Gastrointestinal Imaging and Dysphagia Quiz

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Questions and Answers

What imaging modality is NOT typically used for gastrointestinal examinations?

  • Echocardiogram (correct)
  • Magnetic resonance imaging
  • Barium meal follow-through
  • CT and MR enterography

Which symptom is indicative of oropharyngeal dysphagia?

  • Weight loss
  • Regurgitation of bile
  • Chest pain after swallowing
  • Nasal regurgitation (correct)

Which condition must be ruled out as a possible cause of esophageal dysphagia?

  • Goiter
  • Malignancy (correct)
  • Osteophytes
  • Parkinson's disease

In the context of esophageal dysphagia, what does 'bird's beak sign' indicate?

<p>Achalasia (D)</p> Signup and view all the answers

What type of dysphagia is characterized by difficulty with solid food only?

<p>Esophageal dysphagia (B)</p> Signup and view all the answers

Which of the following is a common symptom experienced during esophageal dysphagia?

<p>Chest pain after swallowing (B)</p> Signup and view all the answers

What is a primary cause of oropharyngeal dysphagia?

<p>Stroke (C)</p> Signup and view all the answers

Which of the following imaging modalities is specifically used for examining small bowel conditions?

<p>Enteroclysis (D)</p> Signup and view all the answers

What is the primary cause of closed-loop obstruction in the bowel?

<p>Adhesions forming between bowel segments (A)</p> Signup and view all the answers

What imaging technique is preferred for diagnosing appendicitis?

<p>CT of the appendix with oral and IV contrast (A)</p> Signup and view all the answers

In the context of bowel obstruction, what does the presence of little air in the descending colon suggest?

<p>Obstruction in the sigmoid colon (C)</p> Signup and view all the answers

In the diagnostic algorithm for suspected appendicitis, what is the next step after obtaining equivocal results from a CT scan?

<p>Ultrasound of the abdomen/pelvis (B)</p> Signup and view all the answers

Which screening procedures are considered usually appropriate for colorectal cancer screening in moderate-risk individuals?

<p>CT colonography (C)</p> Signup and view all the answers

Which of the following procedures might be appropriate for patients with first-degree family history of cancer or adenoma when screening for colorectal cancer?

<p>X-ray barium enema double-contrast (A), CT colonography (D)</p> Signup and view all the answers

Which of the following screening options is categorized as usually not appropriate for colorectal cancer screening?

<p>X-ray barium enema single-contrast (B)</p> Signup and view all the answers

For follow-up procedures after an initial negative screen, how often should moderate-risk individuals with a first-degree family history of cancer be screened?

<p>Every 5 years (D)</p> Signup and view all the answers

What characteristic is associated with esophageal spasm?

<p>Retrosternal pain independent of swallowing (B)</p> Signup and view all the answers

Which imaging finding is commonly associated with perforation of a gastric ulcer?

<p>Free abdominal air as a radiolucent band below the diaphragm (B)</p> Signup and view all the answers

In the case of gallstone ileus, what significant finding may be observed?

<p>Formation of a cholecysto-duodenal fistula (C)</p> Signup and view all the answers

Which of the following is a feature of scleroderma related to the esophagus?

<p>Dilation of the lower two-thirds of the esophagus (C)</p> Signup and view all the answers

What typically separates functional ileus from obstruction on imaging?

<p>Presence of transition points on CT (A)</p> Signup and view all the answers

Which imaging technique is useful for confirming a diagnosis of hypertrophic gastritis?

<p>Endoscopy (D)</p> Signup and view all the answers

Which of the following options describes findings in a benign gastric ulcer during a barium swallow?

<p>Collection of barium at the lesser curvature (C)</p> Signup and view all the answers

What symptom is characteristic of right femoral hernia in elderly patients?

<p>Right lower quadrant pain (C)</p> Signup and view all the answers

Which imaging procedure is considered 'usually appropriate' for a pregnant woman with suspected appendicitis?

<p>US abdomen (A)</p> Signup and view all the answers

Which imaging technique is mentioned as being 'may be appropriate' for assessing right lower quadrant pain?

<p>US pelvis (A), CT abdomen and pelvis without IV contrast (D)</p> Signup and view all the answers

Which sign is NOT indicative of acute appendicitis on ultrasound imaging?

