imaging in acute abdominal pain
DESCRIPTION
Imaging in acute abdominal painTRANSCRIPT
![Page 1: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/1.jpg)
IMAGING PATIENTS WITHIMAGING PATIENTS WITH
ACUTE ABDOMINAL PAIN ACUTE ABDOMINAL PAIN
![Page 2: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/2.jpg)
OverviewOverviewImaging modalitiesIndications Systematic approach to
abdominal x-rayClinical scenario
![Page 3: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/3.jpg)
Imaging ModalitiesImaging Modalities
1. Plain Abdominal Radiograph2. Ultrasound FAST Formal US3.CT
![Page 4: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/4.jpg)
AXR - IndicationsAXR - IndicationsSuspected bowel obstruction Suspected perforationSuspected foreign bodyModerate to severe
undifferentiated abdominal painRenal tract calculi follow-up(Exclude pregnancy)0.1-1 mSv
![Page 5: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/5.jpg)
Abdominal Ultrasound - Abdominal Ultrasound - IndicationsIndicationsTrauma survey and follow up
(FAST)Suspected acute cholocystitisSuspected acute pyelonephritis –
single kidney, transplant, immunocompromised, abnormal renal function, DM, cong anomalies, recurrent/failed to respond to AB, equivocal
RIF pain – young femalesAscites localization
![Page 6: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/6.jpg)
Abdominal CT - IndicationsAbdominal CT - IndicationsAppendicitisColitis (Inflammatory, infective,
ischaemic), DiverticulitisPerforation – Normal erect CXR
strong clinical suspicionStrong suspicion of bowel
obstruction on AXR – further investigation (If not for urgent surgery), uncertainty about the site of obstruction
Urolithiasis AAA/rupture
![Page 7: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/7.jpg)
CT vs USCT vs USRadiation dose (10mSv for
abdominal CT)Patient’s age <25yrs Estimated risk of induced cancer 1
in 900 Estimated risk of induced fatal
cancer 1 in 1800
Body habitus
![Page 8: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/8.jpg)
CTCTHigh sensitivityHigh specificityAvailabilityNot real time, but dynamic study
(artery,vein, delayed phases)Lack of operator dependence
![Page 9: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/9.jpg)
USUSInexpensivePortableSafeDynamic and real time survey
Operator dependence
![Page 10: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/10.jpg)
AXRAXROften anatomical structures are not
demonstratedAbnormalities can be obscured by
anatomical structuresStomach – seen when it contains
air, LUQSmall bowel – generally central,
valvulae conniventesLarge bowel – peripheral, haustra,
retroperitoneal colon is relatively constant in position
![Page 11: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/11.jpg)
AXR AXR Soft tissue – assessment is
limited liver, spleen, psoas, kidney,
bladder, lung basesBones – landmarks ureters, VUJAdded densities – artifacts or
calcified soft tissue
![Page 12: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/12.jpg)
AXRAXR
![Page 13: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/13.jpg)
Abdominal painAbdominal painPlain AXR 1.Strong suspicion of small bowel
obstruction2.Strong suspicion of large bowel
obstruction3.Uncertainty about the site of
obstruction69% sensitivity and 57% specificity
for bowel obstruction
Strong suspicion of paralytic ileus or psedo-obstruction – no imaging
![Page 14: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/14.jpg)
Strong suspicion of small Strong suspicion of small bowel obstruction - AXRbowel obstruction - AXRNo further imaging - needs urgent surgery - known adhesive obstruction and
to be managed conservativelyFurther Imaging - acute high grade symptoms
CT- 94% sensitivity 96% specificitySensitivity low (64%) for low grade
SBO
![Page 15: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/15.jpg)
![Page 16: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/16.jpg)
Suspected large bowel Suspected large bowel obstructionobstructionSigns of volvulus – contrast enema CTSuspected complicated diverticulitis –
CT Likely obstructing lesion – CT (mural
changes and transcolonic abnormalities) Contrast
enema
Colon 5.5 cm, cecum 10cmCT 96% sensitivity, 93% specificity
![Page 17: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/17.jpg)
![Page 18: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/18.jpg)
