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GI Studies 1c


Radiography: GI indications: Bowel Obstruction (adhesions, Hernias, Volvulus, intussusception); Adynamic Ileus; Free air (upright & LLD)
SBO on xray dilated bowel (SB > 3 cm, LB > 6 cm, cecum > 9 cm); poss free air; may also be post-op ileus
US uses Cholecystitis; Liver cirrhosis; Patency of hepatic vessels; Intussusception (kids); Appendicitis (kids)
Normal GB on US dark (anechoic); bright tissue interfaces (GB wall)
US: Cholecystitis findings Wall thickening, pericholecystic fluid, sonographic Murphy’s sign
CT uses: Abdominal pain Appendicitis, diverticulitis, bowel obstruction, cholecystitis, biliary tract obstruction
CT uses: Complications of cirrhosis HCC, varicosities, portal hypertension
CT uses: Complications of pancreatitis abscess, pseudocyst, necrosis, hemorrhage
MRI uses: Liver lesion characterization Focal nodular hyperplasia, hepatic adenoma, HCC, hemochromatosis, hemosiderosis
MRI uses: Pancreatic cystic lesion characterization Pseudocyst, mucinous or serous neoplasms, intraductal papillary mucinous neoplasms
MRI uses: Biliary tract pathology Obstructing stones, cholangiocarcinoma
Nuclear med: uses: Biliary imaging Obstructed cystic duct (ie, cholecystitis); Bile leak
Nuclear med: uses: Lower GI bleeding Diverticulosis, malignancy, anticoagulation
HIDA If cystic duct is patent: GB accumulates radioactivity; if CBD is patent: sm bowel will accumulate radioactivity
Tc-99 tagged RBC scan tagged RBCs accumulate in area of hemorrhage
Diverticulosis/diverticulitis: sx of inflammation: fat or tissue stranding
Appendix: normal size s/b no bigger than 6 mm diameter
Hepatitis labs AST/ALT very high (20x nml) early; WBC nml to low; TBil follows AST/ALT; alkphos parallels bili
Hepatitis: urine labs: mild proteinuria; bilirubinuria often precedes jaundice; may be incidental indicator of liver injury
Most common cause of chronic hep viral hep
IgM anti-HAV = prior exposure to HAV, noninfectivity & immunity; past exposure common in US (30%); Total anti-HAV to screen ppl who may need vax
Hep B: more likely to become chronic if: young at age of infxn (or immunocompromised); 95% of pts clear the virus & develop Abs; chronic Hep B increases risk of cirrhosis & HCC
First sero evidence of hep B infxn = HBsAg (persists throughout clinical illness)
Appears after clearance of HBsAg or successful vax vs Hep B Anti-HBs
Anti-HBs detection signals: recovery from HBV infxn, noninfectivity & immunity
Anti-HBc IgM appears when? soon after HBsAg, before anti-HBs; presence w/ acute hep sx = acute Hep B; Persists 3-6 mos
Anti-HBc IgG appears when? Appears with Anti-HBc IgM, but persists
HBcAg does not: appear in serum
HBeAg = Secretory form of HBcAg; found only in HBsAg positive serum soon after its detection; presence indicates viral replication & infectivity
Created by: Adam Barnard Adam Barnard