<p>Decreased echogenicity around the appendix (C)</p> Signup and view all the answers

Which of the following imaging procedures is classified as 'usually not appropriate' for suspected appendicitis in a pregnant patient?

<p>CT abdomen and pelvis without and with IV contrast (B)</p> Signup and view all the answers

What is a characteristic MRI finding for acute appendicitis in pregnant women?

<p>Perforated appendix with extraluminal air (A)</p> Signup and view all the answers

Which imaging method is NOT typically recommended for right lower quadrant pain suspected to be appendicitis?

<p>WBC scan abdomen and pelvis (B)</p> Signup and view all the answers

Which is a common indication of appendicitis found in the ultrasound imaging of the appendix?

<p>Thick-walled and non-compressible appendix (D)</p> Signup and view all the answers

What is the preferred imaging method for patients under 50 years due to lower ionizing radiation exposure?

<p>Magnetic resonance enterography (C)</p> Signup and view all the answers

Which of the following methods is rated as extremely appropriate for the first diagnosis of Crohn's disease?

<p>Multidetector CT enteroclysis (A)</p> Signup and view all the answers

In Crohn's disease management, what does the Coomb sign indicate?

<p>Dilated vessels supplying inflamed bowel (D)</p> Signup and view all the answers

When screening for colorectal cancer, how often should follow-up screenings be conducted after an initial negative screen?

<p>Every 5 years (D)</p> Signup and view all the answers

What does a score of 7-8 indicate in terms of the appropriateness for follow-up imaging in Crohn's disease?

<p>Usually appropriate (A)</p> Signup and view all the answers

Which imaging technique is indicated to assess complications of Crohn's disease, based on its high appropriateness rating?

<p>Magnetic resonance enteroclysis (B)</p> Signup and view all the answers

Which condition is least likely associated with abnormal small-bowel loops found anterior to the bladder on imaging?

<p>Cholecystitis (D)</p> Signup and view all the answers

What aspect of Crohn's disease is demonstrated by the presence of a skip lesion?

<p>Non-inflamed segments between inflamed areas (C)</p> Signup and view all the answers

Flashcards

Dysphagia

Difficulty swallowing; a common symptom with various causes.

Oropharyngeal dysphagia

Difficulty swallowing due to problems in the pharynx or esophagus.

Esophageal dysphagia

Difficulty swallowing due to problems within the esophagus.

Achalasia

A condition where the lower esophageal sphincter (LES) fails to relax, causing difficulty in emptying food from the esophagus.

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Bird's beak sign

The characteristic appearance of the esophagus in achalasia on a barium swallow study, with the distal esophagus appearing narrowed and beak-like.

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Esophageal spasm

A contraction of the esophageal muscles that prevents proper passage of food.

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Barium swallow examination

A type of examination using a contrast agent (barium) to visualize the esophagus and stomach.

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GERD (Gastroesophageal Reflux Disease)

A common issue involving acid refluxing back into the esophagus from the stomach.

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Closed-loop Obstruction

A condition where two points of the same loop of bowel are obstructed at a single location, typically caused by adhesions. The closed loop remains dilated and prone to vascular compromise (strangulation).

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X-ray for Colon Obstruction

A technique used to identify the level of obstruction in the colon. The dilated colon frames the dilated small bowel loops and the presence of little air in the descending colon suggests the obstruction is in that area.

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Colocolonic Intussusception

A condition where a segment of the colon telescopes into itself, creating a blockage in the digestive tract. This commonly occurs in the right lower quadrant causing small bowel obstruction. A significant predisposing factor is present.

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Appendicitis

Inflammation of the appendix, a small pouch attached to the large intestine. It is commonly diagnosed using CT scan with oral and IV contrast, and ultrasound may be used in specific cases.

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Appendicitis Diagnostic Algorithm

A diagnostic algorithm used to evaluate suspected appendicitis. It involves a spiral CT of the appendix, along with laboratory evaluation. Equivocal results may necessitate laparoscopy or ultrasound depending on the patient's age and sex.

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CT Colonography

A low-dose CT scan specifically designed to examine the colon.

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Virtual Colonoscopy

A 3D imaging technique using CT colonography to visualize the colon.

