Gastroenterology
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| Radiography common uses | Bowel Obstruction (adhesions, Hernias, Volvulus, intussusception); Adynamic Ileus; Free air (upright & LLD)
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| SBO on xray | dilated bowel (SB > 3 cm, LB > 6 cm, cecum > 9 cm); poss free air; may also be post-op ileus
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| US uses | Cholecystitis; Liver cirrhosis; Patency of hepatic vessels; Intussusception (kids); Appendicitis (kids)
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| Normal GB on US | dark (anechoic); bright tissue interfaces (GB wall)
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| US: Cholecystitis findings | Wall thickening, pericholecystic fluid, sonographic Murphy’s sign
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| Fluoroscopy uses: Esophagus | motility disorders, structure abnormalities (hiatal hernia)
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| Fluoroscopy uses: Small bowel | Celiac sprue, Crohn disease, Midgut volvulus (children)
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| Fluoroscopy uses: Colon | cancer screening in setting of failed colonoscopy, sigmoid or cecal volvulus
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| Fluoroscopy uses: Congenital structural abnormalities | microcolon, anorectal malformation, Hirschsprung disease
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| Fluoro Esophagus | single contrast (barium alone) or double (barium & air)
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| CT uses: Abdominal pain | Appendicitis, diverticulitis, bowel obstruction, cholecystitis, biliary tract obstruction
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| CT other uses: | Trauma; Malignancy (Detect / stage tumors)
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| CT uses: Complications of cirrhosis | HCC, varicosities, portal hypertension
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| CT uses: Complications of pancreatitis | abscess, pseudocyst, necrosis, hemorrhage
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| MRI uses: Liver lesion characterization | Focal nodular hyperplasia, hepatic adenoma, HCC, hemochromatosis, hemosiderosis
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| MRI uses: Pancreatic cystic lesion characterization | Pseudocyst, mucinous or serous neoplasms, intraductal papillary mucinous neoplasms
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| MRI uses: Biliary tract pathology | Obstructing stones, cholangiocarcinoma
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| Nuclear med: uses: Biliary imaging | Obstructed cystic duct (ie, cholecystitis); Bile leak
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| Nuclear med: uses: Lower GI bleeding | Diverticulosis, malignancy, anticoagulation
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| HIDA | If cystic duct is patent: GB accumulates radioactivity; if CBD is patent: sm bowel will accumulate radioactivity
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| Tc-99 tagged RBC scan | tagged RBCs accumulate in area of hemorrhage
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| Diverticulosis/diverticulitis: sx of inflammation: | fat or tissue stranding
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| Appendix: normal size | s/b no bigger than 6 mm diameter
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| Pancreatic cancer diagnostic studies | Abd US (shows biliary duct dilatation). CT (TOC: mass & ductal dilatation). ERCP if CT neg (double duct sx of CBD & panc duct). Lap for staging.
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| For resectable pancreatic tumors, aspiration bx is: | contraindicated (risk of spreading tumor)
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| Acute pancreatitis on KUB/CXR | Atelectasis. Effusion. Sentinel loop air in small bowel/LUQ
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| If suspect pancreatic necrosis (in pancreatitis), choose this test | Abd CT with contrast on day 3
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| Acute panc: Abd US (purpose) | to r/o or establish GB/GS/BD dilatation; enlarged hypoechoic pancreas; poss pseudocyst, edema, calcification
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| MRI/MRCP in pancreatitis (purpose) | to detect necrosis, stones/ductal disruption
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| Role of endoscopic US in pancreatitis | Limited role acutely. Useful in occult biliary disease (microlithiasis)
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| Air fluid levels on upright abd plain film | SBO
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| Apple core lesion = | Colon Cancer
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| Ascending cholangitis on US = | gallstones & dilated common bile duct
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| Classic imaging modality for free air | plain film (abd flat & upright)
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| CXR is useful to identify: | calcifications; foreign bodies; free air; obstruction
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| CXR with barium is what type of study? | fluoroscopy (used to assess transit times and mucosal abnormalities) (no longer for : CRC screening or reflux)
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| Study of choice to diagnose pancreatic cancer | EUS (if not available: CT; may also do MRI/ERCP)
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| Study of choice: staging of rectal, esophageal and gastric tumors and identification of pancreatic tumors: | EUS (also used for aspirational bx)
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| Gold std to visualize small bowel | Video capsule endoscopy (VCE)
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| Video capsule endoscopy (VCE) contraindications | avoid in patients with GI distress, fistulas, pregnancy or swallowing disorders
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| Role of trans-abd US | often TOC in liver, biliary dz; TOC in pediatric appendicitis
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| GI imaging modalities that have both diagnostic and therapeutic uses | EGD; ERCP; EUS (has interventional use)
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| CT/MRI | CT: primary GI malig (liver, panc); MRI: liver lesions
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| Virtual colonoscopy | req bowel prep, rectal tube; low sens/spec; MRI cannot detect lesion <5 mm
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| Ischemic bowel on imaging | X-ray: dilated loops with edema (thumbprinting). Angiography. CT may show aortic dissection, bowel distention/edema, arterial calcification