Sentinel loop in pancSentinel loop in panc
![Page 19: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/19.jpg)
Paralytic ileusParalytic ileus
![Page 20: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/20.jpg)
Coffee bean in sigmoid volvCoffee bean in sigmoid volv
![Page 21: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/21.jpg)
Caecal volvCaecal volv
![Page 22: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/22.jpg)
PerforationPerforationPeptic ulcerDiverticulitisMalignancy
CXR – insensitive for air pockets <1mm
less sensitive for 1-13mmCT – 86% can detect the site of
perforation
![Page 23: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/23.jpg)
Bowel ischemiaBowel ischemiaAccuracy of CT is comparable to
angiographySensitivity 93% and 96%
respectivelySpecificity 79% and 99%
respectively
Arterial and PV phases – ischemia could be arterial or venous
![Page 24: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/24.jpg)
Bowel ischaemiaBowel ischaemia
![Page 25: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/25.jpg)
Cases
![Page 26: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/26.jpg)
Suspected acute Suspected acute cholecystitischolecystitisUS (88% sensitivity 80%
specificity)Acute abdominal pain - CT has
demonstrated accuracy comparable to that of US in diagnosing acute cholecystitis
![Page 27: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/27.jpg)
![Page 28: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/28.jpg)
Cholestatic jaundiceCholestatic jaundiceUS – to assess duct dilatation Yes – cause identified – treat cause not identified suspect stone -
MRCP/CTIVC/EUS suspect malignancy
– CT No – consider hepatocellular
![Page 29: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/29.jpg)
![Page 30: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/30.jpg)
Acute LIF painAcute LIF painFemale of reproductive age – US
to exclude gynaecological pathology
Suspected acute diverticulitis – CT
Suspected renal colic 1st/recurrent presentation, age
(>/<50y), pregnantOther - CT
![Page 31: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/31.jpg)
Acute RIF painAcute RIF painHigh likelihood of appendicitis –
young patient (US to exclude gynae pathology)
Atypical for appendicitis young or thin patients – US others – CT
Graded compression – to identify non compressible bowel
![Page 32: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/32.jpg)
DiverticulitisDiverticulitis
![Page 33: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/33.jpg)
![Page 34: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/34.jpg)
Ovarian torsionOvarian torsion
![Page 35: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/35.jpg)
Acute PancreatitisAcute PancreatitisClinical and biochemicalUS – gall stonesCT- diagnosis uncertain assessment of severe cases failure to improve or sudden
clinical deterioration clinically suggestive of
developing complications follow up
![Page 36: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/36.jpg)
![Page 37: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/37.jpg)
Scrotal painScrotal pain
USTraumaEpididymo-orchitis?? Torsion
![Page 38: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/38.jpg)
EpidydimitisEpidydimitis
![Page 39: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/39.jpg)
TorsionTorsion
![Page 40: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/40.jpg)
TraumaTrauma
1. FAST – Focussed Assessment with Sonography for Trauma
2. CT
![Page 41: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/41.jpg)
![Page 42: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/42.jpg)
Small bowel obstructionSmall bowel obstruction
![Page 43: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/43.jpg)
Small bowel obstructionSmall bowel obstruction
![Page 44: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/44.jpg)
PneumoperitoneumPneumoperitoneum
![Page 45: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/45.jpg)
PneumoperitoneumPneumoperitoneum
![Page 46: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/46.jpg)
ColitisColitis
![Page 47: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/47.jpg)
AppendicitisAppendicitis
![Page 48: Imaging in acute abdominal pain](https://reader034.vdocuments.mx/reader034/viewer/2022052410/555f1584d8b42a5c388b54c5/html5/thumbnails/48.jpg)
THANK YOUTHANK YOU