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Stenosing Cancer

A potential reason for utilizing CT colonography when colonoscopy is incomplete due to a narrowing or blockage.

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Routine Abdominal CT

Part of a CT scan that includes a low-dose CT colonography along with imaging of the abdomen.

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Separate Low-Dose CT Colonography

A CT scan performed specifically for colon imaging; it involves a lower radiation dose compared to a routine abdominal CT.

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Scleroderma Esophageal Involvement

A condition where the lower 2/3 of the esophagus becomes wider due to muscle atrophy and fibrosis, leading to a narrowing of the distal end. This makes it difficult for food to pass through and can cause regurgitation, especially when standing up.

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CT Scan for Appendicitis

A diagnostic imaging technique that uses X-rays and contrast dye to visualize the appendix and surrounding structures.

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Ultrasound for Appendicitis

A diagnostic imaging technique that uses sound waves to create images of the appendix.

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Hypertrophic Gastritis

A type of gastritis characterized by a thickened stomach wall that can be seen on CT scans and confirmed by endoscopy.

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Functional Ileus

A condition where the small or large bowel is dilated but there is no physical blockage. It can be distinguished from obstruction by using plain abdominal films and CT.

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Dilated Appendix on Ultrasound

A thickened, enlarged appendix that does not compress when pressure is applied during an ultrasound.

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Benign Peptic Ulcer

A type of peptic ulcer that is not cancerous. It appears as a round collection of barium on a barium swallow study and can be seen on CT scans.

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Increased Echogenicity on Ultrasound

A sign of appendicitis on ultrasound, where the area around the appendix appears brighter on the image.

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Gastric Ulcer Perforation

A complication of a gastric ulcer where a hole develops in the stomach wall. It can be seen on chest x-rays as free air under the diaphragm and on CT scans as a hole in the stomach wall.

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Thickened Appendix Wall on CT Scan

A sign of appendicitis on CT scan, where the wall of the appendix appears thicker and brighter.

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High-Density Surrounding Fat on CT Scan

A sign of appendicitis on CT scan, where the surrounding fatty tissue appears denser.

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Gallstone Ileus

A condition where a gallstone becomes lodged in the small intestine, causing an obstruction. It can be seen on CT scans as a large stone in the ileum and a connection between the gallbladder and the duodenum.

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Preferred Imaging for Appendicitis in Pregnant Patients

Ultrasound is the preferred imaging method for suspected appendicitis in pregnant women.

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Femoral Hernia

A condition where a portion of the small intestine protrudes through a weak spot in the abdominal wall, often in the groin area.

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Magnetic Resonance Enterography (MRE)

A type of imaging test that uses magnetic fields and radio waves to create detailed images of the small intestine.

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Appropriateness Criteria for Crohn's Disease Imaging

A scoring system used to assess the appropriateness of different imaging tests for diagnosing and managing Crohn's disease.

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Lead-Pipe Morphology

A narrow, tubular appearance of the small intestine on imaging studies, typically seen in Crohn's disease.

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Enteroenteral Fistula

A rare but serious complication of Crohn's disease where a connection forms between two loops of the intestine.

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Coomb Sign

A diagnostic feature of Crohn's disease visible on MR imaging, where the blood vessels supplying the inflamed bowel become dilated and resemble a comb.

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Skip Lesions

A pattern of inflammation in Crohn's disease where affected areas alternate with normal, healthy areas in the intestines.

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Colorectal Cancer Screening

Routine screening tests to detect colorectal cancer in people at average risk.

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Follow-Up Colorectal Cancer Screening

The recommended time frame for follow-up colorectal cancer screening after an initial negative test.

