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1. Plain X-ray
Plain X ray
Indications: 1. Acute abdomen (obst or non obst). 2. Abdominal colics. 3. Pre contrast study. Positions: 1. Abdomen erect & supine. 2. Abdominal lateral decubitus. 3. Chest (why?).
Causes:
A. GIT
1-Gut
Acute appendicitis Intestinal obstruction Perforated peptic ulcer Diverticulitis Inflammatory bowel disease Acute exacerbation of peptic ulcer Gastroenteritis Mesensteric adenitis Meckels diverticulitis
2-Liver and biliary tract
cholecystitis
cholangitis Hepatitis biliary colic
3-Pancreas 4-Spleen
Acute pancreatitis
Splenic infarct and spontaneous rupture
Causes:
B. Urinary tract
Cystitis Acute pyelonephritis Ureteric colic Acute retention
E. Peritoneum
C. Vascular
Ruptured aortic aneurysm Mesenteric embolus Mesenteric venous thrombosis Ischemic colitis Acute aortic dissection
Causes:
F. Retroperitoneal
Hemorrhage e.g anticoagulants
H. Extra-abdominal causes
Lobar pneumonia Pleurisy MI Sickle cell crisis Uremia Hypercalcemia DKA Addisons disease Acute intermitent porphyria
G. Gynecological
Torsion of ovarian cyst Ruptured ovarian cyst Fibroid denegeration Ovarian infarction Salpingitis Pelvic endometriosis Severe dysmenorrhea Endometriosis
Plain X ray
Looking for
1. Gas pattern
Small Bowel
Two or three loops of non-distended bowel Normal diameter = 2.5 cm
Large Bowel
In rectum or sigmoid almost always
Gas in stomach
Plain X ray
Stomach
I. Gas pattern
Small Bowel
Two or three levels possible
Large Bowel
None normally
Plain X ray
I. Gas pattern
Intestinal obstruction
Clinical background. Diffuse of focal dilatation of the bowel. Multiple air/ fluid levels, > 5.
Large Bowel
Peripheral
Haustra don't extend from wall to wall (incomplete rings) Diameter usually > 5
0
Small Bowel
Central
1. Dilatation or no?
2. Distribution.
3. Air/fluid levels or no 4. SB or LB
Multiple
dilated SB.
No air/fluid levels.
1. Dilatation or no?
2. Distribution.
3. Air/fluid levels or no 4. SB or LB
to
was
1. Dilatation or no?
2. Distribution.
3. Air/fluid levels or no 4. SB or LB
The findings are of localized ileus and their location suggest diverticulitis.
1. Dilatation or no?
2. Distribution.
3. Air/fluid levels or no 4. SB or LB
1. Dilatation or no?
2. Distribution.
3. Air/fluid levels or no 4. SB or LB
1. Dilatation or no?
2. Distribution.
3. Air/fluid levels or no 4. SB or LB
Multiple
dilated SB.
No air/fluid levels.
No gas in colon.
The findings are of mechanical SB Obst.
1. Dilatation or no?
2. Distribution.
3. Air/fluid levels or no 4. SB or LB
Distended
sigmoid.
Air/fluid levels.
1. Dilatation or no?
2. Distribution.
3. Air/fluid levels or no 4. SB or LB
Multiple
Multiple levels.
DIAPHRAGM
Rupture of diaphragm scanogram) the left (CT
Plain X ray
Perforated viscus:
Trauma (blunt or
iatrogenic)
Post-op 57 days
Plain X ray
The Signs of Free Air Air under the diaphragm Air on both sides of bowel
wall
Plain X ray
Pattern
III. Calcifications
Rim-like
Linear or track-like
Lamellar Cloudlike
Rim like Ca
Vascular: aneurysm
Rim like Ca
Gallbladder Wall
Renal Cyst
Ureter.
Arterial wall
Atherosclerosis
Calcification Vas
Lamellar or laminar
Renal stones
Gallstones Bladder stones
Lamellar or laminar
UB stone
Leiomyomas of uterus
Ovarian cystadenomas
Pancreaic ca.
Nephrocalcinosis
Panc. calcificaion
Plain X ray
Look for
The spleen projects well below the 12th rib and displaces the stomach to the right
Splenomegaly
Hours later
Bladder outlet obstruction-after catheterization, the dilated bladder returns to normal size. The bowel gas returns to pelvis.
Plain X ray
Looking for
1. Gas pattern
Thank You
Contrast studies
Barium : used in most studies , with
different composition according to part examined. : in suspected perforation or intestinal obstruction , in CT examination as barium will cause artifact .
Gastrographin
Lipidol in TOF .
Barium swallow
Indications:
Dysphagia Anaemia Pain Assessment of TOF Assessment of the site of perforation. Preoperative assessment of bronchial carcinoma Left atrial enlargement
Technique Technique
Cervical and dorsal esophagus. AP, Lateral, oblique. Gastro esophageal junction
Cervical esophagus
Benign stricture
Smooth Zone of transition :
tapering Moderate to marked dilatation Causes: post corrosive ,peptic
Achalasia
Narrowing of the
lower end of the esophagus : parrot peak appearance . Dilated esophagus with air fluid level Absence of gas in the stomach
Achalasia
Malignant stricture
Abrupt
Shouldering Mild to moderate dilatation above Irregular outline Mucosal destruction and intra luminal filling defects .
Ca of esophagus
Malignant stricture
Paraoesophageal hernia
Less frequent Gastro-esophageal
Varices
Worm like
Barium meal
AP View of the Stomach Left Posterior Oblique View of Gastric Antrum.
Malignant ulcer
Non projecting ulcer . May formed within an intraluminal
mass Surrounded by excessive edema
Malignant ulcer
Linitis plastica
Crohns disease
Skip lesions Deep & shallow ulcers Can affect any part of the gut,
Barium Enema
carcinoma
Polyp
Rounded
Colonic polyposis
Ulcerative colitis
Loss of haustra Superficial ulcers Wide prerectal
space Tubular colon of late ulcerative colitis .
and consist of herniation of the mucosa and submucosa through the muscularis, usually at the site of a nutrient artery. Congenital diverticula are outpouchings of the entire thickness of the intestinal wall. Diverticula involve sigmoid colon in 95%.
Thank You
Imaging in GIT
US
Screening for any
abnormality as bowel wall thickening or presence of mass related to the GUT .
Computed tomography CT
Indications:
Tumor: o To show exophytic component of the
mass. o Staging : presence of LN, direct infiltration. o Metastatic deposits :liver or lung Ischaemia (CTA). Inflammatory bowel disease. Intestinal obstruction.
CT abdomen
Computed tomography CT
Ischemic intestinal obst.
Computed tomography CT
Esophageal CA:
o To show exophytic
component of the mass. o Staging : presence of LN, direct infiltration. o Metastatic deposits :liver or lung
Computed tomography CT
Diverticular disease of the colon
Outpouches of colonic wall. Contain air, barium, or fecal material . Diagnosis of diverticulitis by using CT scans is based on the detection of colonic and paracolic inflammation in the presence of underlying diverticula .
.
Virtual Colonoscopy
It
is a recently developed technique uses a soft ware of the MSCT to look inside the body without having to insert a long tube (Conventional Colonoscopy) into the colon or without having to fill the colon with liquid barium (Barium Enema).
CT:
endoscopy, Barium,
Thank You