RECAP: Which image below shows which imaging modality?Abdominal x-ray (AXR)Computed Tomography (CT)Barium studies
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RECAP: Which image below shows which imaging modality?Abdominal x-ray (AXR)Computed Tomography (CT)Barium studies
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RECAP: Label the following anatomy:
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RECAP: Label the following anatomy:
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Answers:
Liver
Kidneys
Bladder
Psoas muscle
Tip of spleen
Gallbladder
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Case 1:
A 52-year-old man presents to A&E with a 2-day history of abdominal pain, vomiting and constipation. He has no recent travel history, and his underlying medical conditions include well controlled type 1 diabetes and hypertension.
You are the F1 on duty. Which of the following imaging would you request?
A 52-year-old man presents to A&E with a 2-day history of abdominal pain, vomiting and constipation. He has no recent travel history, and his underlying medical conditions include well controlled type 1 diabetes and hypertension.
You are the F1 on duty. Which of the following imaging would you request?
An abdominal x-ray was performed. The image is show below. Which of the following diagnoses is best supported by this image?Case 1 (continued):
An abdominal x-ray was performed. The image is show below. Which of the following diagnoses is best supported by this image?
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A: Pneumoperitoneum B: Large bowel obstruction C: Small bowel obstruction D: Chron's disease E: Coeliac disease
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Case 1 (continued):
An abdominal x-ray was performed. The image is show below. Which of the following diagnoses is best supported by this image?
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A: Pneumoperitoneum B: Large bowel obstruction C: Small bowel obstruction D: Chron's disease E: Coeliac disease
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Large Bowel Obstruction:
The cardinal signs of a large bowel obstruction include abdominal pain, vomiting, and unopened bowels. The appropriate initial modality for viewing an obstruction is an abdominal x- ray, as this allows clear view of dilated bowel loops.
It is a large bowel obstruction and not small bowel due to the presence of haustra. The ileum poseses valvulae conniventes instead of haustra.
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Large Bowel Obstruction:
The cardinal signs of a large bowel obstruction include abdominal pain, vomiting, and unopened bowels. The appropriate initial modality for viewing an obstruction is an abdominal x- ray, as this allows clear view of dilated bowel loops.
It is a large bowel obstruction and not small bowel due to the presence of haustra. The ileum poseses valvulae conniventes instead of haustra.
Haustra can be identified as their transverse lines do not cross the entire width of the bowel wall.
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EXAM TIP: Do not miss a closed loop large bowel obstruction!
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EXAM TIP: Do not miss a closed loop large bowel obstruction!
If the ileocaecal valve is competent and a patient develops large bowel obstruction (LBO), the colon will dilate and become very large, and it cannot decompress back into the small bowel (since the valve prevents backflow), so the colon will progressively get larger and larger and will eventually perforate.
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EXAM TIP: Do not miss a closed loop large bowel obstruction!
Essentially, aportion of the large bowel becomes closed proximally and distally, meaning it becomes gasless and keeps growing until it perforates.
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EXAM TIP: Do not miss a closed loop large bowel obstruction!
A closed loop large bowel obstruction can involve a blockage on both the proximal and distal ends of the colon.
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Case 2: Signs of Extraluminal Gas (Pneumotosis intestinalis)
There are three main signs of extraluminal gas that can appear on imaging scans:
Rigler sign, Football sign, and Falciform sign
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Case 2: Signs of Extraluminal Gas (Pneumotosis intestinalis)
Rigler sign: both sides of the bowel wall can be seen which also results in triangles of air
Football sign: pockets of air seen on either side of the abdomen
Falciform sign: the liver's falciform ligament is visible on AXR. This should not usually be the case with its thin fibrous structure that connects the anterior part of the liver to the ventral wall of the abdomen
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Football signRigler signFalciform sign
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Can you match the sign to the image?
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Football signRigler signFalciform sign
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Can you match the sign to the image?
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Thumbprinting
Thumbprinting is a radiographic sign of large bowel wall thickening, usually caused by oedema, related to an infective or inflammatory process (colitis).
A 24 year old man presents with constipation, abdominal pain and vomiting. He recently underwent abdominal surgery for a chronic condition. The X ray on the right was done. What is most likely to have caused this presentation?
