git-radiology- introduction to medical students.pptx

This PPT gives an overview of GIT radiology. It gives an insight to the medical student to the basics of GIOT radiology.

1. GI R ad i o l o gy Dr. Wangju Sumnyan MD Professor & HOD , Department of Radiology & Imaging TRIHMS

2. P l a in X- r a y s ( S u p i n e, E r e ct , De c u b i t us) B a r iu m s t u d i e s ( B a S w allo w , Me al, F ol l o w t h ro u g h , E n t e r oc l y s is, E n em a ) U l t r asoun d A bdo m e n C T S c an / M RI A b d o m e n E R C P, Cho l a n g io g r a phy . A n g io g r a ph y a n d N uc l e a r Me di c i ne I MAG IN G M O D A L I T I E S I N G I T

3. P lai n A b d o m i nal X -r a y s E r ect Chest S u p i n e A bdo m e n E r ect / D ec ubi t u s A bdo m e n ( 1 m i n ) Ra d i a t io n Dos e ( 1 A b d = 75 C X R ) C o n t r a i ndi c a t e d – p r e g n a n c y

4. I nd icat i ons. “ A cu t e A bdo m e n ” • Abd o m i n al P a i n . ? O b s tru c ti o n . N o t I nd i c a t e d f or: T r a u m a . So li d o rg a n a ssess me nt .

5. Basic principle: radiographic densities • Air • Fat Black • Water/soft tissue • Calcium • Bone • Metal White

6. Ap p roac h t o a AXR T ec h n i cal A s s e ss m e n t . P r o j ec t i on . B ow e l / G a s S h a do w s. N o r m a l / Abn or m al C a l c i f i c a ti on s . S o li d O r g a n s. L oo k at l un g b a s e s a n d at t h e s k e l e t o n .

7. No rm al V s Abno r m a l G as shado w s • • • Sto ma c h . C o l o n . S m a l l B o we l. • W i t h i n t he L u m en : D ilate d b o w e l ? O bst r u c t i o n O u ts i d e th e Lu m e n : F ree ? p er f ora ti o n I n a ca v i ty ? absc e s s •

8. Small bowel obstruction : Supine and upright abdominal radiographs show disproportionate dilatation of small bowel (SB) with a relatively small amount of colonic gas (C). There are air- fl uid levels (arrows) with different height in the same small bowel loops. Small bowel obstruction due to adhesion

9. C o n t r ast M e d iu m f o r GI W a t e r So lu b le • Io n ic (g a st r o gr af i n ) C a n l e a d t o pu l m o n a r y e d em a i f a sp i r at e d. N o n - I o n i c ( L o w • O s m o l a r ) a sp i r at e d. G a d oli n i u m ( M RI ) R e l a t i v e l y s a f er i f • • Non-water soluble B a r i u m Ca n c a us e s e v er p e r i t o n i t i s a nd fi b r o s i s i n p er fo r a t io n or l e a k a g e .

10. C o n t r a s t S w al l o w • • • • • I n d icati o n s : Dy sp h a g i a P a i n R e fl ux Tr a c h eo - e so ph a g e a l f is t u l a P er fo r a t ion • • C o n t r a i nd i c ati o n s: A sp i r at i on

11. Bar i u m M e al • • • • • • • I n d icati o n s : Dy sp e ps i a U pp er a bd o m i n a l m a ss W e i g h t L o ss G a s t ro i n t e s ti n a l H emo rr h a ge . P a r t ia l O b s t r u c t ion A ss e s s me n t fo r p er f or a t ion • • C o n t r a i nd i c ati o n s Co mp l e t e la rge b o w e l o bs t r u c t ion • • • P at ie n t p r e pa r a t i o n: NP O - - - 6 h r s N o s m o k i n g – i n c r e a s e s GI m o t ili t y