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| CXR with barium is no longer used for: | CRC screening or reflux
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| Gold standard for dx appendicitis | CT (>7 mm & >2mm thick = appy)
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| Imaging used for appy in kids: | US
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| Gall stones: dx imaging | US best; plain films only 15%; CT; HIDA (dye)
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| Acute pancreatitis: plain films | calcified gall stone/panc; sentinel loop of sm bowel; colon cut-off sx (no air distal to splenic flexure)
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| Acute pancreatitis: US/CT | US: enlarged hypoechoic pancreas; CT: enlarged panc, peripancreatic edema
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| Imaging of choice for pancreatic parenchyma | CT
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| Chronic pancreatitis findings on abdominal plain film: | Pancreatic calcifications (classic finding)
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| Chronic pancreatitis findings on CT | Pancreatic calcifications, atrophied pancreas
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| Chronic pancreatitis findings on MRCP/ERCP | Chain of lakes (areas of dilation / stenosis along pancreatic duct)
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| Pancreatic cancer: dx modalities | CT; MRI; EUS (if no lesion on CT/MRI & still have high suspicion)
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| Achalasia imaging | CXR (air fluid level in enlarged fluid filled esoph); Barium esophagography (birds beak: smooth symmetric tapering; esophageal dilatation; loss of peristalsis); upper endoscopy
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| Diffuse esophageal spasm: findings on Barium Esophagography | corkscrew contraction; rosary
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| Diffuse esophageal spasm: findings on manometry | intermittent simultaneous contraction
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| Achalasia: dx gold standard = | manometry; see complete absence of peristalsis, with simultaneous, low amplitude waves; very tight LES, lack of contractions in esophagus
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| Gastric cancer: imaging | EGD; EUS; Barium Swallow (Upper GI); CT/MRI
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| Study of choice to dx pancreatic cancer | EUS (if not avail: CT) (may also do MRI/ERCP)
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| Study of choice: staging of rectal, esophageal and gastric tumors and identification of pancreatic tumors: | EUS (also used for aspirational bx)
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| Trans-abdominal US is often test of choice in: | Liver & biliary dz; pediatric appendicitis
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| Esophageal ca on CXR | mediastinal widening, lung or bony mets
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| barium esophagram: polypoid, infiltrative, or ulcerative lesion = | esophageal ca adiography: GI indications:
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| SBO on xray | dilated bowel (SB > 3 cm, LB > 6 cm, cecum > 9 cm); possible free air; may also be post-op ileus
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| US uses | Cholecystitis; Liver cirrhosis; Patency of hepatic vessels; Intussusception (kids); Appendicitis (kids)
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| Normal GB on US | dark (anechoic); bright tissue interfaces (GB wall)
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| US: Cholecystitis findings | Wall thickening, pericholecystic fluid, sonographic Murphy’s sign
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| CT uses: Abdominal pain | Appendicitis, diverticulitis, bowel obstruction, cholecystitis, biliary tract obstruction
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| CT uses: Complications of cirrhosis | HCC, varicosities, portal hypertension
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| CT uses: Complications of pancreatitis | abscess, pseudocyst, necrosis, hemorrhage
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| MRI uses: Liver lesion characterization | Focal nodular hyperplasia, hepatic adenoma, HCC, hemochromatosis, hemosiderosis
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| MRI uses: Pancreatic cystic lesion characterization | Pseudocyst, mucinous or serous neoplasms, intraductal papillary mucinous neoplasms
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| MRI uses: Biliary tract pathology | Obstructing stones, cholangiocarcinoma
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| Nuclear med: uses: Biliary imaging | Obstructed cystic duct (ie, cholecystitis); Bile leak
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| Nuclear med: uses: Lower GI bleeding | Diverticulosis, malignancy, anticoagulation
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| HIDA scan: normal findings (ie, patent ducts) | If cystic duct is patent: GB accumulates radioactivity; if CBD is patent: sm bowel will accumulate radioactivity
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| Tc-99 tagged RBC scan | tagged RBCs accumulate in area of hemorrhage
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| Diverticulosis/diverticulitis: sx of inflammation on imaging | fat or tissue stranding
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| Normal-size appendix should be no bigger than: | 6 mm diameter
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| US: useful in biliary dz to: | Detect GS; eval dilation of biliary ducts (limits: obesity; eval liver parenchyma/panc)
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| Gold standard for gall stones | US; sensitivity > 95% for stones > 2mm (less sensitive for stones in CBD); GS best seen after 8hrs of fast; Stones seen as echogenic, mobile objects with acoustic shadow
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| ace of spades deformity on barium enema imaging signifies: | sigmoid volvulus
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| PUD perforation: diagnostic imaging | free air on CXR; US; CT to confirm
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| IBS Imaging/Invasive Testing (by age groups) | Pt < 40 y.o. with diarrhea: flex sig. Pt >40 y.o.: ACBE or colonoscopy
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| IBD imaging | CD: UGI, ABCE, capsule endoscopy; UC: abd film; colonoscopy, sigmoidoscopy
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