👤 Benjamin H Taragin

Upper gastrointestinal obstruction (UGIO), obstruction occurring at the level of the stomach or duodenum, represents only about 5% of bowel obstructions. As with other bowel obstructions, timely diagnosis is necessary to prevent complications including ischemia and death. Because the presenting symptoms of UGIO can be vague and nonspecific, the diagnosis may not be suspected clinically. The radiologist therefore provides immense value as the diagnosis and often the etiology of the obstruction can be ascertained through imaging. Here we present a simple classification scheme of etiologies of UGIO into congenital, malignant, infectious/inflammatory, and mechanical categories, and provide examples of the most common and some uncommon causes for each category. We highlight that several of the congenital etiologies of UGIO can present at any age, including adulthood, and therefore it is important for the radiologist to keep these diagnoses in mind when reviewing cases of UGIO. For each etiology, we provide typical imaging strategies that are used for diagnosis as well as key points regarding the diagnosis. Show less

The purpose of this study is to determine the proficiency of emergency medicine residents in selecting appropriate radiologic examinations for specific clinical scenarios and to ascertain whether their training improves competency in this area over the course of their residency. An online multiple-choice questionnaire was created. It included 10 clinical scenarios excerpted from the American College of Radiology Appropriateness Criteria guidelines and instructed residents to select the most appropriate initial imaging study. A link and invitation to the survey were e-mailed to the residency program directors and coordinators of all American Council for Graduate Medical Education-accredited emergency medicine residency training programs with the request that they be forwarded to their current residents. Responses were graded, with correct answers derived from the American College of Radiology guidelines. Results were stratified by year of emergency medicine training, and an analysis of variance was performed. A total of 583 residents from at least 77 different emergency medicine residency training programs completed the survey. Overall, the average number of questions answered correctly was 7.1 of 10 (SD, 1.2). First-through fourth-year residents averaged 6.9 (SD, 1.3), 7.1 (SD, 1.2), 7.1 (SD, 1.1), and 7.5 (SD, 1.1) correct answers, respectively. Analysis of variance found no significant difference between the scores of the four classes (p = 0.09). Emergency medicine residents do not show significant improvement over the course of their residency in their ability to choose appropriate imaging studies. This finding suggests that there is a role for more-rigorous focused instruction to better familiarize residents with appropriateness guidelines for diagnostic imaging selection. Show less