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|
Term
| what are three signs on film of acute pancreatitis? |
|
Definition
-body is boggy and edematous (swollen)
-sharp margins lost
-extensive retroperitoneal effusion at tail in particular |
|
|
Term
| what is a pancreatic pseudocyst? |
|
Definition
-large, thick walled collection of pancreatic fluid
-not a true cyst
-consist of pancreatic fluid surrounded by a thick walled fibrous scar
-drained via stomach |
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|
Term
| what is common characteristics of a cirrhotic liver? |
|
Definition
r lobe scars
L lobe enlarges
liver lobulates |
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Term
| are hemangiomas benign? are they hypo- or hyperdense initially? with IV contrast they fill in from ______ slowly. they become _____-dense after venous spaces fill |
|
Definition
benign
hypo
periphery
hyperdense |
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|
Term
| what is the name for multicystic kidney dz that effects the liver? |
|
Definition
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|
Term
| On ultrasound, materials that transmit sound well will be _______. what are some examples? |
|
Definition
black/dark
water or cystic structures |
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|
Term
| on US materials that reflect sound will be _______. examples? |
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Definition
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|
Term
| how well sound is transmitted/reflected is referred to as __________ |
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Definition
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Term
| Water is _____-echoic to other material. It is so much this way that it is actually considered ________, which means what? |
|
Definition
hypoechoic
anechoic- produces no reflecting echos |
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Term
| bone is _____echoic to other substances |
|
Definition
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|
Term
sonographic images are viewed with the pt's head to the _____ and the feet toward the ______
anterior is ___ and posterior is ____ |
|
Definition
|
|
Term
| what does doppler do? what is it used most frequently in the assessment of? |
|
Definition
-evaluates direction and velocity of flow, most commonly in blood vessels
-used most frequently in assessment of the carotids, leg veins, and other vascular structures |
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|
Term
| US is generally considered safe, esp since there is no ionizing radiation, but what is the only caveat? |
|
Definition
| can cause minor elevation of heat, which can be potentially harmful to a fetus |
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Term
| what are 5 common US uses? |
|
Definition
-female pelvis (esp during pregnancy)
-suspected biliary/gb dysfxn
-interventional/ mammographic procedures
-neonatal head and spine eval
-characterize cystic lesions |
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|
Term
| what is diagnostic of stones on US? |
|
Definition
| acoustic shadowing- objects that strongly reflect US beams cause shadowing distal to the object |
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|
Term
| what is a good way, besides shadowing, to distinguish a gallstone from a polyp? |
|
Definition
| they usually fall to the most dependent part of the bladder |
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|
Term
| what is biliary sludge an aggregation of? |
|
Definition
| cholesterol crystals, bilirubin, and glycoproteins |
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Term
| signs of acute cholecystitis on US? |
|
Definition
-gallstones
-GB wall thickening (>3 mm)
-pericholecystic fluid
-positive murphy's elicited with probe |
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Term
| what is a good test to use if you suspect cholecystitis but other test are negative? |
|
Definition
| nuclear medicine HIDA scan |
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|
Term
| Are normal intrahepatic ducts well visualized? |
|
Definition
| no- if you can see them they are probably dilated |
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|
Term
| what is the upper limits of normal for size of the common bile duct? |
|
Definition
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|
Term
| what is most common indication to get an US of the urinary tract? |
|
Definition
| to evaluate for hydronephrosis in the setting of renal failure |
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|
Term
| what are the two approaches to US of the uterus/ovaries? |
|
Definition
-transabdominal- need a distended bladder to act as an acoustic window
-transvaginal- usually a better visualization of the uterus |
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|
Term
| What is the normal endometrial stripe thickness in a pre and post menopausal female? |
|
Definition
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|
Term
| what is the general appearance of uterine fibroids? what is an interventional radiology tx to treat fibroids? |
|
Definition
-heterogenously hypoechoic solid masses that can calcify and are oftentimes very vascular
-UFE (uterine fibroid embolization) |
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|
Term
| What are the parameters for simple benign ovarian cysts in a premenopausal female? |
|
Definition
<5 cm: usually no further follow up
5-7: yearly FU
>7: MRI, and or gyn referral |
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|
Term
| What are the parameters for simple benign ovarian cysts in a postmenopausal female? |
|
Definition
<1 cm: no follow up
1-7: at least yearly FU, closer to 7 consider MRI/referral
>7: MRI/referral |
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Term
| In order to view a pregnant uterus on US, the HCG needs to be greater than what? at what week in the pregnancy is it often visible? |
|
Definition
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|
Term
