09. GIT and Abdomen..pdf Read and understand medical notes on GIT and abdomen

Medical notes

1. DIAGNOSTIC IMAGING OF GASTRO-
INTESTINAL TRACT AND ABDOMEN
Dr ViqtGerald Z.S.A.M. Makwaruzi.
D.D.R., M.D., M.Med(Radiodiagn), FICA.
Senior Consultant Radiologist.
Senior Lecturer:Radiology/Diagnostic Imaging, CUHAS

2. I: CURRICULUM
A.Investigations of Gastrointestinal Tract (GIT).
–Overview
B.Barium (Ba) Swallow
–The oesophagus
C.Ba Meal
–Stomach and duodenum
–Ba meal follow through
–Small bowel enema.

3. ….curriculum
C. Barium Enema
–The colon
D. HepatobiliarySystem
-Cholecystography
-Intravenous Cholangiography
-PercutaneousTranshepaticCholangiography(PTC)
-Endoscopic Retrograde Cholangiopancreatography
(ERCP)
-Ultrasonography, endoscopic

4. ….curriculum
E. Abdominal Imaging
–Nuclear Medicine, CT, U/S, NMRI
–Focal hepatic disease
–Diffuse liver disease
–Pancreatic disease
–Spleen
F. Further Reading
Chapman et al, (1993)A guide to Radiological
Procedures,3
rd
edn, London, W.B. Saunders Comp. Ltd

5. II: G.I.T Investigations
•Radiological
–Contrast media
•Positive
•Negative
•Non Water soluble (Barium Sulphate)
•Water soluble: Conventional hyperosmolar, Low osmolar
•Single/Double contrast examination
•Radiopharmaceuticals: e.g
99m
Tc-Colloid or
99m
Tc-
Diethylenetriaminepenta-acetic acid (DTPA) for gastro-
oesopagealreflux
•Other Imaging Modalities
–Ultrasound (U/S): Transluminal, transabdominal
–Nuclear Magnetic Resonance Imaging (MRI)

6. III: Ba Swallow

7. …Ba swallow
•Definition
–Radiological (X-ray) investigation of oesophagus
using barium sulphate as positive contrast
medium.
•Procedure
–Barium mixture, usually a paste swallowed.
–Gas-forming granules for double contrast study.
–Fluoroscopic examination.
•Indications

8. …Ba swallow, indications
–Dysphagia
–Pain (odynophagia)
–Suspected tracheo-oesophageal fistula.
•Contraidications:
–None
•Complications:
–Leakage of barium from an unsuspected
perforation
–Aspiration

9. …Ba swallow
•Diseases:
–Oesophagitis
–Carcinoma of oesophagus
–Achalasia cardia
–Foreign bodies
–Tracheo-oesophageal fistula.

10. …Ba swallow
Achalasia cardia

11. …Ba swallow
Foreign Body

13. …Ba swallow
Aspiration

14. …Ba aspiration
Aspiration/ TOF

15. IV: Barium Meal

16. …Ba meal
Supine
Erect

17. …Ba meal
•Definition
–Radiological investigation of oesophagus, stomach and
duodenum using barium sulphate as positive contrast
medium.
•Procedure
–Barium sulphate mixture in high density suspension
ingested
–Gas-forming granules for double contrast.
–Examination done under fluoroscopy following due
preparations.

18. …Ba meal
•Indications
–Dyspepsia
–Weight loss
–Upper abdominal mass
–Gastrointestrinal haemorrhage
–Partial obstruction
•Contraindications
–Complete large bowel obstruction

19. …Ba meal
•Complications
–Leakage of barium from unsuspected perforation.
–Aspiration
–Impaction of barium in large bowel or in appendix
(barium appendicitis)

20. …Ba meal
•Diseases and signs:
–Gastritis
–Malignant and benign neoplasia
–Peptic ulcer disease
–Post-operative stomach
–Duodenal atresia

22. …Ba meal
Gastritis

23. ….Ba meal
Gastric tumour, a ca

24. …Ba meal
Ulcer

25. …Ba meal
Duodenal Atresia

27. V. Barium Enema

28. …Ba enema
•Definition
–Radiological investigation of colon using barium sulphate
as positive contrast medium.
•Procedure
–Fluoroscopic examination, following at least two days of
bowel preparations
–High density barium suspension injected through the
rectum.
–Air injected per rectum for double contrast examination.

