This was a jam-packed session on surgical conditions common to the exam (and the floor!!) We reviewed a good approach to abdominal plain film and CT abdomen referencing Rabi et al and CT radiology teaching atlas. AXR useful for obstruction, perforation, volvulus patterns, toxic megacolon 1.assess general gas pattern - caecum, tvs, descending, air in rectum, small bowel pattern in middle. 2.free air pattern? RUQ air? gas around organs? air on both sides of bowel wall ? ligament teres or falciform lig signs? 3. obstruction patterns- fluid levels, large bowel or small dilated , ileocecal valve competent? cecal or sigmoid volvulus CT / CTA abd wall - free air beneath free fluid liver and liver kidney area (hepatorenal space) spleen and kidney (splenorenal space) gallbladder - thickening cecum - tvs - descending - sigmoid colon - rectum - in axial profile bowel wall thickening - infection, inflammatory, ischemia, cancer, ibs gas in gallbladder gas in portsplenic circ pneumatosis intestinalis (air in bowel wall) sma ischemia on cta bush on trauma cta - bleeding Assessment QuestionUsing the above summary tool for assessment we reviewed films ct and uss on the following topics.
The 'analysis' part of the question was the image analysis and the knowledge component was review of causes, classification, symptoms etc using the guide above we did a rapid 1 min of sections using UpToDate: Sigmoid colitis TVS colitis Diverticulitis risk factors, 5 points on clinical review, severity assessmnt, complications checking for all of these on the scan Gallstones - colic vs acute cholecystitis vs cholangitis Tokyo guidelines 2013 Pancreatitis - focussed on severity scoring for prognosis and disposition - BISAP vs ransons vs CT severity index vs apache vs sirs score BISAP = renal f + SIRS + age + effusion BUN > 25 mg/dL (8.9 mmol/L) Abnormal mental status with a Glasgow coma score < 15 Evidence of SIRS > 60 years old Pleural effusion Bowel wall thickening DD: ischemia infection - clostridium, shigella, campylobacter, e coli (has related toxin producing), yersinia inflammatory - UC / chrohns / vasculitis / sle neoplasm - primary adenocarcinoma / mets / sec to nodes form lymphoma ibs - low on the list
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