The Radiology Assistant : Acute Abdomen. Clinics, laboratory, and plain abdominal film. The clinical presentation of patients with an acute abdomen is often nonspecific. Read etimologia-e-abreviatura-de-termos-medicos.pdf text version. ETIMOLOGIA E ABREVIATURAS DE TERMOS MÉDICOS Um guia para estudantes, professores, autores e. Perforated peptic ulcer.Patients with perforated peptic ulcers commonly experience sudden onset of severe epigastric pain, which becomes generalized after. Free ebook: Machiavelli's Laboratory "Ethics taught by an unethical scientist" 12,000 BIOMEDICAL ABBREVIATIONS This page is provided "as is", without warranty of any. Alphabetical guide of diseases and conditions from Mayo Clinic experts. Click on disease or condition by first letter for more information. Both surgical and nonsurgical diseases may present with a similar clinical history and symptoms. Findings may be normal in patients who need emergency surgery (such as appendicitis) and may be abnormal in patients without a surgical disease (like salpingitis). A plain abdominal film has a limited value in the evaluation of abdominal pain. Sign up for our newsletter Get health tips, wellness advice, and more.A normal film does not exclude an ileus or other pathology and may falsely reassure the clinician. RIGHT: Subsequent CT shows distended small bowel loops (arrowheads) that are not seen on plain abdominal film because they are filled with fluid only and do not contain intraluminal air. An ileus may not be appreciated on a plain abdominal film if bowel loops are filled with fluid only without intraluminal air (figure). Alternatively if a plain abdominal film does indicate an ileus than sonography or CT are usually needed to identify its cause. For all other indications use sonography or CT. Confirm or exclude the most common disease Many disorders may cause an acute abdomen, but fortunately only a few of these are common and clinically important. Focus on confirming or excluding these frequent disorders: RLQ : Appendicitis. Pain in the RLQ, regardless of any other symptom or laboratory results, should be considered to be appendicitis until proven otherwise. If you are unable to find the appendix you cannot rule out the diagnosis of appendicitis unless a good alternative diagnosis is found. If you do not find the appendix and there is no altermative diagnosis call the results of the examination indeterminate. Do not call it: ' no appendicitis'. Normal appendix : Longitudinal (A) sonogram depicts a blind- ending tubular structure (arrowheads) with 'gut- signature', with a maximum outer diameter of 6 mm, with noninflamed surrounding fat. On an axial view (B) the appendix can be compressed crossing the iliac vessels. Normal Appendix. Your first task is to identify the appendix. At sonography and CT the appendix is seen as a blind- ending nonperistaltic tubular structure arising from the base of the cecum. Do not mistake a small bowel loop for the appendix. Secondly determine if the appendix is normal or inflamed. The outer- to- outer diameter of the appendix is the most important imaging criterium. Although an overlap of appendiceal diameters in normal and inflamed appendices can incidentally be found, a threshold value of 6- 7 mm is generally used. Normal appendix: CT shows an air- containing non- distended appendix (arrowheads), with homogeneous low- density periappendiceal fat. A normal appendix has a maximum diameter of 6 mm, is surrounded by homogeneous non- inflamed fat, is compressible and often contains intraluminal gas. Inflamed appendix at sonography. Longitudinal (A) and transverse (B) cross- section show a distended noncompressible appendix, surrounded bij hyperechoic inflamed fat (arrowheads). Inflamed Appendix. An inflamed appendix has a diameter larger than 6 mm, and is usually surrounded by inflamed fat. The presence of a fecolith or hypervascularity on power Doppler strongly supports inflammation. Inflamed appendix at CT. The appendix (arrows) is fluid- filled and distended with periappendiceal fat- stranding. CT depicts an inflamed appendix as a fluid- filled blind- ending tubular structure surrounded by fat- stranding. In the case on the left a hyper- attenuating wall is seen on the enhanced CT. In patients who lack intra- abdominal fat the use of iv. A hypoechoic thickened diverticulum is surrounded by hyperechoic inflamed fat (arrows). LLQ : Diverticulitis. If the pain is located in the LLQ your main concern is sigmoid diverticulitis. In diverticulitis sonography and CT show diverticulosis with segmental colonic wall thickening and inflammatory changes in the. Uncomplicated sigmoid diverticulitis. Fat stranding and focal thickening of the colonic wall in an area with diverticula. No abscess formation. Complications of diverticulitis such as abscess formation or perforation, can best be excluded with CT. LEFT: Sigmoid diverticulitis. Diverticulum (arrow) is surrounded by hyperattenuating fat. The sigmoid wall is thickened. RIGHT: Sigmoid carcinoma with limited fat stranding. An important pitfall is colon cancer, which may present with similar imaging features, especially when the colon cancer is surrounded by fat stranding due to invasive groth, desmoplastic reaction or inflammation. Frequently it is not possible to reliably distinguish diverticulitis from colon cancer and therefore we routinely include colon cancer in the differential diagnosis of sigmoid diverticulitis. RUQ : Cholecystitis. Cholecystitis occurs when a calculus obstructs the cystic duct. The trapped bile causes inflammation of the gallbladder wall. As gallstones