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 Question

Using 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