| you need to correlate findings of a pregnant uterus with what? |
|
Definition
|
|
Term
| what is the difference between transudative and exudative ascites on US? |
|
Definition
-trans should be sonolucent/anechoic
-exudative may contain echoes |
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|
Term
| what is the indication to use US to dx appendicitis? |
|
Definition
-its not very sensitive so only used in kids and pregnancy to spare radiation
->6 mm and non-compressability raises possibility of it |
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|
Term
| AAA is signified by what on US? |
|
Definition
dilatation greater than 50% of the expected size
3 cm can be a soft cut off |
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|
Term
| if a pt has an asymptomatic pulsatile abdominal mass, then US is the study of choice. what should you do if they have severe pain and pulsatile mass? |
|
Definition
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|
Term
| US to examine for DVT looks from what vein to what vein? |
|
Definition
| popliteal vein to the common femoral vein |
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|
Term
| what imaging modality uses strong magnetic fields to manipulate the atomic nuclei which causes proton spinning with relaxation resulting in the release of energy? |
|
Definition
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|
Term
| what is the strength of the MRI magnet measured in? |
|
Definition
| TESLA (most scanners are between 0.5 and 3 T) |
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Term
| with MRI the stronger the magnet, the better/worse the spatial resolution (ability to distinguish between to pixels)? |
|
Definition
|
|
Term
| what is the primary benefit of MRI? |
|
Definition
| anatomy/pathology can be highlighted/better visualized based off the different magnetic properties of tissues |
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|
Term
| There are numerous sequences for an MRI and they are altered by their ____ and ____ relaxation times |
|
Definition
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|
Term
| What is the easiest thing to remember when trying to differentiate T1 from T2? |
|
Definition
| fluid will be bright on T 2 |
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|
Term
| What does T1 do better than T2? |
|
Definition
| provides better tissue contrast so you can define structures better |
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|
Term
| fat, hemorrhage, proteinaceous fluid, melanin, and gadolinium will be bright on T1 or T2? |
|
Definition
|
|
Term
| MRI can utilize tissue suppression- when is fat suppression typically very useful? |
|
Definition
| in cancer evaluation following contrast administration |
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|
Term
| What is diffusion? When do we use a DWI? why? |
|
Definition
-refers to how well molecules are able to move around (Brownian motion)
- stroke evaluation
-Infarcted brain tissue or other tissue lacks ability for diffusion to occur (diffusion restriction occurs) and these tissues are bright |
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|
Term
| Gradient echo or susceptibility weighted sequences are good at looking for ________ |
|
Definition
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|
Term
| Gradient susceptibilty images can demonstrate blood ______ after actual bleed. conversely, will often not be able to identify what on CT? |
|
Definition
|
|
Term
| ____________ is the most common IV contrast agent used in MRI |
|
Definition
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|
Term
| Gadolinium _______ the T1 relaxation times of hydrogen nuclei. For this reason, nearly all________ MRI images are obtained on T1 sequences |
|
Definition
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|
Term
| Gadolinium _______ the T1 relaxation times of hydrogen nuclei. For this reason, nearly all________ MRI images are obtained on T1 sequences |
|
Definition
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|
Term
| With MRI contrast there is no nephrotoxicity, but there is the risk of what? |
|
Definition
| NSF- nephrogenic systemic fibrosis |
|
|
Term
| should MRI contrast be used during pregnancy? |
|
Definition
| used with extreme caution- it is thought to cross the placenta, and we are not definite of the risk to the fetus |
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|
Term
| In MRI if contrast is given what is almost always also taken? |
|
Definition
|
|
Term
| what are critical regions in the body that are contraindicated for metal? |
|
Definition
orbits
near major vascular structures
spinal canal |
|
|
Term
| comapre MRI and CT in three points? |
|
Definition
MRI has better tissue characterization
CT has better resolution
CT is cheaper and faster |
|
|
Term
| What is MRI best for and CT? what are they equal for? |
|
Definition
-MRI: brain and MSK
-CT: chest imaging
*they have separate purposes for abd and pelvic imaging |
|
|
Term
| whats better for fetal eval, MRI or CT? |
|
Definition
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|
Term
| A 55 yo F presents with a 6 month history of HA and a new facial droop. The best course of action is |
|
Definition
|
|
Term
| what is the best study for a chronic headache with new features? |
|
Definition
| MRI head without and with contrast |
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|
Term
| 25 yo M +EtOH, involved in MVA with focal posterior C-spine tenderness. Best course of action? |
|
Definition
| CT cervical spine without contrast |
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|
Term
| 70 yo F w/ new vaginal bleeding. Best first study? |
|
Definition
| Transabdominal and/or transvaginal pelvic ultrasound |
|
|
Term
| 19 yo college baseball pitcher with acute right shoulder pain. Best first exam is… If this is unhelpful, next best exam would be… |
|
Definition
XRAY shoulder
MRI shoulder without contrast |
|
|
Term
| 39 yo F w/ 8 hours of acute RUQ pain, fever, and WBC 18k. Best initial test? |
|
Definition
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