are often occult on CT, sonography is the preferred imaging method for the evaluation of cholecystitis, also allowing assesment of the compressiblity of the gallbladder. The diagnosis of a hydropic galbladder is solely made on the non- compressability of the galbladder. Do not rely on measurements. Some galbladders happen to be small and others are large. The gallbladder is noncompressible ('hydropic') and causes an impression in the anterior abdominal wall (arrowheads). The imaging appearance of cholecystis consists of an enlarged hydropic (meaning non- compressible) gallbladder with a thickened wall in the region of maximum tenderness (the so- called 'Murphy sign')Cholecystitis at CT. The gallbladder is enlarged with edematous thickening of its wall (arrowhead), and some regional fat- stranding can be found. The inflamed gallbladder usually contains stones or sludge, whereas the obstructing calculus itself may or may not be identified because it is located deep within the galbladder neck or cystic duct. The gallbladder may be surrounded by inflamed fat, but on sonography this frequently is not seen, while CT sometimes does show fat- stranding. Potential pitfalls are pancreatitis, hepatitis or right- sided heart failure, which all may lead to thickening of the gallbladder wall without cholecystitis. Therefore be certain that hydropic obstruction of the gallbladder is present before assigning the diagnosis of cholecystitis. Its most common cause is gastric pathology in which radiological imaging plays a minor role. Extended- view of the ventral abdomen depicting an area of hyperechoic noncompressible inflamed fat in the omentum (red arrows). Compare this to the echogenicity of normal abdominal or subcutaneous fat (green arrows). This patient had an omental infarction. Inflamed fat. Inflamed fat is hyperechoic, space occupying and noncompressible at sonography. Same patient as above. Compare this to normal low- density subcutaneous fat. Diagnosis: omental infarction. Inflamed fat is shown as fat- stranding at CT. Inflamed fat usefully points out where and what the problem is. As a rule, the organ or structure in the centre or nearest to the inflamed fat is the cause of the inflammation. Diffuse thickening of bowel wall in a patient with colitis. Bowel wall thickening. Thickening of bowel wall indicates inflammation or tumor, and has an extensive differential diagnosis. Thickening of small bowel loops usually indicates regional inflammation, as small bowel tumors (carcinoid, lymphoma, GIST) are relatively infrequent. In patients with local colonic wall thickening a carcinoma is a prime concern. Obstructive ileus. CT depicts distended small bowel loops, but part of the small bowel and the whole colon is nondistended. Therefore this must be an obstructive small bowel ileus, and in this case its cause can easily be identified: intussusception (arrowhead). Ileus. Pathologic distention of bowel loops may be caused by obstruction or paralysis. Firstly determine which parts of the gut are affected: small bowel, large bowel, or both. Look for normal nondistended bowel loops, which, if present, strongly suggest an obstructive cause for the ileus. Scroll through the images. Small Bowel Feces Sign: Feces in the dilated small bowel just proximal to the site of obstruction. Obstruction was due to adhesions. Small bowel obstruction (SBO) accounts for approximately 4% of all patients presenting with an acute abdomen. The diagnosis of SBO is made when you see dilated small bowel and collapsed small bowel loops. Adhesions account for 6. The 'Small Bowel Feces Sign' (SBFS) is a very useful sign as it is seen at the zone of transition thus facilitating identification of the cause of the obstruction. The SBFS has been defined as gas and particulate material within a dilated small- bowel loop that simulates the appearance of feces. Scroll through the images on the left to see the small bowel feces sign indicating the site of obstruction. Alternatively, an ileus without any normal bowel loops strongly suggests a paralytic cause. This is usually a response to general peritonitis, wich may have many possible causes of the inflammation. Clinically appendicitis. US only showed a little bit of ascites. A diagnostic puncture (arrow marks needletip) revealed blood. In a woman this finding is very suspicious of an EUG. Ascites. Asymptomatic volunteers do not have a detectable amount of free intraperitoneal fluid, with the exception of an incidental drop of fluid in Douglas in fertile women. The presence of ascites is a nonspecific sign of abdominal pathology, indicating that 'something is wrong'. You may want to perform a US- guided diagnostic puncture of the ascites, in order to investigate whether it is sterile reactive fluid, pus, blood, urine, or bile. Intraperitoneal air in a patient suspected of having appendicitis. Air better seen on images with lungsetting on the right. Free air. The presence of free intraperitoneal air is proof of bowel perforation, and indicates a surgical emergency. A pneumoperitoneum has only two frequent causes. Ileocecal Resection: Background, Indications, Contraindications. Juan L Poggio, MD, MS, FACS, FASCRS Associate Professor of Surgery, Director of Robotic Colon and Rectal Surgery, Division of Colorectal Surgery, Department of Surgery, Drexel University College of Medicine. Juan L Poggio, MD, MS, FACS, FASCRS is a member of the following medical societies: American College of Surgeons, American Society of Colon and Rectal Surgeons. Disclosure: Nothing to disclose.
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