Term
| how does a zenker's diverticulum appear on x-ray? |
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Definition
| the sac is below the neck of the diverticulum and food gets stuck in it and putrifies. it is found in the proximal esophagus. (a true/traction diverticulum is in the mid esophagus and takes in all the walls of mucosa. scarring usually draws these above the neck.) |
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Term
| what are common signs/symptoms of a pt with esophageal CA? |
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Definition
| insidious onset of dysphasia (but no emesis), problems w/solid food, and drinks a lot of liquid |
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Term
| how would a esophageal CA appear on x-ray? |
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Definition
| non-tapering narrowing in distal area (caustic agents cause tapered narrowing). need to bx this, generally what you see in the esophageal lumen is just the tip of the iceberg. |
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Term
| how will a an x-ray appear for a pt who swallowed a caustic agent? |
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Definition
| long, narrowed, tapered stricture due to alternating inflammation/resolution. if early on, maloney dilators can be used. |
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Term
| what is seen in the esophagus of a pt with scleroderma during a barium swallow? |
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Definition
| in the supine position, contrast stays in the esophagus/if sitting up, the barium will empty to some degree. in a normal barium swallow, it goes through to the ileocecal valve in about 30 min, but in pts w/scleroderma after 30 mins, barium may still be in the esophagus - *due to lack of peristalsis* (w/o stricture). you want to check scleroderma pts for CREST syndrome. |
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Term
| how will achalasia appear on x-ray? |
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Definition
| dilation of the esophagus with "beak" appearance at LES. barium extends all the way to the proximal part of the esophagus. these pts often aspirate, |
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Term
| how will menetrier's disease appear on x-ray? |
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Definition
| large gastric folds in fundus and body (generally antrum is normal). this would appear similar to gastric CA/ZE syndrome and the pt may complain of abdominal pain that is worse with eating. there would be very succulent fluid in the stomach, higher pH, high protein content, and low serum albumin. |
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Term
| how will ulcerative gastric CA appear on x-ray? |
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Definition
| indentation inside the greater curvature of the stomach as well as a mass effect where contrast won't fill. |
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Term
| how might crohn's disease appear on x-ray? |
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Definition
| there may be a fistula between the duodenum and splenic flexure. the intestine may also be so edematous that there is no space for the barium (need to allow inflammation to subside and try again). |
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Term
| what needs to be done before a barium enema can be confirmed negative? |
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Definition
| rectal exam - b/c the balloon which keeps the barium in the colon obscures this area |
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Term
| if a pt presents with RLQ pain, what else should be in the ddx besides appendicitis? |
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Definition
| lymphadenopathy of the mesenteric nodes. this can also appear as CA on x-ray. |
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Term
| what might calcified lymph nodes around the aorta and iliac arteries be? |
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Definition
| tuberculous peritonitis - can appear as metastatic CA |
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Term
| how might *chronic ulcerative colitis appear on x-ray? |
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Definition
| "lead pipe" colon - where haustrations are lost and rat-tooth/mothy markings go dowm the side of the mucosa |
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Term
| how might diverticulitis in the acute inflammatory state appear radiographically? |
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Definition
| spiky. make sure the pt doesn't have a chronic low grade fever - could be the sign of microabscesses. pts w/this will have LLQ pain pre/during defecation w/relief after. ddx: UC, CH, neoplasm |
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Term
| how do gallstones appear in different imaging modalities? |
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Definition
| normal gallstones on x-ray: radiopaque, faceted sharp margins if clumped together. *cholesterol gall stones are radiolucent however - therefore a cholecytogram is necessary |
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Term
| what is the #1 study to be done on a pt with abdominal pain? |
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Definition
| ultrasound - shows you stones, mass, an organ pushed to one side and determines invasiveness. |
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