Kadom and Fasih

Kadom and Fasih

PALET: A tool for making an engaging teaching event

Disclosures

None

“PALET” tool

Preparation

Link

Attention

Engagement Transfer

Professor E.D. Ott

Case presentation

Abdominal Imaging fellows

Mag view

45 y.o. F, family history colon cancerAcute abdominal pain during annual colonoscopy

Plain film signs free air:1.Air under diaphragm2.Falciform ligament sign3.Air both sides of bowel (Rigler sign)

Pearls:•Best erect or l lat decub•CT more sensitive•Most common cause perforated ulcer•1 in 400-500 colonoscopies, rectosigmoid site most common

Washington DC Abdominal Imaging CEDP

course

Quiz caseApril 13th, 2013

History withheld

What is going on?

Supine

Mag view

Quiz 1-Use I respond software

Q. Which segment of the bowel is most likely to have perforated and why?

A. Rectosigmoid

Quiz 2

Q. What are the two most common causes of pneumo-retroperitoneum?

A. Perforated diverticulitis b. Perforated duodenal ulcer

Quiz 3What is the rate of perforation in:A: Optical Colonoscopy? 1 in 400-500B: CT Colonography? 1 in 3000

Coronal

Axial

Supine

Coronal

Pearls

• CT is the most sensitive modality to detect complications of endoscopy.

• Rectosigmoid junction is the most frequent site of perforation.

• Most cases are managed conservatively.

Methods of Engagement

• Multiple choice Q and A, touch pads, show of hands• Quiz, games, case• Questions, answers, discussion – dialogue!• Visuals (slides, videos, white board drawing)• Handouts (tables, articles, resources etc)• Demonstration, simulation, role play

Thank you

Audience #2

High school students

Scenario• 45 year old woman visits the family

doctor for annual health exam. • Anxiety regarding personal health.

Parents had cancer of the large intestine.

• Family doctor refers for a camera test of the large intestine called Colonoscopy(Colon=large bowel, Scope=direct visualization)

Course of events• Patient develops severe belly pain

during the camera examination.• An x –ray of the belly is requested

and performed in the Radiology department.

Normal structures ( Anatomy)

A BNormal X-RAY

Patient’s X-RAY

X ray of the Belly

Patient lying down

Patient lying down: enlarged view

Specialist doctor performing the camera test (Gastroenterologist) requests a CAT scan.

CAT scanner

(Computerized Axial Tomography)

X ray of the Belly

Image from a CAT scan optimized to show free air

Take home points• Camera examination of the bowel

is used to detect cancers in the large intestine.

• Rarely, this may produce a hole in the intestinal wall resulting in air and other contents to leak out into the belly.

• This is an emergency…

Questions?