29. …Ba enema
•Indications
–Change of bowel habits
–Pain
–Mass
–Melaena
–Obstruction

30. …Ba enema
•Contraindications
–Absolute:
•Toxic megacolon
•Pseudomembraneous colitis
•Recent rectal biopsy
–Relative
•Incomplete bowel preparation
•Recent Ba meal

31. …Ba enema
•Complications
–Perforation of bowel.
•Risk increased : infants and elderly, obstructing
neoplasm, ulceration of bowel wall, inflation of Folley
catheter balloon in colostomy or rectum, patient on
steroid therapy, hypothyroidism.
–Venous extravasation –barium pulmonary
embolism, mortality up to 80%
–Water intoxication
•Risk increased in megacolon –large mucosal surface for
water absorption: drowsiness, convulsions

32. …Ba enema
–Intramural barium
–Cardiac arrhythmia due to rectal distension
–Transient bacteraemia
•Diseases and signs
–Mass lesions: Primary carcinoma, Polyp,
Lymphoma, Extrinsic masses.
–Inflammatory diseases of colon: Ulcerative colitis,
Crohn’s disease, Pseudomembraneous colitis.

33. …Ba enema
Carcinoma of colon

35. …Ba enema
Ulcerative colitis

39. Crohn’s Disease., cobblestone

40. …Ba enema
Pseudomebraneous colitis (Clostridiumdificile)

41. …Ba enema
Pseudomembraneous colitis (thumbprint)

43. VI: Hepatobiliary System

44. …biliary tree, pancreatic ducts
A. Investigations of biliary tree and pancreatic
ducts.
•Cholecystography
–Oral cholecystography: Radiological contrast imaging
of gall bladder.
•Intravenous Cholangiography
–Radiological imaging of bile ducts and gall bladder
following intravenous injection of contrast medium

45. …biliary tree, pancreatic ducts
•Percutaneous Transhepatic Cholangiography
(PTC)
–Radiological contrast imaging of biliary ducts
following fluoroscopic or ultrasound guided direct
percutaneous puncture of bile dilated ducts.
•Endoscopic Retrograde
Cholangiopancreatography (ERCP)
–Radiological contrast imaging of bile and
pancreatic ducts guided by endoscopy.

46. …biliary tree, pancreatic ducts
•Ultrasound:
–Transabdominal
•For specific Examinations:
–Indications….
–Contraindictions….
–Complications….

47. …biliary tree, pancreatic ducts
B. Diseases and signs
–Gall stones
–Acute vs Chronic cholecystitis
–Gall bladder carcinoma
–Biliary tract obsruction

48. …Hepatobil. d.
Radio-opaque calculi

49. …hepatobil. d.
cholecystogram, calculi

50. …hepatobil. d.
gb

51. …hepatobil. d.
GB

52. …hepatobil. d.
gb

53. …hepatobil. d.
Wall –echo-shadow (WES) sign

54. …hepatobil. d.
CB ca

55. …hepatobil. d.
Gb ca.

56. …hepatobil. d.
Double Barrel sign

57. …hepatobil. d.
Dil comm duct.

58. VII: Abdominal Imaging other
Modalities
•Computed Tomography
–Primary axial images
–Vertical reconstructions
–Plain vs Contrast medium scans
–Specific organs and software applications (e.g
Angioraphy) and Protocols

59. …CT Abdo
Plain

60. ….Ct Abdo
Oral CM

62. …Ct Abdo
Coronal reconstruction

63. …CtAbdo
Sagittal reconstructions

64. …Abd. imag. other mods
•Ultrasound:
–Transducers and Probes
–Gray scale b-mode imaging, Doppler mode
–U/S barriers and windows
–Patient preparation for Abdominal U/s

65. …U/s Abdomen
Liver

66. …u/s Abdomen
Pacreatic duct, transluminal

67. …u/s Abdo
RUQ

68. …Abd. imag. other mods
•Nuclear Magnetic Resonance Imaging (MRI)
–Non-radiological imaging
–With gadolinium, rivals CT for assessing solid
organs (liver, pancreas, kidneys). MR angiography
for non-invasive vascular assessment.
–Examination takes average of 30 min (compared
to CT of less than 5 min)

70. …MRI Abdo

71. …MRI Abdo
T1 weighted, CSF Bright

72. …abdominal imaging
FOCAL HEPATIC DISEASE
•Cyst
•Abscess
•Cavernous haemangioma.
•Focal nodularhyperplasia
•Adenoma
•Hepatocellular carcinoma
•Hepatic metastases

73. …focal hepatic disease
•Cyst:
–Simple,
–Complex,
–Hydatid

74. Simple hepatic cyst, CT

75. Simple hepatic CYST, u/s