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Study Notes

Gastrointestinal Abdominal Radio Part I

  • This section covers imaging modalities used to diagnose gastrointestinal conditions.
  • Plain abdominal X-rays (AP, supine) are a fundamental imaging technique.
  • Contrast examinations are crucial for detailed visualization:
    • Barium swallow: assesses the pharynx and esophagus.
    • Barium meal follow-through: examines the small intestine.
    • Enteroclysis (small bowel enema): a specialized barium-based examination of the small bowel.
    • Barium enema: assesses the large intestine.
  • Additional imaging methods include:
    • Ultrasound (US)
    • CT and MR enterography and enteroclysis
    • Virtual colonoscopy

Practice Guidelines: Dysphagia

  • Dysphagia is difficulty or discomfort in swallowing.
  • A crucial distinction is between oropharyngeal and esophageal dysphagia.
  • Oropharyngeal dysphagia ("high dysphagia"):
    • Difficulty initiating a swallow.
    • The cervical area is the primary location of the problem.
    • Symptoms like regurgitation and choking are common.
    • Discomfort occurs about one second after swallowing.
    • Patients spit rather than vomit.
    • Potential causes include infections, goiter, Zenker diverticula, neck tumors, stroke, and Parkinson's disease.
  • Esophageal dysphagia ("low dysphagia"):
    • Difficulty passing food through the esophagus and cardia.
    • Chest pain (usually behind the sternum) is a typical symptom.
    • Pain is often felt after swallowing.
    • Water may relieve the pain.
    • Forceful swallowing behavior is common.
    • Potential causes include foreign bodies, radiation therapy, scleroderma, achalasia, esophageal strictures due to reflux, and malignancy.

Esophageal Dysphagia

  • Anatomy:
    • Upper 1/3 of the esophagus: striated muscle.
    • Lower 2/3 of the esophagus: smooth muscle
  • Achalasia: the lower esophageal sphincter fails to relax properly.
    • Barium swallow reveals a dilated esophagus.
  • Scleroderma:
    • The lower two-thirds of the esophagus are affected.
    • Fibrosis results in shortening and stricturing of the distal end.
    • The lower sphincter does not function correctly.
  • Esophageal spasm
    • Retrosternal pain that is often unrelated to swallowing.
    • Increased intraluminal pressure.
    • The lower two-thirds of the esophagus take on a corkscrew appearance.

Gastritis

  • Hypertrophic gastritis: CT shows a diffusely thick-walled stomach.
  • Endoscopy confirms CT findings.

Functional Ileus versus Obstruction

  • In evaluating functional ileus vs. obstruction, the key is to determine if the cause is mechanical or not.
  • Initial imaging should include an upright, lateral decubitus, and prone or erect plain abdominal X-ray.
  • A key consideration is bowel dilation, air-fluid levels, and air in the rectum.
  • CT should follow to look for the transition point and the level of obstruction.
  • Small bowel series may be needed to ascertain the precise level of blockage.

Peptic Ulcers

  • Benign ulcers are characterized by a barium collection at the lesser curvature of the stomach.
  • Contrast-enhanced CT scan reveals active ulcers with severe edema in the gastric body and antrum.

Complication of Gastric Ulcer - Perforation

  • Free abdominal air appears as a radiolucent band below the diaphragm on chest X-ray.
  • Axial CT scans during the venous phase demonstrate perforation on the anterior side of the stomach.
  • Free abdominal air may be present in the vicinity.

Anatomical Issues and Procedures

  • Large bowel obstruction/small bowel obstruction:
    • A large bowel obstruction is characterized by dilated loops of large bowel, focal dilatation, air-fluid levels etc.
    • A small bowel obstruction involves dilated loops of small bowel, and perhaps focal or diffuse bowel dilatation, air-fluid levels or air in the rectum.
    • CT or possibly a small bowel series is used to find the transition point, aiding in pinpointing the blockage level.
  • Gallstone ileus: a large laminated gallstone lodged in the distal ileum.
    • A cholecysto-duodenal fistula, a connecting passage, can be identified between the gallbladder and the duodenum on CT images.
  • Right femoral hernia: the bowel is impacted in the hernial sac, causing an obstruction of the right inguinal area, while the femoral vein is compressed. Images from the coronal plane display this.

Other Conditions

  • Appendicitis: CT abdomen or pelvis with IV contrast or US.
  • Diverticulitis: CT scan of the abdomen or pelvis with oral or IV contrast.
  • Crohn's disease: Imaging modalities include CT enterography, conventional enteroclysis, magnetic resonance enterography (MR-e), ultrasound, and endoscopy.
  • Colorectal cancer:
    • Screening for colorectal cancer in average-risk patients (age 50+) typically involves CT colonography or X-ray barium enema.

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