12. Anatomy on upper GI study

13. S m all B o we l F o l l o w t h r o u g h / S m all b o we l e n e m a ( E n te r oc l y s i s) • • • • • • • I n d icati o n s : P a i n D ia r r h o e a A n em ia / GI b l ee d P a r t ia l O b s t r u c t ion M a la bs or p ti on A bd o m i n a l m a s s • • C o n t r a i nd i c ati o n s Co mp l e t e o bs t r u c t ion • • • P at ie n t P r e parati o n : L o w r e s i du e d i et B o w e l P r e p ( Du lc ola x -2- 4 T a b )

14. S m all B o w el f o ll ow t hrough V S S m all b o w el ene m a

15. Bar i u m En e m a • • • • • • I n d icati o n s : C h a n ge i n b o we l h a b i t s P a i n M a ss M e l a en a / An em i a S i n g l e c o n t r a st – O b s t r u c t io n & In t us s us c e p t io n . • • • • C o n t r a i nd i c ati o n s: R e ct a l b i o ps y — 5 d a y s T o xi c m e g a c o lon P s e ud o m em br a n o us c o l i t i s • • • Pr e pa r a t i o n : ( T w o d a y s) L o w r e s i du e d i et B o w e l p r e p (D u l c ol a x – 4 T a b)

16. U lt r as o u nd A bd o m e n A d v an t a g e • • • • C os t e ff ec t iv e A d e q u a t e v is c e r al v isu a l iza t io n Be s t fo r G B N o r a d ia t i on Ind i c at ions : A c u t e A bd o me n , O b s t r u c t iv e ja u n d i c e , ab d o m i n a l m a ss e s, c o l l e c t i o n s, F r e e f l u id , f o l l o w u p - tu m o r s . • D i s a d v an t a g e O p e r a to r d e p e nd e n t P oo r i n O b e s i t y B o w e l g a s s e s B o n e s / Cal c if ic a ti o ns • • • •

17. Diagram showing the areas included in FAST (focused abdominal sonography for trauma). These four areas are 1) perihepatic and hepato- renal space, 2) perisplenic, 3) pelvis, and 4) pericardium. 1 2 3 4

18. Hydronephrosis due to obstructed upper ureteric stone : Sagittal ultrasound image of the right kidney shows dilated renal collecting system and proximal ureter in a 57-year-old man presenting with acute renal failure. He had bilateral hydronephrosis due to obstructing ureteric stones . h yd r oneph r osis h yd r ou r eter

19. C T Sc a n A b d o m e n • • • • • A d v a nta ge s Acc ur a t e & qu i c k B o w e l / g a ss e s/ b o ne s R e fo r m a t io n a n d a n g i o I n d icati o n s : Ac u t e a b d o m e n , A bd o m i n a l m a s s , t u mor s t a g i n g / fo l lo w up , A pp e nd ic i t is / a bs c e ss e s , P o s t op c o m p li c a t i o ns • • • • D i s a d v an t a ge s: R a d i a ti o n ( 25 C X R ) R e n a l f a i l u r e Co n t r a s t r e a c t ion

20. M R I A b d o m e n • • • • • A d v a nta ge s M u l t i p l a n er R e n a l fail u r e M R CP L i v er sp e c ifi c c o n t r a s t s • • • • • • D i s a d v an t a ge s B o w e l m oti o n/ c o n t r a s t Cal c ifi c at i o ns Me tall i c im p la n t R e la t iv e l y l o n g p ro c e d ure time Cla us t r o ph o b i a

21. Ch o la n g i o g r ap hy • E nd o s c o p i c R e t r o g r a d e C h o l a n g i o p a n c r e a t o g r a ph y ( E R CP ) M R C h ola n g io p a n c r e a t o g r a ph y ( M R C P ) • • • T - t u be C h o l a n g i o g r a ph y . P er c u t a n e o us Tr a ns he p a ti c C h o l a n g i o g r a ph y ( P T C ) .

22. GI R ad i o l o gy THANK YOU