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A: Acute flare up of chronic conditon
B: Adhesions from surgery
C: H. pylori
D: Colon cancer
E: Surgical site infection
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Case 3: Small Bowel Obstruction
A 24 year old man presents with constipation, abdominal pain and vomiting. He recently underwent abdominal surgery for a chronic condition. The X ray on the right was done. What is most likely to have caused this presentation?
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A: Acute flare up of chronic conditon
B: Adhesions from surgery
C: H. pylori
D: Colon cancer
E: Surgical site infection
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Case 3: Small Bowel Obstruction (continued)
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The most common cause of small bowel obstruction is adhesions. This is where two parts of ileum scar together.
If a short bowel obstruction is of chronic nature, the ileum will initially fill with gas but will eventually dilate the bowel and then become filled with fluid.
If this happens, a CT scan is the preferred imaging modality as x-rays do not show fluid well.
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Section 4: Neurology
When it comes to neurology, there are two main methods of imaging that you will be utilising. These are: CT scan MRI scan
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Section 4: Neurology
So given that these two different imaging modalities are often used in neurology, how do doctors know which scan to use? Here are some examples of which scans are used for common pathologies:
Usually, this decision depends on a combination of what pathology a patient has presented with coupled with the amount of time available (i.e. acute emergency vs. routine scan)
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Now that you know the basics of CT and MRI scans in neurology, let's pause and review some basic anatomy which you will already know.
One of the most common organs that regularly requires imaging in patients is the brain. Label this image of the brain below as a review of basic brain anatomy:Click the button below to view the answers...
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The Frontal Lobe
Functions:
Primary motor cortex
Short-term memory
Attention
Planning
Motivation
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The Parietal Lobe
Functions:
Pain
Temperature
Proprioception
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The Temporal Lobe
Functions:
Auditory processing
Contains limbic system for processing of memory and emotion
Contains Wernicke's area to allow for speech comprehension
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Functions:
Visuospatial processing
Distance and depth perception
Colour determination
Object and facial recognition
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The Occipital Lobe
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What is Radiology?
Radiology is a branch of medicine that utilizes imaging technology for the diagnosis and treatment of a disease
Put simply, this means using technology (such as cameras or scanners which are known as 'imaging devices') in order to diagnose and treat disease
Often, these imaging devices are used to allow doctors to see inside the human body for the purposes of diagnosis only. An example of this would be using an x-ray to see the state of a patient's lungs (more about this in the 'diagnostic radiology' section). However, sometimes special devices can be deployed to both capture what's inside someone's body and also to perform certain treatments
Therefore, radiology can be divided into two domains: diagnostic radiology (purpose only for capturing images of what's inside the body for diagnosing a disease) and interventional radiology (purposes both for capture/diagnose as well as treatment)
The term 'radiology' is used to describe all of this because the cameras and scanners used to see inside the human body utilise radiation to pass through the skin in order to obtain an image (more on this in the 'how it all works' section). This is the fundamental principle of what radiology sets out to achieve - obviously the naked eye can't see what's underneath the skin, so we must use these special imaging devices that have the ability to emit radiation in order for us to achieve this
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Diagnostic Radiology
Diagnostic radiology refers to the use of imaging devices for the sole purpose of capturing images of bodily organs underneath the skin in order to detect the presence of pathology and diagnose a disease
Often times, being able to physically see the presence of a disease inside the body is considered to be the ultimate proof needed to draw upon a diagnosis, and as such radiology forms a very important role in this
The main imaging devices used in diagnostic radiology are: X-Ray; CT; MRI; Ultrasound
Further examples of imaging devices often used in diagnostic radiology include: Fluoroscopy; Mammography; PET
As mentioned in the 'What is Radiology' page, the general principle of radiology is that radiation is utilised to see what's underneath the skin (more on what radiation is in the 'how it all works' section). As such, the reason there are multiple different types of imaging devices as listed above is because each device has a different way of using radiation to capture images, and often times the differences in how they each emit their radiation is what allows doctors to get the best images of a wide variety of different organs and diseases. Certain pathologies will appear better using certain imaging devices as opposed to others.
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